Food isn’t your foe

Dietitian, Retha Harmse, encourages us to not see food as our foe but too work on a healthy relationship with food.


A while ago, my husband and I had breakfast at a cafe. Just as we were finishing up and settling the bill, they served the lady next to us the most delicious looking avocado toast topped with some dukkah and chilli flakes. I told my husband, “That looks amazing, I need to order that next time.” I realised I said it a bit louder than I intended because just then the lady then turned around and said, “And I don’t even have to feel guilty because it’s so healthy.”

Standing there, flabbergasted and at a loss for words, I don’t recall if I even responded. Unfortunately, this is not an exception or an isolated incident. This has pretty much become the norm of people’s attitudes towards and relationships with food.

This can be seen in your gym class where people ‘burn off the calories’ or in the grocery store where a mother doesn’t want to buy the ‘bad food’ for her children, or in corporate companies where working through breakfast and lunch is praised (both for productivity and for the will power to maintain intermittent fasting).

How would you describe your relationship with food?

Food has become the enemy, people fear eating and distrust their body’s innate wisdom of what and how much it needs. What food can do for you has taken the backseat and now food the foe is in the driver’s seat.

Well, that is most definitely the case for the majority of clients I see. That is why one of my first questions during my consultations is “How would you describe your relationship with food?”

Evelyn Tribole, author of Intuitive Eating, writes, “The Japanese have the wisdom to keep pleasure as one of their goals of healthy living. In our fury to be thin and healthy, we often overlook one of the most basic gifts of existence – the pleasure and satisfaction that can be found in the eating experience. When you eat what you really want, in an environment that is inviting, the pleasure you derive will be a powerful force in helping you feel satisfied and content. By providing this experience for yourself, you will find that it takes much less food to decide you’ve had enough.”

Improve your relationship with food

So, how do we change this? How do we give back food in its rightful place? How do we improve our relationship with food and grow in eating competence?

  • You can’t change something that you aren’t aware of. Therefore you want to become aware of where you may have negative attitudes towards food and eating: food fears, food rules, etc. This might be so deep in your subconscious that you aren’t aware of it or so prevalent in everyday life that it feels like the norm (that is why it’s called diet culture). You want to change this into positive attitudes about eating and food.
  • All food can be a part of a healthy diet. You want to grow in becoming more open and accepting towards all food groups, showing acceptance skills that support eating an ever-increasing variety of the available food. If this is not yet the case, you may want to explore what are the barriers standing in your way of achieving this. For example, the way you were raised, your daily habits, lack of mindfulness, your emotional state, etc.
  • Growing in listening to your body is extremely important. You want to cultivate internal regulation skills that allow you to intuitively consume enough food that provides you with energy, and stamina and supports a stable body weight. This means not depriving yourself of specific food items, as bingeing is the natural consequence of restriction.
  • We all know that eating doesn’t just exist in a silo, most social events have eating linked to it in some way or another. That is why you want to have the skills and resources to manage the food context and organise family meals.

Eating competence

Research has shown that adults with eating competence have body weights that tend toward the average. They are more satisfied with their weight and are less likely to cycle between dieting and non-dieting. They show better health indicators: higher HDL; lower blood pressure, total cholesterol, LDL and triglycerides.

Adults with high eating competence also do better socially and emotionally. They feel more effective, are more self-aware and are more trusting and comfortable both with themselves and with other people.

Encouragement

Don’t stop at this article. This is merely the starting point for improving your relationship with food. Go read up more, make it a priority – the same as a friendship or romantic relationship – choose to work on your relationship with food daily. May you choose to have your avocado toast because you really love it and not just to avoid experiencing food guilt.

Retha Harmse is a Registered Dietitian and the ADSA Public relations portfolio holder. She has a passion for informing and equipping the in the field of nutrition. She is currently in private practice in Saxonwold, Houghton and believes that everyone deserves happiness and health and to achieve this she gives practical and individual-specific advice, guidelines and diets.

MEET THE EXPERT


Retha Harmse is a registered dietitian and the ADSA Public relations portfolio holder. She has a passion for informing and equipping the in the field of nutrition. She is currently in private practice in Saxonwold, Houghton and believes that everyone deserves happiness and health and to achieve this she gives practical and individual-specific advice, guidelines and diets.


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The skinny on milk and diabetes

There are currently controversies surrounding the consumption of milk as well as which forms to consume. Annica Rust gives us the facts and clears up any confusion.


Benefits of dairy (milk)

Dairy is a versatile food item, with numerous benefits, such as shown in Figure 1. Diary contains all the macronutrients, including carbohydrates, fats and protein as well as vitamins and minerals.1

Dairy contains fat-soluble vitamins A, D and E as well the water-soluble B-complex vitamins and vitamin C. The fat content of milk will determine the number of fat-soluble vitamins, therefor the amounts may differ in low-fat and fat-free milk. Although the fat component is removed in low-fat or fat-free milk, some manufactures will fortify milk, with vitamin A & D.1,3

Dairy is also an excellent source of calcium and contains minerals, such as phosphorous, magnesium, potassium and zinc.1,3 One serving of dairy (250ml milk, 200ml yoghurt or 40g cheese) contains 300mg of calcium. This is a large portion of the daily recommended allowance for adults, which is 1000-1200mg of calcium per day. The role of each component can be viewed in Figure 1 below.1

Figure 1: The functions of macro and micronutrients from Rediscover dairy1

Figure 1: The functions of macro and micronutrients from Rediscover dairy

Food and dairy matrix

Food is more than simply nutrients. We don’t eat individual nutrients (vitamins and minerals), however, we consume different food items in a variety of meals which contain the nutrients our bodies require.1

The unique food structure can influence the digestion and absorption of nutrients. Milk fat globule membranes (MFGM) may have a significant influence on the digestion of dairy and the absorption of dairy fat. MFGM may prevent the negative effect of saturated fatty acids on low-density lipoprotein (LDL) cholesterol, or simply known as the bad cholesterol, but the protective effect needs to be further investigated. The structure of milk and fermented dairy will also have a positive effect on digestion and absorption. This may partially explain why the benefits of whole foods will always exceed supplementation.1

 

Milk and diabetes

A positive association has been found between dairy, more particularly low-fat or fat-free dairy and the risk of diabetes. The positive effect may be contributed to the food matrix which suggests that the combination of nutrients in dairy seem to have a more positive effect for people living with diabetes when compared to individual nutrients. The calcium, magnesium, vitamin D and whey protein in dairy may all through different mechanisms of action play a role to lower blood glucose levels.1

 

Milk and cardiovascular disease (CVD)

People with diabetes have an increased cardiovascular risk which can’t be ignored. High cholesterol and high blood pressure as well as unhealthy lifestyle factors (obesity, inactivity and smoking) are common risk factors associated with CVD.

