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halloween

Don’t let glucose levels scare you this Halloween

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If your family is planning to go trick-or-treating, Donna van Zyl shares ways to enjoy Halloween without fussing over glucose levels.

Halloween need not only be about the trick-or-treating. Encourage your child to partake in non-food activities, such as carving a pumpkin; make decorations; having fun with friends and family whilst watching a scary movie; dressing up or visiting a ‘haunted’ house. It is, however, important to know what your child is looking forward to on this day, so that you can help meet their diabetes management in the middle.

Plan ahead

Sit down with your family and make Halloween plans in advance so your child knows what to expect. Create boundaries and general rules with your family. Your child will be more likely to be on board with a plan they helped create.

The rules of the plan may include:

  • Make sure your child does not go alone.
  • Ensure your child eats well and smart throughout the day, prior to the trick-or-treating so he/she can start off the evening with normal blood sugar level.
  • Then, make a deal with your child to avoid snacking until you’re both home from trick-or-treating.
  • Your child should take his/her own water or non-sugary drinks along, as they may get thirsty.
  • Your child should keep track of his/her sugar levels throughout the evening. Trick-or-treating may include a lot of excitement, running around or even having a treat out of the extraordinary.
  • Be prepared – test and ensure your child has something appropriate to treat a hypo. It is likely that he/she will have something in their bag to treat a hypo, however, the chocolate containing sweets do not necessarily act rapidly. Ideally, they should choose the sugary option and may need a follow-on snack, like a half of a peanut butter sandwich.
  • Friends and family can be very supportive and have healthy snacks waiting for your child. These options may include nuts, dark chocolate and fruit (strawberries dipped into dark chocolate). If they do have chocolate, encourage them to make sure they’re the snack-size versions.

Returning home

Once both of you have returned home, allow your child to choose his/ her favourite treat and administer an insulin dose accordingly.

The non-chocolate treats could be sorted into 15g carb packets and kept to treat a hypo. Those chocolate coated treats can be exchanged for a desired gift i.e. a toy, TV game, movie ticket, or a trip to the zoo etc. The exchange of sweets for a desired toy or game could apply to all the children of the house. The exchanged treats can also be donated to the less fortunate community groups as a treat they often do not receive.

Diabetic-friendly Halloween recipes

You can also make great Halloween diabetic-friendly recipes that will allow your children with diabetes to enjoy the day, without missing out treats.

Suitable Halloween treats:

MEET OUR EXPERT - Donna Van Zyl

Donna van Zyl is a private practicing dietitian for Nutritional Solutions, Bloemfontein. She is growing in the field of paediatrics and plays a key role in individualising nutritional therapy for Type 1 diabetics. She has a special interest in optimising health, managing chronic lifestyle related diseases, and sports nutrition. She lectures part-time at the University of the Free State, which she enjoys thoroughly.
exercise feet

Put your sole at ease: exercise feet

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Anette Thompson, a podiatrist, tells us how to exercise feet to improve blood circulation, especially if you have diabetes.

An immense amount of recent research has reinforced the fact that exercise is essential for those who live with diabetes – at whatever stage you are – pre-diabetic; diabetic on diet + exercise only; diabetic on diet + exercise + tablets; diabetic on diet + exercise + tablets +/or insulin. This makes sense because we know that exercise helps ‘switch on’ insulin receptors in those with Type 2 diabetes, therefore is useful in lowering blood sugar levels.

There are also benefits of regular exercise of the feet, such as improved blood circulation. Blood contains oxygen, nutrients and repair cells so it’s vital that increased blood supply reaches each cell in the body, especially nerves and other structures in the feet, which are furthest away from the heart.

SA research

As part of Louise Stirk (a South African podiatrist) master’s degree, she studied the effects of an eight-week endurance exercise programme on blood sugar control and peripheral sensory neuropathy in people with Type 2 diabetes.

Her study was conducted on eight previously inactive diabetic volunteers, aged 34 to 47 years. They completed an eight-week endurance exercise intervention of moderate intensity. They started the exercise programme at the same time as two control groups. The first control group, aged 45 and 46 years, continued with a sedentary (inactive) lifestyle and the second active control, aged 40 years, continued with a prior exercise programme.

All participants were requested to maintain their usual diet. The moderate exercise for the previously inactive group consisted of a 30-minute cycling regime, during which the heart rate fluctuated between 60-80% of age-predicted maximum, repeated three times per week.

She measured the effects of this endurance exercise programme on diabetic peripheral neuropathy (DPN) and possible associations between exercise-induced changes in resting heart rate, blood pressure, body mass index, waist circumference, % body fat, six objective neurological measures of diabetic peripheral neuropathy, and eight subjective ratings of symptoms of foot discomfort. She also measured changes in HbA1c, plasma brain neurotrophic factor and serum adiponectin concentrations in all 11 participants.

The only significant change (p>0.05) in the passive (non-exercising) controls was an increase in subjective ratings of foot discomfort, while no significant change (p>0.05) was observed in the active control.

The eight-week endurance exercise programme was not combined with dietary intervention so it did not improve HbA1c levels, but it did result in significant improvements (p<0.05) in the average resting heart rate, systolic blood pressure, and patellar and ankle reflexes in the group of eight people.

Common reasons for not exercising

The most common reasons as to why diabetic patients don’t exercise on a regular basis is: their feet or legs hurt, they don’t know what shoes to wear, they don’t know how to exercise, they feel it isn’t safe to walk outside or they can’t afford a gym membership.

