ASSESS THE CURRENT NUTRITIONAL RECOMMENDATIONS FOR; HIGH BLOOD PRESSURE, DIABETES AND OBESITY.

INTRODUCTION
Good health depends on small decisions we make everyday.

The decisions we make that most affect our health have to do with the food we eat. There are so many options available that we must continually decide which foods to select and how they are best prepared. It is vital to understand foods well in order to select those that maintain health and those that can treat various diseases. The more complete information we have concerning available foods the easier it is to make the best choices for health. Human beings need food throughout their lives. While foods provide nutrients and energy, some can cause disorders and diseases and others bring health and healing. Therefore there are harmful foods and beneficial foods.

DEFINITION AND DESCRIPTION OF DIABETES MELLITUS

Diabetes mellitus is a chronic metabolic disorder in which blood glucose levels

are raised because of a deficiency or diminished effectiveness of insulin. The disease is not curable and may lead to a variety of complications some of which are serious. Type I diabetes also known as insulin-dependent diabetes (IDDM) or juvenile-onset diabetes because it often begins early in life commonly at age 8 to 14 years (Latham, 1997). It occurs due to a viral infection, a toxin or an autoimmune reaction, all reinforced by a hereditary pre-deposition which destroy the insulin producing cells (-cells) of the pancreas. The patients tend to be thin and must receive insulin from infancy.
Type II diabetes also known as non-insulin dependent diabetes (NIDDM).

The cause is a combination of resistance to insulin action and an inadequate compensatory insulin secretory response. High levels of sugar may be present in the blood causing pathologic and functional changes in various target tissues, but without clinical symptoms. It is far more common and begins later in life. The patients tend to be obese and present disorders associated with fat metabolism, with excess cholesterol since insulin promotes the synthesis and accumulation of fat.

 Gestational diabetes mellitus (GDM) is defined as

any degree of glucose intolerance with onset or first recognition during pregnancy. The definition applies whether insulin or only diet modification is used for treatment and whether or not the condition persists after pregnancy. It does not exclude the possibility that unrecognized glucose intolerance may have begun concomitantly with the pregnancy.
Other specific types of diabetes (due to other

causes, e.g., genetic defects in -cell function, genetic defects in insulin action, diseases of the exocrine pancreas, drug or chemical induced).

DIABETES STATUS IN KENYA

It is estimated that the prevalence of diabetes in the

country is about 3.3%. This figure is projected to rise to 4.5% by 2025 if the trend is not checked. Currently, the country has over two million people and 25,000 children living with diabetes. Experts blame the

increase in diabetes to poor eating habits and lack of

physical exercise (Standard (2012)

NUTRITIONAL RECOMMENDATIONS
From a nutritional point of view diabetes is related

to obesity, cardiovascular disease and alcoholism. The main aim of treatment is to maintain health and to avoid complications. This is done by trying to get blood glucose levels as close to normal as possible and by so doing reduce the amount of glucose spilling into the urine. Control is greatly assisted by reduction of weight in obese diabetics and by maintenance of a healthy body weight in all diabetics (Latham, 1997).

FOODS OR NUTRIENTS RECOMMENDED FOR DIABETES

Legumes
In spite of containing between 20% and 30% carbohydrates, legumes are very well tolerated by diabetics. They help regulate the level of glucose in the blood because of their fiber content and the unique

histological structure of their seeds. Legumes have a low glycemic index, which means that they raise blood glucose levels very little. They reduce the need for insulin in diabetics and therefore legumes are fundamental food for diabetics.

Vegetables
All vegetables are very well tolerated by diabetics and because of

their low calorie content they help prevent or treat the obesity typical of adult diabetics. No vegetable is fattening even when eaten in large quantities except when fried. Vegetables produce a much greater feeling of satiety than other foods when one compares the amount eaten with calories taken in. Particularly appropriate are: broccoli, cauliflower, cabbages, lettuce, endive, green beans, peas and cucumber.

Whole Grains
Studies performed at the Harvard Universitys School of Public

Health confirm the hypothesis that high sugar and low whole grain foods increase diabetes risk (Salmeron, 1997). As a result, diabetics tolerate whole grain products better than those of refined grains and can eat them without difficulty. In addition to preventing diabetes, whole grains are well tolerated by these patients and should be used liberally particularly barley, oats and wheat.

Fruits
Fruit s are necessary in cases of diabetes since they contains

antioxidant vitamins that mitigate the course of the disease and protects against the cardiovascular complications that tend to accompany it. The only precaution is the need to control their use to avoid excess sugar and not to eat dried fruits (raisins, dates etc). Mangoes and bananas are the best tolerated.

