Sugar aka…

Registered dietitian and diabetes nurse educator, Tammy Jardine, educates us on the many hidden names of sugar (there are over 50) and why sugar is seen as a villain.

Sugar is the new villain in the diet industry and making it even more wicked is that sugar is a master of disguise. Historically, the misconceptions about sugar in the greater health industry has revolved around white sugar, otherwise known as table sugar. 

White sugar is the end product of refining and processing of cane sugar. During this process, moisture, minerals and compounds that give them their darker colour are removed, as a result forming white refined sugar. With these nutrients removed, sugar provides energy but has no other nutritional value. Sugar is therefore often referred to as empty calories, adding no value to a healthy diet. Cancer, obesity and diabetes have been linked to white sugar consumption.

For decades, it has been advised that people with diabetes avoid sugar as it has a high glycaemic index (GI), which implies a rapid increase of blood glucose after eating.

Daily sugar limit

The Scientific Advisory Committee on Nutrition (SACN) recommends the following limit for added sugars in the diet for the general population.

Age group Maximum added sugar value per day
4 to 6 years old No more than 19g
7 to 10 years old No more than 24g
11 or over No more than 30g
People with diabetes 25g or less

For reference:4 grams of sugar is equal to a teaspoon of sugar.

The hidden names of sugar

However, just because you don’t see ‘sugar’ on the ingredient list when scanning a food label does not guarantee the item is sugar or sweetener-free. Sugar goes by a number of different names, making it easily unnoticed. Sugar has over 50 different names. While some of these names are more obvious, like brown and cane sugar, others are trickier to spot (e.g. maltodextrin and dextrose).

Most common names for sugar that you may find on an ingredient list

  • Basic Simple Sugars (monosaccharides and disaccharides) – dextrose, fructose, galactose, glucose, lactose, maltose, sucrose.
  • Solid or Granulated Sugars – beet sugar, brown sugar, cane juice crystals, cane sugar, coconut sugar, castor sugar, corn syrup solids, date sugar, demerara sugar, malt, glucose syrup, grape sugar, icing sugar, ethyl maltitol, dextrin, maltodextrin, muscovado, raw sugar, sucanat, turbinado.
  • Liquid or Syrup Sugars – agave nectar, syrup, barley malt, molasses, rice syrup, caramel, carob syrup, corn syrup, evaporated cane juice, fruit juice, golden syrup, high fructose corn syrup, honey, invert sugar, malt syrup, maple syrup, sorghum syrup, treacle.

Why is sugar added to food?

Sugars are being added to a huge range of foods from bread and hams to more obvious foods, such as cakes and biscuits. Sugar is added to foods to increase the shelf life since sugar is a preservative and it also makes foods more palatable. Most of us will be aware of more obvious sugar, such as sugary fizzy drinks, cakes and biscuits but there are also other foods which contain a lot of sugar that may not be immediately obvious.

However, it’s not just added sugar that can increase blood glucose levels. Sugar is a form of carbohydrate. Carbohydrate is one of three macronutrients found in food. Carbohydrates breakdown to glucose (sugar) through the process of digestion. We now know that all carbohydrate raises blood glucose levels.

Forms of sugar

Sugar can be found in three forms.

  • Natural – There are natural sugars found in fruit, milk-based products, honey, and vegetables.
  • Added – Also called free sugars, these are the sugars that are added to a whole range of processed foods and drinks, including microwave meals, pasta sauces, breakfast cereals, biscuits, sweetened drinks and desserts. These are the sugars listed above.
  • The product of the digestion of more complex carbohydrates – Many of us are unaware that starchy foods like bread, rice or potatoes are broken down by digestion into surprisingly large amounts of sugar. A small slice of whole-meal bread is equivalent to three teaspoons of sugar. It’s important therefore that your diet does not contain too much carbohydrate either (e.g. bread, pasta, rice).

Clarifying Total carbohydrate on nutrition label

Therefore, for somebody with diabetes, it’s the total sugar burden from any of the three sources (natural, added or as a product of the digestion of complex carbohydrate) which need considering to keep blood glucose levels low. This is identified as the total carbohydrate on a nutrition label.

Carbohydrates and sugar raise blood glucose levels quickly and require insulin to be produced (or taken by injection) as high blood glucose levels over time cause damage. Many people find that sugar has addictive qualities meaning that we may crave sugary foods even if we know they’re not good for us. Insulin causes the cells of your body to take up the free glucose in your bloodstream. So, having too much sugar means having or needing more insulin.

Nutrition label laws

By law, all packaged food and beverage nutrition labels must display the carbohydrate and sugar content per serving. The best way to ensure you’re not consuming excess added sugars is to get in the habit of always scanning the ingredient list before you throw the item in your trolley.

Keep in mind that ingredients are listed by quantity from high to low: the closer to the front of the list, the more the product contains. If you spot any of above sugar names listed on a label, keep in mind it’s not automatically a no-go. It’s the amount of sugar that counts. If the total carbohydrate count is 1-2 grams, it’s still fine to have if you’re following a low-carb lifestyle. That’s why it’s also important to always look at the total carbohydrate content.

