DIET IN

DIABETES MELLITUS

WITH

HYPERTENSION

AND

ISCHEMIC HEART DISEASESBy:-Dr. Shrinivasan IyengerDr. Padma IyengerDietician Nandini Panchamiya

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.