Artichoke
The artichokes active ingredient cynarin is mildly hypoglycemic

(lowers the level of sugar in the blood). It contains inulin a carbohydrate beneficial to diabetics that is formed from fructose molecules and is easily absorbed. It can be included in meals in raw form in salads or as grilled or steamed vegetable.

Celery
Celery contains small amounts of glycoquin a substance similar in

action to insulin which reduces blood sugar level. It helps regulate blood glucose level, reduces cholesterol and neutralizes excess acids that may be produced in the body because of diabetes. It can be included in the meals in soups, raw in salads or fresh juice.

Mushroom Mushrooms produce a certain sense of satiety with very few calories. While they are excellent for the obese in general they are of particular benefit to diabetics because they reduce the need for insulin. Onions Onions contain glycoquin which helps to reduce blood glucose in cases of diabetes they are also blood alkalizers and protect against arteriosclerosis, which is beneficial to the diabetics. They can be included in the meals in raw for in salads, in broths, onion water or onion syrup.

Wheat germ The combined action of the vitamin B1and E present in wheat germ explains its anti-diabetics effect: 4 or 5 spoonfuls can reduce the glucose level and the need for insulin.
B group vitamins Vitamins B1, B2 and B6 are essential for glucose metabolism, transforming it to energy. Because of this diabetics must assure a good supply. Wheat germ, brewers yeast, legumes and nuts are all good sources of these vitamins.

FOODS OR NUTRIENTS THAT SHOULD BE AVOIDED Sugars

All dietary sugars with exception of fructose are formed

partially or completely of glucose. This is easily absorbed causing a steep rise in its level in the blood which is detrimental to diabetics who should avoid sugars in general and the sweetened products made from them. Fructose does not raise blood glucose level as much and it requires less insulin to be metabolized. However, this does not mean that diabetics can use fructose in large amounts deleterious effect on diabetics in the same as any refined sugar since it contains no fiber and provokes sudden rise in blood glucose level.

Honey is formed of equal parts of glucose and fructose. Its

Refined Baked Foods

These products supply refined sugar and flour but very little fiber or

vitamins. This leads to abrupt increase in blood glucose which is detrimental to diabetes since they cannot properly metabolize it. This includes all types of rolls, pastries, cookies and other dessert items.

Saturated Fat
It has been proven that fat consumption particularly saturated fat

reduces glucose tolerance and worsens diabetes. Saturated fat is the principal dietary determinant of plasma LDL cholesterol and persons with diabetes appear to be more sensitive to dietary cholesterol than the general public. Because of this diabetics should avoid butter, cream fatty meats and meat derivatives that are high in saturated fat such as sausages and bacon.

Shellfish
Quite frequently shellfish are contaminated with a variety of viruses and

bacteria that can cause serious infections in diabetics since these individuals tend to have somewhat compromised immune system.

Alcoholic Beverages
Alcohol makes the body cells more resistant to insulin worsening the course of diabetes. It also contributes to the generation of peripheral nerves

(neuropathy) which is one of the complications of diabetes.

Salt
Consistently consuming more than the ADI (admissible daily intake) of 6g the possibility of hypertension to which diabetics are particularly

susceptible is increased. Hypertension contributes to the cardiovascular complications of diabetics .

DEFINITION AND DESCRIPTION OF OBESITY

Obesity is basically an imbalance between the

calories taken in and those utilized. If one takes in more energy than necessary the body converts it to fatty deposits (adiposity) increasing the body weight.

In clinical practice and epidemiological research, obesity is most often defined by the body mass index a calculation that gives a reasonable approximation of adiposity. BMI is derived by dividing an individuals weight in kgs by height in meters squared (kg/m2). Adults between 25kg/m2- 29.5 kg/m2 are overweight and those with greater than 30 kg/m2 are obese .

NUTRITIONAL RECOMMENDATIONS
To avoid obesity one should eat foods that have

these characteristics ; low in calories, rich in fiber, low in fats, low sodium content because it retains water and increases body volume and weight and they must produce a feeling of satiety.

FOODS OR NUTRIENTS RECOMMENDED FOR OBESITY

Diuretic Foods
These foods such as fruits and vegetables stimulate kidney function and

increase urine production. The diuretic effect of these foods facilitates the elimination of fluid and sodium retained in the tissues which contributes to weight loss. Examples of these food include; celery, borage, cauliflower, green beans, apples, peaches, loquats, watermelon and grapes.

Whole Grains
A bowl of oatmeal or whole-grain cereal has benefits that last all day.

