Diet Therapy for Both Types of Diabetes - Essay Example

Carbohydrates are polyhydroxy aldehydes, ketones, alcohols, acids, their simple derivatives and their polymers having acetal linkages (Food and Agriculture Organization, 1998). Carbohydrates can be classified based on their degree of polymerization into three main groups: sugars, oligosaccharides and polysaccharides (Food and Agriculture Organization, 1998.) 1.Sugars a. Monosaccharides-Glucose, galactose, fructose b. Disaccharides-Sucrose, lactose, trehalose c. Polyols-Sorbitol, mannitol 2. Oligosaccharides a. Malto-oligosaccharides-Maltodextrins b. Other oligosaccharides-Raffinose, stachyose, fructo-oligosaccharides 3. Polysaccharides a. Starch-Amylose, amylopectin, modified starches b. Non-starch polysaccharides-Cellulose, hemicellulose, pectins. A monosaccharide consists of one sugar unit, a disaccharide consists of two sugar units, oligosaccharides, contain 3 to 10 sugar units, and polysaccharides, contain more than 10 sugar units (Food and Nutrition Board, 2005). Proteins are large organic compounds made of amino acids arranged in a linear chain and joined together by peptide bonds. Proteins include structural proteins, enzymes, nucleoproteins, proteins that transport oxygen, muscle protein, and many other types of proteins that have specific functions (Guyton, 1986). Proteins differ from one another in their nutritive value and maybe classified into three groups (Pruthi, 1999): a. Complete proteins (proteins of high nutritive value): These include proteins found in milk, eggs, meat, fish, liver etc. b. Partially complete proteins (proteins of moderate nutritive value) E.g. Proteins of cereals, millets, pulses, nuts and oilseeds. c. Incomplete proteins (proteins of very low nutritive value). These proteins do not promote any growth. E.g. Gelatin. Fats are organic compounds made up of carbon, hydrogen, and oxygen. Fats are the most concentrated source of energy in foods, and they belong to a group of substances called lipids (Food and Nutrition Board, 2005). Dietary fat consists primarily (98 %) of triacylglycerol, which is composed of one glycerol molecule esterified with three fatty acid molecules, and smaller amounts of phospholipids and sterols (Food and Nutrition Board, 2005). Fatty acids are hydrocarbon chains that contain a methyl (CH3-) and a carboxyl (-COOH) end (Food and Nutrition Board, 2005). The fatty acids vary in carbon chain length, and may be saturated or unsaturated depending on their proportions (Food and Nutrition Board, 2005). Sources of fat include cooking fats and oils, butter, margarine, fried foods, animal products etc (Pruthi, 1999). Minerals are found as a constituent of the mineral matter of the bones, as structural constituents of the soft tissues and as constituents of physiologically active substances e.g. Iron in haemoglobin. The important minerals are calcium, phosphorous and iron. Vitamins are nutrients and biomolecules required in small amounts (Lieberman & Bruning 1990; Pruthi 1999.). The vitamins include: Vitamin A (retinal), Vitamin B group (B1-thiamine, B2-riboflavin, B6-pyridoxine, B12-cobalamin), Vitamin C (ascorbic acid), Vitamin D (calciferol), Vitamin E (tocopherol) and Vitamin K, biotin, folate, pantothenic acid and Niacin (Lieberman & Bruning 1990). Carbohydrates and fats serve as the main sources of energy to the body. The Recommended Dietary Allowance (RDA) for carbohydrate is set at 130 g/d for adults and children (Food and Nutrition Board, 2005). Fat in the diet serves as a carrier for the fat-soluble vitamins (A, D, E) and is also essential for the absorption of carotene (provitamin A). Fat also supplies the essential fatty acids, which are needed by the body (Pruthi, 1999). There is no Adequate Intake (AI) nor Recommended Dietary Allowance (RDA) set for total fat. There is an association between total saturated fatty acid intake and total and low-density lipoprotein (LDL) cholesterol concentration with increased risk of coronary heart disease (CHD) (Food and Nutrition Board, 2005). Proteins are required for promoting growth and for the building