Know your sweeteners

In a world where sweeteners have become a focus for people living with diabetes or wanting to lose weight, the Huletts EquiSweet range provides sweetness without the drawbacks of traditional sugar.

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What are sweeteners?

There are various alternatives to sucrose and other carbohydrate sweeteners such as fructose and glucose. There are two different categories of sweeteners and each have a different effect on blood glucose levels and weight.

   1. Non-nutritive or intense sweeteners

The first category are products with very intense sweetening properties that are used solely to replace the sweetening effect of sugar. They have sweetness levels that vary from around 20 times to around 600 or more times the sweetness of sugar. Therefore, they only need to be used in very small quantities and accordingly contribute minimal kilojoules to the products in which they are incorporated. They also have minimal impact on blood glucose levels. Examples: aspartame, sucralose, saccharin, acesulfame potassium and stevia.

    2. Polyols (sugar substitutes) 

The second category is polyols which are sugar substitutes that provide sweetness at a lower level than that of non-nutritive sweeteners but still usually lower than that of sugars.

They are used to replace sugar in those applications where the functional properties of sugar are still required but removal of sugar is desirable for health reasons; the best examples are sugar-free chocolate and other confectionery.

Polyols have a similar structure to sugars but are not as well absorbed by the body. Hence, they have lower kilojoule contents than sugars (although contribute more kilojoules than non-nutritive sweeteners) and a lower effect on blood glucose, making them more suitable for people with diabetes. Although, it would be advisable to discuss this with your doctor before making them part of your regular diet.

Some polyols, such as sorbitol and xylitol, play an important role in dental cavity prevention as they are unable to produce the acids that can cause dental decay. The downside is that, if consumed in large quantities, they can have a laxative effect and cause bloating, wind and diarrhoea. Examples: sorbitol, mannitol, xylitol, maltitol and erythritol.

How does the taste of sweeteners compare to sugar?

The taste and sweetness can vary based on the type of sweetener and the blend used. Some may closely mimic the taste of sugar with a similar sweetness level, while others may have a slight aftertaste or different sweetness intensity. It often comes down to personal preference and the specific application in which it is used.

How does the Huletts EquiSweet range differ from regular sugar?

Huletts EquiSweet comprises a range of sugar substitutes from both the non-nutritive and polyol categories.

The EquiSweet non-nutritive sweeteners, known as the EquiSweet Sweetener range, are mainly intended to replace sugar in beverages and products where they only provide sweetness without any other function. The products include EquiSweet Classic and EquiSweet Sucralose which is an aspartame-free variant.

The EquiSweet polyols, known as the EquiSweet Sugar Substitute range, are designed for use in cooking applications where sugar removal is desired, but the physical properties of sugar are still needed, for example baking. The products include EquiSweet Erythritol and EquiSweet Xylitol. These are lower in kilojoules than sugar but not as low as those in the EquiSweet Sweetener range.

Huletts EquiSweet Erythritol is derived from starch and is a low-GI and low-kilojoule sugar substitute. Among the sugar substitutes, it has a higher digestive tolerance because about 90% of the ingested erythritol is readily absorbed and excreted in urine. This is why it’s called a low-kilojoule sugar substitute as opposed to xylitol where it’s kilojoule levels aren’t low enough to be called a low-kilojoule sugar substitute.

Huletts EquiSweet Xylitol is also a low-GI sugar substitute derived from plant sources. It’s slowly and partially absorbed and metabolised which results in very insignificant changes in blood glucose levels. It can assist in weight management as well as managing diabetes. High consumption of xylitol can cause digestive symptoms, such as diarrhoea, due to it only being partially absorbed.

Huletts EquiSweet range

EquiSweet Product Usage Sweetness Measure & Energy Values Comparison
Classic and Sucralose Sachets (low kJ)
  • Hot or cold beverages
  • Cereals and porridge
  • Cooking and baking
  • Sprinkle over yoghurt
1g EquiSweet Sachet =  2 level teaspoons of sugar

  • 1 EquiSweet Sachet   = 16 kJ
  • 2 teaspoons of sugar = 136 kJ
Classic and Sucralose Tablets (low kJ)
  • Hot beverages:tea and coffee
1 EquiSweet Tablet =  1 level teaspoon of sugar

  • 1 EquiSweet Tablet  = 1 kJ
  • 1 teaspoon of sugar = 68 kJ
Erythritol (low kJ and low glycaemic response)
  • Cooking and baking
  • Beverages
60% – 80% as sweet as sugar

  • Erythritol  =  100 kJ/100g
  • Sugar =  1700 kJ/100g
Xylitol (low-GI)
  • Cooking and baking
  • Beverages
1 teaspoon Xylitol = 1 teaspoon of sugar

  • Xyltitol  = 1400 kJ/100g
  • Sugar    = 1700 kJ/100g

Can the Huletts EquiSweet range be used in cooking and baking?

EquiSweet products can generally be used in cooking and baking as substitutes for sugar. However, it’s essential to note that they may behave differently from sugar when heated or mixed with other ingredients. For best results, follow specific guidelines or recipes designed for the particular sweetener you’re using.

Visit EquiSweet Archives – Huletts Sugar for recipes using their sweetener range.

Can people living with diabetes use the Huletts EquiSweet range?

Yes, Huletts EquiSweet is a suitable option if you have diabetes as the range generally doesn’t significantly impact blood glucose levels. However, it’s crucial to monitor your responses and consult a healthcare provider for personalised guidance.

Are sweeteners safe for consumption?

Sweeteners have to undergo country-specific safety assessments and evaluation processes prior to approval for use. Post-approval evaluation and monitoring of sweeteners are also conducted by regulatory agencies.

All the sweeteners in the Huletts EquiSweet range have undergone rigorous testing and are considered safe when consumed within recommended limits.

Regulatory bodies like the Food and Drug Administration (FDA) and European Food Safety Authority (EFSA) have approved the ingredients used in Huletts EquiSweet Sweeteners for consumption.

In South Africa, there are comprehensive regulations on sweeteners and the Huletts EquiSweet products are fully compliant with these regulations.

At global level, considerable research has gone into determining the maximum desirable quantity of each sweetener that should be consumed on a daily basis. This is known as the Acceptable Daily Intake (ADI) and has been determined in such a way that it’s an extremely safe level of consumption.

Are there side effects associated with sweeteners?

While generally safe for consumption, some people may experience digestive issues like bloating or diarrhoea when consuming large amounts of polyols found in the Huletts EquiSweet Erythritol and Xylitol products.

