NUTRITION THROUGH LIFE CYCLE

TOPIC: ISSUES IN ADULTHOOD

GROUP: 4

Submitted By:

Liza Kamran (F19BSFN048)

Laiba Akhtar (F19BSFN071)

Zainab Zahid (F19BSFN065)

Zaima Imran (F19BSFN016)

Minahil Faisal (F19BSFN007)

Submitted To: Ma’am Fasiha Ilyas

Semester/ Section:
3/E

KINNAIRD COLLEGE FOR WOMEN, LAHORE

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Contents

1. Cardiovascular Disease (CVD)…………………………………………….3

 Introduction to Cardiovascular Disease
 Prevalence of Cardiovascular Disease
 Etiology and Physiological effects of Atherosclerosis
 Risk Factors of Cardiovascular Disease
 Screening and Assessment of Cardiovascular Disease
 Nutritional Assessment of Cardiovascular Disease
 Nutritional Interventions of Cardiovascular Diseases
 Pharmacotherapy of Cardiovascular Disease
2. Metabolic Syndrome……………………………………………………....19
 Introduction to Metabolic Syndrome
 Prevalence of Metabolic Syndrome
 Etiology and Physiological Effects of Metabolic Syndrome
 Screening and Assessment of Metabolic Syndrome
 Nutritional Interventions of Metabolic Syndrome
3. Diabetes Mellitus………………………………………………………….24
 Introduction to Diabetes Mellitus and Prediabetes
 Prevalence of Diabetes Mellitus
 Etiology and Physiological Effects of Diabetes Mellitus
 Nutritional Assessment of Diabetes Mellitus
 Nutritional Interventions of Diabetes Mellitus
 Carbohydrate Management
 Self-Monitored Blood Glucose
 Physical Activity in Diabetes Mellitus
 Pharmacotherapy for Type 2 Diabetes
 Herbal Remedies and other Dietary Supplementations

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 CARDIOVASCULAR DISEASE

INTRODUCTION TO CARDIOVASCULAR DISEASE:

This disease involves the heart and blood vessels. This includes angina and myocardial infraction
(heart attack), stroke, Heart failure,
cardiomyopathy, carditis, valvular heart disease,
rheumatic heart disease and venous thrombosis. It is
most common in older adult. This may be caused by
high blood pressure, diabetes mellitus, smoking,
and lack of exercise, obesity, High cholesterol level,
poor diet and excessive consumption of alcohol. CVD are leading cause of death except Africa, it
results in 17.9 million deaths in 2015 and 12.3 million in 1990 worldwide. It has increased much
in developing countries because of sedentary lifestyle and inventory of machinery in life. In US
11% of CVD patients are between 20 and 30, and 37% of 40 to 60 age and 85% of age above 80.
Diagnosis of disease occurs seven to ten years earlier in men as compared to women. There are
some types of:
 Coronary heart disease (CHD)
 Peripheral vascular disease
 Congenital heart disease
 Endocarditis, and many other conditions
 Deep vein thrombosis and pulmonary embolism – blood clots in the leg veins, which can
dislodge and move to the heart and lungs.

Heart attacks and strokes are usually acute events and are mainly caused by a blockage that
prevents blood from flowing to the heart or brain. The most common reason for this is a build-up
of fatty deposits on the inner walls of the blood vessels that supply the heart or brain. Strokes can
also be caused by bleeding from a blood vessel in the brain or from blood clots. The cause of heart
attacks and strokes are usually the presence of a combination of risk factors, such as tobacco use,
unhealthy diet and obesity, physical inactivity and harmful use of alcohol, hypertension, diabetes
and hyperlipidemia.

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PREVALENCE OF CARDIOVASCULAR DISEASE:

People who have cardiovascular disease (CVD) or a high CV risk (owing to hypertension,
diabetes, hyperlipidemia, smoking, poor nutrition, obesity, or lack of physical activity) require
early detection and management. In 2018, 30.3 million U.S. adults (12.1%) were diagnosed with
CVD. In adults without disability, 12.8% were physically inactive; about 30 million adults had
type 2 diabetes; and 39.6% of adults were obese. During office visits, CVD specialists wrote new
prescriptions for CVD agents (anti-hyperlipidemics, 5% of visits; beta-adrenergic blockers, 6.1%
of visits; calcium channel blockers, 6.2% of visits; ACE inhibitors, 8.1% of visits) and continued
the use of more than 90% of CVD drugs previously prescribed.

Prevalence by Race/Ethnicity: Of adults who experienced a stroke, non-Hispanic black patients

had the highest prevalence (4%), followed by 2.7% of non-Hispanic white patients and 2.5% of
Hispanic patients. Non-Hispanic black patients had the highest prevalence of hypertension
(32.8%), followed by 25.1% of Hispanic patients and 24% of non-Hispanic white patients.
However, the order of prevalence was different for coronary heart disease; the greatest
prevalence was found in 5.8% of non-Hispanic white patients.
ETIOLOGY & PHYSIOLOGICAL EFFECTS OF ATHEROSCLEROSIS:

Arteriosclerosis occurs when the blood vessels that carry

oxygen and nutrients from your heart to the rest of your body
(arteries) become thick and stiff — sometimes restricting blood
flow to your organs and tissues. Healthy arteries are flexible
and elastic, but over time, the walls in your arteries can harden,
a condition commonly called hardening of the arteries.
Etiology:

Atherosclerosis is a slow, progressive disease that may begin as early as childhood. Although the
exact cause is unknown, atherosclerosis may start with damage or injury to the inner layer of an
artery. The damage may be caused by:

 High blood pressure

 High cholesterol and triglycerides, a type of fat (lipid) in your blood

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  Smoking and other sources of tobacco
 Insulin resistance, obesity or diabetes
 Inflammation from diseases, such as arthritis, lupus or infections, or inflammation of
unknown cause

Once the inner wall of an artery is damaged, blood cells and other
substances often clump at the injury site and build up in the inner
lining of the artery. Over time, fatty deposits (plaque) made of
cholesterol and other cellular products also build up at the injury site
and harden, narrowing your arteries. The organs and tissues
connected to the blocked arteries then don't receive enough blood to
function properly.
Eventually, pieces of the fatty deposits may break off and enter your bloodstream. In addition,
the smooth lining of the plaque may rupture, spilling cholesterol and other substances into your
bloodstream. This may because a blood clot, which can block the blood flow to a specific part of
your body, such as occurs when blocked blood flow to your heart causes a heart attack. A blood
clot can also travel to other parts of your body, blocking flow to another organ.

Physical effects:
 Atheroma - Cholesterol embolism / Atheroembolism
 Carotid artery stenosis
 Lower extremity arterial disease
 Pain and cramping in legs
 Hair loss, shiny thin skin and gangrene as more symptoms
 Sudden crushing or indigestion-like chest pain that can radiate to nearby areas, as well as
shortness of breath and dizziness
 If the levels of cholesterol in your blood are too high, it can clog your arteries. It becomes
a hard plaque that restricts or blocks blood circulation to your heart and other organs.
 As you age, your heart and blood vessels work harder to pump and receive blood. Your
arteries may weaken and become less elastic, making them more susceptible to plaque
buildup.