and up-keep of the body tissues. In addition, they are necessary for the production of metabolic and digestive enzymes, blood proteins and hormones (Pruthi, 1999). The Recommended Dietary Allowance (RDA) of protein for adults is 0.80 g /kg body weight/day (Food and Nutrition Board, 2005). RDA for 1-to-3-year-olds is 0.55 g/pound of body weight/day; 0.5 g/pound of body weight for 4-to-6-year-olds; 0.45 grams for 7-to-14-year olds; and 0.4 grams for 15-to-18-year-old boys. Lack of adequate protein in the diet leads to Kwashiorkor in children (Pruthi, 1999). Vitamins are required for essential metabolic reactions in the body, growth, development, and regulation of cell function. Vitamins are bio-molecules and act as both catalysts and substrates in chemical reactions (Pruthi, 1999). When acting as a catalyst, vitamins are bound to enzymes and are called cofactors. Vitamins (See Appendix, Fig. 1 for the daily RDA for vitamins) also act as coenzymes to carry chemical groups between enzymes (Pruthi, 1999). Lack of adequate vitamins in the diet leads to various disorders. Vitamin A deficiency leads to impaired immunity, skin rashes and ocular effects (xerophthalmia and night blindness); thiamine deficiency causes diffuse polyneuropathy, high-output heart failure, and Wernicke-Korsakoff syndrome; riboflavin deficiency causes lesions of the lips and mucosa of the mouth, glossitis, conjunctivitis, seborrheic dermatitis, and normochromic-normocytic anaemia; B6 deficiency causes peripheral neuropathy, a pellagra-like syndrome, anaemia, and seizures; B12 deficiency causes megaloblastic anaemia, damage to the white matter of the spinal cord and brain, and peripheral neuropathy; Vitamin C deficiency causes scurvy; Vitamin D deficiency causes rickets in children and osteomalacia in adults; Vitamin E causes haemolytic anaemia and neurologic deficits; Vitamin K deficiency causes defective coagulation; Niacin deficiency causes dermatitis, diarrhoea, and dementia; isolated pantothenic acid deficiency is rare. There may be malaise, abdominal discomfort, and burning hands and feet with paresthesias; biotin deficiency causes seborrheic dermatitis and glossitis; folate deficiency causes megaloblastic anaemia (The Merck Manuals, 2005). Minerals like calcium and phosphorous form the major constituents of bones and teeth and are essential for their formation. In addition, calcium participates in the coagulation of blood (Pruthi, 1999). A deficiency of calcium causes rickets and tooth decay. Iron is mainly required for the formation of haemoglobin, which is an important constituent of the red blood cells. Prolonged deficiency of iron in the diet causes anaemia (Pruthi, 1999). A balanced diet comprises adequate and appropriate types of foods, which would supply the necessary nutrition and energy for the normal growth, maintenance, and development of the body (Medlineplus, 2006). Food sources of a balanced diet include milk and milk products, meat and meat substitutes, legumes, nuts and seeds, fruit and vegetables, breads and cereals (Medlineplus, 2006). Without a balanced diet, the normal growth, maintenance, and development of the body are impaired. Some of the guidelines for a balanced diet include the food guide pyramid and the U.S. Dietary Guidelines (RDA guidelines). In the food pyramid, food groups are arranged vertically, and represented by six different colors: Orange–grains, Green–vegetables, Red–fruits, Yellow–oils, Blue-milk products, Purple-meats and beans (Medlineplus, 2006). For a newborn baby, breast-feeding is the ideal food. As the child grows older, there is a higher requirement for nutrients, especially calcium, vitamin A, D, iron, protein etc (Holden & MacDonald, 2000). Adolescence is a time of rapid growth spurts. Therefore, there is a greater demand for nutrients like iron, calcium, and protein (Holden & MacDonald, 2000). Increasing age also modifies the nutritional requirements. For example, the skin of young adults makes much more vitamin D than that of the elderly. Therefore, older adults require a supplement to prevent the development of osteoporosis and