The fiber and complex carbohydrates in whole grains help you feel fuller for longer, so you'll be less tempted to overeat at lunch. They also help reduce LDL cholesterol and can be an important part of your weight loss strategy. Other examples of whole grains include wild rice, popcorn, brown rice, barley, and whole-wheat flour.

Seaweed

The gum contained in the seaweed is capable of retaining up to ten times its weight in water. This causes it to increase in volume in the stomach, producing a feeling of satiety and reducing the appetite at least temporarily. It also stimulates the production of thyroid hormone because of its iodine content which increases the metabolic rate and with it the combustion of carbohydrates.
When pineapple either the fruit or its juice, is eaten before a meal it reduces the appetite. It is also slightly diuretic which makes it a good complement for weight loss diet or treatments. The sweet potato is a good source of easily digested carbohydrates (starch and saccharose) as well as carotene. It is beneficial in weight loss diets because it produces a feeling of satiety that reduces the appetite. Sweet potatoes are nourishing and can relieve hunger fro several hours. They can be oven roasted, pureed with milk or used in pastries. Broccoli is low in sugars and calories while providing vitamin A, vitamin C, minerals and anti-carcinogenic phytochemicals. It produces a significant sensation of satiety in relation to its very low caloric content so the obese may eat as much as they like. It should be cooked slightly to avoid loss of nutrients.

Pineapple

Sweet Potato

Broccoli

Zucchini

Zucchini contains very little fat, sodium or calories while providing a certain amount of mineral salts and vitamins. Because if this its soothing effect on the digestive tract and its diuretic (purifying) action, it is recommended for weight loss diets.

Cherry

Cherries must be eaten slowly one by one so that they give the sensation of having eaten a great deal. They contain virtually no fat or sodium which potentiates their weight loss effect. A handful of cherries can substitute a plate of food. They are also depurant and diuretic.

Cabbage

All cabbages provide a feeling of satiety because of their high fiber content and supply very few calories. They also contain phytochemicals that protect against cancer.

Lettuce

Lettuce satisfies the appetite while producing a certain sedative effect that is necessary for those following weight loss diets. It provides vitamins and minerals but very few calories.

Turnips

They are recommended for weight loss diets because they are nutritious, easy to digest, very low in fat, have few calories and are quite filling.

Cucumber

Cucumbers are rich in alkalizing minerals and very low in fat and calories. A cucumber salad is a very appropriate dish in cases of obesity.

FOODS OR NUTRIENTS THAT SHOULD BE AVOIDED

Saturated Fat
This comes primarily from animals based foods (whole milk, cheese, eggs,

meats, sausages, etc) and is solid at room temperature. This is a reserve fat, stable and non reactive which unless one performs vigorous physical exercise tends to deposit under the skin, between the muscles and in the abdominal cavity, contributing to obesity.

Fried Foods
Fried foods always retain a certain amount of cooking oil, which contains a

great deal of calories e.g. fried potatoes have between 5 and 7 times more calories than boiled potatoes.

Refined Baked Goods

Products made with refined flour and white sugar provokes abrupt

increases in blood sugar. This forces greater insulin secretion to utilize this sugar. If energy supplied from these rapidly supplied carbohydrates is not used; insulin transforms it to fat contributing to obesity.

DEFINITION AND DESCRIPTION OF HIGH BLOOD PRESSURE/HYPERTENSION

Hypertension is said to exist in one or both of these conditions: systolic (maximum) pressure exceeds

140mm Hg and diastolic (minimum) pressure exceeds 90 mm Hg. Hypertension does not produce symptoms but rather slowly deteriorates the arteries and various organs. Elevated BP results from environmental factors, genetic factors, and interactions among these factors. Of the environmental factors that affect BP (diet, physical inactivity, toxins, and psychosocial factors), dietary factors have a prominent, and likely predominant, role in BP homeostasis. Diet can play an important role in maintaining blood pressure within healthy limits. The more simply prepared fruits and vegetables are eaten the lower hypertension risk.

NUTRITIONAL MANAGEMENT
Dietary management with moderate sodium restriction has been effective in reducing blood pressure in individuals with essential hypertension. Weight reduction can reduce blood pressure independent of sodium intake and also can improve blood glucose and lipid levels. The loss of one kilogram in body weight has resulted in decreases in

mean arterial blood pressure of 1 mmHg. Given the present evidence, weight reduction should be considered an effective measure in the initial management of mild-to-moderate hypertension, and these results could probably be extrapolated to the diabetic hypertensive population. (Hypertension, 2008).

FOODS OR NUTRIENTS RECOMMENDED FOR HYPRETENSION

Diuretic Foods

Diuretics reduce blood volume by increasing the volume of urine; thus blood pressure is maintained. Diuretic fruits and vegetables are also rich in potassium, fiber and antioxidant vitamins, all of which exercise healing power on the cardiovascular system.