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RISK FACTORS OF CARDIOVASCULAR DISEASE:

The most important behavioral risk factors of heart disease and stroke are unhealthy diet,
physical inactivity, tobacco use and harmful use of alcohol. The effects of behavioral risk factors
may show up in individuals as raised blood pressure, raised blood glucose, raised blood lipids,
and overweight and obesity. These “intermediate risks factors” can be measured in primary care
facilities and indicate an increased risk of developing a heart attack, stroke, heart failure and
other complications.
Cessation of tobacco use, reduction of salt in the diet, consuming fruits and vegetables, regular
physical activity and avoiding harmful use of alcohol have been shown to reduce the risk of
cardiovascular disease. In addition, drug treatment of diabetes, hypertension and high blood
lipids may be necessary to reduce cardiovascular risk and prevent heart attacks and strokes.
Health policies that create conducive environments for making healthy choices affordable and
available are essential for motivating people to adopt and sustain healthy behavior.
There are also a number of underlying determinants of CVDs or "the causes of the causes".
These are a reflection of the major forces driving social, economic and cultural change –
globalization, urbanization and population ageing. Other determinants of CVDs include poverty,
stress and hereditary factors.

 Alcohol:
Drinking too much alcohol can raise blood pressure, and increase your risk for
cardiomyopathy, stroke, cancer and other diseases. It can also contribute to high
triglycerides, and produce irregular heartbeats. Additionally, excessive alcohol
consumption contributes to obesity, alcoholism, suicide and accidents.

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 Obesity and being overweight:
People who have excess body fat – especially if a lot of it is at the waist – are more
likely to develop heart disease and stroke, even if those same people have no other risk
factors. Overweight and obese adults with risk factors for cardiovascular disease such as
high blood pressure, high cholesterol or high blood sugar can make lifestyle changes to
lose weight and produce significant reductions in risk factors such as triglycerides, blood
glucose, HbA1c and the risk of developing Type 2 diabetes.
 Diabetes:
Diabetes seriously increases your risk of developing cardiovascular disease. Even
when glucose levels are under control, diabetes increases the risk of heart disease and
stroke. The risks are even greater if blood sugar is not well-controlled. At least 68 percent
of people with diabetes over 65 years of age die of some form of heart disease. Among that
same group, 16 percent die of stroke.
 High blood pressure:
High blood pressure increases the heart’s workload, causing the heart muscle to
thicken and become stiffer. This stiffening of the heart muscle is not normal and causes the
heart to function abnormally. It also increases your risk of stroke, heart attack, kidney
failure and congestive heart failure.
 Physical inactivity:
An inactive lifestyle is a risk factor for coronary heart disease. Regular, moderate
to vigorous physical activity helps reduce the risk of cardiovascular disease. Physical
activity can help control blood cholesterol, diabetes and obesity. It can also help to lower
blood pressure in some people.
 High blood cholesterol:
As your blood cholesterol rises, so does your risk of coronary heart disease. When
other risk factors (such as high blood pressure and tobacco smoke) are also present, this
risk increases even more. A person’s cholesterol level is also affected by age, sex, heredity
and diet. Here’s the lowdown on:
 Total cholesterol:
Your total cholesterol score is calculated using the following equation: HDL
+ LDL + 20 percent of your triglyceride level.

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  Low-density-lipoprotein (LDL) cholesterol = “BAD” cholesterol:
A low LDL cholesterol level is considered good for your heart health.
However, your LDL number should not be the main factor in guiding treatment to
prevent heart attack and stroke, according to the latest guidelines from the
American Heart Association.
 Triglycerides:
Triglycerides are the most common type of fat in the body. Normal
triglyceride levels vary by age and sex. A high triglyceride level combined with
low HDL cholesterol or high LDL cholesterol is associated with atherosclerosis,
which is the buildup of fatty deposits inside artery walls that increases the risk for
heart attack and stroke.

SCREENIGN AND ASSESSMENT OF CARDIOVASCULAR DISEASE:

Some measurements such as body weight

and blood pressure are taken during
routine medical appointments and some
cardiovascular screening tests begin at age
20. The frequency of follow up will
depend on your level of risk.

Some measurements such as body weight

and blood pressure are taken during
routine medical appointments and some cardiovascular screening tests begin at age 20. The
frequency of follow up will depend on your level of risk.

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Risk factors for CVD events include older age, male sex, high blood pressure, current smoking,
abnormal lipid levels, diabetes, obesity, and physical inactivity. Resting ECG records cardiac
electrical activity while the patient is at rest, over a short period. Exercise ECG records cardiac
electrical activity during physical exertion, often at a pre-specified intensity level. The most
common method of exercise ECG is the treadmill test. Both resting and exercise ECG look for
markers of previous myocardial infarction, myocardial ischemia, and other cardiac abnormalities
(such as left ventricular hypertrophy, bundle branch block, or arrhythmia) that may be associated
with CVD or predict future CVD events.
 Blood Pressure:
Blood pressure is one of the most important screenings because high blood pressure
usually has no symptoms so it can’t be detected without being measured. High blood
pressure greatly increases your risk of heart disease and stroke.
If your blood pressure is below 120/80 mm Hg, be sure to get
it checked at least once every two years, starting at age 20. If
your blood pressure is higher, your doctor may want to check
it more often. High blood pressure can be controlled through
lifestyle changes and/or medication.
 Fasting Lipoprotein Profile (cholesterol):
You might have a fasting lipoprotein profile taken every four to six years, starting
at age 20. This is a blood test that measures total cholesterol, LDL (bad) cholesterol and
HDL (good) cholesterol. You may need to be tested more frequently if your healthcare
provider determines that you’re at an increased risk for heart disease or stroke. After age
40, your health care provider will also want to use an equation to calculate your 10-year
risk of experiencing cardiovascular disease or stroke.
Like high blood pressure, often cholesterol can be controlled through lifestyle
changes and/or medication.
 Body Weight:
Your healthcare provider may ask for your waist circumference or use your body
weight to calculate your body mass index (BMI) during your routine visit. These
measurements may tell you and your physician whether you’re at a healthy body weight

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 and composition. Being obese puts you at higher risk for health problems such as heart
disease, stroke, atrial fibrillation, congestive heart failure, and more.

NUTRIONAL ASSESSMENT OF CARDIOVASCULAR DISEASE:

Nutritional assessment is the systematic process of collecting and

interpreting nutritional information of a person in order to make decisions
about the nature and cause of nutrition related health issues that affect an
individual. A comprehensive nutritional assessment includes:

 Anthropometric measurements of body composition:

Anthropometric measurements are a series of
quantitative measurements of the muscle, bone, and adipose tissue
used to assess the composition of the body. The core elements
of anthropometry are height, weight, body mass index (BMI),
body circumferences (waist, hip, and limbs), and skinfold thickness.
 Biochemical Measurements:
Biochemical assessment uses laboratory measurements of
serum protein, serum micronutrient levels, serum lipids, total serum
cholesterol, HDL, LDL, triglycerides and immunological parameters
to assess general nutritional status and to identify specific nutritional
deficiencies.
 Chemical Assessment of Altered Nutritional Requirements:

Clinical assessment is an evaluation of a patient's physical

condition and prognosis based on information gathered from
physical and laboratory examinations, through observations,
patients’ interview and the patient's medical history. It includes:
Obesity severity, extent of physical limitations, and impact on
activities of daily living.