rickets. There is also a greater need for dietary vitamin B12 in the elderly, since people over the age of 60 years have insufficient stomach acid to break the bonds between the vitamin B12 and proteins. Pregnancy is also a period of increased dietary requirements, especially folic acid, since it is essential for normal nervous development in the fetus (Zeisel, 2000). Diabetes mellitus, which is the most common endocrine disease, is a chronic disorder characterized by impaired metabolism of carbohydrates, protein, and fats. There are two major forms of the syndrome: Insulin-Dependent Diabetes Mellitus (type1 IDDM) and Non-Insulin-Dependent Diabetes Mellitus (type 2 NIDDM) (Foster, 1998). Type 1 diabetes is usually diagnosed in childhood. Type 1 diabetes mellitus is considered to be an autoimmune disease, where there is destruction of the beta cells of the pancreas, which produces insulin. This results in absolute insulin deficiency (Foster, 1998). Type 2 diabetes is more common than type 1 and accounts for 90%-95% or more of all cases of diabetes. It is characterized by insulin resistance and relative insulin deficiency (Foster,1998). Other causes of diabetes include: chronic pancreatitis in alcoholics, hormonal abnormalities like pheochromocytoma, acromegaly, and Cushing’s syndrome, steroid hormone administration, endogenous release of glucagon and catecholamines following severe burns, acute myocardial infarction (“stress hyperglycemia”), diabetes caused by drugs or chemicals, diabetes caused by insulin receptor abnormalities, and diabetes associated with genetic syndromes like lipodystrophies, myotonic dystrophy and ataxia-telangiectasia (Foster,1998.) Diabetes mellitus is characterized by the typical symptoms of polyuria, polydipsisa and polyphagia; there is a rise in the blood glucose level (Foster, 1998). NIDDM, which is not controlled by dietary management, requires the use of oral agents like sulfonylureas. These drugs act by stimulating the release of insulin from the beta cells of the pancreas (Foster, 1998). In case of IDDM, insulin therapy is required. The three standard insulin treatment regimes include: conventional, multiple subcutaneous injections (MSI) and continuous subcutaneous insulin infusion (CSII) (Foster, 1998.) A proper diet is essential in both types of diabetes. In NIDDM, the main treatment approach would be diet control, since most of the patients with insulin resistance are overweight and have an increase in VLDL and LDL, associated with decreased HDL, and presence of cholesterol and hypertension. The goals of diet therapy are: to maintain glucose at near normal levels, and attain optimal serum lipid levels and calories to maintain a reasonable body weight (Foster, 1998). In general, 50-60% of the total caloric amount should be from carbohydrates, 35% from lipids (less than 10% of these 10-15% from monounsaturated fats with less than 300 mg/day of cholesterol) and 10% from protein (Foster, 1998.) References Food and Nutrition Board (2005). Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients). The National Academies Press. Food and Agriculture Organization (1998). Carbohydrates in human nutrition. Report of the Joint FAO/WHO Expert Consultation. Foster, DW (1998). Diabetes Mellitus. Harrison’s Principles of Internal Medicine. 14th edition, Vol 2:2061. Guyton, AC (1986). Protein metabolism. Textbook of Medical Physiology. 7th edition. W.B. Saunders Company. Holden, C, MacDonald, A (2000). Nutrition and Child Health. Elsevier Health Sciences. Lieberman, S, Bruning, N (1990). The Real Vitamin & Mineral Book. NY: Avery Group. Medlineplus (2006). Balanced diet. Retrieved April 25, 2007 from, http://www.nlm.nih.gov/medlineplus/ency/article/002449.htm Pruthi, JS (1999). Quick Freezing Preservation of Foods: Principles, Practices, R & D Needs. Allied Publishers. The Merck Manuals (2005). Nutritional disorders. Retrieved April 25, 2007 from, http://www.merck.com/mmpe/sec01/ch004/ch004h.html Zeisel, SH (2000). Is there a metabolic basis for dietary supplementation? American Journal of Clinical Nutrition. 72(2). Appendix Figure 1. Read More