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[Food Exchanges] 

 

 

Diet advise

 

 

 

 

Diet should be the mainstay of all diabetic management.

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Diabetic diet, is a diet for patients with diabetes mellitus. 

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The diet usually limits sugar or simple carbohydrates. 

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It increases proteins, complex carbohydrates, and unsaturated fats.

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Many persons with Type II diabetes can control their disease by diet alone and need not take insulin. 

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The diet helps to keep the level of sugar in the blood stable.

 

Guidelines.

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Diet should be the mainstay of all diabetic management.

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The prescribed diet should be individualized. 

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It must be realistic, flexible, and take into consideration the patient's likes and dislikes, to as large an extent as possible, and must suit the patient's life style.

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It is important to educate the patient about the basic requirements of the diet and judge compliance at regular intervals.

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Interestingly, our traditional Indian diets, with slight modification, are close to what is considered ideal diabetic diets.

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Patients do not have to make any major changes to their usual dietary habits, with the exception of avoiding simple sugars and adjusting the fat intake.

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This allows increasing compliance with the diet advise.

 

Basic diet advise.

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Avoid simple carbohydrates like sugar, sweets, jiggery, honey, etc., as they tend to cause a sharp rise in the blood glucose levels.

Total calories.

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Total calories allowed to an individual will depend on the present weight and the targeted optimal weight.

 

Underweight

Normal Weight

Overweight

May have to increase food intake to optimize weight

Continue same amount of food intake May need to increase food intake to make up for calories lost through avoiding sugar.

Gradual decrease in amount of food normally eaten, if excessive, increase activity level.

 
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Usually, the prescribed diet should contain 30 calories/kg optimal body weight. 

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The total calories prescribed should also take into account the activity levels of the patient, as well as special circumstances like pregnancy and lactation, etc.

 

Carbohydrates.

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Carbohydrates should constitute around 60-70% of the total calories.

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The carbohydrates should be in the form of complex polysaccharides (starch) and contain adequate amount of fibers.

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The widespread misconception that carbohydrates (in any form) should not be eaten by diabetics should be removed. Carbohydrates in the form of simple sugars need restriction.

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It is important to emphasize that rice, potatoes and fruits are not contraindicated in a diabetic diet.

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Most traditional Indian diets usually meet with this requirement.

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There does not seem to be any need for additional fibers supplement in the form of a pharmaceutical prescription.

 

Proteins.

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Protein intake should be approx. 0.8 grams/kg ideal body weight; this usually comprises around 12-18% of the calorie intake.

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The requirements for proteins may be increased in catabolic states, pregnancy, lactation and in some elderly patients.

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Protein intake may need to be restricted in patients with nephropathy.

 

Fats.

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Fats should be restricted to around 20-25% of the total calories.

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One should preferably take equal amounts of saturated, mono-unsaturated and polyunsaturated fats.

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It is a misconception to feel that polyunsaturated fats are safe and can be taken freely.

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Many foods contains fats; this "invisible fat" should be taken into account when estimating the total fat intake.

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It is advisable to restrict the total intake of cooking fats to less than 6% of the total energy intake; in simple terms, food should be cooked in the least amount of oil or ghee; if feasible, food should be preferably be grilled, steamed or broiled, micro waved, rather than fried.

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The total intake of cholesterol should be restricted to around 300 mg per day.

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The fat intake may need to be further modified if associated dyslipidemia is present (Abnormal levels of lipids)

 

Essential fatty acids. (EFAs)

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Recent evidence suggests that attention must be paid to the intake of essential fatty acids (EFAs) such as omega-6 (w6) and omega-3 (w3) fatty acids.

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These EFAs make to be derived from food and cannot be made in the body.

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Not only must they be eaten in adequate amounts, but the relative ratio is around 4:1.

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Indian diets usually contain too much of w6 fatty acids and little, if any, of w3 fatty acids. This is due to the fact that most foods are rich in w6 fatty acids and poor in w3 fatty acids which is mostly found in fish.

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Indian diets usually give a ratio of around 40:1.

