Dr. Shamanthakamani Narendran

M.D. (Pead), Ph.D. (Yoga Science)

Oh, God, Give us food which does not cause any disease and also gives us

strength- Yahurveda

He, who takes food in proper measure lives a long life and lives without disease,

gets strength and alertness of mind. However, his children are born healthy and without any deformity or disease.

- Mahabharata

Yoga is neither for one who over eats nor for him who observes complete

fasting.

- Bhagavad Gita :VI - 16

Yoga is a science of mindHelps to control mind, desire & reaction

to stressSkilful – rather than brutal

- Maharshi Patanjali

FOOD REQUIREMENTS

Vary according to age, sex, and activity of the individual.

Special demands are made during stress periods, such as pregnancy, lactation, infancy, and childhood, since during these periods, the individual needs increased amounts of Body-Building and Protective nutrients.

COMMON NUTRITION PROBLEMS

Protein energy malnutrition (PEM), micronutrient deficiencies such as vitamin A deficiency (VDA), iron deficiency anemia (IDA), iodine deficiency disorders (IDD) and vitamin B-complex deficiencies are the nutrition problems frequently encountered, particularly among the poor.

Under-nutrition starts even at the time of conception.

Because of extensive maternal under-nutrition (under-weight, poor weight gain during pregnancy, and nutritional anemia, and vitamin deficiencies), about 30% of the infants are born with low birth-weights (<2500 g), as compared to less than 10% in the developed countries.

Both clinical and subclinical undernutrition are widely prevalent even during early childhood.

About 1-2% of preschool children suffer from severe and florid forms of PEM like kwashiorkor and marasmus. This is only the tip of the iceberg.

In the case of vitamin A deficiency, up to 3% of preschool children show Bitot’s spots and night blindness, and about 30-40 thousand children become blind every year.

Vitamin A deficiency also increases the risk of disease and death.

A large segment of the population suffers from nutritional anemia.

It is more prevalent irr pregnant women. More than 50% of preschool children also

suffer from anemia.

DIETARY GOALS Maintain a state of positive health and optimal

performance in populations at large. Ensure adequate nutritional status for pregnant

women and lactating mothers. Improve birth weights and promote growth of

infants, children, and adolescents to achieve their full genetic potential.

Achieve adequacy in all nutrients and prevent deficiency diseases.

Prevent chronic diet-related disorders. Maintain the health of the elderly and increase the

life expectancy.

legumes

DIETARY GUIDELINES

A nutritionally adequate diet should be consumed through a wise choice from a variety of foods.

Additional food and extra care are required during pregnancy and lactation.

Exclusive breast-feeding should be practised for 4-6 months. Breast-feeding can be continued up to 2 years.

Food supplements should be introduced to infants by 4-6 months.

Other non-essential amino acids can be synthesized in the body to build proteins.

Proteins perform a wide range of functions and also provide energy (4 Kcal/g)

Protein requirements vary with age, physiological status and stress.

More proteins are required by growing infants and children, pregnant women and individuals during infections and illness or stress.

Animal foods like milk, meat, fish, eggs and plant foods such as legumes are rich sources of proteins.

Choose a variety of foods in amounts appropriate for age, gender, physiological status and physical activity.

Use a combination of grains, grams, and greens. Include jaggery or sugar and cooking oils to bridge the calorie or energy gap.

Prefer fresh vegetables and fruits in plenty. Include in the diets, foods of animal origin such as

milk, eggs and meat, particularly for pregnant and lactating women and children.

Adults should choose low-fat, protein-rich foods such as lean meat, fish, pulses and low-fat milk.

Develop healthy eating habits and exercise regularly.

IMPORTANCE OF DIET DURING DIFFERENT STAGES OF LIFE

For growth and appropriate milestones.

Breast-milk, energy rich foods (fats, sugar)

For growth, development and to fight infections.

Energy, body building and protective food (milk, vegetables, and fruits.

For growth spurt, maturation and bone development

Body building and protective foods.

For maintaining health productivity and prevention of diet-related disease and to support pregnancy/lactation.

Nutritionally adequate diet with extra food for child bearing/rearing.

For being physically active and healthy.

Nutrient dense low fat foods.

