1336127460526-1335866620103-nutritional_management_of_diabetes

Information about 1336127460526-1335866620103-nutritional_management_of_diabetes

Published on August 9, 2014

Author: ranjana_tiwari

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Nutritional Management of Diabetes And Heart Diseases: Nutritional Management of Diabetes And Heart Diseases RANJANA TIWARI DIETICIAN Burden of Major NCD’s in India: Burden of Major NCD’s in India 35 million cases of Cardiovascular Diseases 45 million cases of Diabetes 2.4 million cases of cancer 22 million Obesity 1 million cases of Cerebrovascular Disease/stroke Every 5 th Diabetic is an Indian Every 5 th to 10 th Asian Indian Native Urbanite is a Diabetic Glucose is the currency of body & every cell needs it: Glucose is the currency of body & every cell needs it Type 2 DM: Type 2 DM Oxidative Stress Damages Here: Oxidative Stress Damages Here Endothelial lining Smooth muscle Collagen Food : Food Any substance that can be metabolized by an organism to give energy and build tissue Any solid substance (as opposed to liquid) that is used as a source of nourishment; "food and drink" Anything that provides mental stimulus for thinking Traditional Diets: Traditional Diets Traditional Diet: Traditional Diet PowerPoint Presentation: Food Pyramid Fruits 2-3 Units Cereals & Pulses 8-12 Units 10-14 units (veg) Meat & Fish 1-2 Units Fats, Oils & Nuts 2-3 Units Vegetables 3-4 Units Milk & Milk Products 2-3 Units Food Components: Food Components MACRONUTRIENT Carbohydrates Proteins Fats MICRONUTRIENTS Vitamins Minerals Carbohydrates : Carbohydrates Primary source of energy Sources:cereals, fruits, vegetables,milk Carbs are of two types simple carbs: sugars, honey, colas, fruits juices, jaggery,maida,bakery products Complex carbs: cereals, vegetables, pulses How to choose carbohydrates.: How to choose carbohydrates. Complex carbohydrates are good for our health. Simple carbohydrate easily increase our blood sugar, so decrease their consumption. Eat carbohydrates only in recommended amounts. Choose complex carbohydrates high in fibre e.g unpolished rice, ragi ,whole wheat Fruits Exchanges ( to be eaten in prescribed amount) : Fruits Exchanges ( to be eaten in prescribed amount) Apple Guava Orange Papaya Pineapple Pears Sweetlime Water melon Pomegranate Coconut water Jambun 1 small/½ medium 1 medium 1 medium 1/3 medium or 3 slices 2-3 slices 1 medium 1 medium 2-3 slices 1/3 rd medium 150 ml 100 gm FIBRE: Boon of nature : FIBRE: Boon of nature Fibre is non digestible carbohydrate. It forms a bulk and hence makes us feel full. Soluble – oats, barley, psyllium, fruits ( guava, apple ), gum Insoluble-whole grains, pulses, vegetables, fruit ( oranges, sweetlime ) PowerPoint Presentation: Fruits Exchanges: (to be avoided) High Calories Fruits Banana Chickoo Mango Sitaphal Grapes ½ big 1 small ½ medium (75 gm ) ½ big size (50 gm ) 12-15 pieces Properties of Dietary Fibre: Properties of Dietary Fibre Type Major Food Sources Known Effects Cellulose Bran, whole wheat four, cabbage, peas & beans, root vegetables, apples Affect food texture, increase fecal bulk, shorten transit time Hemicelluloses Bran, cereals, whole grains Same as cellulose Soluble noncellulosic pectin's Polysaccharides Apples, citrus, fruits, various berries, apricot, banana, carrots, sweet potato Alter consistency of gastric & intestinal contents, reduce absorption of cholesterol, reduce serum cholesterol , water holding PowerPoint Presentation: Properties of Dietary Fibre Type Major Food Sources Known Effects Gums & Mucilage's Oat meal, dried beans, other legumes Binding of ions & other substances, water holding cholesterol-lowering Lignin Old (tough) vegetables, wheat Indigestible by fecal bacteria Quantity of Soluble Fibre to Produce Lipid Lowering Effect: Quantity of Soluble Fibre to Produce Lipid Lowering Effect Source Quantity Pectins Gums Dried beans Dry oat bran Oat meal Psyllium 6 to 40 8 to 36 100 to 150 25 to 100 57 to 140 10 to 30 Fibre Content of Foods: Fibre Content of Foods Low Fibre Moderate Fibre High Fibre Milled rice Refined wheat flour Bread white Whole gram (bengal) Lentil Green gram dal Bottle gourd Ash gourd Cucumber Tomato Spinach Lettuce Banana Whole wheat flour Wheat germ Brown bread Field beans Red gram dal Brinjal Cauliflower Radish leaves Fenugreek Cabbage Apple Rice bran Bengal gram Whole Rajmah Peas Red gram Green gram whole drumstick PowerPoint Presentation: Fibre Content of Foods Low Fibre Moderate Fibre High Fibre Sweet lime Lichi Water melon Prunes Peaches Pears Orange Parwar Double beans Colocasia Amaranth Amla /Dates/Grapes/ Guava/Pomegranate/ Sapota /Papaya Proteins: Proteins Repair of tissues, immunity Sources: pulses, nuts, milk and milk products, meat, egg, fish, poultry. Egg ,poultry and red meat have saturated fats in them Good source of proteins are dals, sprouts, fish, egg whites,chicken breast. Advantages of proteins: Advantages of proteins Is not converted into sugar as fast as carbohydrates. It keeps us full for a long period of time. It takes a lot of energy to burn proteins, therefore you store less energy. FATS : FATS Source of stored energy Source: oil, butter, ghee, nuts, non-veg, cheese, bakery products PowerPoint Presentation: A consumer is a confused lot as far as choosing the right kind of cooking medium is concerned. Every supplier of any type of cooking oil claims the same to be best for health A common man is not aware of the yardstick by which any cooking oil could be rated as the best one . . CHOICE OF A HEALTHY COOKING MEDIUM: a controversial subject PowerPoint Presentation: Recommended fats (heart friendly oils )are MUFA eg. ground nut oil, rice bran oil, olive oil CHOLESTEROL BALANCING OXIDATION STABILITY Invisible Fats: Invisible Fats Coconut Peanuts, Almonds, Cashewnuts etc. Condiments like pappad, pickles, chutney’s etc. Garnishes like cheese, cream, white sauce, etc. Bakery items like biscuits, kharis, puffs, etc. Farsans and sweets Non-Vegetarian food Milk & milk products Total Fat : Total Fat Total fat intake is most important Invisible sources of fat should be included in the total fat intake Total fat intake is closely related to serum lipids Recommended intake is 20 gms per person per day Diets should not provide more than 30% calories from fat Effect of heating on oils: Effect of heating on oils Depends on saturation of oils Temperature of heating PUFA > MUFA > SFA Change in saturated:unsaturated ratio Formation of peroxides Loss of antioxidants Dietary cholesterol: Dietary cholesterol Associated with animal fat Sources of dietary cholesterol : ghee, cream butter, non-vegetarian foods. Excess consumption of fat leads to production of fat in our body Prudent fat intake : 3-4 tsp/day/person Good oils :ground nut oil, olive oil, rice bran oil PowerPoint Presentation: Alternatives 1 cereals exchange gives 100 kcals 1 chapatti (30 g) 1 thepla or 1 khakra (dry) or 1 medium vati porridge or 2 medium size bread slice or 1 pav (30 gm ) or 1 vati (medium) cooked rice or 1 medium vati onion poha (no potato) ½ Thalipith or 1 Ghavan or 1 bowl of spaghetti or ¼ bhakri or 1 bowl of corn flakes or 1 idli with sambhar or 1 dosa (home made – medium sized – on nonstick) with sambhar 4-5 pieces of dhokla or muthia (steamed) 4-5 pieces of Khandvi Meal Patterns: Meal Patterns Breakfast: Meal consumed within one hour of rising Most important meal of the day Should be rich in complex carbs and protein eg: cereal, porridge, roti, dosa, idli, upma, daliya, paratha, eggs, milk, fruits. Avoid :bakery products Meal Patterns: Lunch Eat balanced meal Make right food choices Do not skip lunch Include protein as a important part of meal eg thali, roti-subzi , dal rice, curd rice Meal Patterns Meal Patterns: Dinner Meal should be as light as possible Low in carbohydrates especially simple carbs Make clear soups as integral part of dinner Meal Patterns Eating Out (Make Right Choices): Eating Out (Make Right Choices) Meal time Cuisine Meal selection Hygiene A la carte: A la carte Either starter, main course or dessert never all together Clear soup should be an integral part of menu Choose grilled, tandoori, broiled, stir fry Do not order for deep fried, makhani, white sauces, mayonnaise Salad(?) Buffet: Buffet Choose