Category: 2021 Winter – Diabetes Focus eMag

SASFA

The SA Seniors Fitness Association (SASFA)

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SASFA is open to anyone over the age of 50, if you are looking for fun and friendship.

About SASFA

The South African Seniors Fitness Association (SASFA) started in 1990 as a non-profit organisation. The aim and purpose is to reach as many seniors throughout the country as possible, to advocate why regular and appropriate senior related exercise is extremely valuable and vital in creating a better quality of life.

Members and instructors pay an annual membership fee at the beginning of each year. All monies received from membership, sponsorship, donations, fund raising etc, is used to run SASFA and any unused or extra profits get ploughed back into the Association for future use.

The Management Committee meets every second month, seeing to the needs and running of SASFA. There are eight members on the committee: Iona Henning (Chairperson and National Trainer), Dot Tyldesley (Vice-chair), Rosemary Swemmer (Treasurer), Helga Calitz (Gauteng Regional Rep), Carol Alty, Edwina Fillies, Sally McKinley and Pat Wright.

SASFA instructors

Instructors are required to take their SASFA exam to become qualified and receive their SASFA Instructors certificate. Instructors are obligated to attend the yearly national course when the new programme is presented.

How does it work?

By presenting exercise and recreational programmes in a relaxed environment, members are able to release tensions, stresses and anxieties that may be troubling them. Physical exercise plays an important part in maintaining the health of the body. Just as important is social well-being.​

A senior’s fitness exercise programme comprises, flexibility, balance, poise, co-ordination, stamina, muscle strengthening and cardiovascular exercises. These exercises are set to enjoyable and stimulating music. Our senior instructors are all fully trained and must hold a national certificate.

Fun, friends and exercise

SASFA is a very successful organisation that we are all proud of and privileged to belong to. It’s important for body, mind and soul to keep active in our senior years. Often people say, ‘what would I do without SASFA’.  Well when you join a club it becomes a very special group, making new friends, bonding together, and soon this becomes a part of your life.

Should you be interested in finding out more about joining SASFA, either to take part in an exercise programme or to be trained as an instructor, visit saseniorsfitness.co.za

summer 2023

DSA News – Winter 2021

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DSA Port Elizabeth news

Denim for Diabetes

Well done to Megan Soanes who promotes the Denim for Diabetes project in Port Elizabeth, she got CompRSA to participate in this project by wearing denim for a day (14 May 2021) to raise much needed funds for the Port Elizabeth branch.

Diabetes Wellness meetings

We are thrilled to report that after more than a year of lockdown we have had two successful Diabetes Wellness meetings so far this year, in April and in May.

They were both held at our main meeting venue in Newton Park. Sadly, the venues for the Malabar and  Springdale meetings are not yet available, but they are most welcome to join us at the main meeting.

April Diabetes Wellness meeting

The people listening to our April speaker, Kevin Stead.

May Diabetes Wellness meeting

Magda Black, a registered dietitian, was the speaker in May.

Camp Diabetable

Our exciting news is that we have a camp for Type 1 children, thanks to the dedication and enthusiasm of Ernest Groenewald and his helpers, Paula Thom and Darren Badenhuizen. They are all young adults with Type 1 diabetes. There is still space available if you are in the Eastern Cape area.

LADA

Latent autoimmune diabetes in adults (LADA)

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Dr Louise Johnson explains why the correct diagnosis can prevent unnecessary complications, especially in latent autoimmune diabetes in adults (LADA).

Diabetes is the world’s fastest growing non-communicable (non-infectious) disease. Diabetes is more diverse than the crude subdivision into Type 1 and Type 2 diabetes.4

LADA, or latent autoimmune diabetes in adults, is a common hybrid form of diabetes with features of both Type 1 and Type 2 diabetes. The incidence of LADA is 2-12% of all cases of diabetes in the adult population.

LADA is a diverse disease characterised by a less intensive autoimmune (antibodies against the pancreas) process than Type 1 diabetes and sharing features of Type 2 diabetes, such as abnormal cholesterol, higher blood pressure and a wider waist circumference.

Autoimmune diabetes is characterised by the presence of specific autoantibodies directed against pancreatic beta cells and initial requirement of insulin therapy.4 This condition is as prevalent in adulthood as in childhood.

In 1977, Irvine showed that 11% of individuals initially diagnosed as Type 2 diabetes had antibodies against the beta cells.The term LADA was introduced in 1993 and described as a subset of diabetes sharing the autoantibodies of Type 1 diabetes and the phenotype (look like) of Type 2 diabetes.

