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SPECIAL DIETS

Diabetes Mellitus is a disease in which the body does
not produce or properly use insulin to regulate the
amount of glucose or sugar in the blood
Type 1 Diabetes : Insulin-dependent diabetes
Insulin Dependent Diabetes mellitus (IDDM) or
formerly called juvenile-onset diabetes accounts for
about 5 to 10 percent of all diagnosed diabetes.
Normally affect children and young adulthood but can
occur at any age.
Patient with Type 1 diabetes must have daily injection
to survive.
Type 2 Diabetes: Non-insulin-dependent
diabetes
Type 2 diabetes - Non-insulin dependent diabetes
mellitus (NIDDM) or formerly called adult onset
account for more than 90 percent of all diabetes cases.
It normally affect adult which is age 40 and above, and
people which is overweight.
Type 2 diabetes is characterized by high level of
glucose in the blood. Glucose is the main energy
source used by the body to fuel almost every action it
performs. Insulin is produce by pancreas to control the
amount of glucose circulating in the body by controlling
the uptake of glucose into the body cell.

Risk Factor
The main risk factors include the following: Risk Factors
A major advance for people at risk of developing type
2 diabetes:
 Family Health History –
 Autoimmune Conditions
 Birth and Early Childhood Conditions  Family Health History –
 Born to an older mother  Obese or Overweight
 Born to a mother with preeclampsia  Sedentary or Inactive lifestyle
during pregnancy  Carrying fat around the waist and stomach
 Early introduction of formula milk to
infants. Complication
 Ethnic Background Without effective intervention to limit this strain can
cause significant, severe complications such as heart
Signs and Symptoms disease, kidney disease, blindness and loss of limbs
through amputation.
 Weight loss
 Increased urination Treatment
 Extreme thirst Proper treatment and glucose control enable people
with type 2 diabetes to live normal, productive lives.
 Hunger
 Fatigue, weakness
 Blurry vision Treatment differs at various stages of the condition. In
 Irritability its early stages, many people with type 2 diabetes can
control their blood glucose levels by losing weight,
 Skin infections
eating properly and exercising.
 Wounds that don't heal
Many may subsequently need oral medication, and
Treatment some people with type 2 diabetes may eventually need
There isn't any cure for diabetes yet. The insulin shots to control their diabetes and avoid the
only thing patient can do is to control and disease's serious complications.
maintain their blood sugar level within a
healthful and ideal range. This can be done
Metformin, which is usually thought of as
by a combination of insulin therapy, diet,
a treatment of diabetes, increases the
and exercise.
body’s response to insulin. This not only
regulates blood sugar, but has also been
shown to increase ovulation in women who
were previously anovulatory.

Gestational Diabetes
Gestational diabetes is a form of diabetic
which affect non-diabetic pregnant women
with high blood glucose during pregnancy.
 Begins between 24th and 28th weeks
of pregnancy and is consider as a
temporary form of diabetes because it
usually dissolve after delivery.
However, in some instances,
gestational diabetes patient might
subsequently develop type 2 diabetes.
Gestational diabetes happen when body
not produce or properly use insulin to
regulate the amount of glucose in the
blood.
This condition is known as insulin
resistance. The result, glucose level in the
bloodstream rise. During pregnancy there
is normally an increase in the amount of
insulin produced by the pancreas. This
occurs because hormones during
pregnancy make it difficult for your body to
use insulin. When a woman has
gestational diabetes, pancreas can't cope
with the demand and blood glucose levels
rise.
Risk Factors
Women most at risk for gestational
diabetes are obese or over 30 years of
age, have a family history of diabetes
and/or have previously given birth to a
baby over 9 pounds.
Treatment
It is important to get early treatment for
gestational diabetes as it imposes danger
on both the baby and mother. Treatments
include diet with a special meal plans and
scheduled physical activity, insulin
injections, monitoring blood sugar and
urine ketones. The goal of gestational
treatment is to keep blood glucose level
equivalent to those pregnant women who
don't have gestational diabetes.
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Diabetic Diet
Diabetic Diet
 Maintain DBW


