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Know more about Uric Acid

Know more about Uric Acid

PRinc_photo_of_inflamed_gout_toe

Gout is an inflammatory disease affecting the joints , commonly the big toe of the foot, the mid foot or the ankle. This is caused by an increased level of uric acid in the blood. Purines break down inside the body to form uric acid. When there is too much of purine intake or when there is less of excretion of uric acid by the kidneys, it leads to an increase in the body.

A lot of people are affected by this and often are mistaken for having fractures and land up having X-rays taken. The pain is excruciating and can make life miserable to a point where common chores such as walking, standing, driving are so much limited.

Hyperuricemia ( high levels of uric acid) are associated with the following:
kidney stones

 

 

 

• Abdominal obesity
• Associated with diabetes mellitus type 2
• Associated with metabolic syndrome
• Joint destruction with recurrent attacks
• Stones in the urinary system- these cannot be seen in normal X-Rays as it does not block the X -rays. Uric acid stones are smooth rounded and so may not cause blood in urine.

• Generally males are affected more. Women after menopause can be affected.

Stages in Gout

gout3

 

• Hyperuricemia- high uric acid levels in blood.
• Precipitation of uric acid crystals in the joints ( commonly the base of the big toe, mid foot joints or ankle)
• Acute pain and swelling of the foot or joints. The skin may be reddened which is why it is often mistaken for an abscess.
• Chronic inflammation leading on to joint destruction and change in bone shape. This can lead to Tophi ( pronounced as TOE-fi)

 

What precipitates high uric acid levels? :
kidney stones 3kidney stones 2

 

 

 

 

 

 

• Being exposed to very cold climate
• Binge drinking of alcohol
• Red wine in excess of 2 units/day
• Tea in excess of 4 cups a day ( whether green or black)
• Coffee in excess of 4 cups a day.
• Dark chocolate in excess
• Food such as mushrooms, asparagus, anchovies, moong beans, lentils, soya beans, white beans and raisins.
• Sea food such as mussels, lobster, shrimps or prawns, scallops, salmon and tuna.
• Rabbit meat, duck meat, turkey, chicken, Pork, salmon, beef and mutton.
• Some medicines for blood pressure, medicines taken for preventing rejection after organ transplant, those on cancer chemotherapy and low dose aspirin.
• Drastic weight loss measures.
• Dehydration
• To vigorous an exercise regime
• Too much of sugar sweetened carbonated beverages

What are the gout friendly food items ?:
• Fruits such as apples, figs, bananas, pineapples, grapes, cherries, water melon, grape fruits, papaya, peaches, pears, guavas, lemon, orange, strawberries.
• Vegetables such as celery, egg plant, onion, lettuce, cabbage, cucumber, ginger
• Tofu, eggs, low fat dairy, sesame seeds, cereals, vitamin C, nut butter.
Beware the sugar content of some of the food items listed above.
Interestingly, the high blood sugar levels can help in excretion of uric acid by the kidney. Thus, when the sugar levels improve, the uric acid levels can increase leading onto a flare.
How to prevent gout:
• Adequate water or fluid intake
• Avoid the precipitating factors
• Consume the gout friendly food
• Maintain a healthy lifestyle and prevent being overweight or obese.
• Avoid sugar sweetened beverages

How to treat:
• Meet the doctor.
Ice cubes to be used for fomentation of the affected areas.
• Pain killers such as Indomethacin or Naproxen or Sulindac are preferred. However noted pain killers such as Ibuprofen ( Cataflam®) or diclofenac ( voltaren®) will not always be effective.
Colchicine to be used within the first 24 hours of an attack helps.
Oral Steroids ( prednisolone) in high doses can be used to reduce the inflammation. Some need an injection of steroids into the joints to relieve the pain.
• After the acute attack is subsided, allopurinol can be used to prevent the flares. Taking this during an acute attack may cause worsening of the attack.
• Sometimes Probenecid is advised by the doctor along with the other medicines to help in excretion of uric acid.

 

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Vitamin D

Vitamin D

sunshine

Vitamin D is a fat soluble vitamin which is not excreted through kidneys unlike the water soluble vitamin . Over the past 6 years, Vitamin D has caught the attention of both patients and health care providers alike.
Causes of deficiency:
• Animal based products are richer in Vitamin D in comparison to vegetarian diet.
• Those who spend more time indoors.
• Those using a lot of sun block lotions.
• Those with dark skin absorb less.
• Obese people absorb less.
• Elderly people are more prone as they spend less time outdoors, kidneys do not work well, the skin will not absorb sunshine effectively.
• Some people have digestive tract problems which will not help in absorption. Those with Crohns` disease, cystic fibrosis and Celiac disease are known to have associated Vitamin D deficiency.

In the Muslim population wearing of the ” Abhaya” by the women which covers the whole body as well as the men who wear long robes can prevent sunshine falling on the body. This robe is helpful against the harsh sunlight in the middle east.

Vitamin D deficiency is quite common among the middle East population as they prefer spending more times indoors. Vitamin D deficiency is quite common in the USA or UK because of lack of effective sunlight.
A study was conducted in Hawaii among 93 people who spent an average of 29 hours a week in the sunshine without sun block. Interestingly, slightly more than half of them had low levels of vitamin D !!!.

