Author: Diabetes Focus eMag

nutrients

Understanding nutrients

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Esteé van Lingen expands on what nutrients are and the difference between macronutrients and micronutrients.

Nutrition is a fundamental aspect of your life, influencing your health, energy levels and overall well-being. The food that you eat provides your body with essential nutrients (substances that provides nourishment essential for the maintenance of life and for growth) that are crucial for various functions in the body. Nutrients can be categorised into two main groups: macro- and micronutrients.

Macronutrients: energy providers and building blocks

Macronutrients are nutrients that your body requires in large quantities to provide you with energy, support growth and development and maintain overall health. There are three primary macronutrients: carbohydrates, proteins and fats.

  • Carbohydrates

These are the body’s primary source of energy. This can be found in various starches. Examples include grains (bread, pasta, pap, barley, quinoa, cereals etc), fruits, vegetables (especially starchy vegetables: corn, pumpkin, potatoes, sweet potato), legumes (beans, lentils, chickpeas) and dairy products.

When consumed, carbohydrates are broken down into glucose, which is used as a source of fuel for your cells.

Carbohydrates also play a crucial role in brain function and support physical activity.

  • Proteins

Proteins are essential for building and repairing tissue, as well as producing enzymes, hormones and other vital molecules. Protein is found in meat, chicken, poultry, fish, eggs, dairy products, legumes, nuts and seeds as well as plant sources like soya and tofu.

Amino acids, the small building blocks that make up protein, are used by the body to synthesise new proteins and perform various other functions.

  • Fats

Often also referred to as lipids, are essential for energy storage, insulating your organs and maintaining the health of cell membranes as all cell membranes consist of fat and the type of fat you consume, will determine how well the cell will let through nutrients into the cell and let waste out of the cells. Fat is also important when it comes to absorbing fat-soluble vitamins (A,D,E,K).

Healthy fats are found mostly in plant-based foods, such as avocadoes, nuts, seeds, olives, olive oil as well as in fatty fish, such as salmon, mackerel, pilchards, sardines and trout.

While unhealthy fats are mostly found in animal-based foods, such as processed foods (foods not in its natural form). For example, crumbed, battered, sausages, nuggets, Schnitzel, etc.) as well as fat on the meat, chicken skin and also fried foods. For example: takeaways (chips, fish, samosas, etc).

Macronutrients provide the body with kilojoules (calories) which are the measurements of energy. Carbohydrates and protein provide about 17 kilojoules (kJ) per gram while fats offer more energy at 38 kJ per gram.

The balance of these macronutrients in your diet can greatly influence overall health and body composition. For example, a diet high in carbohydrates can provide quick energy, but in excess can lead to weight gain especially when it’s not combined with an active lifestyle or exercise. A diet high in fat (especially unhealthy fats) can contribute to heart disease.

Micronutrients: the essential nutrient helpers

Micronutrients are the essential vitamins and minerals that your body requires in smaller quantities compared to macronutrients. However, these tiny powerhouses are critical for numerous bodily functions and overall health. Some common micronutrients include vitamins (A, Bs, C, D, E and K) and minerals (calcium, iron, magnesium and zinc).

  • Vitamins

These organic compounds play a variety of roles in the body. For example, vitamin C is known for its immune-boosting properties, while vitamin D is essential for bone health as well as plays a role in immunity. Different vitamins are found in various food sources, such as fruit, vegetables, dairy products and meats.

A deficiency in vitamins can lead to various health issues, including scurvy (lack of vitamin C), rickets (lack of vitamin D) and beriberi (lack of vitamin B1).

  • Minerals

Minerals like calcium, iron and potassium are inorganic nutrients that are essential for maintaining proper bodily functions. Calcium is crucial for strong bones and teeth. Iron is needed for oxygen transportation in the blood and potassium helps regulate blood pressure. Minerals are found in a variety of foods, with sources ranging from dairy products and leafy greens to lean meats and legumes.

Micronutrients are often involved in metabolic processes, acting as little helpers in the forms of coenzymes and cofactors that enable enzymes to function correctly. They also support growth, immune function and the maintenance of healthy skin, eyes and bones. An inadequate intake of micronutrients can lead to various health issues, including anaemia (iron deficiency), osteoporosis (calcium deficiency), and scurvy (vitamin C deficiency).

What is the difference between these two nutrients?

Quantity

The primary distinction between macronutrients and micronutrients is the quantity required by the body.

Macronutrients are needed in larger amounts, typically measured in grams or kJ/calories whereas micronutrients are required in much smaller quantities, often measured in milligrams or micrograms.

Energy content

Macronutrients provide the body with energy in the form of kJ, while micronutrients don’t contribute to caloric intake. The energy content of macronutrients is significant in terms of maintaining energy balance and body weight.

Types

Macronutrients are categorised into three main types: carbohydrates, protein and fats; each serving specific functions in the body. In contrast, micronutrients encompass a wide range of vitamins and minerals, each with its unique roles.

Food sources

Macronutrients are commonly found in foods such as grains, meat, vegetables and dairy products. In contrast, micronutrients are distributed throughout the food supply, with specific vitamins and minerals often associated with specific food groups. For example: vitamin C is found in citrus fruits, calcium is abundant in dairy products.

Roles in the body

Macronutrients primarily provide energy and structural components such as amino acids for protein synthesis. Micronutrients are involved in various metabolic and regulatory processes, acting as helpers or playing essential roles in specific bodily functions.

Measurements

Macronutrients are typically measured in grams with recommended daily allowances (RDAs) or dietary reference intakes (DRIs) established to help meet your macro needs.

Micronutrients are measured in smaller units, such as milligrams or micrograms, and have their own recommended daily allowances.

How do you balance macro- and micronutrients in your diet?