The intake of saturated and trans fatty acids have a significant impact on increasing LDL cholesterol levels. Dietary strategies will therefore aim to substitute saturated fat with polyunsaturated fatty acids as shown in Table 1.

Table 1: Types of fats

Saturated fat Trans-fatty acid                     Polyunsaturated fats

Omega-3                         Omega-6

Triglycerides in which most of the fatty acids are saturated

 

Fatty acids with hydrogen’s on opposite sides of the double bond Polyunsaturated fatty acid in which the first double bond is 3 carbons away from the methyl end of the carbon Polyunsaturated fatty acid in which the first double bond is 6 carbons away from the methyl end of the carbon
Visible fat on meat
Skin of the chicken
Bacon
Butter
Chocolate (cocoa)
Coconut
Cream cheese
Cream
Lard
Full cream milk products
Sour cream
Coconut, palm oil
Fried foods

Commercially baked foods (cakes, cookies)

Snack food (chips, crackers, microwave popcorn)

Margarine (hydrogenated)

Fatty fish (tuna, salmon, herring, mackerel)

Walnuts

Flaxseed

Pumpkin and sunflower seeds

Oils (corn, sunflower, cottonseed)

Mayonnaise

Margarine (nonhydrogenated)

 

 

Products that are higher in fat also tend to be high in saturated fats, dietary recommendation will therefore recommend low-fat or fat-free dairy, to reduce saturated intake. The difference in milk can be seen in Table 2.

Table 2: Comparison of milk per 100g/ml

  Full Cream Low Fat Fat Free
Energy 256 190 160
Protein 3.3 3.3 3.4
Carbohydrate 5 4.8 4.8
Of which Sugars 4.1
Total Fat 3.3 1.5 0.5
Of which mono unsaturated fatty acids 1 0.4 0.0
Of which poly unsaturated fatty acids 0.1 0.0 0.0
Of which saturated fatty acids 2.2 1.1 0.5
Of which trans fatty acids 0.1 Trace Trace
Cholesterol 11 8.4 0.0
Dietary Fibre 0.2 0.0 0.0
Sodium 39 44 44
Calcium 117.5 122 123

The recommendation is to aim for less than 1.5g per 100g of saturated fats (Table 3). However, based on the food matrix dietary, approaches can be more open to move away from nutrient-based approaches and to move more toward food-based dietary patterns (looking more at your diet as a whole vs one single food items). But most importantly dairy intake shows to have a protective to neutral effect on CVD risk.1

Table 3: Recommended fat and saturated intake

NUTRIENT   Per 100g Total Fat Saturated Fat
HIGH: Avoid – Eat occasionally > 20g > 5g
MODERATE:  Eat seldom 3 – 20g 1.5 – 5g
LOW: Healthier option -Eat often < 3g* < 1.5g

*Milk, yogurt and ice-cream products, the aim is for less than 2g of saturated fats per 100g. For cheese, the target is for less than 15g of saturated fats per 100g.             

Milk and glycaemic index (GI)

Dairy contains lactose, which is the main carbohydrate in milk. Low-fat dairy has a low glycaemic index and is ideally used in combination with other foods items for meals or for a snack.Visit the GI foundation site to look at endorsed products.

Visit www.gifoundation.com/food-list/dairy/2

Conclusion

 

There are numerous factors to take in consideration when deciding whether full cream, low-fat or fat-free milk or dairy will be most beneficial for your health. It therefore remains the best to contact a registered dietitian for individualised advice.


References:

  1. Rediscover Dairy: https://www.rediscoverdairy.co.za/evidence-based_reviews/
  2. The Glycemic Index Foundation of SA: https://www.gifoundation.com/food-list/dairy/
  3. Mahan, L.K. & Raymond, J.L. (eds).2017. Krause’s food and the nutrition care process. 14th ed. St Louis. MO: Elsevier Saunders.

MEET THE EXPERT


Annica Rust is a registered dietitian practicing at the Breast Care Unit at Netcare Milpark Hospital as well as in Bryanston. She assists with medical nutritional therapy for cancer prevention, treatment, survivorship and palliation. She gives individualised nutritional care to prevent or reverse nutrient deficiencies, nutrition-related side effects and malnutrition to maximise quality of life.


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Winter meal planning

Dietitian, Rhodene Leydekkers, shares basic steps to help you on your winter meal planning journey.


The winter cold is here, and with winter typically comes warmer, hearty and comforting food. But just because the season is changing doesn’t mean that you should stop nourishing your body with good nutrition.

Planning your meals for the week can save you some money, time and stress. It can also make healthy eating a bit easier and prevent food waste. But if the thought of meal planning overwhelms you, here are basic steps to help you on your meal planning journey this winter

First decide what works for you

There are different styles to meal planning, so you need to decide for yourself what will work best for you. Although planning and meal prepping a perfect week sounds amazing, sometimes you need to ask yourself whether that is realistic for you.

Some people prefer to only plan their meals to know what to get from the shops, and other people like to meal prep and cook some or all of the meals in advance to lessen the load during the week. Some people only plan their dinners for the week, while others prefer to plan for breakfast and lunch as well. Your food preferences are also important to take into consideration when planning for the week.

Focus on balance

Before we plan our meals, it’s important to know what to aim for. Balancing our meals is important to ensure that we are getting all our nutrients in that our body needs to function optimally.

An ideal plate would be: ½ your plate full of vegetables, ¼ of your plate lean protein (skinless chicken, fish, lean beef, beans, lentils or eggs), and ¼ of your plate high-fibre carbs (brown rice, whole-wheat couscous, quinoa, barley, sweet potato or whole wheat bread or pasta), and then to include some fats that will usually come from using a little bit of oil in preparing the meal, or by adding fats to a meal like avocado, nuts or seeds.