The diagnosis of LADA is based on three criteria

  1. Adult age of onset of diabetes. Usually older than 30 years of age. The person can have the phenotype (look like) of Type 2 diabetes but there tends to be fewer signs of the metabolic syndrome, such as healthier lipids, lower BMI and better blood pressure profiles.
  2. Autoantibodies against the beta cells of the pancreas, called GAD antibodies.
  3. Insulin requirements within six months after diagnosis.

The early detection of LADA among newly diagnosed Type 2 diabetes patients seems crucial since the autoimmune process against the beta cells of the pancreas can cause rapid beta cell loss if treated wrong. Treatment to prevent beta cell failure is needed and should be implemented early.

Autoantibodies and C-peptide

It is very difficult to distinguish Type 1 diabetes from LADA on a blood test. The antibody load against the beta cell of the pancreas is larger in Type 1 diabetes than in LADA.

The functionality of the beta cell of the pancreas that produce insulin can be measured by C-peptide. This is a blood test that can be done in South Africa. In Type 1 diabetes, the C-peptide is very low or absent where in LADA the C-peptide is low.

The antibody that can be measured to confirm LADA is called glutamic acid decarboxylase autoantibody (GAD). A regular laboratory in South Africa can measure this and if this is positive, it confirms the presence of autoimmunity (antibodies against the pancreas) and if diabetes is also present then this person has LADA.

C-peptide values can be used to help in determining the treatment of LADA patients:

  1. Below 0,3nmol/L – This group needs insulin and can be treated according to the guidelines for Type 1 diabetes with insulin at bedtime and before meals.
  2. More than 0,3 and less than 0,7nmol/L -This is a grey area and it’s suggested to treat this group at first with therapy that preserve beta cells. The classes of medication considered would be: DPP4i (sitagliptin, saxagliptin, vildagliptin) or GLP1-receptor agonist, such as liraglutide, exenatide or dulaglutide. The newer class of SGLT2 inhibitors empagliflozin or dapagliflozin can also be considered in some patients.
  3. C-peptide levels of more than 0,7 nmol/L needs to be treated as insulin resistant patients with metformin and the above-mentioned therapy in 2. Their antibodies need to be repeated to make sure it wasn’t a false positive and their C-peptide levels need to be followed-up.

Treatment strategies for LADA

It’s important to evaluate all newly diagnosed Type 2 diabetes patients with a test for antibodies as to not miss the diagnosis of LADA.

The reason why this is important is that certain Type 2 diabetes drugs can worsen the autoimmunity in the pancreas and accelerate the loss of beta cells. The drugs that should be avoided in LADA patients are sulfonylureas. Drugs such as gliclazide, diaglucide, glimepiride and the rest of the class.

Insulin

This is essential in all people where the C-peptide level is very low or undetectable. Insulin administration supports the declining beta cells and improves the attack of antibodies against the pancreas. This process is called insulinites.

 DiPeptidyl Peptidase 4 (DPP4) inhibitors

This is a class of drugs that work in the gut by inhibiting the enzyme DPP4 that is responsible for secretion of insulin, inhibition of glucagon and production of incretin. Incretin helps to keep the satiety level up and prevent weight gain. In LADA patients, the DPP4 inhibitors protect against beta cell loss. Drugs in this class are vildagliptin, sitagliptin and saxagliptin.

Glucagon Like Peptide Receptor Agonist (GLP RA)

This group of drugs works like the DPP4 inhibitors but are injectable and more potent. They cause weight loss of 4-5kg and a greater reduction in glucose if that is needed. They are also protective against heart disease. Drugs in this class are liraglutide, exenatide and dulaglutide.

The overlap

Patients with LADA show midway features between Type 1 and Type 2 diabetes. Although adults with high GAD antibody tests are clinically closer to Type 1 diabetes than Type 2 diabetes, an overlap does exist. The overlap causes a misdiagnosis of 5-10%. This is the reason that we recommend the testing of antibodies in new type 2 diabetes.5

It’s important to remember that the misdiagnosis of LADA in Type 2 diabetes can lead to an increase of complications due to the fact that glucose control is a lot more difficult in this group, if not treated correctly.

In the new millennium that we are living with available technology, all newly diagnosed Type 2 diabetes patients should have a GAD antibody test. Type 2 diabetes patients that are struggling to control glucose on tablets should also be evaluated. The correct diagnosis can prevent unnecessary complications. Remember information can save a life riddled with complications.

