Dietitian, Annica Rust, helps us understand why the body needs salt as well as why too much is dangerous.

Salt (sodium chloride) is important for your body as it performs vital functions, but consuming more than your daily requirements can be harmful. Most people consume on average 9-12 grams of salt per day, which is double the recommended maximum intake.³ It’s therefore no surprise that 13% of deaths caused globally are by high blood pressure and that on average 225 South Africans are killed by heart disease every day.⁵

The role of salt in food

Salt is commonly used to enhance the flavour of food, in addition to its commonly known benefit of being a preservative, which inhibits bacteria growth and increases the freshness and shelf life. Salt is also used to improve the texture and appearance of food.^1,2

The role of food in our body

The human body needs a small amount of salt to perform vital functions, such as conducting nerve impulses, contracting and relaxing muscles and to maintain the water and mineral balance in the body.¹

How much salt is needed to maintain the vital functions?

We need a minimum intake of 500mg of sodium (1/4 teaspoon of salt) a day to perform vital functions², however it’s recommended that adults don’t exceed 2000 mg of sodium which is equal to 5 grams/1 teaspoon of salt per day. This will prevent high blood pressure (hypertension) and the associate risks of cardiovascular disease, strokes and heart attacks.

Eating too much salt

With a high intake of sodium, your kidneys can’t keep up to excrete the excess sodium in the blood and sodium will accumulate in the bloodstream. To compensate for this, your body will retain additional water to dilute the sodium. However, this in turn will increase your blood volume.

An increase in your blood volume will put unnecessary strain on your heart as it needs to work harder, which over time contributes to high blood pressure. High blood pressure further increases the risk for a heart attack, stroke and cardiovascular conditions. This is especially a problem if you have diabetes, which already places you at an increased risk of a heart attack, stroke and cardiovascular disease. ^1,2

High blood pressure also increases the risk for chronic kidney disease and osteoporosis. Osteoporosis occurs with a high intake of salt which can further increase the amount of calcium that is excreted via urination, causing low blood calcium levels. Low blood calcium levels will result in the breakdown of bone to release the necessary calcium in the bloodstream to maintain blood calcium levels.¹

 Steps to reduce your salt intake

1. Reduce processed and restaurant/fast food

Processed and restaurant foods accounts for more than 70% of the sodium intake of Americans. Cutting down on processed foods will therefore be beneficial to lower your salt intake.⁶

2. Label reading & logo identification

It’s valuable to look at labels, especially the nutritional information table as well as the ingredients listed when deciding which product to buy.

When comparing products, look at the amount per 100g and not the amount per serving. When looking at the ingredient list look out for sodium, monosodium glutamate (MSG), baking soda or sodium bicarbonate or any words containing the term sodium, nitrites, nitrates and salt.

The order in which the ingredients are listed is important as it serves as a rough indication as to how much of that ingredient is in the product. Ingredients will always be listed in descending order of weight (largest to smallest weight). Usually, the first three ingredients that appear in the list make up the largest portion of the product. Make sure that salt is not one of top three ingredients.⁴

Look out for food items with the Heart and Stroke Foundation South Africa logo, given that these food items will be lower in sodium when compared to similar products.

3. Stop using the salt shaker on the table 

4. Reduce the amount of salt when cooking, by using more herbs, unsalted spices and strong flavoured food components to flavour your food.

5. Be aware of hidden sodium

Many food items already have a high amount of sodium included, such as bread, breakfast cereals, processed meats and sausages, stock, soup and gravy powders as well as brick margarine.⁴

When in doubt contact a registered dietitian for assistance. For more information on sodium, please visit The Heart and Stroke Foundation of South Africa

References

1. https://www.hsph.harvard.edu/nutritionsource/salt-and-sodium/ [10 February 2022]
2. Centers for Disease Control and Prevention. 2022. https://www.cdc.gov/salt/role_of_sodium.htm [9 February 2022]
3. World Health Organisation. 2020. https://www.who.int/news-room/fact-sheets/detail/salt-reduction [10 February 2022]
4. Salt watch: https://www.heartfoundation.co.za/wp-content/uploads/2017/10/Salt-brochure.pdf [10 February 2022]
5. Heart & Stroke Foundation. 2022. https://www.heartfoundation.co.za/
6. American Heart Association. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/hold-the-salt-infographic[10 February 2022]

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Yoga teacher and Type 1 diabetes patient, Rachel Zinman, expands on which yoga practice is best for you as an individual.