Three different sources of sugars that make up our total dietary ‘sugar burden’

Shown as 4g teaspoon of table sugar equivalents:

Naturally occurring sugar (1) Foods with added sugar (2) Foods digested down into sugars (3)
4.9 teaspoons/100g
Coco pops
21.85 teaspoons/100g
Sasko brown bread
10 teaspoons/100g
Honey (Floaris group Organic raw)
20.6 teaspoons/100g
Coca Cola
2 teaspoons/100ml
Boiled spaghetti
3.7 teaspoons/100g
Spar low fat Milk
1.25 teaspoons/100ml
Marie biscuits
18.5 teaspoons/100g
Mc Cains Skinny fries
4.75 teaspoons/100g
17.1 teaspoons/100g
Medium fat strawberry yoghurt
(Parmalat)3.75 teaspoons/100g
Basmati rice
6.8 teaspoons/100g
Apple juice
4.3 teaspoons/100ml
Lindt dark chocolate mint intense

12.75 teaspoons/100g

Baked potato
6.3 teaspoons/100g

When it comes to picking starchy foods, such as rice, bread and any other products made from flour, it’s best to opt for whole grain versions of these products. This is because the fibre in wholegrains impact upon blood glucose levels more slowly than the more refined forms of carbohydrate. However, portion control is still the most important as higher levels of fibre rich or unprocessed carbohydrate can still raise blood glucose levels substantially.

To identify how much total carbohydrate you can tolerate, test your blood glucose before you eat, and two hours after you eat the food. Ideally your blood glucose should not increase by more than 2mmol/L after the food is eaten.

How to cut down on sugar

The good news is that reducing sugar intake reduces the likelihood of needing medication and diabetes-related complications. Cutting back on all sources of sugar is a great strategy to stay healthy.

  • Cut down on sugary drinks – non-diet versions of cola, lemonade, tonic water.
  • Swap fruit juices for water and whole fruit.
  • Replace sugary cereals with plain porridge, whole grain cereals or lower carb breakfasts.
  • Avoid having ready meals on a regular basis.
  • Make your own pasta or curry sauce. You can make larger portions and freeze what you don’t need for a future meal.
  • Get into the practice of having fruit instead of sugary snacks or desserts.
  • Don’t have takeaways more than once a fortnight.


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:

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How to accept a diabetes diagnosis

Registered counsellor, Bernadine Rust, offers guidance on how to accept a diabetes diagnosis.

“Behind every chronic illness is just a person trying to find their way in the world.” – Glenn Schweitzer

Being diagnosed with a chronic disease, such as diabetes mellitus, may be experienced as a life crisis. Within a few seconds your whole world changes. Suddenly there is no such thing as a ‘normal’ life anymore.

Diabetes can be a frustrating and a scary diagnosis, regardless of the ‘type’ you are diagnosed with. Although it doesn’t have to be a death sentence, you will have to make life changes.

As the mind and body directly influence one another, a person’s quality of life may depend on their ability to learn to adapt and cope with life changes, which in turn builds resilience.

By adopting a practical and solution-focused approach, you may be able to focus on things you can control or change, which in turn may aid in better managing anxiety and stress levels and lead to a healthier and better quality of life.

Managing your emotional health

A diabetes diagnosis may be very isolating and can leave you with more questions than answers. Attending counselling sessions may help you deal with your emotions and help to redefine who you are. This may include the process of finding a new normal and striving for acceptance through meaning making: finding a reason for your pain or making it work for you.

As your entire life changes, it’s incredibly normal to show signs of depression, anxiety or heightened stress levels which, if untreated, may eventually negatively impact your overall health, well-being and functioning.

These symptoms may worsen blood glucose control, medication and diet compliance and lead to low self-care. Through counselling you will be able to identify your blind-spots and in turn get unstuck and change harmful behavioural patterns.

You may also need to learn how to have grace with yourself, learn to listen to your body and to be okay with the fact that you will not get everything right the first time. It takes time to find the right balance, team, diet, exercise routine, mind-set and medication. Therefore, do not get discouraged and rather focus on the small victories.

Accept, grieve and heal

Initially, you may cope well but at a later stage feel overwhelmed or discouraged because of a setback. It’s never too late to seek therapy.

Grieving your diagnosis forms the cornerstone of emotionally healing. Your loved ones may feel powerless and heartbroken too. Open communication and addressing the proverbial elephant in the room is the only way to start the healing process as you will need to find ways to express your emotions. Your therapist may help you to identify your triggers to combat already existing destructive behavioural patterns or potential ones.

Symptoms that may encourage you to seek help can include: insomnia, low mood, crying spells, concentration problems, irritability, anger outbursts, frustration, lashing out at loved ones, self-isolation, rebellion, feeling out of control, panic attacks, fear of dying, decrease in productivity at work or drop in marks at school, personality changes, or if you feel life is not worth living.

