It is a welcome change in the climate after months of scorching heat in the middle East. This might last for a couple of months before the scorching heat picks up again. It is the time for outdoor partying, smell of inviting barbeques and probably increase in bad cholesterol levels !!!!! It is also the time for contracting viral fevers. Have you had your annual flu shot? The Flu Vaccine at least helps against many of the strains of virus which are getting more complex with each passing year.
Losing weight is something the doctor always stresses on. Interestingly, you might notice that the males are generally reluctant to address the obesity as well as their female counterparts. Moreover, weight loss is slower among those with diabetes due to the medicines they are on and also due to diabetic dysregulation. But , that cannot be used as an excuse for losing weight or even trying to.!!!! There is always a weight loss plateau that is to be expected and that should not deter yourself from continuing, but will need a self assessment as how to overcome the plateau.
Many now blame the cold weather and cold breeze and wish to remain cuddled under the blankets or remain indoors and try eating more to keep the body heat.
Impulsive eating can occur when stressed ( positive stress is during a vacation and negative stress during a personal tragedy) , when angry, when depressed or when worried about an upcoming event or even when stewing over a conflict at office or work. This often leads to impulsive eating followed by the guilt and again feeling low followed by eating again which gets you nowhere healthy !!!
Bed time snacking
People might keep on snacking to give them the so called energy while staying up awake while working late hours. There are certain occasions when you are allowed to snack especially when having an early light dinner and sleeping late. But, there are certain things to be known while snacking.
Warm milk contains tryptophan and helps in sleep
A bowl of cereal with milk or a glass of labaan( butter milk) , crackers or bread and cheese all can cause sleep due to the carbohydrate content.
Sources of hidden caffeine and fatty food such as burgers can impair with sleep.
Alcohol ( nightcap) might cause nightmares, frequent awakening, night sweats and headache for some which can impair with sleep. Drink plenty of water after the sleep.
Protein rich and high fat food will cause problems in digestion which can impair sleep.
Spicy food and smoking can impair with digestion.
So make healthy choices while snacking. Snack is just a small meal and not another meal.
The winter months are a cause for celebrations and family outings . The smell of barbeque fills the air after the sun sets. People might eat more of meat and prawns which might increase the cholesterol levels. You can however go a walk outside as the climate is much better than the hot humid summer climate.
Generally sugar levels and cholesterol levels rise with the increased food and alcohol consumption during the winter months.
You can safely exercise indoors if the weather outside is not to your liking. Tai Chi, Pilates, using the Hula Hoop, dancing to music, yoga, skipping rope or just spot jumping helps burn calories. Zumba or kick boxing are options that needs a trainer to help you out. For the fitness freaks who like to sweat it out in a gym, try something new at the gym or use resistance bands. You can swim or do any exercise in the pool as water is kind to the joints. Aqua aerobics is catching up in a big way as it is entertaining and kind on the joints as well. One can enjoy shopping by walking in the malls and doing window shopping !!!! Walking is still a good exercise. Take care of your footwear and use proper clothing if walking outdoors. Cover your head and neck if very chilly. The new form of play station using the X box helps you engage in interactive games and helps you combine entertainment with exercise and it can be enjoyable when performed with either family of friends.
For those who are interested in resistance training using small weights, remember to always warm up, stretch and do repetitions of ten to twelve in a smooth controlled motion. The muscles might ache at the beginning, Give a rest in a between and try these on alternate days to help the muscles to recover.
How to overcome barriers to exercise?
Break the times of exercise to smaller periods if it not practical to spend 30 minutes a day for five days a week.
Identify causes of waste of time such as watching the television, lying on the sofa. See if these can be overcome.
Reframe the concept of exercise such as walking the dog or taking the kids for playing, playing ball on the beach or even dancing, walking in a mall, walking around a large airport terminal while waiting for the flight.
Join a group who can motivate you.
Watch the television or listen to music while exercising.
Take stairs instead of the lift or escalators.
When ill, do not exercise.
There are numerous apps which can be downloaded from the app store if you have a smartphone. These can monitor the progress and can even motivate you to get moving.
