The Effect of Barley and Oat in Blood Glucose Level in Diabetic Patients - Assignment Example

The Effect of Barley and Oat in Blood Glucose Level in Diabetic Patients Introduction Scientists class diabetes as a disorder in metabolism (Wood 1988). Metabolism refers to how organisms use the food they digest for growth and energy. Most of the food consumed is broken down by the digestive system into glucose, which is found in blood in the form of sugar. The glucose is the fundamental source of energy for the body and also facilitates growth (Trepel 2004). After digestion of consumed food, the blood absorbs glucose with the help of insulin, which is a hormone produced by the pancreas. Adequate amounts of insulin are automatically released by the pancreas to move blood sugar into cells, which normalises the level of sugar in the blood. People suffering from diabetes have a condition whereby the level of glucose in their blood is much higher than normal, scientifically known as hyperglycemia. In the UK, the National Health Service (NHS) estimates patients of diabetes as 3.8 million, with the figure projected to grow to 6.2 million in 2035 (Stewart et al 2007). 17 percent of the NHS’ healthcare budget will also be spent on diabetes by 2035. Diabetes, or diabetes mellitus as doctors refer to it, is a collection of chronic, metabolic diseases characterised by the patients’ high level of blood sugar (or blood glucose). It occurs in three key forms; type 1 diabetes, type 2 diabetes and gestational diabetes. A report released by the Centers for Disease Control and Prevention (CDC) in the United States placed the prevalence of type 2 diabetes at 90 percent of all reported cases, with type 1 taking up the remaining 10 percent (Polonsky 2012). Gestational diabetes was not in the statistics, which only affects 2 to 5 percent of pregnant women. Out of the affected pregnant women, 20 to 50 percent of them develop type 2 diabetes in later years of life. There is also a condition known as prediabetes, which most of type 2 diabetes patients experienced in their early stages of the disease. Typically, they had higher blood sugar levels than normal, although not high enough to warrant a diabetes diagnosis but rendering body cells resistant to insulin. In that stage, damage will usually have occurred to the heart and the circulatory system (Piller, Chang-Claude & Linseisen 2006). Other common characteristics observed in diabetes patients include increased thirst, increased hunger and more frequent urination, known as polydipsia, polyphagia and polyuria respectively. The condition is as a result of either insufficient production of insulin by the pancreas, or the improper response to the insulin by the body cells, with the occurrence of both circumstances not being a rare phenomenon (Jensen et al 2004). Eventually, there is too much glucose in the blood but it is not used by the cells for energy and growth, which the body passes out in urine. With the exception of very specific situations, no cure is known yet for diabetes, and its management focuses on maintaining blood glucose levels as close to normal as possible while avoiding going to dangerously low levels (hypoglycemia) (Mitchell, Kumar, Abbas & Fausto 1994). This paper will discuss how the use of barley in treating diabetes is perceived in Islam. It will also show how barley and oats affect diabetes and blood sugar levels, as well as show which of the two is more effective. Further, the effect of barley in renal disease will also be discussed. Islam and Barley in Treating Diseases Barley is a high-fibre, whole-grain cereal. In Islam, the teachings of Prophet Muhammad mention barley as a super food due to its properties that help to prevent and fight diseases as well as maintain the immune system. Barley is ranked only below wheat in Islam for its food and disease healing capabilities. The prophet adviced his followers to first seek medical help in times of illness, then resort to prayer and an assortment of recommended, nutritious, foods, such as barley. For the grieving and the sick, the prophet recommended a meal prepared from powdered barley, or barley soup. That was believed to rest patients’ troubled hearts, making them active while reliving their grief and sorrow. It is also believed in Islam that barley meals help in curing coughs, getting rid of inflammations in the stomach and expel body toxins while acting as effective