Anxiety or depression is not a decision, but a reaction to a real stressor or trauma and, in some cases, may need medication to help your body reach balance again. This doesn’t make you weak. The fact that you have enough courage and bravery to seek help already means you are strong. 

Find your tribe

This not only includes your medical team but also support groups or a support system. A holistic approach works best. It helps if your physician, general practitioner, dietitian/nutritional therapist, therapist/counsellor and even physiotherapist, or any other healthcare workers that form part of your treatment plan, are in contact with each other to make sure that you receive the best treatment altered to your specific needs.

A healthcare practitioner can only work with the information at hand. Therefore, having a multi-disciplinary team and transparent communication can add to the success of treatment.

As this is your journey, you can seek a second opinion or even see a different healthcare professional if you don’t feel comfortable with yours. You need to feel safe, heard, understood and supported.

Having the support of family and friends will also help you to adapt to your new reality and gain a sense of control. Your initial consultation might be very overwhelming and you may struggle to remember everything that was said. With that in mind, it might be a good idea to take someone with to follow-up consultations that can make notes on your behalf or ask additional questions.

Focus on the facts

The best weapon to have when fighting a new reality is knowledge as this can empower you and eliminate fears. However, with the vast amount of information available this task may actually prove overwhelming as inaccurate beliefs may have a significant impact on your self-care.

You may ask your healthcare practitioners for information or to advise scientifically founded books, blogs or websites. Understanding what is happening in your body and how the medication works, or which warning signs to look out for may not only possibly save your life, but also give your overthinking mind a rest. This will also help you to explore and investigate all treatment options and make informed decisions.

Have a game plan

The best approach to any life-changing situation may be to strive for prevention rather than cure or crisis management. This may include a little bit of organisation to ensure a healthy routine and schedule, which will also help manage possible anxiety or stress in the future.

Strategies to employ might include: setting reminders on your calendar for follow-up consultations, buying pill-holders to remind you of taking necessary medication, keeping track of your glucose levels, having a meal plan or meal prepping and ensuring that you have a ‘go-bag’. This bag may include necessary medication, treats to aid in fighting dropping glucose levels and your medical information. You can even have a few of these (in your car, at work, at school). This will help you to always be prepared. It also helps to educate those closest to you about what to do in a crisis and who to contact.

Create a health-oriented approach to life

This process may be more practical and can include adopting a healthy diet, exercise routine, sleep schedule, adhering to a medication regime, managing your emotions, and limiting or eliminating harmful behaviours, such as drinking, smoking, binge eating, addictions and a sedentary lifestyle.

Exercise, quality sleep and a healthy diet along with stress management have all been found to combat depression, anxiety, weight problems and additional health problems, such as cardiovascular problems, high blood pressure, cholesterol, burnout, infectious diseases and unstable glucose levels.

In turn, it also boosts your immune system, memory, resilience and self-esteem. You don’t have to become a health guru, but rather focus on living a balanced and healthy life.

A diabetes diagnosis doesn’t mean you can’t still live a happy and healthy long life. As three-time Olympic Gold Medallist, Kristin Armstrong, argues, “Times of transition are strenuous, but I love them. They are an opportunity to purge, rethink priorities, and be intentional about new habits. We can make our new normal any way we want.”

Therefore, if all else fails, there is always hope.

Bernadine Rust is a registered counsellor, life coach and NLP practitioner with a special interest in the effect of physiological health on emotional and mental well-being. She advocates a holistic approach to overall health and believes in striving for a balanced and peaceful life. She has a private practice at Grace Medical Centre in Shelly Beach, KwaZulu-Natal and offers online counselling sessions.


Bernadine Rust is a registered counsellor, life coach and NLP practitioner. She has a special interest in the effect of physiological health on emotional and mental well-being, and advocates a holistic approach to overall health and believes in striving for a balanced and peaceful life. She has a private practice at Grace Medical Centre in Shelly Beach, KwaZulu-Natal and offers online counselling sessions.

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Securing higher income in retirement

Bjorn Ladewig informs us how an enhanced life annuity offers retirees with diabetes the opportunity to ensure they are getting the highest possible starting income in retirement.

Diabetes affects over 4,5 million[1] known adults in South Africa, while many more may be living with the disease and are unaware. A key comorbidity of COVID-19, it unfortunately gives those retiring with the disease greater reason for concern over the years ahead.

An enhanced life annuity offers retirees with diabetes (or any life-threatening illness or poor health) the opportunity to ensure they are getting the highest possible starting income in retirement.

Latest stats

Based on latest figures, and other statistics relating to the health of the South African population, enhanced life annuities benefit at least 40% of retirees. 

Our Retirement Insights research shows while 74% of South Africans in or approaching retirement have re-evaluated their retirement risks due to COVID-19, only two in five are confident that their retirement savings will last.