 Observations of visible signs – pale skin, dark circles, eyesight, hair loss, nail, etc
 Potential contributing causes of the disease.

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  Disease associated conditions history – example for CVD: diabetes, hypertension,
Cholesterol, obesity, fatty liver disease.
 Active medical diagnoses and medication use.
 Nutrition Knowledge, Attitudes and History:
Nutrition knowledge, refers to knowledge of concepts and processes related
to nutrition and health including knowledge of diet and health, diet and disease, foods
representing major sources of nutrients, and dietary guidelines and recommendations.
 Nutrition knowledge of healthy-eating recommendations and relationship of food
choices to CVD risk,
 Basic understanding about foods and nutrition, guidelines for healthy eating, and
recommended serving sizes
 Role of nutrition in patient’s diseases or conditions; previous diet instruction or
lifestyle-management program
 Level of self-care regarding nutrition: experience in meal planning, food purchasing
and preparation.
 Current eating patterns: meal and snack patterns (skipped meals, largest meal,
snacks/grazing.
 Eating location and environment: meals eaten out (cafeteria, fast food, restaurant,
carry lunch), family meals, television on at mealtime
 Types and amounts of food typically eaten: 24-hour recall or food frequency, food
preferences, ethnic foods, cultural practices.
 Nutritional intake: assessment of reported intake for
energy and adequacy of key nutrients.
 Total caloric intake.
 Type and amount of fat - saturated, mono saturated,
polyunsaturated, trans fats, omega-3 fatty acid
 Presence of All food groups in diet.
o Fruits and vegetables - vitamins A, C,
antioxidants and phytochemicals, potassium,fiber.
o Cereals- fiber, B-vitamins, iron, folic acid
o Dairy - calcium, vitamin D

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 o Meat, beans, Poultry and nuts - protein, iron, omega-3 fatty acid
o Deserts and fast foods – calories
 Salt intake
 total water intake – 12 glasses/day
 Supplement use
 Psychological issues that may preclude adequate intake
 Issues such as stress, depression, anxiety, recent life-
changing events such as birth,
 Death, marriage, job change or loss, new medical
diagnosis.
 post-traumatic stress disorder
 Eating disorder - binge eating, bulimia
 Liking and disliking foods, positive /negative perceptions about foods.
 Social history
 Food security , approach to variety of foods , availability
 Economical Background – budget, occupation
 Nutrition program participation
 Access to health care

 Physical Activity
 Level of activity at work, school, home; and leisure-time activities
 Frequency, intensity, and duration of planned exercise.
 Daily steps.

NUTRITONAL INTERVENTIONS OF CARDIOVASCULAR DISEASE:

The purpose of a nutrition intervention is to resolve or improve the nutrition diagnosis or nutrition
problem by provision of advice, education, or delivery of the food component of a specific diet or
meal plan tailored to the patient.

Nutrition intervention for CVD should begin early in life to prevent or delay the development of
atherosclerosis. Studies show that nutrition therapy is effective at controlling cardiovascular

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disease risk factors and therefore reducing cardiovascular disease risk. Physicians should play an
active role in providing nutrition interventions for patients who would benefit from cardiovascular
disease risk reduction. Population-oriented messages and dietary guidance are primary prevention
strategies. Intervention shifts to the individual level with medical nutrition therapy and
therapeutic lifestyle change programs when risk factors develop or CVD is diagnosed.

 Primary Intervention:
“You Are What You Eat” If we understand and
implement this single quote we can protect ourselves from
many diseases. Our diet identifies our health, appearance and
personality. Therefore, it is essential to take care of our health
from very beginning by adapting healthy dietary habits.

Cardiovascular health has direct link with our eating patterns and
adaptations. Therefore, being neglectful of healthy diet at primary stage influence the development
of atherosclerosis and risk for CHD and stroke. Whereas, being careful and cautious can help us
prevent CVD and improve heart health and promote healthy aging.

The American Heart Association (AHA) has prevention guidelines to reduce risk for CVD
across the population and to modify diet, physical activity, and smoking to reduce risk factors.
The aim is to prevent subclinical signs and symptoms from developing into overt acute and chronic
CVD.

Guideline on lifestyle management to reduce cardiovascular risk:

1. Dietary Pattern:
Consume a dietary pattern that emphasizes
intake of vegetables, fruits, and whole grains;
includes low fat dairy products, poultry, fish,
legumes, non-tropical vegetable oils and
nuts; and limits intake of sweets, sugar
sweetened beverages and red meats. Adapt
this dietary pattern to
a. appropriate calorie requirements,

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 b. Personal and cultural food preferences,
c. Nutrition therapy for other medical conditions.

This plan can be achieved by following plans such as the DASH dietary
pattern, the USDA Food Pattern, or the AHA Diet.

2. Type of Fat:
Reduce percent of calories from
saturated fat and trans-fat while using
polyunsaturated fats such as olive of, fish oil
that also contain essential fatty acids omega-3 that promotes heart health.
3. Sodium:
For those who could benefit from blood pressure reduction (two-
thirds of adult population) Lower sodium intake to 2400 mg or
preferably 1500 mg per day; or reduce by at least 1000 mg/day.
4. Calorie Restriction:
For those who need to lose weight based on BMI or WC (2/3 of population) 1200–
1500 kcal/ day women, 1500–1800 kcal/day men (adjusted for current body
weight), or 500–750 kcal/day energy deficit.
a. Prescribe evidence-based diet that restricts certain food types; chose based
on patient preference and health status.
b. Aim for 3–5% weight loss for clinical outcomes, but aim for greater loss to
get greater clinical changes and avoid need for medications.
c. Refer to nutrition professional for counseling and/or recommend
comprehensive lifestyle program of at least 6 months to assist in adhering
to diet and increasing physical activity.

Cardio-protective diet: A diet that emphasizes plant foods (vegetables, fruits, grains, especially
whole grains, and legumes), appropriate fats, and fish, along with smaller amounts of lean meat
and dairy.

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  Factors that can Improve selection of food

AHA provides evidence-based recommendations for changes that can be made by big industries
such as the media and the food industry, and for changes at worksites that impact what adults
choose to eat.

 Media and education

Sustained, focused media and education campaigns for
increasing consumption of specific healthful foods and
decreasing consumption of specific less healthful foods or
beverages.
Awareness can be spread through:
 Radios
 Television shows, commercials, ads and news
 Banners, newspaper, magazine
 Volunteers that spread awareness from door to door.
 Labeling and information

Mandate nutrition information panels or front-of-package labels or icons as a

means to influence industry behaviors and product formulations.

