Strategies for dining out or ordering meals at restaurants

For a person with diabetes, the thought of dining out or ordering meals can be challenging and quite daunting when trying to control blood glucose levels. Annica Rust shares strategies to follow when deciding what to order.


What to drink

When dining out, the first confrontation is what to drink. Sparkling water, flavoured water and sugar-free soft drinks would be the preferred choices.

If it is a special occasion, moderate amounts (one or two drinks/units not more than twice a week) of alcohol may be consumed, only in combination with a well-balanced meal to prevent delayed hypoglycaemia.2 This happens because drinking alcohol on an empty stomach can interfere with the ability of the liver to release stored glucose. A low kilojoule white wine with lots of ice is an example of a smart choice.

What to eat

Plate method

When deciding what to eat, it may be helpful to take the plate example in consideration. (See Figure 1.) The plate example will in most cases have a low glycaemic load (GL), even though some of the individual items have a high glycaemic index (GI). Choose a meal as close to the example or construct a meal to achieve a well-balanced meal. Try sharing, if possible, to be able to construct a more balanced meal.

Figure 1: Plate method1

Let’s look at a few examples when ordering:

  1. Pizza


2. Burger



3. Chicken

Take note of the carbohydrates

It is crucial for people with diabetes to control their carbohydrate intake. Carbohydrate containing items used in recipes can sometimes be hidden and may add to the total carbohydrate count for the meal. It is therefore important to be on the lookout for them whilst ordering.

Items that contain carbohydrates1

  • Grains: bread, baked goods, cereal, crackers, pancakes, rice, tortillas and pasta
  • Starchy vegetables and legumes (beans): white potatoes, sweet potatoes, corn, peas and lentils
  • Fruit and fruit juice
  • Milk, milk substitutes and yoghurt
  • Some condiments: jelly, braai sauce, tomato sauce and many salads dressings
  • Sweeteners: sugar, honey, concentrated fruit juice, maple syrup and corn syrup
  • Sweets: ice cream, cake and candy

Dessert is not a must

Lastly, remember that dessert is not a must. If you are satisfied with your meal, rather drink a coffee. Always remember that a flat white, cappuccino or a latte has a large milk basis which makes them high in carbohydrates.

Honour hunger and know when to stop

Lastly never forget about your intuition. Unfortunately, a person with diabetes cannot solely rely on intuitive eating, but a nutritional approach that combines key diabetic dietary strategies in combination with intuitive eating can only reap good results. Honour hunger but know when to stop when you are satisfied and rather ask for a “doggie bag.”

Try not to label certain food items as forbidden but try to incorporate them into your meal plan. Remember with portion control there is a time and place for all food items. Always try to see the bigger picture. For example, if dining out is part of your daily routine, stricter portion control is necessary, however, if you rarely dine out, you can be more lenient whilst still staying within boundaries.

There is no one size fits all approach. Please contact a registered dietitian for individualised advice on strategies for dining out at restaurants.


References:

  1. https://www.nutritionletter.tufts.edu/general-nutrition/diabetes-diet-what-to-eat/
  2. 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 in 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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How biokineticists can assist with exercise in Type 1 diabetes

We learn more about the role of biokineticists in exercise and Type 1 diabetes.


What is a biokineticist?

Biokinetics is a profession that focuses on promoting health and well-being by means of scientifically-based exercise prescription.1 It involves many areas, including: orthopaedic and neurological rehabilitation, health promotion, chronic disease management and sporting performance. As biokineticists, we promote an active lifestyle to prevent non-communicable diseases, such as diabetes, by enhancing muscle strength, endurance, cardiorespiratory fitness, and flexibility.  A biokineticist will improve your physical functioning and educate you on how you can live your life through movement.2

Understanding diabetes

Diabetes is characterised by a sustained elevation in blood glucose. Type 1 diabetes specifically is caused by an autoimmune dysfunction which disrupts the pancreas and its ability to produce insulin.3 Insulin is a key hormone which acts as a gatekeeper between your blood vessels and muscles. Insulin is required for muscles to absorb the glucose circulating in your bloodstream.

Without insulin, blood glucose levels elevate beyond normal levels, which has negative effects on our biology, particularly the cardiovascular system. Type 1 diabetics supplement their insulin levels with injections administered at strategic times throughout the day.