Retirees are in fact able to mitigate the risk of depleting their savings by purchasing a guaranteed income for life in the form of a life annuity. This can be done at or during retirement, as they can switch from a living annuity to an enhanced life annuity at any time. And those retiring with diabetes or other health-related conditions, could qualify for a higher starting income.

How a life annuity works?

The starting income of a life annuity depends on many factors, one being the life expectancy of the retiree. All life annuities use average life expectancy to determine the initial starting income.

However, if you have an impaired life, it’s possible for an enhanced annuity to offer a higher starting income based on the assumption that you may have a shorter-than-average life expectancy. An enhanced annuity can offer up to 30% higher guaranteed income for life.  There is no downside to the life expectancy assessment. The initial personal assessment is free and there is no obligation.

Underwriting may not always lead to an uplift in income. It may be the case that a medical condition results in a lower quality of life, but not a lower life expectancy, or that a quote is prepared for not one client but a couple, where one life is medically impaired and the other is healthy and/or young, which could dilute the impact.”

Underwriting at retirement is a fair way of ensuring you get the right income, for life, and gives you confidence that you are getting the highest possible starting income for your retirement savings.

Four steps to receive an underwritten quote for retirees

  1. A 20-minute phone call by a professional underwriter.
  2. Answer a few questions about socio-economic, health and lifestyle factors – no new medical tests or paperwork required.
  3. Your personal situation is assessed by the insurer to see if you qualify for a higher income. If it is for a couple, this will incorporate your spouse’s assessment.
  4. A fair quotation based on the answers is presented, which confirms the starting income.

This article was written by Bjorn Ladewig, Longevity Actuary at Just SA.

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Easing anxiety disorders

Anxiety disorders can be devastating, but the good news is that help is available. Sindisiwe Mlotshwa explains how it is possible to overcome anxiety.

It’s not unusual to experience feelings of anxiety or worry from time to time, but for some people these feelings can be ongoing and debilitating. Anxiety is a normal part of life, and so it may not always be simple to distinguish when it may have developed into an unhealthy preoccupation.

Anxiety typically consists of physical, emotional and mental reactions, and in moderation these reactions are quite normal and may even be helpful.

In small doses, anxiety can help protect us from danger and help focus our attention when tasks need to be completed. However, when these reactions occur too frequently and are more severe, they can begin to affect our work performance, relationships and quality of life.

When worry becomes too much

When worry and anxiety begin to manifest to the point where they are becoming unmanageable, the person could be suffering from an anxiety disorder. 

While there are different types of anxiety disorders, if your anxious experiences are becoming intolerable there are certain signs you should take note of. These include:

  1. Uncontrollable worry
  2. Excessive nervousness
  3. Sleep problems
  4. Muscle tension
  5. Poor concentration
  6. Increased heart rate
  7. Upset stomach
  8. Avoidance of situations that may cause fear, or the fear itself

When these symptoms become both too frequent and severe for those affected to manage, it’s important to seek professional help.

Anxiety disorders share elements of extreme fear and anxiety where the person’s behaviour changes because of these anxious thoughts and feelings.

Example – fear of driving in traffic

For example, if a person has anxiety about driving in traffic, this may be helpful if it promotes more cautious driving behaviour. If anxiety is making you so cautious that you are a danger to other drivers by driving too slow, fast or indecisively for instance, or if you avoid driving at all, then the anxiety has become a problem.

If the person’s anxiety leads them to stop going to work or visiting friends and family because they don’t want to travel in a vehicle, then the anxiety is disrupting their life. It would suggest the possibility of an anxiety disorder, which may require professional mental health support to overcome.

There are multiple types of anxiety disorders, including social anxieties or social phobia, separation anxieties and panic attacks.


Fortunately, professional help is available and there are various ways of treating and navigating anxiety, which may be useful either on their own or in combination.

Exercise can be very helpful, as it promotes the healthy production of serotonin and endorphins to help regulate anxious feelings. These natural hormones promote feelings of calm and well-being, and can assist in managing the symptoms. Exercise is often recommended in conjunction with other interventions, such as psychotherapy or medication prescribed by a psychiatrist.

Cognitive behavioural therapy (CBT) is one of the techniques psychologists most frequently use when treating anxiety disorders. Through CBT, unhealthy thinking patterns that elevate anxiety levels are identified and challenged. Often, CBT will also include elements of exposure therapy and relaxation techniques.

Exposure therapy, which should only ever be undertaken with a trained professional, involves slow and gradual exposure to whatever is triggering the client’s anxiety, with the aim of diminishing their distress.

Relaxation techniques can also assist in managing the symptoms of anxiety. These include practices, such as deep breathing, progressive muscle relaxation, and mindful sensory engagements.

Through focusing on external and physical experiences or senses, we can help the person to step out of their internal emotional experiences. Once the client is comfortable with relaxation techniques, they can be applied whenever needed, without the presence of a guiding professional.

Psychiatrists may prescribe anti-anxiety medication to help address the chemical causes of anxiety within the body. Medication should only ever be taken exactly as prescribed, and it’s important not to stop taking psychiatric medicine without first consulting your treating doctor, even if you are feeling better.

