* Decide on 1-2 changes that you can make.
* Eating regular meals will stop you getting too hungry and being tempted by foods high in fat and/or sugar.
* Ensure you have a good fluid intake at least 6-8 cups/day.
* If you drink alcohol keep within safe limits.
* If you need to lose weight set a realistic target and aim to lose weight slowly.
* Increasing exercise will help you to lose weight as well as being good for your general well-being.
There are no good or bad foods just good or bad diets.
What to Eat
Meat small portions only. The size of your palm .Remove all visible fat.
Aim to eat 5 portions of fruit and vegetables each day remember to choose a wide variety.
Fish all kinds, but grill or steam, don’t fry. Shellfish may be eaten occasionally if liked.
Eggs not more than about 5 eggs in one week.
Cheese not more than about 50g (2oz) cheddar type cheese in one week. Cottage cheese may be eaten as desired.
Milk use skimmed milk, fresh or dried, if possible. Low fat yoghurt is suitable, but remember fruit varieties contain sugar, so are fattening.
* Margarine use polyunsaturated margarine instead of butter, but try not to use more than 150g (6oz) weekly.
* Oil use vegetable oil instead of solid fat for cooking, but try not to have fried foods very often.
* Vegetables, fruit eat plenty of these, but do not add any fat. If you want to eat chips of fried potatoes occasionally, cook them in vegetable oil.
* Bread and cereals wholemeal bread may be better than white. Eat it with a scrape of polyunsaturated margarine. Have skimmed milk on breakfast cereal, and use skimmed milk for custard or milk
Cut down fat in your diet, particularly saturated fat.
Eat less saturated fat (visible fat on meat, hard fats eg lard, butter) and use unsaturated fats (corn, olive, sunflower, rapeseed oils, oily fish) instead
Use lower fat alternatives like semi skimmed milk, low fat yoghurt.
WHAT TO AVOID
Butter, lard, ordinary margarine, cream, ice-cream, pastry, cakes or biscuits made with saturated fat. Fat on meat, cream cheese, salad cream, mayonnaise, chocolate, toffees, fudge, butterscotch.
Food groups and what’s in a portion? How many portions should you eat in a day?
Bread, cereals, rice, pasta and potatoes
• 2 – 4 tbsp cereal
• 1 slice of bread
• Half small chapatti
• 2 – 3 crispbreads or crackers
• 2 – 3 tbsp rice, pasta, cous-cous, noodles, mash potato
• 2 new potatoes or half a jacket potato 2-3 at each meal
More than this will cause your blood glucose levels to rise above normal levels
Fruit and Vegetables
• a whole banana or apple
• a slice of melon
• 2 plums
• A handful of grapes
• A cereal bowl of salad
• 3 heaped tbsp of vegetables 1 fruit per meal maximum
As much vegetables and salad as you like
Meat, Fish and alternatives
• 2 – 3oz (60 – 85g) meat, poultry or vegetarian alternative
• 4 – 5oz (120 – 140g) fish or oily fish
• 2 eggs
• 1 sausage
• 1 rasher of bacon
• 2 tbsp nuts
• 3 tbsp beans, lentils or dahl 1 with light meal
1 with main meal
Milk and dairy foods
• 1/3 pint of milk
• Small pot of yoghurt
• 2 tbsp cottage cheese
• 1 ½ oz cheese (40- 45g, matchbox size) 1 per meal maximum
• 2 tsp spread or butter (1tsp per slice of bread)
• 2tsp oil (olive, sunflower, vegetable)
• 1 tblspn of coleslaw or salad cream or cream
High fat and sugary foods
• 1 mini chocolate bar or biscuit
• 2 tsp sugar, jam or honey
• 1 scoop ice cream
• 1 packet of crisps 1 per meal maximum
Maximum of 4 per week
|Diet and health|
|Fruit and veg||5 a day can reduce stroke risk by 1/4|
|Meat||Red and processed meat
increases risk of colorectal cancer up to 30%
recommended limit 300g week
|Salt||Increased levels increase risk of hypertension and cardiovascular events
Recommended target of 6 g per day
|Magnesium||A portion might be a medium-sized apple, a cup of raw salad greens, half a cup of cut-up vegetables, half a cup of cooked beans or peas, or three-quarters of a cup of 100% fruit or vegetable juice.|
|Alcohol||cancers of the mouth, pharynx, larynx, oesophagus, colorectum, and breast, and also leading to cirrhosis, which predisposes to liver cancer|
|Obesity||increases the risk of cancer of the oesophagus, colorectum, pancreas, breast, endometrium, and kidney|
source GP Update?
