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Restricted DietDr Leong Lai Peng
S14-06-03
Food Science and Technology Programme
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Calorie Restriction (CR)
A diet that restrict Calorie intake (most areabout 30% less than unrestricted Calorie level)but adequate essential nutrients.
Subjects are normal and without any medicalconditions.
Found to increase median and maximumlifespan in rodents, fish, dogs and yeast.1
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1Toxicologic Pathology(2009) 37(1): 4751
http://www.pnas.org/content/106/47.cover-expansion
http://www.pnas.org/content/106/47.cover-expansionhttp://www.pnas.org/content/106/47.cover-expansionhttp://www.pnas.org/content/106/47.cover-expansionhttp://www.pnas.org/content/106/47.cover-expansion8/11/2019 Restricted Diet 3.pptx
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Calorie Restriction for longevity,anyone? SMS your answer to 77577,
Chmgek10 Message
Replace Message with y or n.
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Calorie restriction in primates1did not increaselongevity. Genetic and healthy diet may mattermore.
No human studies have shown CR to increaselife span. Average weight highest life
expectancy. Care should be taken when extrapolating results
from animal studies.
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1Nature 488, 569 (30 August 2012)
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Diet Restriction
Diet
Eating habits
Health
Reduce risk ofdisease Disease management
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Purpose of Diet Restriction:
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The Need for Restricted Diet
Medical Condition Obesity Weight management diet
Cardiovascular Diseases Healthy Fat Diet Diabetes High blood pressure Phenylketonuria (PKU)
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*Information given in this lecture cannot replace the need to seek
professional medical advise if you have a medical condition.
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Overweight and Obesity Abdominal fatness can be defined using waist to
hip ratio (WHR). >1.0 for men; >0.85 for
women. BMI is normally used to indicate the weightstatus of an individual. For Singapore:
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http://viweightloss.com/find-safe-and-effective-products-from-evolution-slimming/1WHO Consultant, The Lancet, 363, 157-163
BMI cut off (kg/m2) Risk Level1
18.5 to 22.9
Acceptable risk23 to 27.4 Increased risk
27.5 High risk
http://viweightloss.com/find-safe-and-effective-products-from-evolution-slimming/http://viweightloss.com/find-safe-and-effective-products-from-evolution-slimming/http://viweightloss.com/find-safe-and-effective-products-from-evolution-slimming/http://viweightloss.com/find-safe-and-effective-products-from-evolution-slimming/http://viweightloss.com/find-safe-and-effective-products-from-evolution-slimming/http://viweightloss.com/find-safe-and-effective-products-from-evolution-slimming/http://viweightloss.com/find-safe-and-effective-products-from-evolution-slimming/http://viweightloss.com/find-safe-and-effective-products-from-evolution-slimming/http://viweightloss.com/find-safe-and-effective-products-from-evolution-slimming/http://viweightloss.com/find-safe-and-effective-products-from-evolution-slimming/http://viweightloss.com/find-safe-and-effective-products-from-evolution-slimming/http://viweightloss.com/find-safe-and-effective-products-from-evolution-slimming/http://viweightloss.com/find-safe-and-effective-products-from-evolution-slimming/http://viweightloss.com/find-safe-and-effective-products-from-evolution-slimming/http://viweightloss.com/find-safe-and-effective-products-from-evolution-slimming/http://viweightloss.com/find-safe-and-effective-products-from-evolution-slimming/8/11/2019 Restricted Diet 3.pptx
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Obesity in Singapore
For population between 18 to 69 years1,
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1National Health Survey 2010, Ministry of Health
10.8% are obese (BMI > 30 kg/m2)
- 12.1%; - 9.5%
Malays 24.0%, Indians 16.9%, Chinese 7.9%
23.0% are high risk (BMI > 27.5 kg/m2)
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Obesity and Health Risk
Obesity is associated with:
Cardiovascular Disease
Diabetes
Atherosclerosis
Inflammation
Some cancers
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Causes of Obesity
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IncreaseCalories
ReducedPhysicalActivity
Genetic Susceptibility
Within ones control
Within ones control
Not within ones control
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Weight Loss Strategies
To maintain weight loss, one should:
Exercise regularly
Make small changes to diet and physical activity(300 to 500 kcal reduction from usual intake).
