Management of Diet in Coronary Artery Disease With Diabetes Mellitus

MANAGEMENT OF DIET IN
CORONARY ARTERY DISEASE

WITH DIABETES MELLITUS
Geeta Arora, Diabetes Educator

Endocrine Department
A.I.I.M.S., New Delhi
 CAD is a condition in which the coronary artetries
become narrowed due to artherosclerosis, coronary
artery spasm & the blood supply to the heart is
obstructed & can damage the heart muscle .
 DM is a disease characterized by high blood glucose
concentration resulting from defects in insulin
secretion, insulin action or both.
Common Modifiable Risk Factors
 Hypertension
 Dyslipidemia
 Being Overwieght B.M.I.>25Kg/m2
 Sedentary Lifestyle
 Smoking
Dietary Goals For CAD With DM
• To attain and maintain normal blood glucose, blood lipids

& blood pressure levels
• To prevent degenerative complications (Macro and Micro)

• Improve health through healthy food choices & physical
activity
• To maintain appropriate weight and optimum nutrition.
Targets for diet management in CAD
with DM
ABC
A1C <6.5%
Blood Pressure 130/90mmhg
Cholestrol <200mg%
LDL <130mg%
HDL >50mg%
TG <150mg%
Recommended Kcal/kg of the Ideal body weight
for height or BMI
Sedentary Moderate Strenuous

activity activity activity
Normal weight 25 Kcals 30 Kcals 35 Kcals
Over weight 20 Kcals 25 Kcals 30 Kcals
Under weight 30 Kcals 35 Kcals 40 Kcals
Distribution of Macronutrient in Normal
Diabetic
Nutrient % of Total Calories
Carbohydrates 60-65
Proteins 15
Fats 25-30
Carbohydrates :
 Individualized based on eating habits of patients
Types
Simple Complex Fiber

Monosaccharides Whole wheat dalia, Fruits, Green Leaf
Disaccharides Flour,Bread,Oats, vegetables, Soyabean Pulses with Husks
Legumes, Beans, Barley
Grams
Fiber
Fiber : 25- 40 g / day
14 g TDF/ 1000 Kcal
Benefits of fiber
Reduces gastric emptying
Slow digestion, slow absorption
Prolonged intestinal transition
Reduction in the following:
Blood glucose
Triglycerides
Total Cholesterol
LDL
Body weight
Colon cancer
Glycemic Index (GI)
Blood Glucose Response of Foods
Low G.I. Foods : • Reduce insulin resistance

• Prevent & control DM
• Prevent cardiovascular disease
Factors affecting GI
 Source of Starch (whole grains low G.I.)
 Fiber -Sources :Oats, legumes , rice bran, apples ,dried peas , beans, barley,
fruits & vegetables are most effective.
 Fat , Lime
Nutritive sweeteners
*Fructose, honey, molasses, fruit juice, dextrose, maltose, sorbitol, xylitol
* Fructose
(Fruits, vegetables & honey) 4 cal/g – slower blood
glucose response
* Sorbitol, mannitol & xylitol 2-3 cal / g
* Tolerance level = 10 g / day
* Excess : Abdominal gas, discomfort, osmotic

diarrhoea
Non Nutritive Sweeteners
Sweetener Safe margin

*Sucralose - (Splenda, Sugar Free Natura, Kaltame) -
5 mg / kg B.W
*Aspartame - (Nutra sweet, Equal, Sugar Free ) - 50 mg / kg B.W
*Saccharin - (Sweet'N Low, Sugar Twin)- 5 mg /kg B.W
Do not use for children , pregnancy , lactation ,liver

& kidney disorders.
Fat
 Individualized ,based on the nutrition assessment & treatment goals
 Total Cholesterol < 300mg/day
Sources Function
Saturated fat Red Meat, butter, cheese, ghee, Cholestrol level

7% whole milk cream and LDL
PU FA Sunflower Oil , Corn Oil, HDL

10% safflower Oil & LDL
MUFA Olive Oil, Canola Oil, Ground Nut Oil, HDL

Mustard Oil, Seasame Oil Fish
10-15 % LDL
Trans fat Baked Products , Biscuits cakes HDL &

