Improving satiety for healthier eating

The Protein Limits Action Towards Eating (PLATE) approach to improving diet could help shift the macronutrient balance in the diet towards lower carbohydrates and lower calorie intake, and this could be helpful in helping those in the South Asian community address their risk of type 2 diabetes. PLATE was discussed at the recent South Asian Health Foundation conference in a session on lifestyle intervention, with diet as its focus. Dr Susan Aldridge reports.

South Asians are at high risk of developing type 2 diabetes, even at low BMI, and rates are on the increase. Vinod Patel, Professor of Diabetes and Clinical Skills at Warwick Medical School, noted that many lifestyle factors may contribute to this risk, including diet. Food is important in South Asian culture and many traditional dishes are high in sugar, carbohydrates and fat. However, diet can be improved through education and small changes in eating patterns.

“Diet is all about satiety – it’s why we eat,” said Professor Patel. “But macronutrients are not the same in terms of satiety.” That means that if you eat until you are satisfied, you may consume too many calories and put on weight. One way of achieving satiety without excess calories is the Protein Limits Action Towards Eating (PLATE) approach, which was presented here by Deepa Lad, a public health officer in the London borough of Newham and Sheena Bhageerutty, a nutritionist at Action on Salt and Action on Sugar.

Protein is more satisfying than either fat or carbohydrates. People will carry on eating, even if they are consuming excess calories, carbohydrates and fat, until they get enough protein from their meal. The ‘magic’ number for satiety in PLATE is 16% of calories from protein to satisfy hunger. The PLATE idea can be applied, according to Deepa and Sheena, to anything from snacks to full meals, by simply increasing their protein content. For instance, nuts could be a better snack than fruit, because they are higher in protein.

Healthier South Asian food

Deepa and Sheena have experimented with six traditional South Asian dishes, making some simple changes that can help transform them into more satiating versions. For instance, consider a vegetable biryani served with white rice and plain yoghurt. If you add a salad, some okra to the vegetables, replace the plain yoghurt with Greek yoghurt and the white rice with brown rice, the protein in the dish, by calories, is increased from 12% to 15%.

They also made some changes to butter chicken made with ghee, chicken thighs and white rice. The protein content of this dish can be boosted from 12% to 21% by replacing ghee with butter, chicken thighs with chicken breast, adding salad and replacing white rice with brown rice.

Aside from South Asian cooking, it’s interesting to note that in the DiRECT trials on type 2 remission, which involved a very-low-calorie diet phase, 23% of the calories come from protein so, although the calorie content is meagre, it is relatively easy to follow, with most participants saying they didn’t actually feel hungry on it. The high protein content probably contributed to the trials’ success in achieving a high rate of remission.

To make PLATE even simpler, perhaps just reduce the amount of rice served with a curry dish to shift the balance towards protein and away from carbohydrates. When making these changes, it’s important to focus on increasing protein without adding more calories – so cut carbohydrates back, by all means, but don’t add more fat. Focus on altering the protein content in order to cut the calories needed to feel satisfied. Small changes like this, rather than cutting foods out, are more likely to result in significant weight loss for those with, or at risk of, type 2 diabetes. Lots of restrictions and rules on diet could even result in malnutrition or eating disorders, the latter being all too common in diabetes.

Professor Patel had a simple piece of advice to offer on carbohydrates and weight loss. “Halve your carbohydrates and make sensible adjustments. Try adding bhindi to your meals – after peas, it has the highest protein content of any vegetable. Adding carbohydrate is like putting more petrol into a full tank.”

For diabetes healthcare professionals wanting to discuss healthy diet with people, the SAHF team also recommended Plant-based Nutrition in Clinical Practice by Dr Shireen Kassam, a recently published evidence-based textbook for healthcare professionals. Another useful resource is the Alternative Healthy Eating Index, created by the Harvard T H Chan School of Public Health, which assigns ratings to food and nutrients predictive of chronic disease such as diabetes. 

Any opinions expressed in this article are the responsibility of the EASD e-Learning Programme Director, Dr Eleanor D Kennedy.