DOSTI

DARE TO DREAM

DARE TO FLY

DARE TO FAIL

DARE TO SUCCEED

LIFE STYLE

MODIFICATION AND

DIABETES

Dr. Jagruti Shah

Preventive Diabetologist

Founder DOSTI

GOALS OF THERAPY

• Relieve symptomsRelieve symptoms• Maintain near normal body weightMaintain near normal body weight• Achieve & maintain normal physical well beingAchieve & maintain normal physical well being• Achieve blood glucose level of 70 – 140 mg/dlAchieve blood glucose level of 70 – 140 mg/dl• Achieve normal glycated haemoglobin levelsAchieve normal glycated haemoglobin levels• Achieve normal lipid levelsAchieve normal lipid levels• Improve / maintain quality of lifeImprove / maintain quality of life• Prevent / delay complicationsPrevent / delay complications

 Diabetes with a Tomato figure increases

Risk of heart disease by 2.5 times in men

And 8 times in women.

Choose the way

You want to look

 IDEAL BODY WEIGHT

1. For male = Ht. In cm – 105

2. For female = Ht. In cm - 107

HOW TO CALCULATE IDEAL BODY WEIGHT ?HOW TO CALCULATE IDEAL BODY WEIGHT ?

OPTIMAL BODY WEIGHTOPTIMAL BODY WEIGHT 

Body Mass Index ( BMI) =Weight in Kg

-------------------------

Height in meters2

Values Good Fair Poor

Indian Women <21 21-25 >25

Indian men <23 23-27 >27

. BMI < 19 signifies Under nutrition

. BMI > 30 signifies Gross Obesity.

WAIST – HIP (W-H) RATIO

Normal Values

Indian Men : < 0.90 Indian Women : < 0.80

(Waist and Hip are measured in centimeters.)

It’s not just size. Shape runs in families, too. If your parents carried extra weight in their hips and thighs, you are likely to find it there, too. If they carried weight around their waistlines, you may well have inherited that trait.

However,a trait that runs in a family is not necessarily genetic, hardwired forever in to your chromosomes. The fact is, we give our children a lot more than DNA .We also give them recipes.We pass on our tastes for foods, ideas about the role of food in the family, and innumerable meal time traditions. So what looks like a genetic pattern may really be habits passed from generation to generation.

Human diseases arise as a result of The interaction between Heredity, Mobility,Environment & Food.•It is Impossible to change Heredity.

•It is difficult to change one’s Environment .

•But it is relatively easy to change one’s Food Habits and increase exercise.

Diet in Diabetes has undergone lots of changes in concepts in last one decade, from calories restricted diet to nutritionally rich diet. The traditional Lacto-vegetarian diet with changing outlook towards consumption of fruits, fat & fibre can not only help in primary prevention of diabetes but also in reduction of micro & macro-vascular complications and hence morbidity & mortality

Fruits are loaded with nutrition. They are rich in vitamins (esp. vitamin C) and some minerals, as well as fiber and other micronutrients like phytochemicals. Phytochemicals are biologically-active compounds with health-giving properties that scientists believe may help protect us against diseases like cancer. Examples include: bioflavonoids (citrus fruits), bromelain (pineapples), resveratrol (red grape juice), ellagic acid (raspberries, blueberries), d-limonene in citrus peel. So for a lower glycemic response and healthy nutrition, eat more fruit - especially fresh.

GUAVA Is a good source of lycopene, beta-carotene, and vitamin C, and is an excellent source of soluble fiber. Current research suggests that consumption of guava fruit may reduce LDL (the "bad") serum cholesterol. Another health benefit attributed to guava is its antimicrobial potential in combating certain bacteria such as Staphylococcus aureus and beta-streptococcus group A. Guava is employed as a natural medicine by people who live in the tropics as a treatment for diarrhea.

PAPPAYA1.Has more carotene compared to other fruits. 2.Contains very less calories. 3.Will ensure a good supply of vitamin A and C. 4.Is an excellent aid to digestion. 5.Can be prescribed for dyspeptic patients. 6.Is an ideal food for invalids. 7.Can be used as tenderizer in cooking. 8.Is reported to speed up healing.

Visible Fats Vegetables Oils

Animal fats

Invisible Fats Cereals, pulses nuts, oil seeds, Milk

INVISIBLE FATThe total fat content determined in cereals may vary from 2 to 5 per 100g. Considering the amount of cereals consumed it is estimated that fat present in cereals in our diets can meet more than 50% of our essential fatty acid requirement. Cereals together with pulses can nearly meet the EFA requirement of an adult.