1. Feet or legs hurt
You may have an imbalance of the feet due to the effects of diabetes on soft tissue, or because of incorrect footwear or other biomechanical reasons of which you may be unaware. Feet should never hurt – this is a sign that something is amiss.

A podiatrist will conduct a full clinical biomechanical examination or you may choose to go to a biokineticist for a full-body assessment if other parts of your body also hurt when you exercise. Take your exercise shoes as well as your usual shoes with you to be assessed.

If imbalances or bony protrusions are present in the feet or ankles, a podiatrist will then take an impression of your feet in plaster of Paris or orthopaedic foam to fabricate custom foot orthoses, which fit into your shoes.

These can re-align your feet to make muscles work in balance with each other, offload sore spots or high pressure areas, and make you comfortable in your shoes once more.

Custom inserts, made by a podiatrist, can be moved between pairs of shoes and, even sandals, with a piece of adhesive Velcro affixed underneath to prevent sliding.

Do custom shoe inserts really work? 

In July 2005, James Wrobel, Adam Fleischer, Ryan Crews, et al., reported in the Journal of the American Podiatric Medical Association on examining the outcomes of custom foot orthoses on patients with plantar heel pain.

These researchers randomised 77 patients with plantar fasciitis to one of three groups in a double-blind fashion (custom foot orthoses, prefabricated orthoses, and a sham). Using objective and subjective outcome measures, they found a 5,6-fold increase in physical activity and improved outcome measures with the custom foot orthoses in comparison with the other methods at three months.

2. How to exercise feet

The second largest pump mechanism of blood in the body (after the heart) is that of the calf muscle ‘pump’. When the calf muscles contract, they push up against the big blood vessels deep in the leg.

exercise feetAny exercise that helps the calf muscles to contract is a good exercise for lower limb blood circulation. Walking is excellent – choose a flexible pair of shoes that grip the back of your heels, and grip over the top of your foot with adjustable fastening.

If you have never exercised, start with a 5-minute walk then turn around and go back and you’ll have completed 10 minutes. The next day, increase by 5 minutes. The day after, increase by 5 minutes, or stay at the same number of minutes for a few days until you feel you can add on more minutes.

Motivating tip: If you are new to exercising, do not measure distance when walking as it will only discourage you, only measure by time spent. As you become fitter, you’ll naturally increase your distances. Work up to 30 minutes of exercise every second day, then eventually 30 minutes every day.

3. What shoes to wear

You need flexible flat soled shoes/takkies that have a good grip on your feet, either in the form of: laces up the foot or sturdy Velcro straps up the foot. No open back shoes. If you want to walk in hiking sandals, wear a pair of socks together with the hiking sandals to prevent chafing or blisters. Other types of fashion sandals are not suitable.

Make sure the shoes are wide enough for your feet. The easy way to check this, is to remove the innersole from the takkie and stand on top of it as if your foot was in the shoe. If your foot width spills over the sides, the shoe is too narrow for you and should be avoided.

New Balance and Asics now have sports shoes available in wider fittings, called 2E and 4E.

Be aware that your foot volume naturally increases by 7% after four hours of standing or walking, so allow for foot expansion when fitting.

exercise feetMake sure the shoe is flexible – you should be able to bend it back from the ball of the foot with one finger. If it is not flexible enough, the calf muscles can’t work to their full capacity because the foot can’t bend easily at the ball of the foot.

4. Can’t afford gym or scared to walk outside?

Here are simple ways to exercise feet in your own home:

Sitting: Sit up on a chair with your feet flat on ground and knees bent to 90 degrees. Keeping your toes on the ground, lift the heels off the ground then put them down. Increase the number of repetitions until the calf muscles feel tired, then stop.

The next day, try to increase beyond the previous day’s number of repetitions by 1, the day after by 2, the day after that by 3. That way you will gradually build up to being able to do 300 repetitions while watching TV, or sitting in the office, or waiting at an appointment.

Standing: You can do calf raises holding onto the back of a chair, or the supermarket trolley, or while waiting for the kettle to boil or the photocopy machine to do its work.

On your bed: If the weather isn’t good, you can still lie on your bed and do exercises pointing your toes away from you and then pointing them towards you. Do at least 100 repetitions or until your calf muscles ache. If you persist with the exercise each day, it will become easier to do and the aches ease up as you improve your blood circulation.

MEET OUR EXPERT - Anette Thompson

Anette Thompson
Anette Thompson (M Tech Podiatry (UJ) B Tech Podiatry (SA)) is the clinical director at Anette Thompson & Associates, Incorporated, a multi podiatrist practice in KwaZulu-Natal. Tel: 031 201 9907. They run a member service for Diabetes SA members at their Musgrave consulting rooms as a service to the community.
sleep timing

Early to bed, early to rise: sleep timing and your health

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Paula Pienaar explains why sleep timing is important to your health, adding that the time you go to sleep and wake up plays a large role in whether you increase your risk of obesity and Type 2 diabetes.

