Health Tips- Lifestyle, diet, exercise and diabetes and heart disease

1. Health Tips- Lifestyle, diet, exercise and diabetes and heart disease Dr Bevan Hokin PhD Director of Pathology Sydney Adventist Hospital

2. Introduction to the food groups • carbohydrates energy source • fats energy source and storage • protein growth, repair and reproduction • Vitamins and body regulators - minerals metabolic co-factors • Water • Fibre

3. Energy - body fuels • Cannot be created or destroyed - but it can change its form • Body obtains its energy in the form of chemical energy from the food we eat • Food energy is measured in K Joules (used to be calories: 1 calorie = 4.2 KJoules

4. Food sources of energy I Food class Calories/gm KJoules/gm • Carbohydrates: 4 17 • Proteins 4 17 • Fats 11 45

5. How much energy do I need each day?? (K Joules for men by age grouping) Desirable 20-39 40-59 60-79 weight 60 kg 9500-10200 9200-9400 7500-7900 70kg 11300-12100 10400-10600 8300-9000 80kg 13200-14000 11500-12100 9200-10000

6. How much energy is contained in some common foods? • Apple pie moderate serving 1257 • Baked beans 1 cup 1173 • Banana split with icecream 2095 • Hot cross bun with butter and jam 1264 • Cheese cheddar 1 slice (28 gm) 460 • Cheese omelette (2 eggs) 1089 • KFC average serving 1173

7. How much energy is contained in some common foods? • Asparagus 6 spears /serving 75 • Weet-bix 1 biscuit 209 • Cabbage 1 cup 126 • Carrot 1 cup raw or boiled 188 • Celery 6 large stalks 63 • Fresh fruit salad -average serving 377 • Green beans fresh or frozen 1 cup 63

8. Energy content of potato • Plain boiled 1 medium 356

9. Energy content of potato • Plain boiled 1 medium 356 • Mashed with milk and butter 1/2 cup 398

10. Energy content of potato • Plain boiled 1 medium 356 • Mashed with milk and butter 1/2 cup 398 • Baked 1 medium 524

11. Energy content of potato • Plain boiled 1 medium 356 • Mashed with milk and butter 1/2 cup 398 • Baked 1 medium 524 • Roasted 1 medium 922

12. Energy content of potato • Plain boiled 1 medium 356 • Mashed with milk and butter 1/2 cup 398 • Baked 1 medium 524 • Roasted 1 medium 922 • French fried 8 chips 943

13. Energy content of potato • Plain boiled 1 medium 356 • Mashed with milk and butter 1/2 cup 398 • Baked 1 medium 524 • Roasted 1 medium 922 • French fried 8 chips 943 (and who eats only 8 chips at a sitting?!)

14. Food sources of energy II The body can inter-convert carbohydrates, fat and protein CHOFatsProtein So not only is what you eat important, but how much you eat

15. CHOFatsProtein • Energy cannot be created or destroyed… • Consume more of ANY food than necessary will result in the energy excess having to go somewhere • If it is not ‘burnt’ through exercise it will be stored as fat

17. Diabetes • Three types; • Type 1 - Insulin dependent. Caused by the pancreas not producing adequate functional insulin • Type 2 - Non-insulin dependent. Body produces insulin, but it cannot be used due to resistance caused by excess stored fat and/or ‘fatty liver’ • Type 3 - Gestational diabetes - a transient (but significant) diabetes which occurs during pregnancy

18. Type II Diabetes • Lifestyle and diet related • too much refined carbohydrate in diet • too little exercise • overweight

19. Why is diabetes so serious? • Disease of glucose metabolism with risk of hypo- and hyper-glycaemic attacks • Glycosylation of proteins (including blood cell surfaces) making them ‘sticky’ • Vascular diseases result: increased risk of: • heart disease • renal failure • blindness and deafness • stroke

20. Prevention of diabetes (Type II) • Consume the correct amount of KJoules (food, calories) • Focus on fresh fruits and vegetables • Avoid refined carbohydrates • Avoid fatty foods • Use whole grains where possible including wholemeal bread • Follow a high fibre low fat diet • Engage in a regular exercise programme • Maintain ideal weight