A well-rounded diet should include an appropriate balance of macro- and micronutrients to support overall health and well-being. Here are tips for achieving this balance:

  1. Eat a variety of foods. Consuming a diverse range of food groups and colours ensures you receive a broad spectrum of macros and micros. Different foods offer various vitamins, minerals and macronutrient ratios.
  2. Ensure that you get the correct balance of carbohydrates, protein and fats to suit your needs and your lifestyle.
  3. Pay attention to portion sizes. Be mindful of portion sizes to avoid overconsumption of macronutrients, especially if you are trying to manage your weight. Use nutritional labels and food scales to ensure you consume the correct portions as well as learn to read and understand labels.
  4. Consider your needs. Your age, gender, activity levels, health status and stress levels can influence your macro- and micronutrients requirements. Consult a registered dietitian to tailor your diet to your specific needs.
  5. Plan balanced meals. When prepping meals, strive to include a source of each macronutrient along with variety of foods rich in micronutrients, such as fruits, vegetables and whole grains. These can also be distributed in different amounts throughout the day. For example: fruits as snacks or consuming grains instead of processed carbohydrates.
  6. Supplement if necessary. In certain situations, such as vitamin or mineral deficiencies, your healthcare provider may recommend supplements to ensure you meet your micronutrient needs. It’s called supplements for a reason; it should supplement a balanced diet and not take over the work of unhealthy diet and lifestyle.
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.

MEET THE EXPERT

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.

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life expectancy

Type 2 diabetes and life expectancy

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Lynette Lacock elaborates on how Type 2 diabetes can affect life expectancy as well offering advice to prolong your life.

What is Type 2 diabetes?

Our bodies need to do two things to regulate blood glucose. The pancreas needs to produce the right amount of insulin and the cells need to be able to react to this insulin to supply the cells with the fuel that we call glucose. If you have Type 2 diabetes, your body isn’t doing either of these effectively.

There is a genetic component to Type 2 diabetes and it can run in families, but the main cause is lifestyle choices. Being overweight, food choices and a sedentary lifestyle are all contributing factors. Not that long ago, it was called adult onset diabetes but due to the rise in childhood obesity there are now so many children with this type of diabetes that we can no longer use that phrase.

Symptoms of Type 2 diabetes

You may be experiencing symptoms that you didn’t even realise were being caused by diabetes. These symptoms can develop slowly, and you may not even be aware that you already have diabetes.

This is a good argument for frequent health checks. You can go into most pharmacies these days and pay a small fee to have you blood glucose checked. If you’re living with high blood glucose, your body is already suffering the negative effects without you even knowing.

If you’re having any of the following symptoms, please get tested.

  • Always feeling tired
  • Loss of weight
  • Vision is blurry
  • Sores take long to heal
  • Frequent infections (urinary tract, chest, etc.)
  • Tingling or numbness in extremities (usually a late sign)
  • Needing to urinate often
  • Thirsty all the time

Life expectancy with Type 2 diabetes

Before the discovery of insulin in 1921, the only treatment for diabetes was eating a diet low in carbohydrates and high in protein and fat. And this only extended your life by another year if you were lucky.

Today, we are fortunate that we have medications and monitoring devices to regulate blood glucose levels that help people with diabetes live a fuller life.

Medication and modern technology aside, diabetes is still the ninth leading cause of death worldwide. Someone with diabetes lives an average of six years less than someone without diabetes. This average can increase or decrease depending on lifestyle and other comorbidities.

People with Type 2 diabetes are also more at risk for developing coronary artery disease, cancer, hypertension and obesity. Having comorbidities, particularly uncontrolled comorbidities, can decrease your life expectancy.

How to increase your life expectancy

Unfortunately, there are factors that you have no control over that make you more susceptible to developing Type 2 diabetes, such as family history, race and age.

If you have a family member with diabetes, you have a higher chance of developing it as well due to the genetic component involved.  People of colour have a higher chance of developing Type 2 diabetes although we are not sure why. And, the risk for developing Type 2 diabetes increases as you age.

Factors you can change

It’s important to remain focused on the factors you can change:

  • Weight – You need to maintain a healthy weight (BMI < 30).
  • Activity level – Exercise, exercise and exercise, particularly if you have a sedentary job.
  • Cholesterol – Follow a low-fat diet and have your cholesterol tested regularly. If you are prescribed medication, take it.
  • Diet – Watch your caloric intake and avoid high-GI foods that are high in carbohydrates and sugar.
  • Blood glucose regulation – Keep your blood glucose within normal range. Unregulated blood glucose plays havoc on your body and should be avoided.

Turn things around

Did you know that Type 2 diabetes is preventable? If you were diagnosed with prediabetes or insulin resistance you can turn things around by changing your lifestyle and possibly never go on to develop diabetes.

If you have already been diagnosed with Type 2 diabetes, you can still improve your life expectancy by making changes to improve your health. This will make it easier to regulate your blood glucose and avoid the damage to your body that uncontrolled levels can cause.

At first, it may be difficult to make these life changes and stay motivated. You may need extra support and encouragement. Fortunately Diabetes South Africa offers support and useful information through membership, literature and Diabetes Community Wellness and Support Groups that can assist in keeping you on track.

 

Sr Lynette Lacock

MEET THE EXPERT

Sr Lynette Lacock received her Bachelor’s Degree in Nursing and Biofeedback Certification in Neurofeedback in the US. She has over 30 years’ experience in healthcare which has enabled her to work in the US, UK and South Africa. Initially specialising in Cardiothoracic and Neurological ICU, she now works as an Occupational Health Sister. She is passionate about teaching people how to obtain optimum health while living with chronic conditions.

