SELF MANAGEMENT OF DIABETES NUTRITION INTERVENTION & DIETARY GUIDELINES Vasantha Narasimhan Ph.D Emeritus Professor of chemistry Skidmore College

Diabetes:: Some Stats and facts (Source: ADA and NIH) about 30 million cases in USA in 2012 21 % of people over 65 have diabetes The total estimated health care cost of diagnosed diabetes in 2012 is $245 billion,( $176 billion in direct medical costs and $69 billion in reduced productivity) Food habits/Life style main cause Diabetes related heart diseases, strokes, kidney diseases and neuropathy on the rise. Certain ethnic groups more prone to diabetes

Division of internal medicine, UCSF, Division of Geriatric Medicine, USC Cardiology and endocrinology divisions, U.Al Human nutrition, endocrinology and internal medicine dept., UT Southwest Med.Center.

??????Oh,My God!!!!????? Do I have to give up my favorite foods and go on a “diabetic diet”? I love dinner parties- should I say goodbye to them? I love eating out. No more of that??? Will I be an “invalid” from now on and worry about my health constantly?? The goal of my talk today is to emphasize that With a few healthy dietary and attitude changes You can answer “NO” to the above questions!!

(CHEMICALS IN FOOD THAT NOURISH THE BODY) Food provides NUTRIENTS (CHEMICALS IN FOOD THAT NOURISH THE BODY) MACRONUTRIENTS MICRONUTRIENTS * CARBOHYDRATES * VITAMINS * FATS * MINERALS * PROTEINS (Energy, growth) (Help proper metabolism of macronutrients, maintain healthy cells)

stomach Intestine Blood Stream Mouth Fibers FOOD Glucose Amino acids Fatty Acids Enzymes Vitamins Minerals “ Waste”- Fibers Blood Stream

Maintain blood glucose within healthy limits Pancreas INSULIN Heart Liver Energy use & Storage As glycogen Blood glucose Energy use Brain ROLE OF INSULIN Maintain blood glucose within healthy limits Muscle Other organs

Insulin not doing its job right What can go wrong? CONDITIONS CAUSES RESULTS NO Insulin made damage to pancreas, genetic defect in making insulin etc TYPE 1 DIABETES Not enough insulin made sluggish pancreas due to overwork, cell defects etc TYPE 2 DIABETES Insulin not doing its job right “Insulin resistance”, organs not responding to insulin USUAL SYMPTOMS Frequent urination, excessive thirst, irritability, tingling & burning sensation in limbs, hunger pangs, lack of concentration, sometimes unexplained weight loss

Risk factors for diabetes Genetic/hereditary factors Age/ethnicity Obesity/overweight Sedentary life style High fat/high carb. diets High Blood Pressure High fat levels in blood

If you are at risk or you have been diagnosed as diabetic……. Don’t Panic ! Set your GPS to take control of your health! Then follow through! Your destination should be “A healthy you” with acceptable values of blood sugar blood cholesterol and triglycerides blood pressure body weight You can reach there with small, step by step lifestyle changes.

Acceptable blood values (suggested by National Diabetic Education Program) Fasting Blood sugar: 80-120 mg/dl Post-prandial sugar: 140-170 mg/dl Hemoglobin A1C (Hb A1C) under 7.0 Total cholesterol: under 200 mg/dl HDL (“good cholesterol”) over 40 for men/over 50 for women LDL(“ bad cholesterol”) under 100 Triglycerides under 150 mg/dl Blood Pressure: below 130/80 Body Mass Index : under 27

HbA1C tells us about average blood sugar levels over a 12 week period. Glu HbA1C Controlled diabetes, not much glucose, not much HbA1C Uncontrolled diabetes, more glucose, much more HbA1C

Body Mass Index chart (BMI)

Steps towards a healthy “you”…… Medications and monitoring as prescribed Physical activity goals! Dietary Goals Healthy Life style changes

Physical activity goals Set goals-(lose 10 lbs? increase strength? be active? ) Follow the “F.I.T.T.” principle to become fit! Frequency, Intensity, Time, Type of activity Stop negative thoughts! Keep a record of your progress! Reward Yourself!

Diet & Nutrition Goals Total calorie control CARB counting/Glycemic Index Diabetes food pyramid Simple common sense dietary habits

Calorie Counting source: National Institute of Health 2008 profile/ activity level Calories/day Number of servings*/day Small/F/ moderate Medium/F/sedentary, low 1200-1600 6 carbs, 3 fats, 1 proteins, 2 dairy,3 veggies, 2 fruits Large/F/moderate Small/M/ moderate Medium/M/sedentary 1600-2000 8 carbs,4 fats,2 proteins, 2 dairy, 4 veggies, 3 fruits, Medium/M/high Large/M/Moderate Large/F/high 2000-2400 10carbs,5 fats, 3 proteins 2 dairy, 4 veggies, 4 fruits Servings: Carbs- 1 slice bread, 1 roti , ½ cup cooked rice, 1 cup cooked pasta Dairy: 8 oz Protein : 4 oz.cooked meat. ½ cup cooked lentils/beans/dhal Fat: 1 teaspoon Veggies: 1 cup raw or ½ cup cooked Fruits: ½ cup diced , ½ of whole fruit ( apple, pear etc)

10% 20% 30% 40%

Now for some practical ways to watch your diet and nutrition……… When you eat- frequency and schedule How much you eat- portions and sizes How you eat- rates and combinations Where you eat- at home or out What you eat- choice of foods

When you eat…………

How much you eat………. Portion control Be conscious of how much you put in your plate When you start your new “diet” , record what you eat each day at least for 10 days. “Plate method” is recommended by ADA Milk or yogurt 1 serving Fruit 1 serving

How and where you eat……… Take a minimum of 20 minutes to finish your meal. The hormone that gives the sensation of fullness takes 20 mins to take effect. Place all the components of your meal in small serving dishes on the table. Never eat on the run! Be conscious of what you put in your mouth! Sit at the table and enjoy your meal.