References:

  1. Pieralice S et. al. “Latent autoimmune diabetes in adults: A review on clinical implications and management Diab Metab J 2018;42:451-464
  2. Bluestone JA et. al. Genetics, pathogenesis and clinical interventions in type 1 diabetes” Nature 2010 ;464: 1293 -300
  3. Buzetti et al. Management of Latent autoimmune diabetes I adults: A consensus statement from an International expert panel. Diabetes oct 2020 vol 69
  4. Tuomi T et. al. The many faces of diabetes: a disease with increasing heterogeneity. Lancet 2014, 383;1084
  5. Mishra et. al. 2018 
Dr Louise Johnson

MEET THE EXPERT

Dr Louise Johnson is a specialist physician passionate about diabetes and endocrinology. She enjoys helping people with diabetes live a full life with optimal quality. She is based in Pretoria in private practice.

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winter jabs

Discussing winter jabs

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Winter has arrived in South Africa and the question on everyone’s mind is: Do I get the winter jabs (vaccines)?

The answer is yes! Will a flu shot protect you from COVID? NO! These are two different strains of virus. The COVID-19 vaccine will give you that protection.

But the flu vaccine still helps that you don’t get so sick in winter. By protecting yourself against one contagious infection, the flu, you should be able to reduce your level of risk somewhat against the other virus.

Getting your flu vaccine helps to ensure that healthcare professionals are freed up to respond to treating COVID-19 infections as fewer people need to be treated for severe flu. Ultimately, fewer flu infections result in less of a burden on hospitals, and more time for doctors and hospitals to focus on treating people who have serious COVID-19 illness.

So, how do flu vaccines work?

They are designed to protect us from developing serious sickness when we are exposed to a virus. The World Health Organisation decides annually on what strains will be put in the year’s vaccine. This is also why you need to do a flu jab annually so as to get the latest protection.

Who needs to prioritise getting a flu jab?

As some people’s immune systems are more vulnerable to disease, this makes them more at risk of developing dangerous complications associated with the flu. These include:

  • Pregnant women, and including mothers in the two-week period after delivery.
  • Babies and infants under two years.
  • Elderly people over the age of 65 years.
  • People with existing chronic diseases that affect their heart, lung, kidney or endocrine system, such those with as diabetes, asthma, or diseases that affect your immune system (such as HIV and AIDS).
  • Morbidly obese people, that is, those with a body mass index (BMI) equal or over 40, or other with a BMI≄35 who have obesity-related health conditions.
  • People who are 18 years old or younger who receive chronic aspirin therapy.

What are flu symptoms?

Symptoms of flu commonly include fever, cough, a sore throat and body aches. It can also cause headache, fatigue, muscle pain, shivers, vomiting and diarrhoea.

 How do we treat flu?

Antibiotics only treat bacterial infections and flu is viral, not bacterial. Anti-viral medications are only indicated for patients who are at very high-risk of complications related to flu, and are available only when prescribed by your doctor. Anti-viral agents, such as oseltamivir, are recommended for people at risk of complications.

When you have flu, you may feel awful, but unfortunately, there’s not usually much you can do besides wait it out. Most of the treatment is generic, and involves symptom relief, like pain medication, decongestants and antihistamines.

If you are generally healthy and don’t fall into any of the high-risk categories, then make sure to drink a lot of water and other clear fluid and get plenty of bed rest and sleep.

Is flu contagious?

Yes, it is, even before you started having symptoms. And here we follow the exact same precautions as for COVID: social distancing, washing hands, masks and sanitise. So, cover your mouth and nose with a tissue or your elbow when coughing or sneezing. Never sneeze into your hand and wash your hands right away if you do to prevent infecting others. This why it is so important to vaccinate against flu to minimise your chances of being sick and infecting those around you.

Will getting the flu vaccine give me flu?

No, it won’t. The inactivated viruses in the flu vaccine simply enable your body to make the antibodies needed to ward off influenza. It is like showing a picture to someone when you want to warn them about a dangerous person, like on TV’s most wanted criminals. Your immune system will recognise this ‘criminal’ and fight him off. Your arm may feel a bit sore where you were injected, and a few people get a slight temperature and aching muscles for a couple of days afterwards, but other reactions are very rare.

When should I have the flu vaccine?

Now! Vaccines are already available in pharmacies and at your doctor’s practices.

