Chosen transformation – Travis Frans

University student, Travis Frans, shares his story of losing over 20kg by exercising and cutting down his intake of carbohydrates and sugar. This lifestyle change has led to the termination of his Type 2 diabetes medication.


Travis Frans (21) is currently studying music at Nelson Mandela University in Port Elizabeth. He is originally from East London.

Travis before he started his lifestyle transformation.

Diagnosis

In March 2016, Travis had mumps and went to a doctor. Out of curiosity he asked the doctor why his urine colour is dark and never light.

The doctor tested his sugar and told him to come back for a fasting blood test. The test results confirmed he had Type 2 diabetes. “As a 19-year-old, I was dumbstruck. A lot of thoughts were crossing my mind. I did not know what do, who to tell or call because I didn’t know anyone who has diabetes besides my late grandfather. News like this is not what one expects at this age,” says Travis.

Travis was put on oral medication: Glucophage 500 and Diaglucide MR 30mg.

Student lifestyle

At that time, the music student weighed 91kgs. He explains, “As any student can relate, one survives on pasta, rice, bread and potato chips as a foundation of every meal. My only exercise consisted of walking to the university, which is about 1,7km, and sometimes walking back.

Deciding to make a change

With the news of his chronic illness, Travis decided to change the way lived. Plus, he knew his 21st birthday was approaching and as he says, “We (my family) go big. So, I wanted to look good for it.” So, then his transformation journey began. “I have a friend, Sibabalwe Ngewu, who studied Human Movement Sciences and is a fitness trainer. I asked if we could do some exercises and I’ll start eating healthy. She agreed and our journey started,” Travis explains.

Implementing the change

Growing up in a Christian environment, the young man knew he had to start with his mind. The Bible scripture Romans 12v2 (“Do not be conformed to this world, but be transformed by the renewal of your mind, that by testing you may discern what is the will of God, what is good and acceptable and perfect.”) was his reference point. Siba’s advice before a training session ‘to be mentally prepared for the session’ proved Travis was off to a good start.

In 2017, Travis started training sessions, with Siba, two to three times a week, which focused more on cardio (to lose weight). “Instead of following a diet or eating plan, I substituted, for example, brown rice rather than white rice; sweet potatoes instead of normal potatoes; and I gradually cut down on my sugar intake and ate more proteins and vegetables,” Travis explains

Unfortunately, Siba had to leave and Travis was then referred to Sikhumbuzo Dlamini, another fitness expert. They started training together in August. With the new trainer, so came more intense training: three times a week for one hour. “It may sound a little but it was hard,” Travis adds.

What did the change come down to for the music student? “It’s all about changing your habits -what you do daily. Once it became a regular thing, it became second nature.

Cardio (fat burning exercises) was the main part of the exercise regime so Travis could lose weight. Though, he now focuses more on toning and building muscle.

21kg lighter

After a year of dedicated training and clean healthy eating, Travis weighs 70kgs. He looked and felt incredible at his 21st birthday party.

The 20kg weight loss led to his doctor cutting down his medication. Six months later, at his check-up, his medication was stopped completely. Well done Travis!

The 21-year-old is extremely proud of himself and admits he wouldn’t have made the change if he hadn’t been diagnosed with Type 2 diabetes. He has since been made a brand ambassador for Bullyz Fitness.

Follow Travis on Instagram @travisfrans92 or Facebook Travis Frans.

MEET OUR EXPERT

Laurelle Williams is the Editor at Word for Word Media. She graduated from AFDA with a Bachelor of Arts Honours degree in Live Performance. She has a love for storytelling and sharing emotions through the power of words. Her aim is to educate, encourage and most of all show there is always hope. Feel free to email Laurelle on [email protected]

The new you

The saying, “You cannot heal in the same environment where you got sick” presumes that changing yourself and your environment can be a healing medicine.


It’s time to find out who you want to be, to see what is not working and to plan something new. Each one of us is a mystery, with both a creative and destructive side. Sometimes what we think we want is not what we manage to do. Sometimes we feel we want to be different but we do not know where to start.

Be the architect of your own life – start with a blueprint

Architects always start by asking questions to see what the new building needs.

  1. When do I feel good about myself and my life?
  2. What do I recognise needs to be changed?
  3. What have I truly accepted that I need to change to have better health?
  4. Am I aware of the urgency of making these changes?
  5. Is there something I can do differently now than what I did before?
  6. Can I introduce something new into my life?

Start laying the foundations of your new life

Here is an opportunity to write your own new story of who you want to become, by doing a short introspection with the help of Dr Seuss, the prize-winning author and cartoonist who wrote many inspiring books for children and adults.

Start by taking an exercise book, which will become your daily companion, and write down each of the following questions below on separate pages – page 1 – 5. Then with the wisdom and help of the thought-provoking quotes from Dr Seuss, write down your own plans, dreams and strategies for each question.

At the end, you’ll have a clear picture of who you want to be, where you want to go and how to get there. You’ll also have found ways to encourage and empower yourself when things get tough. As Dr Seuss says, ‘Kid, you will move mountains!’

Your Blueprint – preliminary questionnaire

All italics quotes are by Dr Seuss to inspire you to have fun while you design the new you.

1. What am I doing with my life?

  • “Today was good. Today was fun. Tomorrow is another one”.
  • “You’re off to great places! Today is your day! Your mountain is waiting, so get on your way!”
  • “And will you succeed? Yes! You will, indeed! (98 and ¾ percent guaranteed)”

2. When do I sabotage (harm) myself?

  • “Sometimes the questions are complicated and the answers are simple.”
  • “If things start happening, don’t worry, don’t stew, just go right along and you’ll start happening too.”
  • “With your head full of brains and your shoes full of feet, you’re too smart to go down any not-so-good street.”
  • “Don’t cry because it’s over. Smile because it happened.”
  • “When you’re in a slump, you’re not in for much fun. Un-slumping yourself is not easily done.”
  • “My trouble was I had a mind but I couldn’t make it up!”

3. Who do I want to be?

Only you can control your future.