References

https://www.webmd.com/diabetes/type-2-diabetes

https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193

https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death

https://www.medicalnewstoday.com/articles/317477#life-expectancy

https://www.cdc.gov/diabetes/resources-publications/research-summaries/reaching-treatment-goals.html#:~:text=Life%20expectancy%20can%20be%20increased,than%20for%20people%20without%20it

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calcium

The highs and lows of calcium

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Dr Angela Murphy explains the symptoms and the treatment for both low and high levels of calcium.

What is calcium?

It’s is a mineral necessary for the healthy functioning of bones and teeth. In addition, it’s necessary for normal blood clotting, muscle contraction, nerve function and heart rhythms. Most calcium in the body is stored in bone with only 1% found in blood, muscles, and other tissues.

The body gets calcium from eating foods rich in calcium, particularly dairy products, nuts and seeds and certain vegetables, such as kale. If the diet is low in calcium, then the body will start to extract calcium from bone which can cause bone disorders, such as osteoporosis.

Recommended daily requirements

The table below lists the recommended daily requirements for different age groups.

AGE MALE FEMALE
< 12 years 500mg/day 500mg/day
12-18 years 1000mg/day 800mg/day
>18 years 700mg/day 700mg/day

How are calcium levels affected?

Levels of calcium are controlled by the parathyroid glands, which as the name suggests, lie next to the thyroid gland in the neck. These four, small glands secrete parathyroid hormone (PTH) which acts in several places in the body:

  1. Gut – to stimulate uptake of calcium from food by activating vitamin D.
  2. Kidneys – to slow down the loss of calcium in the urine.
  3. Bone – to stimulate release of calcium from bone into the circulation.

The system should be balanced enough to keep enough calcium available to all the cells in the body, but not remove too much from the bones. When calcium levels are too high or too low, we always look to see what the PTH level is first and from there can decide the cause of the imbalance.

Hypercalcaemia (high blood calcium)

The most common causes are:

  • Primary hyperparathyroidism – This usually occurs sporadically, although sometimes there is a family history. In most cases, one of the four parathyroid glands have an adenoma which overproduces PTH. Sometimes the entire gland is enlarged, and this is called hyperplasia. Rarely more than one gland will be overactive. It’s rare for cancer to be a cause.
  • Malignancy – Some cancers produce a PTH-like hormone which then increases calcium levels in the blood. Other cancers cause direct damage to bone which releases too much calcium.
  • Hormonal disorders –  Such as an overactive thyroid gland or adrenal gland disorders.
  • Medications – Can also increase calcium levels. For example: lithium, certain water tablets and excess use of vitamin A and D.

There are less common conditions, such as prolonged illness in ICU, hereditary disorders and inflammatory conditions, which can also cause hypercalcaemia.

Symptoms

A traditional mnemonic categorises the main symptoms of hypercalcaemia: bones, stones, abdominal groans, and psychic moans. This summarises the main clinical features of high calcium levels:

  • Bone loss resulting in diseases, such as osteomalacia and a type of osteoporosis;
  • Kidney stones and decrease in kidney function;
  • Constipation and other gastrointestinal complaints;
  • Mood disorders, such as depression, and a general feeling of being unwell.

Treatment

Naturally, this depends on the cause as well as the actual level of calcium. If the levels are very high, the first step is to lower it with medication and intravenous fluids. The definitive treatment for primary hyperparathyroidism is to surgically remove the overactive parathyroid gland. This is a safe procedure in experienced hands with excellent results.

Hypocalcaemia (low blood calcium)

The most common causes are:

  • Hypoparathyroidism – Again this can occur sporadically but more commonly as a result of surgical removal of the parathyroid glands, radiation to the neck or a disease process that infiltrates the parathyroid glands.
  • Resistance to the action of PTH – This can occur in kidney disease and with certain drugs as well as a condition on its own called pseudohypoparathyroidism. This means that although the PTH level is normal, the body is resistant to its action and behaves as if there is no PTH to keep calcium levels stable.
  • Vitamin D deficiency.
  • Resistance to the action of vitamin D – This is a rare hereditary condition.

There are other illnesses which can cause a sudden drop in calcium levels, such as acute pancreatitis, but when treated the levels can normalise.

Symptoms

The classic symptom of hypocalcaemia is tetany. This is spontaneous muscle contractions resulting in spasm, especially of the hands or feet. There may also be a tingling sensation around the mouth and in the fingers. If the levels drop too low this may cause seizures. Chronic low calcium levels in children will affect growth and development.

Treatment

If levels are very low and especially if they have dropped suddenly, it might be necessary to give intravenous calcium. The goal of therapy is to maintain levels in the normal range, and to get to the correct dose of supplements may take some time.

It will usually be necessary to have vitamin D supplementation as part of the treatment. An average dose of calcium supplementation for hypocalcaemia is 1.5 – 3g daily. Long-acting vitamin D2 can be given weekly in many cases. Sometimes a shorter-acting vitamin D, such as calcitriol, needs to be used. If there is difficulty restoring levels to normal, you should be referred to a specialist.

Conclusion

For people living below the poverty line, dietary calcium deficiency can occur. Fortification of foodstuffs has helped to lower this risk. For example, a 100g of Pronutro porridge has 530mg of calcium.

Generally, low calcium due to poor absorption or dietary deficiency can be easily corrected. There is no benefit to taking supplements if you have normal calcium levels. High calcium levels must always be investigated and then the cause can be treated.

Dr Angela Murphy qualified as a specialist physician in 2000 and joined the Department of Endocrinology and Metabolism at Charlotte Maxeke Johannesburg Academic Hospital. Currently she sees patients at Sunward Park Medical Centre. She retains a special interest in endocrinology and a large part of her practice is diabetes and obesity. She is a member of the Society of Endocrinology and Metabolism of South Africa and the National Osteoporosis Foundation and is actively involved in diabetes patient education. Living with diabetes in the family for 17 years has shown her that knowledge is power. Basic principles in diabetes must always be applied but people living with diabetes should also be introduced to innovations in treatment and technology which may help their diabetes journey.

