Slide 1 - Novo Nordisk India

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   Modern Living and Eating Habits
   Are they causing a health havoc?
 Mismatch between need and supply

 Modern living with limited physical activity does not need
  food which is refined :
       high simple sugar
       calorie dense
       high fat

 This is the type of food we normally eat
                       Modern Diet
 The result…rising prevalence of :
           • Heart disease
           • Diabetes
           • High Blood Pressure
           • Obesity
             An Increasing Problem
 Rising prevalence

       Almost 30 million people with diabetes in India - highest in
        the world. Likely to become 60 million in 25 years

 Occurs a decade earlier in Indians – affects people in their prime
   – 40-60 years

 Often associated with high level of blood fat (Cholesterol and

 Equally large number have a pre-diabetes state (IGT)
               What is Diabetes?
 Diabetes is a condition in which there is too much sugar
   (glucose) in the blood. Although sugar is needed to provide
   energy for the body, when in excess, it causes problem.

 Persons with diabetes have excess sugar because they lack or
   have deficient supply of insulin.
               Diabetes Mellitus
               A Serious Disease
Leading cause of new        6 times higher risk for
cases of blindness          Paralysis (stroke)
25 times more prone to
eye problems
                            2-3 times higher risk for
                            heart attack

                            5 times more prone to
20 times more prone to
                            Kidney failure
lower limb amputation
Nerve damage causes
loss of sensation
             What is healthy food ?
   Food that helps attain and maintain normal weight &

   Is not harmful or does not increase risk of an illness

   Provides satisfaction

   Supplies daily requirement of :
       Calories
       Correct proportion of CHO, Protein & Fat
       Vitamins & Minerals
       Roughage
       Water
        Healthy Food Vs Tasty Food
 Often the two are considered to be non compatible

 Often good healthy food is made unhealthy by the way we
  process it

 Need of the hour is to ensure that we give the right concepts
  and change behaviour

 You are the trend setters for eating habits and food choices
    How to Destroy Good Healthy Food
   Roti - Naan - Paratha – Butter Naan

   Boiled Rice - Pulao – Biryani

   Steamed Idli – Idli With Ghee – Fried Idli

   Plain Dosai – Masala Dosai – Ghee Roast Masala Dosai

   Fresh Green Salad – Salad With Thousand Island Dressing or
    Mayonnaise Dressing

   Lauki(Sorekai) - Vegetable Koftas - Malai Kofta

   Bhindi - Bhindi Masala Fry or Do-piazza

   Tomato Rasam - Cream of Tomato Soup

   Steamed Fish - Fish Tikka - Fish Fry - Fish in Lemon Butter Sauce
        Healthy Food Choices
Signal system based on traffic light concept

     Red       Preferable to avoid :
               Biryani, Fried rice, Puri, Paratha etc

     Yellow    Not a healthy choice :
               Biscuits, Bun, White Bread

     Green     Healthy choice :
               Chappati, Rice, Whole Wheat Bread, Idli
             Problem with Restaurant
               Food : Fats and Oils
 The biggest problem in food is high amount of fat used in

 Saturated fats ( ghee and oils that freeze at room temp) are most

 Vanaspati is one of the most unhealthy cooking medium

 Repeated use of oil for frying changes its composition and makes
   it atherogenic (cis-trans)

 No one type of oil is best – combinations of oils are better
                       Fats and Oils
                 Fat Distribution in commonly used oils
                                     Fatty acid (g/100g)
                 Saturated FA   MUFA           PUFA (n-6)   PUFA (n-3)
 Olive Oil       14             70             15           1
 Canola Oil      6              58             26           10
 Rapeseed Oil    7              57             32           14

 Corn Oil        13             25             61           1
 Peanut Oil      18             48             34           -
 Soyabean Oil    15             24             54           7
 Sunflower Oil   11             20             69           -
 Ghee            66             30             2            2
 Safflower Oil   8              17             74           1