Need help?

In the event of a psychological crisis, emergency support can be reached on 0861 435 787, 24 hours a day.

If you need information about mental health services, accessing care, information about mental health issues, or are in an emotional crisis, Akeso is here to help.

Sindisiwe Mlotshwa is a counselling psychologist who practises at Akeso Parktown in Johannesburg.


Sindisiwe Mlotshwa is a counselling psychologist who practises at Akeso Parktown in Johannesburg.

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The effects COVID has on exercise

We look at the effects COVID-19 and lockdown had on how people exercise.

COVID-19 changed our lives in so many ways, from the way we socialise, our sleep patterns, work routines and even the way we exercise.

We know exercise is good for us, but it’s never been as apparent since the onset of COVID-19. According to the World Health Organization, certain conditions, such as cardiovascular disease, obesity and diabetes can significantly increase the risk of severe illness resulting from COVID-19. All these conditions are significantly improved or can be prevented by regular physical activity.

Regular exercise has also been proven to strengthen the immune system. Therefore, during this pandemic, many people started to re-evaluate their reason for exercise. Not just as a tool for aesthetic appeal, but to keep themselves healthy and prevent illness in the long-term.

Lockdown injuries

During lockdown, many people tried new forms of exercise: new online classes, running in circles around their garden or getting outside in the fresh air for a walk. Across the country, gym franchises and instructors took their classes online to help people keep active while staying safe at home.

Many people had great results, such as significant weight loss and fitness gains at home. But biokineticists saw the downside to this kind of training. We encountered patients with injuries from these workouts, sometimes due to lack of proper instruction from qualified instructors, and incorrect training methods, or poor biomechanics.

Exercising with a mask on

With gyms now open and enforcing people to wear masks, many people still prefer the comfort of their home or the outdoors to do their exercise.

When the wearing of a mask was made mandatory in public, many exercise fanatics complained that it was detrimental to their health to do vigorous exercise with a mask.

A study in the International Journal of Environmental Research and Public Health has found that mask-wearing appears to have virtually no detrimental effects during vigorous exercise. Although, if one has a chronic lung disease, such as chronic obstructive pulmonary disease, you should talk to your healthcare provider before attempting any physical activity while wearing a mask.

After-effects of having COVID

Many infected by COVID-19 have struggled in returning to their usual exercise regime. For a small yet significant number of these patients, the road to recovery has been protracted, with patients suffering from ‘long COVID’.

One symptom study revealed that at four weeks, 1 in 7 patients, and eight weeks, 1 in 20 patients are still suffering from at least one debilitating COVID-related symptom. This includes fatigue, dyspnoea, chest pain, muscle pains, amongst other multi-system symptoms that can last for many months.

These symptoms can impact return to usual exercise activity, and therefore require a multi-disciplinary approach in return to activity. Some patients may have prolonged rehabilitation needs for up to three to six months after recovery.

Returning to exercise

The rehabilitation and return to exercise guidance monitored and progressed by a biokineticist would focus on activities of daily living, return to function, and then exercise.

Return to exercise guidelines are likely to adopt a more cautious and prolonged timeline in non-athletes, which takes into account their baseline health, premorbid function, rehabilitation and occupational needs.

Biokineticists may be able to offer unique skills and help coordinate individualised rehabilitation plans for patients. This could involve undertaking biomechanical assessments, prescribing exercise and reviewing patients holistically in a multi-system approach.

The article was written by Avinesh Pursad, Olivia Bloomer and Wendy Vermaak on behalf of BASA.


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What is iridology and how does it assist people living with diabetes?

Dr Jessica Leske educates us about iridology as a screening tool that is used to detect inherent individual predispositions.

What is iridology?

Iridology is the study of health via an examination of the colour and structure of the iris, the sclera, and the pupil.

The iris is the most complex external structure of human anatomy and by way of the nervous system, it has a reflex connection to every tissue and organ of the body. Through the optic nerves, which are attached to the eyes, visual information is sent to the brain. At the same time, there is information sent back to the eyes from the brain about the state of the tissues and organs in the body.

Each iris is as unique as a fingerprint. The colour and pattern of the iris fibres will determine your underlying genetic weakness, which may or may not be activated according to your diet, lifestyle, and psycho-social factors.

How it works?

It has been said, “The eyes are the windows of the soul.”

Iridologists assess the iris colour and fibre structure variations to determine the constitutional strength of the physical body and aspects of personality. Iridology is not a treatment, but rather a screening tool that is used to detect inherent individual predispositions.

The colour and pattern of your iris fibres reflects your genetic inheritance from three generations behind you. Whether you develop these dispositions to the best- or worst-case scenario depends on your diet, lifestyle, and stress management techniques.

Iridology can be used to determine potential health problems at an early stage. This enables you the opportunity to prevent illness and maintain optimum wellness.

