Registered dietitian, Raeesa Seedat, educates us on why our choice of breakfast is so important.

Importance of breakfast

Breakfast is an important part of the diet that contributes significantly towards daily nutrient intakes. Consumption of breakfast leads to positive health behaviour, improved stress management, feeling energetic, and making less unhealthy snack choices.

Skipping breakfast results in fatigue, sub-optimal concentration levels, as well as an increased risk for developing obesity. In people living with diabetes, skipping breakfast can have negative consequences. Studies show that breakfast skipping is associated with increased average blood glucose, poor glycaemic control and increased HbA1C levels.

Skipping breakfast can also lead to an increase in energy intake in the form of lunch, snacks and supper. Achieving and maintaining blood glucose targets is the primary objective for diabetic treatment. Carbohydrate intake is the determining factor in whether this objective is achieved.

Carbohydrates

In all meals, carbohydrates are an important part of a healthy balanced diet. The amount and quality of carbohydrates directly impacts blood glucose levels.

Refined starches and sugars from processed foods are linked with weight gain and poor glycaemic control. These include white bread, white rice, potatoes, certain breakfast cereals and crackers, refined pastas, chips and crisps, sugar sweetened beverages, sweets, muffins and sweetened baked goods.

It is recommended that added sugars, refined and processed carbohydrates be restricted in favour of high-fibre and low-glycaemic index (GI) carbohydrates. The low-GI concept describes how foods consumed impact blood glucose levels.

Food sources of carbohydrates with a low-glycaemic Index (foods with a GI-level below 50) should provide the main source of energy in a diabetic diet. It is recommended they provide 40-50% of the daily energy intake.

Carbohydrates that have a low-GI are gradually absorbed into the bloodstream. This leads to improved control of blood glucose levels after eating as well as optimal insulin release. It is recommended that a diet with a low-GI content be consumed to aid treatment of diabetes, coronary heart disease and possibly obesity.

 A low-GI diet is characterised by:

• Increased intake of wholegrains, nuts, legumes, fruit and vegetables.
• Decreased intake of potatoes, white rice, white bread, cookies, cakes, sweets, sugar sweetened beverages and sugar coated breakfast cereals.

Fibre

Dietary fibre is defined as the carbohydrate found in food products that is not digested by the stomach or absorbed in the gastrointestinal tract. Fibre has multiple benefits for the human body. It keeps the digestive tract healthy, lowers cholesterol levels, helps control blood glucose levels and promotes a healthier colon by increasing good gut bacteria.

For people living with diabetes, a high-fibre intake is associated with improved outcomes, better satiety (keeps you fuller for longer) and prevents obesity. It may also prevent heart disease, constipation and colon cancer.

The recommendations for fibre intake are as follows: 20 to 35 grams of fibre from raw vegetables and unprocessed grains. High-fibre carbohydrate sources includes legumes, wholegrain breads and cereals, whole fruits and vegetables. These should be included as part of the daily carbohydrate intake.

The goal of 20 grams or greater of fibre per day may be difficult to achieve for some, as large amounts of fibre may cause bloating and gas. Fibre should be slowly incorporated into the diet if one is not accustomed to large amounts of fibre in the diet.

What to eat for breakfast

It is strongly suggested that wholegrain be added to your morning meal. This may be in the form of a porridge or cereals. Look for options that list whole wheat, whole oats, or other wholegrain first on the ingredient list without added sugars.

Choose breakfast cereals with greater than 6 grams of fibre per 100 grams.  Ready-to-eat breakfast cereals are highly-processed and have a very little to no fibre.

Oats and oat bran

Oat bran is a cereal product that has been receiving increasing attention.  Originating from oat grain or oat flakes, fragmented and separated to remove the starchy endosperm from the fibre containing fractions, it is nutrient rich.

It is particularly high in soluble fibre which helps control blood glucose levels and lower cholesterol. The substance found in oats responsible for this effect is β-glucans. It binds to water to form a gel inside the digestive tract, thereby increasing the viscosity of the food and delaying gastric emptying.

This delayed absorption of nutrients also means that carbohydrates are absorbed slower, leading to improved blood glucose levels after meals. Oat bran may be consumed daily as a breakfast cereal and can also be added to soups or be used in baking as a partial substitute for flour.

Conclusion

Do not skip meals, especially breakfast. Include a high-fibre, low-GI breakfast cereal, such as oats, oat bran or bran flakes daily. Avoid poor quality carbohydrates that are sugar-rich and processed. Consume a healthy balanced diet including high-fibre, low-GI carbohydrates.

MEET THE EXPERT

Raeesa Seedat is a registered dietitian, based in the northern suburbs of the Western Cape. She is very passionate about dietary management of disease with the application of clinical research and science. She also has a special interest in chronic conditions, such as diabetes, cardiovascular disease as well as gastroenterology.

Header image by FreePik

Everything we do is intertwined with all things surrounding family, especially feasting. This can leave us feeling utterly satiated, or sometimes utterly guilty. All aspects of our lives should include feeling good and enjoying the positive health benefits without the long-term risks.

Feeling

Health costs associated with chronic medications, surgeries, prolonged hospital stays and rehabilitation places a large financial burden and poses significant challenge for healthcare systems and the global economy. It has been said that 5-20% of all health spending is utilised for the management of diabetes¹.

Most people know of that feeling of having a bad day which often leads to reach for a quick pick-me-up snack which gives immediate gratification and seems quite pleasurable at the time. However, over time this affects our health in quite drastic ways.

Feel-good activity

An even better ’feel-good’ activity can be attained with moderate physical activity. Physical activity is often described as medicine, and not only has few risks and almost no side effects, but rather excellent long-term benefits.