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Increase energy
expenditure
Reduce intake
= Weight Loss
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Weight Loss Strategies
To maintain weight loss, one should:
Ensure nutrient adequacy by taking foods with
high nutrient density but low energy density.
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Weight Loss Strategies
Comparing energy density:
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Weight Loss Strategies
To maintain weight loss, one should:
Consume lower fat foods (30% of total kcalories)
Use less cooking oil.
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LowFat
Intake
LowEnergy= High
FatIntake
HighEnergy
=
http://www.dreamstime.com/stock-image-raw-meat-image17630391 http://wildchildurbancity.blogspot.sg/2012/03/red-meat-consumption-and-mortality.html
100 g
164 kcal
100 g
272 kcal
http://www.dreamstime.com/stock-image-raw-meat-image17630391http://wildchildurbancity.blogspot.sg/2012/03/red-meat-consumption-and-mortality.htmlhttp://wildchildurbancity.blogspot.sg/2012/03/red-meat-consumption-and-mortality.htmlhttp://wildchildurbancity.blogspot.sg/2012/03/red-meat-consumption-and-mortality.htmlhttp://wildchildurbancity.blogspot.sg/2012/03/red-meat-consumption-and-mortality.htmlhttp://wildchildurbancity.blogspot.sg/2012/03/red-meat-consumption-and-mortality.htmlhttp://wildchildurbancity.blogspot.sg/2012/03/red-meat-consumption-and-mortality.htmlhttp://wildchildurbancity.blogspot.sg/2012/03/red-meat-consumption-and-mortality.htmlhttp://wildchildurbancity.blogspot.sg/2012/03/red-meat-consumption-and-mortality.htmlhttp://wildchildurbancity.blogspot.sg/2012/03/red-meat-consumption-and-mortality.htmlhttp://wildchildurbancity.blogspot.sg/2012/03/red-meat-consumption-and-mortality.htmlhttp://wildchildurbancity.blogspot.sg/2012/03/red-meat-consumption-and-mortality.htmlhttp://www.dreamstime.com/stock-image-raw-meat-image17630391http://www.dreamstime.com/stock-image-raw-meat-image17630391http://www.dreamstime.com/stock-image-raw-meat-image17630391http://www.dreamstime.com/stock-image-raw-meat-image17630391http://www.dreamstime.com/stock-image-raw-meat-image17630391http://www.dreamstime.com/stock-image-raw-meat-image17630391http://www.dreamstime.com/stock-image-raw-meat-image17630391http://www.dreamstime.com/stock-image-raw-meat-image17630391http://www.dreamstime.com/stock-image-raw-meat-image176303918/11/2019 Restricted Diet 3.pptx
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Weight Loss Strategy
Normal Diet
Lipid:Protein:CHO= 35:20:45
Weight Loss Diet Lipid:Protein:CHO =
30:15:55 Energy from fat is replaced by
protein and carbohydrate.
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Reducing % protein helps reduce fat intake andhigh energy density foods.
Increasing % carbohydrate helps increase fibreand low energy density foods.
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Weight Control
To maintain weight loss, one should:
Increase high fiber food.
To promote satiety.
Lower energy density.
High in nutrient density.
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http://www.fruitsinfo.com/uses_of_fruits.htmhttp://crazy-frankenstein.com/vegetables-wallpapers-3.html
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Weight Loss Strategy
To maintain weight loss, one should:
Increase water intake.
Increase fullness without adding calories.
Help in coping with high fiber diet.
Avoid empty calories e.g. sweetened drinks andalcohol.
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http://success-fitness.blogspot.sg/2011/02/carbonated-drinks-affect-health.html
http://www.scientificamerican.com/article.cfm?id=beer-batter-is-better
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Weight Loss Strategy - Precautions Reducing calories without compromising on
nutrient adequacy.