Helping diabetes patients

For a person living with diabetes, an iris assessment will give more insight into what eating plan, exercise regime, stress management techniques, and supplementation will suit your genetic profile the best. Thus, will allow you the opportunity to enhance the efficacy of your current treatment regime.

Dr Jessica Leske is a registered homeopathy and iridologist.


Dr Jessica Leske is a registered homeopath and iridologist. She is a member of the Homeopathic Association of South Africa (HSA) (2010), Registered Allied Health Professions Council of South Africa (AHPCSA) and Board of Healthcare Funders of South Africa (BHF) (2016).

Lifestyle habits to thrive mentally

Gabrielle Mixon shares lifestyle habits that have helped her to thrive mentally while managing her diabetes.

Gabrielle Mixon (26) lives in Johannesburg, Gauteng.

Living with diabetes is a continuous mental challenge. As a person living with Type 1 diabetes, since 2012, I’ve been through the highest of highs and lowest of lows, both literally and figuratively.

Eight years in and I’m witness to the stresses of living with diabetes. Diabetes distress can occur in social situations and when you feel emotionally and physically burdened by the condition. The good news is that with good lifestyle habits you can thrive mentally

Choose your health over fitting in socially

Eating food is most often a social experience that involves other people. In these situations, we want to be a part of the experience, share and indulge in the same things our family and friends do. There is tension between wanting this and what we as a person living with diabetes should be doing.

To choose your health over fitting in socially, and not eating a slice of cake after dinner with everyone else, is not an easy or comfortable choice. It takes practise and, sometimes,trial and error.

Eat clean

On one hand, the food that becomes more Instagram-worthy and socially accepted to consume is filled with sugar. On the other hand, eating clean foods that facilitate healing with properties that promote well-being is also a growing trend. No doubt, we ought to favour the latter.

Consuming products with excessive sugar content is a no-­‐no. Let us make habits that are inspired by the words of Hippocrates, ‘’Let food be thy medicine and let medicine be thy food.’’

Read labels and know the sugar content

Get into the habit of reading the labels and build up your knowledge about the sugar content in the food products you like. Choose options with the least sugar content when meal planning and get creative.

Eating clean doesn’t have to be boring. It can be a treat; you’re going to feel great afterwards and it can be tasty while look visually appetising too. When you eat clean,you feel good and the result is undoubtedly being in a better frame of mind.

Good night’s rest

Another important factor in being in your best frame of mind is to get a good night’s sleep. This way, you aren’t over doing it on the coffee the next morning.

Make it a priority to get your daily six to eight hours’ sleep. Build on the habit of sleeping enough with getting outside as part of your everyday routine.

Get outside

This is not always feasible, weather permitting, but take advantage of pleasant weather as much as you can.

If not, there are gyms to go to and home fitness workouts to try. Working out is not only about improving your chances of living long but also a vital element to a strong mental life.

The happy hormones are so beneficial to both your health and social life. The endorphins automatically make you less stressed and allows you to celebrate what is good and makes you forget about what is less favourable.

Fitness is physical, but it can also be meditation.


When it comes to the misses one experiences with diabetes, here’s my advice: let it go and carry on.

This doesn’t mean you should live in denial if your habits are bad, and are resulting in poor health and blood glucose levels. These bad habits can be due to other stresses and circumstances that you are experiencing that is making it difficult to control your condition.

The best thing you can do to thrive mentally is begin journaling. This will help emotionally and educationally. Having diabetes and trying to control your blood sugar level is taxing and to find the discipline to thrive is not an easy or straight path.

Documenting your feelings on the journey will make navigating your way easier as you have physical evidence of your experiences. Keep note of your blood glucose levels when you consume particular foods.

Emotionally you will be able to determine what you were eating, thinking and doing when you felt your best and educationally you will know which foods work for you and which don’t.

Choose good habits

There will always be difficult days and we will all fall off the wagon from time to time.But the aim is to choose good habits and keep doing them to gain control of diabetes so it doesn’t control us and spiral our minds and bodies into a stressful place. By doing this, you can thrive mentally.

Feel good about what you are eating and make sure that what you are eating is good for you. Try, really try, to move your body in a way that feels good to you every day or at least more than three times a week. Your mind and your body will thank you for it.

Lastly, to regain control and have a point of reference should your diabetic journey lead you into a rut, make it a habit to journal.

Wishing you everyday health and happiness.

Gabrielle Mixon is advocate for T1 Diabetes.


Gabrielle Mixon is an advocate for T1 diabetes.

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Why all the fuss about intermittent fasting?

Dietitian, Chantal Walsh, explain the how intermittent fasting works and how it is an eating pattern rather than eating plan.

Intermittent fasting (IF) has become quite a buzzword and there is no shortage of freely available information about it. With its many promises to assist with weight loss, especially around the belly, control insulin levels and help brain function, it’s no wonder that we are all intrigued by this new pattern of eating.

What is intermittent fasting?