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 Economic incentives
 Subsidy strategies to lower prices of more healthful food and beverages so that people
with low income can also buy.
 Tax strategies to increase prices of less healthful food and beverages.
 Changes in both agriculture subsidies and related policies to create an infrastructure
that facilitates production, transportation, and marketing of healthier foods, sustained
over several decades. This will increase availability of healthy foods.
 Workplaces
 Comprehensive worksite wellness programs with nutrition,
physical activity, and tobacco cessation/ prevention
components.
 Increased availability of healthier food/beverage options
and/ or strong standards for foods and beverages served, in
combination with vending machine prompts, labels, or icons to make healthier choices.
 Encouragement to bring homemade food for lunch.
 Local environment
Increase availability of supermarkets near homes.
 Psychological support
A healthy eating environment can help in eating healthy.
 Families can eat together at home.
 Serving healthy homemade food.
 Encouragement select healthy foods.
 Therapeutic Lifestyle Changes
It is a higher-intensity dietary approach for reducing risk
of cardiovascular disease with defined targets for type and
amount of fat and dietary fiber, physical activity, and
weight reduction. It is a healthy eating plan designed to
improve heart health. It was developed by the National
Institutes of Health to help lessen the risk of heart disease
and stroke.

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Therapeutic Lifestyle Changes (TLC), with behavioral counseling and follow-up by health
care providers, is recommended for individuals identified at high-risk. Diet and lifestyle
change is the cornerstone of therapy and is recommended even when pharmacotherapy is
implemented. Medical nutrition therapy provided by a registered dietitian tailors
behavioral change and outcome goals to each individual’s situation.
TLC diet focus on the healthy type of fat that is polyunsaturated and essential fatty acids
and avoid saturated and trans-fat that are harmful for heart health they must not be more
than 5–6 percent of calories. It also encourages sterols and viscous fiber.

 Sterols
Sterols, also known as steroid alcohols, are a
class of chemicals that play multiple important
roles in the body. They have parts that can
dissolve in fat-like molecules and parts that can
dissolve in water. The most widely known
human sterol is cholesterol, which serves as a
precursor to steroid hormones and fat-soluble vitamins. Some people take plant
sterols -- such as vitamins A, D, E and K -- as supplements.
When eaten, they block particles responsible for cholesterol transport, which results
in less cholesterol absorption. Regular consumption of 2–3 grams per day with
meals is associated with a 7–15 percent reduction in LDL.
 Sources of plant sterol:
 Sesame oil, wheat germ oil, mayonnaise, pistachio nuts, olive oil, sage,
oregano, thyme, paprika, cocoa butter oil, almond butter, sesame seeds,
and macadamia nuts are good sources of sterol.
 Sterol is also added in food products such as margarines, salad
dressings, beverages and bars.
 They are also available in capsules.
 What happens when taken in excess?
They can cause some side effects, such as diarrhea or fat in the stool.
Sitosterolemia, a rare inherited fat storage disease: Plant sterols can build up in the

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 blood and tissue of people with this condition. This build-up can make these people
prone to early heart disease.
 Viscous Fiber:
Some types of soluble fibers form a thick gel when they blend with water. These
are known as viscous fibers. When eaten viscous fiber, it forms a gel-like substance
that “sits” in the gut. Viscous fibers include glucomannan, beta-glucans, pectins, guar
gum, and psyllium.
 Functions:
Viscous fiber is responsible for the fiber-related
physiological effects of decreased LDL. Viscous fiber
holds water in the gut, forming a thick gel that reduces
absorption of cholesterol-rich bile acids and carries
them out of the body. When this happens, the liver shifts
from producing cholesterol that ends up in the blood to producing bile acids that
are necessary for digestion. In addition, fermentation by colonic bacteria inhibits
fat absorption and cholesterol transport and synthesis.
 Sources:
Viscous fibers occur exclusively in plant foods. Rich sources include beans and
legumes, flax seeds, asparagus, Brussels sprouts and oats.
 Recommendations:
Eating 5–10 grams of viscous fiber (1½ cups of cooked oatmeal provides 3
grams) a day has been shown to reduce LDL by 10–15 percent.

PHARMACOTHERAPY OF CARDIOVASCULAR DISEASE:

Pharmacotherapy is the treatment of disease through the use of drugs. At the end, when diet alone
cannot help in curing CVD, pharmacotherapy is given to the patient. Diet and drugs together work
efficiently in recovering from the disease.

Treatments:

 Medication, such as to reduce low density lipoprotein cholesterol, improve blood flow, or
regulate heart rhythm.

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  Surgery, such as coronary artery bypass grafting or valve repair or replacement
surgery.

 Cardiac rehabilitation, including exercise prescriptions and lifestyle counselling.

 Medication
 Lipid-lowering medications are prescribed when LDL is >190 mg/dL, or 70–189 mg/dL if the
individual has an increased 10 year risk score or diabetes.
 Two types of drugs are used to lower blood cholesterol levels. Ezetimibe and Statins

Function:

 Ezetimibe inhibits intestinal absorption of cholesterol whereas, Statins work by blocking

the enzyme (HMG-CoA) responsible for making cholesterol in the liver.
 They stabilize plaques, making them less prone to rupturing and forming clots that can
block arteries,
 Statins also reduce arterial inflammation, which contributes to atherosclerosis.

Results:

Lowered blood cholesterol results in reduced formation of new plaques

and reduced size of existing plaques lining arterial walls thus allowing
blood to circulate without blockage. This prevents strokes and
atherosclerosis.

METABOLIC SYNDROME

INTRODUCTION:

Metabolic Syndrome is also known as “Syndrome X” or “Dysmetabolic Syndrome” or Insulin

Resistance Syndrome”. It is a medical term that is a cluster of altered metabolic conditions, which
involves high risk of coronary artery disease, stroke cardiovascular diseas es and type 2 diabetes,
in a single individual.

 In this condition, the individual have abdominal obesity, that is indicated by large waist
circumference, elevated blood pressure, insulin resistance, which is indicated by elevated

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 fasting glucose, and dyslipidemia, which is indicates by elevated triglycerides and low
HDL cholesterol.
 The diagnosis of metabolic syndrome is made when an individual has three of these five
risk factors:
 LARGE WAISTLINE:
If women have waistline of 35 inches or more and men have 40 inches or
more, will have a risk factor of metabolic syndrome.
 HIGH TRIGLYCERIDES LEVEL:
Triglycerides are the type of fats in blood. Triglyceride level of 150mg/dL
or higher is a risk factor of metabolic syndrome.
 LOW HDL CHOLESTEROL LEVEL:
If women have HDL cholesterol level less than 50mg/dL and men have less
than 40mg/dL, will have a risk factor of metabolic syndrome.
 HIGH BLOOD PRESSURE:
A blood pressure of 130/85 mmHg or higher is a risk factor of metabolic
syndrome.
 HIGH FASTING BLOOD SUGAR:
A fasting blood sugar level between 100 mg/dL or higher is the risk factor
of metabolic syndrome.

PREVALENCE:

This disease has affect over a fifth of US adults. Prevalence has declined slightly in 10 years, but
the condition leading to diagnosis has changed.