VISIBLE FAT  The desired n-6/n-3 ratio 4/1 or lower can be maintained by combination of oils like Mustard oil, Olive oil, Ricebran oil ,sesame oil Groundnut oil &soyabean oil. Also desired saturated fat / polyunsaturated fat ratio can be maintained by adding small quantity of pure ghee or coconut oil. Since 50% of fat requirements are met from invisible fats, for a person on 2400 Kcal, 15-20gms of visible fat will be enough.

defense against infection

N-6 Fats

bloodblood pressure affect HDLadversely

• Blood viscosity

• Lower blood pressure

• Fibrinolytic activity

• Prevent inflammation arthritis ,migraine headache

• Required for normal insulin action

N-3 FatsN-3 Fats

Sources of n-6Sources of n-6fatsfats

Sources of n-3Sources of n-3fatsfats

Foods itemsFoods items

whole grains likewhole grains like rice,wheat,pulsesrice,wheat,pulses chana,chanadalchana,chanadal millets,like bajramillets,like bajra maiza,spices,egg.maiza,spices,egg.

Fish,green leafy Fish,green leafy vegetables, rajmah vegetables, rajmah urad dal, mehti saeds, urad dal, mehti saeds, linseeds (alsi) linseeds (alsi) walnauts. walnauts.

Cooking oilsCooking oils

Safflower oil,Safflower oil, sunflower oil,cornsunflower oil,corn oil,till oil,oil,till oil, oil,groundnut oil.oil,groundnut oil.

Fish oil,linseed Fish oil,linseed oil,mustard oil.oil,mustard oil.

Fat or oil Linoleic Linolenic Total Pufa

w-6 w-3

gm/100 gm gm/100 gm Gm/100 g

Safflower oil 74 0.5 74.5

Soyabean oil 52 5.0 57.0

Cotton Seed Oil 50.3 0.4 50.7

Maize Oil (corn) 50.0 2.0 52.0

Sesame Oil (gingelly) 40.0 0.5 40.5

Rice Bran 33.0 1.6 34.6

Groundnut Oil 28.0 0.3 28.3

Mustard oil 13.0 9.0 22.0

Olive oil - - -

Vanaspati 3.4 - 3.4

Ghee (Butter Fat) 1.6 0.5 2.1

Cocnut oil 2.2 - 2.2

POLYUNSATURATED FATTY ACID CONTENTPOLYUNSATURATED FATTY ACID CONTENT

Fish is a rich source of long chain n-3 PUFA which are biologically more active than their parent member namely alpha linolenic acid in producing several health benefits. Those who have a taste for fish are advised to take about 100 - 200 gm of fish twice a week. Fish is a good source of proteins and it constitutes about 17 - 20 %. Fish proteins are good sources of all essential amino acids. Fish protein beings rich in lysine and threonine supplement effectively with cereal proteins. Small fish eaten along with bones are a rich source of calcium. Salt-water fish is rich in iodine, phosphorous and calcium. Fish also contain mineral copper. Vitamin A and D is also present

Fish Fish may be eaten 2-3 times a week. Both

fatty Lean fish ar desirable. It is also all right to take shellfish like clams, mussels and scallop. Avoid crabs, prawns, lobsters and shrimps

Prefer fatty fish, which have dark flesh (Muscle). Depth of Colour reflects the amount of oil present in the flesh. Lean fish is pale. Their fat is concentrated in liver, instead of muscle.

• Prefer deep sea fish over coastal fish to

Minimize chances of eating fish, contaminated.

with industrial and other environmental toxins.

 

• Choose fresh fish over canned fish or fish

packed in oil.

Have at least 2-3 servings of fish per week

Select a low fat cooking method.

In general, cold-water sea fish are fatty.

Examples of fatty fish are Tuna, Salmon,

Mackeral, Black pomfret and trout

  Indigenous fatty fish are Hilsa, Katla,

Puruva and seer .

IS IT GOOD TO BREAK A MEAT HABIT1 . Preventing and reversing heart disease 2 . Easy weight loss3 . Preventing Alzbeimer’s Disease 4 . Preventing cancer5 . Preventing osteoporosis6 . A cleaner food supply

FLAXSEEDS

A BOON TO OUR LIFEUnique feature of flax seed is the high ratio of alpha linolenic acid (Omega-3) to linolenic acid (Omega-6), Flaxseed oil is 15% Omega-6, but 55% Omega-3.

100 grams of flaxseeds provide :

Energy 450kcal

Protein 20 gms0

Fat 431 gms

Fiber 28 gms

FLAXSEEDS

Linolenic acid and alpha linolenic acid found in flax are important for :-

1) They are responsible for forming s group of hormone like compounds called prostaglandin's.

2) They make cell membrane permeable, which helps in protection of cells against invading bacteria, toxins, infection and viruses.

3) Flaxseeds contain substances called lignans, which are equally important in boosting the immune system in many ways.

