SELF MANAGEMENT OF DIABETES NUTRITION INTERVENTION & DIETARY GUIDELINES Vasantha Narasimhan Ph.D...
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Transcript of SELF MANAGEMENT OF DIABETES NUTRITION INTERVENTION & DIETARY GUIDELINES Vasantha Narasimhan Ph.D...
SELF MANAGEMENT OFDIABETES
NUTRITION INTERVENTION & DIETARY GUIDELINES
Vasantha Narasimhan Ph.DEmeritus Professor of chemistry
Skidmore College
Diabetes:: Some Stats and facts
(Source: ADA and NIH)
• about 30 million cases in USA in 2012• 21 % of people over 65 have diabetes • The total estimated health care cost of
diagnosed diabetes in 2012 is $245 billion,( $176 billion in direct medical costs and $69 billion in reduced productivity)
• Food habits/Life style main cause• Diabetes related heart diseases, strokes, kidney
diseases and neuropathy on the rise.• Certain ethnic groups more prone to diabetes
Division of internal medicine, UCSF, Division of Geriatric Medicine, USCCardiology and endocrinology divisions, U.AlHuman nutrition, endocrinology and internal medicine dept., UT Southwest Med.Center.
??????Oh,My God!!!!?????
• Do I have to give up my favorite foods and go on a “diabetic diet”?
• I love dinner parties- should I say goodbye to them?• I love eating out. No more of that???• Will I be an “invalid” from now on and worry about my
health constantly??
• The goal of my talk today is to emphasize that
With a few healthy dietary and attitude changes
You can answer “NO” to the above questions!!
Food provides NUTRIENTS(CHEMICALS IN FOOD THAT NOURISH THE BODY)
MACRONUTRIENTS MICRONUTRIENTS * CARBOHYDRATES * VITAMINS * FATS * MINERALS * PROTEINS
(Energy, growth) (Help proper metabolism of macronutrients,
maintain healthy cells)
Mouthstomac
h
Intestine
Amino acidsFatty Acids
Vitamins Minerals
“ Waste”- Fibers
Blood Stream
FOOD
Glucose
Enzymes
Blood glucose
Liver
Muscle
Heart
Brain
Other organs
Pancreas
INSULIN
Energy use
Energy use &Storage As glycogen
ROLE OF INSULINMaintain blood glucose
within healthy limits
What can go wrong?
NO Insulin madedamage to pancreas, genetic defect in making insulin etc TYPE 1 DIABETES
Not enough insulin made
sluggish pancreas due to overwork, cell defects etc TYPE 2 DIABETES
Insulin not doing its job right
“Insulin resistance”, organs not responding to insulin TYPE 2 DIABETES
Frequent urination, excessive thirst, irritability, tingling & burning sensation in limbs, hunger pangs, lack of concentration, sometimes unexplained weight loss
CAUSES RESULTS CONDITIONS
USUAL SYMPTOMS
Risk factors for diabetes
• Genetic/hereditary factors• Age/ethnicity• Obesity/overweight• Sedentary life style• High fat/high carb. diets• High Blood Pressure• High fat levels in blood
If you are at risk or you have been diagnosed as diabetic…….
• Don’t Panic ! • Set your GPS to take control of your health! Then
follow through!• Your destination should be “A healthy you” with
acceptable values of
blood sugar
blood cholesterol and triglycerides
blood pressure
body weight
• You can reach there with small,
step by step lifestyle changes.
Acceptable blood values(suggested by National Diabetic Education Program)
• Fasting Blood sugar: 80-120 mg/dl• Post-prandial sugar: 140-170 mg/dl
• Hemoglobin A1C (Hb A1C) under 7.0
• Total cholesterol: under 200 mg/dl• HDL (“good cholesterol”) over 40 for men/over 50 for women
• LDL(“ bad cholesterol”) under 100• Triglycerides under 150 mg/dl• Blood Pressure: below 130/80• Body Mass Index : under 27
HbA1C tells us about average blood sugar levels over a 12 week period.
Controlled diabetes, not much glucose, not much HbA1C
Uncontrolled diabetes, more glucose, much more HbA1C
HbA1C
Glu
Body Mass Index chart (BMI)
Steps towards a healthy “you”……
Physical activity goals
• Set goals-(lose 10 lbs? increase strength? be active? )
• Follow the “F.I.T.T.” principle to become fit!
Frequency, Intensity, Time, Type of activity
• Stop negative thoughts!• Keep a record of your progress!• Reward Yourself!
Diet & Nutrition Goals
Total calorie control
CARB counting/Glycemic Index
Diabetes food pyramid
Simple common sense dietary habits
Calorie Countingsource: National Institute of Health 2008
profile/ activity level Calories/day Number of servings*/day
Small/F/ moderateMedium/F/sedentary, low
1200-1600 6 carbs, 3 fats, 1 proteins,2 dairy,3 veggies, 2 fruits
Large/F/moderateSmall/M/ moderateMedium/M/sedentary
1600-2000 8 carbs,4 fats,2 proteins,2 dairy, 4 veggies, 3 fruits,
Medium/M/highLarge/M/ModerateLarge/F/high
2000-2400 10carbs,5 fats, 3 proteins2 dairy, 4 veggies, 4 fruits
Servings: Carbs- 1 slice bread, 1 roti , ½ cup cooked rice, 1 cup cooked pasta Dairy: 8 oz Protein : 4 oz.cooked meat. ½ cup cooked lentils/beans/dhal Fat: 1 teaspoon Veggies: 1 cup raw or ½ cup cooked Fruits: ½ cup diced , ½ of whole fruit ( apple, pear etc)
40%
30%
20%
10%
Now for some practical ways to watch your diet and nutrition………
When you eat…………
How much you eat………. Portion control• Be conscious of how much you put in your plate• When you start your new “diet” , record what you eat
each day at least for 10 days. • “Plate method” is recommended by ADA
Milk or yogurt
1 serving
Fruit 1
serving
How and where you eat………• Take a minimum of 20 minutes to finish your meal.