 Waist circumference had increased in women and

glucose has increased among men. Declines in
rates of suboptimum blood pressure, triglycerides,
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and HDL cholesterol are attributed to increased
awareness and medication management.
 Metabolic syndrome is present in:
 10 percent of people with normal body weight

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  One-third of people who are overweight
 Two-thirds of people who are obese
 The prevalence increases from 20 percent for ages 20–39 to 41 percent for ages 40–59. The
prevalence of metabolic syndrome varies substantially by gender and ethnicity even after
accounting for a person’s BMI, age, socioeconomic status, and other factors.
 Mexican American males have the highest prevalence and Black males have the lowest.
 Among females, Mexican American and Black females have 1.5 times the rate of White
females.
 African Americans with very high BMIs and very high levels of insulin resistance can
have very low levels of triglycerides, even though they have a significantly higher
prevalence of cardiovascular disease and diabetes compared to Whites.
 Asians, especially South Asians, can develop metabolic syndrome with only moderate
excess in abdominal fat. Thus, African Americans and Asians could be at risk for
metabolic syndrome with only two metabolic risk factors

ETIOLOGY AND PHYSIOLOGICAL EFFECTS:

The underlying cause of metabolic syndrome is not yet clear, but it is thought to be the result from
central adiposity and insulin resistance.

 INSULIN RESISTANCE:
Insulin resistance refers to the diminished ability of cells to respond to the action
of insulin in promoting the transport of glucose
from blood into muscles and other tissues. To
compensate, the pancreas produces more
insulin, resulting in hyperinsulinemia.
Sedentary lifestyle and a pro-
inflammatory, atherogenic diet (high calories, total fat and saturated fat, and low in whole
grains, vegetables, and fruits) contribute to insulin resistance.
Progressive weight gain and high body fat (especially central obesity),
inflammation, existing cancer, and HIV also increase risk.

21
  GENETIC AND ENVIRONMENT:
As is true with many medical conditions, genetics and the environment both play
important roles in the development of the metabolic syndrome. Genetic factors influence
each individual component of the syndrome, and the syndrome itself. A family history that
includes type 2 diabetes, hypertension, and early heart disease greatly increases the chance
that an individual will develop the metabolic syndrome.

PHYSIOLOGICAL EFFECTS:

The hyperinsulinemic state related to insulin insensitivity is considered a prediabetic condition,

but it is also recognized as a major risk factor for the development of early atherosclerotic
cardiovascular disease. The presence of metabolic syndrome increases the risk of developing
type 2 diabetes fivefold, heart disease by 2–4 times, and nearly doubles the risk of stroke.

Metabolic syndrome is also associated with fat accumulation in the liver (fatty liver disease or
steatahepatitis), chronic kidney disease, obstructive sleep apnea, polycystic ovary syndrome,
and cognitive decline and dementia in the elderly, as well as a general proinflammatory and
prothrombotic state.

SCREENING AND ASSESSMENT:

 Waist circumference is a simple, low-cost method that

can be used to screen for metabolic syndrome in
community or clinic settings and identify those who
should be referred for laboratory tests.
 A fasting lipid profile providing LDL cholesterol,
HDL cholesterol, and triglyceride levels, and fasting

22
 blood glucose, along with blood pressure, are necessary for diagnosis and provide baseline
measures to track changes over time.
 Screening for metabolic syndrome is recommended beginning at age 45 for
asymptomatic adults or earlier for individuals who are overweight and have one additional
risk factor, such as smoking or physical inactivity.
 With identification, earlier treatment can be initiated to minimize the effects noted above.
 Insulin resistance, a hallmark of metabolic syndrome and type 2 diabetes, can present with
phenotypic manifestations (physical signs). These are hyperpigmentation of the skin at
the back of the neck (acanthosis nigricans), “buffalo hump” (fat accumulation at the base
of the neck), and double chin.
 These signs suggest high risk and should signal further assessment.

NUTRITIONAL INTERVENTIONS:

The goal of clinical management of metabolic syndrome is to reduce

the risk of atherosclerotic diseases and progression to diabetes.
Intervention is directed to the problem identified:

 CENTRAL ADIPOSITY:
For central adiposity, a person have to reduce weight and fat mass
 DYSLIPIDEMIA:
For dyslipidemia, a person have to achieve an optimal lipid profile
 HYPERTENSION:
For hypertension, a person have to normalize blood pressure
 ELEVATED GLUCOSE:
For elevated glucose, a person have to reduce fasting blood glucose and increase
insulin sensitivity.

The first-line therapy, guided by the dietitian or other healthcare provider, is diet and lifestyle
modification to adopt healthy eating, increase physical activity, and reduce weight.

Medical nutrition therapy sections for CVD and diabetes provide details. Adherence to a
Mediterranean-style dietary pattern reduces risk factors. Exercise has beneficial effects on blood

23
pressure, cholesterol levels, and insulin sensitivity, even if weight loss is not achieved. If a period
of lifestyle intervention does not reduce risk factors, or the individual is in a high-risk category,
medications to treat the dyslipidemia, hypertension, elevated blood glucose, and/or insulin
resistance are added.

DIABETES MELLITUS

INTRODUCTION TO DIABETES MELLITUS AND PREDIABETES:

The chronic disease linked with abnormal glucose level in the body. When glucose level became
high in the blood, the condition is called diabetes mellitus.

TWO TYPES:

 TYPE 1 DIABETES:
The condition in which there is minimal or no production of insulin by the pancreas
is called the type1 diabetes. This is the less common type. Basically in this condition
pancreas loses its ability to produce
insulin. It’s an autoimmune
disorder. The self-inherited defect;
in which the immune cells attack
the beta cells of the pancreas that
produce insulin and make them
unable to release insulin. Hence
Diabetes Type 1 is caused. This
type usually occurs in childhood
and adolescence. These affect
growth and proper functioning of body as without insulin body’s energy metabolism
changes. As for the treatment, the patient can receive insulin either by injection or by
external pumps. Insulin is a protein so it cannot be taken orally.

24
  TYPE 2 DIABETES:
This is the most common type of diabetes. Almost 90-95% of diabetes is the type
2 diabetes. This is the defect in
insulin production. Basically it’s a
primary defect in insulin
resistance and reduced sensitivity
of insulin. This defect leads the
muscle and adipose cell so they
cannot remove glucose. Hence
body will have elevated level of glucose. As insulin plays an important role in maintaining
the blood glucose level, so pancreas will release more insulin and plasma insulin level in
the body elevate abnormally. The abnormality will leads to the exhaustion of pancreas
hence this will cause impaired insulin production. This type of diabetes is increase due to
obesity, poor dietary habits and alcohol consumption.

COMPARISON BETWEEN TYPE 1 AND TYPE 2 DIABETES:

PRE DIABETES:

This is long a long pre symptomatic phase of Diabetes. This

usually leads to type2 diabetes if not treated at the right
time. In this type, the blood glucose level marginally
elevated and most of the vascular changes occur. Diabetes
Preventive Program started for the purpose to control the

25
pre symptomatic diabetes. Basically they are looking for the best solution taking in account all the
conditions. They are encouraging pre symptomatic diabetic patient to lose right amount of weight
by per physical activities.

HOW DIABETES DEVELOP:

Diabetes is basically a metabolism disorder characterized by high blood sugar level due to either
by the malfunctioning of the metabolism of pancreas or due to the poor resisting ability of body to
insulin. This is usually characterized by the disturbance in the insulin production. Hyperglycemia
is a condition in which blood glucose level increases causing damage of blood vessels, tissue and
nerve cells.