Traditional lifestyle-related risk factors, such as overeating, poor nutritional choices and physical inactivity, have long been blamed for the alarming global increase in obesity, diabetes and cardiovascular disease. In recent years, it has become evident that sleep habits (sleep timing) also contribute significantly to one’s health risk status. In fact, did you know that the time you go to sleep and wake up plays a large role in whether you increase your risk of obesity and Type 2 diabetes?1-3

Sleep timing is crucial

Studies on how sleep timing affect health have shown that late bedtimes, combined with sleep deprivation (often due to waking up early enough for work) results in increased caloric intake in the late evening hours, as well as increased appetite for foods that are calorie-dense. In addition, later bedtimes seem to have become more frequent in the general population and is associated with an increased prevalence of Type 2 diabetes as well as poorer glucose control in diabetic patients.1,3

The circadian rhythm influences sleeping, eating, heart rate, blood pressure, body temperature, the levels of certain hormones, and the immune system.

Tick-tock our body clock: our circadian rhythms

The time you go to sleep and the time you wake up, or your sleep-wake cycle, is referred to as your circadian rhythm.

This internal body clock is a 24-hour internal timer that functions by cycling between sleepiness and alertness at regular intervals throughout the day.

The pattern of feeling energised and tired at usual times is an example of your circadian rhythm at play.

For most adults, the biggest energy dip occurs between 2:00 am and 4:00 am, when we are meant to be sleeping, and 1:00 pm and 3:00 pm, usually after lunch. These circadian dips are especially prominent in those who are sleep-deprived.

Did you know?

After midday, body temperature drops slightly which prompts the release of melatonin. Although this effect is at a smaller scale compared to nighttime, we often experience it as a ‘post-lunch’ energy dip occurring between 2pm and 4pm.

Social jet-lag

Today’s society has created an illuminated environment that alters the natural light-dark cycle needed to regulate the circadian rhythm. Big cities with 24-hour light exposure, workplaces with bright artificial lighting, and neon lights adorning places of entertainment are all examples of how we are constantly exposed to unnatural lighting during the time when our body needs to wind down.

Additionally, our lifestyle choices may also create a body clock that is out of sync with the environment. For example, our natural rhythm is affected by being awake when we are meant to be sleeping; sleeping for long periods during the day; and even having erratic meal times.

When we intend on ‘catching-up’ on sleep during weekends, or days off from work, we expose ourselves to the same health ramifications, as now we are trying to change our sleep timing once again. This mismatch in sleep time is called ‘social jet-lag’ and affects most of us at some stage in our lives, whether it is due to travel, social engagements or work demands.

Consequences of a disrupted body clock

The sleep disruption and deprivation resulting from irregular sleep times and increased night-time light exposure have shown to disrupt metabolic and hormonal processes.2,4,5

The body responds by:

  • Increasing hunger hormones, which may lead to weight gain and obesity.
  • Suppressing the release of sleep-inducing hormones, making it more difficult to fall asleep.
  • Creates an immune response, which lowers your immune status.
  • Increases stress hormones, which have shown to lead to hypertension and cardiovascular disease.
  • Disrupts insulin action, which favours fat accumulation.

The good news is that by adjusting your sleep routine to follow the environments natural light-dark cycle, you can support your body clock in restoring your health.

Managing sleep timing

The following tips have shown to help improve circadian function and sleep disruption:

  • Ensure adequate exposure to daylight: exposure to sunlight during the day and darkness at night helps to maintain a healthy sleep-wake cycle. This is especially important for people who spend most of their time indoors.
  • Stick to a healthy sleep and wake time routine: try to consistently make your way to bed when it gets dark, and wake up to natural light instead of hitting the snooze button.
  • Ensure the bedroom is dark, quiet and comfortable: cosy temperature; no television, mobile phones and bright lamps (see next tip below); and pets that wake you up should be kept out of the bedroom. The mattress and pillows should also be comfortable. It may be helpful to use blackout curtains, ear plugs, and eye shades.
  • Refrain from screen time at least an hour before going to bed: the blue light from certain televisions, mobile phones and tablet devices suppress the release of sleep-inducing melatonin. It may be useful to use blue-blocking glasses and apps to filter short-wavelength emissions from electronic devices. You can download such an app from https://justgetflux.com/ .
  • Avoid napping during the day, but if the need is very high, limit it to before 03:00 pm and for no longer than 30 minutes. You do not want to end up with a late bedtime and sleep deprivation the following day.
  • Get regular physical activity: moderate activity, such as brisk walking, has shown to help improve sleep quality. If you are a morning-type person, use that to your advantage and get natural morning light during your outdoor sessions.
  • Go camping! A weekend dose of nature’s light-dark cycle has shown to restore a disrupted circadian rhythm.

Shift workers and individuals who travel regularly across time zones are most vulnerable to circadian rhythm disruption and would benefit greatly from sleep-timing support. If having tried these tips, but you still are out of sync, or struggle with excessive daytime sleepiness, it is best to seek help from a sleep health professional.

References:

  1. Knutson, Kristen L., et al. “Association Between Sleep Timing, Obesity, Diabetes: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Cohort Study.” Sleep 40.4 (2017).
  2. Baron KG, Reid KJ, Kern AS, Zee PC. Role of sleep timing in caloric intake and BMI. Obesity (Silver Spring). 2011; 19(7): 1374–1381.
  3. Merikanto, Ilona, et al. “Associations of chronotype and sleep with cardiovascular diseases and type 2 diabetes.” Chronobiology international 30.4 (2013): 470-477.
  4. McHill, A. W., and K. P. Wright. “Role of sleep and circadian disruption on energy expenditure and in metabolic predisposition to human obesity and metabolic disease.” Obesity Reviews 18.S1 (2017): 15-24.
  5. Sharma, Arpita, Shashank Tiwari, and Muniyandi Singaravel. “Circadian rhythm disruption: health consequences.” Biological rhythm research 47.2 (2016): 191-213.
  6. Potter, Gregory DM, et al. “Circadian rhythm and sleep disruption: causes, metabolic consequences, and countermeasures.” Endocrine reviews 37.6 (2016): 584-608.