4) It is also a good source of fibre.

Flax Seed OilExtensive research has demonstrated the health benefits of essential fatty acids in reducing the risk of heart attack. Flax seed oil is often used in weight loss supplements because of its positive effects in burning fat. Flax seed Oil is one of Nature's richest plant sources of essential fatty acids (EFAs) which are necessary for health and must be supplied by the diet. Flax seed oil health benefits

RICE BRAN OIL Unsaturated fatty acid about 80% in rice bran oil out of which 40-45% is oleic acid (an important monounsaturated fatty acid) is effective in lowering the cholesterol level in human blood.          Oryzanol a mixture of ferulic acid esters of sterol and triterpene alcohols found 0.5-2% in rice bran oil acts as natural antioxidant, lower the cholesterol level in the blood, effective in reducing menopausal symptoms, to stimulate the nerves and relieving various complaints caused by malfunction in the nervous system.          Vitamin E is a high value substance. It improves the blood circulation and reduce oxygen demand of human body reduce aging. In rice bran oil, it acts also as a natural antioxidant that protects the occurrence of rancidity in oil without adding any synthesis antioxidant.

FATTY ACID COMPOSITION OFFATTY ACID COMPOSITION OF COMMON OILSCOMMON OILS

OIL OIL ω-3ω-3 ω-6ω-6 MUFA MUFA SATURATEDSATURATED PUFA PUFA PUFA PUFA FAT FAT

Flax 58 14 19 9Flax 58 14 19 9Soybean 7 50 26 15Soybean 7 50 26 15Canola 7 30 54 7Canola 7 30 54 7Safflower 0 75 13 12Safflower 0 75 13 12Sunflower 0 65 23 12Sunflower 0 65 23 12Corn 0 59 24 17Corn 0 59 24 17Olive 0 08 16 16Olive 0 08 16 16

Fibre Advantages• Delays gastric emptying

• Provides sense of satiety.

• Holds water-stools are soft, readily eliminated.

• Gets fermented in large intestine.

• Good source of vitamin minerals antioxidants, n-3 fatty acids.

• Effective in reducing Blood sugar and Lipid values.

 Fibre Advantages     Fibre helps in slimming since it is bulk forming

but not containing much of calories. .        3. Coronary heart diseases are low in people who

consume high fibre diet. 4. High fibre has a beneficial effect on dental

caries since the fibre requires more chewing that promotes salivary flow and prevents food stagnation

Sources of Fibre ComponentsCellucose Hemicellulose Lignin

Insoluble Whole wheatFlour

Vegetables

BranWhole grains

Mature Vegetables

Wheat, fruits with Edible

seeds such As strawberries

Soluble Gums, Oats,LegumesGuar,Barlay,Vegetables

Pectins,Apples

Citrus fruits

Strawberriess

• Free radicals are like

Robbers which are

Deficient in energy.

• Free radicals attack

And snatch energy

From the other cells to

Satisfy themselves

WHAT ARE FREE RADICALS?

Free radicals are produced during various metabolic Activities carried out inside our body.

Our body also gets exposed to free radicals present in Environment. For eg.

Sunlight, Automobile exhaust.

Cigarette smoke,Alcohol consumption.

Emotional Stress.

Exposure to heavy metals like mercury, cadmium, lead Etc.

HOW ARE FREE RADICALS PRODUCED?HOW ARE FREE RADICALS PRODUCED?

HOW ARE THEY HARMFUL?

Free radicals cause

The damage to the

Blood vessels.

This injury leads to

Deposition of LDL

(Bad Cholesterol) in

blood vessel and blocks them.

HOW DOES BODY PROTECTS ITSELFHOW DOES BODY PROTECTS ITSELF

FROM FREE RADICALS?FROM FREE RADICALS?Antioxidants are the substances

produced inside our body that prevents the damage done by free radicals.

Antioxidants provide energy to the free Radicals and prevents the cells from the Damage done by free radicals.

WHICH ANTIOXIDATNS WILL PROTECT MY BodyThe antioxidants available from the food that The antioxidants available from the food that

prevent our body from the damage of free prevent our body from the damage of free radical are :radical are :

Vitamin EVitamin E Vitamin CVitamin C ZincZinc SeleniumSelenium

HIGH VITAMIN “C”

VEGETABLES FRUITSDrumstick leaves 220 mg(shevaga pan,saijan patta) Cabbage 124mg(kobi,band gobee)Drum stick 120mg(shevaga sheng,saijan-ki-phalli)

Guava 212 mg(peru,Amrud)Cashew fruit 180 mg(kaju) Amla (anvla) 600 mgKorukkapalli 108 mg(chinch,singhri)

(All the values are per 100 gms. of edible portion)