Function of exercise in diabetes

The primary reason for exercise in the management of diabetes is to improve glycaemic control. In conjunction with diet and medication, exercise can reduce the risk of diabetes-related health complications.3

A biokineticist will perform a personalised evaluation and assign an exercise prescription that will help improve your glycaemic control, in turn aiding cardiovascular health and increasing life expectancy.3 Your biokineticist will ensure that you are exercising safely and meeting your personal goals.

Principles for exercise

There are various principles that biokineticists use to ensure that exercise is prescribed correctly. These include frequency, intensity, time, and type.1

  1. Frequency: This is how often you exercise during the week. Studies show that 3-7 days of aerobic exercise and 2/3 days of resistance exercise is recommended.
  2. Intensity: This is either how moderately or vigorously you exercise. It is calculated using a rating of perceived exertion (RPE) scale. This scale ranges from 1-20. 1 being no discomfort to 20 being unbearable. Aerobic exercise can be performed moderately (11-12 RPE) to vigorously (14-17 RPE). Resistance exercise can be performed moderately and vigorously using a percentage of your 1 repetition maximum, which your biokineticist will calculate.
  3. Time: This is how long you exercise for. Your biokineticist will recommend at least 150 minutes a week for moderate exercise to 75 minutes of vigorous aerobic exercise. Resistance training uses repetitions and sets. It is encouraged to do 8-10 exercises with 10-15 repetitions and 1-3 sets.
  4. Type: The type of exercise is important. Your biokineticist will give you aerobic exercises, like swimming and cycling, and resistance exercises, such as lifting weights or using resistance bands.

Where to find a biokineticist?

Biokineticists are found in private practice, gyms, or wellness centres. Head over to the BASA website to find a biokineticist near you.


References

1.Biokinetics Association of South Africa. (2021). What is a Biokineticist? Retrieved from Biokinetics SA – Life through Movement : biokineticssa.org.za/public-information/

2.Ellapen, T. J., Strydom, G. L., Swanepoel, M., & Hammill, H. V. (2018). Biokinetics: A South African Health Profession Evolving from Physical Education and Sport. Sport and Exercise Science, 15-27.

3.Riebe, D., Ehrman, J. K., Liguori, G., & Magal, M. (2016). ACSM’s Guidelines for Exercise Testing and Prescription. Tenth Edition. Philadelphia, PA: Wolters Kluwer.


Written by Stephanie Irons (Biokinetics Intern at Rob Evans Biokineticists) on behalf of The Biokinetics Association of South Africa (BASA).

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How to overcome energy dips

Energy dips are most often experienced mid-afternoon. You may have rushed to the vending machine and grabbed a chocolate or packet of crisps in the past. But read what Tammy Jardine has to say first before grabbing that snack.


There is a myriad of reasons for energy dips that make you feel like you have hit a wall that you can’t climb, and if you have diabetes it’s important to see if you really are having a blood glucose dip before noshing on that high-energy snack.

Feeling fatigued can be related to eye strain, dehydration, stress and tension, hunger, illness, low blood pressure, low blood glucose and high blood sugar.

Test your glucose levels

If you have diabetes, it is important to test your blood glucose to double check what is happening. Your blood glucose reading will determine what kind of snack to choose.

If your blood glucose is lower then normal then choose a carbohydrate snack but if it normal or high then choose a snack that is low in carbohydrate.

Most people with diabetes may be able to tolerate 15g of carbohydrates for a snack. Having more carbohydrate between meals often will mean that your blood glucose is high before the next meal.

If you typically have low blood glucose before meals or experience hypos during the day, you should have a carbohydrate snack of 15g between meals.

If you do not have hypos or drop blood glucose quickly between meals then you should stick to low carbohydrate snacks (less than 5g carbohydrate).

You may also need a carbohydrate snack if you have a very long gap between meals.

Carbohydrates per portion food label

Use the food label to determine the amount of carbohydrates per portion. Choose natural foods as snacks as often as possible.

Snacks options containing 15g carbs


Snacks containing less than 5g of carbs


1 small apple (6,5cm diameter)

100g low-fat fruit yoghurt

4 Salticrax crackers

40g peanuts and raisins

2 cups popcorn

1 large carrot (7,5cm long) and 2 tablespoons hummus

½ an avocado

1 slice low-GI bread with butter or margarine or cheese

½ cup berries

100g double cream plain yoghurt

1 Salticrax cracker

40g peanuts

2/3 cup popcorn

1 stalk celery and 1 tablespoon hummus

Sugar-free jelly

Boiled egg

Biltong

Cheese, cottage cheese, Laughing Cow cheese wedge

Olives

¼ avocado

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.