If you want to enjoy a warm soup, stew or curry (because who doesn’t enjoy a warm meal on a cold day), you can still apply this model to that meal. Soups, stews and curries are a great meal to add lots of veggies in, a lean protein like mentioned above, and enjoying that meal with some brown rice, barley or a slice of whole wheat bread.

Evaluate your week

Now that you know what to aim for, the next step would be to evaluate your week and plan your meals according to your schedule. There might be upcoming social events, work functions or other obligations that can influence your meal planning. If these events include food (which honestly is the best, am I right?), then you don’t have to plan for that day. Or it could mean that you will not have a lot of time to prepare a meal, so then a quick heat-and-go left-over meal would be best to plan for those days.

Make a menu for the week

So, now that you know what to plan for, you can start colouring the picture in. Have a list of go-to balanced meal options that you know will work for you and your family. Choose recipes with simple ingredients that you can use in different dishes, and that is quick and easy to make. This makes it easier to pick the meals for the week without thinking too much about it.

Food should also be an adventure, so continue to add recipes to this list, and even experiment here and there with new flavours if you have the time.

Ideas for meals

  • Chicken or canned black bean stir-fry with whole wheat noodles.
  • Lentil curry with lots of vegetables and brown rice.
  • Baked fish, boiled potato and roasted vegetables.
  • Chicken soup (again with lots of vegetables) with a slice of whole wheat bread.
  • Whole wheat spaghetti bolognaises made with lean mince and bulk it up with tomatoes, onions, mushrooms, carrots, zucchini and spinach.

Make a shopping list and stock your kitchen

This is my favourite part, the shopping. From your meal plan for the week, you can now make a shopping list for what you might need for the week to prepare the meals.

Stock your pantry and fridge with some staples like salt, pepper, herbs, spices, olive oil, etc., and then go and buy the necessities for the week.

If you find that you just don’t have the time to go to the shops, or it is just too cold to leave the house, then there are other options. Most of our favourite grocery stores have online options available to help you stock your kitchen for the week without putting a foot in the shops.

Prepping your meals

Now remember, meal planning and prepping looks different for everybody, so this step depends on what will work best for you. One way of meal prepping is to choose a day, like Sunday, to prepare some of the meals in advance. The pre-prepared meals can then either be refrigerated and eaten over the next few days, or frozen to eat over the next few weeks or even months.

Meal prepping can also include preparing ready to cook ingredients for a specific meal, like chopping vegetables or cook starches, like rice, to save some time on cooking. By doing this, it can really save you a lot of time in the kitchen, especially now that your days are shorter with the sun setting much earlier.

Meal planning might seem a bit overwhelming at first, but the moment you start doing something, you might notice how easy it makes your life. So, go make yourself a warm cup of tea, grab a pen and get planning.

MEET THE EXPERT


Rhodene Oberholzer Leydekkers is a registered dietitian and is passionate about people and wellness. She believes that life is too short to eat a boring meal, as food can be both nutritious and delicious. She encourages her clients to focus on enjoying every meal and is eager to help them build a healthy relationship with food and themselves. She also has a special interest in diabetes management, gut-brain connection and women’s health.


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Exercise in cooler months

We hear why BASA advocates that a healthy body is made through consistency and why exercise is imperative in cooler months.


It’s so easy to get active and exercise when the sun is shining and the sky is blue. But what happens when the winter months start to roll in, temperatures start to drop, and the sky becomes dark and grey? Even the most dedicated of fitness enthusiasts can struggle to get out of bed in winter, let alone get moving.

Winter can be very disruptive to our regular exercise routines. Typically, as temperatures start to decrease, so does physical activity. Light levels are also a contributing factor. With the sun rising later and setting earlier, our days become shorter, and so does the perceived window period for physical activity. Many people find the dark to be demotivating and a barrier to physical activity participation.

Why to keep moving in winter

Despite these difficulties experienced during winter, movement and physical activity remain a central and essential component in the management and prevention of diabetes.

There is an abundance of research which demonstrates that regular physical activity improves blood glucose, decreases cardiovascular risk factors and reduces reliance of chronic medication in individuals with diabetes.1,2

Additional benefits include improved cardiovascular fitness, improved blood pressure, improved cholesterol and triglyceride levels, decreased abdominal fat, improved body mass index (BMI) and enhanced well-being.

During winter, the benefits of physical activity for people with diabetes don’t change. However, there are some additional reasons that you might benefit from getting active in the cooler months.

  • Increased Core Body Temperature

With physical activity, we typically observe an increase in both muscle and core temperature. This is because not all of the energy produced in our muscles is used for muscular contraction, and the remainder of the energy is converted to heat energy which increases the muscle temperature and eventually core body temperature.3 The greater the exercise intensity, the greater the heat production. Essentially, exercise of sufficient intensity will help you become your own human heater during winter.

  • Reduced depression and anxiety

Although the exact mechanisms are complex and multifactorial, there is ubiquitous agreement in scientific communities that exercise is beneficial for the treatment and management of symptoms of depression and anxiety.4

Physical activity leads to the release of endorphins or ‘feel good chemicals’, such as serotonin and dopamine. These endorphins help to better regulate mood and promote feelings of well-being, whilst reducing feelings of depression and anxiety. Exercise can therefore help you to beat the winter blues and protect against Seasonal Affective Disorder (SAD).

  • Preventing winter weight gain

During the cooler winter months, the average person tends to eat more and do less. With this human hibernation, comes the dreaded winter weight gain. Exercise helps to boost your metabolism and increase the number of calories you burn each day, which allows you to better maintain your weight and help you avoid packing on the pounds.

With the above benefits of exercise, the goal during winter should be to reduce the number of barriers to physical activity and commit to small, sustainable changes that make staying active easier until the return of the warmer months.

Five tips to help keep you active in the cold

  1. Create a support structure

Create a support structure that will encourage you and help you remain focused on your goals. It’s much easier to stick to a habit if you have someone to keep you accountable to your goals. Get active with a friend or family member or sign up for regular exercise sessions with a healthcare professional, such as a biokineticist.