HIGH VITAMIN “A” Vegetables Fruits

Coriander leaves 15,000 μg Mango 2,210 μg (kothimbir,hara dhania) (Amba,Aam)Curry leaves 21,000 μg Orange 2,240 μg (kadhi limb,gandhela) (Santre,Narangi)Drumstick leaves 42,000 μg Papaya (ripe) 2,740 μg (shevaga pan,saijan patta) (Papita)Mint (pudina) 18,950 μgSpinach (palak) 9,440 μgCarrot (gajar) 8,840 μgTomato ripe 3,010 μg

(All values are μg per 100g of edible portion)

FOODS CONTAINING HIGH “SELINIUM”

VEGETABLES

1. Brussels sprouts (Chotee gobee) 212 mg2. Celery leaves (Ajwan-ka-patta) 102 mg3. Drumstick leaves (Saijan-patta) 137 mg4. Fenugreek leaves (Methi sag) 167 mg5. Mint (Pudina) 84 mg6. Cauliflower (Phulgobi) 231 mg7. Drumstick (Shevaga sheng,Saijan-ki-phali) 137 mg8. Pink Beans (Barli) 182 mg

(All values are mg. per 100 gms. of edible portion)

FOODS CONTAINING HIGH “CALCIUM” VEGETABLES FRUITS

Cauliflower Green 626 mg Lime 90 mg(phool gobee) (neembu,musumbe)Curry leaves 830 mg Lemon 70 mg(kadhi limb,gandhela) (limbu)Drumstick leaves 440 mg(shevaga pan,saijan patta)Carrot leaves 340 mg(gajar pan,gajar sag)

(All the values are per 100 gms. of edible portion)

BIOACTIVE PHYTOCHEMICALS IN FOODS 1.A large array of chemical substances which influence cell metabolism and thereby exert significant effects on health / disease processes. 2. Known to be capable of playing not only a ‘health-promoting’, but also a ‘disease-preventing ‘role.3. Bioactive chemicals in foods fall into three broad (overlapping) categories; antioxidants, detoxifying agents, and blocking / suppressing agents.

1.    Ripe tomato contains very good amount of vitamin A      2.        Both ripe and unripe have large amount of vitamin C but more in unripe one. 3.        It is low in calories, advisable to weight reducing diet preferably raw as salad. 4.        Tomato may help to prevent some forms of cancer by lessening the damage caused by free radicals. 5.        Tomato by preventing platelet clots helps to cut down deaths from heart diseases and strokes. 6.        Role of tomato in stone formations is controversial.

Some common foods containing Bioactive substances.

  Cabbage, Carrots, Onions, Cauliflower, Tomato, eggplant, Green leafy vegetables,celerymethi , Amla, citrus fruit, Guava,  Sesame, Sunflower oil, palm oil Chillis, Cloves, Ginger, Garlic, Peppers turmeric  

Turmeric extract A herb from ginger family exhibits a high degree of protection against lipid free radical damage . It can suppress the mutation of common carcinogens such as cigarette smoke. It balances LDL cholesterol levels and helps to stop clogging of arteries by inhibiting pletelet deposition . 

TURMERIC1.Its antiseptic property is been proved scientifically. 2.It is used in treating arthritis due to its anti-inflammatory property. 3.Turmeric is used to relieve digestive problems like ulcers, dysentery. 4.It has protective action on liver. 5.Turmeric helps by lowering serum cholesterol and by preventing the formation of the internal blood clots improves circulation and prevents heart disease and stroke. 6.Turmeric can be taken as a drink other than adding to dishes to help prevent all problems. Use one teaspoon of turmeric powder per cup of warm milk every day. It is also used as a paste for local action.

Fresh or dry turmeric is used for saline gargles to relieve and prevent sore throats

METHI -FENUGREEK SEEDS1. Fenugreek seeds helps to control blood sugars. 2. It reduces high serum cholesterol. 3. This seeds relieves constipation may be because the

seeds contain a gum which when mixed with water expands in the gut and adds bulk to the stool.

4. It can be prescribed to nursing mothers to increase their milk production.

5. Since fenugreek seeds contain chemicals (diosgenin and estrogens isoflavones) similar to the female sex hormone oestrogen is considered as a potent menstruation promoter (menstrual discomforts), minimise symptoms of menopause.

Fenugreek* Fenugreek (Methi) is thought to -delay gastric emptying -slow carbohydrates absorption -inhibit glucose transport.* It has been shown to increase erythrocyt insulin receptors and improve peripheral glucose utilization,thus showing potentialpancreatic as well as extrapancreatic effects* The main side effects are flatulence and diarrhoea,which subside after a few days. Hypersensivity reactions have also been reported.

* Because of the coumarin constituents, fenugreek may potentially enhance anticoagulant activity of drugs or herbs that have antiplatelet activity.

