The deadly duo — heart disease and diabetes — can be kept at bay making the proper changes to lifestyle, writes DR LIEW YIN MEI.
HEART disease and diabetes are indeed a deadly duo, and people with diabetes are two to four times more likely to develop cardiovascular disease (CVD) than those without diabetes.
This is because those with diabetes usually have associated CVD risk factors: High blood glucose, high blood pressure, abnormal blood fat levels and central obesity.
High blood glucose and high blood pressure levels can damage the inner lining of your blood vessels (arteries), making it easier for cholesterol and other fat substances to accumulate inside the artery walls.
This causes plaques (fatty deposits) to form. These plaques narrow your arteries, restrict blood supply and may also rupture, leading to the formation of blood clots.
If the blood clots travel to other parts of your body and partially or totally block blood flow to an organ, say for example, your heart, you may end up with a heart attack. If a plaque ruptures in the brain, you will suffer a stroke.
HEART DISEASE DOESN’T HAVE TO BE YOUR FATE
While diabetes and heart disease are indeed closely linked, having the former doesn’t mean that you will invariably succumb to the latter.
There are steps you can take to protect your heart and keep it healthy. The key here is good control of your diabetes.
This includes becoming more physically active, reducing excessive body weight and maintaining a healthy body weight and normal blood glucose levels.
In addition, good control of your lipids (blood fats), blood pressure and avoidance of smoking are equally important. What you consume also makes a world of difference.
Highlighted below are some easy-to-follow dietary tips that will help you maintain healthy levels of blood glucose, blood pressure and blood fats (lipids):
Keep blood glucose levels within normal range
Ideally, if you have diabetes, your blood glucose level targets should be between 3.8 and 6.1 mmol/L before meals and less than 7.8 mmol/L two hours after meals. This can be achieved by:
• Eating smaller but more frequent meals. Your body can handle only so much glucose at a time.
• Consuming sensible amounts of complex carbohydrates (e.g. rice, wholemeal or wholegrain bread, noodles and tubers) instead of refined ones at every meal, every day.
• Spacing out the carbohydrate intake evenly throughout the day and have a consistent amount at every meal. Don’t overload on carbohydrate foods (or any other types of foods, for that matter) at any one meal. This helps to avoid a spike in blood glucose.
• Eating more complex carbohydrate foods that contain higher amounts of fibre. There are two types of fibre — soluble and insoluble.
Soluble fibre (such as beta glucan, pectin, etc) can be found in high quantities in oats, barley, legumes and some fruits, like apples. Insoluble fibre is found in fruits, vegetables, seeds and whole grains.
Consume a mix of both types of fibre to make up the recommended total dietary intake of 20-30g per day, of which at least 6g should comprise of soluble fibre.
High fibre foods are digested at a slower rate. This means that glucose is absorbed into the blood stream at a slower rate, leading to a slower rise of blood glucose levels.
• Choosing low glycaemic index (GI) carbohydrate foods. Glycaemic Index (GI) is a measure of how quickly or slowly your body converts carbohydrates in a particular food into glucose and releases it into your bloodstream.
Foods with low-GI include barley, brown rice, specially-formulated bread, pasta (made from durum wheat) and muesli.
• Avoid sugar and highly sweetened food and drinks and go for processed edibles that are low or free of fat and sugar. Sweetened foodstuff causes your blood glucose levels to rise quickly.
Keep your blood pressure down
You should ask your doctor to check your blood pressure at your every visit. People with diabetes should aim for lower blood pressures of 130/80 mmHg or less (irrespective of age).
The following dietary tips may help you achieve your target:
• Too much sodium, a type of mineral that is vital for the healthy functioning of your body (especially the heart, muscles and nerves), can aggravate blood pressure, particularly if you have diabetes and are obese.
Minimise sodium or get rid of it entirely. Try not to add salt, soy sauce or monosodium glutamate (MSG) to your meals. Instead, season your food with natural herbs and spices.
• Avoid processed foods (e.g. sausages and burger patties), preserved foods (pickles, salted eggs and salted fish) and canned foods as these contain too much salt.
• Limit or stay away from alcohol. Alcohol increases blood pressure and makes your heart work harder. If you must drink, the recommendation for men is not more than two standard drinks a day, while women should not exceed one standard drink a day.
Eat right to maintain healthy fat levels
If you have diabetes, it is crucial to maintain healthy fat levels. Keep your total cholesterol level below 5.2 mmol/L.
