Why Change Eating Habits?

To prevent complications of diabetes

by keeping control of: Blood glucose Cholesterol Blood pressure

Why Change Eating Habits?

To improve your health
by making healthy food choices and being physically active

The Balance of Good Health

For a balanced diet have a variety of food from the five groups below, in the portions shown. Bread, other cereals, pasta, rice, potatoes, chapattis Starchy foods. Base meals and snacks on these. Encourage low GI, high fibre foods.

Fruit and Vegetables To provide vitamins + antioxidants. No evidence for use of supplements except in special situations.

Protein Foods Aim not more than 1g/kg bodyweight. Encourage oily fish 1-2 portions/week.
Foods containing fats, oils and sugar Cut down on fatty foods and sugary food. Avoid diabetic foods and nutritive sweeteners.

Milk and dairy foods Choose lower fat varieties. Advise pint milk or equivalent/day.

Image reproduced with the kind permission of the Food Standards Agency

Advise a decrease in saturated fat. Choose fats high in MUFA, eg: olive oil, rapeseed oil.

Carbohydrate and Diabetes

Include foods containing carbohydrate from whole grains, fruits, vegetables and low-fat milk in your diet

Carbohydrate and Diabetes

The amount of carbohydrate at a meal affects your blood glucose more than the type
Sugar and starch have similar effects on blood glucose

Carbohydrate and Diabetes

Consistency in carbohydrate intake is important from day to day
For people not taking diabetes medication For people taking a fixed dose of insulin

Insulin should be adjusted based on amount of carbohydrate at meals

For people on varying doses at meal times

Carbohydrate and Diabetes

Several things affect how much your blood glucose increases after you eat:
amount of carbohydrate type of sugar or starch cooking and food processing food form other foods in the meal that slow digestion

Carbohydrate and Diabetes

Limited amounts of sugar or foods containing sugar can be used without affecting blood glucose
when substituted for other carbohydrates at the meal

Large amounts of sugar-containing foods are not recommended

Substituting Sweets
Usual diet: 45 grams carbohydrate
(or 3 Carbohydrates Choices)

Substitute ice-cream for 15 grams of carbohydrate (or 1

Carbohydrate Choice)

1 slice bread 1/3 cup rice 1/2 cup fruit 3 ounces chicken Vegetable salad

1/2 cup ice-cream 1/3 cup rice 1/2 cup fruit 3 ounces chicken Vegetable salad

Sugars Foods with large amounts of added sugar, eg: sugary cereals, ordinary fizzy drinks and squashes, sweets, chocolates, apple pie, sweetened fruit juices

Fructose & Lactose Type of sugar found naturally in fruits, milk and milk products like yoghurt , ice cream, fromage frais

Starches These are complex CHO as they have a complex structure, eg: potatoes, rice, pasta, bread, cereals, pastry, etc.

These raise blood glucose levels rapidly. They are high in calories and can also be high in fat.

These raise blood glucose more gradually. Contain useful nutrients, eg: vitamins, protein, calcium and so are an important part of a balanced diet.

This form of CHO slows down digestion so it is an excellent choice but need to be aware of the quantity.

Carbohydrate and Diabetes

To observe effect of new food on blood glucose:
check blood glucose 2 hours after meal for several days substitute food containing sugar for other carbohydrate in meal check blood glucose 2 hours after meal and compare

Sweeteners and Diabetes

Sugar alcohols (polyols): sorbitol, mannitol, xylitol Used as sweeteners and bulking agents Safe to use May cause diarrhea, especially in children Fructose: Not recommended as a sweetener

Sweeteners and Diabetes

Low calorie sweeteners: are safe for people with diabetes when consumed within recommended levels
Packets (maximum/day) (maximum/day) Cans of soda

Acesulfame K Aspartame Saccharin Sucralose

25 15 2 4.5

18 86 7.5 60

Carbohydrate and Diabetes

Fiber: Fiber is encouraged for everyone: 20-35 grams/day Good sources of fiber:
Whole grain cereals Fruits Vegetables Beans and peas

High and Low Fibre

Food groups High fibre foods Low fibre foods Cereals Whole cereals like whole wheat, dalia, Refined cereals like rice, bread, maida, whole wheat flour suji, noodles, macaroni, etc Whole dals and dals with husk Vegetables like peas, beans, lotus stem etc. Milk and milk products Washed dals Eggs, chicken, fish

Milk and milk products Pulses Meat, fish and poultry

Vegetables

Vegetables like potato, lauki etc.