  • “You have brains in your head. You have feet in your shoes. You can steer yourself any direction you choose.”
  • “Think! You can think any think that you wish…”

 

4. Where can I find my true self?

  • Today you are you, that is truer than true. There is no one alive who is youer than you.”
  • “Think left and think right and think low and think high. Oh, the things you can think up if only you try!”
  • “It is fun to have fun but you have to know how.”
  • “You’re in pretty good shape for the shape you are in.”
  • “Today I shall behave, as if this is the day I will be remembered.”
  • “A person’s a person, no matter how small.”
  • “It’s opener there in the wide-open air.”

5. How can I change to be more me?

  • “So be sure when you step, step with care and great tact. And remember that life’s a great balancing act. “
  • “It is better to know how to learn than to know.”
  • “Unless someone like you cares a whole awful lot, nothing is going to get better. It’s not.”
  • “It’s not about what it is, it’s about what it can become.”

Start building your new life and make a habit of reviewing it every evening

  1. Each evening, before you go to sleep, look back on the day with wonder for what has happened.
  2. Use your book to plot your progress and find new strategies with the help of Dr Seuss to overcome difficulties and to celebrate your miracles.
  3. Write down your miracles and your challenges and sleep on them.
  4. In the morning, new strength will come to you with the dawn.

Positive words for inspiration

When forming your responses to problems, you may like to look at these positive words for inspiration:

  • Action, abundant, accept, adopt, adventure, achieve, active agree, alive, amaze, appreciate, artistic, assertive, astonish authentic
  • Beaming, believe, benefit, big-hearted, blessed, brave, bright bubbly, brilliant
  • Calm, celebrate, change, charming, cherish, clarity, clean companionship, comrade, connect, confident, courageous creative, cultivate, curious
  • Delight, delicious, discover, deliver, dream big, dig-deep, direct distinguished, donate
  • Eager, earnest, easy, efficient, enthusiastic, essence, essential excited, expand, express, explore
  • Faith, family, famous, fortunate, flourish, freedom, frolic, fresh, friendship, friendly, full, fun
  • Gather, glad, generous, genius, gift, giving, graceful, grin gratitude, grow, group
  • Happy, harmony, healthy, heaps, heartfelt, helpful, here, hold, honest, honour, hug, human
  • Idea, ideal, imagine, indescribable, incredible, independent, innovative, inspire, intuitive, invaluable
  • Jovial, joy, jester, jubilation, juggle, jump, just
  • Keep, kind, kindle, kingly, knead, knit, knowledge, kitten
  • Laidback, laugh, leader, legendary, learn, lift, light, lively, love lovely, luscious, luxurious
  • Maintain, master, mend, metamorphose, mind-blowing, miracle, mission, mobile, mould, modify, motivate, move, muster, multiply
  • Nature, natural, nail, nimble, nurture, nourish, novel, now
  • Oasis, open, open-minded, optimistic
  • Pact, pace, pat, peace, playful, plant, plenty, pleasure, positive proud, poise, popular, positive, prepared, productive, project pretty, purpose
  • Quaint, quest, quick, quiet, queenly, quintessential, quality
  • Ready, recognise, refresh, rejoice, remarkable, renew, resolve replenish, respect, restore, revere, respond, resolution, rewarding
  • Safe, secure, serenity, smart, solution, solve, sparkling, splendid, spontaneous, strong, support, supple, surprise, sure, sustain
  • Thankful, thrive, team, tranquil, truthful, trusting, together, transform, trail-blazer, top
  • Unity, unusual, unwavering, up, upbeat, untie
  • Value, venerate, venture, vibrant, victorious, vigorous, vision vital, vivacious, voyage
  • Wander, wait, well, welcome, whole, wholesome, wonderful, wonder, wishes
  • Yes, young, youthful, yin yang, yippee, yell, yes
  • Zeal, zen, zest, zing, zephyr, zodiac, zzzzz

With thanks to http://www.creativeaffirmations.com/positive-words.html from their ideas.

Please contact Noy Pullen if you would like more information on her resources: [email protected] or 072 258 7132.

AGENTS FOR CHANGE IS A DIABETES SOUTH AFRICA PROJECT

MANAGED BY NOY PULLEN


Understanding the steps to diabetes self-management

We explore ways to help you learn and implement self-management practices.


The diagnosis of diabetes

If you or a loved one have just been diagnosed with diabetes, you may be feeling an overwhelming amount of mixed emotions. Diabetes is a complex and serious condition, and living with it every day can be challenging1. Part of that challenge is due to the fact that the management of diabetes will largely rest in your hands. This can be daunting. Be kind to yourself and remember that small positive steps every day will make a difference in the long run.

Getting started with self-management

Ideally, on diagnosis, you should have access to a team of healthcare professionals. This may include the treating doctor, a diabetes educator or coach, and possibly a dietitian.

However, in many cases you might only have access to a doctor and your time spent with him or her in consultation will be limited.

In the beginning, you may feel overloaded with information about what to eat, how much to exercise, when to take your medicine, how to test as well as confusing terminology, such as HbA1c, hyperglycaemia, hypoglycaemia, glycaemic control etc.

To help make sense of it all, diabetes educators have developed some key areas to focus on1:

  1. Healthy eating

Having diabetes does not mean you must give up your favourite foods. Over time and through experience, you’ll learn how the foods you eat affect your blood sugar. You should eat regular meals and make food choices that will help control your diabetes better1.

Work with a dietitian or diabetes educator to develop a healthy, balanced eating plan that suits your lifestyle. Remember that it is okay to treat yourself once in a while. You can also visit the Accu-Chek website and download the Accu-Chek portion plate which will give you some practical tips on healthy eating.

  1. Being active

Guidelines for the management of Type 2 diabetes refer to studies that have proven that regular physical activity significantly improves blood sugar control, reduces cardiovascular risk factors, and may reduce chronic medication dosages2. Regular physical activity may also improve symptoms of depression and improve health-related quality of life2. Try to include a combination of cardio and resistance training into your weekly exercise routine.

  1. Self-monitoring of blood glucose (SMBG)

The International Diabetes Federation (IDF) recommends SMBG as an effective means for patients with diabetes to understand more about their condition and the influence of events – such as exercise, stress, food and medication – on blood sugar levels3.

However, for SMBG to be effective, it’s recommended that you practice structured testing using a tool, such as the Accu-Chek 360 3-Day Profile Tool3 which can be found on www.accu-chek.co.za

Structured testing is testing at the right times, in the right situations, and frequently enough to generate useful information3. Always agree with your doctor or diabetes educator what your individual structured SMBG testing plan is.

