medical nut therapy in dm

8/14/2019 Medical Nut Therapy in DM

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Medical Nutrition Therapy inDiabetes


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Diet in diabetes is like religion

Everybody talks about it

Everybody interprets it

Everybody claims to understand it

Nobody truly practices it


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Primary goals of Medical NutritionTherapy for all persons with

Diabetes

Attain & maintain recommended metabolicoutcomes (glucose, HbA1c, cholesterol,triglycerides, blood pressure & body weight)

Prevent & treat the chronic complications & co-morbidities of diabetes

Improve health thro healthy food choices &physical activity

Address individual needs


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Goals of Medical Nutrition Therapythat apply to specific situations

Youth with type I diabetes : adequate energy &integrating insulin with eating regimen

Youth with type II diabetes: to facilitate change in

eating habits & encourage physical activity

Pregnant & Lactating women : adequate energy &other nutrients for optimum outcomes

Older adults : Provide nutritional & psychosocialneeds of aging

For individuals at risk : encourage good foodhabits & encourage physical activity


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Medical Nutrition therapyinvolves the following

Nutrition assessment to evaluate the patientsintake

Assessment of metabolic status

Lifestyle & readiness to make changes

Goal setting

Dietary instructions

Evaluation


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Assessment criteria

Dietary factors

Socioeconomic details

Lifestyle

Anthropometry

Physical examination

Biochemical Parameters

Clinical parameters


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Diabetes and Energy

The amount of energy provided to a diabetic dependson his/her weight

Weight loss in obese diabetics is an imp therapeuticobjective for persons with type 2 diabetes

Wt loss is associated with decreased insulin resistance,improved measures of glycemia & dyslipedemia &reduced blood pressure

Along with a reduced caloried diet, exercise andbehaviour modification are most useful for long termweight loss


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Diabetes and CHO

CHO can be divided into Sugars, Starches & Fibre

50 60% of energy should come from CHO

Different CHO have differing glycemic responses & they aredependent on a no of factors

Recent studies indicate that sucrose does not increase glycemiathan iso caloric amounts of starch.

Sucrose containing food need not be restricted, but substitutedfor other CHO sources or covered by medication

Fibre intake is encouraged as they confer metabolic benefits onglycemic control & plasma lipids (20g/1000cal)

The contribution of CHO should therefore be individualized basedon nut assessment, metabolic profile & treatment goals


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Diabetes and Protein

For persons with diabetes, 15- 20 % of the totalenergy should come from proteins

Prudent to avoid consuming > 20 % as the long

terms effects of high protein consumption on thedevelopment of nephropathy has not beendetermined

Food proteins can come from both veg andanimal sources and with the onset ofnephropathy, lower protein intakes arerecommended ( 0.8 gm / kg body weight)


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Diabetes and fat

For persons with diabetes, < 10 -15 % of the energyshould come from fats and < 7 % when LDL is above100mg

The primary dietary fat goal for persons withdiabetes is to limit saturated fat & dietary cholesterol

intake

Since sat fat is the primary determinant of plasmaLDL, < 10 % of the energy should come fromsaturated fat

Dietary cholesterol should not exceed 300 mg / dayand < 200 mg /day when LDL levels are above 100mg

N3 polyunsaturated fats may be most beneficial forthe treatment of hypertriglyceridemia and havecardioprotective effects

Intake of transfatty acids should be limited as it


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Diabetes and micronutrients

Persons with diabetes should be educated about theimportance of consuming adequate amounts of vitsand minerals from natural food sources

There is no clear evidence of benefit from vit &mineral supplementation in diabetics who have nounderlying deficiency

Exception to the above include folate for prevention ofbirth defects and calcium for prevention of bonedisease

Supplementation of vit and minerals in selectpopulation may be beneficial, but the patient shouldbe educated about the toxicity


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Diabetes and alcohol

Precautions for alcohol use is the same for diabetics andthe general population

Abstention is advised for * women during pregnancy *Pancreatitis * Advanced neuropathy * Severe

hypertriglyceredemia *Alcohol abuse

Alcohol limit : one drink for an adult woman and 2 for aman ( one drink is equal to 12 oz of beer, 5 oz of wine, 1.5oz of distilled spirits)

