diet in DM HT IHD]
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Transcript of diet in DM HT IHD]
DIET IN
DIABETES MELLITUS
WITH
HYPERTENSION
AND
ISCHEMIC HEART DISEASES
DIABETES MELLITUS ?
Diabetes = flow through
Mel = honey
It is a chronic metabolic disorder.
Has a strong hereditary basis.
Associated with high blood sugar
and passage of sugar in the urine.
SYMPTOMS OF DM ?
RISK FACTORS FOR DM ?
Dietary restrictions in foetal stage
Excess sugar intake
Low dietary fibre
Infections
Acute stress – Physical injury,
surgery, emotional distress
Prolonged malnutrition
SOME OTHER RISK FACTORS FOR DM ?
RISK FACTORS FOR HT & IHD ? Cigarette smoking
High HDL cholesterol
High fat diet
High blood pressure
Diabetes mellitus
Physical inactivity
Low HDL cholesterol
High Triglycerides
Psychological factors
LP (a)
Age – 50-55 years
Male gender
Family history
Obesity
Post menopausal
status
CLUSTERING OF THREE MAJOR RISK FACTORS CAN CAUSE HEART ATTACK !!!
CHILDHOOD OBESITY A CONCERN!!!
Pizza, Icecream
,Candy,
Pastry…
PRINCIPLES OF DIETARY MANAGEMENT ? Low calorie
Low cholesterol
High in unsaturated fats –
mono (MUFA) and poly (PUFA)
High in fibre
High in minerals and vitamins
Low in sodium especially salt
Plenty of fluids
High in omega-3 fat (n-3)
Low fat particularly saturated fats (SAFA)
Maintain slightly lower than normal weight.
Diet should be rich in fibre.
Have 500 gm of fruits & vegetables each day.
Use vegetable oil rich in MUFA & n-3.
Include fish in diet.
Have small quantities of walnuts and almonds.
Use only skimmed milk.
Have coffee and tea in moderation.
Include Soya bean, fenugreek, garlic, onion and
turmeric in diet.
DIETARY GUIDELINES
DIETARY GUIDELINES CONTINUED…
Use combinations of oils.
Have plenty of water.
Prefer whole wheat instead of rice.
Have 6 meals a day
3 main meals
3 in between meals (snacks)
Avoid feasting and fasting.
Sweets, chocolates, cakes, pastries, Ice creams
Aerated drinks, alcohol and sweetened juices
Sago (sabudana)
Egg yolk
Coconut
Sugar, honey, jaggery, glucose
Meat and pork
Sodium rich foods (salt)
Fried foods
Heavy meal
AVOID THESE …
THESE ARE LOW CALORIE FOODS!!!
Beans (green) Broccoli Cabbage Cauliflower Cucumber Brinjal Lettuce Mushrooms Radishes
Tomatoes Strawberries Buttermilk, low fat Milk, 1% milk fat Soy milk Yogurt, plain Tea (no milk & sugar) Lime water (no sugar) Water
HAVE PLENTY OF THESE…
ANIMAL FOODS HIGH IN SAFA AND CHOLESTEROL Butter Ghee Cheese Egg yolk Chicken Beef Mutton Pork Organ meats – brain, heart, kidney, liver Prawns and shrimps
AVOID THEM TO PROTECT YOUR HEART
WHERE DOES CHOLESTEROL COME FROM ?
From food Liver
Triglycerides&
Cholesterol
Triglycerides&
Cholesterol
Chylo-microns
Packed in lipoproteins (LP)
VLDL(Very low density
LP)
LDL(Low
density LP)
HDL(High
density LP)
Bad cholesterol Good cholesterol
ROLE OF FAT ?Excess fat and LP
Injury to blood vessels
Foam cells formed
Deposition of fat
Fatty streak (narrowing of blood vessels)
Plaque (Blocks the blood vessels)
Retinopathy/neuropathy/nephropathy/heart attack
FAT COMPOSITION OF SOME OILS
FAT SAFA MUFAPUFA
n-3 n-6
Coconut 86 6 1.8 -
Ghee 74 19 2 0.9
Dalda 76 19 3.4 -
Olive 14 72 8 0.7
Groundnut 19 47 28 0.8
Sesame/Til 15 39 40 0.5
Corn 13 25 57 0.8
Sunflower 11 34 49 0.3
Mustard 6 66 13 10
Soyabean 15 23 51 7
SOME RECOMMENDED COMBINATIONS OF OIL
Groundnut : Mustard 3:1
Groundnut : Canola 2:1
Groundnut : Soya bean 2:1
Groundnut : Sunflower 3:1
Groundnut : Sesame 3:1
THE KEY TO GOOD HEALTH !!!