  1. Get active in your lunch breaks

Does going to the gym or for a walk before work in the pitch-dark sounds like a nightmare to you? Try to squeeze in some activity into your lunch breaks whilst it’s still light outside. Try a brisk walk around the block if the weather is tolerable, or, if you’re lucky to have a gym close by or at the office, try to fit in a quick 30-minute workout.

Here is a great balance and mobility exercise to try, which we have called the #teatimetactic challenge. Here is the explainer video on YouTube:

Challenge yourself and nominate others. Practice it, film it, upload it to social media and tag others you would like to nominate to take up the challenge and include hashtags #TeaTimeTactic and #biokineticssa!

  1. Try hydrotherapy

If exercise in the cold is something you’re just not willing to subject yourself to, hydrotherapy in a heated pool is a great option. Hydrotherapy has many benefits, including improved circulation, reduced pressure on joints, reduced joint and muscle pain, muscle relaxation, improved muscle strength, improved joint range of motion and improved balance. Not only will you be warm, but you will reap all these other benefits too.

  1. Invest in new gym wear

Nothing motivates people like some new active wear. Putting on gym gear is not unlike putting on a uniform, or an actor putting on a costume. By putting these specific clothes on, you remind yourself of the specific task or job you have to perform, and you become more psychologically ready for the task at hand. Invest in some warmer gym clothing, not only to help keep you warmer during your workouts, but to help motivate you to get active.

  1. Try new indoor activities

If you regularly exercise outdoors but can’t bring yourself to go for your usual morning walk in winter, it may be time to try some new indoor activities. This doesn’t necessarily require you to take out a gym membership. With the global COVID-19 pandemic, there are now many options available online to help get you moving within the very comforts of your own (warm) home.

A healthy body is made through consistency

There is a saying that goes “summer bodies are made in the winter”. But we like to think that a healthy body is made through consistency, which means putting in the work every day, regardless of the weather outside.

Biokineticists are registered healthcare practitioners that treat injury and disease through individualised, evidence-based exercise prescription. They are specifically educated to prescribe and supervise exercise to individuals for the management and prevention of non-communicable diseases, such as diabetes. To find out more about biokinetics, or to find a biokineticist near you, visit https://www.biokineticssa.org.za


References 

  1. Gill, Jason MR, and Dalia Malkova. “Physical activity, fitness and cardiovascular disease risk in adults: interactions with insulin resistance and obesity.” Clinical science 110.4 (2006): 409-425.
  2. Way, Kimberley L., et al. “The effect of regular exercise on insulin sensitivity in type 2 diabetes mellitus: a systematic review and meta-analysis.” Diabetes & metabolism journal 40.4 (2016): 253-271.
  3. Takeda, R., & Okazaki, K. (2018). Body Temperature Regulation During Exercise and Hyperthermia in Diabetics. In (Ed.), Diabetes and Its Complications. IntechOpen. https://doi.org/10.5772/intechopen.74063
  4. Drew, E. M., Hanson, B. L., & Huo, K. (2021). Seasonal affective disorder and engagement in physical activities among adults in Alaska. International journal of circumpolar health80(1), 1906058. https://doi.org/10.1080/22423982.2021.1906058

To find out more about biokinetics and to find a biokineticist near you, visit biokineticssa.org.za



Written by Tayla Ross (Registered Biokineticist, MPhil Biokinetics) on behalf of The Biokinetics Association of South Africa.

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Hacks for healthy winter living

Dr Louise Johnson offers hacks for healthy winter living for people with diabetes.


Professor Elliot Joslin was the first doctor specialising in diabetes in the United States. He was involved in diabetes for seven decades (June 6, 1869 – January 28, 1962) and first recognised the management of diabetes as the management of diet, exercise and correct medication to prevent complications. He coined it the “three wild horses of diabetes running each in its own direction.” To live healthy, it’s important to get the balance between diet, exercise and the correct medication. Either too little or an excess of any of the three can throw the scales over and cause havoc.

Diet 

A well-balanced diabetes diet that has adequate portions of starch, lean protein, vegetable, fruit and fat in the form of nuts and avocado is important.

Note, it’s vital to take in all your vitamins, especially in winter or during stress and illness when the immune system is down. Oral supplementation may be necessary. In winter and during stress and illness there is a need for more vitamin C, zinc and vitamin D.

Diet hacks

  • Vitamin C in dosage of 500 to 1000 mg per day improve the immune system.
  • Zinc is a nutrient that is important in the body for a healthy immune system, good wound healing and prevention of age-related macular degeneration. It’s found in chicken, red meat and fortified breakfast cereals. It’s good to supplement in winter: a dosage of 8 mg for women and 11 mg for men.
  • Vitamin D is more important in winter since we get less sun exposure.
  • Adequate calcium (600mg/d) is also important for good bone health throughout life in both men and women. Osteoporosis is four times more prominent in people with diabetes and can be prevented by calcium supplementation, sunlight and exercise.
  • During winter or sometimes watching TV, snacking is a problem amongst many people. Try to minimise this or do healthy snacking with cucumber or popcorn.
  • Water is always important. The calculated amount of water is your weight without the naught. For example: 60 kg person will need six glasses of water per day. This can be divided between tea, juice and water. Remember that coffee doesn’t hydrate. To get access to healthy water, use a water filter or boiled and cooled down water.
  • Don’t forget your probiotics for a healthy gut. The best form is in the form of yoghurt. Should you not get enough yoghurt, a supplement can also help but natural is always better.

Exercise hacks

The importance of aerobic exercise can’t be overstated. This increases insulin sensitivity and helps you use less insulin more effectively, burn fat and prevent osteoporosis. Any form of aerobic exercise (walk, swim, run or cycle) for 30 minutes per day is recommended.

  • Exercise in the morning is better for glucose control since insulin resistance is at its highest value then. Be careful of hypoglycaemia after exercise, especially if you do it in the evening.
  • Anaerobic exercises (weightlifting) can push up glucose due to the stress response of the body. It’s wise to do a combination of aerobic and anaerobic exercises dependent on the glucose level to help with control. For example, if glucose is above 10 mmol before exercise start with aerobic training (walking or running) and end with squats and weights. The reverse works well too when glucose is between five and 10 mmol to start with weights and end with aerobic exercise.
  • Always have a sugar snack handy and remember to hydrate well. Drink enough water and stretch well before and after exercises.
  • Proper shoes are important for people with diabetes, especially if you already have nerve damage with loss of sensation and burning feet. Don’t forget proper socks are as just important as shoes.