MUFA = Monounsaturated fatty acids, PUFA= Polyunsaturated fatty acids
       Problem with Restaurant Food
             Salt And Sodium
 Another important element of unhealthy food -
  most Indian gravies and curries contain high amount of salt

 Salt also used for marination and pickling

 Baking powder is often used and contains high sodium

 Most chutneys and pickles are rich in salt

 Ajinomoto is often used in Chinese and Thai cooking
         Modern Life Requires Eating out
 Eating out is very common today - for some a way of
        Work takes us away from home
        Eating at work
        Special occasions like birthdays, anniversaries, festivals, or success
        Too tired to cook, parties or Friends drop in suddenly so a ―take out‖
         meal is ordered

 With each of these ‗special occasions‘ becoming more and
more common our diabetes and heart conditions are
worsening, waistlines increasing and blood pressures
shooting up
                         Eating Out
 Should people with diabetes or heart ailments
       Stop eating in restaurants?
       Stop going out and isolate themselves?

 Are there no healthy choices while eating out?

 Is it possible to eat healthy in a restaurant?

 What you should know about eating healthy?
                   Indian Cuisine
 The culinary styles of Indians are actually a conglomeration of
   many different cuisines

 The popular ones are – Moghlai, Punjabi, Avadhi, Hyderabadi,
   Goan, Bengali, Gujrathi, Kashmiri, and the different versions of
   South Indian cuisine

 The unifying factors being the use of spices, dals, curds, and
                    Indian Cuisine
 Basically Indian food is healthy, unfortunately, the modern

  practise of using abundant oil in the gravy or deep-frying, high

  salt use makes the food unhealthy
                    Indian Cuisine
 A Typical Indian meal

      Rice or Roti (at times both)
      Dal, Rajmah, Chole or Sambhar
      Vegetables dishes 1 or 2
      Curds or Raita
      Salad or Kachumber
      Papad and/ or pickles
      Non-vegetarians add a dish of meat, fish or chicken
                     Indian Cuisine
                    Soups or Shorba
 Rasam or Tomato Shorba - 2-5 grams of fat/serving.
 Chicken Shorba - 10 grams of fat.
 Mulligatawny soup - 15 grams of fat/serving.
 Lamb or Paya Shorba -15 grams of fat/serving.
 Rasam and Tomato Shorba are healthy and low in calories and

   Client may ask the chef not to add any cream, ghee or butter
   before serving
                      Indian Cuisine
 Plain steamed rice, Chappati, Plain Tandoori Roti

                                                            1Tandoori Roti = 2 home made chappatis
                                                                                                     1 Naan = 4 home made chappatis..
    1 serving - less than 1 gram of fat.- Healthy choices

 Kulcha, Jeera Pulao, Lemon rice, Tomato rice
    1 serving - not more than 5 grams of fat

 Parathas, Missi Roti, Khasta Roti
    1 serving - upto 15 grams of fat

 Puri, Bhaturas, Kachoris are deep fried - rich in fat

 Biryani (Chicken, Vegetable, mutton)
    1 serving - more than 70 grams of fat
                    Indian Cuisine
 Sambhar, Yellow Dal, Moong Dal, Panjrathni Dal, Chole and Rajmah
  are healthy options
       A serving around 10 grams of fat

 Dal Makhini
       A serving more than 30 grams of fat

 The fat comes mainly from the Tadka or Baghar
   Client may ask the chef not to do takda or baghar
   before serving
                        Indian Cuisine
 Methi Palak, Aloo Palak, Khumb Palak, Khumb Makai, Khumb Matar, Gobi
  Matar, Sabj Punch Mahal, Jeera Aloo, Tandoori Gobi, Tawa sabzi may all
  have less than 7 grams of fat/serving –healthier

 Bhindi do Pyaza, Masala Bhindi, Baghade Baigan, Baigan Bhaja – rich in

 Dum Aloo, Banarsi Dum Aloo, Shahi Kofta, the Koftas and potatoes are
  deep-fried and the gravy is rich. The fat content could go upwards of 30

 Paneer (cottage cheese) rich in both protein and fat. 1 serving approx. 15 –
  25 gm of fat. Is it necessary to fry it before putting in the gravy?
                 Indian Cuisine
              Fish, Chicken or Meat
 Fish is considered good for health. But, depends on how it is
   cooked? Is it fried, baked, roasted, stir fried or steamed?