Simple balanced healthy meal
Balance food with exercise
 Eating enough calories
 Recommendations of diabetic diet differ for person
to person, based on their nutritional needs,
lifestyle, and the action and timing of medications
 Type 1 diabetic, focus mostly on matching food
intake to insulin whereby one needs to know when
insulin peaks and how fast the body
 Type 2 diabetic the concern may be more
oriented to weight loss in order to improve the
body's ability to utilize the insulin it does produce.
Diabetes Guidelines
Whether it is Type I, Type II diabetes or Gestational
diabetes, the goals of achieving control of blood
glucose levels are similar: to keep blood glucose as
near as possible to that of a person without diabetes.
The following table show the desirable blood sugar
level supply by The American Diabetes Association
Blood Glucose Goals - Desirable Blood Sugar
Levels
Time of Test Person without diabetes Person with diabetes
Before meals Less than 115 mg/dl 80 to 120 mg/dl
_____________________________________________________
Before bedtime Less than 120 mg/dl 100 to 140 mg/dl
 Recommended daily food portion:
 Daily calories count : carbohydrates - 50% to 60%
protein - 12% to 20%
fat - not more than 30%
 Spacing meal throughout the day, help a
person avoid extremely high or low blood
glucose levels.
 Diet undertaken with the supervision of a
doctor.
 In take of food which help lower blood
cholesterol.
 Use Exchange lists in planning diabetic diet.

DIABETIC FOOD PYRAMID
Fats (Limit to 1 serving per meal) A serving can be
 10 Peanuts.
 1 Tbsp Salad Dresssing
 2 Tbsp light salad dressing or sour cream.
 1 Tsp margarine, Oil or mayonnaise.
 1/8 Avocado.
Sweets (Substitute for starch or fruit serving
occasionally) A serving can be:-
 2 Small Cookies.
 1 Small Cupcake or Muffin
 ½ Cup Ice cream.
 1/3 Cup Frozen Yoghurt.
 ¼ Cup Sherbet.
 1 tsp Syrup or Honey.
Milk (2-3 Servings per day) A serving can be:
 1 cup Milk.
 1 Cup Low Fat.
 1 Cup Artificially Sweetened yogurt (No sugar)
Meat / Fish/Chicken (2-3 Serving per day) A serving
can be:
 2 oz Cooked Lean Meat/Poultry/Fish.
 ½ - ¾ Cup Tuna or Cottage Cheese.
 1 Egg or 4 oz Tofu or 1 oz cheese.
 2 Tbsp peanut Butter.
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Vegetables (3-5 Serving Per day) A Serving can be:
 1 Cup Raw Vegetables.
 ½ Cup Cooked Vegetables.
 ½ Cup Tomato or Vegetable Juice.
Fruits (3 Serving per Day) A Serving Can be:
 70 gm small fruit.
 ½ Cup canned fruit.
 ¼ cup Dried Fruit.
 ½ Cup Fruit Juice. (No sugar)
Grains, Starchy Vegetables and Beans. (6-11
Servings Per Day) A Serving Can be:-
 1 Slice of 1 oz bread or ½ (1 oz) Bagel or 5
Crackers or 1 Granola bar.
 ½ Hamburger or Hot dog Bun or a tortilla of 6
inch or 2 tacos.
 ½ Cup Cooked Cereal, Cooked beans, Lentils,
Corn, Peas, S. Potato, Potato or Pasta.
 1 Cup winter Squash, 1 Cup Soup.
 1/3 Cup Rice or 3 Cup Plain Popcorn (Fat free)
HYPERTENSION
Medical Description
Hypertension, or high blood pressure, is characterized
by high blood pressure on the artery walls.
RISK FACTORS
* Heart failure: by imposing an additional workload on
the heart, hypertension can cause depletion of the heart
muscle;
* Of angina, myocardial infarction and stroke: high blood
pressure means that the blood exerts greater pressure
on the artery walls, making them fragile and increases
the risk that the artery Hangs by atherosclerosis;
* Kidney problems (renal failure) and eyes (injury to the
retina can lead to blindness): Again, due to the
weakening of blood vessels.
”.
Prevalence
According to the World Health Organization, 30% men
and 50% of women aged 65 to 75 years suffer from
hypertension. Nowadays, hypertension affects
populations increasingly younger.