BALANCED DIET FOR ADULT WOMAN (SEDENTARY)

* Portion Size **No. of portions

Elderly man: Reduce 3 portions of cereals and millets and add an extra serving of fruit.

CEREALS AND MILLETS*30 g x 10**

FRUITS *100 g x 1**

PULSES *30 g x 2**

FATS/OILS SUGAR*5 g x 4** *5 g x 4**

MILK & MILK PRODUCTS*100 g x 3**

VEGETABLES*100 g x 3**

EAT ENOUGH IODINE-CONTAINING FOODS/USE ONLY IODIZED SALT

Iodine is required for formation of thyroid hormones.

Thyroid hormones are necessary for growth and development.

Iodine deficiency leads to goiter. Lack of iodine in water and diet is the main cause

of iodine deficiency disorders. Iodine deficiency during pregnancy results in still

births, abortions, and cretinism. Use of iodized salt ensures adequate iodine intake.

WHAT ARE FOOD GROUPS?

Foods are conventionally grouped as: Cereals, millets and pulses Vegetables and fruits Milk and milk products, egg, meat, and fish Oils and fats and nuts and oilseeds.

Foods may also classified according to their functions.

ENERGY RICH FOODS

MAJOR NUTRIENTS OTHER NUTRIENTS

Carbohydrates & fats

Whole grain cereals, milletsProtein, fibre, minerals,

calcium, iron and B-complex vitamins

Vegetable oils, ghee, butterFat soluble vitamins, essential fatty acids

Nuts and oilseeds Proteins, vitamins/minerals

Sugars Nil

BODY BUILDING FOODS

MAJOR NUTRIENTS OTHER NUTRIENTS

Proteins

Pulses, nuts, oilseedsB-complex vitamins,

invisible fat, fibre

Milk and milk productsCalcium, vitamin A,

riboflavin, vitamin B12

Meat, fish, poultryB-complex vitamins, iron,

iodine, fat

PROTECTIVE FOODS

MAJOR NUTRIENTS OTHER NUTRIENTS

Vitamins & Minerals

Green leafy vegetablesAntioxidants, fibre and

other carotenoids

Other vegetables/fruitsFibre, sugar and

antioxidants

Eggs, milk, and milk products and flesh foods

Protein and fat

WHAT IS A BALANCED DIET? A balance diet is one which provides all the

nutrients in required amounts and proper proportions.

It can easily be achieved through a blend of four basic food groups.

The quantities of foods needed to meet the nutrient requirements vary with age, gender, physical activity and physiological status.

A balanced diet should provide around 60-70% of total calories from carbohydrates, preferably starch, about 10-12% from proteins and 20-25% from fat.

What is Diabetes

The body is made of millions of cells that need energy to function. The food you eat

is turned into sugar, called glucose. Sugar is carried to the cells through the blood stream. It is one of many substances

needed by cells to make energy.

For glucose to enter the cells, 2 conditions must be present. First, the cells must have

enough "doors," called receptors. Second, a substance called insulin is needed to

"unlock the receptors." Once these two conditions are met, glucose enters the cell

and is used by the cell to make energy.

Without energy, all cells die.

Uncontrolled Diabetes

Can Lead To:

• Heart Attack

• Kidney Diseases

• Nerve Damage

• Eye Disease

Diabetes management consists of:

• Following a diet plan

• Testing blood sugar

• Exercising

• Taking any prescribed medication on time

• Ensuring good hygiene

• Learning about diabetes

Diabetes can be controlled by

A healthy diet may include changing what one eats, in what quantities, and how often.

Diabetes can be controlled by

Exercise helps diabetic patients in many ways. It lowers glucose levels, helps weight loss, and maintains a healthy heart and healthy circulation. In addition, exercising helps relieve stress and strengthens muscles.

Diabetes can be controlled by

Blood/urine sugar testing is important in order to find out if the sugar level is where it should be. If the blood/urine sugar is too low or too high, a change in the diabetes medication, diet, or exercise plan may be needed. Blood sugar or urine sugar should be checked at every visit of the diabetic patient.