Fruits

Fruits like apple, cherries, pears, peaches, plums, guava etc. -

Fruit juices and fruits like banana and papaya Fats

Fats

Carbohydrate and Diabetes

Fiber: Only large amounts (50 grams/day) have shown improvement in blood glucose and cholesterol
Primarily soluble fiber (barley, oatmeal, beans, apples, broccoli) Side effects make this difficult for many people

Protein and Diabetes

Protein has very little effect on blood glucose Avoid large amounts of protein
may promote kidney disease

Restrict protein only if you have early kidney disease

Protein and Diabetes

Protein does not slow the absorption of carbohydrate
Adding protein to snacks does not help prevent hypoglycemia Fruit or crackers are good snack foods

Protein and Diabetes

Safety of high protein, low carbohydrate weight loss diets are unknown
do not promote long-term weight loss may increase LDL cholesterol

Dietary Fat and Diabetes

Primary goal - Lower LDL cholesterol by: Eating less saturated fat and cholesterol Eating less trans fats

Dietary Fat and Diabetes

Foods That Contain Saturated Fats: Meat and meat fats (bacon, lard) Dairy products (whole milk, butter, cheese, cream, ice-cream) Palm and coconut oil Baked goods made from these fats

Dietary Fat and Diabetes

Foods That Contain Trans Fats: Formed when a liquid oil is made more solid Found in many types of stick margarine, fast foods, and baked goods like cookies, crackers, snack foods, pastries and croissants

Dietary Fat and Diabetes

Foods That Contain Cholesterol: All animal foods Organ meats like liver Egg yolks

Dietary Fat and Diabetes

Choose monounsaturated fat in place of saturated:
olive oil, canola oil, peanut oil, olives, avocados, nuts

Dietary Fat and Diabetes

Eat less total fat Low-fat diets can help:
with weight loss improve cholesterol and other fats

Dietary Fat and Diabetes

Eat 2-3 servings fish per week
contain a type of fat protective against heart disease fatty fish especially beneficial

Weight Loss and Diabetes

A small amount of weight loss can: improve insulin resistance lower blood glucose improve blood cholesterol reduce blood pressure

Weight Loss and Diabetes

Successful weight loss usually requires: a structured weight loss program education reduced fat and calories regular physical activity frequent follow-up

Vitamins and Minerals and Diabetes

Vitamins and minerals from foods important High doses of vitamin and mineral supplements can be toxic

Vitamins and Minerals and Diabetes

People who may benefit from a multivitamin supplement: persons deficient in a vitamin or mineral elderly pregnant or nursing mothers strict vegetarians persons on calorie-restricted diet

Vitamins and Minerals and Diabetes

No clear benefit from vitamin and mineral supplements except
calcium for prevention of bone disease folate for prevention of birth defects

Use of antioxidants is not advised

vitamin C, E, selenium, beta carotene long-term safety and effectiveness unknown

Alcohol and Diabetes

If you choose to drink, limit to:
1 drink/day for women 2 drinks/day for men

To reduce risk of hypoglycemia, consume alcohol with food

High Blood Pressure and Diabetes

You can lower blood pressure by: Eating less salt Losing a modest amount of weight

Preventing Diabetes
Family members of people with Type 2 diabetes can prevent diabetes by: Weight loss if overweight
using a structured weight loss program

Regular physical activity

What is Glycaemic Index (GI)?