The types of hypertension and its causes
* The primary hypertension represents about 90% of
cases. It depends on many factors related to age,
heredity (especially for males) and harmful habits, the
effects accumulate over the years. Obesity, inactivity,
smoking, alcohol abuse, stress and too much salt diet
contributes to hypertension.
A high intake of salt causes water retention. According to
a survey conducted by Statistics Canada, over 85% of
men and 60% of women have an intake of salt or sodium
than the recommended upper limit of 2 300 mg per day1.
* Secondary hypertension may result from another
health problem (a kidney problem or endocrine,
congenital deformity of the aorta) or the frequent use of
certain drugs. For example, nasal decongestants,
because they contain ephedrine (a substance whose
effect resembles that of adrenaline secreted under
stress), anti-inflammatory, which create the retention of
water and salt, and bronchodilators, which have a
stimulating effect on the heart.
Diagnosis
Doctors measure blood pressure several times during
successive visits, as figures can vary significantly from
one time to another.
It is uncommon for tension rises significantly when a
patient enters the doctor’s office, and tension begins to
decrease when it emerges. This is called the “syndrome
of the white coat.” To avoid this type of reaction, the
doctor may suggest the patient to measure his own
blood pressure at home using a monitor.
Once reliable values found, the doctor may diagnose a
person whose pressure is equal to or greater than
140/90 suffers from hypertension. Note that people with
diabetes or renal disease should ideally maintain a blood
pressure that does not exceed 130/80.
Level of blood pressure
Measurement of systolic pressure
Measurement of diastolic pressure
Optimal
115 mmHg and 75 mmHg
Normal
less than 120 mmHg and less than 80 mmHg
Prehypertension
120-139 mmHg or 80-89 mmHg
High
- Stage Light
140-159 mmHg or 90-99 mmHg
- Stadium moderate
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160-179 mmHg or 100-109 mmHg
- Late Stage
180 mmHg or 110 mmHg
Note
In the case where the measurement of the systolic and
diastolic blood pressure are two different levels, the
physician takes into account the level corresponding to
the higher value for assessing the condition of blood
pressure.
Understanding the measurement of blood pressure
Blood pressure consists of systolic and diastolic
pressures, which are measured in millimeters of mercury
or mmHg.
* Systolic pressure corresponds to the period of heart
contraction and ejection of blood into the arteries. It
ensures a supply of blood around the body.
* The diastolic pressure is the pressure exerted on the
arteries between each pulse when the heart relaxes. It
corresponds to the period of ventricular relaxation that
allows the heart chambers to fill. This pressure tends to
increase with age, but passed the sixties, it gradually
decreases due to the weakening of blood vessels in the
body.
Blood pressure depends on the amount of blood
pumped by the heart and resistance in the arteries.
Symptoms
Hypertension is usually asymptomatic. However, a very
high blood pressure (moderate or advanced stage) can
cause the following symptoms:
* Headache accompanied by fatigue (these headaches
are located in the neck and occur early in the morning);
* Dizziness or ringing in the ears;
* Palpitations;
* Nosebleeds;
* Confusion or sleepiness;
* Numbness or tingling in the feet and hands.
People at risk
* People over 55 years. Blood pressure tends to
increase from that age.
* Among young adults, the percentage of hypertension is
higher among men than women among those aged 55 to
64 years, the percentage is roughly the same in both
sexes among persons over 64 years, the percentage is
higher among women.
* Americans of African descent.
* Individuals with a family history of early hypertension.
Risk Factor
* Obesity.
* A diet high in salt and fat and low in potassium.
* Excessive consumption of alcohol.
* Smoking.
* Physical inactivity.
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* Stress.
* Regular consumption of black licorice or products Onion
containing black licorice It has an essential oil that lowers the systolic levels

