Diabetes, Heart Disease and your Diet

When you have Diabetes, you are at risk of heart disease and more likely to have certain conditions that increase the chance of having a stroke, high blood pressure or high cholesterol and that's why it is important to take good care of your heart. Heart disease affects your circulation which makes other Diabetes-related complications such as eyes and feet problems worsen.

People with Diabetes tend to develop heart disease at a younger age than people without Diabetes. While all people with Diabetes have an increased chance of developing heart disease, the condition is more common in those with Type 2 Diabetes. If your blood sugar level is high and constantly fluctuating for a period of time, then sugar sticks to your red blood cells and builds up in your blood as your body can't use all of this sugar properly. This build-up can block and damage the interior surfaces of blood vessels carrying blood to and from your heart, starving the heart of oxygen and nutrients and this can lead to serious heart complications. This causes potentially higher levels of lipids or fats in the blood (including high cholesterol levels) associated with heart disease. When the blood sugar level is consistently high, this activates a biological pathway that causes irregular heartbeats - a condition called cardiac arrhythmia - that is linked to heart failure and sudden cardiac death.

Therefore, it is important to keep your blood sugar level as close to the target blood sugar and make healthy lifestyle changes such as eating a healthy diet, regularly exercising, managing stress and alcohol and tobacco cessation. These will help protect your blood vessels and lower blood pressure and cholesterol which in turn will improve your heart health.

Dietary and Lifestyle Considerations

People should be assisted to adopt a healthy eating pattern according to their personal and cultural preferences. Focus on variety, nutrient density, and whole foods within the food groups.

Calorie intake

Weight loss and maintenance are critical for prevention and control of cardiovascular disease risk factors. The calories intake should be appropriate for the individual to help achieve and maintain healthy body weight and restricted for those attempting weight loss. Weight loss in obese people leads to a considerable reduction in the workload of the heart, a drop in blood pressure, thereby improved cardiac efficiency.

Fats

It is recommended that total dietary fat should be 25-35 per cent of total calorie consumed. For example, for a person eating a 1500 calorie diet, this would be around 50 g of fat per day. It is not desirable to restrict all forms of fats as severe restrictions result in mental depression, risk getting insufficient amounts of fat-soluble vitamins and essential fatty acids.

The association between LDL (bad) cholesterol and saturated fats and trans fats is very strong with risk of cardiac disease. 1 per cent increase in the recommended saturated fats consumption equals to 2.7 mg increase in serum cholesterol.

 Avoid foods high in saturated fat/trans fats

1)       Red and white meat like beef, pork, lamb and skin of poultry and processed meats such as hot dogs, sausages, salami, etc.

2)       High-fat dairy products- cream, ice cream, whole milk, cheese, butter. It is also present in some tropical oils such as palm, palm kernel, coconut oil.

3)       Bakery items like cookies, pastries, cakes, etc.

PUFA and MUFA

PUFA (polyunsaturated fatty acid) prevents the accumulation of cholesterol in blood vessels, also decreases the synthesis of bad cholesterol VLDL, LDL. It also helps in prevention of thrombus formation and decreases the stickiness of platelets and prevents the tendency of blood platelet clot.

Non-vegetarian foods high in PUFA are fatty fish such as salmon, mackerel, sardines, hilsa, seer, katla, halwa. 100-150 g of steam or grilled fatty fish twice a week or 2 g of fish oil every day can reduce bad cholesterol and increase HDL-good cholesterol.

Vegetarian foods high in PUFA are chia seeds, walnuts, flaxseeds. Recommended intake is 2-3 tsp/day. Unsaturated oils like sunflower, soybean, groundnuts, and rice bran oil are healthier choices than saturated fats like butter, mayonnaise, ghee, cream, cheese. Limit your intake not more than 5-6 tsp/day

A research study found that high MUFA (monounsaturated fatty acid) diets could reduce plasma triglycerides by 19 per cent and VLDL cholesterol by 22 per cent in people with Diabetes. Another study showed that people who ate high MUFA diets had less inflammation and better insulin sensitivity than those who ate diets high in saturated fat. MUFA sources include olive oil,  avocado oil, peanut oil, almonds, cashews, walnuts. Lowered intake of dietary saturated fatty acids replaced with MUFA and PUFA may reduce CAD by 30 per cent.

Cholesterol

Excessive cholesterol in your blood builds up in the walls of blood vessels. This  causes blood vessels to become narrow  and decreases or blocks blood flow to the heart muscle. This leads to insufficient blood carrying oxygen to the heart and you may suffer chest pain. If the blood supply to the heart is completely cut off by a blockage, the result is a heart attack. There are two forms of cholesterol that many people are familiar with: LDL or bad cholesterol and HDL or good cholesterol.