Ask Tammy


Do you have a question for Tammy?
Email your question to tamjdiet@gmail.com
PLEASE NOTE: Not all questions can be answered, click here to read our Q&A 
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Support your immune system with good nutrition

How our bodies fight off diseases has gained more attention recently since the unprecedented global pandemic hit. The immune system is the intricate mechanism your body uses to fight off diseases and foreign invaders. Your diet and lifestyle can greatly affect your immune system, Jessica Pieterse tells us how.


Vitamin D

Vitamin D has always been a large role player in immune health. Receptors of vitamin D have been identified on several immune cells; in addition, they regulate the immune system by suppressing the pro-inflammatory molecules.

To improve your vitamin D levels, spend 15-20 minutes daily in the sun with as much skin exposed as possible. It must be from direct sun exposure and not through any windows. To get as much vitamin D, avoid applying sun cream, however, being sun smart is just as important. Eat more foods that contain vitamin D, such as liver, mushrooms, whole eggs, salmon, mackerel, and cod liver oil. Take a supplement if you know you are deficient. It is best if your health practitioner monitors your vitamin D levels annually and regulates your supplementation.

Gut bacteria

We have billions of bacteria making their home in our gut. Gut bacteria can be helpful or harmful depending on the type of bacteria. If a person has a healthy balance of the good bacteria, it can be vital in supporting immune health. Good bacteria fight harmful foreign substances that enter the body by detoxifying them and easing their elimination. Bacteria can also stimulate immune cells and affect gut lining integrity.

Ways to improve your gut bacteria balance is to take a good quality probiotic supplement, increasing prebiotic fibres, adopting a balanced healthy diet, reducing stress and improving sleep.

Good quality probiotic supplements contain several different strains of bacteria, have high doses of bacteria (at least 1 billion CFUs) and are stored in the refrigerator to keep bacteria alive. Take probiotics on an empty stomach so the bacteria are released further down the gut system and not in the stomach.

Most fruit, vegetables and wholegrains (barley, brown rice, oats) are sources of prebiotic fibres. Eating more of these foods will improve your gut bacteria balance. People suffering with IBS, be cautious. Some prebiotic fibres can worsen IBS symptoms so it’s best to seek individualised advice from your health practitioner.

Antioxidants, vitamins and minerals

Many supplements marketed to improve your immune system will contain a variety of vitamins, minerals and antioxidants. Antioxidants help by reducing oxidative stress. Eat more cocoa, red grapes, berries, herbal teas, turmeric, olive oil and pomegranates to boost your antioxidant intake.

The main vitamins and minerals that support your immune system are vitamin A, C, E, D, selenium and zinc. They each play a unique role. One vitamin or mineral is not a magic pill for avoiding getting sick. To clean your house, you can’t just use a broom; you also need a mop, cloth, water, and a bucket to do a good thorough job. Your immune system is the same. Many different vitamins, minerals and substances are needed to protect your body. They all play a part in the big picture.

Eat more beans, chickpeas, lentils, salmon, pilchards, fish, oysters, nuts, seeds, sweet peppers, strawberries and orange fruit and vegetables to improve your intake of these key nutrients.

Exercise

Being active can improve your immune system. It is interesting to note that very high amounts of exercise can potentially strain your immune system and have the opposite effect. That is why it is common to hear of many Comrades runners getting sick right before the race as they are extensively exercising at that point.

Aim for 30-45 minutes of exercise 3-4 times a week of varying intensities as a gauge. Exercise that lowers stress levels will have further beneficial impacts.

Sleep

Most people are told when they are sick to sleep more. This is not just an old wife’s tale but is correct. While you sleep, your body releases certain immune and inflammation molecules which affect your immune health.

Aim to improve how long you sleep and the quality of your sleep. Make these changes to improve your sleep.

  • Avoid digital devices an hour before sleeping.
  • Make your room dark and cool enough.
  • Avoid drinking liquids too late at night.
  • Reduce your caffeine intake.
  • Be more active.

Do a relaxing activity before sleep like reading, deep breathing, prayer or mediation.

MEET THE EXPERT


Jessica Pieterse is a registered dietitian and owner of Dish Up Dietitians. She practices in Edenvale, Johannesburg and has a special interest in women’s health and gut health.


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Meditation – more than just gongs and incense

Daniel Sher explains how meditation can improve the mental and physical well-being of people with Type 1 and Type 2 diabetes.