What you eat…….. Choosing the right foods You don’t have to carry around tools like charts, counters, weighing tools etc.! Just simple common sense substitutions and choices will do the trick. Make choices based on simple available information in paper and on internet.

Some examples of Simple Substitutions INSTEAD OF THIS USE THIS Processed/ polished grains Whole grains White bread Wheat or rye bread Fried snacks, chips Baked snacks and chips Regular dairy products Low fat/no fat dairy products Red meat Fish, poultry , lentils, beans Canned fruits, fruit juices Fresh or frozen fruits White or yellow potatoes Yams, sweet potatoes Sugary desserts Low fat dairy based desserts Salty and sugary snacks Peanuts, almonds, walnuts, Always read nutrition labels to see amount of total carbs and sugar!

Can I include rice in my meals?? Of course you can! 1-2 carb servings can be rice dishes Glycemic Index is a method nutritionists use to study the effect of foods on diabetes. GI score ranges from 1-100 with pure glucose being 100 GI < 55 low, 56-69 medium and over 70 high IRRI has rated 235 varieties of rice based on GI

Sticky rice (japanese,thai) 90 Brown Rice 55 ✔ Swarna (Ponni) rice 56 ✔ Samba Masoori rice 57 ✔ Basmati rice 58 ✔ Long Grain rice Medium Grain rice 69 Sticky rice (japanese,thai) 90 over Cooking (Mushy) increases GI 5-8 pts) Siimmer over low heat (+1) Rice cooker (+1) Boiling and straining (+6 to 8) Pressure cooker ( +6 to10) Use with 1 isp ghee Use with protein (kichadi!) (-5 to 8)

How about rotis and pastas??? Whole wheat based rotis over white “nan” Chapati flour with1% rye/bajri flour + 1% besan ---- lowers GI Pastas made with durrum wheat better than multigrain ones. Larger the size of pasta, less GI “al dente” lower GI/overcooking higher GI Ghee on roti and olive oil on pasta- lowers GI

What about fats and oils?? Total “Non-fat” meals are not so good if you are trying to control your blood sugar. Fat helps to release the sugar from carbs slowly into blood----- less sugar spikes and yo-yo’S! 4 -5 servings ( 4-5 tsps) of fat/day Ghee (clarified butter) (ayurvedically adviced) Sesame oil preferred over olive oil (J,clinical.nutr. 2011, J.nat.med. 2012) Efficacy of oral diabetic medicines.  B.P & TG Peanut oil preferred over corn or canola oil

Can I include dessert in my meal plan??? Occasionally yes! Instead of this have this! Rich, creamy sugary cakes/pies Low fat, low sugar cakes/pies Cheese cake/vanilla cake Dark chocolate cake chocolate mousse Fruit Pies, tarts Fresh frozen fruits with nonfat whipped cream Sugar based ,fried desserts (e.g : gulab jamun, jalebi, ladu) Dairy based, baked, steamed desserts (e.g Ras malai, ras gulla, Kheer) Fruit sorbets ( 2 scoops) Ice cream or kulfi ( ¾ to 1 scoop) Nut cakes and sweets Plain nuts with fruits

Finally, a word or two about fruit and veggie choices. OK to choose in plenty (3-4 servings a day) Green leafy veggies, cruciferous veggies, Karela, egg plant. Berries, orange varieties Moderate use ( 1 serving/day) Carrots, beets, yams, sweet potatoes Bananas, pears, apples, peaches, melons, papaya Very limited/occasional use ( >3 servings/week) Potatoes, Taro root (Arvi) other root veggies Mangoes, watermelon ,

(facilitates insulin secretion, Slows down absorption from intestine) Karela( bitter gourd) (momardica charantia) Polypeptide-P ( insulin mimic) Charantin (  uptake of glucose by cells) α-lipoic acid (anti-neuropathy agent) Methi ( Fenugreek) (Foenum Graecum) 4-hydroxy isoleucine (facilitates insulin secretion, Slows down absorption from intestine)

Tips to succeed in your dietary goals…. Use Variety and diversity in choosing foods Don’t be rigid and narrow in your choices Allow for “cheatings” occasionally, but remember to get back on track soon Most of all, be self confident and positive Always remember you control your diabetes, don’t let diabetes control you!

Some useful websites www.diabetes.org (american diabetic assn) www.diabetescare.net www.ndep.nih.gov (national diabetes education) www.fda.gov www.cdc.gov/diabetes Thank you all for your patient listening!