MEET OUR EXPERT - Paula Pienaar

Paula R. Pienaar
Paula R. Pienaar (BSc (Med)(Hons) Exercise Science (Biokinetics)), MSc (Med) Exercise Science) is the scientific advisor to EOH Workplace Health and Wellness, and a PhD candidate at the University of Cape Town. Her scientific research relates to sleep health and managing daytime fatigue to improve workplace productivity and lower the risk of chronic disease. Her thesis will identify the link between sleep and cardiometabolic diseases (Type 2 diabetes and cardiovascular disease) in South African employees. She aims to design a tailored sleep and fatigue management workplace health intervention to improve employee health risk profiles and enhance work productivity. Contact her at paula.pienaar@eoh.co.za
mind

Mind over body

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Ilze Alberts explains how her excellent management of Type 1 diabetes came about – through mind over body.

Ilze Alberts (58) lives in Johannesburg with her husband. She has two adult children.

Type 1 diabetes fell out of heaven and hit my body; unexpected, uninvited, and bringing only promises of devastation. It felt like the end, but in retrospect, it was really just the start of a new beginning. One that proved infinitely better than the original plan that I had in mind.

If you’re reading this, you might have Type 1, Type 2, or you might be pre-diabetic. I know how scary that can be. Our afflictions, though different, are much the same – especially in the way we need to handle them. Perhaps you’re feeling angry, confused, even depressed. Maybe you blame yourself. “Why has this happened to me? What now?” It is within this context that I share my story with you.

Unexpected change in direction

I was a blooming 21-year-old with big dreams ahead of me; healthy and filled with a zest for life. I was in my final year of studies at university, working towards becoming a teacher, but I had wanderlust. I decided to become a flight attendant, to explore the world.

When I went for the medical, they told me, “You have diabetes.” It was one of the most cataclysmic events of my life. I was terrified, but I knew the first step was education. This is what I learnt:

  • Type 1 diabetes is an autoimmune condition in which the immune system is activated to destroy the cells in the pancreas. The cause is unknown, and it cannot be cured or prevented.
  • It occurs when the pancreas does not produce insulin.
  • It is managed with insulin injections several times a day, or the use of an insulin pump.
  • It represents around 10% of all cases of diabetes and is one of the most common chronic childhood conditions.

Finding the terrific in the terrible

Our biggest defeats often turn into our biggest victories. I would like to encourage you to find the terrific in your terrible. This requires that you apply your mind. I am not saying that your mind alone can be a substitute for the medication that you might need to take, but with the power of your mind, you can change the emotional and health impact it has on you.

Once I had educated myself and got the hang of things like the injections, correct eating, and regular exercise, I turned my attention – and still do – to the power of the mind to overcome challenges. I became aware, with lots of help, that my insulin dependency might well respond to the healing powers of my own mind.

I was so inspired to see the power that my mind had over my body. I began realising that my diabetes was not solely genetic, but also resulted from my unconscious perception that the condition somehow gave me more benefits than drawbacks, more pleasure than pain, and more positives than negatives. I wanted to know, “What is my hidden strategy? Why have I pulled this into my life?”

Exceptional management

Over time, as I committed my mind to wisely take control of my diabetes, my body started to respond positively to my actions. It was a slow process; it didn’t happen overnight. But eventually, with sustained physical and mental commitments, conscious actions to take control of my diabetes, the impact of diabetes became less. My HB1Ac levels remained constantly under 6, and my body loved the healthy eating and regular physical exercise.

Even an integrative and healthy-ageing practitioner was impressed. He had this to say: “When I met Ilze as a patient four years ago, I was blown away. She mentioned she was a Type 1 diabetic. I stopped in disbelief and looked at the blood tests done prior to her consultation. There was no indication of any underlying diabetes. The level of glucose in the red blood cells over the last 90 days was normal. Even today, this remains the case. Her holistic approach to her being, her life and her health is astounding. It is a source of hope not only to others, but also motivates me as a medical doctor to focus more on all the preventative lifestyle factors, and not just the disease and the management of the symptoms, signs and complications.”

How diabetes saved my life

Ironically, diabetes is one of the best things that has happened to me, for the following reasons:

  • I had to let go of my flight attendant plan. Instead, I studied psychology to master’s degree level, and I have practiced for over 30 years now. Today, I am also a life strategist, helping other people to create beautiful lives of their own. It gives me joy as I fulfil my purpose and live a life of meaning in serving others.
  • I was blessed to have given birth to two wonderful children, Charne and Jacques, despite my illness. They are healthy and diabetes-free, with a lust for life. They watch what they eat and exercise regularly.
  • I was widowed in my forties, but then met an extraordinary man, who is younger than me. One of the reasons he was attracted to me is because I am focused on empowering my life in all areas. We are happily married.
  • I am healthy, and I am filled with energy and vitality.
  • My health issues forced me to deal with the onslaught of bad food that we are exposed to. I exercise daily, eat very well, and I have a good body (according to my hubby).
  • My friends and family have been inspired by my life and my example.