MEET THE EXPERT

Dr Angela Murphy qualified as a specialist physician in 2000 and joined the Department of Endocrinology and Metabolism at Charlotte Maxeke Johannesburg Academic Hospital. Currently she sees patients at Sunward Park Medical Centre. She retains a special interest in endocrinology and a large part of her practice is diabetes and obesity. She is a member of the Society of Endocrinology and Metabolism of South Africa and the National Osteoporosis Foundation and is actively involved in diabetes patient education. Living with diabetes in the family for 18 years has shown her that knowledge is power. Basic principles in diabetes must always be applied but people living with diabetes should also be introduced to innovations in treatment and technology which may help their diabetes journey.

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help

Asking for help; it’s a sign of strength

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Knowing when to ask for help and understanding why you need it is crucial to manage your mental health. Monique Marais expands on this.

Children find it easy to ask for help, irrespective of how challenging the task might be. Adults on the other hand view asking for help as a sign of weakness. Somewhere in the growing up phase, we lose our ability to freely ask for assistance, and by doing this, we isolate ourselves, placing more and more strain on ourselves to make it work. The reality, however, is that at some point, everyone needs help. Knowing when to ask for help and understanding why you need it is crucial to manage your mental health.

World Mental Health Day

On 10 October each year, we celebrate World Mental Health Day, which is a global initiative to raise awareness and support for mental health issues.

The World Health Organization advocate that “World Mental Health Day 2023 is an opportunity for people and communities to unite behind the theme ‘Mental health is a universal human right” to improve knowledge, raise awareness and drive actions that promote and protect everyone’s mental health as a universal human right.”

The stigma behind mental health issues makes it even harder for people to ask for help. We need to debunk the myths society has, so that everyone can freely ask for help without judgement.

What is mental health?

Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behaviour. If left untreated, mental health issues can overwhelm you and can lead to suicidal thoughts or an attempt to take your own life.

The American Psychological Association reports that from 2008 to 2018, a survey showed that 5.8% of Americans were not receiving the care they needed for their mental health.

Fear of asking

At some point, you need to let go of your fear of asking and take the assistance that is available or offered. This can be something small, such as sharing household chores, or something bigger, such as not taking the lead in a group project.

It can mean facing your fears and seeing a doctor, psychologist, or social worker to address your mental health concerns, to find a treatment regimen that works for you, so that you can lead your best life.

Three tips to assist with asking for help

Krista Rizzo, a life coach, shares three tips to assist you with asking for help:

  1. Change your mindset – You do not have to do it alone; you are only one person, and it’s okay to ask for help. Learn to delegate; most people want to help.
  2. Make time for yourself – Self-care is important for you to be effective; you can’t give from a cup that is empty.
  3. Reassess your priorities – Take time to evaluate what is important and what you need to change to enable you to meet your goals and live your best life.

Dr Joan Rosenburg (PhD in Psychology) has the following view on asking for help, “It is appropriate to absorb what is good and to feel grateful for the appreciation and support of others. When others extend their assistance, wisdom, availability, time, talents, or enthusiasm to you, unquestionably, they are giving of themselves. Gracious receipt of their generosity not only meets whatever needs you may have, it also honours them. When you allow yourself to receive, you have reached that harmonious balance between independence and dependence.”

Help

H – Asking for help, gives you HOPE that things will work out, that you will achieve your goal instead of fail because you tried to do it alone.

E – Everyone needs help at some point in their lives, you are not alone.

L – Link with resources, know where your support lies and when to reach out.

P – Prioritise your mental health, ask for help when things are too much to deal with alone.

Asking for help is a significant and valuable skill, and it’s a sign of personal strength and emotional intelligence. Here are several reasons why asking for help is important and why it reflects strength:

  • Fosters collaboration – It brings people together and can lead to better problem-solving and innovation.
  • Shows self-awareness – You realise your own limitations, which is a crucial component to emotional intelligence.
  • Promotes learning and growth – By asking for help, you gain new knowledge, skills, and insights which you can apply in the future.
  • Strengthens relationships – You show trust and vulnerability when you ask someone for help.
  • Relieves stress – Attempting to handle everything on your own can lead to stress and burnout.
  • It creates a culture of reciprocity – When you ask for help, others are more likely to ask you for help when they need it.

Remember that you are only one person, you don’t need to do it all, and you don’t need to do it alone. You have unique qualities and attributes, you should share these qualities with others. Asking for help is therefore not a sign of weakness, but rather a display of strength, wisdom, and humility. It benefits not only you who is seeking assistance, but also the people you turn to for support. It creates a culture of collaboration and mutual growth, and it’s an essential component of personal and professional development.

Go out, be healthy, and know when to ask for HELP to live your best life.

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.

MEET THE EXPERT

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.

References

  1. Why Asking For Help Is A Strength (And Three Ways To Do So Effectively) (forbes.com)
  2. What Makes It So Hard to Ask for Help? | Psychology Today
  3. World Mental Health Day 2023 – Mental health is a universal human right (who.int)
  4. Mental health – Wikipedia
  5. Mental health in education – Wikipedia
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Males

Males with diabetes and eating disorders

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Daniel Sher, a clinical psychologist, educates us on males with diabetes and eating disorders, in hopes of breaking down stigmas and misconceptions.

When we talk about diabetes and eating disorders (EDs), a topic often left in the shadows is their impact on males (men).1 Traditionally, research in this realm has focused on females (women); and for good reason. Research shows that females who have diabetes are disproportionately affected by disordered eating.