Diet should also be well balanced. Nutrient supplements may be required.
Lower calories should not lead to feelings ofstarvation which may lead to irresistible urge.
Beware of fad diets normally focus on extremechanges and sudden weight loss.
Beware of weight loss products. E.g. consumesomething to loose weight without change in diet.
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Weight Management Weight loss Weight Management Weight loss is not useful if weight is regained.
Weight loss products and services thrivebecause: Success rate is low in retaining weight loss Social pressure to maintain normal weight
People are willing to try quick-fix solution People believe that if a product sells, it must be
effective. Some evidence in animal models. Explanation sounds good.
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Low Fat or Low Carbohydrate?
Low Fat Low Carb
Total Calorie intake less than total expenditure Adequate and balance?
Within recommended range of energy ratio?
Undesirable effect?
Possible to maintain healthy weight? ? ?
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Low Fat Low Carb
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Cardiovascular Diseases
Diseases of heart and blood vessels.
Includes:
Coronary heart disease (CHD)
Blood flow to the heart is affected.
Leads to heart attack
Stroke
Blood supply to brain is affected.
>30% of total deaths in Singapore is due toCardiovascular Diseases1.
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1http://www.myheart.org.sg/heart-facts/statistics/
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Risk Assessment of CHD
Blood lipid profile analysis.
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Functions of LDL and HDL
LDL transport TG,cholesterol and
phospholipid to cellsof all tissues.
HDL transport
cholesterol back to theliver for disposal.
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Healthy Fat Diet Purpose:
Weight loss or maintenance
Reduce LDL level and obtain blood lipid balance.
Recommendation: Total Fat 2035% of energy
Limit saturated fat to 7% of total energy. This can be done by Taking lower fat food.
Cut off fats from meat.
Reduce cream and butter.
Replace with carbohydrate (but maintaining between 50-60% totalenergy).
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How to Reduce Saturated Fats
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Healthy Fat Diet Recommendation:
Limit cholesterol to 200 mg.
Sources of cholesterol: Animal fats
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http://www.mrbigben.com/food/dairy.html
http://faith-resources.blogspot.sg/2011/08/meat-shops-for-home-delivery.html
http://www.foodsubs.com/Eggs.html
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Cholesterol
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Cholesterol is not essential. When absorbed, the body will reduce the synthesis. Some evidence shows that dietary cholesterol has little effect on blood
cholesterol.
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Healthy Fat Diet Recommendation:
Avoid trans fatty acid
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NUTRITION INFORMATION
SERVINGS PER PACK 50 SERVING SIZE 10g
QTY^ PERSERVING
% DAILYINTAKE*
QTY^PER100g
ENERGY 242 kJ 3 2420 kJ
PROTEIN
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Transfatty acid vscisfatty acid Oleic acid (cis18:1)
Elaidic acid (trans18:1)
Saturated fatty acid
Small quantities
are found
naturally in
meat and milk.
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Healthy Fat Diet Recommendation:
n-6 Polyunsaturated fatty acids (linoleic acid)* 510% energy
n-3 Polyunsaturated fatty acids (-linolenic acid)* 0.61.2%energy
* Approximately 10% of total can come from longer chain n-6 or n-3fatty acids
http://foodiesunite.com/2011/05/grilled-fish-101-mango-salsa-for-memorial-day/
Replace meat with fish:
Low in saturated fat.
Suppress inflammation reducing
blood clotting, lowering TG levels.