21. Treatment of diabetes (Type II ) • Loose weight • Consume the correct amount of KJoules (food, calories) to achieve then maintain your ideal weight • Avoid refined carbohydrates esp. sugars • Follow a high fibre low fat diet- lots of fruit and veges • Use whole grains where possible including wholemeal bread • Engage in a regular exercise programme • Follow your doctor’s advice - tablets can assist with glucose control

22. Blood fats and heart disease

23. Heart disease • 1 person in 3 will die of heart disease • A “Heart attack” and death will be the first symptom for about a half of those affected • A heat attack occurs when a blockage in one of the coronary arteries causes inadequate blood flow (and hence oxygen supply) to part of the heart muscle and as a result that part of the heart muscle dies.

24. Preventing sudden death from heart attack • Strategies to prevent heart attack: • don’t allow the coronary arteries to become occluded with fatty deposits. Control blood fats and cholesterol • prevent artery lining from becoming damaged thus allowing debris to adhere (diabetes, homocysteine) • prevent blood clots from forming

25. Blood fats • Two main types: • Triglycerides • Lipoproteins and Cholesterol

26. Triglycerides

27. Structure of fatty acids H-C-C-C-C-C-C-C-C-C-C-C-C-C-C-C-C-C-C-COOH Saturated fat H-C-C-C-C-C-C=C-C-C-C-C-C-C-C-C-C-C-C-CO0H Mono-unsaturated fat H-C-C-C-C-C=C-C-C-C=C-C-C-C=C-C-C-C-COOH Poly-unsaturated fat

28. Structure of fatty acids H-C-C-C-C-C-C=C-C-C-C-C-C-C-C-C-C-C-C-CO0H Omega-6 mono-unsaturated fat H-C-C-C=C-C-C-C-C-C-C-C-C-C-C-C-C-C-COOH Omega-3 mono-unsaturated fat

29. Lipoprotein • Spherical molecules made up cholesterol fats and protein in differing proportions: • HDL high proportion of protein, low amount of cholesterol • LDL Moderate amounts of both cholesterol and protein • VLDL Small amounts of protein, large amounts of cholesterol • These are three of several combinations...

31. Arteriosclerosis • Thickening of the artery walls • One important cause is the deposit of cholesterol in the arterial wall • This deposit is reinforced with calcium salts • Lumen of artery is occluded such that a blockage would be more likely in the event of a small clot or broken off piece of plaque.

32. Contributing factors to arteriosclerosis formation • Damage to vessel wall e.g. from elevated homocysteine concentrations • High blood pressure • Diabetes • Lack of exercise • High levels of cholesterol • Sex (gender) • Smoking

33. How to prevent heart disease • Maintain ideal weight through a healthy diet and exercise programme • Enjoy a healthy diet low in saturated fats • Maintain a low cholesterol/HDL ratio (<4.5) • Avoid diabetes. If too late, control it carefully • Engage in a regular exercise programme • Develop a low stress lifestyle through a deep faith in God’s leading

34. Role of HDL • So-called ‘good cholesterol’ • HDL is cholesterol that is being transported back to the liver for destruction • Ration of total cholesterol/HDL cholesterol should be < 4.5 and preferably <4.0 • Can increase HDL by exercise • I have never seen a vegetarian at or below his ideal weight with abnormal blood lipids

35. If you have heart-disease risk factors….. • Control blood pressure • Control diabetes • Increase exercise (minimum of 3 hours/week on non consecutive days) • Healthy diet low in fats especially saturated fats • Monitor cholesterol and keep low • Consider medication…. E.g. low dose aspirin • Lower homocysteine levels to <10 umol/L

36. Conclusions • The Adventist Church-recommended diet most closely complies with these recommendations and when followed, does result in a reduced incidence of diabetes and heart attack. High fibre, low saturated fat, an abundance of fruit and vegetables, adequate protein, and micronutrients. • A Vegetarian diet was for many years ridiculed. In the 60’s vegetarianism started to be tolerated; in the 80’s vegetarianism became accepted. Now vegetarianism is acclaimed.

37. Question time ?