* It may inhibit corticosteroid drug activity, interfere with hormone therapy,and potentiate monoamine oxidase (MAO) inhibitor activity.

Methi - Fenugreek seeds contain 50% total fibre, 20% soluble fibre and n-3 fatty acids and are very effective in reducing blood glucose, serum cholesterol and triglycerides . Therefore, diabetics could be advised to take 25g of fenugreek seeds in three divided doses along with breakfast, lunch and dinner.Fermantation Idli, Dosa, Dhokla Rice preparation Dal preparation FodaniAtta

 Garlic and Onion have fibrinolytic action and reduce platelet aggregation. In addition, they have hypolipidaemic actions. About 50 g onion and 1-3g of fresh garlic are adequate in the daily diet . Agoene, a chemical derived from garlic is also known to prevent platelet aggregation. The beneficial effect of Garlic in heart disease could be attributed to these properties. 

GARLIC* Garlic contains the sulfur containing chemical constituent, alliin,which must be covered to allicin (the active form) by the enzyme allinase. * Ajoene is formed by the acid-catalyzed reaction of two allicin molecules.* Allicin has antibacterial and antioxidant activity.It may possibly increase blood levels of catylase and glutathione peroxidase activity.

* Ajoene decreases the activity of factors needed for lipid synthesis by reducing the thiol group in coenzyme A and HMG.* Ajoene has antiplatelet activity and interferes with thromboxines synthesis and decreases platelet aggregation. * Garlic use may be associated with increasedserum insulin and improved liver glycogen storage.* Side effects include breath odor,mouth and GIburning or irritation,heartburn,flatulence,and rare topical reactions.

* For fresh garlic,the dose is one clove (4g) taken once/day.

BITTER MELON

* It is a vegetable also known as karela.* Bitter melon has been used to treat diabetes.* Bitter melon contains several chemical constituents like glycosides mormordin and charantin.* Charantin contains mixed steroids with hypoglycemic activity.* Another component is the peptide polypeptide-p.* Bitter melon also contains the alkaloid mormordicine.

*Bitter melon also contains the alkaloid mormordicine.*Its seeds contain the abortifacients α-mormorcharin and β-Mormorcharin as well as the pyrimidine nucleoside vicine. *Its hypoglycemic activity include charantin,polyppeptide p.*Other theoretical actions include extrapancreaticactivity, such as increased tissue glucose uptake,liver/ muscle glycogen synthesis, and decreasedblood glucose synthesis through depression of theenzymes glucose-6 phosphatase,fructose-1,and6bisphosphatase, and enhanced glucose oxidation.

CARBOHYDRATES:Generally in Indian diets, carbohydrates provide 60-65% calories .Ragi is rich in minerals, especially calcium. Millets including ragi are rich in minerals and fibre. Complex carbohydrates, present in cereals and pulses have a low glycaemic index and are better. . Rice and wheat have similar glycaemic index. 1gm carbohydrates = 4.0 CAL

CARBOHYDRATESCereals and millets : The major cereals and millets consumed in India are rice, wheat (cereals), jower, bajra, ragi (millets) and maize. Cereals are also source of some nutrients like Ca & Fe. However rice among the cereals is poorer in these two minerals. Hence diets based predominantly on rice have lower Ca & Fe content.

PROTEINS: The best quality protein is the one which provides essential amino acid pattern very close to the pattern of the tissue proteins. Egg proteins, human milk protein, satisfy these criteria . Proteins from vegetable sources are better than from flesh foods as they provide fibre, and do not contribute cholesterol to the diet. The added advantage is that progression of renal disease is lower with vegetable proteins than those animal foods . A combination of cereal and pulse in the ratio 5:1 has been found to give an optimum .Sprouted pulses have more nutritive values and more digestibility.

PROTEINS:1gm of protein gives approx . 4cals. Req.-0.8 g/kg body wt. Additional Supplement for pregnancy, lactation/growth. Cereals contain 6-12 % protein which is generally deficient in lysine and provides more than 50% of daily protein intake. Soya, Rajama,Udad dal has more nutritive values Include a small quota of animal proteins (milk/yoghurt/fish). Avoid meat, seafood crabs, lobster.

The germination of pulses increases its nutritional content. The germinated pulses have high vitamin C content than the normal seed. Other vitamins that show an increase are B complex vitamins and folic acid. Tannin and phytates, those adversely affect the bioavailability of nutrient, are broken down on germination. Like wise the chlorophyll content also increases when the sprouted shoots change from yellow to green. Fermentation of the dhal to make idli, dosa, and dhokla also enhances the B vitamins and decreases the phytate content and trypsin inhibitors.