<1% processed cheese LDL
Essential Fatty Acids Cold water, Fish, Nuts, Seeds, Makes cell membrane more flexible
OMEGA3 Fenugreek, Mustard, Corn Oil, Blood Pressure and Cholesterol, TG Level
OMEGA 6 Soyabean Oil, Cotton Seed, Mortality rate from heart disease
Sunflower,
Recommended fats
* Cooking oil
* Moderate N6, more N3
Mixed Oil: Soya bean/ mustard + sunflower/ safflower,

Sesame /groundnut/corn/rice bran oil
* High MUFA :Olive ,canola , rice bran ,mustard oil
*Trans fats – To be avoided

Sodium :
2.5 g/day - mild to moderate hypertension
< 2 g/day - nephropathy, hypertension &
edema
Salt: Less than 5 gm/day
Vitamins & Minerals: Normal population

ALCOHOL
 Alcohol is not a recommendation.
 Alcohol has calories. (Beer & Wine)
 Alcohol interacts with certain drugs.
 To be avoided when Triglycerides are high.
However if allowed
Moderate amounts – 2 drinks per day, 4-5 times a week for a man &
1 drink per day for a woman
In addition to strengthening
& toning up the muscles
Consumes more energy

Sensitize the tissue
To the action of insulin
Exercise
Reverses insulin resistance & increases insulin
receptors
Reduces weight
Lowers LDL
Increases HDL
Reduces total cholesterol
Psychological benefits
Guidelines for Exercise
 Test the blood sugar before and after exercise
 Maintain gap of at least 1 and half – 2 hrs after meal
 Snacks (10-15 g carbohydrate for < one hour of

moderate exercise (fruit 100-150 g or 1 stuffed roti)
 Extra snack for peak periods of insulin
 Add 7-8 g protein for 1 or > 1 hour of exercise

Fazit
1. Education to maintain healthy lifestyle
2. Maintain ideal body weight
3. Maintain normal blood lipid levels
4. Food should contain whole grains,legumes and green

vegetables (fiber)
5. Use low GI foods

Fazit
6. Mixed oils should be used to achieve N6/N3 fatty acid ratio
7. MUFA is beneficial
8. Reduce SFA and avoid TFA
9. Small sized, frequently spaced meals
10. Regular exercise is essential

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MANAGEMENT OF DIET IN

CORONARY ARTERY DISEASE

Geeta Arora, Diabetes Educator

• To attain and maintain normal blood glucose, blood lipids

• To prevent degenerative complications (Macro and Micro)

Sedentary Moderate Strenuous

Simple Complex Fiber

Low G.I. Foods : • Reduce insulin resistance

 Source of Starch (whole grains low G.I.)

* Sorbitol, mannitol & xylitol 2-3 cal / g

* Tolerance level = 10 g / day

* Excess : Abdominal gas, discomfort, osmotic

Sweetener Safe margin

*Saccharin - (Sweet'N Low, Sugar Twin)- 5 mg /kg B.W

Do not use for children , pregnancy , lactation ,liver

Saturated fat Red Meat, butter, cheese, ghee, Cholestrol level

PU FA Sunflower Oil , Corn Oil, HDL

MUFA Olive Oil, Canola Oil, Ground Nut Oil, HDL

Trans fat Baked Products , Biscuits cakes HDL &

* Moderate N6, more N3

Mixed Oil: Soya bean/ mustard + sunflower/ safflower,

* High MUFA :Olive ,canola , rice bran ,mustard oil

*Trans fats – To be avoided

Vitamins & Minerals: Normal population

Consumes more energy

Reduces total cholesterol

 Snacks (10-15 g carbohydrate for < one hour of

 Extra snack for peak periods of insulin

 Add 7-8 g protein for 1 or > 1 hour of exercise

1. Education to maintain healthy lifestyle

2. Maintain ideal body weight

3. Maintain normal blood lipid levels

4. Food should contain whole grains,legumes and green

5. Use low GI foods

6. Mixed oils should be used to achieve N6/N3 fatty acid ratio

8. Reduce SFA and avoid TFA

9. Small sized, frequently spaced meals

10. Regular exercise is essential

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