What if everyone in Australia were to visit a dietitian….?
e-GPS are pleased to have as our guest blogger this week: Accredited Practising Dietitian, Sally Marchini
It’s a frightening statistic that three in five people with diabetes die of cardiovascular disease. However, this doesn’t need to be the case. Managing the condition correctly will be of benefit and this includes a healthy diet and regular exercise.
If you’re wondering why it is that diabetes and cardiovascular disease are so closely linked, Diabetes Australia explains: “People with type 2 diabetes often have ‘abnormal’ levels of blood fats (cholesterol and triglycerides). Not only are the blood fat levels different to those of a person without diabetes, the cholesterol also tends to ‘behave’ differently. This is a contributing factor in the up to six-fold increase in atherosclerosis that people with diabetes experience.”
If everybody in Australia were to have a visit with an Accredited Practising Dietitian (APD) or Accredited Nutritionist (AN) to have ‘healthy’ explained in a personalised format, it is possible that the rates of these conditions could be significantly reduced. This is because an APD/AN would help you to find the best way to avoid them by tailoring an approach that follows the Australian Dietary Guidelines.
In a nutshell, the guidelines recommend a wide variety of nutritious foods including plenty of a variety of coloured vegetables and legumes, whole fruits, mostly wholegrain cereal foods, lean protein sources, reduced fat dairy produce and choosing to drink plenty of water. They also talk about foods that should be limited including foods high in saturated fat (fats from animal origin plus coconut and palm oils), added salt, added sugars and alcohol.
However, these guidelines were developed for healthy people. People who already have diabetes or are in a high risk group for diabetes should also minimise highly-refined starches (for example white bread, crackers, savoury snacks) and eat fewer highly-refined starchy vegetables such as potato or corn chips, or crisps. These high-glycemic index carbohydrates are linked to higher risk of cardiovascular disease, diabetes and some cancers, and sit alongside saturated fats (animal fats plus coconut and palm oils) and sodium as the main dietary contributors to cardiovascular disease.
Evidence is growing that people with diabetes should enjoy a diet based on nutrition-dense and low-glycemic index carbohydrates, lean proteins and should include mono- and poly-unsaturated fats (a Mediterranean-style diet) for improved diabetes control and minimised cardiovascular disease risk.
If you would like to learn more about how these ideas relate to your own circumstances, to understand portion sizes and to find ideas to make your diet more satisfying and rewarding, then arrange to see an APD/AN. You can find one near you through www.daa.asn.au
Diabetes Australia – Eating Well
Glycaemic Index – University of Sydney
Diabetes info for under 25s
A Shared Voice – Australian Diabetes Council
General Practice Solutions
Living with Diabetes and Coeliac Disease
Despite a modest decline in the total cholesterol (TC) levels of Australian men and women between 2004 and 2008, the risk of developing heart disease (cardiovascular disease or CVD) remains a constant concern.1
The 2011 Australia’s Cholesterol Crossroads report found that over 30% of both men and women have total cholesterol levels that are too high, while 56% of all men and 54% of all women have high levels of low-density lipoproteins (LDL cholesterol) putting them at risk of heart disease.1
Whether someone with high cholesterol needs medication or not, health professionals should discuss risk factors and lifestyle approaches that can reduce cholesterol levels. Dietary modifications, physical exercise, quitting smoking and weight control can assist in achieving desirable lipid levels.1
Dietary changes can include:
- Reducing energy intake;
- Decreasing saturated fat intake; and
- Replacing saturated fats with polyunsaturated or monounsaturated fats and carbohydrates (excluding sugars and syrup).1
Plant sterols (also known as phytosterols) have received considerable attention in recent years, as an effective cholesterol-lowering food additive. Margarines containing phytosterols are no longer exclusive to this market.
Phytosterols added to milk, yogurt, bread and cereal can help to lower LDL cholesterol.3 Milk has been shown to be the most effective source with a 15.9% lowering of LDL cholesterol for people who drank 500mL of milk fortified with 1.6 g/day of phytosterols for three weeks.3
These phytosterol enriched foods may be used in addition to a balanced diet, including lean meats (or meat alternatives), vegetables, fruit and reducing intake of fried foods, sugars and refined carbohydrates like white bread, pasta potatoes and rice.
Regular exercise, quitting smoking and reducing alcohol intake are also strongly recommended.
The following key recommendations have been developed for GPs. You should be aware of these as a health consumer and discuss them with your doctor:
- Comprehensively assess all cardiac risk factors including modifiable lifestyle factors
- Identify absolute CVD risk
- Discuss dietary modification and lifestyle approaches as part of a wider cholesterol management plan 2
Baker IDI Heart and Diabetes Institute www.bakeridi.edu.au
Heart Foundation www.heartfoundation.org.au
1. Carrington MJ and Stewart S. Australia’s Cholesterol Crossroads:
January 2011, Baker IDI Heart and Diabetes Institute, Melbourne, Australia. www.bakeridi.edu.au
2. National Vascular Disease Prevention Alliance. Guidelines for the assessment of absolute cardiovascular disease risk. 2009 www.nhmrc.gov.au
3. Clifton PM et al. European Journal of Clinical Nutrition (2004) 58, 503–509.
Gestational diabetes (GD) is a growing problem among Australian women. Around 5% of women aged 15 to 49 years were diagnosed with GD in 2005-6, an increase of over 20% since 2000-01.1
The risk increases with age from 1% among 15 to 19-year olds to 13% among women aged 44 to 49 years and is 1.5 times higher among Aboriginal and Torres Strait Islander women than among other Australian women. Women born overseas are twice as likely to develop GD than women born in Australia, with the incidence being highest among women born in Southern Asia—at least 3.4 times the rate of women born in Australia.1