 Chicken Tikka, Reshmi Kabab, Fish Tikka, Tangdi Kabab,
   Tandoori chicken low in fat

 Tawa Machili, Tawa Chicken cooked on the Tawa or griddle use
   less oil - are a healthy choice if less than 10 gram of fat per
                  Indian Cuisine
               Fish, Chicken or Meat
 Malabar (Kerala) Fish Curry, Malabar Lamb Curry, Murg
  Makhani, Mutton do Pyaza, Mysore Chilli Chicken,
  Osmani Korma, Butter Chicken Curry, Achar Ghost,
  Chicken Korma, Ghost Korma are all loaded with fat

  One serving could be upwards of 25 grams of fat

 One serving with coconut added to it could have up to 40
  grams of fat
                      Indian Cuisine
 Idli, Dhokla (without the coconut), Fruit Chaat, Aloo Chaat,
  Uppma etc are healthy choices

 1 Masala Dosa could have nearly 10 grams of fat

 Onion Pakora, Vadas, Aloo Bonda, Samosa, Kachori, Paneer
  Pakoras - all deep fried - rich in fat

 Papdi in the Papdi Chaat and Vadas in the Dahi-Vadas are deep-
  fried - rich in fat
              Continental Cuisine
 French, Italian, American, and English

 In a Continental restaurant, meals are served on individual
  plates and even if the portion size is large, food is not

 Use lighter sauces
            Continental Cuisine Soup
 Cream of asparagus, chicken, tomato, or mushroom - rich in calories
  and fat

 One serving of mushroom cream soup - 6-8 grams of fat and 110

 Consommé - 50 calories, 2/3 grams of fat – healthy option

 Vegetarian farinaceous soup - pumpkin lentil soup or lentil soup –
  healthy option

    Client may ask the chef to hold the cream, which is often put as a
    garnish over most soups. Avoid fried croutons in the soup.
                  Continental Cuisine
 Breads

      Whole wheat, multigrain, corn and rye bread are healthy
      Croissants, Danish pastries - rich and not good

 Pasta

      Tomato based pasta (Puttanesca) healthy
      Spaghetti bolognaise or macaroni with cheese are rich
                  Continental Cuisine
 Vegetables are served as accompaniment or as stew, grilled,

   stuffed, augratin or ratatouille

 Usually served as sautéed or buttered assorted vegetables,

   (carrots, broccoli, mushrooms, capsicum etc)

 Potato -Baked, roasted, boiled and mashed potatoes, sautéed

   potatoes (with or without butter or dill cream sauce) and also

   fried or as potato croquettes
                Continental Cuisine
 Ratatouille is a healthy vegetable choice

 Vegetable au gratin is rich in fat, because of white sauce and

   Client may ask the chef to serve the vegetables boiled or
   steamed as an accompaniment and not sautéed in butter, to
   hold the butter and cream in mashed potatoes
         Continental Cuisine
Sauces / Dressings Make the Difference

 Continental dishes can be made lighter or heavier depending on

   what sauce has been used and if cream was avoided in the end

 Difference could be of 10-15 grams of fat

 Hollandaise, Mayonnaise, Tartare, have egg, oil and vinegar as

   the main ingredients. – rich sauces
         Continental Cuisine
Sauces / Dressings Make the Difference
 White sauce has equal quantities of flour and butter or oil.

   cheese, mustard, mushroom sauces are prepared with white

   sauce as a base - rich in fat

 Thousand Island is an oil and egg based dressing - rich in fat

 Vinaigrette dressing the main ingredients are vinegar, olive oil

   and mustard – rich
         Continental Cuisine
Sauces / Dressings Make the Difference
  Brown sauce (Black pepper) is relatively healthier sauce