Mind over body

“Yes, but I have Type 2,” you might say. “So, what worked for you will not work for me.” Not so. Like me, what has happened is that your body has communicated to you, that you need to adjust your lifestyle to be healthier. Your body is doing all that it can to wake you up and show you how to live an inspired and magnificent life. That is actually a blessing:

  • Has your illness added years to your life because you are forced to eat better and exercise?
  • Has this saved you from a stroke or a heart attack?
  • Have you helped your family because you have inspired them to live healthier?
  • Do you find you want to make every moment count, because you see how precious and valuable your life is? If not, when will you start?
  • Have you empowered your life by taking control, educating yourself, and focusing more on your family and the people that love you?

What is your big why?

You see, you need to have a big WHY, like I do – why is it so important to manage diabetes? If we don’t have this big why, the how will not appear. That is the big motivation. I desire to live my life with fulfilment, to live my vision, to make an impact on the world, to serve my family, to serve my clients, and I can only do that if I have a body that’s filled with health and vitality.

It became ever more apparent that I really wanted to be there for my husband, my children, my clients. I still do, as much as I ever did. My body is the vehicle through which I take my unique gift to the world (we all have one). If I don’t look after my body and my mind, then I cannot do this. How will you use your body’s response of trying to become well (manifest in your diabetes), to serve the people that you love, and the world?

I hope, with all my heart, that you see your life through new eyes because of my story. Our biggest stresses can be our biggest blessings. This is so true for me, because of my empowering journey with diabetes. May you, too, be inspired and motivated to live a beautiful life, and to powerfully share that with the world.

For more info or to contact me please go to bellavida.co.za

plan workday lunch box

How to plan your workday lunch box

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The 1st to the 7th of July is Corporate Wellness Week, and Pick n Pay encourages you to pick up healthy eating habits at work.

The foods you eat at work are important to your overall health, productivity and well-being. Planning appropriate meals and snacks helps to maintain normal blood glucose levels, helps you meet your nutrient requirements each day, prevents you from snacking on more energy dense foods, which could cause weight gain in the long term, and helps you sustain your energy levels throughout the work day.

Choose 1 to 2 foods from each of the food groups below to build your balanced lunch box for work:

Lean protein
Roast chicken breast cut into strips
Chicken drum sticks
Boiled egg
Smoked chicken breast
Lean shaved turkey, chicken, ham (whole muscle)
Tuna
Lean biltong
Toasted, flavoured chickpeas
Meat leftovers from previous night’s dinner
Veggies
Carrot sticks / baby carrots
Cherry tomatoes
Mange tout
Cucumber sticks
Celery sticks
Bell pepper strips
Green beans
Coleslaw
Vegetable kebabs
Snap peas
Lettuce (for wraps and sandwich fillings)
Vegetable chips
Fruit
Raspberries
Blueberries
Strawberries
Mini fruit kebabs
Apple pieces
Banana chips
Watermelon
Naartjie
Pear sticks
Melon cubes
Mango
Pineapple
Any whole fruit chopped into bite-sized serving
Dairy
Mozzarella cheese
Cottage cheese
Milk carton
Drinking yoghurt without added sugar
Plain yoghurt
Homemade dairy smoothie
High fibre starchy food
Beans, chickpeas or legumes (in a salad)
Mini whole-wheat wrap
Whole-wheat roll
Whole-wheat pita
Whole-wheat pasta
Pearl Barley
Brown rice
Baby potato
Potato wedges
Sweet potato wedges
Popcorn (unsalted)
High fibre crackers
Mini corn
Sweet corn
Mini oat/bran/apple muffins
Plain instant oats
Healthy fat
Reduced oil salad cream
Hummus
Peanut butter without added sugar
Salsa
Guacamole
Peanuts and raisins (unsalted)
Raw nuts
Low-fat dressings and dips
Tzatziki
Bean dip

Other tips:

  • Remember to drink water throughout the workday – keep a jug or bottle on your desk for frequent sipping.
  • Keep your lunch safe in a clean insulated lunch box or bag. If possible, store the perishable foods in your lunch box in a fridge, or use a small re-freezable ice pack to help keep your food cold.

MEET OUR EXPERT - Leanne Kiezer

Registered Dietitian BSc Diet, PgD Diet UKZN, MSc Nutrition NWU. Leanne joined Pick n Pay as the resident dietitian in May 2014. She is the voice behind the Pick n Pay Health Hotline, providing advice to customers on a range of nutrition and health-related topics. She also provides nutrition input as part of the Pick n Pay food development team, and ensures that all communication is in line with the most recent advances in nutrition science and research.

Need some ideas of healthy lunch box snacks to pack for work?

Pick n Pay provides you with a few nutritious, easy-to-prepare and convenient to pack lunch box solutions here!

