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DIET IN DIABETES MELLITUS WITH HYPERTENSION AND ISCHEMIC HEART DISEASES. By:- Dr. Shrinivasan Iyenger Dr. Padma Iyenger Dietician Nandini Panchamiya. DIABETES MELLITUS ?. Diabetes = flow through Mel = honey It is a chronic metabolic disorder. Has a strong hereditary basis.

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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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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.




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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


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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



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CHILDHOOD OBESITY A CONCERN!!! ATTACK !!!

Pizza, Icecream,

Candy,

Pastry…


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PRINCIPLES OF DIETARY MANAGEMENT ? ATTACK !!!

  • 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)


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DIETARY GUIDELINES ATTACK !!!

  • 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.


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DIETARY GUIDELINES CONTINUED… ATTACK !!!

  • 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.


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AVOID THESE … ATTACK !!!

  • 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


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HAVE PLENTY OF THESE… ATTACK !!!

  • 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!!!


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ANIMAL FOODS HIGH IN SAFA AND CHOLESTEROL ATTACK !!!

  • Butter

  • Ghee

  • Cheese

  • Egg yolk

  • Chicken

  • Beef

  • Mutton

  • Pork

  • Organ meats – brain, heart, kidney, liver

  • Prawns and shrimps

AVOID THEM TO PROTECT YOUR HEART


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WHERE DOES CHOLESTEROL COME FROM ? ATTACK !!!

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


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ROLE OF FAT ? ATTACK !!!

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



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SOME RECOMMENDED COMBINATIONS OF OIL ATTACK !!!

  • Groundnut : Mustard3:1

  • Groundnut : Canola 2:1

  • Groundnut : Soya bean2:1

  • Groundnut : Sunflower3:1

  • Groundnut : Sesame3:1



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FIBRE RICH FOODS… ATTACK !!!

  • 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…


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FOODS HIGH IN SODIUM ATTACK !!!

  • 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 !!!


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NATURAL ANTIOXIDANTS ATTACK !!!

  • 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!!!


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SOYA PROTEINS ATTACK !!!

  • Soya bean

  • Soya milk

  • Tofu

  • Textured Soya supplements

  • Soya nuggets

  • Soya flour

IT REDUCES CHOLESTEROL!!!


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GARLIC ATTACK !!!

DOSE: 1 or ½ clove of garlic per day

  • Reduces blood pressure.

  • Reduces cholesterol levels.


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FENUGREEK SEEDS (Methi) ATTACK !!!

DOSE: 25 to 50 g per day

  • High in fibre

  • Reduces blood sugar

  • Reduces cholesterol and TG

  • Helps loose weight


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GLYCEMIC INDEX (GI) ATTACK !!!

  • 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


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FACTORS AFFECTING GI OF FOOD ATTACK !!!

  • Rate of ingestion

  • Food form

  • Food components – fat, fibre,

    protein, starch

  • Method of cooking and processing


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VERY LOW GI FOODS ATTACK !!!

  • Dals and pulses

    Moong dal, tur dal, rajmah, moong, soybeans, channa etc.

  • Low fat dairy products

    Milk, curds, paneer and buttermilk.


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INTERMEDIATE GI FOODS ATTACK !!!

  • 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.


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HIGH GI FOODS ATTACK !!!

  • Cornflakes

  • Rice

  • Maida Bread

  • Root vegetables like potato, yam

  • Sugar, honey, jaggery, sweets, chocolate

  • Icecream


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DISTRIBUTION OF CALORIES IN A DAY IF NO INSULIN TAKEN ATTACK !!!

Breakfast

Mid morning

Lunch

Tea

Dinner

Before going to bed

33 %

33 %

33 %


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ALCOHOL….. MUST BE AVOIDED ATTACK !!!

  • 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.


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ALCOHOL….. IF STILL TAKEN ATTACK !!!

  • 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.


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MYTHS ATTACK !!! … & 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.


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MYTHS ATTACK !!! … & 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.


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THANK YOU ATTACK !!!