Ask yourself why you want to lose weight:
Feel comfortable in clothes
Improve self image and confidence
Improve physical stamina
Improve energy levels
Be a role model for my family
Improve the blood pressure, cholesterol and diabetes
Reduce joint pain
Improve life expectancy
You might want to add more…..such as want to look good at a function or don those clothes which you outsized and so on…..
Write down the challenges and obstacles you face towards achieving the goals. The more honest you are with yourself, both in recognizing the obstacles and coming up with realistic strategies, greater are your chances at succeeding. Let that be your New Year resolution.
Diabetes is on the rise the world over. Just about anybody can become a diabetic whether you are rich or poor or a male or female or whether your parents are diabetic or not. It is largely attributed to the disordered lifestyle habits and increased stress levels in day to day life that has caused this to blow out of proportion.
People turn to shortcuts such as the great number of diets available each one claiming superiority over the others, a great number of holistic medications or alternate medicines and of course, sugar free substitutes. It has taken the markets by storm and you have so many available in the market today which has been incorporated into carbonated soft drinks, chewing gums, baked goods, cakes, fruit juices, candies, ice cream and even yogurt.
There are natural sweeteners such as Agave nectar, date sugar, fruit juice concentrate, honey, maple syrup and molasses which are available in the market.
The artificial sweeteners are always artificial though some products such as those containing stevia are claiming themselves to be natural. But it has to be either refined or processed to be marketed. These are intensely sweet and are many times sweeter than natural sugar. All the sweeteners leave an aftertaste.
There are different types of sweeteners such as :
Low calorie or no calorie sweeteners
Non nutritive sweeteners
Reduced calorie sweeteners
Some of the sweeteners can be used for either baking or cooking as well. These can come in different forms such as tablets, or sachets containing powder or in liquid forms.
Sugar alcohols do not contain alcohol and do not contain ethanol which is seen in alcoholic drinks. These are naturally seen in certain vegetables and fruits, but can also be manufactured. These help to increase the bulk and improve texture when added during cooking or baking. These are seen in toothpastes, mouthwashes, chewing gums, frozen desserts, fruit spreads and chocolate. It is labeled as Xylitol or sugar alcohol in the nutrition labels.
When consumed in large quantities the use of sugar alcohols can cause a bloated up feeling, loose stools and abdominal fullness
I have seen many people who had a craving for sweets after consumption of the artificial sweeteners which in turn, causes the sugar levels to fluctuate. This in turn, leads to an increase in either the doses of medicines or injectables with the hope to control sugar levels. Just being off the artificial sweeteners bring about so many changes and reduces the cravings as well.
Some of the common brands available in the market are:
Sweet N low® contains sachharin
Equal® contains aspartame
Sweet one® contains Acesulfame potassium
Splenda® contains Sucralose
Fruit juice concentrates contain Neotame
How sweet are these artificial sweeteners?
Sachharin is 300 times sweeter than sugar, aspartame is 180 times sweeter, acesulfame is 200 times sweeter, sucarlose is 300 times sweeter and Neotame is 7000 times sweeter than sugar.
Whenartificial sweeteners are used there are some health concerns to be careful of- these can attribute to weight gain, tooth decay, probable increase in incidence of diabetes, cancer and troublesome numbness of the hands and feet, muscle spasms, giddiness and cramps. Generally people who are diabetic or those at risk to develop diabetes tend to rely more on ingestion of the so called sugar free containing food items. Besides having a lot of artificial sweeteners, the rest of the ingredients are the same which do add to the calories. Also it is worth bearing in mind that the taste has to be modified to enhance the flavor and also help it being sold off the racks at the supermarkets. The enhancement of flavor is done with the help of adding more hydrogenated oils or butter or fats which leave an excellent buttery taste and can help increase cholesterol levels !!!! People in this mad frenzy, tend to overeat their portions because of the false security given by the artificial sweeteners.
Being a diabetic does not mean you should be off sugar in totality. Your body needs a balance of sugar, salt, fats, carbohydrates, proteins and fat to make a complete meal which can be taken as small frequent meals to prevent cravings later on. Combine this with adequate physical activity and all will be well.
