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Diabetes - Dietary and Lifestyle Recommendations
Diabetes - Dietary Recommendations

Nutrition & Cardiovascular Disease

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Nutrition and Cardiovascular Disease (CVD)

For many years health care professionals have focused on nutritional changes for glycaemic control but food choices for heart protection are just as important.

See - Microvascular and Macrovascular Complications

 

Hypertension

Important factors in the prevention and management of cardiovascular disease are:

 

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good glycaemic control
 

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not smoking
 

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healthy diet
 

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moderate alcohol intake
 

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weight loss in the overweight
 

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regular exercise

The nutritional factors in the prevention and management of cardiovascular disease related to blood pressure are:

Salt reduction from the average daily intake of 12g to 6g (approximately 1 teaspoon). This will result in:

 

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A drop in systolic/diastolic pressure of about 5/2-3mmHg. The drop may be greater in those with type 2 diabetes.

 

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It potentiates the effect of some anti-hypertensive drugs in those with type 2 diabetes.

A diet low in total fat, saturated fat, rich in fruit and vegetables and low fat dairy products has been shown to reduce blood pressure.

A modest amount of maintained weight loss (4.5kg or more) in the overweight and obese results in improvement in blood pressure.

Drinking alcohol within recommended limits; sustained and excessive consumption of alcohol has a deleterious effect on blood pressure.

 

See - Alcohol Fact Sheet

 
 

Tips for Reducing Salt Intake

     
 

Avoid adding these to food:

 
    • Table salt  
   

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Sea salt  
   

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Rock salt  
    • Celery salt  
    • Garlic salt  
    • Salt substitutes: LoSalt, BioSalt  
 

Flavour foods with these instead:

 
    • Herbs  
   

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Spices  
   

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Lemon juice  
   

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Pepper  
   

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Garlic  
 

Try not to add salt at the table. Reducing it gradually is often easier.

 
 

If salt adding in cooking, add only a little.

 
 

Eating a diet based on more fresh than processed foods.

 
 

Processed foods which contain the most salt include:

 
 

 

anchovies

bacon

biscuits

breakfast cereals

cheese

cooking sauces

gravy granules

ready meals

sausages

smoked foods

soy sauce

stock cubes

tinned foods

 

 

 
 

Choose foods that are lower salt alternatives.

 
 

See - Salt Fact Sheet

 
     
 

Dyslipidaemia

Important factors in the prevention and management of cardiovascular disease are:

weight loss in the overweight

good glycaemic control

healthy diet

moderate alcohol intake

not smoking

regular exercise

The principles of nutrition in the prevention and management of cardiovascular disease related to dyslipidaemia are:

Reduce total fat intake, mainly in the overweight and obese

Reduce saturated fats and choose unsaturated fat preferably monounsaturated fat.

Limit intake of Trans- fatty acid.

Dietary cholesterol is less important and less significant on reducing blood cholesterol than saturated fat but excessive intake of dietary cholesterol rich foods should be discouraged.

Include Omega-3 fats such as fish oils at least twice a week.

Eat 5 portions of fruit and vegetables daily.

Daily consumption of foods fortified with plant sterols or stanols (2-3g/d)

Supplementation with up to 3 gram per day of n-3 marine fish oils can improve blood triglyceride levels without adverse effects for those with elevated blood triglycerides.

Patients who drink alcohol should be advised to keep weekly consumption within safe limits.

 

See -  Facts on Fat and Eat Your Way to a Healthy Heart

 

Saturated Fat

     
 

Reducing energy and total fat intake by cutting down saturated fats in the overweight and obese is beneficial for lipids.

 
 

Prevent unwanted weight loss in those of ideal weight by replacing energy intake/fat intake from saturated fat with carbohydrate or or unsaturated fat preferably such as olive and rapeseed oil.

 
 

Foods high in saturated fat to reduce includes: :

 
    • meat pies  
   

•

sausages and fatty cuts of meat  
   

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butter  
    • ghee  
    • lard  
    • full fat milk and yoghurts  
    • cream  
    • cheese  
    • cakes and biscuits  
    • foods containing coconut or palm oil  
 

Trans fat such as hydrogenated vegetable oil has similar effect on cholesterol to saturated fat. This can be found in some cakes, biscuits, chocolate and margarines.

 
     

Weight loss in the overweight and obese is beneficial. Reducing energy by cutting down saturated fats reduces concentrations of triglycerides and LDL-cholesterol and may increase HDL-cholesterol.

Monounsaturated fats do not increase LDL-cholesterol and may help to decrease it. The main sources of monounsaturated fat are olive oil, rapeseed oil, peanut oil, peanuts, pecans, almonds and avocado pears.

Polyunsaturated fats are found in plant oils such as sunflower, corn and soya oils. Monounsaturated oils and spreads should be used in preference to these.

Dietary cholesterol is less important than saturated fat but intake of cholesterol should not be excessive. While cholesterol is present in some foods such as eggs and shellfish, most of the cholesterol in our blood is made from the saturated fat in food. Cutting down the saturated fat in the diet can help reduce blood cholesterol. The emphasis therefore should be on reducing saturated fat intake rather than the number of eggs eaten each week. However, consumption of eggs and shellfish should not be excessive.

   

Omega-3 fats:

 

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Including a portion of oily fish at least twice a week has been found beneficial: 100g or 4oz portion, such as mackerel, herring, sardines, trout, salmon, pilchards and fresh tuna. Tinned tuna does not contain sufficient omega-3 fat to be counted.

 

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Pregnant women, young girls and women intending to have children are advised not to have oily fish more than twice a week.

 

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Non-fish sources of omega-3 fats are rapeseed, canola, walnut, linseed and flax oils. It can found as well in ground or crushed linseeds, soya, flax seeds, unsalted nuts, tofu and soya beans, dark leafy greens, sweet potatoes and whole grains, however in small quantities.

 

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Some foods now have Omega-3 added or are ‘enriched’ for instance eggs, milk, yoghurt and yoghurt drinks. Omega 3 maybe labelled as EPA, DHA, ALA. The content of the enrichment can vary.

  See - Omega 3 Leaflet

Daily consumption of foods fortified with plant sterols or stanols (2-3g/d) significantly improve total and LDL cholesterol irrespective of statin treatment.

 

See- Stanols and Sterols for more information

   
Post MI Diet
 

Visit the NICE website for the guidance on post-MI

Patients should be advised not to take supplements containing beta-carotene, and should not be advised to take antioxidant supplements (vitamin E and/or C) or folic acid to reduce cardiovascular risk.

Patients should be advised to consume from two to four portions of oily fish.

For patients who have had an MI within 3 months and who are not achieving the recommendation for oily fish consumption, omega-3 fish oil supplements may be considered.

Patients should be advised to have a healthy balanced diet.

 

See -  Facts on Fat and Eat Your Way to a Healthy Heart

Patients should be offered an individual dietary consultation to discuss diet, including their current eating habits, and advice on improving their diet tailored to their needs, which can be extended to the whole family.

Patients who drink alcohol should be advised to keep weekly consumption within safe limits.

 

See - Alcohol Fact Sheet

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Useful External Links & Resources

View

Food Standards Agency

View

NICE

PDF File

Salt Fact Sheet

PDF File

Fats Fact Sheet

PDF File

Alcohol Fact Sheet

PDF File

Eat Your Way to a Healthy Heart

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