Roast veg chicken wrap
Roast veg and chicken wrap with harissa yoghurt dressing
Vegetable crisps
Vegetable crisps
Chicken kebabs peanut sauce
Mini chicken kebabs with a quick peanut sauce
Veggie sandwich
The ultimate salad sandwich
Roast veg and chicken wrap with harissa yoghurt dressing

Vegetable crisps
Mini chicken kebabs with a quick peanut sauce
The ultimate salad sandwich

Shopping List

The ingredients referred to in the recipes above are available from Pick n Pay:
Vegetables and fruit
Roasting vegetables
Carrots
Beetroot
Radishes
Baby marrow
Sweet potato
Butternut
Parsnip
Red cabbage
Condiments
Harissa paste
Lemon juice
Coconut milk
Red curry paste
Soy sauce
Dairy
Plain yoghurt
Fat-reduced feta
Legumes and lentils
Tinned chickpeas
Other
Wooden skewers
Protein
Rotisserie chicken
Chicken breasts
Starch
Whole wheat fusilli
Whole wheat spaghetti
Whole wheat penne
Fats and oils
Canola oil
Sugar-free peanut butter
Hummus
Avocado
Herbs and spices
Fresh coriander
Salt
Black pepper
Dill
Mint
Horseradish
Starchy foods
Whole-wheat wraps
Dumpy, low-GI, wholegrain, seeded bread

Pick n Pay is committed to promoting health and wellbeing among South Africans, and employs the services of a registered dietitian to provide food and nutrition-related advice to the public. For all your nutrition and health-related queries, email healthhotline@pnp.co.za or call 0800 11 22 88.

winter warming soup

Five winter-warming soup ideas to boost your immune system

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The winter months are here – the days are shorter, the nights colder but nothing can be quite as soothing than mouthfuls of a delicious, warming soup. In your quest to make it through cold- and flu-season without a sneeze, the Heart and Stroke Foundation South Africa (HSFSA) gives you some soup ideas with food combos, packed with nutrients and flavour, to give your immune system a boost.

Creamy roasted red pepper & tomato soup

Red peppers are packed with vitamin C, which is important for cells of the immune system to work properly, helping them to detect and destroy invading germs. Half a cup of chopped red pepper has nearly double the recommended daily intake of vitamin C – double that of the famous orange. Tomatoes are also excellent sources of antioxidants, specifically lycopene and vitamin E, which protect immune cells from damage. Add a creamy texture with a punch of protein by stirring in some low-fat plain yoghurt.

Carrot, orange & ginger soup

All citrus fruit, including oranges, are high in vitamin C which is well-known for its immune-boosting effect. Vitamin C is also known to help maintain the integrity of your skin, which is the body’s first line of defence against microbes and viruses. Vitamin A-rich carrots pair well with citrus fruits to make a vibrant sniffle-fighting soup.

Ginger contains potent anti-inflammatory compounds, called gingerols. It has also been thought to promote healthy sweating which is helpful for fighting colds and flu’s since sweat contains a potent germ-fighting agent, called dermicidin. Ginger has also been seen to improve symptoms of nausea, which is often experienced with the flu.

Practical tip: add the orange towards the end to minimise the amount of vitamin C lost from the heat.

Chicken soup made with bone broth

Granny was right to give you chicken soup when you were sick. Chicken is a valuable source of protein and iron, both of which support a healthy immune system. Too little iron could lead to anaemia and weaken the immune system. Combining iron-rich foods with a source of vitamin C, such as broccoli, red pepper and sweet potato, can help boost your absorption even further.

Chicken soup made with real bone broth will also work wonders on your digestive and immune health. The gelatine in the bone broth contains a vital nutrient, called glutamine, which is the primary fuel for the cells lining your gut, keeping it healthy and able to block out pesky bugs.

Butternut, sweet potato & cinnamon soup

Butternut and sweet potato are both rich in vitamin A. Vitamin A has long been known for its role in supporting the immune system, as it was called ‘the anti-infective vitamin’ from as early as the 1920s. Vitamin A is needed to maintain the surfaces of the respiratory and digestive systems, which is important to make sure they block harmful bacteria from entering the bloodstream.

Cinnamon’s essential oils have antimicrobial properties; these help to stop the growth of harmful bugs. It’s so effective that research has shown that it can be used as an alternative to traditional food preservatives. Besides these benefits, what can provide as much relief from the cold or flu as a warm cup of tea with cinnamon and ginger?

Click here to view the recipe!

Super seed & nut soup toppers

Add some crunch and texture to your soup by sprinkling a mixture of your favourite roasted nuts and seeds over it. They’re great sources of many nutrients needed for a strong immune system, including selenium, copper, zinc and vitamin E. Almonds and sunflower seeds are particularly high in the antioxidant vitamin E, with a 30g serving giving you a whopping 50% of your daily requirements. If you’re looking for more affordable options, seeds and unsalted peanuts are the way to go.

Remember that most of the immune-benefits seen from the nutrients mentioned above, are largely only obtained from eating foods rich in these nutrients. The same benefit is not always seen when using supplements. In fact, using mega-doses of some nutrients could actually harm your immune system. So, make sure to maintain a healthy, balanced diet this winter, and get cooking.

The HSFSA plays a leading role in the fight against preventable heart disease and stroke, with the aim of seeing fewer people in SA suffer premature deaths and disabilities, and to reduce the cardiovascular disease (CVD) burden in SA and ultimately on the SA health care system. Their mission is to empower South Africans to adopt healthy lifestyles, make healthy choices easier, seek appropriate care and encourage prevention

relationship ophthalmologist diabetes

How is your relationship with your ophthalmologist?

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Dr Gareth Fernandes explains why a good relationship with your ophthalmologist will stand you in good stead.

We are often looking for a quick fix, when it comes to medical problems. We have become accustomed to near instantaneous results regarding ophthalmic treatments; vision is often excellent within a few hours of cataract or refractive eye surgery. Many diabetes patients would have had cataract surgery as they tend to get cataracts at a younger age than non-diabetes patients. However, many of the other ophthalmic problems, which are associated with diabetes patients, are chronic and persistent and require long-term treatment. For this reason – a good, steady long-standing relationship with your ophthalmologist is essential. This relationship would ideally go through a number of stages as discussed below.