I’ve been practicing yoga since I was 17 and teaching and sharing yoga worldwide for more than 25 years, so when my diagnosis, at age 42, of Type 1 diabetes came along, it absolutely floored me.

I was convinced that I could reverse my condition and spent six years trying my best. I couldn’t accept that Type 1 diabetes is an autoimmune disease with no known cure.

When life hits rock bottom it’s the simple things that resonate. For me it was my yoga mat. The postures and the meditation kept me sane. I wanted to run away but there was nowhere to go. Slowly and gently I found my way back. First, I found a way to accept my diagnosis. Then I realised that yoga had saved my life.

Ayurveda – how can we keep the body in total balance?

My personal passion for understanding the complexity of the body and how to achieve optimum health happened when I was introduced to the sister science of yoga, Ayurveda. If you’ve never heard of Ayurveda, it means the science of life, and like yoga it considers the body/mind mechanism as a whole and asks the question: how can we keep the body in total balance?

Ayurveda is based in the theory that the body, being composed of the five elements: earth, water, fire, air and ether, is constantly trying to balance itself. And that the mix of elements in each person is completely unique. In other words, it’s not one size fits all.

Each element has a specific quality. For example, ether or space is vast and open while air is light and fast-moving. In Ayurveda, those qualities translate into both body type, and mental and emotional characteristics.

A person who is forthright and charismatic with a more muscular physique has a predominance of the fire element. Whereas someone who is loving and stable with a strong and sturdy build has more earth and water. And someone who has a light frame, quick mind and an artistic bent tends to have more air and ether in their system. What one body thrives on can be another’s downfall. That’s why it’s important to understand your constitution and then find a yoga practice that fits your type.

Benefits of finding a yoga practice that fits your type

In my 30 years’ experience of yoga practice and teaching, I have found that working with a practice that suits you as an individual, decreases stress which in turn leads to a more positive attitude, better blood glucose control and a range of other benefits such as:

• Increased physical strength
• Improved flexibility
• More muscle tone
• Increased insulin sensitivity
• Weight loss
• Better sleep
• Improved function of the internal organs
• Better blood circulation
• Better concentration
• General overall well-being

What is your Ayurvedic type?

Often, we head to the gym or yoga studio and choose a style of yoga that we think we should do. But what we think we should do isn’t always the right practice. If you’re a sucker for hot tamales, garlic and chilli but you always end up with heartburn, you might want to rethink that craving and have cucumber soup instead.

So, if you’re loving hot yoga, but wonder why you keep going hypo, or adore a yin class, but can’t shed those extra kilos. It might be worth knowing your Ayurvedic type by taking this quick ayurvedic quiz.

Vata dominant constitution

1. Do you have a light frame?
2. Are you highly creative and innovative?
3. Do you get stressed easily?
4. Do you crave light, dry foods like salads and crisps?

If you said yes to three or more, you most likely have a Vata dominant constitution. The perfect practice for you is restorative yin yoga, or a slow gentle hatha. Something that’s grounding and nurturing where you can focus on your breath.

No matter what type of diabetes you have, you’ll need to take things slowly. Your priority is to keep the nervous system calm.

Pitta dominant constitution

1. Are you muscular with a medium frame?
2. Do you tend to get angry or frustrated?
3. Do you crave spicy, hot and strong flavoured foods?
4. Are you super organised and focussed?

