Nutritional Management of Diabetes And Heart Diseases

1. Nutritional Management of Diabetes And Heart Diseases Shilpa Joshi RD Mumbai Diet And Health Center Bandra (west) shlpjoshi@yahoo.com

2. 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 5th Diabetic is an Indian • Every 5th to 10th Asian Indian Native Urbanite is a Diabetic

3. BMI 22.3 22.3 Body fat 9.1% 21.2%

4. Glucose is the currency of body & every cell needs it

5. Type 2 DM

8. Oxidative Stress Damages Here Smooth muscle Collagen Endothelial lining

9. 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

10. Traditional Diets

11. Traditional Diet

12. Food Pyramid Fats, Oils & Nuts 2-3 Units Milk & Milk Products 2-3 Units Meat & Fish 1-2 Units Fruits 2-3 Units Vegetables 3-4 Units Cereals & Pulses 8-12 Units 10-14 units (veg)

13. Food Components MACRONUTRIENT • Carbohydrates • Proteins • Fats MICRONUTRIENTS • Vitamins • Minerals

14. 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

15. 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

16. Fruits Exchanges ( to be eaten in prescribed amount)

17. 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 )

18. Fruits Exchanges: (to be avoided)

19. Properties of Dietary Fibre

20. Properties of Dietary Fibre

21. Quantity of Soluble Fibre to Produce Lipid Lowering Effect

22. Fibre Content of Foods

23. Fibre Content of Foods

24. 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.

25. 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.

26. FATS • Source of stored energy • Source: oil, butter, ghee, nuts, non-veg, cheese, bakery products

27. CHOICE OF A HEALTHY COOKING MEDIUM: a controversial subject 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 . .

28. CHOLESTEROL BALANCING OXIDATION STABILITY Recommended fats (heart friendly oils )are MUFA eg. ground nut oil, rice bran oil, olive oil

29. 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

30. 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

31. 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

32. 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

33. Alternatives

34. 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

35. 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

36. Meal Patterns Dinner • Meal should be as light as possible • Low in carbohydrates especially simple carbs • Make clear soups as integral part of dinner

37. Eating Out (Make Right Choices) • Meal time • Cuisine • Meal selection • Hygiene

38. 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(?)

39. 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

40. 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

41. Mid-Meal Options • Skimmed milk • Chaas • Kurmura • Channa • Fruit (permitted quantity only)

42. 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.

43. 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.

44. Alcohol & Sugar Content of Alcoholic Drink Lieber CS. Alcohol Research & Health, Fall, 2003

45. Unit of Alcohol

46. 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

47. Fountain PEPSI WATERFOUNTAINS

48. 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

49. Maharaja Mac ? Jumbo Vadapav? Double Cheese Pizza? DO NOT UPSIZE !!! We Need To Minimize Not Maximize

50. 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