However, in males, especially those living with diabetes, these disorders manifest uniquely and require our attention. Understanding this intersection is crucial, not only for providing effective care but also for breaking down stigmas and misconceptions surrounding EDs in men.

What are eating disorders?

Eating disorders are complex psychiatric conditions involving dysfunctional relationships to food and the body. People with diabetes (Type 1 and Type 2) are at risk of developing eating disorders, such as:

  • Bulimia (intentional purging or vomiting);
  • Anorexia (severe under-eating and weight loss);
  • Binge eating disorder (episodes of extreme overeating); and
  • Diabulimia (skipping insulin in an attempt at losing weight).

Binge eating disorder and sugar addiction both involve an over reliance on high carbohydrate foods in an attempt to regulate distressing emotions. Both of these conditions are important drivers for Type 2 diabetes in particular.

Males vs. females: The different shades of EDs

The presentation and experiences of EDs can differ significantly between males and females. Men are less likely to be diagnosed due to social stigma and a lack of awareness, both by healthcare providers and the men themselves. In men, EDs often co-occur with an emphasis on body shape and muscularity, rather than just weight loss.

Why are people with diabetes vulnerable?

Several risk factors contribute to the development of EDs in males with diabetes. These include genetic predispositions, psychological vulnerabilities (such as anxiety and depression) and increasing societal pressures for a certain body type (namely, a “shredded” muscular physique with limited body-fat). Perfectionism may also be a risk factor and this complex combination of variables can lead to an unhealthy preoccupation with food and body image, particularly in those with Type 1 diabetes.

Picture the following hypothetical scenario: a young man with diabetes is constantly bombarded by social media images of idealised male physiques; ones that emphasise muscle and leanness. He navigates a world where every meal and snack requires careful consideration and balancing with insulin, a world where food is not just nourishment but a mathematical equation impacting his health.

In this environment, his diabetes management starts to morph into a tool for body sculpting, subtly shifting from health-focused to appearance-driven. The lines blur between diligent diabetes care and an emerging obsession with body image. This scenario reflects a reality for many, highlighting the nuanced ways in which societal norms and diabetes management can converge to create a fertile ground for disordered eating behaviours.

The risks of co-occurring diabetes and EDs

Overlooked eating disorder tendencies in people with diabetes can be extremely dangerous, putting a person at risk of:

  • Poor glycaemic management with higher A1Cs and increased blood-glucose variability;
  • Heightened risk of long-term complications;
  • More frequent DKAs which can be acutely life-threatening; and
  • Increased risk of mental health disorders.

Altered brain function

A particularly worrying aspect of disordered eating in diabulimia is the impact on brain function. Insulin plays a crucial role in regulating blood glucose levels. Restricting insulin leads to heightened blood-glucose levels and these fluctuations can damage the brain (especially if sustained over time).

At the same time, eating disorders can lead to nutritional deficiencies which affect serotonin (a brain-chemical that is implicated in depression). Conditions, such as anorexia, have also been associated with changes to the brain’s grey matter. The structural and chemical changes to the brain can further trigger cognitive and emotional difficulties. All of this can lead to a nasty vicious cycle, making the challenging job of managing diabetes that much tougher.

What sort of help is available?

Treating EDs requires balancing the psychological and physical aspects of the condition, meaning that multi-disciplinary collaboration is hugely important. When it comes to diabetes and EDs, dietitians play an absolutely invaluable role. Best results shine through when there is a team approach between the patient, family, endocrinologist, dietitian and psychologist. At times, an eating disorder diagnosis may mean that a short-term admission is indicated.

When to seek professional help?

Recognising when to seek help is a critical step. What are some warning signs to look out for? These include sudden changes in eating patterns, hoarding or stealing food, obsessive thoughts about food or body image and deliberately skipping insulin to lose weight.

All of these may indicate a dysfunctional relationship to food and it’s crucial for men with diabetes to understand that seeking help for an ED is a sign of strength, not weakness. Don’t be ashamed to flag your concerns with your doctor or a mental health professional.

MEET THE EXPERT

Daniel Sher is a registered clinical psychologist who has lived with Type 1 diabetes for over 28 years. He practices from Life Vincent Pallotti Hospital in Cape Town where he works with Type 1 and Type 2 diabetes to help them thrive. Visit danielshertherapy.com

References

Araia, E., Hendrieckx, C., Skinner, T., Pouwer, F., Speight, J., & King, R. M. (2017). Gender differences in disordered eating behaviours and body dissatisfaction among adolescents with type 1 diabetes: Results from diabetes MILES youth—Australia. International Journal of Eating Disorders, 50(10), 1183-1193. https://doi.org/10.1002/eat.22746

Araia, E., King, R. M., Pouwer, F., Speight, J., & Hendrieckx, C. (2020). Psychological correlates of disordered eating in youth with type 1 diabetes: Results from diabetes MILES Youth-Australia. Pediatric Diabetes, 21(4), 664-672.https://doi.org/10.1111/pedi.13001

Broadley, M. M., Zaremba, N., Andrew, B., Ismail, K., Treasure, J., White, M. J., & Stadler, M. (2020). 25 years of psychological research investigating disordered eating in people with diabetes: What have we learnt? Diabetic Medicine, 37(3), 401-408.

Doyle, E. A., Quinn, S. M., Ambrosino, J. M., Weyman, K., Tamborlane, W. V., & Jastreboff, A. M. (2017). Disordered eating behaviours in emerging adults with type 1 diabetes: A common problem for both men and women. Journal of Pediatric Health Care, 31(3), 327-333.https://doi.org/10.1016/j.pedhc.2016.10.004

Dziewa, M., Bańka, B., Herbet, M., & Piątkowska-Chmiel, I. (2023). Eating disorders and diabetes: Facing the dual challenge. Nutrients, 15(18), 3955.https://doi.org/10.3390/nu15183955

Russell-Jones, D., & Khan, R. (2007). Insulin-associated weight gain in diabetes—causes, effects and coping strategies. Diabetes, Obesity and Metabolism, 9(6), 799-812. https://doi.org/10.1111/j.1463-1326.2006.00686.x

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Visceral fat tissue

Visceral fat tissue and cardiovascular risk

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Dr Louise Johnson unpacks the different types of fat and details why visceral fat tissue increases cardiovascular risk.