If you said yes to three or more, you most likely have a Pitta dominant constitution. A cooling practice is best for you. A slow gentle hatha, a yin class, restorative or an easy vinyasa flow. For Pitta, the focus is on keeping your cool. Your tendency is to go hard until you burn out. So, learning to relax, rest and explore gratitude can radically alter the way you approach life.

Kapha dominant constitution

1. Do you have a heavier frame and find it hard to lose weight?
2. Are you patient, loving and calm in the face of stress?
3. Do you crave sweets, bread and fatty foods?
4. Are you good at completing tasks and following directions?

If you answered yes to three or more, you most likely have a Kapha dominant constitution. Your heavier build and slower temperament can benefit from an invigorating practices like Power and Ashtanga vinyasa yoga. The key word for you is energising and stimulating. Anything slow will grind you to a halt. Your biggest challenge is to stay active and motivated.

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One of the biggest fears for people living diabetes is having a low. The good news is that lows are usually avoidable and fairly easy to treat if you have the correct tools at hand.

It doesn’t matter if you have Type 1 or 2 diabetes, having a low (hypoglycaemia) is one of the most frightening experiences you can imagine. So, why do people living with diabetes have lows?

Causes of hypoglycaemia

In very rare occasions, oral diabetic medication can cause a low glucose level. Usually, it’s only insulin that will be potent enough to cause your glucose to drop significantly.

Of all the insulins available, the newer analogue insulins are also less likely to cause a low, so if you’re still taking the same medication as five years ago, perhaps now is the time to change. Added to that, it’s usually the short-acting insulins that are taken at mealtimes that will cause the biggest drop in glucose levels.

The newer, basal or long-acting insulins are more likely to drop your levels across the board and very unlikely to result in a precipitous drop severe enough to cause a ‘hypo’ (glucose level <3,5 mmol/L).

Common factors that cause lows

Most commonly, people have hypos at night as their dinner time short-acting insulin isn’t ideally matched to the food they eat. Adjusting these levels may require a bit of fine-tuning and input from a diabetic educator, dietitian and diabetologist.

The elderly and those with compromised kidney function may also battle with glucose levels that drop for no apparent reason. Eating regular meals and testing often to detect lower levels become especially important in these cases.

Alcohol can also cause glucose levels to drop. Typically, all alcohol is made from carbohydrates: grapes, hops etc. Initially, glucose levels rise as you drink and then they drop as the alcohol is metabolised. A confounding problem in this regard, is we tend to eat less as we drink more, so your body’s ability to maintain normal glucose levels becomes more difficult. Make it a habit to have something to eat with your alcohol to prevent the drop in your glucose levels. Once again, make sure you check your levels often and speak to your doctor about how to avoid this problem.

Exercise can also cause glucose levels to drop as you utilise the calories. However, different types of exercise can result in high or low readings. Once again, it’s best to speak to your healthcare team and get specific and individual advice. Always make sure you’re able to test your levels before and after exercising, and have snacks and insulin available when exercising.

Avoiding a hypoglycaemic event

Regular testing is the obvious answer to how to avoid a low. The more you test, the more you know your own body and can predict how different activities will affect your glucose levels.

You have the option of traditional finger prick glucometers which give point in time measurements, or if you’ve access to a continuous glucose monitor, these give very valuable information on trends throughout the day. Many of the monitors also have alarms that predict levels that are falling too fast, so you can be alerted to lower glucose levels before you actually become symptomatic.

Eating regular meals and, particularly for older people, having a small bedtime snack may also be important in preventing a hypoglycaemic event. Regular snacking isn’t imperative, however, if you find your levels are dropping overnight, then this may be the answer. Ensuring you eat a healthy meal even when you know you will be drinking alcohol is also an important step in preventing unnecessary hypoglycaemic attacks.

If you feel the typical symptoms of low glucose levels, these are often an early indicator that you need to rectify your levels. However, many of the symptoms may also indicate a high glucose level so be sure to test and check. These symptoms may be hunger, thirst, shaking or sweating, feeling tired and weak, restlessness or poor concentration, headaches, or even stomach ache and nausea.