After a meal, insulin signals the body cells to absorb nutrient.

FUNCTION OF INSULIN:

Insulin is used to maintain the blood glucose level. It basically stimulates protein synthesis. It also
leads to the glycogen synthesis in liver and muscles.

PREVALENCE OF DIABETES MELLITUS:

The rising prevalence of diabetes correlates with the rise in overweight and obesity. Although most
often diagnosed in people over the age of 40, type 2 diabetes is becoming increasingly common in
children, adolescents, and younger adults who are overweight. Type 1 diabetes accounts for 5–10
percent of diabetes cases. Racial and ethnic minorities bear a disproportionate burden of the

26
diabetes and its complications. They have higher prevalence rates, worse diabetes control, and two
to four times the rate of complications such as renal disease requiring dialysis, blindness,
amputations, and cardiovascular mortality of Whites.76 Many customized, culturally specific
diabetes outreach, care, and education programs have been developed to address these disparities.

ETIOLOGY AND PHYSIOLOGICAL EFFECTS OF DIABETES

MELLITUS:

DIAGNOSIS OF DIABETES:

Diabetes is usually test by checking few symptoms include;

 Dizziness
 Fatigue
 Frequent urination
 Excessive thirst
 Sudden vision changes
 Hair loss

After checking these symptoms, following test should be taken:

 Fasting plasma glucose test taken after 8 hours fasting

 A1C test to measure the percentage of hemoglobin attached to the glucose. A1C test is
usually long-term evaluation test

NUTRITIONAL ASSESSMENT OF DIABETES MELLITUS:

 Weight status
 Food intake and physical activity
 Laboratory test and medical history
 Medication
 Social, environmental, financial factor and past education

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COMPLICATIONS OF DIABETES:

 Dilation of blood vessel:

Diabetes cause dilation of blood vessel that will cause hypertension that will lead to heart
attack, stroke and hypertension
 Narrowing of blood vessel:
It also caused narrowing of blood vessel cause micro angiopathies disease which also leads to
loss of kidney function and retinal degeneration.
 Nerve degeneration:
Due to diabetes, nerve degeneration is also caused. This will cause loss of sensation in body
parts. In the extreme case it is leaded to the amputation of specific body parts which is
senseless.
RECOMMENDATIONS:
Diabetes mellitus might not be completely curable but we can prevent the severances
By doing following actions
 Checking of carbohydrate:
We can count on carbohydrate by keeping in mind the diet containing carbohydrate.
The amount of carbohydrate allowed per meal is based on body size and activity level
and typically ranges from 45 grams (women) to 60 grams (men) or 2–3 carb servings
per meal. Planned snacks are typically 10–30 grams.
 Limiting Trans-fat and decreasing intake of saturated fat:
The diabetic patient should limit the trans-fat and saturated fat intake by 10% of kcal
 Reduce alcohol consumption:
Excessive alcohol consumption will leads to organ failure or malfunctioning which will
cause severe diabetic complication.
 Adjust the amount and schedule of insulin doses with physical activity and food
intake in type 1 diabetes:
If the patient is taking insulin, the one should regulate the doses of insulin so that it will
not exceed the insulin limit or be hazardous.

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  Moderate weight loss is recommended for type 2 diabetes (up to 5-10% body
weight):
Diabetes is correlated to obesity. Overweight will cause complication in diabetes. So
the diabetic patients who are overweight should lose moderate amount of weight up to
5-10% of body weight.

NUTRITIONAL INTERVENTIONS OF DIABETES MELLITUS:

CARBOHYDRATE MANAGEMENT:

WHAT IS A LOW CARB DIET?

Obesity is one of the main problems, leading to health

problems such as Type 2 diabetes. One popular diet for
weight management to control diabetes is known as the
low carb diet. As the name already states, in a low carb
diet, carbohydrates within the diet are restricted.

There are different types of carbohydrate-restricted diets, some of which restrict carbohydrates to
very low levels without restricting dietary protein or fat (for example, the Atkins-style diet). Others
allow moderate carbohydrate consumption together with moderate protein and fat intake (for
example, South Beach and Zone). Very-low-carb diets limit protein to moderate levels, which
introduces ketosis without restricting fat or total calories. The carbohydrates within a diet can be
divided into simple and complex carbs. Simple carbohydrates such as sugar, white flour, and white
rice have shown to increase the risk of type 2 diabetes.

To prevent type 2 diabetes mellitus, minimizing carbohydrate intake to total daily caloric
consumption, as well as intake of foods with a low glycemic index, is recommended. For patients
with type 2 diabetes mellitus, the American Diabetes Association recommends a moderate intake
of carbohydrates (44%-46% of total calories).

The carbohydrates should be taken from vegetables, legumes, fruits, low-fat dairy, and whole
grains, with limited sugars from natural sources such as fruit. Brown rice and whole wheat products

29
should replace white wheat products, and foods with added sugar should be avoided. Several
studies have shown the effectiveness of a low carb diet for the purpose of weight loss. However,
recent studies have emerged questioning whether this diet has any effects on patients with Type 2
diabetes.

EFFECT OF LOW CARBOHYDRATE DIETS FOR TYPE 2 DIABETES:

Several studies have been conducted to try to determine the most healthful diet for persons with
type 2 diabetes. Results have been conflicting because the types of diets, methods, and study sizes
have all varied. However, a pattern has emerged.

Low carb diet improved 24-hour blood glucose profiles;

hemoglobin A1c (HbA1c; blood glucose) decreased from
7.3% to 6.8 % in only two weeks. These suggests that
blood glucose levels were regulated by carbohydrate
intake. Insulin sensitivity also improved due to an
improved glucose-insulin ratio.

Dietary recommendations for people with type 2 diabetes: a carbohydrate-reduced high-protein

(CRHP) diet was compared to iso-energetic conventional diabetes (CD) diet to see the effects on
glycemic control and selected cardiovascular risk markers during the six weeks. Patients had the
same number of calories on each diet but exchanged some of the carbohydrates from the CD diet
for protein in the CRHP diet. Compared to the CD diet, the CRHP diet reduced HbA1c levels and
fasting glucose levels. The study shows that substituting carbohydrates with protein and fat without
increasing calories for six weeks reduced HbA1c and liver fat content in people with type 2
diabetes.

Taken together, these two studies point to the likely benefits of replacing some carbohydrate intake
with protein. However, this type of diet is very different from some popular high-protein and high-
fat diets that encourage unrestricted or high levels of animal product intake. A 2019 review
by Adeva-Andany et al. showed that increasing animal product intake and following a low-carb
diet increases the risk of type 2 diabetes. Eating high-quality plant-based foods prevents diabetes.

30
It is generally accepted among healthcare providers and nutrition scientists that reducing simple
carbohydrates in the diet (sweets, sodas, white bread, and regular pasta) is important for improving
diabetes outcomes and heart disease. When decreasing carbohydrate intake and increasing protein
intake, patients with diabetes should focus on plant sources whenever possible (beans, legumes,
soy, nuts). Lean meats and fish can be healthful sources of protein and fat for those who eat animal
products.