Let’s talk pneumonia vaccine

Winter increases the chances of getting pneumonia. Pneumonia is a lung infection that makes it hard to breathe.

Who should get this vaccine?

People over age 65. As you age, your immune system doesn’t work as well as it once did.

Those with weakened immune systems as a result of some or other chronic condition, like heart disease, diabetes, emphysema, asthma, or chronic obstructive pulmonary disease(COPD).

Also, people who receive chemotherapy, people who have had organ transplants, and people with HIV or AIDS.

People who smoke. If you’ve smoked for a long time, the small hairs that line the insides of your lungs and help filter out germs could have damage and therefore not give adequate protection any more.

Heavy drinkers. Too much alcohol, may also result in a weakened immune system.

People getting over surgery or a severe illness. A patient who was in intensive care unit (ICU) and needed help breathing with a ventilator, is at risk of getting pneumonia. The same is true for a patient who has just had major surgery or if healing from a serious injury.

Does everyone have to have a pneumonia vaccine?

No! If you’re a healthy adult between ages 18 and 50, you can probably skip the vaccine.

Is there a specific time for a pneumonia vaccine?

No! You can get it done at any time of the year.

How long does it last?

Patients with underlying chronic disease should probably be revaccinated every five years. However, patients over 55 can get another type of pneumonia vaccine, which lasts forever.

Your clinic sister or doctor will give you the best advice how to go about getting the best protection against pneumonia.

MEET THE EXPERT

Jeannie Berg is a pharmacist and accredited diabetes educator. She served as Diabetes Education Society of South Africa (DESSA) chairperson for four years and was a committee member for many years and served on an advisory board for South African diabetes guidelines as well. She also does online tutoring in diabetes management for The University of South Wales.

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cholesterol

How to improve cholesterol profiles with diet

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Registered dietitian, Annica Rust, explains why improving your cholesterol profile with diet is important.

What is blood cholesterol?

Many components in our body are sterols. For example: bile salts, sex hormones, cortisol, vitamin D and cholesterol. These components perform essential functions in our body.1,2

Cholesterol serves as a precursor to synthesise these components in our body and is also a structural compound of all cell membranes. Total blood cholesterol, which consist of low-density lipoproteins (LDL)(bad cholesterol), high-density lipoproteins (HDL) (good cholesterol)l and triglycerides, are used to assess a blood lipid profile. 1,2

Atherosclerosis

An elevated blood lipid profile is dangerous as fat can accumulate in the arterial wall and will form a plaque/deposit. This hardening of arteries due to the formation of fatty deposits is known as atherosclerosis.1,2

The fatty deposits will restrict blood flow or can rupture which then causes blood clot formation in the artery which can cause a heart attack and a stroke.1,2

Atherosclerosis, high blood pressure and a heart attack can be classified under cardiovascular diseases (CVD).1,2 The risk for CVD in Type 2 diabetes is two to three times higher in men and three to five times higher in women when compared to people without diabetes.3

Dietary cholesterol

Dietary cholesterol is often confused with blood cholesterol levels. Blood cholesterol levels is not only influenced by dietary cholesterol alone but also by saturated fat and trans-fat.1,2

A diet high in saturated fat, trans fat and cholesterol may all increase the LDL-cholesterol levels in your blood. Studies have found that saturated fats have the biggest impact in increasing LDL-cholesterol. Saturated fat content of food items is thus more important than the cholesterol content of food.1,2

It has been found that a diet high in soluble fibre and omega-3 fatty acids may have cholesterol lowering effects. The replacement of saturated fats and trans fats with monounsaturated and polyunsaturated fats (as shown in the table below) can also lower LDL-cholesterol levels.1,2

Lifestyle factors, such as stress, sleep, smoking, alcohol and exercise, must be addressed in combination with a healthy balanced diet for the best results. Smoking increases inflammation and blood clotting which can also contribute to atherosclerosis. Regular physical activity can lower blood triglycerides, raise HDL levels and will lower blood pressure to lower CVD risk. Studies have proven that a 5-10% loss of body weight can be beneficial to reduce cholesterol and glucose levels as well as reduce your risk for heart disease.1,2

Types of fats

Saturated fat Trans-fatty acid Monounsaturated fatty acids (MUFAs) Polyunsaturated fatty acids (PUFAs)

Omega-3                         Omega-6
Visible fat on meat

Skin of  chicken

Bacon

Butter

Chocolate (cocoa)

