DIET IN DIABETES MELLITUS WITH HYPERTENSION AND ISCHEMIC HEART DISEASES

1. DIET IN DIABETES MELLITUS WITH HYPERTENSION AND ISCHEMIC HEART DISEASES By:- Dr. Shrinivasan Iyenger Dr. Padma Iyenger Dietician Nandini Panchamiya

2. 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.

3. SYMPTOMS OF DM ?

4. RISK FACTORS FOR DM ?

5. SOME OTHER 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

6. 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

7. CLUSTERING OF THREE MAJOR RISK FACTORS CAN CAUSE HEART ATTACK !!!

9. CHILDHOOD OBESITY A CONCERN!!! Pizza, Icecream, Candy, Pastry…

10. 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)

11. DIETARY GUIDELINES • 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.

12. 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.

13. AVOID THESE … • 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

14. HAVE PLENTY OF THESE… • 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 THESE ARE LOW CALORIE FOODS!!!

15. 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

16. WHERE DOES CHOLESTEROL COME FROM ? From food Liver Triglycerides & Cholesterol Triglycerides & Cholesterol Packed in lipoproteins (LP) Chylo- microns VLDL (Very low density LP) LDL (Low density LP) HDL (High density LP) Bad cholesterol Good cholesterol

17. 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

18. FAT COMPOSITION OF SOME OILS

19. SOME RECOMMENDED COMBINATIONS OF OIL • Groundnut : Mustard3:1 • Groundnut : Canola 2:1 • Groundnut : Soya bean2:1 • Groundnut : Sunflower3:1 • Groundnut : Sesame3:1

20. THE KEY TO GOOD HEALTH !!!

21. 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…

22. 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 !!!

23. 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!!!

24. SOYA PROTEINS • Soya bean • Soya milk • Tofu • Textured Soya supplements • Soya nuggets • Soya flour IT REDUCES CHOLESTEROL!!!

25. GARLIC DOSE: 1 or ½ clove of garlic per day • Reduces blood pressure. • Reduces cholesterol levels.

26. FENUGREEK SEEDS (Methi) DOSE: 25 to 50 g per day • High in fibre • Reduces blood sugar • Reduces cholesterol and TG • Helps loose weight

27. 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

28. FACTORS AFFECTING GI OF FOOD • Rate of ingestion • Food form • Food components – fat, fibre, protein, starch • Method of cooking and processing

29. 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.

30. INTERMEDIATE GI FOODS • All vegetables Cabbage, brinjal, spinach, methi, guvar etc. • Fruitswith 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.

31. HIGH GI FOODS • Cornflakes • Rice • Maida Bread • Root vegetables like potato, yam • Sugar, honey, jaggery, sweets, chocolate • Icecream

32. DISTRIBUTION OF CALORIES IN A DAY IF NO INSULIN TAKEN Breakfast Mid morning Lunch Tea Dinner Before going to bed 33 % 33 % 33 %

33. 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.

34. ALCOHOL….. IF STILL TAKEN • 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.

35. MYTHS  … & FACTS  … Eating sweets cause diabetes. Sweets only increase weight. Inability of the body to form insulin cause diabetes. Sugar free products can be freely taken. Sugar free products can be high in fat and hence must be avoided.

36. MYTHS  … & FACTS  … Continue… Diabetics must avoid fruits. Only few fruits such as mango, grapes, chikoo, coconut, sitaphal and banana must be avoided. Rest all can be taken daily. Diabetes is curable. Diabetes cannot be cured but can be managed with diet, exercise and medication.

37. THANK YOU