Your LDL ("bad") cholesterol should be kept lower than 2.6 mmol/L and the HDL ("good") cholesterol higher than 1.03 mmol/L for men and 1.3 mmol/L for women.
You also need to keep your triglyceride level below 1.7mmol/L.
In addition to practising an active lifestyle, here are some diet tips that can help you achieve healthy fat levels:
• Avoid high cholesterol foods which raise LDL cholesterol levels, such as prawns, crabs, oysters, squids, egg yolk and offal (liver, kidney, intestines, brain).
You can eat about two to three eggs a week provided you keep your animal fat intake low.
• Minimise your intake of saturated fats, which tend to boost LDL cholesterol levels.
Saturated fats are found mostly in animal or animal-derived foods, which include whole fat dairy foodstuffs like ghee, lard, full cream milk, butter, cheese and mayonnaise.
Coconut milk should be avoided as they are high in saturated fat.
A healthier alternative would be to use low-fat milk in curries, desserts (cendol, bubur cha cha) and your favourite kuih-muih.
• Love your unsaturated fats. Polyunsaturated fats help lower LDL cholesterol levels but also decreases the HDL ("good") cholesterol levels while monounsaturated fats are neutral.
Monounsaturated fats sources include plant oils such as canola, olive and peanut while polyunsaturated fats are derived from vegetables, plant oils (corn, sunflower, soy) nuts (almonds, hazelnuts) and certain kinds of fish like salmon and tuna.
• Limit your total fat intake by reducing fat from all sources including cooking oils. Watch out also for hidden fats from pastries and cookies.
• Use as little oil as possible when cooking. Instead of deep-frying food, try stir-frying or shallow-frying and experiment with other low-fat cooking methods like steaming, boiling, grilling, baking or roasting.
• Avoid trans fatty acids, which are regularly found in commercially prepared baked goods, margarine, snack foods and processed foods.
Trans fats are damaging to cholesterol levels as they increase the bad LDL cholesterol and lower the good HDL cholesterol. Read food labels to find out if a particular treat contains trans fat.
• Consume more soluble fibre because it helps to lower LDL cholesterol levels in the blood.
Keeping your blood glucose levels, blood pressure, blood fats and body weight within the healthy range is critical for every person who has diabetes.
By following the advice given above, you can effectively reduce your risk of heart disease (as well as other complications of diabetes) and be rewarded with the freedom to enjoy life to the fullest.
Note: Datin Dr Liew is a consultant physician with the Heart Foundation of Malaysia
This is because those with diabetes usually have associated CVD risk factors: High blood glucose, high blood pressure, abnormal blood fat levels and central obesity.
High blood glucose and high blood pressure levels can damage the inner lining of your blood vessels (arteries), making it easier for cholesterol and other fat substances to accumulate inside the artery walls.
This causes plaques (fatty deposits) to form. These plaques narrow your arteries, restrict blood supply and may also rupture, leading to the formation of blood clots.
HEART DISEASE DOESN’T HAVE TO BE YOUR FATE
While diabetes and heart disease are indeed closely linked, having the former doesn’t mean that you will invariably succumb to the latter.
There are steps you can take to protect your heart and keep it healthy. The key here is good control of your diabetes.
This includes becoming more physically active, reducing excessive body weight and maintaining a healthy body weight and normal blood glucose levels.
In addition, good control of your lipids (blood fats), blood pressure and avoidance of smoking are equally important. What you consume also makes a world of difference.
Highlighted below are some easy-to-follow dietary tips that will help you maintain healthy levels of blood glucose, blood pressure and blood fats (lipids):
Keep blood glucose levels within normal range
Ideally, if you have diabetes, your blood glucose level targets should be between 3.8 and 6.1 mmol/L before meals and less than 7.8 mmol/L two hours after meals. This can be achieved by:
• Eating smaller but more frequent meals. Your body can handle only so much glucose at a time.
• Consuming sensible amounts of complex carbohydrates (e.g. rice, wholemeal or wholegrain bread, noodles and tubers) instead of refined ones at every meal, every day.
• Spacing out the carbohydrate intake evenly throughout the day and have a consistent amount at every meal. Don’t overload on carbohydrate foods (or any other types of foods, for that matter) at any one meal. This helps to avoid a spike in blood glucose.
• Eating more complex carbohydrate foods that contain higher amounts of fibre. There are two types of fibre — soluble and insoluble.