wisely Do not have to eat it all Select hot, steaming foods Select a live counter so dish can be made as per your choice Avoid greasy foods Mid Meals/Snacks: Mid Meals/Snacks Avoid high calorie snacks- split it into two Avoid super sized snacks Fruits, channa, unbuttered pop corn, sukha bhel with less sev, cooked channa chat are ideal snacks Avoid bakery products, colas, juices, chaat etc The best drink with and between meals is water Mid-Meal Options: Mid-Meal Options Skimmed milk Chaas Kurmura Channa Fruit (permitted quantity only) Alcohol: Alcohol Causes hypoglycemia if consumed without food Foods consumed with alcohol are usually fried foods/junk food empty calories) Alcohol is high in calories 7 kcals/gm and is metabolized in a manner to fat. give up alcohol, if not then fix the quantity, frequency and exchange it with fat. consume salads with alcohol. Alcohol: Alcohol Raises HDL Lowers insulin concentration and improves insulin sensitivity But Raises blood pressure These findings are true for whites. Blacks (Afro American ) and Hispanics do not show this relationship Studies on Indian populations have not been done Ref : Freiberg MS, Cabral HJ, Heeren TC, et al. Alcohol Consumption and the Prevalence of the Metabolic Syndrome in the U.S.A cross-sectional analysis of data from the Third National Health and Nutrition Examination Survey. Diabetes Care 2004; 27:2954-2959. Alcohol & Sugar Content of Alcoholic Drink: Alcohol & Sugar Content of Alcoholic Drink Alcoholic Drink Carbohydrate/Sugar Content (g/L) Alcohol Content (g/l) Distilled Spirit (Whisky, Cognac, Vodka) - 400-500 Dry White Wine & Red Wine 2-10 120 Beer & Dry Sherry 30 40-50 Sweetened White Wine & Poat Wine 120 An average drink namely 5 oz of wine, 12 oz of beer or 1.5 oz of distilled spirit contains 12-14 gms of alcohol. Thus they give approximately 100 kcal. Lieber CS. Alcohol Research & Health, Fall, 2003 Unit of Alcohol: Unit of Alcohol One Unit of Alcohol Calories Half a pint of beer, lager or cider P ub measure of spirit s (whisky, vodka , rum, gin) Gl ass of wine G lass of sherry 90 50 75 55 One unit of alcohol is 10 ml by volume, or 8 g by weight, of pure alcohol. For e.g. Half a pint of ordinary strength beer, 25 ml of spirits, 50 ml of fortified wine such as sherry or port How Should be the Calories from Alcohol Calculated?: How Should be the Calories from Alcohol Calculated? When calories from alcohol need to be calculated as part of the total caloric intake, alcohol is best substituted for fat exchanges (1 alcoholic beverage = 2 fat exchanges or fat calories. ADA Guidelines PowerPoint Presentation: Fountain PEPSI WATERFOUNTAINS Fast Food Joints: Fast Food Joints Order wisely Find a low fat option and order Do not over indulge Eg: just a burger no fries ,one unbuttered pav instead of two buttered pav, bhel puri instead of sev puri, ragada pattice instead of panipuri, samosa ,kachori PowerPoint Presentation: DO NOT UPSIZE !!! We Need To Minimize Not Maximize Maharaja Mac ? Jumbo Vadapav? Double Cheese Pizza? Sweeteners: Sweeteners Sweeteners are of two kind: Nutritive Sweeteners (which have calories) and Non-Nutritive Sweeteners (which have no calories) Nutritive and Non Nutritive Sweeteners should be used sparingly in prescribed amounts Education on appropriate use of sweeteners Impact of nutritive sweeteners on the individual’s blood glucose levels & lipid profile should be assessed on a regular basis ADI of various sweeteners: ADI of various sweeteners Sweetener Acceptable daily intake (mg/kg body weight) Acesulfame potassium 15 Aspartame 40 Cyclamate 11 Saccharin 5 Sucralose 9 Sodium: Sodium Sources: salt, bakery products Blood pressure is significantly related to sodium intake(inter salt study) High salt intake has been implicated in hypertensive target organ diseases Strategies to limit salt intake Reduce salted foods bakery, processed food, pickle, ketchup Avoid : salt shakers, salt on salads, fruits, atta, rice, sherbet Use of lime, tamarind, pudina to bring flavour to foods Integrating Therapies: Integrating Therapies Physical Activity Benefits Physical activity is it necessary?: Physical activity is it necessary? Prevents obesity( weight gain) Improves heart conditioning Improves blood pressure Stabilizes blood sugar Improves muscle mass and bone health Secretes feel good hormones Physical Activity and Its Benefit: Physical Activity and Its Benefit Reduces body weight Reduces blood pressure Keeps blood sugars under control Increases HDL levels Ref: Thompson PD, Buchner D, Piña IL, et al. AHA Scientific Statement - Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease A Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity. Circulation. 