http://foodiesunite.com/2011/05/grilled-fish-101-mango-salsa-for-memorial-day/http://foodiesunite.com/2011/05/grilled-fish-101-mango-salsa-for-memorial-day/http://foodiesunite.com/2011/05/grilled-fish-101-mango-salsa-for-memorial-day/http://foodiesunite.com/2011/05/grilled-fish-101-mango-salsa-for-memorial-day/http://foodiesunite.com/2011/05/grilled-fish-101-mango-salsa-for-memorial-day/http://foodiesunite.com/2011/05/grilled-fish-101-mango-salsa-for-memorial-day/http://foodiesunite.com/2011/05/grilled-fish-101-mango-salsa-for-memorial-day/http://foodiesunite.com/2011/05/grilled-fish-101-mango-salsa-for-memorial-day/http://foodiesunite.com/2011/05/grilled-fish-101-mango-salsa-for-memorial-day/http://foodiesunite.com/2011/05/grilled-fish-101-mango-salsa-for-memorial-day/http://foodiesunite.com/2011/05/grilled-fish-101-mango-salsa-for-memorial-day/http://foodiesunite.com/2011/05/grilled-fish-101-mango-salsa-for-memorial-day/http://foodiesunite.com/2011/05/grilled-fish-101-mango-salsa-for-memorial-day/http://foodiesunite.com/2011/05/grilled-fish-101-mango-salsa-for-memorial-day/http://foodiesunite.com/2011/05/grilled-fish-101-mango-salsa-for-memorial-day/http://foodiesunite.com/2011/05/grilled-fish-101-mango-salsa-for-memorial-day/8/11/2019 Restricted Diet 3.pptx
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all-cis-7,10,13,16,19-docosapentaenoic acid (22:5, n-3)
all-cis-4,7,10,13,16-docosapentaenoic acid (22:5, n-6)
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Healthy Fat Diet Fat replacers
Replace the function of fats in foods (taste, texture
and/or cooking properties) with zero or lowercalories.
Do not contribute to hyperlipidemia.
Can be carbohydrate, protein or fat based.
Precaution
Fat based fat replacers is able to reduce theabsorption of fat soluble vitamin.
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Healthy Fat Diet Examples of fat replacers:
Fat replacers obtained from food components areGRAS. E.g.:
Avicel microcrystalline cellulose
Splendid derived from pectin
Simplese microcapsules of milk protein or egg white protein.
Benefat triacylglycerides with mixture of short chain fattyacids and stearic acid.
Fat replacers which are not natural occurring are testedvigorously for its safety before it is approved for use.E.g.
Olean hexa-, hepta-, and octa-esters of sucrose; can causediarrhea and oily stools if consumed in large quantities.
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Precaution Avoid deficiency of essential fatty acid e.g.
omega 3 (linolenic acid (18:3, -3),
eicosapentaenoic acid (20:5, -3) ,docosapentaenoic acid(22:5, -3) and omega 6(linoleic acid (18:2, -6), arachidonic acid (20:4,-6)) fatty acids
Supply and absorption of vitamin A, D, E and Kmay be affected.
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Healthy Fat Diet Dos and donts of healthy fat diet. What is your
say? Bread, cereal, rice and pasta group
Dairy products Fats, oils and sweets
Protein
Vegetables and fruits Snacks and desserts
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Healthy Fat Diet Food labels
Regulation in Singapore is published by AVA Food regulations
and, HPB Handbook of nutrient claims has guidelines on: Energy lite/light/lowenergy/calorie, less/lower/reduced
energy/calorie, more/fortified/added/enrichedenergy
Total fat fat free, no fat, low/light/litein fat, reduced/lower/lessinfat, leanmeat, extra leanmeat
Fatty acids Saturated fat free, low saturated fat, reduced saturatedfat, contains PUFA, high in PUFA, more/increased PUFA, containsMUFA, high in MUFA, more/increased MUFA
Cholesterol cholesterol free, low/light/litein cholesterol,lower/reducedcholesterol
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Diabetes Diabetes is a disease in which the body does not
produce or properly use insulin.
Muscle Cell
or
Fat Cell
Glycogen G-6-P Glucose
FA
SynthesisEnergy
VLDL
Blood Glucose
Starch, sugar
Digestion
Insulin
Liver
pancreas
Muscle
and fat
cell
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Diabetes - Type 1 (Insulin dependent
diabetes mellitus)
Due to damage of pancreatic cells unable toproduce insulin.
5-10% of cases.
Muscle Cell
or
Fat Cell
Glycogen G-6-P Glucose
FA
SynthesisEnergy
VLDL
Blood Glucose
Starch, sugar
Digestion
Insulin
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Diabetes Problems:
Cells suffer from lack of sugar (starvation).