Sunshine is a good but unreliable source of vitamin D. The vitamin D inactive form absorbed from the intestine and skin are converted to the active form in the kidney.

Dietary Sources of vitamin D
• Fish and fish oils
• Egg yolks
• Fortified dairy products including milk, cheese, yoghurt, buttermilk. Most of the calcium containing food and beverages can be fortified with vitamin D.
• Grain products
One tablespoon cod liver oil contains 1360 IU of vitamin D
3 oz salmon contains 800 IU vitamin D
8 oz fortified milk contains 100 IU vitamin D
8 oz fortified orange juice contains 100 IU vitamin D
Check the nutrition labels for the vitamin D levels which will be entered into the DV ( Dietary value) section.

good food

Assessment of vitamin D levels
VitD-13-grph3

Laboratory assays for vitamin D measurement are highly variable from laboratory to laboratory. Different standardizations are there in different labs.
Ordering the test is to be done after careful deliberation by the health care team.

Interpretation of the results 

< 10 ng/mL                         Deficient
10-30 ng/mL                      Insufficient
30-100 ng/mL                   Sufficient
>100ng/mL                         intoxication

How is Vitamin D produced in the body?

Vit-D-Sources-and-Cycle

 

 

Effects of low vitamin D levels
• In children, the bones become soft- called Rickets
• In adults, the bones become fragile and altered in shape which is prone for fractures- called osteomalacia.
Low levels are found linked to cancer of breast and prostate, high blood pressure, diabetes mellitus type 1 or 2, asthma, depression, unexplained weakness and muscle fatigue, multiple sclerosis, rheumatoid arthritis.
Treatment of low levels:

  • Maintenance -Vitamin D is available in tablet forms combined with calcium (available as an over-the-counter form). This is given in those who have near normal levels.
  • Intensive- Vitamin D is available as capsules or sachets or even injection forms. This is used for treatment of those with low levels.

Like calcium, this vitamin is a threshold nutrient which means, once levels are normal, any excess ingestion will not be of any benefit. All of the vitamin D cannot be absorbed from the intestines. But, there is no easy test to measure the rate of absorption.

International governing bodies from around the world have recommended the following needs of vitamin:
• Infants up to 6 months of age need 400 Units a day and safe limit not more than 1000 IU a day
• Infants aged between 6 and 12 months need 400 units daily and safe limit not more than 1500 IU a day
• Children between 1-3 years- 600 units a day and not more than 2500 IU a day.
• Children between 4 and 8 years 600 Units daily and safe limit not more than 3000 IU daily
• Those between 9 and 70 years, 600 units a day and safe limit not more than 4000 IU daily
• Those above 70 years 800 units daily and not more than 4000 IU daily.
• Pregnant and breast feeding ladies need 600 IU daily.

Magnesium has a huge role in absorption of vitamin D from the intestines. Soya beans, black beans, sesame seeds, green leafy vegetables and dark chocolate are good sources.

Spending quality time outdoors in sunshine such as playing at the beach, getting a whiff of fresh air or going for a swim will definitely make one more energetic rather than remaining indoors. But, too much of sunshine can also predispose to cancer of the skin .

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Tips for Dining Out With Diabetes

Tips for Dining Out With Diabetes

Tips for Dining Out With Diabetes

Eating less salt can substantially reduce the risk of health problems associated with high blood pressure, which is a risk factor for heart disease and stroke — a cause of death for more than 2 out of every 3 people with diabetes

Appetizers

fruits

  •        Select fresh fruit or vegetables.
  •        Avoid creamy soups .
  •        Stay away from bread and rolls with salty, buttery crusts.
  •        Stay away from fried food or breaded snacks.
  •        Muffins, croissants and garlic toast are rich.

Salads

  •        Select fresh fruits and vegetables.
  •        Avoid pickles, canned or marinated vegetables, cured meats, cheeses, salted seeds.
  •        Order salad dressings on the side and use small amounts of them.
  •        Be careful of mayonnaise based salads.

Main courses

  •        Select plain foods including broiled, grilled, or roasted meat, poultry, fish, or shellfish.
  •        Select plain vegetables, potatoes, and noodles.
  •        Ask about low salt menu items
  •        Request food to be cooked without salt or mono sodium glutamate (MSG).
  •        Avoid restaurants that do not allow for special food preparation (such as buffet-style restaurants or diners).
  •         Avoid casseroles, mixed dishes, gravies, and sauces.
  •         At fast food restaurants, skip the special sauces, condiments, and cheese.
  •         Avoid salted condiments and garnishes such as olives and pickles.

Desserts

cakes 3

  • Select fresh fruits, ices, sherbet, gelatin, and plain cakes.

Controlling Portion Size at Restaurants

Servings at many restaurants are often big enough to provide lunch for two days.

  •   Ask for half or smaller portions.
  •   Eyeball your appropriate portion, set the rest aside, and ask for a take home pack.
  •   If you have dessert, share.