It’s an eating pattern that cycles between periods of fasting and feeding. During the fasting phase, there is a significant restriction of calories. On feeding days, there is no specific calorie requirements or certain types of foods recommended but rather focuses on when you should be eating them. It’s therefore not an eating plan but rather an eating pattern.

Patterns of intermittent fasting

There are numerous patterns of intermittent fasting that can be used.

  • 16/8 fast

In this pattern, you will fast for 16 hours and then eat for eight. This is often the pattern where we skip breakfast and only start eating about 16 hours after your last evening meal. This is followed for seven days a week.

  • 5/2 fast

With this pattern, you will restrict your calorie intake to 500 – 600 calories for two non-consecutive days, while the other five days you have your normal consumption.

  • Eat stop eat

This involves a 24-hour fast one to two times per week, where no calories are consumed on those days.

  • Alternate days

In this pattern, there is a restriction of calorie intake every second day (to around 500 calories), while on the feed days you continue your normal intake.

  • Warrior fast

This fast focuses on a 20-hour fasting period followed by a 4-hour feasting period. This is normally for the dinner meal that is a large portion of unrestricted foods.

  • Spontaneous fast

The last of the fasting patterns is where you choose a meal or two to skip as and when you feel it necessary.

Possible benefits

What does science say? Firstly, let’s look at reduction in adipose tissue and weight loss. It’s suggested that due to the limited time that you get to ‘feed’ that there is a reduction in calories and therefore results in weight loss.

In a review1, it was found that intermittent fasting reduced body weight by 3–8% over a period of 3–24 weeks. This was on condition that the food items that were chosen during the ‘feeding’ times where healthy food choices. Ensuring that the meals were balanced, incorporating loads of vegetables, lean vegetables and complex carbohydrates.

It’s therefore important to consider the nutrient density of the food choices, ensuring an intake of a variety of vitamins, minerals and other essential elements.

An observational study2 of overweight and obese men during the religious fast of Ramadan reported that since obesity is accompanied by increases in adiposity and changes in appetite-regulating hormones, if we decrease weight it alters the abnormal release of these hormones, which might be useful in managing obesity. Ramadan IF improved body composition and produced some positive changes in these hormones, these changes in hormone levels persisted for three weeks after the end of Ramadan.

With the possible weight loss that is experienced with calorie conscious IF, glucose (sugar) and lipid (blood fat) can also be improved. A 2017 review3 on intermittent energy restriction (IER) and time-restricted feeding (TRF) found that there are possible benefits of these styles of eating on weight loss and metabolic health. However, most of the studies are on animals and there is very little evidence currently in human studies.

In comparison to a calorie-controlled, nutrient density diet, it was found that long-term the effects on weight loss and lifestyle health benefits are similar to that of IF.

Yay or nay?

If you are considering intermittent fasting, consider the type of IF programme that suits you and ensures that you don’t get too hungry or that it affects your mood stability. Ensure that the types of foods that you choose are nutrient dense and full of vitamins and minerals. Monitor the calorie intake; you still want to stay within your specific daily requirements. It will take time to adjust to the new style of eating and for the body to adjust, be patient.

It’s important to remember that IF is one of the tools in your nutrition toolbox, it will need to be combined with basic nutrition guidelines, sufficient water intake and exercise. To help with the success of this style pattern, please contact a registered dietitian.


  1. Barnosky et al., 2014
  2. Zouhal et al., 2020
  3. Antoni et al., in 2017


Chantal Walsh RD (SA) is a practicing dietician in Gauteng. She has a special interest in lifestyle illness (weight loss, cholesterol, hypertension) and sports nutrition and encourages clients to make small changes to reap the great health rewards. She is also a trained and practicing Pilates instructor.

Make family fitness fun this festive season

Whether there is one person or a few in a family who have diabetes, this may affect lifestyle habits and choices of the family. Wendy Vermaak informs us how to make family fitness fun.

Now that we are nearing a time of holiday or rest and recuperation from a tough 2020, the lifestyle habits of a family (as opposed to just those of each individual) become more evident. This is because when everyone in the family spends so much concentrated time together without the usual commitments of work and school, the choice of meals, leisure and activity times and family fitness must take the whole family into account.

Each generation teaches and guides the younger generations of which lifestyle choices are healthy and important. This follows through from where you decide to go on holiday, what meals you eat, how you plan your leisure or relaxation time and budget, and what physical activity you engage in, and so on.

Children learn from example

Research shows that children learn lifestyle habits from an early age, and that by a mere nine years old, they already have an established idea of what lifestyle habits are perceived to be the ‘norm’.

This is based mostly on their limited exposure to what their own family has taught them, as opposed to have experienced what other family’s lifestyles are like. Children learn by example from their parents and grandparents’ behaviour. Modelling a good example of healthy lifestyle habits entails regularly engaging in:

  • Regular exercise
  • Eating a healthy diet
  • Refraining from alcohol, drugs and smoking
  • Drinking enough water
  • Good hygiene
  • Getting enough quality sleep

Children learn from what they see, and parents choosing healthy lifestyle habits as a regular and continual choice day by day, as opposed to merely lecturing your children, has a much bigger impact on their learning response to healthy lifestyle habits.