It’s advisable to have a moderate intake and to be mindful of your tolerance levels. Additionally, if you have specific health conditions or allergies, please consult your healthcare professional before using sweeteners.

Sweeteners for children

Few studies have examined how non-nutritive sweeteners may affect health outcomes in children. The World Health Organization (WHO) suggests not to use non-nutritive sweeteners as a strategy to reduce non-communicable disease risk in children.

Though harmful effects from the consumption of sweeteners under the Acceptable Daily Intake (ADI) by children or adolescents have not been reported, guidance generally remains that diet beverages should be limited, and unsweetened water and milk should be the preferred fluid source.

For children with diabetes, who follow a balanced diet and routinely monitor their blood glucose levels, substituting sugar-sweetened beverages with alternative beverages sweetened with a sweetener is an option in moderation.

Given the smaller body sizes of children and adolescents, careful planning should be given to ensure the consumption of non-nutritive sweeteners is not excessive. The consumption of sweeteners by children of less than two years of age is not recommended.

It’s a safe yes to Huletts EquiSweet range

In conclusion, Huletts EquiSweet range offers a viable alternative to sugar for anyone seeking sweetness without the added energy. While generally safe for consumption, its essential to use in moderation and consider your tolerances and health conditions.

Whether in beverages, baking or everyday cooking, understanding the nuances of these sweeteners can help you make informed choices towards a healthier lifestyle. Always consult your healthcare professional for personalised advice regarding dietary changes or concerns.

Estée van Lingen is a registered dietitian practicing in Randburg and Fourways, Gauteng. She has been in private practice since 2014 and is registered with the HPCSA as well as ADSA and served on the ADSA Gauteng South Committee for 2020 – 2022.


Estée van Lingen is a registered dietitian practicing in Randburg and Fourways, Gauteng. She has been in private practice since 2014 and is registered with the HPCSA as well as ADSA and served on the ADSA Gauteng South Committee for 2020 – 2022.

This article is sponsored by Huletts in the interest of education, awareness and support. The content and opinions expressed are entirely the health professional’s own work and not influenced by Huletts in any way.

Sleep and screen time: what you should know

Kate Bristow, a diabetes nurse educator, gives a rundown of all you need to know about sleep and screen time.

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World Sleep Day is 15th March.

As children we are told that we need to sleep because sleep is good for us. That’s not just parents trying to get peace and quiet, it’s for real.

Getting less than seven hours of sleep at night on a regular basis can be risky to your health. So, when talking about how screen time affects sleep patterns, it’s best to understand why sleep is important, just like a good diet and exercise is also a priority. 

Why do we need to sleep?

Please note for reference purposes, we are talking about less than seven hours of sleep per night.

Weight management 

  • Studies have shown that adults who don’t sleep enough have a higher risk of weight gain and obesity.
  • Lack of sleep increases the levels of ghrelin, which is the hormone that makes you hungry, and decreases the levels of leptin which is the hormone which makes you feel fuller.
  • People who are sleep deprived tend to be hungrier and eat more, and to compensate for the lack of energy they may crave foods higher in sugar and fat.
  • If you are feeling tired, you are less likely to hit the gym or do any physical activity which you may normally enjoy.

Brain function 

  • Research into sleep has shown that getting enough sleep improved academic performance, problem-solving skills and memory in both adolescents and young adults, possibly also in older folk, but there seems to be less research done here.

Athletic performance 

  • Better sleep enhances athletic performance, fine motor skills and endurance as well as reaction time.
  • Lack of sleep decreases your motivation to actually get out there and exercise, which is beneficial to glucose levels and your mental well-being.

Your health

  • Poor quality sleep and less duration of sleep has been shown to increase the risk of developing heart disease and high blood pressure.
  • Shorter sleep duration is also associated with a risk of developing insulin resistance and diabetes, which along with the risk of obesity and heart disease also associated with lack of sleep leads to metabolic syndrome.
  • Poor sleep is strongly associated with depression. This includes poor quality sleep and sleep apnoea as well as insomnia.
  • Your general immunity is reduced by poor sleep patterns. Getting at least seven hours of sleep has been shown to improve immune function to fight the common cold and flu.
  • Sleep disturbance has been associated with higher levels of general inflammation.
  • Chronic inflammation can cause development of many chronic conditions such as obesity, heart disease, some cancers, Alzheimer’s disease, depression and Type 2 diabetes.


  • Lack of sleep affects your ability to interact socially, resulting in emotional outbursts and behaviours such as social withdrawal. 

Danger to yourself and others 

  • When you are tired, your ability to focus on tasks, your reflexes and your reaction times are affected, in a similar way to having consumed large amounts of alcohol.
  • Less than six hours of sleep increases the risk of falling asleep at the wheel exponentially.
  • Errors at work are also a risk with poor sleep habits.

To sum all this up: sleep along with a good eating plan and exercise is one of the pillars of good health.

Managing screen time

Along with getting enough sleep, with the increased use of technology nowadays, you also need to take into account the amount of screen time you have before you settle in for the night.

How does watching TV or playing on phones, computers or Ipads before bed actually affect health and sleep quality?

These issues arise with the use of technology and screens:

  • You spend more time in front of screens, giving you less available time for sleep.
  • What you watch/play causes psychological and physical stimulation of your senses as well as social interaction which interferes with the ability to sleep or stay asleep.
  • The light from screens affects your circadian rhythms and your alertness.

 What are circadian rhythms?

  • Defined as the natural cycle of physical, mental and behaviour changes that the body goes through in a 24-hour cycle.
  • Light and dark have the biggest influence on circadian rhythms, but your food intake, stress levels, physical activity, social interactions and temperature can also have an effect.

In a nutshell, circadian rhythms are a series of body functions that control cycles such as sleep, being awake, your body temperature, your hormones and a whole lot more.  It’s important to maintain your circadian rhythms consistently by having stable bedtimes and wake-up times, aiming for a healthy seven to nine hours of sleep a night.

 How is the circadian rhythm affected by screen use?  

  • This is how it works: when it’s time to sleep your body produces a hormone called melatonin. Melatonin is produced in the pineal gland, a tiny organ in the middle of your brain which helps control your body’s sleep cycle. It’s also an antioxidant.
  • The bright light from screens supresses the production of this hormone, which affects the quality of your sleep.
  • It’s also estimated that most of us spend at least seven hours a day in front of a screen. The effects of this on general health, physical activity, cognitive function and social interactions are continually being researched, and there is still need for further research.
  • Consistent findings from a number of studies associate screen time with decreased duration of sleep and sleep problems.
  • Also to be noted in the research was the fact that in the advancement of technology, there may be stacking of screen time. What this means is that a single person may be using more than one screen at any one time. For example, as I write this article, I have the television on in the background, my cell phone at my side – and yes, I’m checking it regularly, and my computer on my lap. Three screens – not unusual anymore.