2003; 107: 3109 Diet Issues: Diet Issues Hypocaloric Diets Low Carb Diets Meal Replacement Diets Eat less, Eat on Time Concentrate on Satiety Satiety Index Killer Diet: Killer Diet Fast Foods kill fast Fried,Calorie Dense Oils and Butters Lack of Fibre Cola Culture Traditional Diet Less oil Fibre rich Designer Foods: Designer Foods Low cal mithai’s Diet cola’s Low calorie or diet farsan’s Diabetics adjunct’s – jam, jelly, pickles Healthy Eating: Healthy Eating Eating Out Weight Control Flexible Lifestyle G ood Nutrition Prevention of Heart Diseases: Prevention of Heart Diseases Give up one, reduce two, and increase three give up smoking reduce food and alcohol intake increase exercise Ref: Wada T, Fujishiro K, Fukumoto T, Joki M. Inf Med . 2005; 44(2):319-22. Practical Activity Interventions to Prevent CVD: Practical Activity Interventions to Prevent CVD Education and knowledge Compulsory sport and physical activities in schools and colleges as well Gyms at work places Sport culture to be developed Physical activity intervention : elevators and escalators to be used by only old and sick,walking for short distances, walking at home and in compounds of building Less use of gadgets: cordless phones, remote controls Concept of ‘NEAT’ : do it your self PowerPoint Presentation: Diataal Powder Soya Protein: Soya Protein Soya bean apart from being rich source protein also has other phytochemicals which are unique Soya fibers reduces insulin requirement in diabetes Decrease cholesterol synthesis in humans. Use only processed soya : atta, nuggets, drinks LYCOPENE: LYCOPENE Major carotenoids Imparts colour to vegetables and fruits Recent studies reveal a unique preventive role; Cancer & Cardiovascular complications LYCOPENE: LYCOPENE Are found in: Tomato & tomato products Apricots, papaya Grapefruit, guava etc Shows enhanced absorption when consumed along with fats Deposited in liver, lung, prostate glands, colon & skin Fat soluble LYCOPENE: HEALTH BENEFITS: LYCOPENE: HEALTH BENEFITS Potent antioxidant Major scavenger of harmful free radicals Prevents/delays cardiovascular complications Prevents oxidation of LDL Reduces risk of atherosclerosis & CAD L-ARGININE: L-ARGININE Protein amino acid Classified as semi-essential / conditionally essential Essential for young children Precursor of nitric oxide Shown to play a critical role in: Hypertension Heart dysfunction Inflammation PowerPoint Presentation: It is an herb and a spice Fenugreek contains an active ingredient of blood glucose control an active ingredient for blood cholesterol control The typical range of intake for diabetes or cholesterol-lowering is 5–30 grams with each meal or 15–90 grams all at once with one meal. Use of more than 100 grams of fenugreek seeds daily can cause intestinal upset and nausea. Individuals with peanut allergies use with caution or avoid.  Otherwise, fenugreek is extremely safe. Some Indian remedies : methi seed Effect of nuts: Effect of nuts Rich in MUFA and PUFA Rich in plant protein,fibre,micronutrients like Cu and Mg Plant sterols Vitamin E,thiamin,riboflavin Peanuts are good source of folate and fibre Walnuts are good source of omega 3 oils Effect of garlic: Effect of garlic Bioactive compound allicin Organosulfur compound inhibits hepatocyte cholesterol synthesis Antiplatelet properties S alkenyl cysteine results in decreased HMG coA reductase Effect of green tea: Effect of green tea Bioactive principle CATECHIN Enhances fat oxidation Improves PP glucose response Stimulates insulin secretion

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