Another aspect you should discuss with your doctor will be your target range for your blood sugar levels. In the beginning, understanding this range and what is considered out of range may be confusing, so you may want to make use of a meter such as the Accu-Chek Instant Meter which offers a support tool called the target range indicator (TRI)4.

A study done on the TRI showed that 94% of study participants were able to easily interpret their blood sugar values through the use of the target range indicator4. Furthermore, 94% felt that the support tool will help them discuss their blood sugar values with their doctor4.

  1. Taking medication

You may need to take medication to help keep your blood sugar (glucose) level steady. Diabetes can increase your risk for other health conditions, such as heart or kidney related problems, so you may need to take medicine to help with those too1.

  1. Problem solving

When you have diabetes, you learn to plan ahead to be sure you maintain blood sugar levels as much as possible within your target range goals – not too high, not too low.

As we know, things don’t always go according to plan and a stressful day at the office or an unexpected illness can send your blood sugar in the wrong direction. Days like this will happen from time to time. Here are some tips to cope1:

  • Don’t beat yourself up – managing your diabetes doesn’t mean being perfect.
  • Analyse your day and think about what was different and learn from it.
  • Discuss possible solutions. This can be with your doctor, your diabetes educator or even a face-to-face or online diabetes support group. Try joining some of the online diabetes communities out there, such as the Accu-Chek Facebook page which has over 148 000 members. You can join the conversation at AccuChekSubSahara.

Wearables transform the healthcare industry

Wearable technology is more than just a fancy accessory strapped to your wrist. Nowadays, wearables play a fundamental role in transforming the healthcare industry and provides a clearer picture of an individual’s health status.


Cardiogram 

Cardiogram, an app that allows you to track your heart rate, designed by a mobile tech company with the aim of reinventing preventive medicine, recently announced their learning network, DeepHeart, is not only able to detect hypertension, sleep apnoea, and atrial fibrillation by using data gathered from 14,011 Apple Watch users, but it was also able to detect that 462 of them had diabetes – resulting in 85% accuracy in its diagnosis.

How does it do this?

Cardiogram and the University of California, San Francisco used 14,011 subjects and some 200 million heart rate sensor measurements to train DeepHeart and test the accuracy of the neural network’s ability to distinguish between people with and without diabetes.

DeepHeart can monitor the pattern of beat to beat heart rate variability to detect changes that are associated with diabetes, such as elevated resting heart rates or slower heart rate recovery after exercising.

2018 will see Cardiogram launch new features to incorporate DeepHeart directly within the app. This is just one example of how the merging of two worlds is changing the foundation of an industry.

Apple has the advantage

However, for the potential of wearable devices to be fully realised, it’s critical that the data collected is integrated across all devices, and that there is governance over its storage. It’s vital that all data is secure and presented in a format that is easy for the user to understand.

This is where Apple has the advantage. Apple has gone to extreme lengths to create an infrastructure that ensures the privacy and protection of data. Therefore, not only is health data extremely secure, but Apple’s ‘Health Kit’ is built into the operating system; a programming framework accessible via iOS to all application developers. This central framework plugs into iOS wearables, offering users an activity tracker, health vitals, results and records all in one accessible, user-friendly hub that overcomes previous language barriers through its multi-linguistic functionality.

Then, once the user has personally authorised their information to be available, they are able to share this data with healthcare providers, meaning that these providers receive a consistent and comprehensive medical history and lifestyle overview, which would result in a better-informed treatment plan.

Apple’s ‘Medical ID’, available on all iOS devices, such as iPhones and Apple Watches, takes this a step further. All pertinent health information, such as pre-existing conditions, blood type, emergency contact numbers etc. can be pre-loaded and accessed even on a locked phone, in an emergency.

In an accident scenario, having immediate access to this information leads to a quicker response and more appropriate treatment, which can be the difference between life and death.

MEET OUR EXPERT

Vernon Foxcroft is the Business Development Manager at Digicape.

Sugar tax is here

Sugar tax in South Africa came into effect on 1st April 2018. Abby Courtenay recaps what sugar tax is, the aims and how it will affect you.


Firstly, what is sugar tax?

We all know (or should know) what tax is. It is a compulsory payment you make to the South Africa Revenue Service (SARS) on a regular basis to fund the South African government and their initiatives.

Sugar tax is similar but rather than being compulsory it is a method to dissuade consumers on a household level (this means you) from purchasing and subsequently consuming less healthy sugary choices by making them more expensive.

Whilst we are currently unsure of how South African’s will react to these increases, studies from around the world have shown that only when a hefty sugar tax (up to 20%)1 is implemented does this truly have an impact on consumer spending.

In some countries, when foods become more expensive, consumers tend to look for less expensive substitutes. In this case, beverages that are light/zero or sugar-free (usually artificially sweetened) may be a cheaper (but similar) substitute that consumers might lean towards.

This tax might also drive manufacturers to find innovative ways to reduce the amount of sugar in their products to prevent the tax from affecting their sales.

In a modelling study in South Africa it has been predicted that a sugar tax increase of 20% may reduce obesity rates by 3,8% in males and 2,4% in females.2

What are the sugar tax charges?

Currently, sugar tax is to be implemented only to sugar sweetened beverages (SSBs), syrups and other concentrates, not food nor 100% fruit juice or milk. Sugar tax will be charged at the following rates:3,4

  • There is a threshold of 4g sugar/ 100mL of beverage below which sugar is not taxed.
  • SSBs in excess of 4g sugar/ 100mL beverage will be taxed at 2,1 cents per gram above this rate (this is approximately 11% for the most popular soft drink).
  • Syrups and concentrates in excess of 4g sugar/ 100mL beverage will be taxed at 1,05 cents per gram above this rate.

What will happen with this extra money?5

The revenue generated from sugar tax should ideally be used to fund further investigations and interventions, to help reduce obesity in our country. Obesity is rapidly growing out of proportion, much the same as many South African’s waist lines.

Why is it important to reduce your intake of free and added sugars?

