Counselling About Diet 2009

Dietary guidelines for patients
with Diabetes, Hypertension

and Obesity
Karen Steynberg
Clinical Dietician
Introduction
 Counseling can be very challenging!
 Person should have a degree of readiness.
 Nutrition intervention usually met with
resistance and denial.
 Educator to be strong motivation
Introduction (cont.)
 Dietary changes individual.
 Base nutrition intervention on the
individual.
 American Academy of Family Physicians-
nutrition checklist
 Based on the word “DETERMINE”
 Used to point out warning signs.
“DETERMINE”
 Disease: Any disease that changes the way
a person eats, put them at nutritional risk.
 4 out of 5 individuals who have chronic
diseases are affected by diet.
 Sadness and depression – affects food
intake.
“DETERMINE”
 Eating poorly: Eating too little or too much
– poor nutritional status.
 Eating the same foods, no fruit and
vegetables or dairy.
 One out of 4 adults drink too much alcohol.
 One out 5 adults skip meals daily.
“DETERMINE”
 Tooth loss/mouth pain: Healthy mouth,
teeth and gums are needed.
 Ill-fitting dentures – mouth sores.
 Economic hardship: Having very little
money or choosing to spend very little
money could lead to nutritional
deficiencies.
“DETERMINE”
 Reduced social contact: 1/3 of elderly live
on their own. Being socially active has a
positive effect on morale and well-being.
 Multiple medicines: Multiple drugs could
have nutritional side effects.
 Involuntary weight loss/gain: Needs to be
without trying. Warning sign!!
“DETERMINE”
 Needs assistance in Self-care: Although
older people can still lead a productive lfe.
One out of five have trouble walking,
shopping and preparing food.
 Elderly above age 80: Increased frailty and
poor health
Determine nutritional status
 Medical history: gastro-intestinal surgery –
malabsorption, ‘Little bit of Diabetes”
 Occupation: Determine financial status
 Marital status: Determine if patients eat and
lives alone
 Food purchasing and food preparation: Fast
foods
Nutritional status (cont)
 Facilities available – stove, fridge etc.
 Food preferences and food dislikes, fruits
and vegetables vs. sweets and chips.
 Nutritional supplements
 Food allergies – real allergies!!!
 Recent mass changes? Time frame?
Nutritional status (cont)
 Activity level – determine willingness to
exercise.
 Smoking and alcohol use
 Diet history or 24 hour recall
 Accuracy questionable as some people
cannot remember or really does not know
 People want to please the doctor or dietician
The DIET!!!!
 CVD, HT, and DM are diseases of lifestyle
– thus healthy eating
 Nutrition Society of South Africa and Dept
of Health compiled the food based dietary
guidelines
 Healthy eating based on 11 guidelines
Diet (cont)
 Eat a variety of food: Eating one type of
food can lead to deficiencies
 Exercise regularly: Cardiovascular
exercise three times per week
 Have starch with every meal: Should be
major part of meal.
Swedish suggest it to be 2/5 of the plate
Diet (cont)
 Good sources of glucose and low in fat
 Unrefined starches and unprocessed
starches are the best choice
 High in fiber
 Fiber regulates blood sugar, decreases blood
cholesterol, improves satiety.
 Refined starches should be avoided.
Glycemic index
 Glycemic index may be explained.
 Depends on the education level of the
patient.
 Incorporate with the diet without explaining
in detail
Diet (cont)
 Have at least 5 portions of fruit and
vegetables per day.
Good source of vitamins, minerals and anti-
oxidants.
Portion = ½ cup
Diet (cont)
 Eat dried beans, peas, lentils and soya
regularly.
Could be eaten instead of meat, cheaper than meat
and contains no saturated fats
has similar amino acid profile as that of meat
when eaten with starch
Decreases the risk of CVD and stabilizes blood
sugar.
Decrease risk of colon and breast cancer
Diet (cont)
 Eat a little chicken, fish, meat, milk or eggs
every day.
Red meat may be eaten three times per week
Rest of the week white meat may be eaten
All visible fat of meat should be removed before
preparation
No more than three eggs per week
Diet (cont)
Dairy products should be skimmed or low
fat 2%
Pay attention to food preparation method
Portion size = size of palm of ladies hand
Diet (cont)
 Use only a little fat
Saturated fats – animal fats – avoid
Two plant sources = saturated fat = coconut and
palm kernel oil
Poly-unsaturated fats = sunflower oil and
margarine. Use in small amounts
Do not heat!
Mono-unsaturated fats = olive oil and canola oil
Omega-3-fatty acids – fish decreases clotting
Diet (cont)
 Limit the salt intake
Restrict intake when have hypertension
Packets, bottles, cans and boxes of food
high in salt
Use alt as a preservative
Diet (cont)
 Drink clean safe water
8-10 glasses of water per day
Excluding tea and coffee
Diet (cont)
 Alcohol should be taken in moderation
Men – 2 units of alcohol daily
Women – 1 unit of alcohol daily
1 unit = 1 tot measure of spirits, 340 ml
beer, one small glass of wine
Diet (cont)
 Do not consume excessive amounts of sugar
Empty energy – contain very little nutrients
Sugar that is not used immediately is stored as fat
Sugar could increase triglyceride levels and
increase risk for CVD
Excessive sugar intake leads to obesity – CVD and
hypertension
Sugar will increase blood sugar levels of DM
HT and the DASH diet
 Complex diet that has a more potent effect
than single nutrient supplementation or
restriction
 Lowers BP with 6-11 mm Hg
 Not very restrictive
 Better compliance
DASH composition
 Grains 7-8 portions
 Vegetables 4-5 portions
 Fruit 4-5 portions
 Low fat/non-fat diary 2-3 portions
 Meat/fish 2 or less
 Nuts 1-2 portions
Diet (cont)
 Plate model
Thank You!!!

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Dietary guidelines for patients

with Diabetes, Hypertension

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