What comes to mind when you think about meditation? If you’re envisaging a Buddhist Monk poised in the lotus position, levitating just above the ground, you’re not alone. However, meditation is more than just gongs and incense. 

In my clinical psychology practice for people with diabetes, meditation is one of the most effective and transformative tools that I use to help people learn to thrive with diabetes.

What is meditation?

Quite simply, it is a way of calming the mind through techniques, such as focused breathing and visualisation. There are many different types, including Mindfulness, Transcendental Meditation, Mantra Meditation and Progressive Muscular Relaxation.

Meditation has been practiced for centuries by people all over the world; and it often forms an important part of various ethnic and spiritual practices. However, in the context of health sciences, most people use meditation as a brain-training exercise for improving health, rather than a spiritual practice.

How can meditation help people with diabetes?

Meditation (Mindfulness in particular) is a skill which people with diabetes can use to build up their resilience toolbox. Research has shown, for example, that meditation can help people with diabetes to:

Improve

  • blood glucose control;
  • sleep;
  • overall quality of life

Lower

  • risk of high blood pressure and cardiovascular disease

More generally, meditation is a really powerful tool for people with diabetes, as it can help them to manage the emotional aspects of this condition. For example, diabetes burnout is a situation in which we feel overwhelmed and exhausted by the demands of living with this condition.

Most people with diabetes experience burnout at least once, often more. Meditation can help us to recognise the signs of burnout. Beyond this, meditation gives us a tool to process and move through the feelings of overwhelming frustration that we often feel as a result of living with this condition. What else?

Meditation is a highly effective way of lowering stress. Why is this important for people with diabetes? For starters, stress hormones (such as cortisol) lead to higher blood-glucose levels. Through meditation, therefore, you help your body to lower blood glucose levels naturally. Furthermore, people who are good at managing their stress are also better at making healthy decisions in terms of their day-to-day lifestyle.

Meditation is also a really great way of helping people with diabetes to regulate their emotions. Why is this important? As with stress, uncomfortable emotions (such as fear, worry, anger, sadness or hopelessness) can raise blood glucose.

Uncontrolled emotional fluctuations can also lead to emotional binge-eating, substance use, avoidance of injections and other problematic behaviours. Furthermore, meditation is a great tool for helping people to move through denial, in order to truly accept their condition.

What about people with diabetes and a diagnosed psychiatric condition?

As people with diabetes, we are far more likely than most to have a diagnosed psychiatric condition, such as clinical depression (or Major Depressive Disorder), anxiety disorders, eating disorders and bipolar mood disorder. These disorders can be effectively treated through psychological therapy techniques which draw on meditation.

For example, Mindfulness Based Cognitive Therapy (MBCT) and Acceptance and Commitment Therapy (ACT) are both evidence-based approaches for treating mental illness, which blend Mindfulness with other psychotherapy techniques. A 2020 paper has also shown that Mindfulness-based therapy, in particular, is an effective way for people with diabetes to get better HbA1C levels and treat depression at the same time.

Your brain on meditation

Brain scan technology shows us that certain forms of meditation (including Mindfulness) can actually change our brains. We know, for example, that practicing Mindfulness can lead to changes in parts of the brain that control fear, panic and self-soothing responses. In this sense, the practice can help you ‘rewire’ your brain in a way that promotes health, calm and well-being. Another 2012 study found that practicing Mindfulness can help you grow your hippocampus (often referred to as the memory centre of the brain) thereby helping you to improve your thinking skills.

Summing up

In recent times, rigorous scientific trials and sophisticated brain-scan technologies have shown that meditation can have real benefits for your brain and body. In particular, meditation is a powerful tool for people with diabetes who are looking to live a happier and fuller life. Best of all: meditation can be practiced by anyone, anywhere. In other words, it’s not only for mystics, monks and hippies.


References

Gainey, A., Himathongkam, T., Tanaka, H., & Suksom, D. (2016). Effects of Buddhist walking meditation on glycemic control and vascular function in patients with type 2 diabetes. Complementary therapies in medicine, 26, 92-97.

Greenberg, Jonathan, et al. “Reduced interference in working memory following mindfulness training is associated with increases in hippocampal volume.” Brain imaging and behavior 13.2 (2019): 366-376.

 Hölzel, B. K., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S. M., Gard, T., & Lazar, S. W. (2011). Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry research: neuroimaging, 191(1), 36-43.