Medication hacks

To control the three wild horses, the correct medication is important. Remember that medication changes continually and better medication become available as well as devices (insulin pumps and glucose sensors). Visit your diabetes specialist regularly for an evaluation.

Other general hacks

Sleep

It’s important for good control of glucose and a healthy immune system to sleep at least six hours per night uninterrupted. If you have trouble sleeping talk to your doctor. Avoid caffeine (coffee) before bedtime. Daytime sleepiness can be a sign of sleep apnoea and can be diagnosed with a sleep apnoea test and managed with sleeping with a special mask. This will also improve glucose control and weight issues.

Seasonal affective disorder

Many people suffer from seasonal affective disorder (SAD) when the weather changes to cold. Symptoms include feeling tired, depressed, down or lethargic. Care for your mental health. Depression is 50% more common in people with diabetes and if symptoms persist despite healthy living, seek professional help.

Reduce shower/bath time

There is nothing better than a long hot shower or bath especially during winter times. You shouldn’t exceed this time with 10 minutes since all the healthy oils of the skin can be washed away. This can increase weakness and peeling of nails.

Relax

When we are stressed out, our immune system is compromised, and this can give viruses and bacteria space to cause problems. To help prevent this, spent time meditating daily in whatever form relaxes you. Reading, listening to music, drawing, sitting and reflecting.

Stay warm

The more constant we keep our body temperature, the easier it will be to fight of infections. Remember a scarf. Cold viruses spread in the cold. Your nose is the highway to your lungs. Keep it warm.

Remember to wash your hands

This is now second nature to us in the COVID era but don’t forget when inside and touching your face, wash your hands regularly. Travel with wet wipes when touching all those surfaces that are unavoidable and full of germs.

Gargle

Gargle regularly with warm water and a teaspoon of salt. This is anti-inflammatory and good for teeth and throat health. Gargle and spit with warm water until the salty taste is gone.

Laugh

I can’t think of a better stress reducer than laughing. Watch your favourite movie and start laughing.

Garlic

In the Middle Ages, it was tied around the neck to ward off evil. It still helps with those evil viruses by boosting your immune system. Be sure to crush whole garlic to get all the goodness that comes from its health-giving compound: allicin. Add it to your soups and stews for a healthy winter.

Immunisation

It’s good practice for people older than 50 years of age and those living with diabetes to be up to date with vaccines. Don’t forget the annual flu vaccine that is very effective against flu.

Do everything in moderation from diet, exercise to taking supplements. Remember too much is just as harmful as too little.

Dr Louise Loot

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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How to balance the five elements through reflexology

Reflexologist, Veronica Tift, elaborates on how, if unbalanced, the five elements can cause ailments and pain.


Take a moment to think about how completely and totally unique you are. Everything about you is like no one else on this planet of 7,5 billion. Your fingerprints, personality, genomes and cellular operating instruction are all unique to you. How incredible!

This is where many ancient healing practices had it right, looking at us as the unique humans we are and our deep connection with earth and its elements. Observing the changes in nature and the changing cycle of us humans: birth, adulthood, maturity, aging and dying.

Using five essential features of nature: fire, earth, wood, metal (or air) and water, ancients explained the complex traits of our bodies and minds. These are not literally the elements that make up our bodies, but more metaphorically.

One of these elements is produced by one element and then produces another, this creates a cycle of the five elements within each of us that require balance.

The five elements

The five elements, fire, earth, wood, metal (or air) and water, are broken down into different categories. These include seasons, physical traits, body type, taste, colour, emotion and sound.

While a person is made up of all five elements, there will always be one or two more dominant. So, for example, if we look at the different emotions, you might be quicker to anger or feel frustrated easily (a trait of people with a dominant wood element), or you are incredibly well-organised (like metal element types). Maybe you are more introspective (like those with a strong water element), or possibly you struggle with depression or are passionate (a dominant fire element).

When we experience extremes in our mood, tastes, sense of smell or even over doing it on a colour, this can indicate that there is an imbalance in that related element.

Each person’s element requires different ways of bringing their individual element into balance. A fire dominant will need lively, energetic people with fun activities to help balance emotions, while an earth dominant will look to supportive friends and family, or metal dominant will detach for a while when under stress.

Imbalance in elements causes illness

Ever wondered why you seem to struggle more at different times of the year? The elements correspond with a season: water with winter; wood is with spring; fire with summer; metal with autumn; and earth with late summer.

Extreme imbalances in nature produce forest fires that rage out of control, and flooding and massive storms. When we think of extremes and imbalance in the body, we see illness, fevers, indigestion, high blood pressure and pain. Balancing the five elements within us help generate well-being and enable us to cope better with stressors.

Find balance with reflexology

Reflexology is a very well-rounded complementary therapy. When a client comes into my practice for the first time, I ask a couple of questions. For example, what emotion seems to come up when stressed and the time of the day when they feel extremely tired.

I notice the quality of a person’s hair and the colour of the clothes they might wear often when coming to see me, even what tone of voice a person speaks in: if they have a slight way of singing (earth) or speak in a shouty way (wood). All this tells me what element might be out of balance.

Then when I begin working on the feet, I have a better understanding of what the client’s needs are based on which element might be out of balance.

The body is mirrored on the feet through points called reflexes. Looking at the element out of balance, I can stimulate the reflex that best allows balance to be restored through the body’s own healing ability.

Help yourself

There are many online resources to find out which element might be your dominant and the best ways to balance it.

Visit your local reflexologist. Make sure they are trained in the elements and meridian therapies. This will help you delve deeper into the incredible world of the five elements, giving you specific insight on how to take care of yourself.

Note, as reflexologists, we should never claim to cure a specific disease or diagnose. If you have experienced this with a reflexologist, they might not be qualified to practice.


References:

Dougans, Inge. 2005 Reflexology- the 5 elements and their 12 meridians a unique approach

Axe, Dr Josh. 2021, Ancient Remedies for modern Life

Haas. Dr Elson M. 1981, Staying healthy with the seasons

Wills Pauline. 1995, The reflexology manual

MEET THE EXPERT


Veronica Tift is a therapeutic reflexologist, registered with the AHPCSA, based in Benoni. She continues to grow her knowledge through attending international and local courses on various subjects related to reflexology. Veronica has a special interest in working with couples struggling with infertility.