Coconut

Cream cheese

Cream

Lard

Full cream milk products

Sour cream

Coconut, palm oil

 Fried foods

Commercially baked foods (cakes, cookies)

Snack food (chips, crackers, microwave popcorn)

Margarine (hydrogenated)

 Olive, canola, peanut oil

Avocado

Nuts (cashews, almonds, peanuts, macadamia, pistachios)

Peanut butter

Sesame seeds

 Fatty fish (tuna, salmon, herring, mackerel)

Walnuts

Flaxseed

 Pumpkin and sunflower seeds

Oils (corn, sunflower, cottonseed)

Mayonnaise

Margarine (nonhydrogenated)

 

Steps to improve your blood cholesterol levels:1,3

  1. Control energy intake: Adjust energy/kJ intake to achieve an ideal body weight.
  2. Increase omega 3 fatty acids: Aim for 2-3 servings of oily fish per week, such as tuna, sardines, salmon and trout.
  3. Choose healthy fats: Reduce saturated fat and trans-fat intake by eating less red and processed meats and refined foods. Remove all visible fat from meat before cooking. Total fat intake should also be limited to less than 30% of total energy. Reduce the amount of fat used for food preparation and use non-stick pans as an alternative to butter and/or oil. Consume more MUFAS and omegas 3 fatty acids.
  4. Increase soluble fibre intake: Most fruits and vegetables are high in soluble fibre.
  5. Increase plant stanols and sterols by consuming more fruits and vegetables. Switch out butter for margarine with added stanols and sterols.
  6. Improve beta glucan intake: Eat more oats which contains beta glucans or consider supplements with beta glucans in.
  7. Consume antioxidants by eating more fruits and vegetables.
  8. Cut back on sugar and sugar sweetened beverages.

Beneficial diets: Low-GI diet, Mediterranean diet and DASH diet. The above mentioned are general guidelines. Please contact a registered dietitian for individualised advice on how to practically implement the above-mentioned guidelines.

References:

  1. Mahan, L.K. & Raymond, J.L. (eds).2017. Krause’s food and the nutrition care process. 14th ed. St Louis. MO: Elsevier Saunders.
  2. Rolfes, S.R., Pinna, K., & Whitney, E. 2012. Normal and clinical nutrition. 9th edition. Wadsworth: Cengage Learning.
  3. SEMDSA Type 2 Diabetes Guidelines Expert Committee. JEMDSA 2017; 22(1)(Supplement 1): S1-S196.

MEET THE EXPERT

Annica Rust is a registered dietitian practicing at the Breast Care Unit in Netcare Milpark Hospital as well as in Bryanston, Gauteng. She strives to provide individualised and practical nutritional care to improve the lifestyle and health of all of her patients.

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Covid vaccines

Questions answered: COVID vaccines and diabetes

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Dr Paula Diab addresses some of the more common questions and concerns around COVID vaccines in people with diabetes.

Who would have thought a year ago that we would be talking about COVID vaccines already? I graduated in the middle of the South African HIV epidemic (pre-antiretrovirals) and can remember at the time thinking that medication would take a lifetime to develop as HIV required completely new classes of medication. Within only five years of graduating, not only was medication available, but it had become available to all South Africans.

A year ago, I was again wondering how a vaccine could be developed as quickly as would be necessary and on such a large scale. But, the reality is that COVID vaccines are now available.

As a healthcare provider, I was fortunate enough to be one of the first people in South Africa to receive the vaccine and am now grateful that my patients will soon be offered the same.

Why are people with diabetes at risk of COVID?

It’s important to remember that you are not at risk of contracting COVID purely because you have diabetes. It seems that those with uncontrolled diabetes and other co-morbidities (hypertension, obesity, old age) may be at a higher risk than those with controlled diabetes and fewer complications from the disease.

We have also come to realise that diabetes care itself is affected by contracting COVID and therefore we need to try as much as possible to prevent the infection. This is why we are encouraging everyone with diabetes to get vaccinated as soon as possible.

Does getting the vaccine mean I can’t get the virus?

The main objective of the vaccines is to protect you against severe outcomes of COVID, but you may still be able to contract the virus and spread to others. Current evidence shows that you should still wear a mask and practice social distancing even after having the vaccine.

Which vaccine is best?

This question is a little like asking which the best car is to drive when you need to travel hundreds of kilometres and have only Shanks’ pony. Although all vaccines are produced in different countries and with slightly different technology, they are all showing good efficacy and safety. Worldwide, there are currently more than 60 vaccines in various stages of clinical trials.