 Youth and screen use

The harm of the use of screens, particularly on our young people and the consequences of this in sleep patterns is still under research, and as technology advances and changes, this will be an ongoing field of study. Research thus far is showing that the use of screens of all types is linked to delayed bedtime and not enough sleep in our young people. This includes preschoolers, children of school-going age and adolescents.

  • Insufficient sleep has been associated with a risk of obesity in children, mental health issues as well as impaired cognitive and academic abilities.
  • You may have put a TV in your bedrooms to help you fall asleep. Parents use TV to help children wind down in the evening, and people use calming apps now to help them fall asleep. There has also been suggestion that people who leave an electronic device on in their bedroom after bedtime also have less total sleep as well as poorer quality of sleep as well as daytime tiredness.
  • The brightness of the screen over a long period of time has also been shown to increase alertness before sleep. Screen brightness increases arousal and decreases sleepiness at bedtime and delays the onset of the circadian rhythm, which in turn delays the onset of sleep. If the same wake time is set, the total duration of sleep is therefore shorter.
  • Light-emitting screens have also been shown to suppress the blood levels of sleep-inducing melatonin, which is supposed to increase in the hours prior to bedtime, blue light screens are the ones which suppress the production of melatonin the most. This means less sleepiness at bedtime and interference in the sleep cycle.
  • Delayed bedtimes, and things like violent video games, also increase stimulation before bed, as do TV shows which excite and stimulate your senses.

 AAP guidelines

The American Association of Paediatrics (AAP) has issued guidelines which recommend that any screen-based activities be stopped 30 minutes before bedtime, and that screens are not allowed in bedrooms, to try to reduce exposure in preschool children.

 The link to diabetes

So, if you understand what screen time does to your health in general, how do you tie this up to your diabetes health? There are so many reasons to get a decent night’s sleep and for some of us this may feel like a luxury. Stats in America show that 1 in 3 adults don’t get enough sleep and this increases the risk for developing Type 2 diabetes, heart diseases, obesity or depression.

When you have diabetes, lack of sleep can affect every aspect of how you manage it: your food choices, the amount you eat, how you respond to insulin as well as your mental health. Good sleep puts you in a better mood and gives you more energy.

 Too little sleep can:

  • Increase insulin resistance
  • Make you hungrier
  • You may be more likely to reach for comfort food – high in carbs and sugar
  • Make weight management more difficult
  • Increase blood pressure and increase the risk of heart disease
  • Decrease your general immunity
  • Increase your levels of depression and anxiety

 Tips to improve the quality of your sleep

  • Your bedroom should be dark, quiet and cool (a relaxing space).
  • Remove all electronic devices from the bedroom. This includes TVs, computers and smartphones.
  • Get some exercise in the day.
  • Do some relaxation exercises before you go to bed.
  • Have a regular bedtime routine – take a shower, read or write in a journal.
  • Get into bed when you are tired.

Things you can change

  • Caffeine can affect you for up to eight hours. Avoid it in the afternoon and the evening.
  • Alcohol can affect how you breathe when you sleep and it affects your sleep quality.
  • Avoid large meals in the evening. Late meals can cause indigestion and raise blood glucose levels.
  • Try not to nap after 3pm so you are tired at bedtime.
  • Avoid nicotine; it has the same effect as caffeine.

To sum things up, all the evidence points to the fact that as humans in general we all need better sleep practices and avoid screen time at night. We need to have routine and discipline in our sleep routines just like we do in our dietary choices and our exercise. By doing this we will lead to better long-term health and better quality of life.

Sister Kate Bristow is a qualified nursing sister and certified diabetes educator.


Sister Kate Bristow is a qualified nursing sister and certified diabetes educator. She currently runs a Centre for Diabetes from rooms in Pietermaritzburg, providing the network support required for the patients who are members on the diabetes management programme. She also helps patients who are not affiliated to a diabetes management programme on a private individual consultation basis, providing on-going assistance and education to assist them with their self-management of their diabetes.

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Does apple cider vinegar help with diabetes management?

Estée van Lingen, a registered dietitian, explores the potential advantages of apple cider vinegar for diabetes management.

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What is apple cider vinegar?

Apple cider vinegar is fermented juice from crushed apple. It has all the nutrients of apple preserved in vinegar liquid.

Raw unfiltered organic apple cider vinegar is usually the best choice. It may be cloudy, but this means it’s higher in beneficial bacteria.

Complementary therapy for diabetes

Apple cider vinegar has various health benefits and one of those benefits is regulation of blood glucose levels. Diabetes, which is characterised by high blood glucose levels, is managed by medication and dietary and lifestyle changes. However, many people with diabetes also incorporate natural remedies, such as apple cider vinegar, to complement their primary treatment and overall management of their diabetes.

Health benefits 

Regulating blood glucose levels – It has been shown to improve insulin sensitivity and lower blood glucose levels after meals, especially in people with insulin resistance or Type 2 diabetes. It occurs due to its effect of reducing a glucose spike after a meal through acetic acid that helps to inhibit the digestion of refined carbohydrates, slowing down the conversion of starches into sugars.

Enhancing insulin sensitivity – Insulin resistance is a key factor in Type 2 diabetes, where the body’s cells become less responsive to insulin’s action. Studies suggest that it may help enhance insulin sensitivity, allowing cells to better utilise glucose from the bloodstream. This can lead to improved glycaemic control and reduced reliance on insulin.

Weight management – Obesity is a significant risk factor for Type 2 diabetes; maintaining a healthy weight is essential for managing the condition. It has been suggested that apple cider vinegar helps with appetite suppression and increased feelings of fullness. This may help to consume less calories and achieve weight loss goals since it only has three calories per tablespoon which is way less than standard salad dressings or marinades.

Supporting heart health – People with diabetes are also at increased risk for cardiovascular complications, such as heart disease and stroke. Apple cider vinegar consumption has been linked to improvements in various cardiovascular risk factors, including lower blood pressure, reduced LDL (bad cholesterol) and improved cholesterol levels. By supporting heart health, it can contribute to overall diabetic management.

Anti-inflammatory effects – Chronic inflammation plays a significant role in development and progression of diabetes and its complications. Apple cider vinegar possesses anti-inflammatory properties attributed to its bioactive compounds like phenols and antioxidants. By reducing inflammation, it may help minimise the complications experienced in diabetes and also improve overall health.