 Keyworth, C., Knopp, J., Roughley, K., Dickens, C., Bold, S., & Coventry, P. (2014). A mixed-methods pilot study of the acceptability and effectiveness of a brief meditation and mindfulness intervention for people with diabetes and coronary heart disease. Behavioral Medicine, 40(2), 53-64.

 Ni, Y., Ma, L., & Li, J. (2020). Effects of Mindfulness‐Based Stress Reduction and Mindfulness‐Based Cognitive Therapy in People With Diabetes: A Systematic Review and Meta‐Analysis. Journal of Nursing Scholarship, 52(4), 379-388.

 Varghese, M. P., Balakrishnan, R., & Pailoor, S. (2018). Association between a guided meditation practice, sleep and psychological well-being in type 2 diabetes mellitus patients. Journal of Complementary and Integrative Medicine, 15(4).

MEET THE EXPERT


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


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How to boost your immune system while recovering from COVID-19

Omy Naidoo, a registered dietitian, shares four immune-boosting nutrition tips for people with diabetes and obesity when recovering from COVID-19.


People with diabetes and who are obese are part of the vulnerable group whose immune system is easily compromised, making them vulnerable to contracting COVID-19. If someone has been exposed to or contracted the virus, healthy nutrition is essential for recovery in boosting their immune system.

The impact of COVID-19 is greater for people with diabetes and are obese. People who have diabetes and are obese, are more likely to have serious complications from COVID-19. In general, people with diabetes are more likely to have more severe symptoms and complications when infected with any virus. On the other hand, obesity has emerged as a strong and independent risk factor for severe infection and death due to COVID-19.

According to the World Health Organisation, obesity significantly increases the chances of severe outcomes for COVID-19 patients. Likewise, extra healthy nutritional measures need to be taken for people with diabetes.

Those recovering from the coronavirus should eat a variety of fresh and unprocessed foods every day to get the vitamins, minerals, dietary fibre, protein and antioxidants their body needs. They should also drink enough water, avoid sugar, fat and salt to significantly lower their risk of diabetes and obesity.

Four immune-boosting nutrition tips for people with diabetes and obesity when recovering from COVID-19:

Proteins

Protein is an important nutrient for cell growth and regeneration. It is the building block of life and is required by our body for faster recovery. When suffering from COVID-19 it is recommended to eat a high protein diet.

Eating 75-100 grams of protein is essential every day. Add more foods like lentils, legumes, milk and milk products, soya, nuts, seeds, meat, chicken, fish and eggs.

Vitamins and minerals

  • Fresh fruits and vegetables are loaded with immune-boosting, antioxidants, vitamins and minerals. These can be an excellent addition to your diet for faster recovery and strengthening your immune system.
  • Aim for five portions of fruits and vegetables a day.
  • Citrus fruits are packed with vitamin C, which helps in the formation of antibodies and fights infection, while green and root vegetables help to strengthen the immune system.
  • Also, spend some time outdoors to get a sufficient amount of vitamin D.

Less sugar and salt

  • When cooking and preparing food, limit the amount of salt and high-sodium condiments (e.g. soya sauce and fish sauce).
  • Limit your daily salt intake to less than 5g (approximately 1 teaspoon), and use iodized salt.
  • Avoid foods (e.g. snacks) that are high in salt and sugar.
  • Limit your intake of soft drinks or sodas and other drinks that are high in sugar (e.g. fruit juices, fruit juice concentrates and syrups, flavoured milk and yoghurt drinks). Choose fresh fruits instead of sweet snacks, such as cookies, cakes and chocolate.

Fluids

  • Water is an essential element for life as it carries nutrients in the blood, regulates body temperature, and flushes out toxins from the body. Besides, an infection can dehydrate the body.
  • Try to drink at least two to three litres of water every day. You can also consume herbal concoctions, coconut water, milk and fresh juice.
  • Avoid packed juice, caffeine and fizzy drinks.

MEET THE EXPERT


Omy Naidoo is a registered dietitian and founder of Newtricion Wellness Dieticians. He has been in practice for 13 years. He worked within the government sector and then moved into the pharmaceutical industry. His key focus is on diabetes products. This enabled him to further his knowledge and skills in diabetes management. Thereafter he went into private practice.


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Diabetes in the workplace: speak, prepare, feel

Type 1 diabetic, Gabrielle Mixon, shares the pitfalls and peaks of managing her condition in a new workplace.