Ranking of individual foods according to the effect they have on blood glucose levels The GI is a measure of how quickly foods that contain carbohydrate raise blood glucose levels. Some carbohydrate foods (with a high GI) cause a rapid rise in blood glucose and others (with a low GI) a gradual rise. It is the combination of foods that matters, eg: Corrnflakes (high GI) and milk (low GI) = medium GI

The glycaemic index is a ranking of foods from 0 to 100 based on their effect on blood glucose levels

High GI eg: White bread

Blood glucose level

Low GI eg: legumes

Time

Average Glycaemic Index of some food groups

Low GI Food
Breads Breakfast cereals Rye bread Fruit loaf Mixed grain bread chapatti Porridge, All Bran, Special K All varieties of muesli Bulgur wheat, buck wheat Pearl barley, noodles All types of pasta Peas carrots Baked beans, kidney beans Lentils, chick peas Black eyed beans Apricots, orange, grapes Apple, pear, peaches Grapefruit, plums, cherries Wholemeal/white bread Pita bread, croissant * Sustain, Shredded Wheat Nutrigrain, Vitabrits Basmati/brown rice Sweet/boiled potato Cous cous Sweetcorn Broad beans Baguette Rice Krispies, Rice bubbles Coco Pops, Puffed Wheat Cornflakes White rice, rice cakes, rice bran Mashed potato Baked potato Parsnip, pumpkin Instant potato, baked potato

Medium GI

High GI

Pasta / Rice /Grains / Potato

Vegetables Pulses / legumes

Fruit

Apricots (tinned), pineapple Rockmelon, paw paw Raisins, sultanas Mango, banana, kiwi fruit Ice cream *

Watermelon

Dairy foods

Milk - full cream */skimmed/ semi skimmed/flavoured Yoghurt */Diet yoghurt Banana/sponge cake * Peanuts * Some chocolates Fructose

Snacks & confectionery

Sweet muffins *, Mars bars * Muesli bars *, Potato crisps * Some chocolates* Sucrose

Jelly beans Some biscuits Lucozade Glucose

Sugars

Sample diet plan (for NIDDM)

Meal Early morning Menu Tea (preferably without sugar) Dalia (salted)/ Paneer on toast Tea without sugar Apple 2 chapatti Channa curry / or any other whole dal Beans sabzi / or any other sabzi (avoid potatoes) Curds / ghia raita Salad Tea Salty biscuits / tomato soup / chicken soup 2 chapatti / missi roti (combining wheat flour with channa flour and soya flour) Palak paneer sabzi / paneer bhurji Curds
Vegetable soup

Breakfast

Lunch

Tea

Dinner

Sample diet plan (for IDDM)

Meal Early morning Breakfast Mid-morning Menu Tea (without sugar) Corn flakes
Boiled egg

Toast Fruit chat 2 chapatti (add extra chapatti if required) Lobia curry / or any other whole dal Capsicum sabzi / karela / or any other sabzi Curds / raita Salad Tea / milk Vegetable sandwich 2 chapatti Dry dal Cabbage sabzi / or any other sabzi Salad Kheer / fruit custard

Lunch

Tea

Dinner

Bed time

Some Tips
Food Chapattis Advice Use medium brown or wholemeal flour Avoid spreading fat or use margarine high in monounsaturated fat but sparingly Keep fried breads for special occasions, eg: poori, parathas Rice Choose basmati as lower GI Best to have plain boiled rather than pilau, buriyani which are high fat Meat, fish, paneer Remove all visible fat on meats , avoid frying use minimal vegetable (curd cheese), eggs oil or try baking Encourage all varieties of pulses Vegetables Aim to include 2 to 3 portions daily of any vegetables cooked or raw Fruit Beware of portion sizes especially for tropical fruits, but no fruit is taboo Spices All spices , chillies, herbs are allowed Milk Avoid full cream milk Snacks Keep to a minimum: Chevra (Bombay mix), samosas, pakoras, rusks (Pakistani salted biscuit) Suggest: Fruit , fruit yoghurt, rich tea biscuit. Fats and oil Use margarine high in monounsaturated fat or poly unsaturated fat For cooking choose vegetable oil, rapeseed oil, olive oil but use sparingly Butter, ghee for special occasions

Dispel myths regarding spices and avoiding particular fruits.

The Bottom Line

Your lifestyle affects your health

Eat healthy foods Daily Physical Activity