diuretics. Barley and Diabetes Studies have shown that both the amount and type of glucose in food have an impact on the blood glucose levels (Ensminger & Ensminger 1996). Based on the studies, the most significant tool in management of blood glucose level is a form of carbohydrate counting. A controlled intake of carbohydrates, balanced with physical activity and insulin or diabetes pills, are key aspects in the management of blood glucose levels. Barley contains carbohydrates, and the concept of glycemic index (GI) is used to measure how carbohydrate-containing foods raise levels of blood glucose. The concept ranks the foods in accordance to their comparison with another reference food, which can either be white bread or glucose. White bread and glucose are rated at 100 by the GI. Against this measure, carbohydrate-containing foods can be considered as high GI if they rank at 70 and above; medium GI if they rank between 56 and 69; and low GI if they are 55 and below. Blood glucose is considerably raised by high GI foods compared to low and medium GI foods (Jensen et al 2004). Barley, which is a source of dietary fibre and contains minerals and essential vitamins, is a low GI food. The prominent dietary fibre present in barley is the soluble beta-glucan, which studies have shown to promote healthy levels of blood glucose by slowing down the process of absorption. Barley differs from many grains that only contain fibre in their outer bran layers, because it has fibre in its entire kernel. This makes its beta-glucan soluble fibre and dietary fibre significantly available whether the barley is in processed or whole form, which contributes to its ability to improve levels of blood glucose. A study conducted by Nutrition Research showed that patients whose cells were resistant to insulin experienced considerable reductions in their glucose and insulin responses when they consumed muffins with barley beta-glucan, in comparison to corn starch muffins (Ensminger & Ensminger 1996). The same study found that a standard meal including pearl barley provides 18 grams of soluble fibre, reducing average levels of blood glucose (also referred to as HbA1c) in type 2 diabetes by 30 percent. Oats and Diabetes Oats are cereals high in mineral fibre, vitamins and nutrients, even when cultivated in deplorable soil conditions (Jensen et al 2004). Oats normalise the levels of blood glucose as well as reducing the risk of patients developing type 2 diabetes. They also have a wide range of antioxidants that maintain the heart in a healthy way. Relative to other cereals, oats have an exceptionally high content of proteins. Their concentration of soluble fibre, zinc, copper, manganese, magnesium, calcium, vitamin B family, vitamin K and vitamin E are also higher than most other cereals. They are commonly ground into oat flour, or crushed or rolled into oatmeal for consumption. For diabetes patients, oats significantly help in the regulating of levels of blood glucose, as well as reducing the related high cholesterol levels and blood pressure. The ease of digestion also makes oats an ideal food choice for patients who have digestive problems. A hormone-like substance known as saponin is present in oats and it assists the pancreas in regulating insulin production (Dam, Hu & Rosenberg 2006). Oats’ soluble fibre provides the bloodstream with a continuous release of glucose. Magnesium is a mineral necessary in the manufacture of certain enzymes in the body, some of which play significant roles in the secretion and use of insulin by the pancreas and body respectively. Having a high content of magnesium, oats are thus a significant constituent of a diabetic’s meal. Their blood stabilizing properties are particularly beneficial when oats are part of the first meal in a day, followed by foods rich in fiber, since they ensure levels of blood sugar remain under control for the remaining part of the day. Effect of Barley in Renal Disease Renal disease (or kidney disease) causes the kidneys to be insufficient in their role of glomerular filtration, and it occurs in two forms; acute kidney injury and chronic kidney disease (Klahr & Miller 1998). Diabetes is the most common cause of chronic kidney disease. With that connection of renal disease to diabetes, it follows that the best prevention of renal disease is in the effective control of blood glucose level on a daily basis. Barley water acts as an effective