Firstly, let’s define what free and added sugars are:

Free sugars are energy-providing sugars, such as monosaccharides (e.g. glucose, fructose, galactose) and disaccharides (e.g. lactose, maltose and sucrose – called table sugar), that are added to foods and drinks during processing by food manufacturing companies, cooks or consumers, as well as sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates – so free sugars include added sugars.

Free sugars do not include intrinsic sugars, which are sugars incorporated within the structure of intact fresh fruits and vegetables, and sugars naturally present in milk.5

There is a large body of evidence that links a high intake of free and added sugars (especially in the form of SSBs) to an increased overall energy intake and subsequently weight gain (and an increased risk of becoming overweight or obese).6,7

Obesity in South Africa

We know that this is a huge (pun intended) problem for South Africans; with up to 65,1% of women and 31,2% of men being overweight or obese and alarmingly, 22,9% of children aged 2-14 years are already overweight/obese.8 Obesity substantially increases your risk for diseases, such as diabetes, heart disease, cancer and respiratory diseases.

In addition to this bleak picture, a high intake of free sugars also increases your risk for dental caries a.k.a rotten teeth.6,7 Treating and managing these diseases places a huge financial burden, not only on the patient and their family but the South African healthcare system as a whole.

The World Health Organization (WHO) recommends that no more than 10% of your total energy intake should come from free/added sugars, and they recommend a further reduction to 5% for additional health benefits. In household measurements, this equates to < 6 – 12 tsp added sugar per day (and to put this into context, 1 x 330mL tin of popular soft drink can contain up to 9 tsp added sugar).

We must always remember that many sugar sweetened products are high in energy and do not contain a significant amount of beneficial nutrients (vitamins and minerals). Thus, when you consume them, you’re displacing more nutritious food options thus decreasing the overall quality of the diet and placing the risk of micronutrient deficiencies.8

So, will sugar tax alone help decrease the burden of disease in our country?

It is important to note that whilst price is a major determining factor for many, it is not the only one. Factors, such as taste and cultural norms, also shape purchasing decisions. Interestingly, only 1 in 7 women consider health aspects when purchasing food.8 Just as taxing tobacco does not reduce or stop people from smoking, taxing SSBs will not reduce or stop all purchasing and consumption of SSBs and reduce obesity on its own. So, on its own it is not enough, however, it is potentially a step in the right direction as part of an overall strategy to tackle a complex problem.5


References:

  1. Powell, LM., Chriqui JF, Khan T, Wada R, Chaloupka FJ. Assessing the potential effectiveness of food and beverage taxes and subsidies for 
improving public health: a systematic review of prices, demand and body weight outcomes. Obesity Reviews, 2013; 14:110-128
  2. Manyema M, Veerman LJ, Chola L, Tugendhaft A, Sartorius B, Labadarios D, et al. (2014) The Potential Impact of a 20% Tax on Sugar- Sweetened Beverages on Obesity in South African Adults: A Mathematical Model. PLoS ONE 9(8): e105287. doi:10.1371/journal.pone.0105287
  3. Economics Tax Analysis Chief Directorate. Taxation of Sugar Sweetened Beverages: Policy Paper. 8 July 2016. 
http://www.treasury.gov.za/public%20comments/Sugar%20sweetened%20beverages/POLICY%20PAPER%20AND%20PROPOSALS%20O 
N%20THE%20TAXATION%20OF%20SUGAR%20SWEETENED%20BEVERAGES-8%20JULY%202016.pdf
  4. Republic of South Africa, Minister of Finance. Draft: Rates and Monetary Amounts and Amendment of Revenue Law Bill. 22 February 2017. 
http://www.treasury.gov.za/public%20comments/Draft%20Rates%20and%20Monetary%20Amounts%20and%20Amendment%20of%20Reve 
nue%20Laws%20%20Bill%20-22%20February%202017.pdf
  5. Association of Dietetics in South Africa (ADSA). Position Statement on the Proposed Taxation of Sugar-Sweetened Beverages in South Africa. April 2017. http://www.adsa.org.za/Portals/14/Documents/2017/March/ADSA%20Position%20Statement%20on%20Sugar%20Tax_Updated%20post%20budget%20speech_2%20Mar%202017.pdf
  6. World Health Organization. Guideline: Sugars intake for adults and children. Geneva: World Health Organization; 2015 
(http://www.who.int/nutrition/publications/guidelines/sugars_intake/en/)
  7. Scientific Advisory Committee on Nutrition. Carbohydrates and Health. 2015, London, TSO 
(https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/445503/SACN_Carbohydrates_and_Health.pdf)
  8. Shisana O, Labadarios D, Rehle T, Simbayi L, Zuma K, Dhansay A, Reddy P, Parker W, Hoosain E, Naidoo P, Hongoro C, Mchiza Z, Steyn 
NP, Dwane N, Makoae M, Maluleke T, Ramlagan S, Zungu N, Evans MG, Jacobs L, Faber M, & the SANHANES-1 Team (2014) South African National Health and Nutrition Examination Survey (SANHANES-1): 2014 Edition. Cape Town: HSRC Press. (http://www.hsrc.ac.za/uploads/pageNews/72/SANHANES-launch%20edition%20(online%20version).pdf)

MEET OUR EXPERT

Abby Courtenay RD (SA) is an associate dietitian at Nutritional Solutions Grayston and Melrose. She graduated with a Bachelor of Dietetics at University of Pretoria and also holds a Masters’ degree in Nutrition from the University of Stellenbosch. Abby has a special interest in: women’s health, infant feeding and oncology.

Eat breakfast like a king

Donna van Zyl tells us why breakfast is the most important meal of the day.


Breakfast has often been described as the most important meal of the day. In the 1960s, it was recommended to “eat breakfast like a king, lunch like a prince and supper like a pauper”.

However, breakfast is often skipped due to the rush in the morning, to get the children dressed and ready for school. And then, we can’t understand why we are ravished with hunger, irritated and tired mid-morning.

Eating breakfast can improve your strength, focus and concentration or problem-solving abilities, and leads to less irritability and tiredness.

Diabetic friendly breakfast

A diabetic friendly breakfast should be packed with fibre from unrefined carbohydrates, protein, vitamins and minerals.

Most wholegrain unrefined carbohydrates have a low glycaemic index which help regulate and keep blood sugar levels stable. These carbohydrates are often also a source of  fibre which aids in keeping one fuller for longer. Examples include: oats or a high-fibre bran cereal, wholegrain, rye or seed-loaf breads.