  Plain tomato based sauces - healthy

  Plain lime and vinegar dressing - healthy

  Low fat Yoghurt would make a healthy choice

  Chutney made of tomatoes, black grapes, and cherries are a
   healthy accompaniment to roast or grilled meat
                 Continental Cuisine
                Fish, Chicken or Meat
 Steamed, poached or grilled fish – healthy
      If lemon butter, dill cream or parsley sauce added - rich
      If served with Dijon mustard – healthy

 Roast, grilled chicken – healthy
      If Mushroom sauce is added – rich
      If black pepper sauce is added - healthy
      If Chutney is added – healthier

 Chicken chasseur, Coq au vin, Chicken stroganoff - rich
      Remove cream – healthy
                Continental Cuisine
               Fish, Chicken or Meat
 Beef Tenderloin Steak is healthier than Beef Stew, Shepherd‘s
   pie, or Lamb chops
 Chicken al Kiev- 60 grams of fat
 Crumb fried Chicken, Shepherd‘s pie, Fried fish or Fish cutlet –
   deep fried – rich
 Lobster Thermidor, which despite its fame, is not what a health
   conscious gourmet should look for

    Client may ask the chef to avoid serving any cream, egg,
    and mayonnaise based sauce with the meat
              Chinese / Thai Cuisine
 A traditional Chinese meal :
       Steamed rice or noodles
       Generous amount of vegetables,Soybean products
       Dried or fresh fish and/or small quantities of meat

 A traditional Thai meal :
       Steamed rice
       Spicy or pickled vegetables
       Spicy meat/fish curries (many with coconut milk added)

 In India people like to eat fried rice, fried noodles,
  American Chop Suey
        Chinese/ Thai Cuisine Soup
 Hot and Sour, Wonton, Mixed Vegetable Clear, Tom Yum soup
  - light and healthy

 Sweet Corn Chicken or Egg Drop - heavy and rich

 Tom Kha Kai - rich as coconut milk is added

 Client may ask the chef not to add the egg or fried meat
            Chinese/ Thai Cuisine
 Rice or Noodles (plain / steamed) - healthy

 Vegetable, chicken, pork, or shrimp fried rice
    1 serving - 25 grams of fat

 Pan-fried noodles (Szechwan)
    1 serving –10-13 gm fat

 Crisp fried noodles (American chop suey)
       1 serving –25 grams of fat

 Phad Thai – fried noodles with tamarind and bean sprouts
    1 serving - 400 calories
                  Chinese/ Thai Cuisine
 Salt and Pepper Vegetables- Deep-fried
 Cauliflower or Vegetable Manchurian - Deep-fried
 Spinach With Hot Sesame Sauce or Bok Choy - Healthy
 Stir-fry Vegetable Dish – Healthy *
 Phad Khao Pot Orn Bai Krapao (Stir-fried Baby Corn) – Healthy
 Som Tam Esan (Raw Papaya Salad) – Healthy

  * In a stir-fried dish ask the chef not to deep-fry the vegetables before
                  Chinese/Thai Cuisine
                  Fish, Chicken or Meat
 Steamed Pomfret with vegetables or a pan-fried chicken –

 Chicken/Pomfret in garlic or ginger sauce – rich in fat (as
  chicken is first deep-fried, then stir-fried and then the sauce is

 Pla Jeramet Neung Manao (Steamed Pomfret), Phla Koong
  (Prawn salad), Kai Yang Esan (Northeast grilled chicken), Kai
  Phad Bai Krapao (Stir fried Chicken with hot Basil) are healthy

 Pla Jeramet Sam Ros (Deep fried Prawns) - rich in fat
       1 serving may have more than 22 grams of fat

    Ask the chef not to deep-fry the meat, fish or chicken in a stir- fried
                     Sugars and Sweets
 Fruit Salad
 Fruit Sorbet, Rasogulla, Phirni, Caramel Custard, Fruit
  Yoghurt - healthier choices
      Can also be made lighter with artificial sweetener
      Kulfi - 1serving - 500 calories
 Jalebis and Gulab-Jamuns - deep-fried and then put in sugar
  syrup - rich
 Continental desserts are rich in cream and egg yolk
      Souffles, mousse, custard, shakes can be made with skimmed
       milk and artificial sweeteners
                 Sugars and Sweets
 Healthy tips