Currently, there are no trials to show that one vaccine is superior to another or more effective for a particular population group.

Are the vaccines safe?

Although the speed at which the vaccines came to market was unprecedented, each vaccine has completed the standard three phases of clinical trials. These phases take a pharmaceutical product through a small group of people who are very closely monitored (phase 1), to larger groups, matched by ethnicity, age, comorbidities etc, (phase 2) and finally to much larger groups where it is compared to placebo (phase 3). At no stage was safety compromised with the COVID vaccines, only that the administrative process was expedited.

As an example, ethical approval for clinical trials usually takes months for committees to sit but with the COVID vaccines, most of these committees were called to emergency meetings and documentation provided that allowed them to decide within days so that the trial process could go ahead.

What are the side effects?

It’s important to remember that every medication and vaccination has side effects, but we need to rather weigh up the benefit and risk of the treatment being offered.

If you were offered a simple headache tablet that had the side effect of causing hair loss, it’s most likely that you wouldn’t take it. Headaches often tend to go away by themselves and the risk of hair loss would most probably outweigh the benefit of the medication. Yet, every day, people have chemotherapy that induces hair loss because this risk is outweighed by the benefit of placing a cancer into remission or greatly improving quality of life.

Initial side effects from the COVID vaccines are very similar to those of the general flu vaccines: pain at the injection site, general muscle aches, some nausea, and tiredness. These side effects generally indicate that an immune reaction is taking place (which is what you want).

International feedback is indicating that some, but not all, people with diabetes are experiencing slightly elevated blood glucose levels but these can be managed quite simply in conjunction with your diabetes care team.

What is an mRNA vaccine?

There has been a great deal of attention paid to the Pfizer/BioNTech and Moderna vaccines which are mRNA vaccines. This is the first vaccine to be produced with this technology. The truth is the technology had already been developed prior to 2020 but no suitable vector (virus) had been identified to test the vaccine. This was not technology that was developed de novo in 2020.

The usual mechanism of developing immunity is to give a small dose of the virus to which a person is allowed to develop their own immunity. This is the reason that some of the regular childhood vaccinations cause mild illnesses.

An mRNA vaccine uses a piece of the genetic material (the precursor to the illness) to create antibodies. It’s a little like giving the recipe for a cake so you can get out the required bowls, measuring jugs, ingredients etc and have a good idea how to make the cake but you don’t actually make it.

How should I monitor myself after having the vaccine?

It is generally recommended that you monitor your blood glucose levels for the first 24 to 48 hours after receiving the vaccine. Check your levels frequently, stay hydrated and keep in touch with your diabetes care team if you have any concerns. If you are prone to allergic reactions, make sure you have adequate emergency medication should you require it.

When should we expect to get vaccinated?

The optimistic response would be that hopefully by the time this article is printed, that South Africans over the age of 60 and with co-morbidities, such as diabetes, will be able to receive their vaccinations.

Certainly, the aim is that these groups of people should receive their vaccinations as part of phase 2 (May – October 2021) and that the rest of the population will be vaccinated from November 2021 onwards.

What happens if I refuse the vaccine?

Currently, it will not be mandatory for South Africans to be vaccinated. However, the quicker that we achieve herd immunity, the quicker life can return to “normal.” Even if you don’t receive the vaccine, you should still employ safety precautions.

What about children with diabetes?

Currently most vaccines are approved for people over the age of 16. Approving pharmaceuticals for children requires much stricter review and approval but various companies have requested clearance for ages 12-15. It is still thought that young children are at very low-risk of contracting severe COVID infection.

Hopefully, one day, we will be able to look back upon this time and be proud to have been part of this historic and unique event that changed the course of health care as we know it.

References available on request

Dr Paula Diab

MEET THE EXPERT

Dr Paula Diab is a specialist family physician who enjoys the challenges that diabetes management has to offer. She runs a multi-disciplinary practice in Kloof, KZN, where she works with patients with diabetes and their families to allow them to gain control of their disease rather than being overwhelmed by the complexities and complications often associated with diabetes.
age

Tending to your life energy through the years

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Have you ever considered that there is not a single cell in your body that is as old as your birth certificate says you are? Cells regenerate all through life. So, age is literally just a number.

What is age, actually?