Beware of the urge to order more and the urge to eat all that is on the plate…

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Some nutritional facts

Some nutritional facts

the_food_pyramid 1 vegan-pyramid 3

This is one area many are still unsure of. It is generally assumed cutting down the carbohydrate intake to as low as possible when one is a diabetic helps in control of diabetes.

” Gastronomic voyeurs have long proposed that eating is a holistic form of exercise involving various muscles necessary for scooping up the food, chewing it and getting the food to the mouth.”

Restaurants and supermarkets have taken marketing to whole new level. Terms such as biggies, jumbos, king size, grand,supreme and prompts such as all-you-can-eat -buffets and two-for-one -specials are enough to lure the unwary.

A good diet should contain 50% carbohydrate, 30% fat and 20% protein according to the American Diabetic association. One should aim for a weight loss of 5-7 % of the body weight. Most of the diets turn out to be failures as they are not practical or planned to give drastic results. Normally diabetics find it difficult to reduce weight and maintain weight loss when compared to a non diabetic. Some of the medicines taken for diabetes treatment also can cause weight gain.

Generally pregnant women and growing up children need more calories.

Culture or “habits” may have taught many of us to eat in response to any triggers such as stress, boredom, and guilt. We may multitask and eat and then wonder,” How on earth did I manage to eat that whole bag of chips or that large burger?”

Food , as a four letter word, is both a necessity as well as a burden when taken in excessive amounts. You must be familiar with the age old saying, “Eat to live and not live to eat”.

As one ages, the body weight may increase as you may be consuming more calories than needed. This coupled with the decreased physical activity and excuses such as “too tired from work”, “I just need to sleep for some time” ,” I shall grab a bite and then start”, and sink into the cozy sofa to seal the fate.

Calories

The daily need of calories depend on the following:
• The body size
• The age
• The height and weight.
• Level of activity
• Gender- whether male or female
• If pregnant.

Levels of activity

A person is labelled non active if the person is doing just normal activities such as going to work, shopping and going to school.

If the person does some physical activity such as walking for 2-4 kms daily or some form of exercise besides regular activity, the person is labelled moderately active.

If the person does heavy workouts like a gym workout, good games of squash, tennis or badminton or swimming, cycling, or walking more than 4 kms a day, the person is labelled very active.

One kilogram of body weight will equal 7700 calories. To reduce one kilogram over a week, one will have reduce 1100 calories daily. This may sound impossible. But, reducing the sugar intake by just one spoon daily can reduce the calorie intake by 500 calories. That is not a big burden, is it ?

The table given below will show the caloric needs based on age, gender and level of activity

 


Age
in years

Males Females
Non              active              Mod          active       very active
Non active Mod active

very active

10 1600 1800 2000 1400 1800 2000
11 1800 2000 2200 1600 1800 2000
15 2200 2600 3000 1800 2000 2400
18 2400 2800 3200 1800 2000 2400
21-25 2400 2800 3000 2000 2200 2400
26-35 2400 2600 3000 1800 2000 2200
36-45 2200 2600 2800 1800 2000 2200
46-55 2200 2400 2800 1600 1800 2200
56-65 2000 2400 2600 1600 1800 2000
66-75 2000 2200 2600 1600 1800 2000
>76 2000 2200 2400 1600 1800 2000

If one observes the above table carefully, the calorie intake for both gender groups is maximum between the ages 18-25 . Thereafter the recommended caloric intake comes down to that of a 10-15 year old irrespective of your level of activity. Well, that is something to seriously think about.

A healthy breakfast will include whole grains, lean protein such as peanut butter, lean meat, fish, poultry and hard boiled eggs, low fat dairy such as yoghurt, cheese and milk and a portion of fruits and vegetables.

 

Know the food

Starches

Starches are bread, grains, cereal, pasta, and starchy vegetables like corn and potatoes. They provide carbohydrate, vitamins, minerals, and fiber. Whole grain starches are healthier because they have more vitamins, minerals, and fiber.
Eat some starches at each meal. Eating starches is healthy for everyone, including people with diabetes.
Examples of starches are bread , pasta, corn, potatoes, rice, cereals, beans, lentils, yam

What are healthy ways to eat starches?

• Buy whole grain breads and cereals.
• Avoid fried and high-fat starches such as regular tortilla chips and potato chips, french fries, pastries, or biscuits. Try fat-free popcorn, baked or potato chips, baked potatoes, or low-fat muffins.

• Use low-fat or fat-free plain yogurt or fat-free sour cream instead of regular sour cream on a baked potato.
• Use mustard instead of mayonnaise on a sandwich.
• Use low-fat or fat-free substitutes such as low-fat mayonnaise or light margarine on bread, rolls, or toast.
• Eat cereal with fat-free (skim) or low-fat (1%) milk

Vegetables

Vegetables provide vitamins, minerals, and fiber. They are low in carbohydrate. Examples of vegetables are lettuce , broccoli, vegetable juice, spinach, peppers, carrots, tomatoes, Celery, cabbage, greens.
What are healthy ways to eat vegetables?
• Eat raw and cooked vegetables with little or no fat, sauces, or dressings.
• Try low-fat or fat-free salad dressing on raw vegetables or salads.
• Steam vegetables using water
• Mix in some chopped onion or garlic.
• Use a little vinegar or some lemon or lime juice.
• Add a small piece of lean ham or smoked turkey instead of fat to vegetables when cooking.
• Sprinkle with herbs and spices.
If you do use a small amount of fat, use canola oil, olive oil, or soft margarines (liquid or tub types) instead of fat from meat, butter, or shortening.