-SOYABEANS

-Soya bean contains 43 gms of protein per 100 gms, which is the highest among the pulses. -It also contains 19.5 gms of fat, 21gms of carbohydrate and provides 432 kcal per 100 gms. The protein of soya bean contains all the essential amino acids in adequate amounts except methionine and cystine. Since it has majority of essential amino acid it is one of the best vegetarian food item as far protein content is concerned -It is a good source of thiamine, niacin, folic acid and a fair source of riboflavin. -Soya bean contains a factor that inhibits the action of the digestive enzyme trypsin and this factor can be destroyed by heat. Soya bean should be cooked well for digestion and absorption. Studies have shown that in type II hyper cholesterolemia patients already on low lipid, low cholesterol diets, eight weeks substitution of animal protein by soya bean protein reduced plasma cholesterol by 23 to 25 percent.

GLYCEMIC INDEX

Complex carbohydrates which have to be chewed,digested,assimilated and absorbed produce a less steeper rise in post prandial glucose as compared to simple sugars which are absorbed rapidly and produce a steeper rise in glucose level. Apart from food factors,“human factors” also influence glycemic index.* Dietary fiber derived from legumes andpluses that is viscous (gel-forming) is better than non-viscous dietary fiberpresent in wheat and rice.

GLYCEMIC INDEX

Dilution of food by liquids also affects the glycemic index by decreasing the viscosity of the fluid film surrounding the intestinal villi and thus decreased thickness of the rate limiting unstirred layer resulting in an increase of glucose transport across the intestinal mucosa. Apart from fiber the presence of other substances such as phytates and mineral elements can influence the glycemic response of a given carbohydrate source. Apart from food factors that directly affect glycemic index is also affected by other factors such as GI motility,age,food volume etc.

POSITIVE HEALTH APPROACH

* Unrefined high fibre,high carbohydrate, low fat,low glycemic index diet must be encouraged for all.

* Glycemic Index Food :ITEM % Rajmah 20-29soyabean 10-19

MODIFICATIONChappatis4Kg Wheat +½ Kg Soyabin +½ Kg Ragi +¼ Kg Methi Nutritionaly rich Chappatisin iron ,calcium,n-3 fattyacids, proteins, B -complex vitamins.

MEALS TO BEMEALS TO BE HIGH CARBOHYDRATES AND FIBER, BUTHIGH CARBOHYDRATES AND FIBER, BUT LOW IN FAT AND SALTLOW IN FAT AND SALT

PRINCIPLES OF MEAL PLANNINGPRINCIPLES OF MEAL PLANNINGNO SUGARS

SUGAR JAGGERY HONEY

GENES ARE NOT DICTATORS Scientific research reveals that genes are not dictators; they are committees. They do not give orders. They make suggestions. Genes are not rogue tyrants exerting despotic control over your waistline.rather. they work in groups, often with subtle effects, and you can nudge them in the direction you want them to go. You can counteract the fat genes and boost your thin genes.

We think of genes as unchangeable because, when it comes to eye color or hair color, they really are decisive.. But the genes that establish your size and shape are much more flexible. They need to be able to adjust your appetite and your calorie burning, depending on whether food . Your capacity to shape and renew your body is not perfect, but it is far greater than you may have imagined.the genes for muscle mass only make suggestions. You control how the genes are expressed.

The negative calorie foods contain sufficient vitamins & minerals that produce enzymes in quantities sufficient to break down not only its own calories, but additional calories present in digestion as well. This is the secret of The Negative Calorie Foods.

1.    A 5 calorie piece of celery may require 150 calories to digest, but resulting in a net loss of 145 calories from our body fat !! The more you eat, the more you lose weight!!!

FREE FOODS we can say that any food with fewer than 5 grams of available carbohydrate in a 100 gram portion is a free food. The rest of the portion is protein, fat, fiber, ash, and water. This is similar but slightly different from the concept used in the Dietary Exchange Lists, which says, “Free foods are those with either under 20 calories or 5 grams or less of carbohydrates per serving.” Thus, a 100 gram serving of one of your “free foods” will raise blood sugar by about 50 mg/dl for most people with diabetes.

AsparagusBeet RootBroccoliCabbage CarrotCauliflowerCelery

Hot Chili CucumberGarlicGreen BeansTomatoWatermelon

LettuceOnionRadishSpinachTurnip Lemon/LimeOrangePapaya

Green Tea, the common name for Carmellia Sinensis is an herb that has been used for weight loss because of its thermogenic attributesThermogenesis actually helps boost your body temperature and burn excess calories. The primary thermogenic component of Green Tea is caffeine. It also has two other related components called theobromine and theophylline that help to boost metabolism. Neither of these components can be found in coffee. So although coffee is similar, it does not have the thermogenic properties of Green Tea.Green Tea also contains antioxidants to help nuetralize free radicals which can damage healthy cells.Green Tea contains No calories, No carbohydrates, No Protein, and No Fat. It also provides about 10 mg of potassium per serving.