Impacts of low carbohydrate intake in patients with type 2 diabetes:

All studies confirmed that a low carbohydrate diet could be beneficial for the management of
Type 2 diabetes. In some patients, it even helped to discontinue or reduce their medication.

Decreasing carbohydrate intake can be a healthful weight loss and diabetes control strategy, so
long as carbohydrates are replaced with plant-based sources of protein and fat. Replacing
carbohydrates with animal food sources increases the risk of diabetes and worsens glucose
control for those with diabetes.

SELF-MONITORED BLODD GLUCOSE:

Self-monitoring of blood glucose (SMBG) is an important

component of modern therapy for diabetes mellitus. SMBG
has been recommended for people with diabetes and their
health care professionals in order to achieve a specific level
of glycemic control and to prevent hypoglycemia. The goal
of SMBG is to collect detailed information about blood
glucose levels at many time points to enable maintenance
of a more constant glucose level by more precise regimens.
It can be used to aid in the adjustment of a therapeutic regimen in response to blood glucose
values and to help individuals adjust their dietary intake, physical activity, and insulin doses to
improve glycemic control on a day-to-day basis.

SMBG can aid in diabetes control by:

31
  Facilitating the development of an individualized blood glucose profile, which can then
guide health care professionals in treatment planning for an individualized diabetic
regimen;

 Giving people with diabetes and their families the ability to make appropriate day-to-day
treatment choices in diet and physical activity as well as in insulin or other agents;

 Improving patients’ recognition of hypoglycemia or severe hyperglycemia; and

 Enhancing patient education and patient empowerment regarding the effects of lifestyle
and pharmaceutical intervention on glycemic control.

SMBG can play an important role in improving metabolic control

in patients with diabetes. It is recommended for patients treated
with insulin and is desirable for all patients with diabetes.
Judicious use of SMBG data can help to improve glycemic control,
select an anti-diabetic regimen, and provide powerful feedback to
patients wishing to improve metabolic control.

PHYSICAL ACTIVITY IN DIABETES MELLITUS:

Regular physical activity is recognized as a key determinant of health and wellness. Strong
evidence indicates that low levels of physical activity are linked with morbidity and mortality in
adults, particularly the risk of chronic diseases such as type II diabetes, heart disease,
osteoporosis and certain types of cancer and the risk of overweight and obesity in adults.
Exercising with Diabetes:

 Regular monitoring of blood glucose concentrations, and trial and error is needed to
understand and manage each individual’s response to exercise
 Intensity and duration of exercise
 Pre-exercise insulin dose generally needs to be reduced when exercise extends
beyond 30 minutes
 Varies for each individual; generally, longer exercise, less insulin
 Degree of metabolic control before exercise

32
  Easier to manage and predict the body's response to exercise when metabolic
control is good
 Dangerous to commence exercise when blood glucose levels are high and
ketones are present in the urine
 Type and dose of insulin injected before exercise
 Common practice to use a mixture of short- and long-lasting insulin
 Necessary to predict the peak period of insulin activity to avoid excessive
levels of insulin in the blood at the same time as exercising.
 Site of insulin injection
 Insulin absorption is increased in exercising muscles
 The abdomen is usually the preferred site for insulin injection prior to
exercise
 Timing of previous meal
 Insulin requirements are influenced by the amount and type of food consumed
 During exercise carbohydrate
 Blood glucose 5 to 10 mmol/l: 30 to 45 g CHO/h
 Blood glucose 10 to 14 mmol/l: 15 g CHO/h
 Blood glucose >14 mmol/l: no exercise

Role of the Physiotherapist:

Exercise training programs have emerged as a useful therapeutic regimen for the
management of diabetes mellitus. Primary effects include the development of aerobic and
resistance exercise programs which have been shown to decrease the incidence of NIDDM
(Non-insulin-dependent diabetes mellitus). Secondary effects include the ability of aerobic
and resistance training to help in the control of diabetes. There is accumulating evidence
that combined aerobic and resistance exercise training is more effective than either model
alone.

It is important to be aware of Hyperglycemia, caused by a lack of glucose control, and

Hypoglycemia, caused by taking too much insulin or glucose-lowering drugs. Contra-
indications to exercise are blood glucose levels >250mg/dl and <100mg/dl. Active diabetic

33
retinopathy means no strenuous activity (jogging, stepping). Significant peripheral
neuropathy is an indication to limit weight-bearing exercise. Patient who have difficulty with
thermoregulation should avoid exercise in extreme environments and be vigilant about
adequate hydration. Dehydration can have an effect on blood glucose levels (e.g. 500ml of
fluid consumed 2hr pre-exercise). A standard recommendation for diabetic patients is that
exercise induces a proper warm-up and cool-down period. A warm-up should consist of 5-
10mins of aerobic activity at a low-intensity level.

A combination of aerobic and strengthening exercises should be recommended. But

precautionary measures for exercise involving the feet are essential for many patients with
diabetes. The overall aim of exercise prescription, as mentioned above, is to achieve the
ACSM guidelines for healthy sedentary individuals. A diabetes identification bracelet or shoe
tag should be clearly visible when exercising.

PHARMACOTHERAPY FOR TYPE 2 DIABETES:

 Diabetes mellitus (DM) is a metabolic disorder.

While there are numerous etiological causes,
defects in insulin secretion, insulin action
(sensitivity), or both lead to elevations in blood
glucose as well as altered fat and protein
metabolism.
 DM is a leading cause of eye and kidney disease. Patients with DM are at high risk for CV
events, heart failure, and atherosclerotic disease.
 The two most common classifications of DM are type 1 (absolute insulin deficiency) and
type 2 (relative insulin deficiency due to β-cell dysfunction coupled with insulin
resistance). They differ in clinical presentation, pathophysiology, and treatment approach.
 The prevalence of type 2 DM has doubled worldwide over the last 40 years. This has been
attributed to an alarming increase in the prevalence of obesity due to diminished physical
activity and increased caloric consumption.
 The diagnosis of diabetes is made using any of the following criteria: (1) fasting plasma
glucose (FPG) ≥126 mg/dL (7.0 mmol/L) (2) a hemoglobin A1C (A1C) ≥6.5% (0.065; 48

34
 mmol/mol Hb); (3) a random plasma glucose level ≥ 200 mg/dL (11.1 mmol/L) coupled
with classic symptoms of diabetes; or (4) a 2-hour plasma glucose ≥ 200 mg/dL (11.1
mmol/L) during a 75-g oral glucose tolerance test (OGTT). A diagnosis using criteria 1-3
require two abnormal test results from the same sample or in two separate test samples.
 Goals of therapy in DM are to achieve optimal glycemic control (based on age, comorbid
conditions, and patient preferences), reduce the onset and progression of diabetes-related
complications, aggressively address CV risk factors, and improve quality of life.
 Intensive glycemic control prevents the onset and slows the progression of microvascular
complications (e.g., neuropathy, retinopathy, and nephropathy).
 Knowledge of the patient’s meal patterns and activity levels as well as the pharmacologic
properties of anti-hyperglycemic agents is essential to creating an individualized treatment
plan that achieves optimal glycemic control, avoids hypoglycemia, and minimizes adverse
effects.
 Metformin is the drug of choice and, in the absence of contraindications or intolerability,
should be included in the treatment regimen for most patients with type 2 DM due to its
effectiveness, low risk of hypoglycemia, positive or neutral effects on weight, potential
positive impact on CV risk, and low cost.
 Type 2 DM often requires the use of multiple therapeutic agents (combination therapy)
including oral and injected anti-hyperglycemics to achieve and maintain optimal glycemic
control. A persistent decline in β-cell function over time often necessitates periodic
adjustment and changes in therapy.