There are two types of vegetables- the starchy and non starchy. The starchy vegetables can increase the sugar levels- potatoes, corn and peas are included.
Non starchy vegetables include broccoli, cabbage, sprouts, carrots, cucumber green, egg plants, ladies fingers (Okra), mushrooms, bell peppers, iceberg lettuce, tomatoes to name a few. These help in adding fiber and also keep the stomach full without increasing the sugar levels.
Fruits

Fruits provide carbohydrate, vitamins, minerals, and fiber.

fruits sugar  fruits

What are healthy ways to eat fruits?

• Eat fruits raw or cooked, as juice with no sugar added, canned in their own juice, or dried.
• Buy smaller pieces of fruit.
• Choose pieces of fruit more often than fruit juice. Whole fruit is more filling and has more fiber.
• Save high-sugar and high-fat fruit desserts such as peach cobbler or cherry pie for special occasions.
• Feel the fruits before purchasing them. If fruits are very soft, they are sweeter.
• Generally speaking bananas from the Philippines, grapes, dates, mangoes, water melon, cherries and pineapple are very sweet

Milk
Milk provides carbohydrate, protein, calcium, vitamins, and minerals.

What are healthy ways to have milk?
• Drink fat-free (skim) or low-fat (1%) milk.
• Eat low-fat or fat-free fruit yogurt sweetened with a low-calorie sweetener.
• Use low-fat plain yogurt as a substitute for sour cream.

Meat and Meat Substitutes

Meat and meat substitutes provide protein, vitamins, and minerals.
Examples of meat and meat substitutes include chicken , fish, eggs, peanut butter

What are healthy ways to eat meat and meat substitutes?
• Eat chicken or turkey without the skin.
• Cook meat and meat substitutes in low-fat ways:      broil , grill, stir fry, roast, steam and micro wave
• To add more flavor, use vinegars, lemon juice, soy sauce, salsa, ketchup, barbecue sauce, herbs, and spices.
• Cook eggs using cooking spray or a non-stick pan.
• Check food labels. Choose low-fat or fat-free cheese.

Fiber diet can slow the gastric emptying and slow down the rate of glucose absorption from the intestine. Water soluble fiber includes oats and bran. Men need 38 g of fiber day and women need 25 g a day.

But, do remember………

  • This does not mean one should avoid carbohydrates in total. Please be reminded that carbohydrates are needed for setting up the energy levels during the day.
  • One should have a hearty breakfast, a moderate lunch and a light dinner.
  • It will be worthwhile to have an approximate 45 grams carbohydrate inclusion with each of the main meals ( Normally a healthy person has 3 main meals and snacks in between).
  • Spread the carbohydrate intake during the day to help one curb hunger and thereby prevent overeating.
  • A toast of bread with an egg will fill you longer than a couple of toasts with jam.
  • Please be reminded that fish, chicken, Turkey Ham, eggs do not have carbohydrate.
  • But, addition of cheese or cream or milk while beating the gees to make them creamier, can shoot up the carbohydrate content.
  • Addition of bread crumbs and other coverings such as chick pea flour or corn flour can also send the sugar levels high.
  • All vegetables growing below the ground do contain some amount of carbohydrate and so excess consumption of the same can upset the sugar levels.
  • Those who are on insulin roughly need a unit of insulin for every 12-15 grams of carbohydrates taken.

Given below are 3 options for a meal containing 45 grams of carbohydrates

 

Option 1:

One cup of cooked oatmeal -                              32 gram carbohydrate
Half medium sized banana -                               13 grams of carbohydrate
A Hard boiled egg and some black coffee – no carbohydrate

Option 2:      

2 scrambled eggs -                                                 no carbohydrate
A slice whole wheat bread –                                 15 grams
An orange -                                                                  18 grams
A cup of low fat milk -                                              14 grams

Option 3        

3 Rye bread pieces –                                                 24 grams
Half cup non fat cheese –                                         5 grams
One cup blueberries -                                              15 grams
Avoid fizzy carbonated drinks and sugar free items as one may compensate by eating or drinking more.

Some tips for breakfast:

Those who eat a healthy and balanced breakfast regularly manage their body weight better as well as have better concentration. The breakfast is what sets the tempo and energy levels for the day.
Turkey sandwiches are a good option.
Smoothies with berries and low fat yoghurt are another good option
Whole grain oat meal with fruits or nuts
• Making a French toast with whole grain bread dipped in batter made from egg white, cinnamon powder, salt to taste and vanilla essence makes a delicious dish. This can be topped with thinly sliced apples , berries or bananas.
Do not watch television or use the computer while eating as many studies show an increased consumption of food and improper chewing of the food as well.
• Mid day snacks can be either fruits, low energy granola bars, non salted or non sweetened nuts comprising pistachios, walnuts, almonds, pecan , pine nuts and hazel nuts.
• 2 tablespoonfuls of olive oil is enough a day. Light olive oil is more processed than either the virgin or extra virgin olive oil. The light olive oil is lighter in color, but not lighter in calories or fat. Even too much of olive oil is not healthy.
• Having a bowl of salads is a healthy low calorie option ( of course without the rich creamy sauce or dressing).