Managing diabetes at your workplace can be daunting or you can use it as an opportunity to share more about your condition. I’ve always chosen the easy, take-it-in-your-stride-approach and in all honesty, that hasn’t led to outcomes that really benefited me. Sharing that I have diabetes at a new job is something I’ve battled with, however, I have become bolder over the last couple of years and with certainty I can now say the best advice is to develop these simple habits: speak, prepare, feel (SPF).

Speak

My mistake was that I did not like speaking about the fact that I am  a Type 1 diabetic. This was for a number of reasons that don’t make sense to me anymore. One reason was that I just wanted to be as normal as the next person and not draw any special attention to myself by referring to myself as a diabetic.

My lesson learnt was to speak about the chronic condition openly. Seeing as I have to live with it, I ought to live with it more openly, even in the workplace.

One of the first things is to let the HR team or person know that you have a chronic condition. Should anything happen to you while at work that information is vital to know and for the purposes of office etiquette and catering to your health requirements, conditions should be made known to HR. It also saves you a great deal of pressure if you are in a meeting and need to excuse yourself because you have a low sugar and need to treat it.

You become a floodlight into the life of a person with diabetes who makes several hundred more decisions everyday than the average person, according to research. One decision you can make to manage your diabetes in a new work environment is to speak openly about having it. Tell your team or colleagues your story and how it has impacted your lifestyle and how you got diagnosed. The only way to overcome the nerves you are feeling is to open up about it. You’ll be astounded by the support and ease that comes with opening up.

A large portion of our population are undiagnosed diabetics. So, in speaking about it you can simultaneously raise awareness and perhaps help another colleague who is undiagnosed.

Prepare

One of my mistakes: taking the previous night’s dinner for lunch. Usually I enjoy higher carb content meals at night because it sustains my blood glucose level through the night and prevents me waking up with a low blood glucose at early hours of the morning. The problem with this easy lunch is that my blood glucose and energy level suffer because of it.

My lesson: Prepare lunches that are proven to not affect my blood glucose and energy level negatively. Your well-being is of the utmost importance, as the saying goes ‘’health is your wealth’’ and you can’t be a productive worker without first taking care of yourself, diabetic or not.

A little extra time used to prepare your lunch will result in great energy and productivity at work. Plus, your successful health management will be to your benefit in adjusting to your new job more efficiently.

Feel

My mistake was that in a previous job, I got used to eating cake on every birthday and whenever there was a reason to celebrate in the office. The pressure and natural desire to belong and fit in socially was more important than the guilt I felt for having a high glucose after eating the cake.

Not only did I feel terrible physically which resulted in lower productivity but I’d emotionally beat myself up for having failed at controlling my blood glucose level. Double trouble.

My lesson is to simply get used to feeling comfortable with having the conversation with yourself about how low glucose makes you feel or how high glucose makes you feel. When you can honestly say something makes you feel bad and come to terms with the empowering belief that only you are responsible for making yourself feel otherwise, you change your behaviour, which changes everything.

No one knows the impact of the condition if they do not have it or have not experienced it before through people close to them. Still, nothing compares to actually going through it yourself. As people with diabetes we go through highs and lows, literally and figuratively.

Over the last two years, speak, prepare and feel are habits that I’ve picked up and have really begun to work for me greatly. I urge you to take what you need from this and begin applying or share it with someone.

I believe in the below affirmations more now than ever:

  • It’s normal for you to feel nervous
  • It’s okay to snack in meetings
  • It’s okay to take time away from your work to test your glucose
  • It’s okay to drink a lot of water and use the restroom. Some people need smoke breaks, others need bathroom breaks. As a person with diabetes I need the latter.
  • It’s okay to take a break when you have low blood glucose and to use the time to readjust to normalcy.
  • It’s okay to take a bit of time preparing a considered lunch whether at home or in the work kitchen.
  • It’s okay to be different to your co-workers and have different needs.
  • It’s okay to say no.
  • It’s okay to say yes

With affirmations that empower you to prioritise your diabetes in your new work environment, you can thrive in your occupational spaces despite having to deal with the unexpected and unique experience that comes with being diabetic.

Gabrielle Mixon is advocate for T1 Diabetes.

MEET THE AUTHOR


Gabrielle Mixon is an advocate for T1 diabetes.


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Intermittent fasting – is it for everyone?

Intermittent fasting has become one of the world’s most popular health and fitness trends. People are using it to lose weight, improve their health and simplify their lifestyles. But is it for everyone?


Fasting has been around for decades and many different religions practise some sort of fasting during holy periods.

