Heart week reminders for d-health

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This week 4-10 May 2014 is Heart Week. It’s about raising our awareness and understanding more about our heart health, what the risk factors are, and how you can recognise a heart attack or a stroke.

We know that people with diabetes are 3 to 4 times more likely to develop cardiovascular disease (including heart attack and stroke) than those who do not have diabetes. In addition, around 75% of all people with diabetes die from cardiovascular disease, including heart attack and stroke. So it’s definitely an issue worth paying attention to!

My blog today will take a look at what the Australian Heart Foundation suggests we consider about our heart health. I will also be reviewing some previous Diabetes Counselling Online blogs of mine that relate to this topic to help you to gain a better understanding of how diet and lifestyle can help you protect your own heart health.

Modifiable Risk Factors

Knowing our risk (or risk factors) is the first step we can take to help prevent a heart attack or stroke. The Australian Heart Foundation highlights risk factors for heart disease that you have the ability to change as:

  • Smoking
  • Poor diet
  • Physical inactivity
  • Being overweight
  • High cholesterol
  • High blood pressure

The Heart Foundation wisely advises that we should visit our doctor for a heart health check, and talk with our doctor about risk factors and how best to prevent having a heart attack or stroke. Seeing an Accredited Practising Dietitian for personalised advice about your eating habits and an Exercise Physiologist to find activities that suit you is also something you should discuss with your doctor.

You can also read this Heart Foundation warning signs fact sheet that will help you to recognise if you’re having a heart attack, remembering that the sooner you are treated, the more chance you have of survival.

Review of past relevant Diabetes Counselling Online heart health blogs

I encourage you to have a re-read of some of my favourite blogs which discuss the evidence behind limiting or increasing or exchanging certain foods, thereby improving your cardiovascular risk. They include:

Guideline 3 – this one takes a closer look at the Australian Dietary Guidelines third guideline which in itself is a great summary for this blog: “Limit intake of foods containing saturated fat, added salt, added sugars and alcohol”.

Salt – As salt, or sodium chloride, is strongly associated with heart disease, this blog offers some great tips on how you can reduce your sodium intake.

Fats and Sugars – also strongly associated with heart disease, this blog reinforces the importance of eating a balanced diet.

The Glycemic Index – talks through the evidence of a low-GI diet helping with cardiovascular health.

Dairy – quoting from evidence in the Australian Dietary Guidelines, this blog talks about how many serves you need each day to guard against coronary heart disease, stroke and hypertension.

Oaty heart

Wholegrains – again discusses evidence from the Australian Dietary Guidelines and gives you some great ideas!

Legumes – must be close to the perfect food, with lots of evidence of their positive effects on reducing cardiovascular disease. We should be eating these most days of the week.

Eggs – which brings home that the ‘usual’ rules for heart disease should be stepped up a little when diabetes is in the mix, with evidence indicating no more than 3 eggs a week is prudent advice for people with diabetes.

 

www.nutsforlife.com.au
www.nutsforlife.com.au

 

Nuts – these tick so many of our healthy eating boxes with diabetes. Lots to learn in this one too!

Red white and green veggie heart

I’ll leave you with a few extra tips from The Heart Foundation. They’ve put together a Recipe Finder that will help you to choose heart healthy recipes, as well as a link to some hard copy cook books that you can order online. Don’t forget to see your doctor to assess your own heart health risk.

Remember that Diabetes Counselling Online offers free e-counselling to all Australians who have diabetes. This includes up to 6 hours a year with our dietitians, diabetes educators and counsellors if you feel that you need or would like any support. This service is also available to overseas members for a small fee.

Thanks for taking the effort to improve your heart health – we love you for it!

Sally :)

Sally is the Social Media Dietitian with Diabetes Counselling Online, owner of her private practice (Marchini Nutrition), and has had type 1 diabetes for close to 40 years and coeliac disease for many years too.

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Energy In/Energy Out – understanding how much you need and where you get it

Scales in balance

You may not know that I was a mature-age student when I studied to become a dietitian. As a result I had already lived most of my life with diabetes before being fortunate enough to become an Accredited Practising Dietitian after 4 years full time study at the University of Newcastle. One of the light-bulb moments I had in my studies was that about understanding macronutrient energy values and estimated energy values.

I knew that in order to maintain my weight for wellness, energy in had to equal energy out, but I didn’t know that I could work out how much energy my body needed just to exist (my basal metabolic rate) and why I was putting on weight even when I tried cutting my carbs (such a bad idea!). So I thought I’d share a little of this with you in the hope that it also creates a light-bulb moment for you :)

Remember that the first of the five Australian Dietary Guidelines is ‘To achieve and maintain a healthy weight, be physically active and choose amounts of nutritious food and drinks to meet your energy needs’.