Prescription for Healthy Living

Achieving good metabolic control

• Knowledge of meal planning

• Regularity of food intake

• Flexibility in food choices

• Adherence within recommended caloric levels

SUCCESS OF DIET THERAPY

DEPENDS UPON Regular diet assessmentIndividualisation of DietInvolvement of family

EXERCISEEXERCISE

EXERCISEImportant & integral part of

diabetes treatment for both

IDDM & NIDDM.

EXERCISE PLAN

DEPENDS ON•Age

•General health

•Level of physical fitness

REGULAR EXERCISE

Benefits Controls weight Lowers blood sugar Reduces need for diabetes

medicines Lowers blood pressure Reduces stress Increases fitness Improves functioning of heart

& lungs

GOOD EXERCISE PLAN

Contents Enjoyable activity Affordability Pacing of activities

Exercise, Excuses• That sounds like hard work to me .

• I haven’t got time, I’m too busy.

• I need ralaxation, not exercise.

• I’d be too embarrassed.

• I’m too old for it.

• I’m fat, I’d rather diet .

• That sounds boring.

• I am too thin why exercise.

EXERCISE IS LIKE

“ INVISIBLE INSULIN”

•Most people with Type II diabetesMost people with Type II diabetes

and Type I diabetes need to modify and Type I diabetes need to modify

insulin dose and/or food in take insulin dose and/or food in take

to account for exerciseto account for exercise..

RISK OF EXERCISE• Strenuous exercise may potentiate.

• insulin’s – effect/hypoglycaemia.

• Arrhythmia, Myocardial ischaemia.

• Risk related to underlying.

• retinopathy & neuropathy.

• May aggravate diseases e.g. arthritis.

ADVICE ON EXERCISE FOR PATIENTS WITH COMPLICATIONS

Complication

-Insensitive feet

-Active proliferative

Retinopathy

-Hypertension

Advice

-Use proper foot wear.

-Avoid strenuous

exercise & heavy lifting.

-Avoid strenuous exercise.

GETTING STARTED COMPLETE MEDICAL CHECK

UP CHOOSE AN ENJOYABLE

ACTIVITY START SLOWLY PACE ACTIVITY (Gradual

increase)

Routine Activity Caloric Consumption Per Minutes

Relaxing in lying down position 1 cal

Sitting 1.2 cal

Standing 1.4 cal

Eating 1.4 cal

Talking 1.4 cal

Drying cloths 2.3 cal

Washing Hands – Face 2.5 cal

Walking 2.5 mile/hrs 3.6 cal

Bathing 4.2 cal

Climbing down 5.2 cal

Daily Activity

Specific Activity Caloric Consumption

Per Minutes

Sewing cloths by hands 1.4 cal

Sweeping floor 1.7 cal

Polishing furnitures 2.4 cal

Wiping floor 3.6 cal

Ironing cloths (standing) 4.2 cal

Mopping 4.2 cal

Daily Activity (contd.)

Hobbies Caloric Consumption Per Minute

Painting (Sitting) 2.0 cal

Driving 2.8 cal

Horse riding (slowly) 3.0 cal

Cycling 5.5 mile/ Hrs. 4.5 cal

Golfing 5.0 cal

Dancing 5.5 cal

Swimming 20 yards/ minutes 5.0 cal

Skating 9.9 cal

Gardening 5.6 cal

Tennis 7.1 cal

Daily Activity (contd.)

SOME POPULAR ACTIVITIESSOME POPULAR ACTIVITIES

Hobbies Caloric Consumption Per MinutePainting (Sitting) 2.0 cal

Driving 2.8 cal

Horse riding (slowly) 3.0 cal

Cycling 5.5 mile/ Hrs. 4.5 cal

Golfing 5.0 cal

Dancing 5.5 cal

Swimming 20 yards/ minutes 5.0 cal

Skating 9.9 cal

Gardening 5.6 cal

Tennis 7.1 cal

SOME POPULAR ACTIVITIESSOME POPULAR ACTIVITIES

How Far, How Fast, How Long ?

Distance = speed x time; Speed = Distance/Time =Distance/Speed

Steps/ Min Min/ mile Miles/ hour

2.0Ft/stride

2.5Ft/stride

3.0Ft/stride

90 70 60 30 2

110 90 75 24 2.5

130 105 90 20 3

155 120 105 17 3.5

175 140 120 15 4

200 160 135 13 4.5

220 175 145 12 5

TO FIND YOUR

TARGET HEART RATE• 220-your age = maximum heart rate.