Gut health and digestive benefits – Maintaining a healthy gut microbiota is essential for optimal metabolic function. Apple cider vinegar promotes gut health by acting as a prebiotic (food) for probiotics which is the good bacteria in the gut. Additionally, it may assist in alleviating symptoms such as bloating and indigestion.

Easy and versatile – Apple cider vinegar is a versatile ingredient that can be easily incorporated into various foods. From salad dressings and marinades to beverages and condiments, there are numerous creative ways to add it into your diet. However, it’s essential to dilute it properly and not over consume it due to the potential side effects like tooth enamel erosion and throat irritation.

How to take apple cider vinegar effectively:

  1. Dilute it in water (20ml in 40ml of water).
  2. Consider taking it before meals to help control blood glucose.
  3. Make your own salad dressing or marinade by mixing it with olive oil, fresh or dried herbs.
  4. Remember that individual responses vary, so it’s essential to monitor your blood glucose levels closely.

Always consult your healthcare provider

While apple cider vinegar shows promise as a complementary approach to diabetes management, it’s essential to use it cautiously and in conjunction with medical advice and conventional treatment methods.

Incorporating apple cider vinegar (about two teaspoons per day) into a balanced diet and healthy lifestyle may offer several potential benefits. These include improved blood glucose control, enhanced insulin sensitivity, and better overall health for people living with diabetes.

As with any natural remedy, it’s advisable to consult with your healthcare professional before making significant changes to your diabetes management regimen.

Estée van Lingen is a registered dietitian practicing in Randburg and Fourways, Gauteng. She has been in private practice since 2014 and is registered with the HPCSA as well as ADSA and served on the ADSA Gauteng South Committee for 2020 – 2022.


Estée van Lingen is a registered dietitian practicing in Randburg and Fourways, Gauteng. She has been in private practice since 2014 and is registered with the HPCSA as well as ADSA and served on the ADSA Gauteng South Committee for 2020 – 2022.

This article is sponsored by Safari Vinegar in the interest of education, awareness and support. The content and opinions expressed are entirely the contributor’s own work and not influenced by Safari Vinegar in any way.

Header image by FreePik

DSA News Autumn 2024

– DSA National Office News –

Assisting Bergville Diabetes Support Group

DSA National Office assisted a diabetes support group in Bergville, KwaZulu-Natal run by Mrs Dorcas Mabizela. This group has already had two meetings. The recent one was on 21st February with 15 attendees (four male, 11 female) and six members who sent apologies for not being able to attend. Six new members were given a warm welcome and given more information about the programme.

Reinforcement of following a diabetes- and hypertension-friendly diet was explained using the booklets issued by DSA.

Members were impressed by what DSA had to offer and found it easy to know the difference between high and low blood glucose because of the pamphlets that were handed out.

Mrs Dorcus Mabizela has been invited to do a programme presentation at the local task team meeting at a municipality level on 13 of March 2024. The local government consists of 15 wards.

Assisting Bergville diabetes support group

– DSA Western Cape News –

Silver Stars Group

DSA sponsored The Seniors Club (NPO) namely ECM Silver Stars Seniors club groups members with free diabetes membership for the next year.

Norma and Alvin White are the co-ordinators of the club and based in Malibu Eersteriver, Western Cape. Since so many of the members have diabetes, they approached DSA to educate them on how to manage this chronic condition. With the little income/pension they receive, it makes it difficult to focus on their health as well as what foods to avoid.

There are currently 42 members and they meet once a week on a Thursday morning.

Each member was so grateful to be able to check their own blood glucose level instead of waiting until they have to see a doctor at their clinic.

– DSA Pretoria News –

February Wellness Meeting

Pieter Roos, a leading podiatrist in Centurion, gave an informative talk on feet, how to taking care of them and the correct footwear needed. The video shown was excellent. It was very interactive and we all came away having learned something new.

– DSA Port Elizabeth News –

Department of Recreation, Sports, Arts and Culture

Martin and Elizabeth were invited to give a talk about Diabetes Awareness at the Department of Recreation, Sports, Arts and Culture situated in the Fairview Office Park, Greenacres. A few of those present there have diabetes and most knew somebody who has diabetes. They appreciated the pamphlets.

Trident Steel Wellness Day

Martin and Elizabeth attended the Wellness Day at Trident Steel on Friday 1 December 2023. Each stall holder had a chance to address the people and explain what their table had to offer.

Malabar Diabetes Wellness Meeting

The Malabar Diabetes Wellness Group had their first meeting for 2024 on 13 February at the Malabar Community Centre. Dr Tyrone Moodaley spoke about General Diabetes – Questions And Answers. He ably answered the many interesting questions that were asked.

Springdale Diabetes Wellness Meeting

On 13 February 2024, the people who attended the Springdale Diabetes Wellness Meeting had loads of fun as Soraya Boomgaard, a fitness coach, led them through a variety of exercises. She explained that Exercise should be part of our daily life.

Newton Park Diabetes Wellness Meeting

The Newton Park Diabetes Wellness Meeting was held on Wednesday evening, 14 February 2024 in the hall at the Caritas Centre. The guest speaker, a registered dietitian, Carli Rauch, delivered a most informative presentation titled Carbohydrate Counting 101 and then answered many questions.

Rest in peace Xabiso Mbetshe

We met Xabiso on 7 August 2021 after his brother contacted Paula Thom from our DSA Young Guns, asking for advice and help about diabetes.

Martin, Elizabeth and Pamela, who speaks their home language, took gifts that had been donated to Xabiso. The gifts included a brand-new glucometer, testing strips, needles, sweeteners, breakfast cereals, milk, fresh vegetables, booklets explaining diabetes care and clothing to name a few items. He and his Aunt Nomonde were so happy and grateful.

Xabiso attend our first Campdiabetable and learnt much from the other children living with Type 1.

Sadly, on 21 February 2024, he passed away during the night due to a hypoglycemic coma.

Rest in peace Xabiso Mbetshe

Stages of chronic kidney disease

Although chronic kidney disease is a progressive disease the good news is that not everyone will go on to develop kidney failure. Dr Louise Johnson explains the stages and why screening is imperative for people with diabetes.

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World Kidney Day is 14 March 2024. Visit

Chronic kidney disease (CKD) is a term that includes all degrees of decreased kidney function from at risk to mild, moderate and severe kidney failure.

Almost half of patients with CKD are older than 70 years of age. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines established the diagnosis of CKD as:

Either kidney damage or a decreased glomerular filtration rate (GFR) of less than 60ml/min/1.73m2 for at least three months.