FIBRE RICH FOODS… Whole cereals Wheat, Barley, Ragi, Corn, Muesli, Oats, Isabgul…
Leafy and other vegetables Cabbage, Peas, Broccoli, Carrots…
Beans, whole pulses and legumes Rajmah, Tuver, Chole, Soyabean…
Fruits Apples, Strawberries, Peach, Pear, Guava, Pomogeranate…
FOODS HIGH IN SODIUM Salt
Baking powder
Cooking soda
Biscuits
Breads
Salted butter
Cakes & pastries
Cheese
Salted chips
Corn flakes
Egg
Lobster
Monosodium glutamate
Soya & tomato sauce
Pickles
Wafers
Papad
Canned food
Prepared mixes
Peanut butter
BEST AT ITS MINIMUM !!!
NATURAL ANTIOXIDANTS Guava
Red grapes
Pomegranate
Amla
Berries (Bor)
Tomato
Papaya
Orange
Lime
Dark green leafy vegetables
Walnuts
Almonds
Whole grain cereals
THESE FIGHT TO PROTECT US!!!
SOYA PROTEINS Soya bean
Soya milk
Tofu
Textured Soya supplements
Soya nuggets
Soya flour
IT REDUCES CHOLESTEROL!!!
GARLICDOSE: 1 or ½ clove of garlic per day
Reduces blood pressure.
Reduces cholesterol levels.
FENUGREEK SEEDS (Methi)
DOSE: 25 to 50 g per day
High in fibre
Reduces blood sugar
Reduces cholesterol and TG
Helps loose weight
GLYCEMIC INDEX (GI)
Ability of the food item to raise blood sugar is measured in GI.
Does not depend on amount of food
But on how fast it is absorbed within
the body
Diabetics must prefer low GI foods
FACTORS AFFECTING GI OF FOOD
Rate of ingestion
Food form
Food components – fat, fibre,
protein, starch
Method of cooking and processing
VERY LOW GI FOODS
Dals and pulses
Moong dal, tur dal, rajmah, moong, soybeans, channa etc.
Low fat dairy products
Milk, curds, paneer and buttermilk.
INTERMEDIATE GI FOODS All vegetables
Cabbage, brinjal, spinach, methi, guvar etc.
Fruits with low sugar and high water
Watermelon, pineapple, apple, orange etc.
Whole cereals
Whole wheat, whole wheat noodles, bajra, jowar, ragi, wheat bran, rice bran, barley etc.
HIGH GI FOODS Cornflakes
Rice
Maida Bread
Root vegetables like potato, yam
Sugar, honey, jaggery, sweets, chocolate
Icecream
DISTRIBUTION OF CALORIES IN A DAY IF NO INSULIN TAKEN
33 %
33 %
33 %
Breakfast
Mid morning
Lunch
Tea
Dinner
Before going to bed
ALCOHOL….. MUST BE AVOIDED It is a source of empty calories which is
stored in the body as fat.
It reduces blood sugar and hence must
be avoided especially when on insulin
and oral medicines.
It damages liver.
It may react with certain medicines.
Before taking a drink have some food.
Eat something along with the drink. Avoid fried snacks.
Avoid drinking if sugar levels are not in control or is fluctuating.
Avoid cocktails with sweet mixer like sweet fruit juice, aerated drinks (Limca, Coke etc), Instead use water or soda.
ALCOHOL….. IF STILL TAKEN
MYTHS … & FACTS …
Sweets only increase weight. Inability of the body to form insulin cause diabetes.
Eating sweets cause diabetes.
Sugar free products can be freely taken.
Sugar free products can be high in fat and hence must be avoided.
MYTHS … & FACTS … Continue…
Only few fruits such as mango, grapes, chikoo, coconut, sitaphal and banana must be avoided. Rest all can be taken daily.
Diabetics must avoid fruits.
Diabetes is curable.
Diabetes cannot be cured but can be managed with diet, exercise and medication.