‘To meet your energy needs’

One of my textbooks (Food & Nutrition, edited by Mark L. Wahlqvist) explains, “Living organisms require energy to maintain life. Energy is obtained by oxidation of fuels which include carbohydrates, fats, proteins and alcohol.” The National Medical Health and Research Council (NHMRC) further explains that, “Energy is not a nutrient but is required in the body for metabolic processes, physiological functions, muscular activity, heat production, growth and synthesis of new tissues”.

In today’s blog I’ll share with you links to a mathematical formula that is popularly used to work out how much energy you need to satisfy your basal metabolic rate, and then explain about how those fuels (otherwise known as macronutrients) contribute towards making up the numbers.

Please bear in mind that each of us is different, so these numbers are estimates only that have many possible reasons for inaccuracies. It’s also important to understand that energy requirements for individuals vary with age, gender, body size and activity, so different recommendations are needed for each age and gender group.

There are a variety of formulas available to work out how much energy we need, but the one I prefer to use is called the Schofield Equation. As with all such equations, the number is provides is only an estimate so should only be used as a rough guide. It estimates the metabolic rate in mJ/day (so we need to multiply the final number by 1000 to get kJ/day, and divide that by 4.2 to get calories/day).

Rather than providing the various options for the formulas here, it’s easier to use a link to the NHMRC BMR calculator where you can enter your age and gender to find your BMR. Then all you do is to nominate your Physical Activity Level (PAL) to work out what your approximate energy needs in mJ/day for your approximate weight and height. I generally choose a lower PAL number as most of us don’t do much more than the minimum of 30 minutes per day of physical exercise, so I choose a PAL level of 1.4 (for maintenance) for this purpose.

That makes the number that I’m aiming for as a 48 year old female about 70kg with a 1.4 PAL = 8.3 mJ (8300kJ/1980calories) to maintain my current weight. What number have you worked out for yourself?

The macronutrient energy values that make up your numbers

Remembering that “energy is obtained by oxidation of fuels which include carbohydrates, fats, proteins and alcohol” – each of these has been tested to see how much energy they release.

One of my favourite points that I constantly remind clients of is that, regardless of the numbers, it’s important to recognise that carbohydrates and proteins have similar energy per gram values (16 & 17 kJ/gram respectively) which are at least half as much as alcohol and fats (27 & 37 kJ/gram respectively).

Again we need to remember that each of us is different, but there are what are called Acceptable Macronutrient Energy Ranges (AMDRs) that are generally referred to as a guideline for how much of each we should include within our allotted energy needs which would allow for an adequate intake of all the other nutrients whilst maximising our general health outcome. Each person needs to understand with the help of a health professional (dietitian) which is suitable for them as we all have different requirements. You can read more detail on this topic via the NHMRC website.

For us with diabetes, carbohydrates are always open for discussion and here it’s interesting to note that the American Diabetes Association recommends a minimum amount of 130g per day (about 9 x 15g serves spread across the day) of quality carbohydrates for our brains and bodies to perform optimally.

Speaking of quality, of course we need to always bear in mind the importance of the quality of the foods we eat from each of the macronutrient areas:

  • Carbohydrates should be nutritious with a low-glycemic index wherever possible. As mentioned at the start, you need quality carbohydrates for many reasons. Read more here.
  • Proteins should be lean (to avoid saturated fats) or be plant based.
  • Fats should be mostly mono- and poly-unsaturated with less than 10% of your fat intake being from saturated fats. It’s important to maintain a 1:1:1 ration with Mono-unsaturated fats, Poly-unsaturated fats and Saturated fats.
  • Alcohol is not considered nutritionally important so should only be consumed in moderation as per the guidelines of 1 standard drink for females per day, and 2 for males, with a day or two alcohol free days per week. If you don’t drink, there’s no need to start!

If you feel that you’d like to learn more about these topics and how they apply to you, you can apply for counselling (free to all Australians with diabetes, with a small fee for internationals) through Diabetes Counselling Online, or you can find a dietitian near you via the Dietitian’s Association of Australia or similar organisation in other countries.

Hoping that’s been enlightening for you as it was for me in my early days of university :)

Sally is the Social Media Dietitian with Diabetes Counselling Online, owner of her private practice (Marchini Nutrition), and has had type 1 diabetes for close to 40 years and coeliac disease for many years too.

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