The different stages form a continuum and are classified as:

  • Stage 1 – Kidney damage with normal or increased estimated GFR (>90ml/min).
  • Stage 2 – Mild reduction in GFR (60 – 89ml/min).
  • Stage 3a – Moderate reduction in GFR (45 – 59ml/min).
  • Stage 3b – Moderate reduction in GFR (30 – 44ml/min).
  • Stage 4 – Severe reduction in GFR (15 – 29ml/min).
  • Stage 5 – Kidney failure GFR < 15ml/min.


By itself measurement of estimated GFR may not be sufficient to identify Stage 1 and Stage 2 CKD. In these patients, the estimated GFR may be normal or near normal. In such cases, the presence of one or more of the following markers of kidney damage can establish the diagnosis:

  • Albuminuria (albumin excretion in the kidneys >30mg/24 or Albumin: creatinine ratio > 30mg/g)
  • Urine sediment abnormalities
  • Electrolyte disorders
  • Structural kidney abnormalities as seen by imaging
  • History of kidney transplant

Two important tests

  1. Urine Albumin-to- Creatinine ratio (UACR)

This is a test of the urine to assess the relationship between albumin (which is a protein that shouldn’t be in urine) and creatinine. If protein leaks into the urine, it’s a sign of kidney damage.

UACR levels are staged as:

  • A1 – lower than 3mg/mmol
  • A2 – 3 to 30mg/mmol – moderate increase
  • A3 – higher than 30mg/mmol – severe increase
  1. Estimated Glomerular Filtration Rate (eGFR)

This is a blood test that shows how well your kidneys filter your blood per minute. A GFR of 100 is normal.

Stage 1 kidney disease

In Stage 1, there is mild damage to the kidneys. They are quite adaptable for this, allowing them to keep performing at 90% or better. At this stage, CKD is likely to be discovered by chance during routine blood analysis. Usually in people with diabetes or hypertension (these are the two main causes of CKD).




Manage all risk factors:

  • Keep blood glucose in normal range or HbA1c below 7%.
  • Keep blood pressure below 130/80 mmHg.
  • Don’t smoke.
  • Sleep seven to eight hours per day.
  • Exercise 30 minutes five times a week
  • Reduce stress and anxiety.
  • Maintain a healthy weight.

Stage 2 kidney disease

In Stage 2, the kidney function is between 60 and 89%.


Usually, asymptomatic


Manage risk factors as in Stage 1.

Stage 3 kidney disease

Stage 3a is when your kidney function is 45 to 59%.

Stage 3b is when your kidney function is 30 to 44%

The kidneys aren’t filtering waste, toxins and fluids as well as it should, and toxin and fluid build-up begin to manifest.

This is usually the first time when people with CKD are diagnosed.


Not all people are symptomatic yet, but you can have these symptoms:

  • Back pain
  • Fatigue
  • Loss of appetite
  • Persistent itching
  • Sleep problems
  • Swelling of hand and feet
  • Urinating more or less
  • Weakness


Dietitians may help to prescribe a diet that is low in sodium, phosphate, potassium and protein to protect the kidneys.

Medication that reduce symptoms and preserve kidney function:

  1. Angiotensin-converting enzyme (ACE) inhibitor.
  2. Sodium glucose cotransport 2 (SGLT2) inhibitors. In SA, there are two drugs in this class dapagliflozin and empagliflozin. This class showed in specific studies with patients with and without diabetes an improvement in kidney function on this drug.
  3. Diuretic for fluid retention.
  4. Cholesterol lowering drug. This is important since the risk of ischemic heart disease and stroke increases in this stage. Important to stop taking certain pain killers called non-steroidal anti-inflammatory drugs (NSAIDS).

Stage 4 kidney disease

This stage has moderate to severe kidney damage. The kidneys function between 15 and 29%. According to the Centre for Disease Control and Prevention (CDC), 40% of people with severe reduced kidney function aren’t aware they have it.


  • Back pain
  • Decreased mental sharpness.
  • Fatigue
  • Loss of appetite
  • Muscle cramps and twitches
  • Nausea and vomiting
  • Persistent itching
  • Shortness of breath
  • Sleep problems
  • Swelling of hand and feet
  • Weakness
  • Weight loss

This stage is also at high risk for heart disease and stroke.


The same as Stage 3. In Stage 4, it’s important to be part of a health team to monitor you closely regarding electrolytes, medication, diet as well as possible complications, such as anaemia, bone loss and hypertension.

In Stage 4, erythropoietin supplement for anaemia is important.

Stage 5 kidney disease

This stage means your kidney function is less than15% or you have kidney failure.


The symptoms are the same as Stage 4, but the intensity is worse. A significant drop in kidney function puts more stress on the heart, increasing the risk of heart disease and stroke.

Once you have Stage 5 kidney failure, life expectancy is a lot shorter without dialysis or a kidney transplant.

Dialysis isn’t a cure for CKD but a process to remove fluid and toxins.

Although CKD is a progressive disease, not everyone will go on to develop kidney failure. Symptoms of early kidney disease are mild or even absent. It’s important to screen for kidney disease if you have risk factors such as diabetes and hypertension. Always join a healthcare team to help you along this journey.

Dr Louise Johnson


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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How to balance body positivity, weight, and diabetes

Finding the balance between body positivity and managing your diabetes but it’s important to approach it in a holistic and sustainable manner. Monique Marais explains further.

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Finding this balance is applicable to newly diagnosed diabetes, as well as those who have been managing it for a prolonged period. Your body’s response to food may change over time, your access to resources might improve, and your own knowledge of your diagnosis will empower you to make better decisions, but it remains something that you actively need to seek out and implement in your life.

It’s fundamental for you to address your emotional well-being along with your physical health. Here are tips that may help:

  1. Manage your expectations regarding your goals

  • Don’t focus on the scale – Sometimes your achievements might not be reflected by the number on the scale, and this can be demotivating.
  • Shift your focus from weight to health and set your goals based on what you deem as good health for yourself.
  • Recognise improvements in energy levels, mood, blood glucose control, and overall health as meaningful milestones.
  • Set small, realistic goals and keep track of your progress.
  • Seek professional support from your doctor, dietitian and possibly a mental health professional, so that you have a holistic approach to health and wellness, and they can support your goal setting.
  1. Follow a balanced diet

  • Educate yourself on what a healthy weight is for you; this is very person-specific and will differ from those around you.
  • Shift your focus from a restrictive diet to a diet that nourishes your body.
  • Also educate yourself on how your body processes certain types of food and the impact it has on your blood glucose levels. The more you know, the better you’ll be able to manage a sustainable diet.
  • Adopt a balanced and nutritious diet that supports both weight management and diabetes control.
  • Focus on whole foods, including fruits, vegetables, lean proteins, and whole grains and combine this with smaller portions.
  • Monitor your carbohydrate intake and choose complex carbohydrates to manage blood glucose levels.
  1. Identify a support system

  • Surround yourself with positive influences but be selective when taking advice from people who mean well but aren’t experts.
  • Communicate with your family and friends on how they can support you in this journey.
  • Be open with your family and friends when you’re struggling, you don’t need to do it alone.
  • Be wary of diabetes fatigue. You are constantly confronted with what you are allowed to eat and what not, and how you’ll be impacted, but your family members who don’t have diabetes can manage their diet with less restrictions and less challenges. By identifying these feelings, you can prevent isolating yourself from them, and rather make use of their support.
  • Practice self-compassion. Be kind to yourself and remember that living with diabetes involves continuous adaptation.