Ideally, you should see an ophthalmologist (or optometrist) after five years of diagnosis of Type 1 diabetes and within a year of diagnosis of Type 2 diabetes. We, as medical practitioners, need to detect problems before your vision is affected.

Even if your vision is affected, the deterioration may be very slow, and can be compensated for by the other eye so that you don’t notice the decline. Though, you should not wait for your vision to deteriorate before coming to see us. The reason for this is, many of the effects of diabetes on the retina do not cause symptoms, and when diabetes does start to affect your vision – causing symptoms, some of the damage (to the retina) may already be irreversible. This means that even with ideal treatment, we may be able to improve your vision, however, we may not be able to restore it to normal.

Screening can be frustrating. You may see your ophthalmologist annually, only to be told that everything is okay. Many diabetes patients don’t need any treatment until five, 10 or even 20 years after diagnosis. After a few annual visits, it is easy to become blasé about the health of your eyes and lose motivation to continue your annual visits. You may only return when your vision is reduced and the damage is irreversible, and we may not be able restore your vision to normal again. Hence, why during this screening period it is so important to build a good and lasting relationship with your ophthalmologist.

Reduced vision in the diabetic population has many diverse causes. You may simply need glasses. As mentioned, conditions like cataracts can be easily and permanently cured with surgery, producing good results and a return of normal vision.

The most important and worrying cause of loss of vision in diabetes patients is from chronic damage to the small blood vessels in the retina (the membrane at the back of your eye which detects light and forms an image, much like the film of a camera).

One of the most common causes of retinal visual loss in diabetes patients is macula oedema. This is when the blood vessels of the retina become leaky, allowing too much fluid to seep out into the retina, causing the retinal tissues to swell. Macula oedema can be satisfactorily treated by monthly injections into the eye. The injections make the retina blood vessels less leaky, reducing the seepage of fluid into the retina. As the eye absorbs the excess fluid in the retina, the vision improves. Diabetic patients with macula oedema really need a solid, ongoing relationship with their ophthalmologist because it may take a few months for the fluid to be absorbed and little improvement may be seen initially, despite the monthly injections. But, if you persist with the treatment, you’ll usually be rewarded with improved vision. Once the fluid is gone, your vision is as good as we can get it. Your injections unfortunately do not end there; the injections will still be required to maintain your vision. We can usually increase the interval between injections at this point. The good news is that over the years you will require fewer and fewer injections to maintain control of the macula oedema.

The retina can also be affected by the formation of new blood vessels on the retina. These may bleed into the eye, causing reduced vision, or they may cause scar tissue to form on the retina. The scar tissue can cause permanent damage to the retina. Hopefully, if you have been seeing your ophthalmologist regularly, they would have been able to detect the new blood vessels before they form the scar tissue. We can laser the retina to stop the new vessels from progressing. This will prevent formation of scar tissue and allow you to maintain good vision.

All is not lost if scar tissue has damaged the retina. We then can remove the scar tissue surgically. This should prevent further deterioration in vision and can result in significant visual improvement.

Diabetic eye disease has multiple effective treatment options, and it is critical that patients have a good relationship with their ophthalmologist in order to benefit from these treatments. It is important to have a good understanding of your specific problem; the limitations and side effects of your treatment; and a realistic expectation what the treatment can do for you. This understanding is essential because the treatment is long-term and you need to persist with treatment to get the most benefit.

MEET OUR EXPERT - Dr Gareth Fernandes

relationship ophthalmologist diabetes
Dr Gareth Fernandes is an ophthalmologist in private practice at Visiomed Eye Laser Centre in Northcliff, Johannesburg. He completed his ophthalmology training at Wits University in 2014. He performs a range of treatments for diabetes patients, including diabetic screening, intra-ocular injections, laser treatments and cataract surgery.

How is your relationship with your heart?

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Our hearts serve us dutifully, sustaining us from our first to our very last breath. In view of this, the Heart and Stroke Foundation South Africa (HSFSA) have come up with six practical tips to treat your heart with the respect and care it deserves.

Get active!

A strong heart is a happy heart. Regular exercise provides profound long-term health benefits including benefits which protect your heart’s health, such as:

  • Improves ‘good’ cholesterol levels
  • Helps lower high blood pressure
  • Helps reduce and control body weight
  • Helps control blood sugar levels and reduces the risk of developing diabetes
  • Helps to manage stress and releases tension
  • Reduces the risk of heart disease and stroke

Aim for a minimum of 150 minutes of moderate activity a week, such as 30 minutes 5 days a week, or 75 minutes of vigorous activity per week, such as 20 minutes 4 times a week.

healthy-heart

Know your numbers

All strong relationships are built on good communication. Blood pressure, cholesterol and blood glucose values shouldn’t be a secret than can ruin the relationship with your heart. If these hidden numbers are out in the open, a broken heart could be saved before it’s too late! So go for regular health checks to make sure you know what your numbers are.

heart-healthy-meal-plan

Eat well

How we eat and it’s impact on our daily blood glucose control has an accumulating effect on our heart health. Which means that our daily choices which stretch over months and years have a far larger impact on our heart’s health than the odd chocolate. So, care for your heart by nourishing your body daily with a balanced, healthy diet. Eat more healthy foods such as fruits, vegetables, beans, low-fat dairy, whole grains, and healthy fats like olive oil and avocados. Watch your portion sizes to avoid over-eating and eat less food with excess sugar, salt and bad fats such as take-aways, sugary drinks, cakes and pies. For individualised dietary advice and support, find a dietitian at www.adsa.org.za.