Diabetes can be controlled by

In cases of very high blood sugar levels that do not respond to diet and exercise plans, medications may be needed. If insulin is needed, it can only be injected. Insulin is needed for all patients with Type 1 diabetes and for some patients with Type 2 diabetes.

The three goals of eating right are

• Controlling body weight

• Keeping the level of blood-sugar at a normal level

• Reducing fat in the body

Hyperglycemia Hypoglycemia

• When controlling diabetes, blood sugar can become too high or too low. These conditions should be taken seriously. Fortunately, one can easily re-establish control of blood sugar.

• When there is too much sugar in the blood, this condition is called hyperglycemia. Hyper is Latin and means "more." Glycemia is also Latin and means "sugar in the blood."

• Hyperglycemia is caused by eating too much food, eating sugary foods, or by not taking one’s medication. It can also occur when one is sick. If not treated, hyperglycemia can lead to a coma.

• Hypoglycemia occurs when too little sugar is present in the blood. Hypo is Latin and means "less."

• Hypoglycemia usually occurs with patients who take insulin or other medications.

• Taking too much insulin can cause it. That is why it is also known as insulin shock.

• Hypoglycemia can also be caused when the food intake is reduced or a meal is skipped. . Signs of low blood sugar, or hypoglycemia .

Hyperglycemia Hypoglycemia

• If not treated, low blood sugar can lead to fainting or seizures. Diabetics experience different signs when their blood sugar is low and they learn to recognize these signs.

• Some patients do not experience any signs when their blood sugar is low. These patients must depend on blood sugar testing to find out if they have hypoglycemia..

Hyperglycemia Hypoglycemia

Reasons for diet

• Weight control

• Blood glucose control

• Prevention and management of short-term and long-term complications of diabetes and heart disease

Dietary recommendations

• Eat starchy foods regularly

• Eat more fruit and vegetables

• Reduce animal or saturated fat

• Cut down on sugar

• Reduce salt

Balancing food choices

Eat starchy foods regularly

• Bread• Potatoes• Rice• Pasta• Cereals• Plantain• Chapatis

Eat more fruit and vegetables.

Five a day• Fresh

• Frozen

• Tinned

• Dried

• Juice

Choose more high fibre foods

To help maintain blood glucose levels and cholesterol levels

• Fruit

• Vegetables

• Pulses

• Oats

Helps to maintain a healthy gut

• Wholegrain cereals

• Wholemeal bread

• Wholewheat pasta

• Brown rice, barley

Reduce animal or saturated fat intake

• Use low fat milk• Use low fat spread

instead of butter• Use oil high in

unsaturated fat, eg olive oil, rapeseed oil

Use less fat in cooking

• Grill

• Dry-roast

• Microwave

• Steam

Choose the right sort of fat

SATURATED

• Full fat dairy produce (eg cheese, butter, full cream milk)

• Pies

• Biscuits

• Savoury snacks

• Lard

• Hard vegetable fat

MONO- UNSATURATED

• Olive oil

• Rapeseed oil

• Groundnut oil

POLY- UNSATURATED

• Sunflower oil (products)

• Oily fish

Cut down on sugary foods

• Cut out sweets

• Cut out sugary drinks

Reduce salt intake

• Cut down on added salt

• Use alternative seasonings

Eat regular meals based on carbohydrate:

Warm water (Cu)

CBH breakfast

Lunch or snack meal

Main meal

Issues related to Asian dietsFood AdviceChapattis Use medium brown or wholemeal flour Avoid spreading fat or use margarine high in monounsaturated fat but sparingly

Keep fried breads for special occasions, eg: poori, parathasRice Choose basmati as lower GI

Best to have plain boiled rather than pilau, buriyani which are high fatMeat, fish, paneer Remove all visible fat on meats , avoid frying – use minimal vegetable(curd cheese), eggs oil or try baking

Encourage all varieties of pulses Vegetables Aim to include 2 to 3 portions daily of any vegetables cooked or rawFruit Beware of portion sizes especially for tropical fruits, but no fruit is tabooSpices All spices , chillies, herbs are allowedMilk Avoid full cream milk Snacks Keep to a minimum: Chevra (Bombay mix), samosas, pakoras, rusks

(Pakistani salted biscuit) Suggest: Fruit , fruit yoghurt, rich tea biscuit.