      Take a fruit salad instead of the dessert
      If you do want to take a dessert, eat less than half the portion
      Take advantage of smaller portions available in restaurants or
       ice cream spots
      Check with the chef if they have any low calorie dessert, or
       one prepared with artificial sweeteners
      May be a cup of coffee sweetened with an artificial sweetener
       would satisfy the sweet urge

    Avoid sweets with a lot of cream, or which have been deep fried
 Healthy choices for beverages are:

       Tomato juice
       Plain Nimbu pani
       Unsweetened fruit juice
       Raw vegetable juice like raddish,carrot etc
       Lassi (without sugar)
       Tea/coffee (without sugar)
                     Delayed Meals
 Meal Delay Over 1-½ hours

 If you take Repaglinide (NovoNorm) – delay taking the
  medicine till just before the meal as you normally do.

 If you take sulfonylureas or insulin only in the morning:
      Eat your next snack at the usual time of the meal that has been
       delayed. Eat the delayed meal at your usual snack time.

      Do not eat another snack after the delayed meal.
                       Delayed Meals
 Meal Delay By About One Hour

 If you take Repaglinide (NovoNorm) – delay taking the medicine
  till just before the meal

 If you take a Sulfonylurea or insulin before the meal you can
  delay taking the medicine until just before the meal

 If you take the medicine earlier, say in the morning, as with
  many sulphonylurea and some insulin preparations and the
  dinner is to be delayed. In this situation it is important to take
  about 15gms of carbohydrate such as fruit or biscuits
  Guidelines for Alcohol Consumption
 Preferable to restrict alcohol

 The ADA recommends
      one drink per day for women

      two drinks per day for men

 If drinking alcohol several times a week, the doctor should be
 To prevent hypoglycemia, alcohol should be consumed with
  Guidelines for Alcohol Consumption
 No alcohol to be taken in presence of pregnancy, pancreatitis,
  dyslipidemia, neuropathy
 Do not drive or plan to drive for several hours after you drink
  Guidelines for Alcohol Consumption
 Alcohol contains 7 calories per gram and is utilized by the
  body like fats. Calculate alcoholic drink as part of calorie
  intake, substitute it for fats in the meal plan.

 For example: 1 alcoholic drink equals 1 fat exchange (90

 (One alcoholic beverage is 12 oz. light beer, 5 oz. wine or 1
  ½ oz. distilled spirits such as, vodka, whiskey, gin, etc.)
  Guidelines for Alcohol Consumption
 Healthy Tips to Sip By

      Drink only if blood glucose is under control
      Test blood glucose to decide if you should drink alcohol
      For drink mixers, use calories-free choices—diet soda, club
       soda, diet tonic water, or water
      Drink alcohol with a snack or a meal not empty stomach
      Quench thirst with water or a no calorie beverage and not
      Wear Diabetes identification card that notes you have diabetes
      Healthy choice for snacks - fat free popcorn, crackers, or
Nutritive and Non Nutritive Sweetener
   Non Nutritive (Artificial) sweeteners
         Saccharin - Bitter after taste
         Aspartame - Has a delayed sweetness taste, is unstable at high

   Nutritive sweeteners
         Fructose – 4 cal/g
         Sorbitol – 4 cal /g
         Mannitol- 2 cal/g

   Artificial Sweeteners is added to tea and coffee, used
    to make sweets/ desserts at home
                 Eating out in India
 People with diabetes or heart ailments can eat in restaurants – with
  your care and understanding

 They can get healthy choices while eating out -with your expertise

 Give your client the option to choose a healthy meal

 Put it on your menu card

 Experiment and popularize healthier Indian curries

 Be the trend setters and your clients will follow and appreciate your

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