HERBAL REMEDIES AND OTHER DIETARY SUPPLEMENTATIONS:

Diabetes is a lifelong condition that affects the blood sugar and insulin levels in the body.
Treatment includes lifestyle strategies and sometimes medication, but some complementary
therapies, such as herbs and supplements, may help.
In diabetes, the body either does not produce enough insulin or produces insulin that the body
does not use properly.
Here are some herbs and supplements that may be of benefit to people with type 2 diabetes.

35
 1. ALOVERA:
Consuming aloevera pulp might help repair and protect the
pancreas.
Aloe vera is a common plant with many different uses. Many
people are aware of its benefits for skin care, but it may also
have other benefits, including slowing the progress of type 2
diabetes.
Ways of taking aloe include:
 adding juiced pulp to a drink or smoothie
 taking capsules that contain aloe as supplements
2. CINNAMON:
Cinnamon is a fragrant spice that comes from the bark of a tree. It is a popular ingredient in sweets,
baked goods, and other dishes.
It has a taste that can add sweetness without any additional sugar. It is popular with people with
type 2 diabetes for this reason alone, but it may also offer other benefits.
A 2010 review found evidence from studies involving humans that cinnamon may improve levels
of:
 glucose
 insulin and insulin sensitivity
 lipids, or fats, in the blood
 antioxidant status
 blood pressure
 lean body mass
 digestion
In another review published in 2013, researchers concluded that cinnamon might lead to:
 lower fasting blood glucose levels
 less total cholesterol and “bad” low-density lipoprotein (LDL) cholesterol
 higher levels of “good” high-density lipoprotein (HDL) cholesterol
 a reduction in triglycerides, or fat, in the blood
 increased insulin sensitivity
People can take cinnamon:

36
  in a variety of cooked dishes and baked goods
 in teas
 as a supplement
Anyone who is thinking of using cinnamon supplements should speak to their doctor first.
3. BITTER MELON:
Momordica charantia, or bitter melon, is a medicinal fruit. Practitioners of traditional Chinese
and Indian medicine have used bitter melon for centuries. People can cook the fruit and use it in
many dishes. Some scientists have been looking into its potential medicinal uses.
There is some evidence that bitter melon may help with the symptoms of diabetes. One review
has noted that people have used many parts of the plant to help treat diabetes.
Research has shown that taking bitter melon in the following forms can lead to a reduction in
blood sugar levels in some people:
 seeds
 blended vegetable pulp
 juice
 supplements
Eating or drinking the bitter melon can be an acquired taste, but taking supplements may make it
more palatable.
There is not enough evidence to support using bitter melon instead of insulin or medication for
diabetes.
However, it may help people rely less on those medications or lower their dosages.
4. MILK THISTLE:
Milk thistle may have anti-inflammatory properties, making
it potentially useful for people with diabetes.
People have used milk thistle since ancient times for many
different ailments, and especially as a tonic for the liver.
Silymarin, the extract from milk thistle that has received the
most attention from scientists, is a compound with
antioxidant and anti-inflammatory properties. These are the
properties that may make milk thistle a useful herb for people with diabetes.

37
There appear to be no reports of significant side effects, and many people take milk thistle as a
supplement. However, it is best to speak to a doctor first before using any supplements.
5. FENUGREEK:
Fenugreek is another seed that may help lower blood sugar
levels.
The seeds contain fibers and chemicals that help to slow down
the digestion of carbohydrates and sugar.
There is also some evidence that the seeds may help delay or
prevent the onset of type 2 diabetes.
Findings of a 3-year investigation published in 2015 noted that
people with prediabetes were less likely to receive a diagnosis of
type 2 diabetes while taking powdered fenugreek seed.
The researchers concluded that taking the seed led to:
 increased levels of insulin in the body, leading to a reduction in blood sugar
 lower cholesterol levels
A person can:
 include fenugreek as a herb in certain dishes
 add it to warm water
 grind into a powder
 take it as a supplement in capsule form
6. GYMNEMA SYLVESTRE:
Gymnema sylvestre is herb that comes from India. Its name means “sugar destroyer.”
A 2013 review noted that people with both type 1 and type 2 diabetes who took gymnema
showed signs of improvement.
In people with type 1 diabetes who took the leaf extract for 18 months, fasting blood sugar levels
fell significantly, compared with a group who received only insulin.
Other tests using gymnema found that people with type 2 diabetes responded well to both the
leaf and its extract over various periods.
Some people experienced:
 lower blood sugar levels
 higher insulin levels

38
Using either the ground leaf or leaf extract may be beneficial. But once again, talk to your doctor
about using it before starting.
7. GINGER:
There is some evidence that ginger can lower blood sugar
levels. Ginger is another herb that people have used for thousands
of years in traditional medicine systems.
People often use ginger to help treat digestive and
inflammatory issues. However, in 2015, a review suggested
that it may also help treat diabetes. The results showed that
ginger lowered blood sugar levels, but did not lower blood
insulin levels.
Because of this, they suggest that ginger may reduce insulin resistance in the body for type 2
diabetes. However, the researchers were uncertain as to how ginger might do this, and they called
for more research to confirm these findings.
People can take ginger:
 by adding ginger powder or chopped, fresh ginger root to raw or cooked food
 brewed into tea
 as a supplement in capsule form
 by drinking it in a ginger ale

39
REFERENCES:
 https://www.ncbi.nlm.nih.gov
 www.mayoclinic.org
 www.nature.com
 https://www.nature.com/articles/s41598-019-55372-8
 https://www.uscjournal.com/articles/pharmacologic-treatment-cardiovascular
 https://pubmed.ncbi.nlm.nih.gov/27745593/
 https://www.webmd.com/vitamins/ai/ingredientmono-1537/plant-sterols
 https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-
depth/fiber/art-20043983
 https://www.news-medical.net/health/Are-low-carbohydrate-diets-good-for-Type-2-
diabetes.aspx#:~:text=For%20patients%20with%20type%202%20diabetes%20mellitus%
2C%20the,limited%20sugars%20from%20natural%20sources%20such%20as%20fruit.
 https://clinical.diabetesjournals.org/content/20/1/45#:~:text=Self-
monitoring%20of%20blood%20glucose%20%28SMBG%29%20is%20an%20important,l
evel%20of%20glycemic%20control%20and%20to%20prevent%20hypoglycemia.
 https://www.intechopen.com/books/diabetes-mellitus-insights-and-perspectives/physical-
activity-in-the-management-of-diabetes-mellitus
 https://www.physio-pedia.com/Physical_Activity_in_Diabetes
 https://accesspharmacy.mhmedical.com/content.aspx?bookid=2577&sectionid=22890194
6
 BOOK: Nutrition through Life Cycle (Sixth-Edition) Author: Judith E. Brown

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