Fats and oil Use margarine high in monounsaturated fat or poly unsaturated fat For cooking choose vegetable oil, rapeseed oil, olive oil but use sparingly Butter, ghee for special occasions

Dispel myths regarding spices and avoiding particular fruits

AYURVEDIC HERBS

• Onion

• Garlic

• fenugreek

• Turmeric

• Amalaki

Be more active at least 30min/day for 5 days

Dancing / Yoga

Slimming tips

• Be realistic about your target weight

• Aim to lose weight gradually

• Eat regular meals

• Make small changes you can stick to

STRESS MANAGEMENT

• PRANAYAMA

• SILENT SITTING / MEDITATION

Foods to avoid or take in reduced amounts for diabetics

1. SALT: You get enough salt from vegetables in inorganic form, so reduce the intake of extra salt.

2. SUGAR: Sucrose, a table sugar, provides nothing but calories and carbohydrates. Substitute sucrose with natural sugar, like honey, jaggery (gur), etc.

3. FAT: Excessive fat intake is definitely not a good habit. Try and exclude fried items from the diet But, remember, a small quantity of oil is needed to absorb fat-soluble vitamins, especially vitamin E.

4. WHOLE MILK AND PRODUCTS: Try to switch to low fat milk and its products like yogurt (curd).

5. WHITE FLOUR (MAIDA) AND ITS PRODUCTS: Replace these with whole grains, whole wheat (ATTA) or soya breads and unpolished rice.

6. FOODS WITH A HIGH CARBOHYDRATE (SUGAR) CONTENT: Avoid white rice, potatoes, carrots, breads and banana – they increase the blood-sugar levels.  

AVOID

• Smoking

• Alcohol

• Sleeping after meals

• Sedentary lifestyle

• Stress and worry

Recommended foods for diabetics

• Bitter gourd (karela)– This vegetable contains a high dosage of 'plant insulin'. – It lowers the blood sugar levels effectively.– Have the juice of three to four karelas early morning on an

empty stomach. – As a vegetable, too, it can be taken on a regular basis. – Powder the seeds of karela (measuring 1 teaspoon), mix with

water and drink it.

• Fenugreek (methi)– It is the most common food used to control diabetes. – Gulp a teaspoonful of these seeds with a glass of water daily. – Soak the seeds overnight. Have the water in which the seeds

were soaked.– You can make a chutney with methi seeds. You can also eat

them sprouted, dried and powdered, or mix them in wheat flour to make chapattis.

• Indian blackberry (jamun)– This fruit is very effective in preventing and controlling

diabetes.

– Powder the stone of the fruit and eat it -- it contains glucoside, which prevents the conversion of starch into sugars.

• Garlic – This is used to lower blood-sugar levels. Garlic is rich in

potassium and replaces the potassium which gets lost in urine. It also contains zinc and sulphur, which are components of insulin. Take about three to four flakes of freshly crushed garlic daily.

• Onion – Because of its diuretic and digestive properties, onion works

against diabetes. Raw onion is more useful.

• Flaxseed– This is the richest source of Omega 3 fatty acids. It

helps control diabetes because it maintains the sensitivity of the cell membrane, facilitates insulin, and thereby the uptake of glucose by the cells.

• Fibre– Soluble fibre, found in apples, kidney beans (rajma),

oatmeal, soyabean, etc, help control diabetes. – These aid slow digestion and absorption of nutrients,

resulting in a slow and steady release of glucose. – They soak up excess bile acids found in the intestinal

tract, the same acids that are converted to blood cholesterol.

– They also help empty the stomach and bring about a feeling of satisfaction that can help Type 2 diabetics to achieve weight loss goals.

• Cinnamon solution– Water extracts of cinnamon have been found to

promote glucose metabolism and reduce cholesterol. You can boil cinnamon sticks in water and drink this water.

• Antioxidants– Diabetes is often associated with conditions like

heart disease, diabetic retinopathy, immune deficiency and kidney disease. Many are caused by free radical damage. Therefore, make sure you include foods containing antioxidants, like amla, fresh seasonal fruits, pomegranates and green/black tea in your diet.

SEE YOUR General Physician OR NURSE FOR

MORE ADVICE