However, intermittent fasting (IF) is a type of weight loss strategy in which the person undergoes a voluntary fast for a specific period of time. The benefit of this fasting is that after 12 hours your body starts to break down fat through a process called lipolysis; as opposed to storing fat, which is typically seen after eating a meal. Scientists refer to this process as a way to flip your metabolism’s switch.

The benefits of IF include weight loss, some improvements in blood glucose levels, anti-aging effects, reduction in cardiovascular risk, as well as cancer.

 

May not be good for everyone

Whilst there is growing evidence that IF has its benefits, it’s crucial to remember it may not be an approach that works for everyone. It’s important to work with an expert, such as a registered dietitian, to determine which strategy would be the best for you. This could be IF, low-carb diets, Keto diet, Calorie restriction, Very Low-Calorie diets (800kcal), etc. Remember, it is not a one-size-fits-all approach.

The best approach for IF would be the 16/8 whereby you consume all your calories in an 8-hour window. This would mean having supper at 6pm and then your next meal at 10am the next morning. The best results have been seen when you combine IF and a calorie restriction; this means one should still be mindful of the types of foods being eaten in the 8-hour window.

Some research shows that IF actually helps with fat loss, as well as fat redistribution whereby the fat around the tummy is redistributed in the body, thereby reducing the risk of cardiac disease.

Intermittent fasting is not for everyone, since it does not always yield positive results and can cause hypoglycaemia for people with diabetes and low blood glucose levels in pregnant women.

Although intermittent fasting can seem convenient to do, it is advisable that you consult your medical practitioner before implementing it, especially if you have a medical condition.

MEET THE EXPERT


Omy Naidoo is a registered dietitian and founder of Newtricion Wellness Dieticians. He has been in practice for 13 years. He worked within the government sector and then moved into the pharmaceutical industry. His key focus is on diabetes products. This enabled him to further his knowledge and skills in diabetes management. Thereafter he went into private practice.


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The SA Seniors Fitness Association (SASFA)

SASFA is open to anyone over the age of 50, if you are looking for fun and friendship.


About SASFA

The South African Seniors Fitness Association (SASFA) started in 1990 as a non-profit organisation. The aim and purpose is to reach as many seniors throughout the country as possible, to advocate why regular and appropriate senior related exercise is extremely valuable and vital in creating a better quality of life.

Members and instructors pay an annual membership fee at the beginning of each year. All monies received from membership, sponsorship, donations, fund raising etc, is used to run SASFA and any unused or extra profits get ploughed back into the Association for future use.

The Management Committee meets every second month, seeing to the needs and running of SASFA. There are eight members on the committee: Iona Henning (Chairperson and National Trainer), Dot Tyldesley (Vice-chair), Rosemary Swemmer (Treasurer), Helga Calitz (Gauteng Regional Rep), Carol Alty, Edwina Fillies, Sally McKinley and Pat Wright.

SASFA instructors

Instructors are required to take their SASFA exam to become qualified and receive their SASFA Instructors certificate. Instructors are obligated to attend the yearly national course when the new programme is presented.

How does it work?

By presenting exercise and recreational programmes in a relaxed environment, members are able to release tensions, stresses and anxieties that may be troubling them. Physical exercise plays an important part in maintaining the health of the body. Just as important is social well-being.​

A senior’s fitness exercise programme comprises, flexibility, balance, poise, co-ordination, stamina, muscle strengthening and cardiovascular exercises. These exercises are set to enjoyable and stimulating music. Our senior instructors are all fully trained and must hold a national certificate.

Fun, friends and exercise

SASFA is a very successful organisation that we are all proud of and privileged to belong to. It’s important for body, mind and soul to keep active in our senior years. Often people say, ‘what would I do without SASFA’.  Well when you join a club it becomes a very special group, making new friends, bonding together, and soon this becomes a part of your life.


Should you be interested in finding out more about joining SASFA, either to take part in an exercise programme or to be trained as an instructor, visit saseniorsfitness.co.za


How to improve cholesterol profiles with diet

Registered dietitian, Annica Rust, explains why improving your cholesterol profile with diet is important.


What is blood cholesterol?

