Question

I have just been diagnosed with diabetes and I also have high blood pressure and high cholesterol levels. It seems as if I can hardly eat anything now, because of these problems. What can I safely eat?

Answer

You have three risk factors for cardiovascular disease (and the diabetes also can cause other complications). Each of these risk factors responds to diet. We will deal with each in turn.

Let us start with diabetes. The immediate question here is whether you are overweight or not. If you are, then successful management depends essentially on dietary treatment to reduce your weight. This is particularly important if you have type II diabetes. The dietary treatment of diabetes needs to be individualised for the person, but our general advice is to eat sufficient calories to support your necessary activities and bring your weight to the correct value. The effect of food on the blood glucose of the person is influenced by its speed of absorption. This can be altered by taking carbohydrate at the same time as other foods, such as protein and fats, and dietary fibre. The carbohydrate content should provide 50-55% of the total calories. Food should be spread through the day. Meals should be slowly digested and absorbed. The need for regular feeding should be stressed in insulin dependent diabetics. Do not forget about the benefits of exercise.

Although high blood pressure can be controlled by tablets, it is appropriate for people to look at non-pharmacological treatment as well. They may be able to control their blood pressure completely without taking tablets, or may need fewer tablets. Once again, weight reduction is important. Alcohol restriction is necessary. It is unwise to add sodium (salt) to cooking, or to have it on the table and sprinkle it on your food. For the same reason heavily salted processed food should also be taken in moderation. Potassium (in fruit and vegetables) is probably very important. There is some evidence too that certain fish oils lower blood pressure.

The same arguments can be made for high cholesterol as for high blood pressure. There are certainly drugs which will reduce high cholesterol but it might be inappropriate to try these before dietary advice has been given and adhered to. Once again, the effort should be to reduce obesity (we are sorry to keep harping on about this condition but you can see that it affects all three complaints that you have. We are not implying that you are overweight as we do not know that, but clearly if you are, it would be important for you to reduce your weight). The main dietary effort should be to reduce dietary fat, especially saturated fat, which should be less than 10% of the dietary intake. Saturated fat should be substituted with a mixture of unrefined carbohydrate and monounsaturated and polyunsaturated fats such as sunflower, corn oil and fish oil. Fibre is particularly advisable.

We wish you luck in controlling your three conditions because it is so important for you to do so for a continued long healthy life. However there are other risk factors which may be just as important, or even more important, such as smoking.

Finally, we suggest that you see a dietician because it is important that you eat a diet which will help control your conditions but also does not lead to such a miserable life that you cannot enjoy it. Certain compromises may have to be made.

Links

• Do You Have the Metabolic Syndrome (Syndrome X)?