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The disproportionate ratio is made worse by the use of the so called "safe" cooking oils such as safflower oil and sunflower oil, in which the ratio is around 150:1!

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If this ratio is to be brought down to near optimal levels, then it would be essential to do a RETHINK about the advised mode of cooking media, and possibly revert to our traditional cooking media, which although they may not contain w3 fatty acids, also are poor in w6 fatty acids.

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Although these traditional cooking media like mustard oil, coconut oil and ghee may be relatively high in their saturated fat content, their poor content of w6 fatty acids allows a more optimal w6/w3 intake, especially when associated with increased w3 intake in the form of fish or w3 supplements.

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The saturated fat content of these cooking media are offset by the benefits of the more optimal w6/w3 intake, especially if the total use of the cooking media is minimized.

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This change over to some of the more traditional cooking media, accompanied by the use of as little as possible of the cooking medium, allows a diet with a ratio of around 8:1 which is close to optimal.

 

The Omega-6 and Omega-3 content of the commonly used edible oils is given below

 

 

Omega - 6

Omega - 3

W6 / W3

Safflower

73

0.5

146

Sunflower

49

0.3

163

Corn

57

0.8

71

Sesame

40

0.5

80

Palmolein

9

0.3

30

Groundnut

28

0.8

35

Coconut

1.8

--

--

Ghee Buffalo

2

0.9

2.2

Ghee (Cow)

1.6

0.5

3.2

Mustard / Rape

13

8.6

1.5

 

Salt intake.

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Salt restriction is necessary in patients with associated hypertension, cardiac failure and fluid overload.

 

Fruits.

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These can be eaten by diabetics in moderate amounts. Raw and partially ripe fruits are preferable.

 

Alcohol.

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If consumed, alcohol should be used in moderation.

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It should be avoided in all diabetics who are overweight and on hypo caloric diets, on biguanides (anti diabetic drugs), or in those who have high Triglycerides levels. All other contraindications to alcohol intake also apply to diabetics.

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In those diabetics, who are allowed alcohol, this should be restricted to less than 5% of the total calories. Generally, this is equivalent to about 45 ml of whisky or related alcoholic drinks.

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Wine, sherry and beer are best avoided.

 

Artificial sweeteners. (Sugar Substitutes)

 

Non - Caloric Sweeteners

Saccharin

Aspartame

Use by diabetes allowed in moderation .  (10 -12 tablets per day);

 

Fear that its use may lead to cancer is misplaced, especially if used in moderation;

 

Each tablet contains 12mg approx., permissible doses unto 500mg per day in children and unto 1000 mg/day in adults; such high intake not advisable 

 

Non caloric; may leave a bitter after taste, 

 

 

 

Avoid in pregnancy.

 

Use by diabetics allowed in moderation  (10 - 12 tablets per day); 

Fear that its use may lead to cancer, mental retardation , menstrual irregularities, etc., is misplaced if used in such small doses;

 

Each tablet contains 18mg of aspartame approx., permissible doses unto 50mg/kg/day; such high intake not advisable;

 

Technically does have calories, but so sweet that in amounts used , can be considered non  caloric,  

 

 

Avoid in pregnancy and in patients with phenylketonuria.

 

 

Diet Supplements
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An increasing number of dietary supplements specially formulated for diabetes patients are available in the market.

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These should not be recommended for routine use by diabetics.

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But such supplements may be of help in many special circumstances.

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When prescribed, one must be aware of the precise contents, as many food supplements called as diabetic foods are not calorie free and mislead patients into thinking that such diabetic foods can be taken in any quantity.

 

What Is a Diabetic Diet?

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Good diabetes control means keeping your blood-sugar level as close to normal as possible. 

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You need to maintain a proper balance between the insulin you produce or receive in a shot and the sugar your body makes out of the food you eat. 

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You should maintain a nutritious, healthy diet that would be good for anyone. 

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The main differences are that your diet contains limited or no added sugar that could raise blood-sugar levels too high, specifies the amount of food to be eaten, and sets specific times to eat for regulatory purposes. 

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You should also maintain a proper weight.