high intake of vegetables, legumes, fruits, and cereals, a moderate to high intake of fish, a low intake of saturated fats, but a high intake of unsaturated fats, particularly olive oil, a low intake of dairy products and meat, and a modest
intake of alcohol, mostly as wine.
green leafy vegetables, mustard or soybean oils, certain nuts and whole grains replace fish, rapeseed and olive oils, also reduces risk of cardiac death by up to half at least in Indian men
Less fat in total and choose food high in polyunsaturated and monounsaturated fat rather than saturated fat.
This can be done simply by :
Spreading butter or margarine thinly.
Use semi skimmed or skimmed milk.
Buy lean meat and trim off fat.
Avoid pies and pastries too often.
Eat more chicken and fish dishes fish fingers and fish cakes are suitable.
Use more beans, peas and lentils.
Fill up with more vegetables and fruit.
Have breakfast cereals, porridge, wholemeal bread and rolls more often.
Only fry food occasionally using a corn, soya, rapeseed or sunflower oil.
If you fancy chips use oven chips or use one of the above oils.
Keep intake of cheese to around 4oz per week.
Choose fruit for snacks and puddings instead of biscuits, cakes, pastry, chocolate, crisps or nuts.
Natural yoghurt can be used instead of cream for desserts and in cooking and makes a suitable salad dressing.
Foods containing cholesterol have only a small influence on blood cholesterol levels, therefore, foods such as eggs, liver and shellfish can be included in normal quantities once a week.
|Step 1||total fat <35% calories||<10% saturated||cholesterol <300mg|
|Step 2||total fat <25% calories||<7% saturated||cholesterol <300mg|
|(per 100g)||Sugar||Total Fat||Satturates||Salt|
(clinical craft cards BJPCN Sep 2009)
Low Sat Fat Diet
The best way to reduce the possibly harmful amount of fat and cholesterol in your blood is to limit the total amount of fat you eat and to change some of the saturated fat in your diet for unsaturated fat.
As a rough guide:
Saturated fat is usually of animal origin and solid at room temperature. Includes: butter, cream, milk fat, meat fat. Unsaturated or polyunsaturated fat is usually of vegetable origin, and liquid at room temperature. Includes: vegetable oils, polyunsaturated margarines.
Cholesterol occurs naturally in some foods and is made in your body. By limiting your fat intake you will also limit cholesterol.
Fat soluble vitamins ADEK
Vit A & Carotinaemia
Vitamin A in Under 5s BMJ Aug 2011 (NHS Networks Link)
B12 is sometimes given orally at doses of 1-2 mglday if there is a dietary deficiency (unlicensed use), but, if not, should be administered by intramuscular injection (three times a week for the first 2 weeks, then once every 3 months hydroxycobalamin 1mg).
B12 levels are invariably high in patients receiving injections.
Low folate levels
poor diet eg in alcoholics
increased need eg in pregnancy, haemodialysis and haemolytic anaemias
malabsorption eg coeliac disease
latrogenesic eg in patients taking folate antagonists such as phenytoin or methotrexate.
Folic acid should not be given if there is concurrent vitamin B12 deficiency until the patient has had at least one injection of vitamin B12; otherwise, subacute combined degeneration of the spinal cord can be precipitated or worsened.
When treating folate deficiency, folic acid should be given at a dose of 5 mg per day for 4 months
Vitamin D insufficiency and deficiency BMJ 2010;340:b5664
Most experts say levels should be AT LEAST over 20 AIMING for over 30 ideally so treat if less than 20 aim for 30
Ideal and naturally occurring level in those with full sunlight exposure in equatorial environment) is about 50-70
Only repeat tests if concerns about adherence, if patient requests, or if no treatment for a long time, or failed treatment. Post treatment levels usually around 50.Do repeat and calcium level if concerns in pregnant women.