Much more significant for health is celebrating the rhythm of life, having a healthy relationship to your biographical seven-year cycle (1-7; 7-14; 14-21; 21-28, etc), your sleeping and waking patterns, connecting with nature and nurturing your inner core. A healthy balance between your own time and community living is important too.

All of these impact on your energy body. For example, at the end of the first seven years, you lose your milk teeth and also the protection of your mother’s own immune shield (especially if you have been breast-fed). By fourteen, you have a changed body form, with the odd pimple suddenly showing itself and a voice change from an angelic piping to the expression of your emerging individuality.

The changes in the later cycles may not be as obvious physically but there is a shift every seven years as we mature. If we don’t consider the significance of these subtle changes, spiritually and physically, then we just grow old. If we do acknowledge and respond to these subtle changes we grow ‘up’ to where we came from and we can die healthy.1

Can we enhance our immune response system?

When we don’t feel well, we usually say, “Something is wrong with me.” or “What’s wrong with you?” The conventional approach is to reach for pharmaceutical help. One could also recognise this dis-ease as a messenger that something is out of balance. How you view it is entirely up to you.

Although this is your journey, especially in the case of diabetes, most people around you have an opinion on how you could, should or must change your life, even if they don’t tell you to your face. The vibe is palpable; the concern is written in their voices. This is completely understandable on a physical level because those close to you are affected by the way you view and deal with your situation. No one likes to experience their loved one in a coma, or at the mercy of mood swings resulting from fluctuating blood glucose. Besides adhering to your medication prescribed, there are things you can do to enhance your immune system and lower the rate of complications.

Nurturing through nature  

Sue Visser is a well-respected health writer and produces an effective range, Nature Fresh, found in local pharmacies and health shops. I asked her whether she had anything she could say about diabetes management. Turns out that she has a lot to say.

Did you know, for example, that metformin is based on the molecular components of the plant, French Lilac and Goat’s Rue? And, besides being a tried and trusted drug used to treat insulin resistance, it was originally developed to fight the flu in the 1920s?

Even more topical during this time of COVID, is her report on the benefits of metformin which has demonstrated the potential to inhibit the SARS-CoV-2 infection directly. A comparative reduction in the rate of mortality in diabetic patients on metformin with severe SARS-CoV-2 has been observed according to four hospital studies that show lower instances of death in their patients who take metformin.2

A tip Sue offered is to check and treat depleted magnesium levels, especially when diagnosed with diabetes prior to prescribed treatment.

Baobab powder

Sarah Venter worked as a Forestry Scientist for the Department of Forestry in Limpopo. One day while driving through the northern rural areas of Limpopo, where baobabs grow, she noticed that the baobab fruit was just rotting under the trees. This led her to do a PhD study on baobab fruit.

The excitement around her research led her to start a successful and sustainable enterprise, EcoProducts, involving the local villagers. Situated in Limpopo province, it employs up to 50 people in the processing of the fruit and over 800 helpers for harvesting. Together they create BaoActive, a pure baobab powder which is gluten free, suitable for vegans, and has been certified Halal and Kosher.

Baobab powder is naturally rich in vitamin C, vital for the support of the immune system, boosting defence against disease and infection.3 It has both high soluble and insoluble dietary fibre content. Soluble dietary fibres stimulate the growth of intestinal microflora allowing the more effective absorption of nutrients from food. The insoluble fibre provides the roughage necessary for the movement of food through the gastrointestinal tract. Being rich in polyphenols, baobab powder has a stabilising effect on blood glucose, especially when consuming high-starch foods, such as bread and pap.4 An exciting research paper is rewarding reading: “The polyphenol-rich baobab fruit reduces starch digestion and glycaemic response in humans.”

Bon Voyage!

It’s the persistent pursuit of small changes in lifestyle that leads to surprising and significant results. And this is the goal of Agents for Change. We all know what lies at the end of our road; let us arrive healthy and positive and looking forward to the inevitable next step.

References:

  1. William Bryant – The veiled pulse of Time
  2. http://naturefresh.co.za/metaformin-offers-protection-for-diabetics/
  3. https://www.baoactive.co.za

Please contact Noy Pullen if you would like more information: linoia@web.co.za or 072 258 7132.

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AGENTS FOR CHANGE IS A DIABETES SOUTH AFRICA PROJECT MANAGED BY NOY PULLEN.

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nut butter

Why nut butter options are better

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Annica Rust, a registered dietitian, explains the benefits of nut butter options.