Lean proteins – your source of amino acids and the building blocks of your muscle – also aid in keeping one fuller for longer, and add benefit to stabilising blood sugar levels. Examples include: lean chicken, fatty fish (salmon, mackerel or sardines), lentils/legumes, eggs and dairy products (cottage cheeses, milk or yoghurt).

Then adding fruits, even vegetables, to the meal put colour on the plate and add to the fibre, vitamin and mineral content that should be consumed for the day. Examples include: avocado, olives, sugar-free nut butters or nuts and seeds. These additional food items contribute to a well-balanced king’s breakfast plate providing mono-unsaturated fatty acids that are also cardio-protective.

Ideas for your king’s breakfast plate:

  • Thinly sliced salmon served with thinly sliced avocado, cucumber on rye or wholegrain toast.
  • Poached, scrambled or hard boiled eggs served with sautéed spinach, mushrooms and Rosa/Cherry tomatoes on rye or wholegrain toast.
  • Unsweetened yoghurt served with fruit salad or berries, topped with raw rolled oats, nuts and seeds.
  • Scrambled egg muffins filled with spinach and feta, or bacon and cheese, or any leftover in the fridge.
  • Cooked oats topped with berries, nuts and a drizzle of cinnamon.
  • Bircher muesli (unsweetened muesli and chia seeds soaked in unsweetened yoghurt topped with diced fruit and nuts).
  • Fish (haddock) served with rye or wholegrain toast and freshly diced tomato.
  • Fruit smoothie (berries and banana, or banana and peanut butter, or a tropical version with mango and melon).
  • High-fibre cereal, fruit and milk.
  • Sardines served on rye or wholegrain toast, topped with thinly sliced tomato.
  • Sugar-free peanut butter served on rye or wholegrain toast with a sliced banana.

 Insulin to carbohydrate ration

Importantly, most individuals inject insulin based on an insulin to carbohydrate ration i.e. the amount of insulin required to cover the carbohydrates consumed.

If an individual’s ration is 1:15, then 1 unit is injected to cover each 15g of carbohydrate. With older children one can inject approximately 20min before the breakfast meal.

Final breakfast tip

Be cautious of too much carbohydrate consumption for breakfast, due to the body being more resistant to insulin in the morning. Give preference to lean proteins and colour on the plate. Be a little bit more active after breakfast to promote insulin sensitivity.


References:

  • Spence, C. 2017. Breakfast: The most important meal of the day? International Journal of Gastronomy and Food Science 8:1–6
  • Duyff, RA. Complete food and Nutrition Guide, Academy of Nutrition and Dietetics. 2012.

 


MEET OUR EXPERT

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

The path to long-term weight loss

Weight loss has been and will always be a hot topic, especially given how much focus is placed on image and body shape in general. Cara-Lisa Sham reveals the path to long-tern weight loss.


Before I start, I must emphasise: weight loss must always be a bonus consequence, not the cause of healthy living. You may be thinking ‘but I want to lose weight – that is my goal?’ Okay fine, you want to lose weight. I get it. There is nothing wrong with wanting to better your body. My argument here is, don’t make it the focus of changing your lifestyle, because if it becomes the sole driver of your healthy habits, those habits certainly aren’t going to stick.

Let me explain…

When we focus only on our weight or body shape as the reason for implementing healthy lifestyle changes, these changes become linked with the numbers you see on a scale. This means that if you’ve lost weight, you will think “Yay, healthy eating and exercising is awesome!”, but if you don’t lose weight, or you don’t see quick results (we’re all about instant gratification these days), you’ll think “What a waste of time, I’m not doing this anymore!”

So, in this way, you’re connecting your healthy behaviours to something very fickle. That is, the amount of weight you’ve lost rather than how good you feel, or how much more energetic you are.

Tell me this, what happens when you’ve reached your goal weight? Does this mean that you should stop those healthy behaviours because the link they share to your weight is now fulfilled?

Doesn’t make much sense, does it? Logically speaking, if you go back to your old ways, you’ll inevitably gain the weight back. But if you stick to your healthy changes, where the link between health and weight is now deeply entrenched, you won’t feel satisfied in doing so any longer, because, well you’ve lost the weight. This creates a bit of a predicament: why persist with something that’s already achieved?

The ultimate path here is:

Your thought process about healthy living

In maintenance, there comes discipline. The thing with us weirdly complex humans, is that we always want what we can’t have. If we feel confined or restricted in any way, we start feeling the need to rebel. So, for every crash diet you go on, your cravings for the no-go foods will amplify tenfold. Your mind-set or thinking about why you’re doing what you’re doing is critically important. You need to hack the system here to see and maintain long-term results.

That is, you need to attach the right reason to implementing an inherently restrictive change by appraising it in a way that is maintainable for the long run. If you set your mind right from the get go, the rest is easy. And for this reason, it is never a good idea to programme your mind to focus on weight. There are so many factors that affect weight – hormones, time of day, water retention, what you ate that day…the list goes on. So, you would really be setting yourself up for failure if this becomes the be all and end all of eating clean and exercising.

Now, if you decide to apply healthy behaviours because you care about your longevity, and want to feed your body with nutritious healing foods, and want to feel more energetic and zestful, then that will be a far more motivating reason to stick to eating healthy. In this case, what food you choose to eat becomes more about how it will benefit your body on a cellular level and less about the calories or fat contained in the food.

Don’t obsess

How many of you obsess about fat, calories and carbs? The more attention you put on something, the more it comes back at you. You’ll find you’re craving exactly that: carbs, fat and calories. Don’t underestimate your thoughts; they are a lot stronger than you may like to believe.

If you’re focusing on eating well and exercising because you want to better your health and be more energetic, then that is what you’ll attract. You’ll want to eat more of the good foods that are making you feel great; you will want to exercise consistently because it makes you feel so good and energises you; you won’t crave the not-so-good stuff because the good stuff is making you feel awesome. And, the weight will come off easily.

Of course, this requires time, commitment and discipline. But once you start the habit, it will simply fall into place because you’re feeling fantastic. So, naturally you’re going to want to do more of it. And when you feel like the occasional treat, you’ll still be able to enjoy it without feeling guilty afterwards.