Build healthy relationships

Could love improve heart health? Satisfying relationships and social support don’t only make us feel happy and loved, but may also provide health benefits. One reason for this is that it may lower harmful levels of stress and stress hormones. Many behaviours, such as human touch or showing affection; affirming our love for one another; caring behaviours or offering help, could elicit this calming effect, sense of security and support. Loved-ones may also provide encouragement for us to take better care of ourselves by preparing and enjoying healthy meals together and supporting us to go for regular health check-ups.

Avoid smoking

Even though most people associate smoking with lung health, more smokers will in fact suffer heart disease. Smoking almost triples the risk of heart disease and more than doubles the risk of having a stroke. Therefore, you can’t have a good relationship with your heart if you light up a cigarette daily. It’s like saying ‘I love you, but I don’t want to be with you’. Quitting however, is not easy, it’s like getting out of a bad relationship. So don’t do it alone, ask for help or get in touch with any of the following support programmes:

Mind your mental health

Stress and depression have both been linked to an increased risk of heart disease. While we can’t always escape day-to-day stress, we can manage it effectively. Instead of reaching for a cigarette or a donut, try to relieve your stress with something healthier like going for a brisk walk, speak to a friend or take time to do something you enjoy.

Depression is a common mental disorder characterized by lowered mood, negative thoughts, low energy levels and a change in appetite. It increases the risk of heart disease by 50% compared to someone without depression. If you think you may suffer from depression, then speak to someone you trust and seek professional help from a psychologist or psychiatrist. Depression can be effectively treated but the first step is recognising it.

Toenails – mirrors of your health

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Just as they say, ‘your eyes are the mirror of the soul’, so too are your toenails mirrors of your health – revealing information about nutritional status, general health and even an undiagnosed systemic disease.

Discolouration

The primary cause may be from trauma – either from an object dropped onto the toenail or from constant bumping inside a shoe, as suffered by runners and athletes. This discolouration is due to micro-bleeding under the nail, and will grow out with the nail over a period of months (it can take eight to 10 months for the big toenail to grow out completely). If severe bleeding occurs under the nail, the nail may detach while a new nail grows out, provided there is no damage to the nail matrix or the nail bed.

In some instances, in women who have dark skins, it may be perfectly normal for aging to bring about brown or black streaks in the toenails. These are due to changes in melanin (the natural pigment that causes skin and nail darkening).

Changes in consistency, curvature, surface texture, growth and even colour can be signs of a systemic process. For example, blue half-moons or lunulae on your toenails can indicate Wilson’s disease of the liver or silver salts deposition in argyria. In rare instances, discolouration can indicate the presence of a benign glomus tumour beneath the nail, or, even more rarely, malignant melanoma.

Extremely thick toenails (onychogryphosis)

Poor circulation in the feet affects blood supply to the nail matrix and nail bed. It is thought that the stop-start nature of poor circulation (intermittent hyperaemia) triggers the cell replication that can result in thickened toenails. Poor circulation can be present in cardiac conditions as well as in people who have high or low blood pressure, diabetes mellitus, or visible broken and/or varicose veins.

Onychocryptosis with paronychial inflammation

Onychocryptosis with paronychial inflammation

Ingrown toenails (onychocryptosis)

  • Excessive moisture can cause toenails to bend and penetrate the skin.
  • Pressure from shoes or from adjoining toes can shape or mould the toenail into the surrounding skin.
  • Growth spurts in childhood and adolescence can result in a toenail that is wider than the growing toe for a period.
  • Incorrect cutting of toenails can cause ingrown toenails.
  • Fungal infection under the toenail causes weakening of the nail plate and thus structural change in the curvature of the nail, and discolouration. People living with diabetes have an increased risk of fungal infections in the foot.
  • Trauma, such as accidentally dropping heavy objects onto the nail bed and/or the nail matrix at the source of the nail, causes a shape change in the resultant nail growth.

Footwear knowledge to prevent discoloured, thick or ingrown toenails

  • Avoid shoes that are too narrow in the front of the foot as these can restrict blood circulation to your toes.
  • Shoes that are too tight in the toe area may promote ingrown toenails.
  • Avoid shoes that have a shallow tapering toe box as these will constantly rub against the tops of your toenails. Toe muscle action is essential in preventing bunions and corns, hence why you should have enough toe room to be able to wiggle your toes inside your shoes.
  • Choose styles that do not require gripping friction from your toes, such as those that grip around the heel (either closed heel or strap), plus a strap or some form of fastening or closure across the instep of the foot.
  • Heeled shoes tilt body weight onto the ball of the foot. This can lead to toes curling inside the shoe, possibly resulting in hammer toes. Choose flats or lower heels for everyday use and reserve high heels for short one- to two-hour functions or events.

Find a podiatrist:

Podiatry Association of South Africa Toll-free number 0861 100 249

MEET OUR EXPERT - Anette Thompson

Anette Thompson
Anette Thompson (M Tech Podiatry (UJ) B Tech Podiatry (SA)) is the clinical director at Anette Thompson & Associates, Incorporated, a multi podiatrist practice in KwaZulu-Natal. Tel: 031 201 9907. They run a member service for Diabetes SA members at their Musgrave consulting rooms as a service to the community.