DIET Tomato
Are high in gamma-amino butyric acid (GABA) a
DASH DIET compound that can help bring down blood pressure.
(Dietary Approaches to Stop Hypertension)
Saffron
Contains a chemical compound called crocetin that
Grains: 4 daily servings lowers the blood pressures
Vegetables: 4-5 daily servings
Fruits: 4-5 daily servings Tips to start DASH Diet
Low-fat or  Add a serving of vegetables at lunch and dinner
Fat free dairy products: 2-3 daily servings  Add a serving of fruit to your meals or as a
Meat,Poultry and Fish: 2 or less daily servings snack
Nuts, seeds and  Use only a half butter, margarine or salad
Dry beans: 4-5 servings per week dressing use low-fat or fat free condiments
Fat and Oils: 2-3 daily servings  Drink low-fat or skim dairy products three times
Sweets: try to limit to less than a day
5 servings per week  Limit meat six ounces a day. Try eating some
vegetarian meals
 Add more vegetables, rice, pasta and dry beans
Vegetarian Diet to your diet.
 Instead of typical snack (chips etc…) eat
Lower blood pressure and lower incidence of unsalted pretzels or nuts, graham crackers low-
hypertension and other cardiovascular diseases, fat free yogurt: unsalted plain popcorn with no
vegetarian diet contains more potassium, complex butter and raw vegetables
carbohydrates, polyunsaturated fiber, calcium  Read food labels carefully to choose products
magnesium, vitamin C and A. that are lower in sodium.

Fiber
THERAPEUTIC DIET
Water soluble gel forming oat bran, apple pectin it also Is a modification of normal diet that designed to meet the
reduces cholesterol and promote weight loss requirement of a given situation.
Reduce Salt and Sodium in your diet TYPES OF DIET
Excessive consumption of dietary sodium chloride(salt)
Normal or Regular or Full Diet
Coupled with diminished dietary potassium, induces an
increase in fluid volume and an impairment of blood
Use as a basis for planning therapeutic diet
pressure regulating mechanisms. This results in
CHAR: It follows the principle of good meal planning and
hypertension in susceptible individuals.
permits the use of all foods
AVOIDED: Highly spicy foods, rich fatty foods and gas
A high potassium-low sodium diet reduces the rise in
forming foods (apple, bread, camote, milk products and
blood pressure during mental stress by reducing the
citrus fruits)
blood vessel constriction effect of adrenaline.
Clear Liquid Diet
Sodium restriction alones does not improve blood
To provide and oral source of fluid and small amount of
pressure control; It must be accompanied by a high
calorie and electrolytes in order to prevent dehydration
potassium intake.
relieve thirst, maintain water imbalance and reduce
caloric residue.
Beneficial Vegetables and Spices to control
Indications: Diarrhea, inflammatory conditions of GIT
hypertension
Cold Diet (Tonsillectomy)
Celery
To minimize pain, in the oral cavity and avoid bleeding of
Eating a few as four celery stalks was found to be
the operated areas.
beneficial in lowering blood pressure.
CHAR: consists of solid or iced smooth liquids and foods
(plain ice cream, sherbets, cold milk, ice tea, bland fruits
Garlic
which have been cooled.
1 clove of garlic in 12 weeks- diastolic blood pressure
Indications: Tonsillectomy and tooth extraction
and cholesterol levels were significantly reduced.
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by the body's digestive and waste system , which in turn

breaks down and builds up body and food tissues
through food intake. Generally the uric acid is dissolved
in the blood and also flushed out through the kidneys.

Tube feeding or Blenderized or Osteorized diets When the Uric acid levels are high, it is known as
To provide a source of complete nutrition in a form that Hyperuricaemia.
will easily pass through a tube.
CHAR: Consist of Natural food that are liquid or a
liquefied by means of mechanical blender and
administered by NGT for patient unable to take food by
mouth, It is nutritionally adequate well tolerated by the
patient, easily digested, easily prepared and in
expensive.
Indications: Maybe required for a short period of time or
indefinitely in a variety of circumstances, surgery of the
mouth or GIT, paralysis of the jaw, severe burns,
anorexia nervosa, coma, ordinarily the feeding are given
by NGT.