Benefits of nuts

Consuming more nuts, including peanuts (and nut butter options), may provide numerous benefits for a person with diabetes. These benefits include an improvement in inflammation, decreased cardiovascular risks and a favourable influence on your blood glucose levels. To keep a close eye on your fat intake is thus as important as controlling your carbohydrate intake.

Table 1: Nut butter comparison

Nut butter comparison
Nutritional analysis per 100g
Salted Butter Almond Butter Macadamia butter Peanut butter (no sugar added) Cashew butter
Energy (kJ) 3031 2662 3376 2602 2539
Protein (g) 0.6 24.4 7.7 26.1 20
Carbohydrates (g) 1 4 5 13 14
         of which total sugar(g) 0.6 3.3 3.3 5.9 4.1
Total fat (g) 81.1 58.9 85.4 50.9 51.8
          of which saturated fat (g) 57.3 4.8 14.8 6.3 9.8
       of which polyunsaturated fat (g) 2.4 13.6 3.6 5.2 10.4
of which monounsaturated fat (g) 14.4 40.5 67 39.4 31.2
Cholesterol (g) 160 0 1 0 0
Dietary fibre (g) 0.0 8.1 7.4 6.6 7.7
Total Sodium (mg) 809 28 34 15 34

Nuts, cardiovascular disease and cholesterol

Having diabetes increases your cardiovascular risk significantly, it is therefore important to make sure that the modifiable risk factors, such as your dietary intake, is well-controlled. 1

The latest scientific evidence found that the type of fat* (saturated fat, monounsaturated fat and polyunsaturated fat) consumed, may be more important than the total fat intake to prevent cardiovascular disease2,3. It is therefore important to replace unhealthy fats (saturated-and trans fats) with healthy fats, such as monounsaturated-or polyunsaturated fats, in order to decrease the risk for cardiovascular disease2,3.

In the above nut butter comparison, salted butter was compared to nut butters, which is locally available in South Africa. The nut butters will have much less saturated fats when compared to salted butter. The monounsaturated fat in nut butter is also significantly higher than normal butter.

Nuts or nut butter can definitely replace an unhealthy fat portion or even a protein portion. 

Types of fats*

Saturated fat Trans-fatty acid Monounsaturated                     Polyunsaturated fats

Omega-3                         Omega-6
Visible fat on meat

Skin of the chicken

Bacon

Butter

Chocolate(cocoa)

Coconut

Cream cheese

Cream

Lard

Full cream milk products

Sour cream

Coconut, palm oil

 Fried foods

Commercially baked foods (cakes, cookies)

Snack food (chips, crackers, microwave popcorn)

Margarine (hydrogenated)

 Olive, canola, peanut oil

Avocado

Nuts (cashews, almonds, peanuts, peanuts, macadamia, pistachios)

Peanut butter

Sesame seeds

 Fatty fish (Tuna, salmon, herring, mackerel)

Walnuts

Flaxseed

 Pumpkin and sunflower seeds

Oils (corn, sunflower, cottonseed)

Mayonnaise

Margarine (nonhydrogenated)

 

Nuts and glycaemic index (GI)

The GI of food can be used to compare the effects of food that contains carbohydrates on blood glucose levels.3 Foods with a low-GI will be digested and absorbed at a lower rate and will keep your blood glucose levels constant. As such, nuts with a low-GI will therefore have a positive impact on your blood glucose as it will be slowly digested and absorbed. Monounsaturated fats (which includes nuts) are also associated with improved blood glucose control3.

Nuts and inflammation

Walnuts are high in omega 3 fatty acids which has anti-inflammatory properties. 

Conclusion

Nuts remain one of the better fat options when consumed in moderation and when used to replace an unhealthy fat. Controlling your fat intake in conjunction with a healthy balanced low-GI diet, remains important to all people with diabetes. Please contact a registered dietitian for individualised guidelines.

Note: People who have diabetes and have a nut allergy need to remember that nut butters are not an option for them.

References

  1. Lipid Management in Patients with Endocrine Disorders: An Endocrine Society Clinical Practice Guideline
  2. Saturated Fat as Compared With Unsaturated Fats and Sources of Carbohydrates in Relation to Risk of Coronary Heart Disease: A Prospective Cohort Study

MEET THE EXPERT

Annica Rust is a registered dietitian practicing at the Breast Care Unit in Netcare Milpark Hospital as well as in Bryanston, Gauteng. She strives to provide individualised and practical nutritional care to improve the lifestyle and health of all of her patients.