Diabetes and the role of Healthy Eating

Diabetes And Healthy Eating by Peter Azzopardi

Happy New Year guys, I hope you all had a good Christmas?

I’m looking forwards to working with you all in the Upbeat classes in 2018, as I’m sure the other Exercise Instructors and Nurses are!

Now that it’s the new year, I thought I’d write an article on diabetes, for those who may wish to learn a bit more about this condition and how they can avoid it and for those who already have diabetes and would like to know more about the guidelines for managing your symptoms effectively. If you’d like to know more, then please read on!

Introduction

Diabetes mellitus is one of the most common diseases in the UK. This disease can have major effects to health including potential damage to the kidneys (nephropathy), neuropathy (damage to the nerves), retinopathy (damage to the eyes) and peripheral vascular disease (limbs) as well as the increased risk of cardiovascular disease. Consequently, it is a major contributor to renal failure, blindness, stroke heart disease and even amputations.

Features of diabetes
The glucose in our bodies needs to be transferred from our blood to our tissues and this is done by the hormone insulin. Diabetes is where there is a lack of insulin which may be a lack of insulin production (type 1) or a resistance to the action of the insulin being produced (type 2). As a result, the amount of sugar increases in the blood and excess glucose can pass into the urine. This can lead to:
• Increased levels of urine
• Thirst
• Weight loss that cannot be explained

Type 1

This is where the pancreas completely or partially fails to produce insulin. It can develop at any age and accounts for 10-20% of cases. It may be caused by genetic factors, autoimmune disease or certain viruses, although the exact causes are still not well understood. It is treated through lifestyle changes and insulin replacement by injection or pump therapy.

Type 2

This is where insulin is produced but it is either insufficient or an ineffective form. It accounts for 80-90% of cases and is the much more common form. The development is much more closely associated with obesity and genetic factors and it tends to develop in middle age however it is recently now being seen in younger adults and children. It is managed with lifestyle changes, reduced food / energy intake and taking more activity and exercise. Most individuals also require hypoglycaemic medication which increases insulin production or enhances its effectiveness. In some cases insulin injections are required.

Diabetes and cardiovascular disease

Diabetes greatly increases the risk of premature death from cardiovascular disease, especially in women. Those with diabetes are at least twice as likely to develop heart disease as non-diabetics. There is also a two- three fold increase in the likely hood of stroke. Outcomes of myocardial infarction (heart attack) or strokes are also detrimental in people with diabetes. Hypertension (high blood pressure) is particularly strongly associated with cardiovascular risk in this group and long-term blood pressure control in type 2’s can significantly reduce the incidence of cardiovascular disease. Modifying other risk factors such as smoking, high cholesterol, obesity and physical inactivity are also important.

Dietary modification

The guidelines are very similar for those with diabetes to the general population and should be based on healthy eating principles with specific aspects relevant to the diabetes, in terms of food choice and meal timing. There are many other issues which must be considered:

Meal pattern

In most people, carbohydrate intake will need to be fairly evenly distributed throughout the day. Individuals with erratic eating habits or those who go for long periods without eating will need to adopt a more regular meal pattern to ensure a better and more consistent balance between supply and usage.

For many people, a meal pattern of three evenly sized meals and three smaller snacks per day is ideal, but this will vary according to demands of medication, lifestyle and individual preference. The important aspect is that an appropriate meal pattern remains consistent each day.