The solution to sugar needs:
You can substitute the white sugar with brown sugar or cane sugar which is the unrefined version of sugar. It is extremely hygroscopic and hence absorbs water from the atmosphere once the cover if opened. Store this in air tight containers. Roughly 3 spoons of brown sugar equals one spoon of white sugar.
Remember that people of the previous generation did not rely on artificial sweeteners.
Checking the blood sugar is as common as checking ones blood pressure these days, but is not done as frequently though. There may be no symptoms at all related to high blood pressure or there maybe headache, giddiness or even shortness of breath. Some may present with severe headache or paralysis of one side of the body with a slurred speech or chest pain as part of a massive heart attack.
Having high blood pressure undetected and untreated over a long period of time, can put a strain on the important organs such as the heart, kidney, brain and eyes.
Blood pressure, diabetes mellitus and high cholesterol levels are like close friends. These all are affecting the blood vessels and having one can put you at risk for developing the other two.
Blood pressure is the pressure of the blood in the blood vessels which help propel the blood forward from the heart to different parts of the body carrying oxygen where needed and also carrying away the waste products from the kidneys and liver.
Blood pressure is recorded by a machine called sphygmomanometer in which a mercury expansion is measured. This is operated only by health care professionals as you have to hear the sounds to decide the blood pressure.
Now-a -days, digital blood pressure machines are available. The ones measuring the blood pressure by inflating the cuff around the arms is preferred. The ones measuring around the wrist is not reliable. The digital machines can be battery operated and or AC/DC operated. The batteries have to be removed after each check to prevent the leak of the batteries while kept inside for indefinite periods of time. There are two readings for the blood pressure, called systolic for the top reading and diastolic for the lower reading. So if the doctor tells your blood pressure is 130/80 mm it means, 130mm is the systolic and 80 mm is the diastolic reading.
The blood pressure can vary with the position, posture, soon after exercise, soon after driving, and even for some when they come to the hospital or clinic due to anxiety. It is wise to check the blood pressure after relaxing for some time. For those where anxiety visiting the hospital causes high readings, it is wise to have the blood pressure recorded at home with a machine and make a set of readings for a week and have the doctor analyse that. There is a devise which can be connected to the upper arm for 24 hours ( 24 Hour ambulatory Blood pressure monitoring) which will measure the blood pressure every 20 minutes even during sleep and activity and have the data downloaded. Keep the arms straight while the cuff is inflating to avoid errors in the machine reading. For some, the blood pressure is highest while at work, for some it is highest at night. Mental and physical stress plays a major role in fluctuations of blood pressure levels.
Pregnant women may get high blood pressure readings which are treated with some specific medicines as they will not cause harm to the growing baby. The blood pressure spike is usually associated with swelling of the feet and proteins in the urine. Some even get blurred vision.
Normally a doctor will not start medications for blood pressure based on one reading. An average of readings which show a persistent set of high levels will decide. The blood pressure can be high even for children in those having some diseases of the kidney. The cuff diameter is different while measuring the blood pressure for children and for those who are obese. The normal blood pressure readings are between 120-140 systolic and 70-90 diastolic. Generally the elasticity of the blood vessels is lost as one advance in age and so the blood pressure can be slightly high for the elderly and hence a level of 140/90 mm Hg is normal for the elderly.
What can be done from your side:
Avoid stressful situations as much as possible. Learn relaxing techniques such as doing something you like or meditation or just relaxing on a rocking chair, or listening to songs or reading a book or enjoying a swim or watching a movie.
Incorporate a healthy lifestyle which includes at least 150 minutes of physical activity a week and a diet in which salt consumption is reduced. Sausages, sauces, tinned vegetables , olives soaked in brine, potato fries all come with salt. Use of rock salt is better or low sodium salt is another option. One can use lemon or vinegar to add a salty taste without actually adding salt. Among the exercises, Tai Chi, Yoga, swimming, skipping rope, aerobics, walking, cycling, golf, playing shuttle badminton or tennis if it is okay , are good options. Enjoy the exercises sessions.