Those who suffer from low glucose levels on a regular basis, may not experience these symptoms at all (hypoglycaemic unawareness) so be aware that your levels may drop without you knowing.

Treating a hypoglycaemic attack

The quote from Robert Burns, “The best-laid plans of mice and men often go awry” is quite fitting for anyone living with diabetes. If you’ve had diabetes for a while, you’ll know that having a hypoglycaemic attack is almost inevitable at some point in your journey. But, as it’s with all of life’s challenges, it’s how you pick yourself up afterwards and recover and learn from the experience that is really important.

The following guidelines seem quite simple but, in the panic, and stress of hypoglycaemia, they can be extremely challenging. Find a partner, parent or close friend (or even a few friends) who know you well and can support you through these times.

1. Any blood glucose value below 3,5 mmol/L is considered a low blood glucose value.
2. For children below six years less than 4mmol/L is a low blood glucose value as they tend not to recognise their symptoms, or they can’t tell you.
3. Start with a quickly absorbed carbohydrate (100ml fruit juice or 3 teaspoons of honey or 15g glucose sweets).
4. Test your glucose levels 15 mins after.
5. If the glucose levels are still <4mmol/L, repeat step 3.
6. If the glucose levels have risen, follow up with a longer-acting carbohydrate (half cheese sandwich or three whole wheat biscuits with cheese).
7. Retest after 15 mins again to ensure levels have gone up.

Why different snacks?

The theory behind the different snacks is that the short-acting carbohydrate will push the levels up quickly, whilst the long-acting carbohydrates (low-GI) will maintain it up there. Do not give insulin for these snacks. Think of these snacks as medication rather than food. You’re eating them to raise glucose levels not because you’re hungry.

Glucagon pens do work but tend to raise the glucose levels too much and may need to be repeated to maintain normal glucose levels. However, they are a good option in a severe emergency whilst waiting for more specialised care.

If you have a hypo just before a meal, you can also skip step 6 and just have your regular meal instead (but perhaps consider an insulin adjustment).

It may seem like intense testing and perhaps not necessary, but it does give you a very good indication as to how your body reacts. It may also seem like very small amounts of food but you’re not wanting to rebound your levels to >15mmol/L but rather keep them as stable as possible.

Perfect hypo kit

All the snacks listed above can also be kept in a small container and don’t need refrigeration so can be easily kept on hand and replaced as necessary. Put some extra test strips and a glucometer, your emergency contact details and medical aid information into the same container and you have the perfect hypo kit.

Managing the rollercoaster of lows

One of the biggest problems we see with treating hypos is patients tend to overcompensate for low glucose levels and then end up with high levels. This then results in extra insulin at the next meal and consequently another drop. This rollercoaster continues and contributes significantly to feelings of fatigue and hopelessness as well as increasing risk of developing diabetes complications.

Try to avoid the panic that often happens and results in people having two sandwiches, a whole can of cooldrink, a bunch of grapes and their favourite chocolate to treat a low. This is a feast, not the right way to treat hypoglycaemia and will only complicate matters further.

If you’re battling, spend some time with your healthcare team and get them to assist with individual advice. Eliminating lows is the first step in gaining better control of your diabetes

An irrational fear

Actually, a very rational fear! What often tends to happen is people prefer to have higher glucose levels to prevent the feeling of hypoglycaemia. If you’ve ever suffered a severe hypoglycaemic attack, you’ll know exactly why you don’t want to feel out of control and so fearful ever again. Work with your healthcare team to slowly bring your levels down to a safe place so that you don’t have to deliberately run too high.

Hypoglycaemia is one of the most common and disastrous events that someone with diabetes can experience. However, they are generally avoidable and most certainly, manageable. Speak to your diabetes team and find out how you should be managing your levels so that you are in control and not riding the crazy rollercoaster all the time.

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