Fat is used for energy instead, resulting ketoacidosis intype 1 diabetes. Insulin in type 2 diabetes inhibit fat breakdown.
Ketoacidosis is less severe. Glucagon dominate andgluconeogenesis result in hyperosmolar hyperglycemic
state (dehydration). High blood sugar (hyperglycemic) may affect vision,
delay wound healing, heart disease, kidney failure,stroke, loss of limbs etc.
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Body Weight of Diabetics
Type 1
Normally notoverweight.
Weight gainmay be sideeffect of insulintreatment.
Type 2
Normallyoverweight.
Overweight canworsen insulinresistance.
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Diabetes Principles of diet management;
Balance diet with essential nutrients
Maintenance of ideal weight Meeting energy needs
Prevention of blood sugar variation and keeping itas close to normal level
Decrease of blood lipid levels, if elevated
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DiabetesNutrition Management
How is it achieved?
Consistent carbohydrate content in meals at timed
intervals to maintain blood sugar level. Overall calories eaten must be controlled to
manage weight over long term.
Consumption of carbohydrate must not be lower
than 130 g/day.
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DiabetesNutrition Management
Carbohydrate sources: Different foods has different glycemic effect*
E.g.
*Glycemic Effect rate of change in glucose in blood afterconsumption of food
Food Glycemic Index
Rice 76
Brown Rice 48
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DiabetesGlycemic Index
Glycemic index (GI): An index given to food base on itsability to increase blood sugar level compared to glucose
(sometimes white bread is used instead of glucose). Glycemic index = area under blue curve/area under red
curve x 100
50g glucose
50g carbohydrate
containing food
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Glycemic index is affected by Cook or raw, cooking time, how the food is cut etc. Level of ripeness of fruits and vegetables Variations in digestion and absorption Possibly of other components in foods e.g. fibre.
For people with diabetes, low GI foods should beconsumed.
GI does not give the extent to which bloodglucose is raised by a consumption of aparticular amount of a food.
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Classification GI range Examples
Low 55 or less most fruit and vegetables (except
potatoes), wholegrains, basmati rice,
pasta
Medium 56 - 69 sucrose, candy bar, croissant, some
brown rices
High 70 or
more
corn flakes, baked potato, some
white rices (eg. jasmine), white
bread
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Glycemic Load Glycemic load (GL) represents blood-glucose-raising
potential of specific amount of food consumed.
GL = GI x mass of carbohydrate in food consumed/100 E.g. 1 baked potato has 34 g of carbohydrate. GI of
baked potato is 85. Therefore GL = 34 x 85/100 = 28.9
GL is a better indicator of the effect of a certain amount
food on blood glucose level.
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Is there a need to avoid sugar?
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DiabetesNutrition Management
Fiber Recommendation same as general population
i.e. 21 to 38 g per day. Fiber rich foods are encouraged and may improve
glycemic control.
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DiabetesNutrition Management
Fat intake Due to high risk of cardiovascular disease, healthy
fat diet is recommended. Protein
15 to 20 % of total kcalories. (withinrecommended range for general population).
Alcohol
Minimise. Consume with food to avoid hypoglycemia.
Alcohol interfere with glucose production in liver. May increase triglyceride level.
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DiabetesExchange Lists
Separation of foods into food groups: Bread/starch Vegetable
Milk Meat Fruit Fat
Foods in the same group should have approximatelysimilar number of calories, composition (carbohydrate,fats and protein) and effects on blood glucose levels.
Exchange list can be set up for each group.
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DiabetesExchange List
Example of exchange list:Sample Exchange List
Food group You can have..... Or exchange it for...