Avoiding spicy and oily food helps.
Take plenty of vegetables, fruits depending on diabetes levels, non roasted and non salted nuts, fish and chicken and lean meats.
Avoid too much of caffeine
Maintaining a normal weight is equally important.
Limit alcohol consumption- for males 21 units a week and for women 14 units a week ( one unit is half a pint of beer, a glass of wine or a single measure of spirits)
Cigarette smoking is another thing to be careful of. Smoking can make the blood cells stick together which can help form blocks and also increase the chances for a block in the blood vessels. There are ways to stop smoking by using various nicotine replacement techniques such as nicotine chewing gum, lozenges or patches.
Be regular in your visits to the doctor.
If there is a history of high blood pressure running in the close family ( parents or uncle and aunt), have the blood pressure monitored. If your parents have had either a stroke ( paralysis of one side of the body) or a heart attack at an earlier age ( below the age of 50) you have to be careful.
If you are overweight or obese ( having a body mass index of more than 25) or having diabetes, you have to check the blood pressure.
This involves the basic essentials such as reducing stress levels, stop smoking and alcohol consumption, reducing excess salt intake, maintaining a healthy diet, exercising regularly and having a check up on time.
When the above measures do not work or if you develop some complications such as problems with the kidneys, heart or brain, medicines are prescribed.
The eye doctor looks into the eye and checks for early changes in the blood vessels on the retina which needs you to be starting treatment soon to prevent further damage to the eyes.
There are certain basic tests which are necessary such as checking the haemoglobin, sugar, cholesterol, kidney, liver, urine for leak of proteins, ECG and ECHO for the heart, an eye check up and further tests if anything is amiss and needs further evaluation. Some need a scan of the brain if there has been a stroke.
Some people need one medicine and some need more than one medicine. There are different medicines coming in different strengths. The number of mg of each tablet does not reflect upon the severity of the blood pressure. The doctors decide which medicine based upon the kind of protection needed. Some need to have additional protection to the heart and kidney, some need to have their heart rates reduced, some need to have their feet swelling reduced, some need to have the pressure in their kidney reduced and so forth. The aim is to bring down the blood pressure to normal without causing further damage.
As with all tablets, there are some side effects with the medicines for blood pressure. Some may cause slow heart rate, some cause swelling of the feet, some cause coughing and throat irritation, some cause electrolyte disturbances and some medicines are not tolerated well. The dose of medicines has to be adjusted based on individual needs. Generally, once you are on medicines it must be continued for life. But, having a metabolic surgery ( bariatric surgery) can help avoid the need for a medication. This will help control the diabetes, blood pressure as well as your weight. If the blood pressure is solely due to increased stress levels, change of job or relocation will help cure the blood pressure as well.
Many people delay the initiation of treatment despite the medical advice. This is putting your life in danger as changes once they occur, in important organs, are difficult to reverse. It is much better to control the blood pressure than having a massive heart attack or a stroke and put your family or yourself at risk.
If eyes are the window to the soul, then the smile offers a look into the health of the pancreas. Diabetes can affect the kidneys, feet, heart and eyes just as much as it could affect the oral health. Oral hygiene has often been the most neglected even among those without diabetes.
A smile is fat free, sugar free, reduces blood pressure, can relieve pain and depression, requires no battery and is free of cost.
There are about 500 micro organisms in the mouth which make a human bite quite dangerous ( more dangerous than an animal bite). Some of the micro organisms are helpful and some are harmful. There have some studies which tried studying the organisms in the mouth and predicting the heart health as these organisms could travel by blood stream and get deposited in the coronary vessels.
The oral cavity contains teeth, the gums which hold the teeth together, the bones on which the teeth rests, the tongue, saliva which bathes the mouth and the pink mucosa lining the mouth inside.
Those with diabetes are more prone for developing gum disease and it progresses twice faster than those without diabetes. Serious gum disease could worsen the sugar control and will need an intensification of treatment. The ability to fight the bacteria is affected in those with diabetes. Further , the diabetes is also a good medium for the organisms to thrive.