 

What should I eat?

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Eat foods from the six main food groups--milk, meat, vegetables, breads, fats, and fruits.

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Most diabetic meal plans list foods in terms of exchanges. 

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Exchanges are units of measure that help you keep calories and types of foods controlled but allow variety by letting you trade one exchange for another food in the same group. Within each food group, serving sizes are adjusted to provide about the same amount of calories, carbohydrates, protein, and fat.

 

Isn't fat bad for you? Why can I eat fruits but not sugars?

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Fat is a nutrient, and you need some fat in your diet. But too much fat can be harmful for people with diabetes because it increases the risk of heart disease and hardening of the arteries. Follow these tips:

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Avoid "hidden" fat (e.g., creamy pasta sauces, gravies), fried foods, and high-fat salad dressings.

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Choose lean meats; eat more fish and skinned poultry. Eat liver or organ meats only occasionally.

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Use diet margarine instead of butter.

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Drink low fat or nonfat milk.

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Limit intake of eggs to 2 or 3 a week.

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People with diabetes should eat less sugar.

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Depending on your individualized plan, some fruits may be encouraged because they provide fiber and carbohydrates for energy.

 

What foods should I stay away from?

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Besides monitoring your intake of fats and sugars, you may need to restrict your intake of salt too.

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You should avoid other "ready sweets" like candy, jam, jelly, syrup, most cakes, pies and pastries, regular soda, condensed milk, and sweet pickles.

 

What about packaged foods?

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Learn to read and understand food labels.

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A dietetic label does not necessarily mean that the product is intended for diabetics. Labels list food ingredients in the order of relative quantity. Check food labels of all products.

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Avoid those that contain hidden sugars such as sucrose, mannitol, glucose, sorbitol, fructose, dextrose, corn syrup, invert sugar, and lactose. 

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Consult your doctor or nutritional counselor before buying foods that are labeled fat free.

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You can still enjoy eating out at restaurants. Choose restaurants that are sensitive to the current public interest in fitness and nutrition. 

 

Here are a few ideas to keep your blood sugar under control:

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Order fruits as either a dessert or an appetizer.

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Ask for your salad dressing "on the side" so that you can control the portion.

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Make sure your meat or fish course is broiled, baked, roasted, or poached--never fried!

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Avoid foods that may have unknown ingredients (e.g., foods with sauces).

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Ask how your food will be prepared.

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Some fast food restaurants can give you written information about their ingredients and are written with    diabetic concerns in mind. 

 

What about alcohol?

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Talk to your doctor before drinking alcohol. 

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If your doctor says you may drink some alcohol, you will most likely only be able to have one or two alcoholic drinks, 1 or 2 times a week. 

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The drink can be either a mixed drink with 1 1/2 oz of alcohol, 4 oz of dry wine, or 12 oz of light beer. 

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If you have type I diabetes, eat before you drink any alcohol to avoid low blood sugar and hypoglycemia. Alcohol interferes with glucose production in the liver, which is the glucose used by the body during an episode of hypoglycemia. Even if you eat, hypoglycemia can still occur several hours later, so follow your meal plan and check your blood sugar. Alcohol does have calories.

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Do not add fruit juice or sweetened mixers to alcohol; use diet soft drinks, club soda, seltzer, and water. Avoid drinks containing sugars or starches, such as beer and sweet wines.

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Alcohol can also cause low blood sugar in some people with type II diabetes who take oral medications. 

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The combination of medication and alcohol may cause flushed skin in some people.

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It is all right to cook with alcohol. When alcohol is heated, most of the alcohol evaporates. This leaves few calories but adds flavor to the food in which it is cooked.

 

How will other medications affect my alcohol intake?

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You must check with your doctor about how alcohol may affect other medication you are taking. 

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Remember too that your judgment and control will be impaired after a few drinks. You may forget an injection, forget to eat, or eat too much.

 

To be safe, follow these tips:

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Before you start drinking, decide how much you will eat and drink. 

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Put less alcohol in your mixed drinks.

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Drink slowly; make one drink last.

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Do not drink and drive.

 

 

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