Diet and Diabetes

Dr.S.Sethupathy,M.D,Ph.D.,Professor of Biochemistry,

Rajah Muthiah Medical CollegeAnnamalai University

Diabetes Mellitus

A syndrome characterized by disordered metabolism of carbohydrates, lipids and

Proteins ,Hyperglycemia ,

resulting from either low levels of the Insulin or resistance to insulin’s effects

Complications of DM

Coronary heart diseaseStrokeNephropathyRetinopathyGangrene

Diet

Diet is the cornerstone of all therapeutic regimens for type 2 diabetes. Proper dietary choices are important for all people with diabetes. Unfortunately, dietary habits are the most difficult to change. Diet in Diabetes should not be a complete deviation from the normal diet.

Carbohydrates: 60% of the calories from carbohydrates. The

intake of carbohydrates can be divided in to 4-5 equal parts. One-third (33%) of the diet- lunch ,another one-third during dinner (33%). 25% is served during breakfast and the rest (9%) during evening tea or at bedtime.

Proteins: 15-20% of the total calories be derived from

proteins. Meat and meat products, milk, pulses legumes and nuts are all rich in proteins.

Fats: 15-25 % of the calories be derived from fat. (less of

saturated fats (ghee, butter, vanaspati etc.), and more of PUFA –poly-unsaturated oils (sunflower, safflower oils) and MUFA- mono-unsaturated oils (palm oil, olive oil etc.)

Vitamins and Minerals: Available in green leafy vegetables, fresh fruits, milk, cereals, nuts etc.

Dietary Fibre: Present in cereals, legumes, fruits and vegetables. Intake of 25 g of fibre per 1000 calories for a diabetes

diet.

Aim of Dietary management

To control the blood sugar and to maintain an adequate nutritional status and also satiety.

Essential fatty acids

The omega-3 fatty acid through marine food sourcesThe omega-6 fatty acidomega-3/omega-6 balance needed for cardiovascular health.Consumption of vegetable oils leads to a high ratio of omega-6 / omega-3 fatty acids.

Protein

Dietary sources of protein include meats,soy products, eggs,grains,legumes and dairy products.

Plant protein better , No cholesterol

Fiber

Whole grains, fruits and vegetables are rich in dietary fiber. Fiber prevents constipation and colon cancer.Soluble fibers in whole grains, may help lessen insulin spikes and reduce the risk of diabetes.

Other nutrients

Other micronutrients include antioxidants and phytochemicals One of the principal classes of phytochemicals are poly phenol antioxidants which are beneficial to the CVS and Immune system

Factors to be considered

Types of DiabetesType 1 and 2

Other Risk FactorsObesitySmokingAlcoholPhysical activity

Prescription of diet

What is the calorie need?Protein intake needed?Vitamins ,minerals,fibre needed?Combination of food items?Palatability?What is the frequency of meals?

BMI

Weight in Kg / Height in meter 2 ( W/ H2 )

Non obese 20 – 24.9Over weight 25 – 29.9 Obese Gr 1 30 – 34.9Obese Gr 2 35 – 39.9Obese Gr 3 >40

To Maintain normal body weight

Calorie intake

For overweight individuals- 10% - 20% lesser than actual daily requirement

For underweight. - 10% more than actual daily requirement

Daily energy needs

BMR - Practically Speaking 24 kcal per kg body weight per

day

Calculation(For 60 kg,Moderate )

BMR 24 X 60 = 1440 kcalActivity (40% of BMR) = 576 kcal

_____________________________Sub total = 2016 kcalNeed for SDA (10%) = 201 kcal

_____________________________ Total = 2217 kcal 2200 kcal(rounded)

Major energy sourcesCarbohydrates should provide 45 – 65% of total daily calories.

Best choices are vegetables, fruits, beans, and whole grains. Fats should provide 25 – 35% of daily calories.

Limit saturated fat (red meat, butter) to less than 7% of daily calories.

Limit trans-fats to less than 1% of total calories.Protein should provide 12 – 20% of daily calories

Patients with kidney less than 10% of calories. Fish, soy, and poultry are better protein choices than red

meat.

Energy groups

Carbohydrate 60% - 1320 kcalFats 28% - 616 kcalProteins 12% - 264 kcalTotal - 2200 kcal

Food Groups

I 1 Cereals 2 Legumes and pulses

II 3 Roots and tubers 4 Green leafy Vegetables

III 5 Fruits IV 6 Milk products

V 7 Poultry, Fish and Meat products 8 Fats and oils 9 Spices and condiments

Cereals

Moisture 10 – 15 %They contain 7- 10 % proteinsFibre rice1% wheat 1.2% Ragi 3.6%Fats 1-2%Energy 350 kcal. Make at least half of your grain servings as whole grains, such as 100% whole-wheat bread, brown rice, and oatmeal.

Pulses and legumes

Moisture 10 – 15 %They contain 20 % proteinsFibre 1-1.5 % whole 4.5%Fats 1-5%Energy 350 kcal.