If associated with iron deficiency consider checking for coeliac disease ( TTG)
It is very hard to overdose on vitamin D unless you use very large doses for many months (caution in sarcoid)
Colecalciferol 20 000 two daily for 10 days then one weekly
ALL residents of nursing homes/housebound patients should be on one weekly Use ADCAL as well if established osteoporosis
TREAT THE INFANTS OF ALL VITAMIN D DEFICIENT MOTHERS WITH DALIVIT
CHILDREN with documented deficiency.
If under one year…
3000iu or equivalent per day for 8-12 weeks with calcium supplement( 50 mg/kg per day ) initially…this is equivalent to 20 000 per week ie one capsule. Many children can swallow them
Over one year
6000 units per day initially = two caps of colecalciferol weekly for 8 to 12 weeks
400iu ( as Dalivit OK up to age 10) daily
5 to 10 years 100 000 every three months or 20 000 per month Over 10 years 150 000 every three months or 20 000 per fortnight
Over 10 years give 20 000 two per month
Selected Food Sources of Vitamin D
IUs per serving*
|Cod liver oil, 1 tablespoon||
|Salmon (sockeye), cooked, 3 ounces||
|Mushrooms that have been exposed to ultraviolet light to increase vitamin D, 3 ounces (not yet commonly available)||
|Mackerel, cooked, 3 ounces||
|Tuna fish, canned in water, drained, 3 ounces||
|Milk, nonfat, reduced fat, and whole, vitamin D-fortified, 1 cup||
|Orange juice fortified with vitamin D, 1 cup (check product labels, as amount of added vitamin D varies)||
|Yogurt, fortified with 20% of the DV for vitamin D, 6 ounces (more heavily fortified yogurts provide more of the DV)||
|Margarine, fortified, 1 tablespoon||
|Sardines, canned in oil, drained, 2 sardines||
|Liver, beef, cooked, 3.5 ounces||
|Ready-to-eat cereal, fortified with 10% of the DV for vitamin D, 0.75-1 cup (more heavily fortified cereals might provide more of the DV)||
|Egg, 1 whole (vitamin D is found in yolk)||
|Cheese, Swiss, 1 ounce||
|*IUs = International Units.**DV = Daily Value. DVs were developed by the U.S. Food and Drug Administration to help consumers compare the nutrient contents of products within the context of a total diet. The DV for vitamin D is 400 IU for adults and children age 4 and older. Food labels, however, are not required to list vitamin D content unless a food has been fortified with this nutrient. Foods providing 20% or more of the DV are considered to be high sources of a nutrient.|
|Office of Dietary Supplements|
|Calcium and vitamin D rich foods|
dairy products, such as milk and cheese
Foods modified with supplements that claim to improve well-being or health
Fortified breakfast cereals
Probiotics – live micro-organisms in yoghurts
Streptococcus thermophilus, Enterococcus species, Saccharomyces species, and various species of lactobacilli and bifidobacteria
May be beneficial in a range of gastrointestinal conditions.
MUST nutrition scoring tool
Malnutrition Universal Screening Tool bapen.org.uk
|Potassium rich foods||Serving Size||Potassium (mg)|
|Apricots, dried||10 halves||407|
|Avocados, raw||1 ounce||180|
|Bananas, raw||1 cup||594|
|Beets, cooked||1 cup||519|
|Brussel sprouts, cooked||1 cup||504|
|Dates, dry||5 dates||271|
|Figs, dry||2 figs||271|
|Kiwi fruit, raw||1 medium||252|
|Lima beans||1 cup||955|
|Melons, honeydew||1 cup||461|
|Milk, fat free or skim||1 cup||407|
|Orange juice||1 cup||496|
|Pears (fresh)||1 pear||208|
|Peanuts dry roasted, unsalted||1 ounce||187|
|Potatoes, baked,||1 potato||1081|
|Prune juice||1 cup||707|
|Prunes, dried||1 cup||828|
|Spinach, cooked||1 cup||839|
|Tomato products, canned sauce||1 cup||909|
|Winter squash||1 cup||896|
|Yogurt plain, skim milk||8 ounces||579|