Fruit (Each serving contains about 15
grams carbohydrates)
1 small or medium piece
of fresh fruit
1/2 cup fruit juice,or
canned or chopped fruit
Vegetable (Each serving contains about 5
grams carbohydrates)
1 cup raw vegetables 1/2 cup cooked vegetables
or vegetable juice
Starch(Each serving contains about 15
grams carbohydrates)
cup of rice 1/2 cup noodles
Sugar, honey, molasses 1 teaspoon 4 grams carbohydrates
Milk 1 cup low fat milk 1 cup of low-fat yogurt
Meat 1 ounce meat 1 ounce of fish or poultry
Fat (includes nuts, seeds and small
amounts of bacon & peanut butter)
1 teaspoon oil, butter or
margarine
5 grams fat
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Hypertension
Blood Pressure Systolic Pressure (when theheart beats)/Diastolic Pressure (when the
heart relaxes between beats) Blood Pressure levels for Adults:
Category Systolic (mm Hg) Diastolic (mm Hg)
Normal < 120 < 80
Prehypertension 120-139 80-89
Hypertension 140 90
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Hypertension Salt contain 400mg of sodium in 1000mg of salt!
Na+ causes dehydration of cell and increase in blood
pressure. Na+ can be reduced by reducing intake of food
containing sodium as well as salt.
Water
Blood vessel
Na+
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DASH Diet
Daily nutrient goals (for 2100 kcal eating plan)
Total Fat 27% kcal Sodium* 2300 mg
Saturated Fat 6% kcal Potassium 4700 mg
Protein 18% kcal Calcium 1250 mg
Carbohydrate 55% kcal Magnesium 500 mg
Cholesterol 150 mg Fiber 30 g
*1500 mg lower goal is better for lowering blood
pressure
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DASH Diet
Food Groups
Servings/Day*
1600 kcal/d 2000 kcal/d 2600 kcal/d 3100 kcal/d
Grains (preferably whole grain) 6 6-8 10-11 12-13
Vegetables** 3-4 4-5 5-6 6
Fruits** 4 4-5 5-6 6
Fat-free or low fat milk and milk
products
2-3 2-3 3 3-4
Lean meats, poultry and fish 3-6 6 6 6-9
Nuts, seeds and legumes 3/wk 4-5/wk 1 1Fats and oils 2 2-3 3 4
Sweets and added sugar 0 2 2 2
*To lose weight, aim for lower caloric intake level
**Larger servings of vegetables and fruits are recommended
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DASH Diet Tips to reduce Salt and Sodium
Choose low- or reduced-sodium or no salt alternatives. Choose fresh or frozen food. If canned, no salt added. And if
possible, rinse the salt from the food before using.
Choose processed food carefully some processes involvesthe addition of salt. E.g. cured (bacon, ham), preserved withbrine (tuna, salted vegetables), condiments (tomato sauce,BBQ sauce, steak sauce)
Soy sauce, teriyaki sauce also contains sodium. Choose lowsalt versions. Use condiments and table salt sparingly.
Other words that may show the addition of salt: Smoked,corned, pickled. Cooked food normally has salt added. Many snack foods also contain added salt. Check nutrition labels for information on sodium content.
vs
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DASH Diet Change gradually. For example:
Reduce sodium intake by reducing the use of table salt
and salt during cooking. Increase intake of fruits and vegetables at one meal.
Choose the easiest change. E.g. drinking fruit juice.
Introduce high potassium vegetables or fruits slowly.
Cut down on saturated fat and trans fat.
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Other Examples Gluten Restricted Diet
Who is affected: Celiac sprue
Foods to avoid: all wheat, rye, oats, barley andbuckwheat products. Watch out for hidden gluten: e.g. sausage soy sauce,
sauce and gravy mixes etc.
Assignment: Prepare an exchange list for bread
and cereal, fat, fruit, meat and meat substitutesuitable for a celiac. State in each category whatfoods they should avoid.
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Other Examples Lactose Restricted Diet
Who is affected: Lactose intolerant Foods to avoid: Foods with lactose, casein, caseinate,
whey, whey products, or non-fat dry milk solids. Foods containing very low level of lactose is possible
for the less sensitive. E.g. yoghurt, aged-cheese,buttermilk
Caution: lack of Ca2+
Can consider adding lactase in milk Assignment: What foods with hidden lactose
should be avoided? What is the best food toreplace milk?
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