14 principles to kick-start your path to long-term weight loss but ultimately for a healthier, happier life:

  1. Cleanse your system: As you wake-up, drink a glass of warm water with lemon every single morning. This cleans the gut, detoxifies the system, boosts the metabolism and prepares it for digestion.
  2. Prep your gut: Take one high-quality probiotic capsule per day. Take your probiotic with the cleansing lemon tonic. Probiotics help maintain healthy bacteria in the gut and balances your digestive system. Due to high stress levels, our digestive systems take a lot of strain. Therefore, taking a probiotic is a great way to re-establish a healthy gut environment. Remember healthy digestion is key to fat loss. Digestive enzymes are also very helpful if you’re struggling with digestion; one capsule with every meal will help ensure that your body is breaking down the food properly, and utilising it for energy.
  3. Eat smart carbs: Yes, you can still eat carbs. Carbs are the main and most effective source of energy, so why would we exclude them? It’s not about excluding them, rather it’s about choosing the right ones. Think vegetables, legumes, wholegrains and small portions of fruit. To maximise fat loss, avoid eating complex grain-based carbohydrates after 4pm (unless you have exercised in the evening). Once you have reached your fat loss goal, you can start enjoying small portions of healthy carbs at night. Eat your carbs when it makes sense: if you are having an active day, then carbs make sense to replenish energy. If your day is quiet and involves a lot of sitting, then you don’t need as many carbs.
  4. Exercise: Aim to exercise at least four times per week. Find something that works well for you, and that you enjoy. Don’t go crazy on fads. Train based on what works for your body type. And when you find what you love, pretend you’re an athlete, and then train like one. We, as humans, have forgotten that our bodies are biologically designed to be high-performance machines. Independent of your current physical fitness or ability, know this your body is a performance masterpiece.

Why train like an athlete?

  • By training like an athlete, you will finally tap into your body’s full potential by working it in the way that it was designed for.
  • Your focus will be away from aesthetics, and onto high performance. This is the right kind of focus. Working on improving speed, strength, power, and endurance, all the things the human body is designed for. And, the aesthetics will come in a big way.
  • You will feel better than you’ve ever felt in your life. Your metabolism will be fired up, your circulation will improve, your energy levels will sky rocket. And you will be motivated, not just with exercise, but in all areas of life. It’s a wonder to see how much of what you learn in mastering your physical ability is transferable to mastering work, and life in general.
  • You will finally come to realise just how incredible your body is – what it can do, and tap into skills and abilities you never knew you had, which will also do wonders for your confidence!
  • You will develop mental strength, a mind-over-matter approach, that can be applied to all areas of life.
  • Above all, you’ll realise that the more effectively you fuel your body, the better your athletic performance will be. And so, naturally you’ll want to eat healthier.
  1. Practice restorative movement: Yoga, Pilates and stretching are considered restorative movements as they incorporate movement and breath, and help build the mind-body connection. These types of exercises also work on strengthening and lengthening muscles, and target muscle groups that you wouldn’t usually work in other types of training. Try to add one to two sessions a week to your training to promote a good balance of exercise. There are fantastic online yoga and Pilates workouts.
  2. Rest your body: I cannot stress enough how important it’s to provide your body with sufficient rest. I advise a minimum of two rest days per week to allow muscles to fully recuperate, build and restore. Over-exercising causes muscle breakdown; increases susceptibility to injury; raises cortisol levels (stress hormone which activates fat storage); and can impede fat loss due to fatigue. Too much exercise can really send your body into panic or survival mode which causes it to hold on to all its nutrients including fat, so less is more! I also recommend taking one full week off every four to six weeks to allow your body to fully restore. This will enable your body to settle and reset so that it is ready to perform at maximum capacity again. During this time, focus on restorative movement and stretching to promote blood flow. 
  3. Get a good night’s sleep: Make sure that you get at least seven hours of sleep per night. Switch off your phone, laptop, TV and all technology at least 30 minutes before going to sleep. This will allow your mind to quieten, and your body to relax and prepare for rest. Please do not sleep with the TV on! The flashing light stimulates your brain and prevents you from a deep and peaceful sleep. Lack of sleep also causes us to feel energy-depleted, which makes us crave more and more food to replenish the energy that we need. Our cortisol levels increase too – not great for fat loss! So, get plenty of quality sleep.
  4. Get your mind right: Without your mind on your side, your attempts at fat loss become futile. Negative thoughts are the equivalent of throwing acid on a beautiful work of art – all the effort, all the work is to no avail. Start by ripping those negative thoughts to shreds. As they pop up, cut them out and replace them with positive, healthy, happy thoughts. Write down five short statements about yourself/ your body that you want to achieve and word them in the present tense as if you already have them e.g. “I have the most incredible body / I love my waistline”. Visualise exactly what you want your body to look like and contemplate this image for five minutes every day. Detail is key, try to capture exactly what your body looks like, feel the emotions associated with having achieved your best body. While you are picturing this image, repeat your statements with conviction and belief. Even if at first you don’t believe it, just push through and continue.
  5. Hydrate: Make sure that you drink plenty of water – eight glasses or 2 litres per day. At first, this will be irritating because you’ll need to go to the bathroom often, but once your body adapts, you won’t need to go as much. I recommend making a large jar of green tea (2 tsp. green tea leaves and 1 litre hot water). Keep this by your desk and drink throughout the day. Green tea is incredible for detoxing your system, flushing out any gunk and boosting your metabolism.
  6. Treat yourself: Allow yourself to indulge on occasion. Don’t ever feel deprived. You want to maintain a healthy relationship with food. Enjoy one to two treat meals/snack per week – limit this to 1 meal or snack only and then eat healthy for the rest of that day. Avoid allowing your treat meal to turn into a treat day as this may turn into binge eating. Treat meals are a great way to raise leptin (fat burning hormone) levels which promotes fat loss once healthy eating has commenced again. Try to make your treat meal healthy, for example, zucchini pasta, cauliflower pizza, protein pancakes, or low-carb cheesecake. When you’re eating your treat meal, enjoy it, savour each mouthful and tell yourself that you can have more later if you wish. This will help you really feel satisfied and content. Enjoying the occasional treat ties in to building a positive relationship with food; one that is healthy, sustainable and non-restrictive. This means eating clean 80% of the time and indulging occasionally (20%). In doing so, the perception of forbidden foods is eliminated, leptin secretion is maintained and fat loss is optimised.
  7. Get to know your portions: Remember to keep tabs of your portion sizes. This is a key factor in weight loss. Portion size awareness in conjunction with healthy food consumption and exercise (4-5 times per week) is the most effective recipe for sustained weight loss. When you eat, sit down and enjoy your food without any distractions. Make eating the only activity you’re doing – no phone or TV. Be conscious of your food, your digestion, how your body is feeling and how much you’re eating. Chew your food properly and eat slowly. The more connected to your body you become, the easier it will be for you to gauge when you have had enough to eat, without feeling overfull.
  8. Work with your body: Learn to listen to your body. Let it tell you what nutrients it needs. That way you will be able to learn the difference between a craving and a genuine nutritional need. When you eat, stop consumption once you’re comfortable – not full. It takes 20 mins for our brains to register that we have eaten, which is why we often eat more than we should and begin to feel overfull only 10 mins after eating. You’ll see that if you allow your body 10 to 20 minutes to digest your food and to process that you have in fact eaten, you’ll no longer feel hungry. Only if you still feel a little hungry after 20 minutes, then eat a little more.
  9. Do not overeat: Avoid overeating completely. Learn how to decipher when enough is enough. Be mindful of your body and try to come to understand the difference between that point just before satiation and being too full. Over time, your body will learn what portion sizes to expect and will adjust accordingly so that you feel comfortably satiated after the correct portion.
  10. Be in it for the long run: Most of all, look at the healthy changes you’re implementing as ones you intend to keep for the rest of your life. Remember, you are worth it!