Remember that every person is unique, and what works for one person may not work for another. It’s crucial to find a balance that suits your body and lifestyle while prioritising your overall well-being. By seeking support from healthcare professionals, joining support groups, and involving loved ones in the management process can all contribute to a more positive emotional outlook.

Monique Marais is a registered social worker at Care@Midstream sub-acute, specialising in physical rehabilitation for the past 11 years. She has a passion for the medical field and assisting people to understand and manage their diagnoses and the impact on their bio-psychosocial well-being.


Monique Marais is a registered social worker at Care@Midstream sub-acute, specialising in physical rehabilitation for the past 11 years. She has a passion for the medical field and assisting people to understand and manage their diagnoses and the impact on their bio-psychosocial well-being.

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10 tips to improve your time in range

Diabetes nurse educator, Christine Manga, shares 10 practical tips to improve your time in range.

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Time in range 101

Let’s start off by discussing time in range (TIR) and the importance of this concept.

  • Time in range is the amount of time spent in a specific target blood glucose range and is measured in %.
  • Target range is set at 3.9mmol/L – 10.0mmol/L for most people with diabetes.
  • Guidelines recommend that at least 70% of a day should be spent in range, which equates to just shy of 17 of 24 hours.
  • Less than 4% should be lower than 3.8mmol/L and less than 1% lower than 3mmol/L.
  • Time above range, higher than 10.1mmol/L should be kept to below 25%.
  • Pregnancy has a much narrower range of 3.5mmol/L – 7.8mmol/L. This is to mitigate the risks of pregnancy and birth complications including premature birth, high birth weight babies, miscarriage, or a stillborn baby.

Important to note: The guideline ranges may be too low for certain people. Factors that need to be considered for setting different target ranges in these certain populations would include age, duration of diabetes, life expectancy, physical or mental disabilities and work environment. These targets should be discussed with your health care provider for best long-term outcomes.

How is TIR calculated?

It’s calculated by taking a certain number of readings over a 24-hour period and dividing the number of readings in range by the total number of readings taken and multiplying by 100. This will give a percentage.

The easiest way to determine TIR is by wearing a continuous or flash glucose monitor. These systems measure glucose every five minutes, 288 times a day. An individual using these sensors can see TIR for a rolling 24hours. To get a true reflection of overall glucose control, a period of at least 14 days should be used.

TIR and Hba1c

Hba1c used to be the gold standard for measuring long-term glucose control. Unfortunately, there are shortfalls to using this method; it’s unable to expose glucose excursions and misses hypoglycaemia.

In the below image, all three patients have an Hba1c of 7%. The glucose readings of these patients are vastly different. Patient 3 has a TIR of 100% whereas patient 1 has huge variability. Glucose variability is considered an independent risk factor for developing long-term diabetes complications. TIR and Hba1c are closely correlated. Depending on baseline Hba1c, for every 10% change in TIR there is a 0.4 -1.0% change in Hba1c.

Ticking the TIR boxes

Maintaining a good TIR is possible and made easier by following some of these 10 simple tips:

  1. Medication

Take your diabetes medication as prescribed. Timing and dosage are imperative. Missing doses, taking too much or too little medication or insulin will reduce TIR. If necessary, set a reminder alarm on your phone to take medication timeously.

  1. Eating

Eating low-carb and low-GI foods prevent huge swings in glucose levels. Adding a protein to a meal assists in stabilising glucose levels. Eating vegetables with meals adds fibre, once again preventing spikes. If you are snacking, aim for less than 15g of carbs per snack. Be aware of portion sizes of meals, as the larger the meal, the greater the glucose fluctuation.

  1. Exercise

Regular exercise improves insulin sensitivity. It allows your body to better use the ingested glucose. Exercise can lower glucose levels for up to 24 hours post exercise. To remain in range, it’s important to make sure your glucose levels are not above 14mmol/L when starting exercise or below 5,5mmol/L. Exercise can assist in weight loss.

  1. Stress management

Stress releases hormones such as glucagon, adrenaline and cortisol. These increase insulin resistance causing an increase in blood glucose levels. Illness is a form of stress. Seek medical attention if you are ill.

To manage daily stress, meditation, breathing exercises and general exercise are excellent. If the stress is too great to manage alone, make an appointment to see a doctor or psychologist. During times of stress, try to increase glucose testing frequency.

  1. Monitor blood glucose levels

If you are fortunate enough to have access to sensor technology, use it. But, most importantly is to react to any alerts, high or low. It doesn’t help to know what your glucose level is if you’re not going to do anything about it.

Finger stick monitoring is most common in SA. The general rule is for every insulin injection given; you should be testing. Testing two hours post meal can assist you to increase your TIR by adjusting future meals or insulin doses. If a reading is out of range, think why that would be and see what changes you can make for next time. Advocacy is being done to enable more people with diabetes in SA have access to continuous glucose monitoring sensors.

  1. Sleep

Insufficient sleep can cause insulin resistance giving rise to elevated blood glucose levels in people with diabetes and increasing the risk of developing diabetes for those without.

Hormones released overnight also cause insulin resistance which result in elevated glucose readings in the hours before rising.

This overnight rise can be managed with diabetes medication. Sleep apnoea is another cause of insulin resistance, worsening TIR. If you snore or stop breathing overnight (often mentioned by your partner), it may be worth testing for sleep apnoea.

  1. Weight

Maintaining a healthy stable weight aids in keeping glucose levels stable. If you are overweight, losing just 5% of your body weight will improve insulin sensitivity and therefore glucose levels. If more weight is lost, medication doses may need to be reduced to prevent hypoglycaemia. Imagine having greater TIR with less medication.