The hormone that gives the sensation of fullness takes 20 mins to take effect.
• Place all the components of your meal in small serving dishes on the table.
• Never eat on the run! Be conscious of what you put in your mouth! Sit at the table and enjoy your meal.
What you eat…….. Choosing the right foods
• You don’t have to carry around tools like charts, counters, weighing tools etc.!
• Just simple common sense substitutions and choices will do the trick.
• Make choices based on simple available information in paper and on internet.
Some examples of Simple Substitutions
Processed/ polished grains Whole grains
White bread Wheat or rye bread
Fried snacks, chips Baked snacks and chips
Regular dairy products Low fat/no fat dairy products
Red meat Fish, poultry , lentils, beans
Canned fruits, fruit juices Fresh or frozen fruits
White or yellow potatoes Yams, sweet potatoes
Sugary desserts Low fat dairy based desserts
Salty and sugary snacks Peanuts, almonds, walnuts,
INSTEAD OF THIS USE THIS
Always read nutrition labels to see amount of total carbs and sugar!
Can I include rice in my meals??
• Of course you can! 1-2 carb servings can be rice dishes
• Glycemic Index is a method nutritionists use to study the effect of foods on diabetes.
• GI score ranges from 1-100 with pure glucose being 100
• GI < 55 low, 56-69 medium and over 70 high• IRRI has rated 235 varieties of rice based on GI
Brown Rice 55 ✔Swarna (Ponni) rice 56 ✔
Samba Masoori rice 57 ✔
Basmati rice 58 ✔Long Grain rice 58 ✔Medium Grain rice 69
Sticky rice (japanese,thai)
90
over Cooking (Mushy) increases GI 5-8 pts)
Siimmer over low heat (+1)
Rice cooker (+1)
Boiling and straining (+6 to 8)
Pressure cooker ( +6 to10)
Use with 1 isp ghee
Use with protein(kichadi!)
(-5 to 8)
How about rotis and pastas???• Whole wheat based rotis over white “nan”• Chapati flour with1% rye/bajri flour + 1% besan ----
lowers GI• Pastas made with durrum wheat better than
multigrain ones.• Larger the size of pasta, less GI• “al dente” lower GI/overcooking higher GI• Ghee on roti and olive oil on pasta- lowers GI
What about fats and oils??
• Total “Non-fat” meals are not so good if you are trying to control your blood sugar.
• Fat helps to release the sugar from carbs slowly into blood----- less sugar spikes and yo-yo’S!
• 4 -5 servings ( 4-5 tsps) of fat/day• Ghee (clarified butter) (ayurvedically adviced)• Sesame oil preferred over olive oil(J,clinical.nutr. 2011, J.nat.med. 2012)
Efficacy of oral diabetic medicines. B.P & TG• Peanut oil preferred over corn or canola oil
Can I include dessert in my meal plan??? Occasionally yes!
Instead of this have this! Rich, creamy sugary cakes/pies Low fat, low sugar cakes/pies
Cheese cake/vanilla cake Dark chocolate cake chocolate mousse
Fruit Pies, tarts Fresh frozen fruits with nonfat whipped cream
Sugar based ,fried desserts (e.g : gulab jamun, jalebi, ladu)
Dairy based, baked, steamed desserts (e.g Ras malai, ras gulla, Kheer)
Fruit sorbets ( 2 scoops) Ice cream or kulfi ( ¾ to 1 scoop)
Nut cakes and sweets Plain nuts with fruits
Finally, a word or two about fruit and veggie choices.
OK to choose in plenty (3-4 servings a day)• Green leafy veggies, cruciferous veggies, Karela, egg plant.• Berries, orange varieties
Moderate use ( 1 serving/day)• Carrots, beets, yams, sweet potatoes• Bananas, pears, apples, peaches, melons, papaya
Very limited/occasional use ( >3 servings/week)• Potatoes, Taro root (Arvi) other root veggies• Mangoes, watermelon
,
Karela( bitter gourd)(momardica charantia)• Polypeptide-P ( insulin mimic)• Charantin ( uptake of glucose by cells)• α-lipoic acid (anti-neuropathy agent)
Methi ( Fenugreek)(Foenum Graecum)
• 4-hydroxy isoleucine (facilitates insulin secretion, Slows down absorption from intestine)
Tips to succeed in your dietary goals….
☛Use Variety and diversity in choosing foods
☛Don’t be rigid and narrow in your choices
☛Allow for “cheatings” occasionally, but
remember to get back on track soon
☛Most of all, be self confident and positive
☛Always remember you control your diabetes, don’t let diabetes control you!
Some useful websites
• www.diabetes.org (american diabetic assn)
• www.diabetescare.net• www.ndep.nih.gov (national diabetes education)
• www.fda.gov• www.cdc.gov/diabetes
Thank you all for your patient listening!