Diet
• Base meals on starchy foods such as potatoes, bread, rice and pasta, choosing wholegrain where possible.
• Eat plenty of fiber-rich foods – such as oats, beans, peas, lentils, grains, seeds, fruit and vegetables, as well as wholegrain bread and brown rice and pasta.
• Eat at least five portions of a variety of fruit and vegetables each day, in place of foods higher in fat and calories.
• Eat a low-fat diet and avoid increasing your fat and/or calorie intake.
• Eat as little as possible of: fried foods, fizzy drinks and confectionery high in added sugars
• Eat breakfast.
• Watch the portion size of meals and snacks, and how often you are eating.
• For adults, minimize the calories you take in from alcohol.
• Chew food thoroughly rather than gulping down the food.
• A small gesture such as cutting back on a spoon of sugar a day or even using the salad dressings or mayonnaise as dips rather than mix with the salads can cut back on calories.

  • Try having food on a 9 inch plate with half the plate comprising non starchy vegetables, the other quarter comprising one half of starchy vegetables or grains and the other quarter with protein. The tendency to have plate of 12 inches is quite common these days to get value for money.
  • Some dairy product can be added such as glass of low fat milk or low fat yoghurt. No second helpings! Food must not be more than an inch deep in plate ………!
  • Eat slowly, chew well. It gives enough time for the brain to register the stomach is full.
  • If you feel hungry after meals, try brushing your teeth or drinking water or having non starchy vegetables.

Some tips:

  • Eat more of vegetables which are non starchy ( those grown below the ground contain more starch)
  • Choose whole grains instead of processed grains
  • Use liquid oils rather than solid fats (solid fats contain high amounts of saturated fats which have high calories)
  • Use non fat or low fat dairy products
  • Drink water in plenty. Use less of fruits juices, cocktails, alcoholic beverages.
  • Lentils and kidney beans have more proteins and less fat
  • Beware of high calorie snacks which taste good
  • Beware of junk food.

Some of the commonly used items and their caloric values:
Item                                                                            Quantity                                                         Calories
Canned beans                                                          ½ cup                                                                  127
Bread                                                                         One loaf                                                                70
Normal butter ( salted)                                      Big spoon                                                            102
Non fat creamy cheese                                        28.35 g                                                                  23
Low fat cheddar cheese                                      28.35 g                                                                  79
Half fat creamy cheese                                       2 big spoons                                                        64
Full fat mozzarella                                               28.35 g                                                                   90
Non fat yoghurt                                                     Cup                                                                        137
Flavored non fat yoghurt                                  Cup                                                                        162
Low fat yoghurt                                                     Cup                                                                        155
Flavored low fat yoghurt                                   Cup                                                                        250
Full fat yoghurt                                                      Cup                                                                        150
Flavored full fat yoghurt                                    Cup                                                                        292
Non fat milk                                                             Cup                                                                         86
Full fat milk                                                              Cup                                                                       150
Boiled egg                                                                 One                                                                        66
Egg mixed with oil fried                                      2                                                                            197
Fried falafel                                                            28.35 g                                                                  111
Dried dates                                                                5                                                                             114
Fried potatoes                                                      ½ cup                                                                     87
Fruit juice                                                               Cup                                                                         117
Beef                                                                           85.05 g                                                                  176
Roasted beef                                                          85.05 g                                                                 211
White rice                                                              ½ cup                                                                     103
Brown rice                                                              ½ cup                                                                    108
Spaghetti macaroni                                            Cup                                                                          197
Nuts                                                                           ¼ cup                                                                    161
Peanut                                                                      ¼ cup                                                                     212
Almonds                                                                  ¼ cup                                                                     211
All oils                                                                     One big spoon                                                       120
Mushroom                                                              Cup                                                                            18
Mixed vegetables                                               1 cup                                                                           38
Ice cream 10-12% fat                                        ½ cup                                                                       143
Fruit salad                                                              ½ cup                                                                        47
Chicken                                                                   28.35 g                                                                       56
Cereals:
Some have cereals with milk or some just put in a handful or two into their mouth and chew on them. The market is flooded with innovative labels and cereal boxes have attractive packs to lure the people. Most of the cereals are made targeting the kids and so they are rich in sugar.
• Go for the ones made for adults
• Read the nutrition labels well
• If sugar is written near the top half of the label, it means the sugar content is more.
• High fructose corn syrup, honey coated cereals, dextrose are all forms of sugar.
• Look for serving size- some may have one cup, some half a cup
• Look for calories per serving- Go for the ones which have < 160 cals per serving.
Go for adequate portions of vitamins and minerals, have some fruits and vegetables and limit trans fats, saturated fats.
Did you know?