  1. Sensor augmented insulin pump therapy

Having the privilege of wearing an insulin pump with a connected sensor is one of the easiest ways to maintain a high TIR. The insulin pump adjusts the insulin doses according to the sensor blood glucose levels. These systems enable you to reach a high TIR with a very low time below range.

Unfortunately, these systems are very expensive and not available to most people with diabetes. As mentioned earlier, there are wonderful advocacy groups putting pressure on the necessary bodies to get these pump systems to more individuals.

  1. Sick day/back up

When you are sick, glucose levels usually spike. It’s important to have a sick day protocol especially when using insulin. This will aid in keeping you in range. Your healthcare provider will be able to assist you with this.

Having backup stock for hypos is important, be prepared. Carry sugar or honey sachets, Super C’s or Jelly Babies. To remain within range don’t over correct a low blood glucose. Have 1 to 2 Super C sweets and wait twenty minutes, then retest your glucose level. If still below 3.9mmol/L, then have 1 more Super C.

10. Consistency

Try to remain consistent with all the above. Routine makes staying in range easier. There will be days that regardless of what you do your blood glucose will appear to have its own agenda. That happens. Accept it and move on. It’s the bigger picture that counts, long term, a less than good day here and there is not the end of the world.

Christine Manga (Post Grad Dip Diabetes and Msc Diabetes) is a professional nurse and a diabetes nurse educator. She has worked with Dr Angela Murphy at CDE Centre, Sunward Park since 2012.


Christine Manga (Post Grad Dip Diabetes and Msc Diabetes) is a professional nurse and a diabetes nurse educator. She has worked with Dr Angela Murphy at CDE Centre, Sunward Park since 2012.

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Smoky Kassler Pork and Roasted Veg Salad

This Smoky Kassler Pork and Roasted Veg Salad is a hearty yet refreshing meal perfect for any season.

This dish is a blend of rich flavours of smoked pork steak with the sweet earthiness of roasted butternut and gem squash, tossed with mixed salad leaves, pomegranate seeds, and macadamias and finished with a tangy sun-dried tomato buttermilk dressing.

Makes 4 portions

Cut: Pork shoulder

Preparation time: 10 minutes

Cooking time: 20 minutes


For the salad:

  • 400g smoked Kassler pork steak, cubed
  • 4 cups mixed salad leaves
  • ½ cup deseeded cherries
  • 1½ cups roasted butternut squash, with honey butter
  • 1 gem squash, sliced and toasted, with honey butter
  • Salted and chopped macadamias to taste
  • Pomegranate seeds to garnish
  • Soft goat’s cheese, to taste

For the dressing:

  • ¼ cup buttermilk
  • 1/3 cup sun-dried tomatoes
  • ¼ cup oil (from the sun-dried tomatoes)
  • 1 Tbsp. Dijon mustard
  • 2 Tbsp. honey
  • ¼ cup red wine vinegar
  • Salt and pepper, to taste


  1. Sauté the Kassler pork cubes in a pan until golden.
  2. Prepare the dressing by blending all ingredients until smooth, then chill.
  3. Assemble the salad with leaves, roasted vegetables, pork, cherries, macadamias, and goat’s cheese. Drizzle with the dressing before serving.

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Alcohol: drink safely and smartly

Is it possible to enjoy alcohol if you have diabetes? Yes, however, the key message is to drink safely and smartly. Dr Paula Diab elaborates.

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Diabetes is a disease synonymous with behaviours and activities that you can’t do. Most people still walk into my office wanting a diabetic diet sheet, a list of foods that they can and can’t eat. Thankfully, we’ve moved on from there.

It’s also a disease that places so many restrictions on your health and makes you keenly aware of all the bad habits that people enjoy and the differences between people with diabetes who can’t do something and those without diabetes who can do whatever they like. This is also not completely true.

It is true that most people with diabetes tend to drink about half as much as other adults. Why? Perhaps they have been advised that alcohol and diabetes don’t mix. Perhaps some have health conditions that are incompatible with alcohol. Or maybe they’re just concerned about all those kilojoules and carbs.

But is the occasional glass of wine or beer really so bad? Is it possible to enjoy a few drinks with friends even if you have diabetes? The key message is you need to drink safely and smartly.

What can you drink? 

These are the bare facts. For women, one unit of alcohol a day is considered moderate and for men, up to two units.

A unit of alcohol is 200ml wine, a 340ml beer or 40ml spirits. And you can’t bank your daily allowance and save it for the rugby game on Saturday afternoon. (Although if last year’s Rugby World Cup was anything to go by, you may need to!)

A few cautionary tales 

All alcohol, regardless of whether it’s a lite beer or an expensive whiskey, is made from carbohydrates. Hops and barley are fermented to make beer, wine comes from grapes and spirits are also made from grain or malt; all carbohydrates.

The simple reason that diabetes and alcohol aren’t good friends is that all these drinks will rise your blood glucose levels.

Many of the mixers used in creating drinks are also sugar-containing beverages. These will also raise blood glucose levels. It’s possible to have sugar-free sodas but then glucose levels may drop.

It’s perhaps a lesser known fact that alcohol and glucose compete for metabolism in the liver. What this means is that the liver will preferentially metabolise alcohol over maintaining your blood glucose levels. This is, in part, a survival mechanism to prevent you from becoming over-intoxicated.

It’s also particularly pronounced when your stomach is empty. The result of this being the risk of hypoglycaemia (low blood glucose) after you have been drinking. That is why many clinicians will suggest a high fat meal or snack (peanuts, milk, cheese sandwich) before drinking. Obviously, this food will cause a rise in your blood glucose reading but at least it may help prevent a serious and complicated low glucose level.

The liver is also fairly slow at metabolising alcohol and generally each unit of alcohol will take one to two hours to be fully eradicated from your body. This timing will also depend on your body weight and the frequency that you’re used to drinking.

Reaction of medication and alcohol

Taking insulin or oral anti-diabetic medication combined with the glucose-lowering effects of alcohol can have a combined effect of significant hypoglycaemia.

In addition, the use of a glucagon pen to treat the low glucose level may also not be effective. This is because glucagon works quickly but only for a short time whereas alcohol may cause the glucose levels to drop for up to two hours. Often repeated doses of glucagon are required to counteract an alcohol-induced hypoglycaemic event. Certainly, a better option is to ensure adequate kilojoule intake through liquids and other foods.

Another problem is that many of the symptoms of hypoglycaemia (slurred speech, drowsiness, confusion, or difficulty walking) are also symptoms of being drunk and it can be difficult to tell the two apart.

The added concern of hypoglycaemic unawareness (a condition in which you don’t recognise you’re going low), makes drinking especially difficult.