Fitter, stronger people feel more capable in activities of daily living, perform better at work or play, have better cognitive ability, better psychosocial interaction, have more energy, and lower risks of other co-morbidities.

In fact, it is recommended by the World Health Organisation that every person get at least 30 minutes of moderate-intensity exercise per day or 150 minutes per week.

Just one bout of exercise of moderate intensity for 30 minutes would give you an immediate boost to your system, lowering blood glucose levels and blood pressure, better sleep, and releases endorphins, known as ‘feel-good hormones which helps lift mood and combats stress.

So, instead of feeling your way through the kitchen cupboards for a sugary snack, rather feel your way towards your workout gear. If restrictions to exercise are leaving you feeling frustrated, then consult a biokineticist who can assess, prescribe rehabilitation and get you back to your preferred choice of activity to get you to your health goals and ‘feeling’ fit.

Supervision by a biokineticist

Due to the many considerations and concerns when it comes to exercise training for people living with diabetes, it is recommended that exercise is done with the supervision by a qualified health professional, such as a biokineticist.

Biokineticists are qualified health professionals responsible for rehabilitation of persons with chronic, orthopaedic and neurological conditions through individualised exercise prescription. They are specifically trained and educated to work with individuals affected by chronic and non-communicable diseases, such as diabetes.

Correct exercise prescription from a biokineticist has consistently shown to improve glucose uptake, increase insulin sensitivity, improve circulation and reduce risk of complications, such as cardiovascular disease. It also plays a large role in weight reduction, which is an important component of diabetes management and prevention.

Family

Fluctuations in blood glucose can also be incredibly difficult and frustrating to deal with. This means it can also have an impact on your immediate family who are alongside your day to day choices and frustrations.

Medical expenses also place a huge financial burden on the individuals and their families. If health status declines further and disability, such as blindness, amputation, stroke or heart attack, occurs; this would have an impact on the whole family, and even caregiving may be needed. This is a significant liability for families to bear and may have further financial implications.

Incorporate exercise as daily living

Sometimes people living with diabetes will need to rely on close surveillance by their family to help keep their health monitoring in check, or to assist someone suffering with a hyper/hypoglycaemic attack.

Symptoms of hyperglycaemia (thirstiness, blurred vision, weakness, nausea, vomiting and coma) and hypoglycaemia (fatigue, shakiness, dizziness and loss of consciousness) can have a huge impact on daily living.

One of the keys to positive family involvement is to instil healthy lifestyle habits, such as exercise or recreational physical activity for the entire family.

Exercise and physical activity is for everybody, of every age. Children love to play. Most of their play involves movement and vigorous exercise, so it’s a perfect opportunity for families to engage in physical activity whilst engaging in play with their children. This helps with healthy quality time and bonding, and teaches children that exercise is an important part of day-to-day life. Children learn lifestyle habits from an early age from their parents, so the earlier a family starts this lifestyle habit, the better.

The recommended amount of exercise necessary for children is around 60 minutes per day. The elderly might not be as inclined to start exercising, but once the health improvements begin to be noticeable, it is hugely motivating.

The same specification of exercise for adults of 150 minutes per week still applies for the elderly. Specific exercise prescription will need to be considered for the age, preference, and capability of each person. From children to grandparents, from recreation to elite sportsman, a biokineticist can help create individualised rehabilitation or prescription.

Feasting

The saying “A moment on the lips, a lifetime on the hips”describes our love/hate relationship with unhealthy eating. Type 2 diabetes is mostly considered as a lifestyle disease which occurs because of poor lifestyle choices, including smoking, physical inactivity and poor diet.

Therefore, one of the most effective management strategies for Type 2 diabetes is lifestyle change to better manage weight and promote optimal health. Such changes include improving diet by reducing intake of refined sugar and increasing intake of fruits, vegetable and wholegrains, smoking cessation, as well as committing to regular exercise and physical activity.

‘Feasting’ or bingeing on foods and drink that are high in sugar is largely to blame for the diabetes epidemic and no amount of exercise can make up for these poor dietary choices.

Feasting often appeals to our search for ‘feeling good’. It’s most often also associated with family time and celebration. Unfortunately feasting also seems to be rather excessive as opposed to necessary. It also tends to be focused on large portions and taste instead of healthy nutrition.

You can’t outrun a bad diet

It takes approximately 42 minutes of brisk-walking to burn off the calories from your average chocolate bar. One sugary soft drink would require a walk for 26 minutes, and two slices of a large pizza would require 1 hour and 23 minutes to work off. Basically, one can’t outrun a bad diet. Therefore, committing to making sustainable changes to your diets is of such importance.

Choice is king

Diabetes is a condition faced by many people across the globe. It has many burdens on the individual level, but also affects families and the global economy.

However, it is easily manageable through lifestyle changes, including making better dietary choices and participating in regular exercise and physical activity. To reduce global healthcare costs and the prevalence of this devastating condition, we encourage you all to make the first step to a healthier lifestyle, and visit a biokineticist near you.

For more information on where to find a biokineticist or on the profession itself, visit www.biokineticssa.org.za or call 012 6441506.

References

 Edition, S. (2015). IDF Diabetes Atlas, the Seventh Edition. Retrieved from http://www.diabetesatlas.org/resources/2015-atlas.html

Manuscript, A. (2012). The Psychological Impact of Living With Diabetes. Changes, 29(6), 997–1003. https://doi.org/10.1016/j.biotechadv.2011.08.021.Secreted

Roglic, G. (2016). WHO Global report on diabetes: A summary. International Journal of Noncommunicable Diseases, 1(1), 3. https://doi.org/10.4103/2468-8827.184853 Han Cho, 2015