LDL is the main source of artery-clogging plaque. HDL actually works to clear cholesterol from the blood.Eating healthy and regular exercise is a basic treatment for high cholesterol levels. The fibre-rich diet helps in binding cholesterol and increase the excretion of cholesterol. Plant sterol present in vegetable oils such as mustard oil, soybean oil, safflower oil and corn oil diminish the plasma cholesterol by inhibiting cholesterol absorption. Avoid excessive consumption of cholesterol-rich foods such as animal fat, egg yolk, organ meats, and high-fat dairy products Proteins When choosing proteins, choose the right kind and amount of protein. Opt for low-fat options such as lean meats, low-fat dairy products, tofu, egg whites, pulses which are the lower-fat alternative and are also rich in fibre, vitamins and minerals. Avoid oily/buttery gravies in the preparations.

Combine lean meat/fish and vegetables together. Remove skin of meats before cooking. Watch portion size.

Complex carbohydrates

If total calories are restricted, carbohydrate intake would be reduced. Remember to include complex carbohydrates such as whole grains, fruits, vegetables, pulses in the diet. These foods also contain good amount of fibre which helps to reduce the risk of cardiovascular disease. Avoid simple carbohydrates such as sugars, processed foods, refined flours, canned juices, soft drinks etc. Excessive intake can increase serum triglycerides levels.

Fibre

The soluble fibre present in pulses, whole grains, oats, fruits, vegetables helps in reduction in serum cholesterol and blood sugar levels. Tips to increase fibre intake:

1)     Include whole grains in every meal. Use whole-wheat flour/millet in cooking instead of refined flours.

2)     Choose whole-grain bread. Choose bread with the highest amount of fibre per slice.

3)     Keep regular intake of steel-cut oats preparations. You can Sprinkle over salad, soup, and yoghurt.

4)     Use brown rice instead of white rice.

5)     Include at least 1-2 servings of whole pulses every day.

6)     Eat at least five servings of fruits and vegetables each day. Fresh fruit is slightly higher in fibre than canned. Eat fruits and vegetables with the peel whenever possible.

7)     Eat whole fruits instead of drinking juices. Juices don't have fibre.

8)     Add chopped dried fruits in the regular intake. Dried fruits have a higher amount of fibre than the fresh versions.

Vitamins and minerals

Vitamin A

If total fat, animal fat, meats, eggs and seafood are restricted, vitamin A deficiency may occur and supplementation is essential. Dark green, yellow, orange colour vegetables and fruits are a rich source of vitamin A.

Niacin

Supplement of Niacin increases HDL cholesterol while lowering the levels of LDL Cholesterol and Triglycerides.

Vitamin C

Vitamin C is known to be involved in regulating cholesterol metabolism and in maintaining the structure of blood vessels and avoid tissue damage. Consume fruits, green leafy vegetables, lemons, guavas, amla etc. to include vitamin C in your diet.

Sodium

Sodium should be restricted when there is hypertension, a significant risk factor for heart disease. Extra salt, Salty foods, processed foods, bakery items should be avoided. Try to limit your salt intake of 6-7g or 1 tsp/day.

Potassium

High potassium intake may help counteract the effects of high sodium levels. Potassium helps to maintain cell fluid balance and plays a role in muscle contraction. Low  level of potassium has been associated with high blood pressure. Include potassium-rich foods - Green leafy vegetables, amla, chiku, lemons in your regular diets.

Alcohol

Drinking too much alcohol can raise the levels of some fats in the blood (triglycerides), high blood pressure, heart failure and increased calorie intake which can lead to obesity, higher risk of developing other complications related to Diabetes. The American Heart Association cautions people NOT to start drinking if you do not already drink alcohol.If you drink alcohol, do so in moderation. This means an average of one to two drinks per day for men and one drink per day for women. For those who drink alcohol, consumption should not exceed 30-60 ml of ethanol per day. One drink = 150 ml wine, 360 ml of beer, 45 ml of 80- proof liquor (whiskey, rum, vodka and gin).TobaccoTobacco use continues to be one of the most important risk factors for heart disease, also increase the risk complications of hypertension.Non-smokers who breathe secondhand smoke have between 25-30 per cent increases in the risk of developing heart disease. Helping people with tobacco cessation is a critical component of cardiac disease prevention.

Exercise and physical activity

Physical activity, especially aerobic exercise increases heart strength. This can help a long-term reduction in the heart's workload. Exercise raises blood levels of HDL, the good cholesterol. The coexistence of Type 2 Diabetes and hypertension is especially damaging to cardiovascular health. Apart from controlling blood sugar and blood pressure, exercise improves the heart's blood vessels function.

Exercise also helps to achieve healthy body weight. In addition to the dietary recommendations, people of all ages should meet physical activity guidelines for health promotion and chronic disease risk reduction. Adults are advised to do at least 150 minutes a week of moderate-intensity aerobic physical activity. More benefit may accrue from 60-90 minutes of daily exercise. Older adults/people with any health issues should tailor their activities according to their physician's advice.