MEET OUR EXPERT

Cara-Lisa Sham, founder of the Caralishious brand, is a health expert and blogger, yoga enthusiast and health foods producer with a passion for all things wholesome and nourishing. You can find Cara-Lisa’s online meal plans and lifestyle guides at www.caralishious.com.

Metabolic surgery

Dr Gert Du Toit explains the numerous health benefits metabolic surgery has for obese patients.


Misconception

Many people have the misconception that metabolic surgery (bariatric surgery) is done to achieve weight loss for purely cosmetic reasons. In fact, metabolic surgery shows a high-degree of success in assisting to resolve the medical conditions commonly associated with obesity, including impaired glucose tolerance and Type 2 diabetes.

Although many patients appreciate the cosmetic aspects of metabolic surgery, and the fact that it is effective in assisting them to shed the unhealthy kilograms and keep them off, it is important to note that this treatment is always undertaken for the health benefits it affords patients, rather than for cosmetic purposes.

The health risks associated with obesity

Obesity is associated with a variety of related health conditions, such as metabolic syndrome – a cluster of conditions occurring together including high blood sugar levels and high blood pressure (hypertension); ischaemic heart disease; sleep apnoea; certain kinds of cancers; osteoarthritis, and mobility problems.

One of the most common health risks associated with obesity, and particularly an excess of fat around the abdomen, is Type 2 diabetes. This can cause a variety of severe and even life-threatening complications if it is not properly managed.

There is a strong correlation between the rise in obesity and the explosion in Type 2 diabetes and other lifestyle related chronic health conditions that are currently being experienced not only in South Africa but throughout the world.

Approximately 425 million people globally, and 1,8 million in South Africa, are suffering from diabetes; while one in every two cases have not even been diagnosed, according to the International Diabetes Federation.1 This highlights the magnitude of the global health challenge posed by the deadly combination of obesity and diabetes.

Metabolic surgical approach

Where patients are treated and properly supported pre- and post-operatively by a multi-disciplinary team of medical and other healthcare practitioners at a South African Society for Surgery, Obesity and Metabolism (SASSO) accredited metabolic surgery centre, metabolic surgery presents a safe and viable treatment option for obese individuals, offering real hope of substantially improved health and quality of life.

The surgical approach not only achieves outstanding weight loss results, but also a high degree of success in resolving conditions associated with obesity, including metabolic syndrome, impaired glucose tolerance, as well as Type 2 diabetes.

Three surgical options are available at SASSO-accredited centres to assist obese South Africans who are having difficulties in achieving and maintaining weight loss. The patient is carefully assessed beforehand to ascertain their suitability for surgery, and to establish which kind of metabolic surgery approach will be the most effective in addressing their specific healthcare issue.

The three types of metabolic surgery  all minimally invasive and are undertaken lapascopically through small incisions in the skin. They include restrictive procedures, such as gastric banding and sleeve gastrectomy; procedures with gastric restriction (i.e. Roux-en-Y gastric bypass), which alter gastro-intesinal peptides; and malabsorptive procedures, which involve bypassing a portion of the intestine.

Treatment for diabetes

So successful has metabolic surgery proved in either assisting to prevent, control or even completely resolve Type 2 diabetes, that in 2015 the Second Diabetes Surgery Summit (DSS-II) included metabolic surgery in its global clinical practice guidelines as a standard treatment option for certain categories of people with Type 2 diabetes.2

In addition, the American Diabetes Association (ADA), one of the organisers of DSS-II Summit, has noted that: “Many people who undergo metabolic surgery experience major improvements in glycemia, as well as a reduction in cardiovascular risk factors, making it a highly effective treatment for Type 2 diabetes and a highly effective means of diabetes prevention.”3

Early intervention

As the ADA statement suggests, metabolic surgery can play an important role in diabetes prevention and management. Early surgical intervention shows outstanding potential in preventing the obese patient from proceeding from impaired glucose tolerance (pre-diabetes) to full-blown Type 2 diabetes, and improves outcomes.

Metabolic surgery often achieves a complete remission in diabetes but this depends on how long the patient has had the disease. In international and in our local experience, the best outcomes are achieved in patients who have not had diabetes for more than five years, so early diagnosis is important.

A recent US study4 points out that metabolic surgery in Type 2 diabetes patients results in:

  • Better glyceamic control.
  • Decreased medication use.
  • Reduction in cardiovascular disease risk, heart attack, stroke, cancers and in overall mortality rates.
  • Improved weight loss and quality of life.