Fruits

Eating large amounts of fresh fruits protect against hypertension. One meal a day consisting of fruit is a healthful habit for those suffering from hypertension, particularly if they are obese.

Leafy Green Vegetables

All of these are rich in potassium and magnesium which protects against hypertension. A salad or a dish of cooked greens without salt a day is an excellent custom for those suffering from hypertension, particularly if they are obese. It has been proven that a vegetarian diet lowers blood pressure. Vegetarian diets have been associated with low BP. In industrialized countries, where elevated BP is commonplace, individuals who consume a vegetarian diet have markedly lower BPs than do non-vegetarians.

Depurant Broth

This is a broth made with certain vegetables such as onions and celery. It is particularly effective in detoxifying the blood of waste materials that may cause hypertension and other chronic diseases. One half liter of this broth is drunk throughout the day in place of water. Legumes contain potassium, magnesium and calcium which are minerals that help control blood pressure and avoid hypertension. They also contribute high fibber and very low sodium. In spite containing a certain amount of sodium celery is a vasodilator and diuretic and therefore appropriate for hypertension.

Legumes

Celery

Squash

This is one of the richest foods in potassium and one of the lowest in sodium. Those with hypertension may eat squash daily as it is considered a very heart-friendly food.
Garlic is a vasodilator (dilates the arteries) and hypotensor (lowers blood pressure) although it is necessary to eat a certain amount to achieve this effect. Because of their diuretic action and richness in potassium, pears are among the most effective fruits against hypertension. This is effective in protecting the arteries; it is diuretic and improves blood fluidity.

Garlic

Pear

Grapefruit

Fiber

The more fiber in the diet, the lower the risk of hypertension.
A potassium rich diet protects against hypertension and its negative consequences. Plant-based foods are richest in potassium.

Potassium

Calcium

Calcium deficiency can lead to hypertension. Dairy products are good sources of this mineral but this are plant-based foods such as legumes, nuts, broccoli and cabbage.

Magnesium

Magnesium deficiency predisposes to hypertension. Nuts, legumes and wheat germ are good sources of magnesium.

Fish Oil

Fish oil supplements can contribute to a reduction in hypertension due to their richness in omega 3 fatty acids. If one has high blood pressure, eating fish could be helpful along with other dietary changes and medications, as recommended by your doctor. One strategy is to replace red meat with fish such as salmon, mackerel, herring, lake trout, sardines, anchovies, and tuna during some meals. But it's best to avoid salty fish, such as smoked salmon.

FOODS OR NUTRIENTS THAT SHOULD BE AVOIDED

Salt

An increase in salt consumption produces hypertension particularly in sensitive individuals. This effect is more pronounced with age. In addition to reducing or eliminating table salt it is important to avoid the hidden salt found in many foods. The hypertensive effect of salt is due to its sodium content. This mineral is naturally present in certain foods, additives and medications which should also be avoided. Cured ham is a meat derived with one of the highest so idiom level because the salt and other additives (nitrites and nitrates) added to it. This should be avoided.

Sodium

Ham

Sausages

These are very high in sodium both because of that which the meat naturally contains and that which is added when salt and additives (nitrites and nitrates used to cure the meat are sodium salts).sausages are also high in saturated fat which promotes hardening of the arteries and hypertension.

Meat

Regular consumption of any meat is related to hypertension because of its protein richness, its sodium content and its lack of potassium.

Proteins

The higher the protein consumption, the greater the possibility of suffering from hypertension. Animal proteins (cheese, milk, eggs, fish, and meat) have the highest hypertensive effect since they are accompanied by high levels of salt and/or sodium.

Alcoholic Beverages

Alcoholic beverages increase hypertension. Consumption of amounts that might be considered moderate (three glasses of wine a day) can raise blood pressure.

Saturated Fat

Saturated fat promotes hardening and narrowing of the arteries which causes hypertension. This results in the heart having to pump higher pressure to overcome this resistance to blood circulation.

Coffee

It has been proven that when one stops regularly drinking coffee, the blood pressure drops. Decaffeinated coffee does not affect the blood pressure.

Stimulant Beverages
All these contain caffeine (tea, mate, caffeinated soft drinks etc).

Drinking them on a regular basis raises blood pressure.

Pepper
Pepper causes hypertension just like piquant spices.

Matured Cheese
These should be eliminated since they contain a great deal of salt

and hypertensive amines which are formed during fermentation.

Egg
Egg yolk is quite high in sodium and should be avoided in cases of

hypertension. The egg white has very little sodium.

Thank You.