Metabolic and cardiovascular diseases are increasing worldwide due to the rise in the obesity epidemic. The metabolic consequences of obesity vary by the distribution of the adipose (fat) tissue.

Obesity is defined by an excess of body fat. The most common measurements are waist circumference and BMI (body mass Index). This is calculated by weight per meter squared.

It’s important to realise that not all fats are bad. There are two types of fat:

  • Brown fat is metabolically neutral. The distribution of brown fat is usually the gluteal-femoral fat (the buttock and thigh).
  • White fat is metabolic-active, producing hormones. The distribution of this fat is intra-abdominal (tummy fat) and ectopic fat (found around the heart, kidney, liver and vascular structures).

In 1947, a French physician first described the phenomenon that obese patients with diabetes or signs of cardiovascular disease had a central distribution of body fat. These findings were viewed with scepticism, and it took more than 35 years before this observation was supported.

Measurement of obesity

There are several methods to evaluate obesity.

  1. WHR (waist hip ratio)

This measurement looks at the proportion of the stored fat around the waist and hip. It’s calculated by dividing your waist measurement by your hip measurement since the hips are the widest part of the buttocks. (W/H)

Normal value for women should be below 0.85 or less. A value of more than 0.9 or higher is a high risk for cardiovascular disease.

Normal value for a male should be 0.95 or below. A value of 1.0 and higher is at high risk for cardiovascular disease.

  1. Waist circumference

The measurement of a waist is the middle area between the lower rib and the upper crest of the hip. Normal waist circumference should be below 80cm for a female and 94cm for a male.

  1. BMI (body mass index)

This is the calculation of the length of a person times two. The weight is divided by this value (w/hx2). Normal BMI is 18-24.

  1. MRI imaging

A very effective manner to evaluate abdominal fat is via an MRI scan since all the ectopic fat areas can also be viewed. Unfortunately, this is very expensive.

Metabolic syndrome

The presence of abnormal measurements as described above is usually also associated with abnormal blood values. This is called the metabolic syndrome. It was also previously called syndrome X or insulin resistant syndrome. It constitutes the following abnormalities:

  • Abdominal obesity;
  • Increased triglycerides on a lipogram;
  • Low HDL (good cholesterol);
  • Small dense LDL increased (bad cholesterol);
  • Insulin resistance;
  • Glucose intolerance if not a diabetic yet;
  • Endothelial dysfunction (abnormal blood vessel lining);
  • Increased risk for thrombosis.

In recent large studies, such as the Framingham Heart Study and the Jackson Heart Study, convincing evidence was gathered using the above measurements to prove the association between visceral fat (fat stored deep inside the belly, wrapped around the organs, including the liver and intestines) and cardiovascular disease. This association is independent of the patient’s metabolic control.

Why is visceral fat unhealthy?

Visceral fat has more glucocorticoid (cortisone) receptors. This causes preferential fat deposits to the tummy area as well as ectopic areas. This also induces insulin resistance in the liver and skeletal muscles.

Ectopic fat deposition

An abnormal fat in the liver, around the heart, kidney, pancreas and blood vessels are called ectopic fat and is associated with visceral fat and the metabolic syndrome.

A recent study, by Britton and Fox, showed that ectopic fat can be divided in two groups:

Predominantly systemic effects of fat

  • Visceral fat
  • Liver fat
  • Skeletal muscle fat deposits

Preferential local effects of fat

  • Around blood vessels
  • Heart
  • Kidney
  • Intrathorax

The liver

Abnormal fat in the liver is called non-alcoholic fatty liver disease (NAFLD). This is increased in uncontrolled Type 2 diabetes and high cholesterol.

NAFLD can precede diabetes and cardiovascular disease. It can be diagnosed by an ultrasound that shows the fat content. It’s also increased in obesity.

The heart

Excessive fat in visceral obesity is deposited around the heart and in the heart muscle. This can cause heart problems, such as diastolic dysfunction (difficulty in filling the heart with blood) and heart failure.

What can be done about visceral or tummy fat?

  • Adjust your diet by restricting calories.
  • Exercise regularly, such as walking, cycling or swimming.

Nobody likes to talk about fat. It’s important to remember that not all fats are the same. Do the measurements discussed and a blood test fasting to check for triglycerides. This is the first step in not only preventing cardiovascular disease but also stroke and cognitive impairment in later years.

Get a good healthcare team on your side and start working.

Dr Louise Johnson

MEET THE EXPERT

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

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pharmacy

How to get the best out of pharmacy care

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Medipost Pharmacy share an easy guide to using medicine safely and how to get the best out of pharmacy care.

Medication is a lifeline for South Africans living with chronic conditions and provides relief from illness and pain, but only when it is used safely and appropriately. Pharmacists are there to guide and advise you on all matters related to your medicine and your health. Make the most of their expertise with these simple tips.

“Medication can do more harm than good if it isn’t used correctly, and so it’s really important that everyone understands the basics of responsible medicine use, and pharmacy teams are ideally positioned to support patients,” says pharmacist Joy Steenkamp of Medipost Pharmacy, South Africa’s first national courier pharmacy.