Milk and milk productsMoisture 85 % Cheese 40%Proteins 2-4 % Cheese 24% Fat 4-6 % Cheese 25%Energy 100 kcal. Cheese 400 kcal

Egg

Moisture 75 % Proteins 13% Fat 13 % Energy 170 kcal %

Animal foodsMoisture 75 %They contain 20 - 25% proteinsFat 2-4% egg 13%Energy 100 kcal %.

Roots and tubers

Moisture 80 – 90 % Tapioca 60%They contain 1-2 % proteinsFibre 1 % Fats 0.2%Energy 40-60 kcal , potato 100 ,sweet potato 120 ,tapioca 160 .

VegetablesMoisture 80 – 90 %They contain 2- 8 % proteinsFat 1%Fibre 2% Curry leave 6%Energy 20 -100 kcal. Start every meal with vegetable saladIf you’re hungry, eat more fresh or steamed vegetables.

FruitsMoisture 80 %They contain 2- 8 % proteinsFat 0.5%Fibre 1- 2% Guava 5%Energy 30 -60 kcal.Raisins 300kcal, Banana 110,dates 150,Water melon 15,mango 75 Restrict dry fruitsEat more fruits and drink less fruit juice.

Others

Fats and oils 900kcal% Butter Sat Sunflower PUFA

Spices and condiments Energy 200-350 kcal Fibre 5-10 % Dry chillies 30%Coriander 32% Proteins 5-20%

Sample daily diet plan

Rice 1.5 cups 270G – 945 Kcal P 27GPulses 0.5 cup 100 G -345 kcal P 20 G Milk 250 ml 200G - 200 Kcal P 6 G 1 Egg 60 G - 100 kcal P 7 GOils 70ml 60g - 540 kcal -------- Meat 100 G - 100 kcal P 20 GTotal 790 G - 2230 kcal P 80GFruits and vegetables 0.5 - 0.75 kg

Weekly plan

Rice 1- 1.5 kg /personPulses 0.5 kg/personMilk 2-3 liters/personOil - 0.2 L / personEgg or meat or pulsesMeat 0.3 – 0.5 kg divided (5 times) /personvegetables 1-5 -2 kgFruits 1.5 – 2 kg

High-carbohydrate/high-fiber dietLow-fat dietWestern diet (higher consumption of red meat, processed meat, French fries, high-fat dairy products, refined grains, and sweets and desserts) poses a high risk for type 2 diabetes.

DiabeticsRestrict their daily calorie intake to 1500 or less Diet- 60 % carbohydrates, 25 % fat and 15 % protein to control blood sugar The carbohydrate - slow digesting and unrefined. Eg: Whole grains.Decreasing fat intake, increasing fiber rich foods.

Glycaemic index

Diets with low glycaemic index are considered better for diabetics.Wheat, carrots have high Glycaemic Index, but have complex carbohydrates and so good.Milk has low Glycaemic Index but is bad for diabetics because of high calories and fat content.

GLYCAEMIC INDEX OF SELECTED FOODS

 10 to 19 %  –  groundnuts and Soybeans. 20 to 29 %  –  lentils, kidney beans and fructose. 30 to 39 %  –   apple, tomato soup, skimmed milk, curd, yogurt and ice cream.

 40 to 49 %  –  Bengal gram, black gram, beans, dried peas, sweet potato, whole meal oats and orange juice.

50 to 59 %  –  frozen peas, white noodles, potato chips and sweet corn.60 to 69 %  –  white bread, beetroot, raisins, shredded wheat, sucrose, banana and sprouted green gram.

70 to 79 %  –  potato, broad beans, whole meal bread, millets and white rice.

80 to 90 %  –  honey, maltose, mashed potatoes, carrots and corn flakes100 %   –  glucose.

Healthy eating habitsFirst switch over to eating more vegetables, fruits, grains and beans It is proved that high-carbohydrate, low-fat diet with adequate protein and dietary fiber is ideal for fighting diabetes.Such diet provides more volume and is more filling even if they are low in calories.Diets low in saturated fat, reduce cholesterol, help in weight control and keep diabetes away.Starches, fruits, vegetables and milk products are healthy foods although they raise blood glucose levels more quickly than fats and meat.

Keeping active and eating sensibly

We prefer bikes or cars to walking even shortest of distances

We wait for elevators rather than taking the stairs

We prefer watching Television or playing computer games than outdoor activities

Instead of simple, natural foods we prefer high calorie, fat rich junk foods

So instead of losing weight we tend to put on.

Frequency of meals

Diabetic patients should strictly avoid overeating.

They can take around five small meals a day instead of few large ones.

Eat meals at regular time and intervals.Avoid eating in the living room or bedroom. Don’t talk, read or watch Television when you are eating.Eat food slowly and chew it thoroughly. When you crave for unhealthy snacks, distract your mind. Keep social activities and eating apart.Before leaving for party, eat something healthy at home, so that the hunger pangs are satisfied Eat more fruits, vegetables and whole grains. All it means is that you need to select foods that are high in nutrition and low in calories. .

Take home message

Have small frequent mealsAvoid bulk mealsConsume more fibre rich vegetables and fruits Restrict simple sugars Have adequate dietary antioxidants(Citrus fruits,carrots,spinach etc)Restrict cream and fatty foods to keep body weight under controlAdopt some feasible home remedies

Thank You

Rabbit diet for a healthy heart