HOW THE EATWELL PLATE IS ADAPTED FOR THOSE WITH DIABETES BY A DIETITIAN:

Bread, cereal foods and potatoes:
These are an essential basis for every meal

• Quantity and timing: These need to remain fairly constant from day to day.
• Good food choices: pasta, rice, bread, chapattis, potatoes, breakfast cereals (especially oat-based).
• Reduce the amount of fat added to these foods: including fat spread on bread, chapattis or used in pasta sauces should all be kept to a minimum.
• Wholemeal/wholegrain bread and cereals are high in fibre and have advantages in terms of satiety and preventing constipation. Fruit and vegetables A variety of 5 servings a day
• These foods have major health benefits for people with diabetes.
• 1-2 servings of vegetables (excluding potatoes) should be eaten with main meals.
• Fresh fruit can be chosen as a snack or dessert
• Frozen or canned fruits and vegetables are useful alternatives to fresh varieties.
• Fruit juice should be regarded as a sugar-containing drink and not consumed only with meals.
• Have salad or vegetables with manufactured convenience foods or ready meals. Milk and dairy products 2-3 serving a day
• Low/reduced-fat varieties of milk, yoghurt, fromage frais, etc. should be chosen.
• Full-fat cheese should be used in moderation especially by those who are overweight. It is more helpful to use it as a main meal component rather than a snack.
• Cream should only be used as an occasional treat. Meat, fish, pulses and alternatives 2 servings a day
• Greater use should be made of pulses (peas, beans and lentils), either as an alternative to meat or as a way of making a smaller quantities of meat go further. Fresh, canned or dried pulses are all suitable.
• Ideally at least two portions of fish should be consumed every week, one of which should be oily fish.
• Fat avoidance is important, e.g. meat should be lean; visible fat should be trimmed or drained off after cooking.
• Consumption of meat products e.g. burgers, pies, sausage rolls or high-fat meat mixtures (mince) should be kept to a minimum.
• Poultry is a low source of fat if the skin is removed and fat, which appears during cooking, is discarded.

Fat-rich and sugar-rich foods:
These should be kept to a minimum

Sugar-rich foods:
• The diet does not have to be sugar free, but sugar-rich confectionary and drinks will impair glycaemic control if consumed at inappropriate times or in addition to meals.
• Low-calorie ‘diet’ soft drinks are good alternatives to their higher sugar counterparts.
• Ordinary jam, marmalade or reduced-sugar varieties can be used in small amounts on bread.
• Small amounts of sugar-containing biscuits or cakes can be eaten as scheduled snacks, but higher fibre, lower sugar choices are best, e.g. tea breads, fruit cake, English muffins, plain cakes and biscuits. Those who are overweight should be encouraged to make more use of fruit as snacks.
• Intense artificial sweeteners should be used if sweet-tasting drinks are required. Fat-rich foods:
• Source of fat should be avoided as much as possible.
• Food should be boiled, baked, grilled, dry roasted or micro waved instead of fried.
• Minimum amounts of fat should be spread on bread, added to food or used in cooking.
• Reduced-fat monounsaturated spread and small amounts of monounsaturated oils (olive or rapeseed/canola) are the best choices.
• High-fat snack foods such as crisps and biscuits should be eaten less often and replaced by healthier alternatives such as fruit, low-fat yoghurt or whole-wheat crisp bread.

Other advice to prevent diabetes

1. Check food labels to check whether there is a high amount of sugar.
2. Do not miss breakfast and avoid high calorie lunches. Skipping breakfast will lead to the blood sugar going really low.
3. Keep hydrated and avoid alcohol intake.
4. Exercise 4-5 times per week, for a healthy weight and encourage good blood sugar levels. 5. Replace normal potatoes with sweet potatoes, which can be eaten with skin as this has a lower glycaemic index which means it prevents blood sugars rising as quickly and keep them stable for a longer period of time.
6. White bread with wholemeal bread or ideally with soda bread, crisp bread or rye bread.
7. Replace pasta with Quinoa, Spellt and Millet. All of these have a much higher nutrient density, with much more vitamins and minerals and they will help maintain blood sugars.

before making any changes to your diet or medication, please speak with your GP or a Registered Dietician.

For individuals who may need extra help with non prescriptive diet advice and behaviour / habit changes or if you would simply like to fit in some additional activity to the Upbeat classes, I can offer you Personal Training, straight to your home. Please visit www.pmapersonaltraining.com for more details and please feel free to contact me for further details.

Thank you very much for reading and I wish you all good health in 2018!

Peter

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