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Check your work-life balance to prevent burnout

A shift in working habits affecting work-life balance since the start of the pandemic could be contributing to greater risk of burnout. But, reassessing how we manage demands in our daily routines can make a significant difference.


Sticking to a fixed schedule has become more difficult than ever, perhaps even more so for working parents and people working from home. A 24-hour weekday should ideally be made up of roughly eight hours each for working, sleeping and private time, which would include family responsibilities, rest, and leisure. This ideal balance isn’t always possible, and at times we need to be flexible with a few hours of overtime for urgent work priorities. This should be the exception, however, not the rule.

High expectations

In the last two years a pattern has emerged where productivity expectations seem to be higher than ever, and this shows no sign of abating. While work demands may be intense, it’s very often the pressure employees put on themselves that may alter work-life balance.

This has given rise to an ‘always on’ trend, which is persisting in many workplaces even among those not working from home. The technology and online platforms many people use for work can be convenient for keeping in touch with colleagues and cutting down on travel time, allowing us to pack more meetings into the day, but this can be intrusive after working hours and set a pace that is unrealistic and unsustainable.

Setting boundaries

Work demands are intense, and often we place further pressure on ourselves by trying to meet every expectation. If you feel you can’t even find time for a quick tea break, bear in mind that it’s simply not humanly possible to maintain good concentration solidly for eight or nine hours without a rest. Taking a short mental health break will help to keep you more productive throughout the day.

When the workday has ended, people often tend to take their work home both physically and emotionally. Actively working overtime, as well as time spent processing the demands of the day, worrying about tomorrow, and anxieties about our work can intrude on personal time.

Set boundaries for yourself on how you manage your time, and define a cut off point for work because there will always be priorities no matter how much extra time you put in. If a healthy work-life balance is not restored in time and a person is unable to replenish themselves sufficiently, it can have consequences for mental and physical health.

The need to decompress

Although working from home has allowed employees some flexibility and has squeezed a little extra time into our schedules, one advantage of commuting is that it offers a clear divide between work and home, and the time to decompress and evaluate the day.

After a full day’s work, it’s common to experience depleted emotional energy levels. After logging off work, we would all like to start relaxing but usually there are domestic tasks to be attended to first, such as preparing meals.

Taking a little time, if possible after work when you aren’t expected to be busy with anything else, to refresh your mind before transitioning into domestic life. Taking a breather to shrug off the stress of the workday can be helpful for fulfilling the need to put some distance between our work and home lives and help us transition into private family time.

Parents face extra demands

Parents often face additional demands, as parenting is a full-time job in itself. Working parents may feel worn out by the time they get home, but this is often when parenting time begins. There may be homework to oversee, preparations for school the next day, and bath time, and while you might be physically present for your family, it’s just as important to be emotionally present too.

By the time there is a chance to relax, parents may be so exhausted that they have no resources left for nurturing their personal lives and making the most of any spare time left before going to bed.

We are not meant to only work and sleep

When a person is approaching burnout, often the first thing to fall away is a sense of enjoyment. As human beings, we aren’t meant to only work and sleep. Don’t forget, we need to enjoy ourselves and invest time in our relationships.

Couples may sit together watching a series or scrolling through their phones but lead very separate lives. Spending time together should be about sharing and relating to each other, but often people at risk of burnout feel too exhausted to be fully present, and this could be a sign that it’s time to reassess your work-life balance.

Leisure time is vital for recharging our emotional energy and is therefore necessary to be at our best for both work and family. All too often, it’s only when people are burnt out to the point where they are no longer able to function in their working or home lives, that they reach out for professional support.

Often, we place so much value on the time we spend being productive, but not nearly as much as we should on replenishing our own mental and physical health. If you find you are starting to feel overwhelmed or demotivated, reach out for professional mental health support.

For information about mental health and services, and accessing care, or for help in an emotional crisis, Netcare Akeso is here to help. In the event of a psychological crisis, individuals can phone the Netcare Akeso crisis helpline on 0861 435 787, 24 hours a day, to talk to an experienced counsellor. 

MEET THE EXPERT


Lauren Leyman is an occupational therapist practising at Akeso Crescent Clinic. She has a passion for assisting individuals in their return to a fulfilling and meaningful life. Her experience includes working in general psychiatry, with adolescents, and with addiction. Her approach focuses on the person’s leisure pursuits, hobbies and interests, which are often pushed to the side when work demands, family commitments and life’s responsibilities take priority.


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How meal planning fits into diabetes management

Diabetes educator, Tammy Jardine, offers 12 guidelines for healthy meal planning and explains why meal planning is important for diabetes management.


Diabetes is a condition where your body can’t properly use and store food for energy. The fuel that your body uses for energy is called glucose. Glucose is made in the blood from different types of carbohydrates, a nutrient found in food.

A high amount of this carbohydrate nutrient is found in foods, such as fruit, milk, some vegetables, starchy foods, and sugar. To control your blood glucose (blood sugar) you’ll need to choose healthy foods and limit the amount of the foods mentioned that are high in carbohydrate.

There is no perfect diet for people living with diabetes and you’ll find many contradictions as to which diet is best for diabetes. Instead of taking costly supplements and restricting food groups in your daily diet, it’s recommended that you eat foods that are high in nutrients and that you eat a variety of different foods. It’s always best to seek out a dietitian who has a special interest in diabetes to help you identify what foods are best for you as an individual.

Try these general guidelines for healthy meal planning:

  1. Monitor blood glucose

Always monitor your blood glucose to help determine whether you need fewer meals or whether you do better on smaller more frequent meals. Every person is individual and depending on how diabetes affects you will help to identify what type of eating routine is best for you.

  1. Eat vegetables

Although there is a lot of different information about what is the best diet for diabetes, the one consistent factor is that vegetables are important. Vegetables are high in fibre and high in vitamins and minerals. A variety of vegetables should make up 50% of your daily intake.