Many components in our body are sterols. For example: bile salts, sex hormones, cortisol, vitamin D and cholesterol. These components perform essential functions in our body.1,2

Cholesterol serves as a precursor to synthesise these components in our body and is also a structural compound of all cell membranes. Total blood cholesterol, which consist of low-density lipoproteins (LDL)(bad cholesterol), high-density lipoproteins (HDL) (good cholesterol)l and triglycerides, are used to assess a blood lipid profile. 1,2

Atherosclerosis

An elevated blood lipid profile is dangerous as fat can accumulate in the arterial wall and will form a plaque/deposit. This hardening of arteries due to the formation of fatty deposits is known as atherosclerosis.1,2

The fatty deposits will restrict blood flow or can rupture which then causes blood clot formation in the artery which can cause a heart attack and a stroke.1,2

Atherosclerosis, high blood pressure and a heart attack can be classified under cardiovascular diseases (CVD).1,2 The risk for CVD in Type 2 diabetes is two to three times higher in men and three to five times higher in women when compared to people without diabetes.3

Dietary cholesterol

Dietary cholesterol is often confused with blood cholesterol levels. Blood cholesterol levels is not only influenced by dietary cholesterol alone but also by saturated fat and trans-fat.1,2

A diet high in saturated fat, trans fat and cholesterol may all increase the LDL-cholesterol levels in your blood. Studies have found that saturated fats have the biggest impact in increasing LDL-cholesterol. Saturated fat content of food items is thus more important than the cholesterol content of food.1,2

It has been found that a diet high in soluble fibre and omega-3 fatty acids may have cholesterol lowering effects. The replacement of saturated fats and trans fats with monounsaturated and polyunsaturated fats (as shown in the table below) can also lower LDL-cholesterol levels.1,2

Lifestyle factors, such as stress, sleep, smoking, alcohol and exercise, must be addressed in combination with a healthy balanced diet for the best results. Smoking increases inflammation and blood clotting which can also contribute to atherosclerosis. Regular physical activity can lower blood triglycerides, raise HDL levels and will lower blood pressure to lower CVD risk. Studies have proven that a 5-10% loss of body weight can be beneficial to reduce cholesterol and glucose levels as well as reduce your risk for heart disease.1,2

Types of fats

Saturated fat Trans-fatty acid Monounsaturated fatty acids (MUFAs) Polyunsaturated fatty acids (PUFAs)

Omega-3                         Omega-6

Visible fat on meat

Skin of  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)

Olive, canola, peanut oil

Avocado

Nuts (cashews, almonds, peanuts, macadamia, pistachios)

Peanut butter

Sesame seeds

Fatty fish (tuna, salmon, herring, mackerel)

Walnuts

Flaxseed

Pumpkin and sunflower seeds

Oils (corn, sunflower, cottonseed)

Mayonnaise

Margarine (nonhydrogenated)

 

Steps to improve your blood cholesterol levels:1,3

  1. Control energy intake: Adjust energy/kJ intake to achieve an ideal body weight.
  2. Increase omega 3 fatty acids: Aim for 2-3 servings of oily fish per week, such as tuna, sardines, salmon and trout.
  3. Choose healthy fats: Reduce saturated fat and trans-fat intake by eating less red and processed meats and refined foods. Remove all visible fat from meat before cooking. Total fat intake should also be limited to less than 30% of total energy. Reduce the amount of fat used for food preparation and use non-stick pans as an alternative to butter and/or oil. Consume more MUFAS and omegas 3 fatty acids.
  4. Increase soluble fibre intake: Most fruits and vegetables are high in soluble fibre.
  5. Increase plant stanols and sterols by consuming more fruits and vegetables. Switch out butter for margarine with added stanols and sterols.
  6. Improve beta glucan intake: Eat more oats which contains beta glucans or consider supplements with beta glucans in.
  7. Consume antioxidants by eating more fruits and vegetables.
  8. Cut back on sugar and sugar sweetened beverages.

Beneficial diets: Low-GI diet, Mediterranean diet and DASH diet. The above mentioned are general guidelines. Please contact a registered dietitian for individualised advice on how to practically implement the above-mentioned guidelines.


References:

  1. Mahan, L.K. & Raymond, J.L. (eds).2017. Krause’s food and the nutrition care process. 14th ed. St Louis. MO: Elsevier Saunders.
  2. Rolfes, S.R., Pinna, K., & Whitney, E. 2012. Normal and clinical nutrition. 9th edition. Wadsworth: Cengage Learning.
  3. SEMDSA Type 2 Diabetes Guidelines Expert Committee. JEMDSA 2017; 22(1)(Supplement 1): S1-S196.

MEET THE EXPERT


Annica Rust is a registered dietitian practicing at the Breast Care Unit in Netcare Milpark Hospital as well as in Bryanston, Gauteng. She strives to provide individualised and practical nutritional care to improve the lifestyle and health of all of her patients.


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