• Stress levels and infections can increase the sugar levels.

• Sports drinks contain as much sugar as in a fizzy drink

• Dried fruits contain more carbohydrates

• Birth control pills can increase the sugar levels.

• Prolonged moderate intensity exercise can predispose to low sugar during or after the exercise

• High intensity exercise for a short time can lead to high sugars!

• Cold temperatures and high altitude can increase the risk of low sugars

• Repeated episodes of low sugar can reduce the body`s ability to recognize low sugar. The counter regulatory response by the body is also blunted in such patients.

 

Is this the shape of things to come?

 

Food-Pyramid 2

This is an interesting concept to follow:

my_food_pyramid 4

 To get the maximum of the food one has try these tips:

Pick food from different groups such as using fruits, vegetables, low fat milk, yoghurt, whole grain bread, pasta, brown rice, lean meat, fish, poultry and eggs.

Keep a track of unhealthy eating habits:

  • The day and time of the day
  • The mood at that time
  • What one was doing at that time
  • The location
  • Portion sizes
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Diabetes and digital age

Diabetes and digital age

Though close to 85% use the internet even if from the low socioeconomic  population, digital technology and web based application usage has been very slow to catch on when compared to the boom experienced in the retail shopping and banking sectors worldwide. The vast majority of online communities, mobile applications ( Apps, as they are commonly known) and web sites have been very sluggish in integrating with the mainstream health care stream.

Social networking sites such as Facebook, Twitter, Instagram, WhatsApp and many others I am unsure of, have helped transform social life in a big way to a point where people avoid face to face contact. But these sites have also helped create a platform to support sharing of knowledge, communication and understanding, lever positive behavioral changes and also help in using the audiovisual mode of communication which lingers longer in memory.

More frequent consultations will be costly and not affordable to many even this day. This way of e- health will help tide over this if used well. This will help in increasing treatment adherence, health related behaviors as well as give a feeling of being looked and cared for.

But, there are some barriers to accepting the digital technology such as :

  • in those with physical or visual impairment
  • those who are illiterate
  • those who do not read or speak english
  • those residing in geographically remote areas
  • those with social phobias
  • those concerned about their privacy

 

Telephones have become more than just a gadget to either receive or make a call. With the new generation smartphones, one can record conversations, take excellent photographs, transfer them instantly through internet, chat with friends on the social media, create presentations for meetings, store data in excel format, fax documents, scan documents, use the phone as an organizer, store songs and movies which can be played when alone or bored. Now – a days, these smartphones have also taken the role of a health assistant which can track the progress in exercise schedule, diet, weight loss, and store personal data such as sugar readings over the past 3 months with a graphical representation included. These can be uploaded where you are on this planet and can be linked to the doctors phone for an instant viewing. The list is endless. Maybe there is an app which can remind one to take the medicines on time in case one has forgotten.

There were days when people used log books to record their sugar readings and might even forget to get them when coming for the consultation. Now – a – days with advancements in technology, there have been significant developments in the way a person with diabetes can record their progress or even hide their frustrations by making excuses such as worn out batteries and even having forgotten them at home.

Things have become so technological these days with the data being uploaded to a remote system or a good mobile devise or even the doctors chambers. This comes particularly handy among the young children who sometimes tell lies to escape the wrath of their parents. The data is instantly shared with the parents phone devise helping them keep a track of the events.

There are numerous applications ( Apps) which can be downloaded either for free or for a price which can help in various functions and even take over as a personal health secretary. The list is so vast and all have not been mentioned here. Some are free to download , some have to be paid for.

 

Some apps for nutrition include :  Fooducate, Carbs and Cals, Carbmaster free, calorie counter, calorie tracker, daily burn, lose it, Go meals, weight watchers mobile

Some apps for exercise include: my fitness pal, run tracker,workout trainer

Some for glucose monitoring include: Bant, dLife, Glucose buddy, GluCoMo, Wave sense, Glooko, DBees.com, Glucatrend diabetes, VRee, On track, Handylogs sugar
Ihealth wireless smart glucomonitoring system and TelCare wireless glucose meter can help synchronize ( or sync ) the data with an App, website or even an i cloud.

 

Ditto

ditto glucose data system

This is a devise connected to a glucometer which can transfer data to a remote system or website.

Glook O

glooko

This is a cable connecting a phone to a glucometer. This can be uploaded to the cloud .
Some of the Apps can even show long term trends and graphically represent them making the visualization much better ( if all is going well) . The only problem is one will have to enter the data and allow the App to take care of the rest. This data can be shared with the health care provider almost immediately which helps taking health care to another level.

Diabetes Pal- this helps even recording and advising on level of physical activity and can record the glucose readings as well.