In addition to veggies like cauliflower, carrots, beans, and salad veg, be sure to include dark green leafy vegetables like spinach, kale, and broccoli. These are high in magnesium. You may need to limit these if you are on warfarin; check with your dietitian. Vegetables don’t have to be raw but if you cook them, steam or stir-fry until still crispy as soggy veggies are never appetising.

Try to add at least ½ cup of beans into your weekly meals about three times a week. Beans are high in fibre which helps to control blood glucose. These can be canned but be sure to drain them and rinse them to get rid of most of the salt. Beans include kidney, pinto, black beans, butter beans, cannellini beans and chickpeas.

  1. Avoid processed foods

They are usually crammed with preservatives and additives. Clean, whole foods are a much better choice and if they are closer to the way they come from the earth, the better. For example, choose a mealie (corn on the cob) rather than mealie meal. Also, if you choose starches that are whole grain instead of the more processed versions (white versions), you’ll get more fibre, vitamin B, magnesium, omega 3 fatty acids and folate.

  1. Identify your tolerance for carbohydrates

You can do this by testing your blood glucose before (pre-meal) and two hours after (post meal) eating a meal of carbohydrates. Use an app like FatSecret or MyFitnessPal to determine the amount of carbohydrates you’re going to eat. If your blood glucose post meal is more than 2 above the pre-meal reading, then you know you need to eat less carbohydrate.

Once you’ve identified your individual tolerance level then use the apps to calculate the portion of meals you usually enjoy and help with meal planning.

  1. Eat berries

Berries are the best fruit to eat as they contain very little sugar and are high in antioxidants which help protect your body from everyday damage. Fruits are generally high in a sugar, called fructose, so watch the amount that you eat at a time and never have more than three portions a day.

  1. Palm size protein

Protein foods like meat, eggs, chicken and fish can be eaten daily. Try to keep your portion to the size of your palm at a meal. It doesn’t really matter how much is red meat but do try to have three portions of fish a week (about 180-270g per week). Fish that is naturally oily like mackerel, pilchards, salmon and trout are excellent choices as they are high in omega 3 which is heart healthy and good for your immune system.

Stay away from the breaded and deep fat fried variety. They don’t count in your goal of 60-90gportions three times a week and the crumb will add to your carbohydrate limit.

  1. Avoid non-nutritious foods like sugar and sweeteners

Sugar will increase blood glucose. This includes sucrose sugar (the one we use in beverages and cereal) as well as honey. Although sweeteners are generally safe for people with diabetes, they still don’t add value to your diet and water is still the number one recommended beverage. If your urine is dark, you need more water, and try to replace fluid if you have been to the loo.

  1. Calcium is important especially if you are on metformin

Calcium is found in green leafy veg, as well as the bones of fish (like pilchards and canned salmon), in nuts, and also in dairy products. Milk does contain its own carbohydrate, called lactose, so be sure to consider it in your individual tolerated carbohydrate limit. Limit cheese to three times a week as it’s high in salt.

  1. Limit salt

Try to use less salt added to foods and use more herbs, garlic, ginger, cinnamon, and chilli to flavour your foods. 

  1. Avoid processed and packaged snacks like crisps, sweets and chocolate

This is a guideline that everyone wanting to be healthier should follow and not only people with diabetes. Like the guideline number 3 and 7, they are packed with preservatives and additives and add no real nutritious value to a healthy diet. Also, they do seem to have an addictive quality and the less you eat of them, the less you will crave them.

  1. When eating out, remember your carbohydrate tolerance limit

If you know you can only tolerate a small amount of carbs then choose a meal with a protein and veg or salad and avoid the carb loaded pasta.

  1. Avoid alcohol

People tolerate alcohol differently but in general limit alcohol to one to two drinks since low blood glucose can often be mistaken for drunkenness. Also, avoid sweet drinks like mixers and the sweeter wines and spirits, like brandy and rum. Rather choose the dry wine and white spirits, like gin, vodka and cane. Avoid tonic as it has even more sugar than coke. Mix drinks with water, soda water or sugar-free sodas.

MEET THE EXPERT


Tammy Jardine is a qualified diabetes educator and a registered dietitian. Living with diabetes for over 15 years means that she knows first-hand how difficult it can be to achieve and maintain optimal blood glucose control with good lifestyle habits. She believes that diabetes affects every person differently and takes the time to understand how it’s affecting the individual and to help them manage it effectively. With more than 20 years of experience working as a dietitian in the UK and SA, she has a passion for helping people live a better and happier life with good food. Tammy currently works from Wilgeheuwel hospital. Email: tamjdiet@gmail.com


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What is carbohydrate counting?

Dietitian and diabetes educator,Tammy Jardine, explains what carbohydrate counting is and how it helps in managing diabetes.


Carbohydrate counting (carb counting) is a meal planning method that allows you to match your insulin doses to the different types and amounts of carbohydrates you eat.

The carbohydrate nutrient has the greatest impact on post meal blood glucose, with a smaller and slower contribution from protein. The effect of fat is negligible.

When you eat carbohydrates, they break down into glucose. You need insulin to transport the glucose out of the bloodstream and into the body’s cells. This means that the more carbohydrates you eat, the more insulin you need.

Therefore, if you could quantify (count) the carbs in the meal and take the appropriate amount of insulin to match it, the next blood glucose should neither have risen nor fallen excessively. In other words, you are now mimicking the way the pancreas works.

By combining insulin doses based upon carbohydrate content with corrective doses, you have the opportunity at every blood test and injection of insulin to maintain normal glucose levels, or to bring errant blood glucose back into range. This reduces the fluctuation in blood glucose levels and reduces the risk of hypoglycaemic reaction from taking too much insulin when blood glucose levels are normal, or when too little carbohydrate is eaten at a meal.

Carbohydrate counting is a technique that is easy to learn and apply and offers the ability to match insulin doses with food eaten, carb counting offers flexibility in food choices that is often much appreciated. Carb counting is effective in controlling blood glucose levels and giving you flexibility.

What foods contain carbohydrates?

Carbohydrates are a nutrient found in large amount in starches, like foods made from grains: rice, maize, barley, wheat, oats, and rye; or starchy root vegetables, including potato, sweet potato, beetroot, carrots, turnip and onion. Carbohydrates are also found in dairy, fruit, legumes (beans and lentils), sugar and honey.