Soluble fibre (such as beta glucan, pectin, etc) can be found in high quantities in oats, barley, legumes and some fruits, like apples. Insoluble fibre is found in fruits, vegetables, seeds and whole grains.
Consume a mix of both types of fibre to make up the recommended total dietary intake of 20-30g per day, of which at least 6g should comprise of soluble fibre.
High fibre foods are digested at a slower rate. This means that glucose is absorbed into the blood stream at a slower rate, leading to a slower rise of blood glucose levels.
• Choosing low glycaemic index (GI) carbohydrate foods. Glycaemic Index (GI) is a measure of how quickly or slowly your body converts carbohydrates in a particular food into glucose and releases it into your bloodstream.
Foods with low-GI include barley, brown rice, specially-formulated bread, pasta (made from durum wheat) and muesli.
• Avoid sugar and highly sweetened food and drinks and go for processed edibles that are low or free of fat and sugar. Sweetened foodstuff causes your blood glucose levels to rise quickly.
Keep your blood pressure down
You should ask your doctor to check your blood pressure at your every visit. People with diabetes should aim for lower blood pressures of 130/80 mmHg or less (irrespective of age).
The following dietary tips may help you achieve your target:
• Too much sodium, a type of mineral that is vital for the healthy functioning of your body (especially the heart, muscles and nerves), can aggravate blood pressure, particularly if you have diabetes and are obese.
Minimise sodium or get rid of it entirely. Try not to add salt, soy sauce or monosodium glutamate (MSG) to your meals. Instead, season your food with natural herbs and spices.
• Avoid processed foods (e.g. sausages and burger patties), preserved foods (pickles, salted eggs and salted fish) and canned foods as these contain too much salt.
• Limit or stay away from alcohol. Alcohol increases blood pressure and makes your heart work harder. If you must drink, the recommendation for men is not more than two standard drinks a day, while women should not exceed one standard drink a day.
Eat right to maintain healthy fat levels
If you have diabetes, it is crucial to maintain healthy fat levels. Keep your total cholesterol level below 5.2 mmol/L.
Your LDL ("bad") cholesterol should be kept lower than 2.6 mmol/L and the HDL ("good") cholesterol higher than 1.03 mmol/L for men and 1.3 mmol/L for women.
You also need to keep your triglyceride level below 1.7mmol/L.
In addition to practising an active lifestyle, here are some diet tips that can help you achieve healthy fat levels:
• Avoid high cholesterol foods which raise LDL cholesterol levels, such as prawns, crabs, oysters, squids, egg yolk and offal (liver, kidney, intestines, brain).
You can eat about two to three eggs a week provided you keep your animal fat intake low.
• Minimise your intake of saturated fats, which tend to boost LDL cholesterol levels.
Saturated fats are found mostly in animal or animal-derived foods, which include whole fat dairy foodstuffs like ghee, lard, full cream milk, butter, cheese and mayonnaise.
Coconut milk should be avoided as they are high in saturated fat.
A healthier alternative would be to use low-fat milk in curries, desserts (cendol, bubur cha cha) and your favourite kuih-muih.
• Love your unsaturated fats. Polyunsaturated fats help lower LDL cholesterol levels but also decreases the HDL ("good") cholesterol levels while monounsaturated fats are neutral.
Monounsaturated fats sources include plant oils such as canola, olive and peanut while polyunsaturated fats are derived from vegetables, plant oils (corn, sunflower, soy) nuts (almonds, hazelnuts) and certain kinds of fish like salmon and tuna.
• Limit your total fat intake by reducing fat from all sources including cooking oils. Watch out also for hidden fats from pastries and cookies.
• Use as little oil as possible when cooking. Instead of deep-frying food, try stir-frying or shallow-frying and experiment with other low-fat cooking methods like steaming, boiling, grilling, baking or roasting.
• Avoid trans fatty acids, which are regularly found in commercially prepared baked goods, margarine, snack foods and processed foods.
Trans fats are damaging to cholesterol levels as they increase the bad LDL cholesterol and lower the good HDL cholesterol. Read food labels to find out if a particular treat contains trans fat.
• Consume more soluble fibre because it helps to lower LDL cholesterol levels in the blood.
Keeping your blood glucose levels, blood pressure, blood fats and body weight within the healthy range is critical for every person who has diabetes.
By following the advice given above, you can effectively reduce your risk of heart disease (as well as other complications of diabetes) and be rewarded with the freedom to enjoy life to the fullest.
Note: Datin Dr Liew is a consultant physician with the Heart Foundation of Malaysia
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