• Ask your doctor how hard you should exercise (usually at 50-75% of maximum heart rate).

• If you can’t talk or whistle while exercise, slow down.

EXERCISE PRESCRIPTIONS

Fitness Level Intensity % of Maximum

(min./session) heart rate

Low 15-30 60-70

Moderate 30-45 70-80

High 30-60 70-80

Walking speed(MPH)

Pace Calories Burned(approx)in 30 min in 1 Hr

2 Slow 120 240

2.5 Medium 140 280

3 Medium 160 320

3.5 Brisk 180 360

4 Brisk 210 420

4.5 Fast 250 500

Walking upModerate incline

Brisk 300 600

SOME POPULAR ACTIVITIESSOME POPULAR ACTIVITIES

Yoga means "joined together".

The word comes from the

ancient Sanskrit root word yug,

which means "to unity".

YogaYoga

A yogi is one who consciously A yogi is one who consciously

unifies body, mind, emotions, unifies body, mind, emotions,

and spirit so that they work and spirit so that they work

together very well.together very well.

Asanas are a important part of Asanas are a important part of yoga. They are various body yoga. They are various body

postures designed for keeping postures designed for keeping the internal & external parts of the internal & external parts of the body in good health. Asanas the body in good health. Asanas takes care of both the mind and takes care of both the mind and

body to achieve complete body to achieve complete physical and mental relaxation.physical and mental relaxation.

PranayamaPranayama is the gateway to deeper

relaxation and meditation. The regulation

of breath is the essence of Pranayama.

Pranayama, according to yogic scriptures,

is the gateway to deeper relaxation and

meditation. The Sanskrit word ‘Prana’

means breath of life force, while ‘ayama’

means regulation or control.

YOGA & DIABETES(Studies from Vemana Research institute,

Secunderabad)

MECHANISM• Exercise Effect

• Change in biochemical & hormonal profole

• Elimination of stress & instilling a sense of disicipline

Group ‘A’ Naukasana

Bhujangasana

Shalabhasana

Group ‘B’Halasana

Vajrasana

YOGA STUDIES

4 types of Pranayama for 30 minutes followed by Shavasana for 15 minutes

Group ‘C’ Yogmudra

Shalabhasana

Group ‘D’Dhanurasana

Ardhamatsyndrasana

EFFECT OF ASANAS1. Exercise toleranc

- Significant reduction in the minute ventilation

- Oxygen consumption

2. Plasma cortisol

Non diabetic Asthmatic

Plasma cortisol in diabetic patient

3. Effect of lipik profileFFA

LDL

VLDL

HDL

Benefits of Yogasana:Benefits of Yogasana:It helps in controlling various diseases and

* It improves fitness of the body.

* It improves flexibility of various

joints by reducing stiffness.

* It increases immunity and helps in

improving the function of kidneys,

lungs, intestine, liver, and skin.

* It also helps in breaking down

excess fat and increases blood circulation.

POTENTIAL BENEFITS OF EXERCISE

• Improve glycemic control

• Helps in weight control

• Reduces psychological stress

• Improves insulin sensitivity

• Promotes cardiovascular fitness

• Increase energy

RISK OF EXERCISE

•Strenuous exercise may potentiate

•insulin’s – effect/hypoglycaemia

•Arrhythmia, Myocardial ischaemia

•Risk related to underlying

•retinopathy & neuropathy

•May aggravate diseases e.g. arthritis

MANY PEOPLE SEEM TO THINK SUCCESS IN ONE AREA CAN COMPENSATE FOR FAILURE IN OTHER AREAS. BUT TRUE EFFECTIVENESS REQUIRES

FEMALES ( HOUSE WIVES) WORKING IN KICHENS CAN PLAY MAJOR ROLE IN PRIMARY , SECONDARY AND TERTIARY PREVENTION OF DIABETES AND TOTAL HEALTH OF FAMILY WITH LIFE STYLE MODIFICATION ONLY. HENCE FEMALES CAN IMPROVE THE ECONOMIC BURDEN OF DIABETES TO THE COUNTRY FROM KICHEN ONLY WITHOUT GOING OUT FOR JOBS.FEMALES SHOULD REALISE THIS SOCIAL RESPONSIBILITY AND SOCIETY AND FAMILIES SHOULD LEARN TO RESPECT THAT.

NO ONE CAN CHEAT YOU OUT OF ULTIMATE SUCCESS BUT YOURSELF.

FAILURE IS DELAY BUT NOT THE DEFEAT. FAILURE SHOULD CHALLENGE US TO NEW HEIGHTS. GREATEST GLORY CONSISTS NOT IN FAILING BUT RISING EVERY TIME YOU MAY FALL. WE LEARN WISDOM FROM FAILURE MUCH MORE THAN SUCCESS.