Soft diet
To provide nutritionally adequate and the use of simple
and easily digested foods.
CHAR: Follows the regular diet pattern but modified in
consistency and texture.
Foods Allowed: Easily digested and easily chewed such
as fruits, meat not tough
Foods Avoided: Highly seasoned foods, fatty tough
foods and friend foods.
Mechanical Soft Diet or Geriatric Soft Diet
To provide food with minimum chewing
CHAR: Follows food pattern regular diet but modified by
grinding, mincing, chopping and pureeing.
Bland Diet
To provide chemically, thermally and mechanically non-
irritating diet, to reduce the secretion.
Food Avoided: Decaffeinated coffee, red pepper, cola
beverages, food gastric irritation, black pepper, Chili
powder, caffeine, coffee, tea. Cocoa, alcohol
Indications: Duodenal Ulcers, Ulcer, Ulcerative Colitis
Gall Bladder disease.
Reducing Diet (low Calorie/Low fat)
CHAR: Normal Diet
Fat and CHO Restricted
Low CHO – Fruits and Vegetables are used and
restriction
Gout is a version of arthritis caused by too much uric
acid in the blood stream.
Gout is considered a chronic and progressive disease
It is often related to an inherited abnormality in the
body's ability to process uric acid. Uric acid is a
breakdown product of purines that are part of many
foods we eat.
Gouty arthritis is typically an extremely painful attack
with a rapid onset of joint inflammation.
Gout is nine times more common in men than in women.
It predominantly attacks males after puberty, with a peak
age of 75. In women, gout attacks usually occur after
menopause.
Risk Factors for developing gout:
1. Obesity
2. Excessive weight gain
3. Alcohol
4. High Blood Pressure
Signs and symptoms
1. The small joint at the base of the big toe is the
most common site of an acute gout attack of
arthritis.

It is one of the most common and oldest forms of

arthritis that can cause extreme pain in the areas
affected

The body either makes too much uric acid or it cannot

excrete it from the body in large enough quantities.

Uric acid is a by product of purines being broken down

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Fresh Cherries, Strawberries, Blueberries

Banana, Celery, Tomatoes,
Vegetables including: Cabbage, Parsley, green leafy
vegetables
Pine apple
Foods high in Vitamin C
Red Cababge
Red Bell peppers
Mandarins
Oranges
Potatoes
Drink fruit juices
8 glasses of water a day

Carbohydrates such as Bread, cereals, pasta, rice

Low-fat dairy products
Tuna
Salmon
Tofu

Food to Avoid

 Bacon
 Beer
2. Other joints that are commonly affected include the  Red Meat
ankles, knees, wrists, fingers, and elbows.  other alcoholic beverages.
 Anchovies, sardines in oil, Yeast.
3.Acute gout attacks are characterized by a rapid onset  Organ meat (liver, kidneys, sweetbreads)
of pain in the affected joint followed by warmth, swelling,  Legumes (dried beans, peas)
reddish discoloration, and marked tenderness.  Meat extracts, gravies.
 Mushrooms, spinach, asparagus, cauliflower.
4.Patients can develop fever with the acute gout
attacks
KIDNEY STONE
Treatment

First, it is critical to stop the acute inflammation of joints

affected by gouty arthritis.

Second, it is important to address the long-term

management of the disease in order to prevent future
gouty arthritis

The treatment of an acute attack of gouty arthritis

involves measures and medications that reduce
inflammation. Preventing future acute gout attacks is
equally as important as treating the acute arthritis.

Prevention of acute gout involves maintaining adequate

fluid intake, weight reduction, dietary changes, reduction
in alcohol consumption, and medications to lower the
uric acid level in the blood

Drugs:

Indomthacin- anti-inflammatory
Acetaminophen-pain reliever
Colchicines-decrease joint inflammatory

Recommended Food to Eat:


A kidney stone is a hard, crystalline mineral material
formed within the kidney or urinary tract. Kidney stones
are a common cause of blood in the urine (hematuria)
often severe pain in the abdomen, flank, or groin. Kidney
stones are sometimes called renal calculi
RISK
Anyone may develop a kidney stone
or those who are taking certain medications are more
susceptible to their development.
Most urinary stones develop in people 20-49 years of
age, and those who are prone to multiple attacks of
kidney stones usually develop their first stones during
the second or third decade of life.
Most Common in Males than females
A family history of kidney stones is also a risk factor for
developing kidney stones. Kidney stones are more
common in Asians and Caucasians than in Native
Americans, Africans, or African Americans.
Uric acid kidney stones are more common in people with
chronically elevated uric acid levels in their blood.
Causes
Kidney stones form when there is a decrease in urine
volume and/or an excess of stone-forming substances in
the urine.
The most common type of kidney stone contains calcium
in combination with either oxalate or phosphate.
Dehydration from reduced fluid intake or strenuous
exercise without adequate fluid replacement increases
the risk of kidney stones
Gout results in chronically increased amount of uric acid
in the blood and urine and can lead to the formation of
uric acid stones.
SIGNS AND SYMPTOMS
people who have kidney stones often report the sudden
onset of excruciating, cramping pain in their low back
and/or side, groin, or abdomen.
It may be so severe that it is often accompanied by
nausea and vomiting.
If infection is present in the urinary tract along with the
stones, there may be fever and chills. Sometimes,
symptoms such as difficulty urinating, urinary urgency,
penile pain, or testicular pain may occur due to kidney
stones.
8
TREATMENT:
Ketorolac (Toradol), an injectable anti-inflammatory
drug,
Treatment is directed toward control of symptoms. Home
care in this case includes the consumption of plenty of
fluids. Ibuprofen (Advil) may be used as an anti-
inflammatory medication if there is no contraindication to
its use
Surgical techniques have also been developed to
remove kidney stones
FOODS TO AVOID
Foods Rich in Calcium
Foods rich in calcium are obviously kidney stone foods
to avoid. It is not the calcium rich foods per se that leads
to formation of kidney stones. However, when our diet is
too high in calcium, our body cannot convert these
calcium deposits into useful forms thus they become
stagnant in our kidneys and clump to become a kidney
stone.
Food high in oxalate or salt of oxalic acid produce in
the body’s metabolism excreted in the urine.
Spinach, peanuts, chocolate and sweet potatoes are
oxalate-rich foods that a person prone to kidney stones
should,avoid,eating.
Foods High in Protein
Meat, Egg,Nuts
Foods High In Sugar
Apart from those with diabetes mellitus, people with
kidney stones should also consider sugary and sweet
confections as kidney stone foods to avoid. What
happens with too much intake of sugar, it takes away
calcium deposits from our bones and increases the
amount of calcium in our blood. As such, calcium may
be deposited inside our kidneys and may form in calcium
stones
Diuretic Drinks
Alcohol and caffeine are diuretics. When we say
diuretics, these foods and beverages increases our urine
output. When this happens, we may dehydrate ourselves
and leave our kidneys with a high concentration of
minerals and elements. With dehydration, kidney stones
may form. As such, it is important to keep ourselves
hydrated as much as possible to dilute our urine and
prevent these minerals from turning into kidney stones.
 9

Sodium
Processed Foods

Foods Allowed

Eating whole foods like leafy vegetables, fruits,

vegetables, whole grains, legumes, brown rice and soy
makes the perfect diet for kidney stones. Including foods
containing Magnesium and other minerals, high fiber like
oats, wheat bran, barley etc proves to be beneficial in
preventing kidney stones.

magnesium (dry milk in homemade yogurt increases the

percent of magnesium content through food)

Different Cookery terms:

Bake To cook food by dry heat in an oven, or as if in an

oven.

Blanch To plunge a food into boiling water - then into

iced water to quickly stop the cooking. Often used to
loosen skins, set color, remove bitterness or reduce salt
in cured meats.

Boil To cook food by heating liquid ingredients to boiling

point and maintaining at that temperature. "Bring to the
boil" heating a liquid until bubbles break the surface.

Blend To use a spoon, beater or electric blender to

evenly combine two or more ingredients.

Braising To gently fry meat, vegetables or other foods

by lightly browning in fat and then cooking slowly in a
covered pan with a small amount of flavorful liquid such
as stock or wine.

Dash a seasoning measure indicating a scant 1/8

teaspoon or less.

Fry to cook over direct heat in a hot oil of fat

Garnish To decorate food with strips pf parsley, tomato

slices and other vegetables that are edible.

Sauté To fry food quickly over high heat in a little fat to

seal and lightly brown. The food is moved constantly to
keep an even heat and avoid burning on the outside
before the inside is properly cooked.

Simmer To cook food gently in a liquid at or just below

boiling point so that the liquid quivers rather than
bubbles.

Stew To simmer in a small quantity of water