 What you need to tell your pharmacist

  1. All your allergies
  2. Your existing health conditions
  3. All the medicines you are using, including prescription, over-the-counter and traditional medicines
  4. Report any bad reactions to medication
  5. If you are pregnant or trying to get pregnant

 What you should ask your pharmacist

  1. What is the medication prescribed for?
  2. How much and when to take your medicine?
  3. Are there side effects to be aware of?
  4. Is there anything you need to avoid while taking the medication?
  5. Advice for managing symptoms of common or short-term ailments

Five things you should know

  1. Keep medicines safely out of harm’s way in a cool, dry place away from sunlight.
  2. If antibiotics are prescribed, complete the course.
  3. Always check expiry dates and package inserts.
  4. Often, child and adult doses vary; be sure not to exceed the recommended dose.
  5. If anything to do with medicine is unclear, check with your pharmacist.

Five golden rules of pharmacy

  1. Never share your prescribed medication with someone else.
  2. Do not stockpile medicines.
  3. Medication abuse is dangerous, talk to your pharmacist if you are using more than you should.
  4. Don’t throw away or flush medicines; hand in expired or unneeded medications to Medipost’s courier drivers or at any healthcare facility with a pharmacy.
  5. You can tell a pharmacist anything without feeling embarrassed. As the most accessible healthcare professionals, they can offer guidance and advice when you need to see a doctor.

“Make sure you understand everything your doctor or pharmacist tells you about how to take your medication, and feel free to ask as many questions as you need to; it’s your health at stake. It can be very helpful to speak to a pharmacy professional in your home language to ensure you get the most out of these interactions,” Steenkamp says.

Apart from the convenience and safety of the free delivery of chronic medications, including treatment for high cholesterol, diabetes, and many other conditions, to any address in South Africa, Medipost Pharmacy also offers all registered patients access to telephonic clinical pharmacy advice in all official South African languages. Self-care medication is also available via the online shop.

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myths

Debunking five common myths about diabetes

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We learn about five common myths about diabetes and how they are debunked.

With millions affected worldwide, diabetes remains one of the leading health concerns of our era. However, alongside genuine information, a great deal of misconceptions surrounds this condition.

Over the past decade, South Africa has seen diabetes cases double, reaching 4.2 million, which equates to one in nine adults. Shockingly, 45% remain undiagnosed. As per the International Diabetes Federation’s latest data, it’s now the leading cause of death among South African women and the second highest for both genders.

Understanding diabetes

Diabetes is a complex condition arising from multiple causes. At its core, it’s characterised by the body’s inability to produce or effectively use insulin, a hormone essential for regulating blood sugar.

Type 1 diabetes, often diagnosed in childhood, is an autoimmune condition where the body attacks insulin-producing cells. Its exact cause is unclear but is believed to involve genetic, environmental, and possibly viral factors.

Type 2 diabetes is more common in adults and is caused by insulin resistance and insufficient insulin production. It’s linked to genetics, obesity, poor diet, sedentary lifestyle, and age.

Gestational diabetes affects pregnant women and may increase the risk of Type 2 later in life.

Signs and symptoms

The warning signs of diabetes can be so mild that they go unnoticed. Some common symptoms include:

Increased thirst and urination: High blood glucose levels cause the kidneys to work harder to filter and absorb excess sugar, leading to frequent urination. This can result in dehydration and a consequent increase in thirst.

Unexplained weight loss: Despite eating more, rapid weight loss can occur as the body uses muscle and fat for energy because it can’t use sugar effectively.

Hunger: Fluctuating blood glucose can increase appetite, even after meals.

Fatigue: Insufficient glucose in the cells can cause tiredness and lack of energy.

Blurred vision: High blood glucose levels can lead to fluid being pulled from the eyes’ lenses, affecting the ability to focus.

Slow healing: Sores, cuts, and bruises may take longer.

Tingling or numbness: High blood glucose can cause diabetic neuropathy, leading to tingling or numbness in the extremities, especially feet and hands.

Darkened skin patches: Areas of darkened skin, called acanthosis nigricans, can appear, particularly in the neck and armpits.

Debunking the myths

         Myth: Overeating sugar causes diabetes.

Reality: The causes of diabetes are multi-factorial. While consuming too much sugar, especially in drinks that contain added sucrose and fructose, such as sodas, is linked to an increased risk of Type 2 diabetes, eating moderate amounts of sugar in isolation does not trigger diabetes.

Myth: Only overweight individuals get diabetes.

Reality: While obesity is a significant risk factor for Type 2 diabetes, accounting for 80 – 85% of the risk, many overweight people never develop the condition. Conversely, a fair number of those with average weight can become diabetic. Factors like family history, age, and ethnicity also influence risk.

Myth: People with diabetes should avoid all carbohydrates.

Reality: Carbohydrates are essential to a healthy diet, even for those with diabetes. The key is to opt for complex carbohydrates like whole grains, vegetables, and fruits, which have a lower glycemic index and are processed more slowly by the body.

Myth: Diabetes is not a severe disease.

Reality: If not managed well, diabetes can lead to chronic health complications such as heart disease, stroke, kidney damage, and vision problems. Effective control of blood glucose levels and regular check-ups are paramount to prevent complications.

Myth: Once you start insulin, your condition has worsened.

Reality: Insulin is a standard treatment for people with Type 1 diabetes and can be prescribed for Type 2 diabetes if other methods don’t control blood glucose adequately. It’s a crucial step in the treatment process, not an indication of disease progression.

*This article is attributed to Affinity Health. 

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Medical insurance

Medical aid vs medical insurance

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There is misunderstanding when it comes to medical aid versus medical insurance, and where hospital plans fit in. Reo Botes explains the differences to clear up any confusion.

The reality is that medical aid, medical insurance, and hospital plans are not the same, and you can’t actually compare them, as they offer completely different benefits and serve different purposes. In fact, many people choose to have both, to cover all eventualities. It all comes down to affordability and personal needs, but understanding what each offer, and talking to a financial advisor or broker, can help you to make an informed decision.