The STAMPEDE trial’s (a randomised trial) results were published in the New England Journal of Medicine, and reported similar findings, suggesting that gastric bypass and sleeve gastrectomy, were superior to intensive medical therapy for Type 2 diabetes alone, achieving excellent glycaemic control.5,6

Funding the treatment

Recognising the advantages of early intervention, South Africa’s largest medical scheme, Discovery, revised its funding requirements for metabolic surgery for 2018, reducing the patient body mass index (BMI) requirement from 35 to 30.

This is a significant development and a recognition of the important preventative role that metabolic surgery can play, particularly with regard to pre-diabetes and Type 2 diabetes, which can cause irreversible damage to blood vessels and organs if it is not properly controlled.

This decision, which was made following negotiations with endocrinologist and SASSO chair, Professor Tess van der Merwe, highlights the fact that the metabolic surgery treatment also makes economic sense for many patients, and we expect that other medical schemes will follow Discovery’s lead in covering metabolic procedures in future.

Who will benefit from metabolic surgery?

As there can be numerous highly complex physiological and psychological causes of obesity, and each person has a completely different constitution and metabolic makeup, every case is different and not everyone can have, or will respond well, to the treatment.

Before the decision is taken to recommend metabolic surgery, SASSO-accredited facilities insist that the prospective patient undergoes a thorough physiological and psychological evaluation to ascertain their suitability for the treatment.

The prospective patient needs to demonstrate a commitment to weight loss and long-term follow-up. Those who are abusing drugs or alcohol, or have an uncontrolled psychiatric illness, are precluded from the treatment.

Overweight patients with Type 1 diabetes may qualify for the surgery but it should be noted that, unlike Type 2, it does not assist in managing this form of the disease, but the treatment may have other weight loss related health benefits for them.

All three types of metabolic procedures that are available not only limit how much the patient can eat but also reduce the absorption of nutrients by the digestive system. The individual consequently feels satiated after consuming smaller portions of food.

In the great majority of cases, where patients are treated and properly supported before and after surgery by a multi-disciplinary team, including a psychologist and dietitian, the metabolic surgery approach is safe, achieves outstanding results and is completely life-changing for patients.

Renewed vigour

One patient who has undergone metabolic surgery is Sr Charmaine Thamotharan, a 44-year-old nursing sister who manages the intensive care unit (ICU) at Netcare St Augustine’s Hospital, one of the busiest units of its kind in KwaZulu-Natal.

Her experience of metabolic surgery is typical of most our patients at the Durban Metabolic Surgery Centre based at the hospital, where more than 400 of these procedures have been completed to date.

Weighing 113kg, Sr Thamotharan had reached a stage where she even struggled to climb a flight of stairs without becoming breathless, and her weight was impacting her ability to do her work effectively. She was also pre-diabetic, suffered leg and knee pain, polycystic ovaries, high blood pressure, and high cholesterol levels.

Encouraged by a colleague and the good outcomes that were being achieved at the Netcare St Augustine’s Hospital centre, she decided to investigate the metabolic surgery option. After a thorough physical and psychological assessment at the centre, she finally underwent the surgery in August 2016.

“Since the surgery, my life has changed and I have never looked back,” Sr Thamotharan said. “I have lost 38 kilograms, but more important than that, I have more energy and confidence than ever.”

In consultation with her doctors, Sr Thamotharan was also able to stop her blood pressure, asthma and other medications, and the pre-diabetes and other medical conditions she suffered while she was obese, have been completely resolved. She observed that the procedure itself was quick and painless: it was over within an hour and she suffered little post-operative pain. She was back at work just two days after the operation.

Accredited centres

It is strongly recommended that metabolic surgery be undertaken at a SASSO-accredited metabolic surgery centre, which must at all times adhere to the strict protocols and guidelines of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO).

There are currently 11 centres of excellence for metabolic medicine and surgery in South Africa, six of which are situated at Netcare hospitals, including the unit at Netcare St Augustine’s Hospital. These centres are designed to create a safe and supportive environment for obese patients, who are treated with the highest levels of empathy and care.

Over and above the laparoscopic surgeons, the multi-disciplinary teams at SASSO centres must include highly experienced endocrinologists, physicians, dietitians, psychiatrists and/or psychologists, and biokineticists. Such a team is able to take a comprehensive and holistic approach to weight loss, and determine the most practical solutions for each individual patient.

Not a quick-fix

It should be understood that metabolic surgery is no quick-fix solution for obesity. It requires a long-term commitment to a proper post-surgery diet and on-going follow-ups. However, in appropriate patients who have struggled to lose weight and regain their health for years, such a holistic treatment approach is usually nothing short of life-changing.

Professor Tess van der Merwe who, as director of the Centres of Excellence for Metabolic Medicine and Surgery of South Africa (CEMMS)(SA), oversees the work of the local metabolic surgery centres.

To ensure compliance with stringent international standards, these centres must maintain a comprehensive patient database with statistics on each patient. In addition, strict rules and regulations are in place regarding patients’ dietary environment, as well as care in ICU and wards. Training facilities with specialised technology and equipment are also required.

High-degree of disease resolution

In conclusion, a high-degree of disease resolution and very low complication rates are achieved at dedicated multi-disciplinary metabolic surgical centres. For those who qualify for this treatment, metabolic surgery is a tried and proven option.


References

  1. International Diabetes Federation: http://www.diabetesatlas.org/across-the-globe.html.
  2. Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations: http://care.diabetesjournals.org/content/39/6/861.
  3. Consensus from Diabetes Organizations Worldwide: Metabolic Surgery Recognized as a Standard Treatment Option for Type 2 Diabetes: http://www.diabetes.org/newsroom/press-releases/2016/consensus-from-diabetes-organizations-worldwide-metabolic-surgery-recognized-as-a-standard-treatment-option-for-type-2-diabetes.html.
  4. Metabolic Surgery for Tackling Type II Diabetes Epidemic: https://biomedres.us/pdfs/BJSTR.MS.ID.000401.pdf.
  5. The New England Journal of Medicine, http://www.nejm.org/doi/10.1056/NEJMoa1200225.
  6. The New England Journal of Medicine, http://www.nejm.org/doi/full/10.1056/NEJMoa1600869

MEET OUR EXPERT

Dr Gert du Toit is a surgeon at Durban Metabolic Surgery Centre, Netcare St Augustine’s Hospital.