Alcohol after exercise

What about those people who play a round of golf and then head off to the 19thtee or those who play tennis and then enjoy a glass or two of wine afterwards?

Again, the added effect of aerobic exercise dropping the glucose levels and alcohol-induced hypoglycaemia can be very dangerous. Depending on the type and duration of exercise, this combined double-hit may only manifest a few hours after exercising so you do need to be very careful.

Dehydration and alcohol

Drinking is often associated with a balmy summer’s day by the pool or engaging in water sports at the dam. Another potentially disastrous combination is alcohol and dehydration. This is because your body fluid volume becomes depleted due to dehydration and the effects of the alcohol are all the more pronounced.

A good rule of thumb is to follow each unit of alcohol with a glass of water to ensure you stay well hydrated. If you’re out in the sun or doing physical activity, you can add another glass of water on. 

Faster glucose level reaction

And finally, drinks are liquid. That seems like a simple enough fact. But liquids are absorbed more quickly by the body than solid foods so whatever effect the alcohol is going to have on your glucose levels, it’s likely to happen quicker than what you can treat it with a few peanuts or cheese sandwich. In fact, you can probably expect your glucose levels to peak about 30 to 90 minutes after drinking. 

How to drink safely 

If you’re going to have a drink, here are a few things for you to consider.

  • Firstly, speak to your doctor or diabetes educator and ask him/her to advise you on your specific needs and risks. Discuss your concerns with your healthcare team and ensure that you have the correct information relating to your specific condition.
  • Always take your glucose testing equipment with you when you are drinking and be sure to test regularly (every hour if necessary) as glucose levels can fluctuate rapidly when you are drinking.

Discuss with your doctor when and how to intervene and you’ll also start to be more aware of what effects the alcohol is having.

  • Limit your drinking to the recommended daily limit and to drinks where you know the effects on your body. Drink sizes and carbohydrate portions vary per drink so finding your preferred drink and knowing its effect on your body is probably very wise advice.
  • It’s also a good idea to ensure that the people that you’re drinking with know that you have diabetes and that you have all your essential supplies with you. Make emergency details and arrangements known to those that you’re with (a list of your medications, your regular doctor, where your glucometer is, who should they contact). All this information can be recorded and placed in a safe place in your wallet or on a medical alert device so that it’s easily accessible each time.
  • It may also be a good idea to have a formal discussion with your family about the conditions of safe drinking. Issues such as only drinking when your glucose levels are stable, only with trusted friends and having a distinct emergency plan may be very helpful to discuss in the sober light of day. Alcohol clouds judgement and making decisions when you already have a few units of alcohol can be very challenging.

The takeaway

Drinking is individualised and there’s no universal rule for how to do it safely when you live with diabetes. The best advice is to talk to your healthcare team and your family and make decisions based upon what is best for your health.

Dr Paula Diab


Dr Paula Diab is a diabetologist at Atrium Lifestyle Centre and is an extra-ordinary lecturer, Dept of Family Medicine, University of Pretoria.

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The cholesterol facts

With so many misconceptions regarding cholesterol, it can be hard to separate fact from fiction. Here are some cold hard facts.

While it’s true that cholesterol management is essential for a healthy heart, it’s not as simple as avoiding all cholesterol-rich foods or relying solely on medication. It’s about understanding your risk factors, making smart lifestyle choices, and working closely with your healthcare provider to create a personalised plan for your health.

Myth 1: All cholesterol is bad

Fact: Not all cholesterol is created equal

Cholesterol is often categorised as good (HDL cholesterol) or bad (LDL cholesterol). HDL (high-density lipoprotein) cholesterol is good because it helps remove excess cholesterol from your bloodstream and transports it to your liver for disposal. On the other hand, LDL (low-density lipoprotein) cholesterol is often considered harmful because high LDL levels can lead to plaque build-up in your arteries, increasing the risk of heart disease.

The truth is your body needs some cholesterol to function correctly as cholesterol is essential for building cell membranes, producing hormones, and aiding digestion. The key is to maintain a healthy balance between HDL and LDL cholesterol. 

Myth 2: Eating cholesterol-rich foods raises your cholesterol levels

Fact: Dietary cholesterol has less impact on blood cholesterol levels than previously believed.

For years, consuming cholesterol-rich foods like eggs and shrimp was believed to raise your blood cholesterol levels significantly. However, research has shown that dietary cholesterol has a relatively small impact on blood cholesterol levels for most people.

What has a more significant effect on your cholesterol profile is the saturated and trans fats in your diet. These unhealthy fats can raise LDL cholesterol levels. 

Instead of consuming individual cholesterol-rich foods, focus on a balanced diet that limits saturated and trans fats and includes heart-healthy choices like fruits, vegetables, whole grains, and lean proteins.

Myth 3: Only older adults need to worry about cholesterol

Fact: High cholesterol can affect people of all ages

While it’s true that cholesterol levels tend to rise as you get older, heart disease is not an exclusive concern for the elderly. Poor lifestyle choices, genetics, and other factors can contribute to high cholesterol levels in people of all ages, including children and young adults.

You must check your cholesterol levels regularly to monitor your heart health, starting in your 20s. Your healthcare provider may recommend earlier screenings if you have a family history of heart disease or other risk factors.

Myth 4: Medication is the only solution for high cholesterol

Fact: Lifestyle changes can have a significant impact on cholesterol levels

If you’re diagnosed with high cholesterol, you may worry that medication is your only option. While medication can be effective and necessary for some people, lifestyle changes are pivotal in managing cholesterol levels.

Simple changes like adopting a heart-healthy diet, increasing physical activity, and quitting smoking can make a substantial difference. These lifestyle modifications can help lower LDL cholesterol and raise HDL cholesterol, reducing your overall risk of heart disease. 

Myth 5: If you feel fine, your cholesterol levels must be fine too

Fact: High cholesterol is often asymptomatic

One of the most dangerous myths about cholesterol is assuming that if you feel fine, your cholesterol levels must be acceptable, too. Unfortunately, high cholesterol is often symptomless until it causes a more severe issue like a heart attack or stroke.

Regular cholesterol screenings are crucial because they can detect high cholesterol levels before you experience any symptoms. By identifying and managing high cholesterol early, you can take proactive steps to protect your heart health and reduce your risk of cardiovascular disease.

Remember that knowledge is your best ally in the battle against high cholesterol and heart disease. Don’t hesitate to seek guidance from healthcare professionals, and take control of your heart health through informed decisions and proactive choices. Your heart will thank you for it, both now and in the years to come.

*This article is attributed to Affinity Health.