Demystifying the difference

Part of the confusion that comes in around the various healthcare products is the naming of them. Medical aids are also known as medical schemes, and medical insurance is also called health insurance. In addition, and to add to the complexity, there are hospital plans, which can fall under medical schemes or medical insurance products, but the benefits they offer will also differ slightly.

The most basic difference comes down to the way they are regulated. Medical schemes fall under the Council for Medical Schemes, while medical or health insurance is offered by insurance companies and is regulated by the Financial Services Conduct Authority. But what does this mean for you?

The Council for Medical Schemes regulates the pricing of medical schemes and mandates that all medical schemes must provide cover for a list of 271 Prescribed Minimum Benefits (PMB), which must be factored into the cost of premiums.

Health insurance has different regulatory requirements, but they do not have to cover PMB, some do cover chronic diseases, which in turn means they are able to offer significantly reduced premiums and have more leeway in choosing the way certain chronic conditions are covered.

Health insurance is typically aimed at day-to-day medical expenses such as visits to GPs, dentistry and optometry. Hospital plans offer cover for in-hospital procedures, but under a medical scheme will still offer cover for PMB. However, under medical insurance, this is not the case, some do offer very specific cover for chronic diseases and the management thereof. Medical schemes will not have an overall limit for hospital procedures and will cover elective procedures, while medical insurance will have set limits on the amount of hospital cover and typically will not cover elective procedures.

Cost versus benefits

The most significant difference at face value is the price. While medical aids run into thousands a month, medical insurance is significantly less expensive, which makes it an attractive option. However, it’s vital to weigh up the pros and cons and the differences in coverage before making any decisions that could potentially be life-altering.

Health insurance and medical aid serve different needs, often to different markets. Health insurance is a more affordable option and gives more people access to quality private healthcare, but there are limitations. Medical insurers will work with networks of preferred suppliers, especially for dentistry and optometry, and will not cover hospitalisation unless a hospital plan add-on is selected. This hospital cover will not be the same as a hospital plan offered by a medical aid scheme.

Access to the best private healthcare you can afford

It all comes down to affordability and personal needs. Some people choose to have a basic hospital plan through medical aid and top it up with health insurance to cover day-to-day medical expenses in a more cost-effective way than having comprehensive medical aid, but for others, this is still not an option.

The reality is that there are no perfect solutions, and you need to align with your own unique needs, personal health challenges and goals, especially when it comes to affordability.

Reviewing the various products that are on the market can be a confusing exercise so it’s always a good idea to chat with a financial advisor or a broker to help you get the best fit for your budget and circumstances.

Reo Botes is the managing executive at Essential Employee Benefits.

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Reo Botes is the managing executive at Essential Employee Benefits.
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Harvesting seaweed to treat diabetes and obesity

Harvesting seaweed to treat diabetes and obesity

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S’thandiwe Magwaza received her Master’s in Biochemistry cum laude for her research on the use of seaweed to treat diabetes and obesity.

S’thandiwe Magwaza’s dissertation titled: Studies on the antioxidative, anti-diabetic and anti-obesogenic potentials of some marine macroalgae or seaweeds collected from the Southern and Western coastlines of South Africa, was supervised by Professor Shahidul Islam (University of KwaZulu-Natal).

She explained that obesity and Type 2 diabetes (T2D) have become significant global health concerns in recent years. “These conditions are associated with a range of serious health complications, including heart disease, stroke, kidney disease and certain types of cancer,” she said. “Understanding their causes, risk factors and management is crucial to improve public health and reduce the burden of chronic diseases.”

The prevalence of obesity and T2D has continued to rise in recent decades and is expected to triple in the next 30 years. They are not only a health problem, but they also impose an economic burden. These conditions are often linked as obesity is a major risk factor for the development of T2D. The pharmacological treatments have side effects and are expensive.

“There is great demand for natural anti-obesity and anti-T2D remedies owing to the fact that they cost less and have fewer to no side effects,’ said S’thandiwe. “A number of seaweeds go to waste although many medicinal plant extracts and their isolated compounds have been scientifically proven to possess anti-obesity and anti-T2D properties.”

23 types of seaweed collected

Her research evaluated the anti-obesity, anti-diabetic and antioxidant potentials of 23 types of seaweed collected on South Africa’s southern and western coastlines. They were evaluated using in vitro and ex vivo experimental models.

Seaweeds have been used to treat various ailments in East Asian countries for centuries. Yet the health benefits of seaweeds from South African coastlines are not well-explored. Seaweeds are rich in bioactive compounds including polysaccharides, polyphenols and peptides, which have demonstrated potential health benefits. Investigating these natural sources for their anti-obesity and anti-diabetic properties can lead to the development of safer and more sustainable therapeutic options.

Thankful for support

S’thandiwe has registered for a PhD and is currently continuing her research under Islam’s supervision. She thanked him for his academic guidance and paid tribute to colleagues at the Biomedical Research Laboratory for their contributions and assistance. She also acknowledged the National Research Foundation for financial support throughout her postgraduate studies.

S’thandiwe thanked her mother, Ntombenhle Ngcobo Magwaza, for her love, support, encouragement and prayers and for the sacrifices she made to ensure she had the opportunities she needed. She paid tribute to her late grandfather who ignited her love for education, noting that it was the one thing no one could ever take from her.

“I always use my breaks to spend time with my family as they are important for my mental and emotional well-being,” said S’thandiwe. “The memories we create together and the emotional connection I have with them serve as a source of comfort during challenging times.”

Sthandiwe Magwaza

MEET THE EXPERT

S’thandiwe Magwaza received her Master’s in Biochemistry cum laude for her research on the use of seaweed to treat diabetes and obesity.

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