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

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Presentation on theme: "DIET IN DIABETES MELLITUS WITH HYPERTENSION AND ISCHEMIC HEART DISEASES By:- Dr. Shrinivasan Iyenger Dr. Padma Iyenger Dietician Nandini Panchamiya."— Presentation transcript:

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 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 ?

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 – years Male gender Family history Obesity Post menopausal status

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

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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 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

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 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 …

14 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…

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 foodLiver Triglycerides & Cholesterol Triglycerides & Cholesterol Chylo- microns Packed in lipoproteins (LP) VLDL (Very low density LP) LDL (Low density LP) HDL (High density LP) Bad cholesterolGood 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 FATSAFAMUFA PUFA n-3n-6 Coconut Ghee Dalda Olive Groundnut Sesame/Til Corn Sunflower Mustard Soyabean

19 SOME RECOMMENDED COMBINATIONS OF OIL Groundnut : Mustard3:1 Groundnut : Canola2:1 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. 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.

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 33 % Breakfast Mid morning Lunch Tea Dinner Before going to bed

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 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

35 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.

36 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.

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