Glucose Buddy

diabetest apps_0

This app lets you record blood glucose levels and note the time of day—such as “before breakfast” or “during activity.” You can view trend graphs, interact in the Glucose Buddy forums, and record insulin injections, exercise, and food eaten. You can also sync your phone to an online account to manage your data on Glucose Buddy’s website. Devices: iPhone, iPod Touch, iPad

WaveSense Meter
wavesense app

 

Manufacturer AgaMatrix’s app lets you log blood glucose levels and type in personal notes. You can record the amount of insulin injected and the number of carbohydrates eaten, and view one-, three-, seven-, 14-, 30-, and 90-day trends in graph or chart form. High, in-range, and low readings are color coded in the logbook. And you can e-mail your stats to family or your doctor. The app comes loaded with about 50 diabetes-related videos. Devices: iPhone, iPod Touch, iPad
OnTrack

Medivo-Acquires-OnTrack-Diabetes

With this app one can log and store the blood glucose level as well as food intake, blood pressure, weight, exercise, pulse, A1C results, body fat percentage, and medications  taken. For each entry,  personal notes can be added. Results can be exported via e-mail to your medical team. Devices: Android phones

 

Lose It

 

lose it app

Track  weight loss, daily food intake, and exercise with this comprehensive app. Meals taken can be added instantly (from a list of common foods, brand-name foods, and restaurant meals, or  own recipes) and watch the sliding scale climb toward the recommended daily calorie limit. One can record exercise (choose from a long list of activities), graph the weight loss, get reminders, and share the progress on Facebook and Twitter. Devices: iPhone, iPod Touch, iPad

Calorie Counter by MyNetDiary

my net diary app

With this app, eon can record meals (choose from an expansive food library that includes restaurant picks), exercise, water intake, medications,  weight and measurements. Food selections include nutrition facts

dLife-

app for DM

This app gives an idea of food and how it affects the sugar, recipes and even short videos. The diabetes website dLife makes a diabetes application that you can use to log glucose levels, find recipes and nutrition information, watch dLife videos, and connect with the dLife community and experts to get answers to your diabetes-related questions. Aside from logging the sugar levels, you can graph daily, weekly, or monthly levels and track trends—all of which  can be e-mailed to yourself or your health care provider. Devices: iPhone, iPod Touch, iPad
Fooducate

 

fooducate-diabetes-app-icon

This app could be your shopping companion on the next trip to the grocery store. You can scan barcodes, search for products, and browse categories to find foods you’re shopping for. By selecting a food, you’ll get a list of health pros (100 percent whole grain!) and cons (loaded with high-fructose corn syrup!) and can compare it to similar products. Keep track of products you eat regularly by “liking” a food. Then, next time you hit the store, you can pull up a “my likes” list of foods you might want to buy again. Devices: iPhone, iPod Touch, iPad
7 MINUTE WORKOUT

7 minute workout app

This is an app which can fit into any routine, has 12 simple exercises which are scientifically formulated.
SWORKIT –

sworkit-app-e1360796738997

This has exercises for strength training, yoga, cardio and stretching. All one has to do is to select a workout category, and how long the exercise plan should be for. Accompanying videos will help show how to perform the exercises properly with minimum injury and maximum effect.

 

 

 

 

 

 

 

RUNKEEPER-

run keeper app

This is an app which is ideal for those interested in cycling, running, swimming and biking. This has an in built Goal Coach which sets a realistic goal to follow.
ManageBGL is an app that offers a simulated insulin pump. This is of use among those who are having Type 1 diabetes or those having type 2 diabetes with multiple doses of insulin.This needs some input such as current and previous blood sugar levels, carbohydrate intake, insulin dose and this will predict the future glucose readings and aid in auto calculation of bolus insulin dose.

To help those who are handicapped with poor eyesight, some glucometers have come with a voice readout.
Sharing the data through social media such as WhatsApp, TalkRay , Viber, Instagram and Facebook have made the modes of sending across data almost instantaneously. If you ever noticed, a once upon a time luxury called email, has now almost become mandatory. There have been instances when patients have even used the above to send me snaps of the medicines they wish to have refilled or even to send me snaps of some ulcers on their foot to help monitor the progress and even to help with their appointments. Scanning and sending their test results from the far corners of the world can be sent across through one of these portals.

 

 

 

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Winter and Diabetes

Winter and Diabetes

Winter-Snowman (1)winter

 

Normally during the cold winter months, the levels of HbA1C, the 3 month average of sugar, can be higher due to higher food quantity consumed to combat the cold, the frequent outdoor barbeques and probably excess liquor consumption with the co incident Christmas and New Year festivities. People spend more time indoors in places where the weather is extreme. Lack of adequate physical activity and excess sleeping hours cuddled up under the warm blankets add more insult. It is quite natural to gain 5-6 kilos during the winter.

Blood Sugar Testing

GlucometerThe finger tips may be cold and so warm them by rubbing them together or wrapping them around a hot mug before pricking the finger for testing. In places where it snows, the glucometer kit has to be kept warm in covered bags so that errors do not come in the readings

 

 

 

Exercising

It is difficult to work up a sweat while exercising during this time and one may feel cold after the exercise due to the evaporation. Remember to dress adequately while going for outdoor exercises. Hydration with adequate amounts of fluids is still important even in the colder months. Dehydration can increase the sugar levels.

yoga       Tai Chi

 

 

Hula Hoop             swimming

Exercise such as skipping rope, doing the Hula Hoop, aerobics, dancing, yoga, swimming in thermal controlled swimming pools or working out in an indoor gymnasium do wonders. The benefits of exercise are the same whether done during winter or summer!!