A look into your mouth: Gums:
Gingivitis is a mild form of gum disease, periodontitis is a more serious form of the same. Pockets form between the gums and the teeth which get filled with organisms, pus and then deepen. This can lead to destruction of bone around the teeth, leading to loosening of the teeth and subsequent falling off. The habit of using tobacco rolls or tobacco containing sweetened “paans” can cause a small burn on the insides of the pink mucosa which can later lead on to cancer. Dry mouthcan be due to snoring, poor sugar control, use of too much of alcohol based mouthwashes, some medicines, and also due to kidney diseases. Low salivary production can be a sign of diabetic neuropathy ( autonomic neuropathy) . Saliva helps in digestion of the food while chewing, protects the gums and teeth against the plaques and acid deposition which can damage the teeth and cause decay. Thrush is a type of fungal infection common among those with diabetes.
• Soda, energy drinks, carbonated sweetened beverages and lemon water can damage the enamel which is the protective outer coating of the teeth. For people who have recurrent episodes of low sugar, they consume a lot of sweets which could damage the teeth. Speak with the health care provider on ways to prevent low sugar spells and thereby reduce the intake of sweets, thus protecting the oral hygiene.
Technique of brushing teeth
• Brushing the teeth effectively is to dislodge the plaques which build up at the gum line.
• The tooth brush must meet at the outer and inner surfaces of the teeth at an angle of 45 degrees.
• Move the toothbrush in short strokes, vibrating it back and forth across gum line, gums and tooth surfaces. This involves up and down movements, movements across and also movements to clean the inner sides of the teeth. For brushing the chewing surface, hold the brush horizontally and brush. For cleaning the inner side of the teeth, hold the brush vertically and move it up and down.
• Stiff brushes will not help remove plaques
• Brushing too hard can do more harm and even damage the protective enamel.
• Use a brush size that fits inside your mouth comfortably. A soft bristle brush is good for the gums and also to brush for at least 2 minutes.
• Those with arthritis or braces of the teeth can use an electric brush instead. The electric brush is effective and some of them have a 3000 rpm. Tooth pastes
• There are so many tooth pastes which have flooded the market. Generally the fluoride containing tooth pastes are better.
• Sensitive teeth are due to the damage of the enamel. There are so many toothpastes available for that as well.
• The junk food culture and consumption of processed food items have damaged the teeth enamel more than the yesteryears.
• Use of turmeric is good for those with gingivitis ( diseases of the gums). Use of clove in those with dental aches is another well known home remedy. These have also been incorporated in some of the tooth pastes. Flossing:
Dental floss is a string which helps dislodge food between the teeth. Measure an arms length of floss, roll around the index finger of one hand and roll the other free end around the index finger of the other hand. Slide the floss gently between the teeth, keeping the floss taut across the thumbs and floss up and down in a shoe shine manner following the curve of the teeth. Sometimes blood may come while flossing. Do not floss too hard. Tongue:
Clean the tongue using the under surface of the toothbrush head. The use of metallic cleaners and too vigorous cleaning is to be discouraged to avoid damage to the taste buds on the tongue surface. Mouth wash:
Water is a good mouth wash after any meal. However, there are breath fresheners which make the mouth feel, smell and taste fresh after any meal. There are treatment rinses containing fluoride which help prevent plaque deposition and decay of teeth.
Avoid alcohol containing rinses to avoid dry mouth.
Ask the dentist whether these are needed.
Meet with the dentist at least twice a year to make sure all is well. It is safer and lighter on the purse to have the problem sorted out earlier. Change your tooth brush at least once in 3 months are if bristles have splayed earlier to that.
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:
• 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
• 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? :
• 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.
• 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.
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.
Assessment of vitamin D levels
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.
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 .
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
Select fresh fruit or vegetables.
Avoid creamy soups .
Stay away from bread and rolls with salty, buttery crusts.
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.
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
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 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 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.
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 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
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
2 scrambled eggs - no carbohydrate
A slice whole wheat bread – 15 grams
An orange - 18 grams
A cup of low fat milk - 14 grams
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).
• 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.
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?
This is an interesting concept to follow:
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.