diuretic, which helps to induce urine. Although that function assists the kidneys in turn, it cannot reverse failure of the kidneys. Patients whose kidneys are functioning at less than 15 percent of their capacity are unable to absorb barley, which may further complicate the situation. They can only take up barley after a session of dialysis. This is because the renal failure may render insufficient the kidneys’ ability to process the high contents of potassium found in barley. Since barley regulates blood glucose levels, it directly affects the occurrence of renal disease. The more barley is consumed, the more renal disease is kept at bay. The root causes of high creatinine in patients of diabetic kidney disease are renal dysfunction and renal damage occasioned by the long and persistent term of high levels of blood glucose (Johnsen, Hausner & Olsen 2004). To effectively reduce creatinine, diabetes must be controlled, renal damages repaired and the renal functions improved so that the renal excretory capability to discharge the excess creatinine and other blood wastes is enhanced. Having been established as a food friendly to diabetes and the kidneys, barley helps to control damages to the kidneys hence reducing the high levels of creatinine. The high fiber content in barley prevents blood glucose level from reaching levels that are dangerous and contribute towards renal damages. This also serves to control high levels of creatinine. The fibers also play significant roles in treating gastrointestinal and digestive disorders such as hemorrhage, diarrhea and constipation which occur commonly in patients of kidney disease with high levels of creatinine. According to renal dieticians, patients of diabetic kidney disease must avoid refined flour (Bansal, Strivastava, Eggum & Mehta 1977). The dieticians advice that such patients should use foods and flour with whole grains, such as barley, in the place of refined flour. Another beneficial aspect of barley to renal disease patients is that it acts a cleanser to the kidneys and flushes out more toxins and wastes than most known fibrous foods. That is one of the key ways to reduce levels of creatinine. Comparison of Effectiveness of Barley and Oats in Reduction of Diabetes Barley and oats lower considerably the risk of development of type 2 diabetes, because of their nature of being rich in magnesium (Ensminger & Ensminger 1996). Magnesium is a co-factor for over 300 enzymes, some of which are involved in insulin secretion and the use of glucose by the body. They are permitted by food authorities because they meet the requirement of being at least 51 percent whole grain by weight and are low in saturated fat and cholesterol. Fiber, found in both barley and oats, is known to be among the most significant dietary factors for regulation of levels of blood glucose and the prevention of diabetes. Both grains have the ability to improve the responsiveness of the body to insulin as well as improving the control of blood glucose level in patients with blood sugar that is mildly elevated. The key constituent of barley and oats that make them outstanding among grains as healthful foods is the high content of beta-glucan, which is a viscous fibre that the human body cannot digest (Behall, Scholfield & Hallfrisch 2004). Although beta-glucan is found in other foods such as mushrooms and yeast, its exact structure is dependent on it source. For instance, the beta-glucan present in barley and oats is different from that present in mushrooms and yeast, giving an explanation of why it bears varied properties in the body. Beta-glucan binds with water and slows down the rate at which food is conveyed through the digestive system, hence tempering the response of the body to insulin and glucose after a meal. However, several studies have suggested that barley may be more beneficial in regulating blood glucose levels in comparison to oats (Dam, Hu & Rosenberg 2006). In the study, researchers compared the glucose and insulin response among overweight female adults to oats and barley. It was found that peak insulin and glucose levels were considerably lower after consuming barley meals as compared to those after oats or glucose. From the variety of the forms of tested grains, ranging from oatmeal and oat flour to barley flakes and barley flour, it was established that while the size of the particles had negligible impact on the glycemic responses, the