Some blame the cold for exercising outdoors, but then they also blame the summer heat and humidity when that sets in.

Care of Skin

It is important to take good care of the skin as it can dry quite fast. Adequate and generous application of moisturising creams, and sunscreen if going to winter sports such as skiing or snow surfing or those just trekking in the snow laden mountains are very important. Adequate hydration keeps the skin shining and hydrated.

Those with neuropathy ( where the nerves of the feet are not working properly) may have difficulty in gauging the heat of water used for bathing.

Take care of the feet. Do not use hot water bags to keep yourself warm. Use multiple layers of clothing or socks at night to the feet. In some countries warm fireplaces keep the rooms warm, but beware the carbon monoxide accumulation.

Food & Beverages

Alcohol may cause a sense of warmth caused by dilatation of blood vessels, but the same may be lost after some time. Manage the consumption of alcohol wisely. Try to take hot beverages and easily digestible food such as soups, oats, porridge, steamed food and some fruits. Black tea with crushed ginger and black pepper is a good drink to even soothe the throat. Remember that excess red meat consumption can lead to high cholesterol levels in some races. The temperature can get quite low at night and it is natural people may eat more to raise their body temperature. Remember you do not need that much food at dinner whether it is summer or winter. It is healthier to sleep on a lighter stomach.

Frequent respiratory infections , mostly viral, are quite common. It is wise to have a Flu vaccine taken once a year rather than have to take multiple courses of antibiotics and medications to combat the infection. The elder adults should have a shot of pneumococcal vaccine once in their life.

It is also quite common to get infections due to food poisoning from eating out .

Use tissues, frequent washing of hands  using soap and water or sanitizers especially before shaking hands with others help to prevent transmission.

Gargling of the throat with warm saline helps. So also does steam inhalation.

Fizzy cool sugary drinks do not help whether it is summer or winter.

Enjoy the winter because you will wish it was like this when summer blasts in.

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glycemic index

glycemic index

glycemic-index-chart

Glycemic index ( GI )of a food is the increase in blood glucose ( above fasting glucose) 2 hours after ingestion of a constant amount of food divided by a reference food( usually glucose).

To make this easy to understand, if the GI of a particular food is 72, this means that 72% of the ingested food is converted to glucose within the body after 2 hours of consumption.

GI reflects the rate at which carbohydrate is absorbed and digested by the body. Try to aim for low GI food combined with medium or high GI food rather than have more of high GI food. Whatever be the diet chosen, the dietary management has to be combined with physical activity for maximum benefit. A diet which suits one person may not suit all. It is advisable to see which food increases the sugar levels by checking the sugar levels after each food ( this is painful, but this can help to decide which food suits a person).
Low GI food stuff with the GI levels
Yoghurt low fat 14             Milk chocolate 24             Multi grain bread 48          Broccoli 15            Spaghetti 27              Parboiled rice 48                      Celery 15                              Skimmed milk 32                 Carrot juice 45               Bell peppers 15          Fat free milk 32   Jams and marmalade 49            Spinach 15                         Apple 38                         Low fat ice cream 50            Tomato 15                      Plum 38                   Orange juice 52                       Soya beans boiled 16             Pears 38               Kiwi 53                          Artichoke 15           Apricots dried 31                     Banana 54                            Asparagus 15

Black beans 41               Sweet potato 54              Cauliflower 15          Boiled lentils 29                  Egg plant 15                Boiled kidney beans 29      Lettuce 15                                 Green beans 15                          Peanuts 15                             Cucumber 15

 

Medium GI food with their GI levels

Oat bran 55                       Rye-flour bread 64                        Rice, brown 55                 Apricots (tinned in syrup) 64         Fruit cocktail 55 Raisins 64                          Spaghetti, durum wheat 55           Macaroni cheese 64        Popcorn 55                                             Beetroot 64 Muesli 56                          Mars bar 64                                          Mangoes 56                         Black bean soup, tinned 64         Potato, boiled 56

Cake , tart 65                  Mini Wheats (wholemeal) 57           Potato, steamed 65 *       Table sugar (sucrose) 65       Apricots 57

Barley, flakes 66             Potato, new 57              Pineapple 66         Digestives 58              Rice, white 58     Croissant 67         Pizza, cheese 60               Ryvita 67                          Hamburger bun 61      *Ice-cream 61 Whole meal bread 69     Shredded Wheat 69          Muffin (unsweetened) 62                Potato, mashed 70
High GI food with their GI levels
White bread 71                    Broad beans 79                     Golden Grahams 71                 Jelly beans 80                                               Millet 71             Pretzels 81 **                         Watermelon 72                     Rice Krispies 82                     White rolls 73                          Potato, micro waved 82    Puffed wheat 7                   Cornflakes 83                             Corn chips 74                      Potato, instant 83                                       Chips75

**Potato, baked 85             Rice pasta, brown 92             Doughnut 76                      Wafer biscuits 77 **                 Rice cakes 77

Dates 103
** low in calories and highly nutritious
* empty calories

 

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