In a healthy meal plan, most carbs should come from nutrient-dense foods like whole grains, legumes, fruit, and vegetables. Nutrient-dense foods are high in vitamins, minerals and fibre.

Some sugary foods (cakes, biscuits, pastries and chocolate) can be included in your meal plan but should be limited (just like in any healthy eating plan) as they usually contain very few necessary nutrients.

Use common sense and indulge in moderation. Carb counting will help you decide how to include these foods in your meal plan.

Initially carb counting is a challenge as you need to identify carbs in food and how they affect you as an individual. It takes practice, trial and error, but as you persist it will come easier.

Tools to help with carb counting 

  • Measure portion sizes

It’s easy to overestimate portion sizes so it’s recommended that you use measuring cups and scales at home. Get into the habit of checking portions so that you keep portions in check. Learning portions sizes at home will help you to judge portions more accurately when you eat at a restaurant or dinner party.

When eating at home, always use the same bowl, cup, plate or glass. That way if you always pour milk to a certain point on the glass, then you know that you are eating a consistent amount of food and can expect a consistent blood glucose reaction.

Create a spreadsheet or list of foods that you typically eat at home and then look up the carb values. Then if you’re a person of habit and like to eat a certain band of cereal, you’ll always know how many carbs you’re getting.

  • Use technology

Calorie counting apps are really helpful in identifying carbs in foods. Make a list of the most common meals you eat. Some examples are MyFitnessPal, Carbs & Cals, and FatSecret. Useful websites include www.nutritiondata.com and www.eatright.org

Things to remember

Other tools include food labels, measuring tools, and recipe books. If you’re using food labels, always make sure that you’re looking at the amount of carbs in the portion that you’re eating and not only in 100g.

Pre-portion snack foods by measuring out single servings and putting them into small plastic containers or sandwich bags. This can help control your portions since it’s way too easy to keep grabbing crackers or nuts directly from the package without realising how much you’ve eaten.

Also remember that because a food says that it’s sugar-free on the label doesn’t mean that it doesn’t have carbohydrates.

Some restaurant chains will have the nutritional content of the foods on the menu so look up online so that you can make a choice before ordering.

When eating out, avoid sauces and don’t be afraid to ask the waiter how a meal is prepared or what ingredients are in the food.

For special dinners, eat the foods that are special and avoid the other foods that you can get at any time. For example, if you really love apple pie, then skip the mashed potatoes and bread at the meal and make the dessert your carb portion at the meal. Just be sure to watch your portion size.

What would you have to do?

Keep a very detailed food diary of the carb amount eaten together with corresponding blood glucose levels.

You will need to measure your blood glucose at least morning, midday and evening. If there aren’t excessive increases or decreases in the readings, then you know you have matched the insulin to carbs well.

If they are rising too much (greater than 2-4) then you know that you ate too many carbs at the previous meal and that you need to adjust either the amount that you ate or the dose of insulin that you took.

Provided that they are going lower (by more than 2-4) then you know that you’re giving too much insulin for what you have eaten at the previous meal and you need to either eat more or lower the short-acting insulin dose.

Initially, be very consistent with the amount of carbs that you eat at each meal as this will help to identify how much insulin you need for a specific amount of carbs. Knowing this will help you to be flexible with your insulin doses and adjust according to what you feel like eating.

Carb counting only influences your short-acting insulin. Your long-acting insulin will most likely stay the same and you would not adjust this insulin based on blood glucose or meals eaten.

How many carbs should you eat?

How many carbs you need is dependent on age, height, weight, level of physical activity, current blood glucose levels, and blood glucose targets. Your diabetes educator and dietitian can help you to determine this sweet spot.

Other factors to consider in carb counting

Physical activity, high fat meals and alcohol can have an effect on carb counting.

Physical activity has a various effect on blood glucose so it’s vital to monitor blood glucose to see how exercise affects you as an individual. Most people would require less insulin with a meal post exercise as exercise usually reduces blood glucose as the muscles suck up any glucose post exercise. This is individual so work with your diabetes educator to perfect this for you.

Alcohol also usually reduces blood glucose if it hasn’t been taken with sugary mixer. Keep alcohol to moderate amount (two drinks for men and one drink for women). If this seems impossible then be sure to measure you blood glucose often as symptoms of a hypo can often be confused for drunkenness. Don’t count carbs in alcohol as part of your carbs to match with insulin.

Fat slows the digestion of food in the stomach. This delay means that you may have a blood glucose level that looks fine after eating but spikes before your next meal. Sometimes a high fat meal will require a little more insulin more insulin. Work with your diabetes educator to help you with this scenario.

Step-by-step starter guide to carb counting

  1. Identify foods in carbs using tools and calculate the total of all the carbs in the meal or snack.
  2. Try to keep carbs to similar totals at each meal while your dose of short-acting (mealtime) insulin remains at a standard dose at each meal.
  3. Record your reaction to different meals so that when you eat those meals again, you can make the necessary adjustment to portion or insulin dose to create less flexibility in your blood glucose readings.
  4. Consider factors like fat, alcohol, and physical activity when you’re deciding on your insulin dose.
  5. Consider your premeal blood glucose level. You may need a bit more insulin to bring down high blood glucose. This is called a correction dose. Speak to your diabetes educator to determine this dose for you.
  6. Calculate your insulin dose considering the above factors and give the insulin dose.
  7. Record the blood glucose 2-4 hours after the meal. If it’s too high or low, consider where your calculation could be perfected.

We get over 40 different nutrients a day from food. It’s perfectly okay to eat and enjoy food. It’s just as important to also learn how to balance food, medication, and activity, so that you’re meeting your goals in managing your diabetes. What works for someone else may not work for you so identify and record how your diabetes reacts to these factors.

MEET the EXPERT


Tammy Jardine is a qualified diabetes educator and a registered dietitian. Living with diabetes for over 15 years means that she knows first-hand how difficult it can be to achieve and maintain optimal blood glucose control with good lifestyle habits. She believes that diabetes affects every person differently and takes the time to understand how it’s affecting the individual and to help them manage it effectively. With more than 20 years of experience working as a dietitian in the UK and SA, she has a passion for helping people live a better and happier life with good food. Tammy currently works from Wilgeheuwel hospital. Email: tamjdiet@gmail.com


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