Cardio protective effects of alcohol appear not to bedetermined by the type of alc beverage consumed

To reduce risk of hypoglycemia, alcohol should always beconsumed with food


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Food Groups

Cereals

Pulses

Milk & milk products Vegetables

Fruits

Fats & oils

Meat & meat products


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Cereals

Cereals are the staple food in our country

They are rich in CHO & a fair source of minerals &B-group vitamins

All cereals have the same amount of CHO. Hencethe quantity of cereal consumption should bestressed upon, rather than the quality

A mixture of cereals should provide the fullcomplement of vitamins

A diet rich in whole grains should be advocatedrather than refined grains

The consumption of processed cereal food itemsshould be discouraged


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Pulses

Pulses (dhals & whole grams) are animportant source of protein forvegetarians

Inclusion of sprouted whole grams shouldbe encourged as they provide thenecessary fibre

Pulses should be restricted for patientswith nephropathy


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Vegetables

Vegetables are important for their mineral, vitamins& fibre content

Consumption of vegetables (both raw & cooked)should be encouraged as they provide the necessaryfibre

Some root veg which have more CHO like potato,sweet potato, yam, tapioca & sweet pumpkin are bestavoided

In nephropathy, the intake of raw veg should be

avoided and veg should be consumed after leachingthem of potassium

Leaching is a process in which cut veg and dhals areboiled in water for a few mins. The water is thendrained and the veg cooked with fresh water


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Fruits

Fruits are rich sources of vitamins, CHO & fibre

Fruits can be taken in limited quantities only whenthe blood sugar is below 200mg/dl

Some intensly sweet fruits like Mango,Seethaphal, Sapota, Jackfruit & Banana are bestavoided

Fruit juices in all forms should be completely

restricted

Excessive consumption of fruits can alter theglycemic control and lipid profile


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Milk and Milk Products

Milk & milk products contain good quality ofprotein for vegetarians

The cream of milk is also a rich source of saturated

fat. Therefore milk should always be skimmed ofcream before consumption

Milk can also be consumed in the form of yoghurt,curd and cheese. They should also be fat free

before consumption


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Fats and oils

Fats and oils are rich sources ofconcentrated energy

Consumption of saturated fats (butter,ghee Cream etc) should be kept to aminimum

The intake of transfatty acids should be

completely avoided

A mixture of oils (both saturated &unsaturated) is advocated


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Meat, fish and eggs

Rich sources of protein, vits, iron & phosphorous

Egg yolk is a rich source of cholesterol & should beavoided by people with dyslipedemia

Meat should be skimmed of all fat beforeconsumption

Method of cooking should preferably not involvedeep frying

Fish is a rich source of omega 3 fats and is hearthealthy

The consumption of meat & meat products isrestricted in patients with diabetic nephropathy


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Dietary modifications for co-morbidconditions

Protein, potassium, Sodium & fluid restrictions forpatients with diabetic nephropathy

Sodium restriction for patients with hypertension &

heart disease

Saturated fat restrictions for patients withdyslipedemia

Protein & fat restriction for patients with hepaticdiseases


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Sweeteners

A variety of sweeteners are used and aresafe for consumption in the amountsprescribed even for pregnancy and children

Some of the sweetners available in theIndian market are aspartame & saccharin

Fructose as a sweetening agent is not

recommended as it may adversely affectplasma lipids


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General Principles of Meal Planning

A diabetic should be motivated to adhere to his/her

diet throught life

Discourage fasting or feasting

Help the diabetic plan his meals into 3 major meals

and 2 minor meals or snacks

Stress upon restricting all direct sugars and refinedfoods

Educate the patient on the misconceptions that he orshe may have

Encourage the use of fibre rich foods

Stress on reducing total fat intake


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Strategies consider to affectadherence

Tailor the diet to the clients lifestyle

Involve client in decision making

Promote exercise

Promote self blood glucose monitoring

Identify areas where client is willing tochange


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Role of a diet counselor

Inform about the expected change

Use different appeals

Suggest alternatives for adopting newpractices

Use appropriate counselling skills empathy, reflective listening, praise etc


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Thankyou

medical nut therapy in dm

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