high content of soluble fiber was a contributing factor in the observed greater reduction. As per the comparison table below, barley is lower in calories and fats and also high in dietary fibre as compared to oats. Barley also acts as an excellent supplier of essential minerals like selenium, manganese, iron and magnesium. Barley (per 100 grams Oats (per 100 grams) Calories 354 389 Proteins 12.48 g 16.89 g Fat 2.30 g 6.90 g Total carbohydrates 73.48 g 66.27 g Total dietary fibre 17.30 g 10.60 g Source: United States Department of Agriculture (USDA). Another study was conducted by the CDC, which involved 50 overweight adults whose levels of blood glucose were high, although not high enough to meet the set criteria for type 2 diabetes (Katzung 2007). They received coaching in therapeutic changes of lifestyle targeted at maintenance of weight. They were also assigned to get flavored drinks that would provide three grams of barley beta-glucan per day, six grams of barley beta-glucan per day or placebo for a period of twelve weeks. Another group was also assigned to get the same measure of flavored oat drinks in place of the barley drinks. When the study was completed, those who had been on barley beta-glucan had better control of their blood glucose levels as well as an improved sensitivity to insulin as compared those on oat drinks and placebo. It was also found that fasting insulin levels, which give an indication of the amount of insulin circulating in the blood at times when the body does not respond to rising blood sugar after meals, decreased more significantly among those getting higher doses of barley beta-glucan as compared to those getting oats beta-glucan. Calculated sensitivity was used to estimate the body’s response to insulin, and it indicated that sensitivity was better in the group that received barley beta-glucan than that which received oats beta-glucan. The conclusion drawn from the study was that barley beta-glucan has the potential of slowing down the deterioration of insensitivity to insulin in individuals who are at high risk of getting diabetes (Behall, Scholfield & Hallfrisch 2004). Barley can, therefore, be considered more effective that oats in the control of blood glucose level. References Bansal, HC, Strivastava, KN, Eggum, BO & Mehta, SL 1977, Nutritional evaluation of high protein genotypes of barley, Journal of Science, Food & Agriculture, vol. 28, no. 2, pp. 157-160. Behall, KM, Scholfield, DJ & Hallfrisch J 2004, Diets containing barley significantly reduce lipids in mildly hypercholesterolemic men and women. American Journal of Clinical Nutrition, vol. 80, no.5, pp 1185-1193. Dam, R, Hu, F & Rosenberg, L 2006, Dietary calcium and magnesium, major food sources, and risk of type 2 diabetes in U.S. Black women, Diabetes Care, vol. 29, no. 10, pp. 2238-243. Ensminger, AH & Ensminger, MK 1996, Food for health: a nutrition encyclopedia, California, Pegus Press. Fortin, F 1996, The visual foods encyclopedia, Macmillan, New York. Jensen, MK, Koh-Banerjee, P, Hu, F, Franz, M, Sampson, L, Gronbaek, M & Rimm EB 2004, Intakes of whole grains, bran, and germ and the risk of coronary heart disease in men, American Journal of Clinical Nutrition. Johnsen, NF, Hausner, H & Olsen, A 2004, Intake of whole grains and vegetables determines the plasma enterolactone concentration of Danish women, Journal of Nutrition, vol. 134, no. 10, pp. 2691-2697. Katzung, B 2007, Basic and clinical pharmacology, McGraw, New York. Klahr, S & Miller, S 1998, Acute oliguria, New England Journal of Medicine, vol. 338, no. 10, pp. 671–675. Mitchell, R, Kumar, V, Abbas, A, & Fausto, N 1994, Robbins basic pathology, Saunders, Philadelphia. Piller, R, Chang-Claude, J & Linseisen J 2006, Plasma enterolactone and genistein and the risk of premenopausal breast cancer, European Journal of Cancer Prevention, vol. 15, no.3, pp. 225-232. Polonsky, KS 2012, The past 200 years in diabetes, New England Journal of Medicine, vol. 367, no. 14, pp. 1332–1340. Stewart, WF, Ricci JA, Chee, E, Hirsch, AG & Brandenburg NA June 2007, Lost productive time and costs due to diabetes and diabetic neuropathic pain in the US workforce, Journal of Occupational Environmental. Medicine, vol. 49, no. 6, pp. 672–679. Trepel, F 2004, Dietary fibre: more than a matter of dietetics, Wien Klin Wochenschr, vol. 31, no. 116, pp. 465-476. Wood, R 1988, The whole foods encyclopedia, Prentice, New York. Read More