What type of family is yours?

Choices that affect our families are whether you are the type of family who always goes away over holidays to rest, or decides to stay home.

Is your family avid campers? Adventure holiday seekers? Hotel or resort guests, or rather road trippers? Often your choices of where you go on holiday also affects what food choices you make and the physical activity level you choose to engage in.  

Whatever the choice, families have an opportunity to be physically active anywhere or anytime. Exercising should not be a mere chore to get through, or something to try to fit in when one finds the time.

As early as 1819, Edward Stanley wrote: “He who has not time for exercise, must create time for illness.” This lifestyle choice stands for every person of every age, and what better way to institute this healthy standard in your family than over the festive season break when families are often all together?

Use movement to develop relationships

Exercising together as a family is a great way to use movement to develop relationships and spend quality time together. Movement is an essential part of everyday life, for people of all ages. Movement affects development, learning, communicating, work capacity, health, and quality of life. Exercising together promotes open communication, and the feel-good endorphins promote good family relations as well. Encourage less screen time and more physical outings or games or sports as a family.

Exercise – the most underutilised medicine

Research shows that for those who are sedentary more than seven hours a day are 47% more at risk of developing depression than those who sit for four or fewer hours a day.

Women who don’t exercise at all have a 99% increased risk of experiencing depressive symptoms compared with those who exercise regularly.

Physical activity helps beat stress and prevents or treats many other health concerns and diseases. It is considered the most underutilised medicine and has the least amount of side effects as opposed to most medication.

Physical activity, whilst being fun, can have positive impacts on health, such as decrease dementia risk by 30% which is a specific concern for the elderly, and physical fitness levels improve cognitive performance (e.g. concentration, memory) for children and adults alike.

Exercise reduces the risk of certain cancers, such as breast cancer by 20% and colon cancer by 35%. It can decrease cardiovascular disease risk by 35% and Type 2 diabetes risk by up to 40%. More than 150 minutes of exercise each week is associated with a 0,89% drop in HbA1c.

One of the major benefits of having family as exercise buddies is that they are excellent accountability partners.

How to make family fitness fun

  • Put music on and have a dance contest.
  • Walk the dogs as a family.
  • Go on a hike in your area.
  • Turn a board game into an active game.
  • Play a game of cricket, touch rugby, or any sport in your back yard.
  • Complete an exercise routine in the garden/on the beach.
  • Build a sandcastle.
  • Ride your bike (or hire one for a cycle outing).
  • Participate in an online challenge.
  • Try a new skill that’s physically demanding, such as rock-climbing, or a dance class, or an aqua class.
  • Work as a team to complete physical tasks in and around the house, such as mowing the lawn, washing the car, cleaning the windows, mopping the floors, etc.
  • Incorporate exercise into your outings, such as visiting a zoo or street market where you can walk around a lot.

Before you start your family fitness, it’s always best to:

  1. Get the go-ahead from your doctor and to discuss possible medication changes.
  2. Consult with a biokineticist to discuss a suitable exercise programme to minimise any complications. Biokineticists are trained in monitoring blood glucose levels and effects of exercise on insulin, required nutrition, and specific exercise prescription for each patient noting their level of fitness, medication, and disease profile. Find a biokineticist near you
  3. Use the right gear. Wear well-fitting, cool clothing and the right footwear to look after your feet. Also inspect your feet often to check for blisters, cuts and injuries. If you suffer from foot problems, avoid weight-bearing exercises and opt for cycling or swimming.
  4. Wear your medical alert bracelet or other identification when you exercise. The info should include your name, address, doctor’s details and phone number. If possible it should also include your medicine details.
  5. Inform the person you are exercising with that you have diabetes or any other major health conditions, whether it be a coach of any organised sports team, team players, friends or family. Explain to them how to respond if you should have a hypoglycaemic episode.
  6. Monitor your blood glucose before and after exercising and refrain from exercise if you are feeling ill.

Be aware of symptoms of hyperglycaemia (extreme thirst, hunger and urinations, blurred vision, fatigue) and hypoglycaemia (hunger, shaking, dizziness, confusion, sleepiness and weakness)

Written by Wendy Vermaak on behalf of the Biokinetics Association of South Africa.

Wendy Vermaak is a biokineticist in private practice in Johannesburg, Gauteng. She has a keen interest in falls prevention and balance rehabilitation, and is also the marketing director for Biokinetics Association of South Africa (BASA).

Header image by FreePik

Positive planning and mind-set to stay physically active

Michelle Jonck informs us that positive planning and state of mind are two key factors to initiate and achieve sustainable behaviour changes, such as increasing physical activity.

Despite physical activity (PA) being a cornerstone of diabetes management, it is by far the most underused1. The multiple benefits of physical activity for all ages in almost every population, including people with diabetes have been well-established.

These benefits include improvements in glycaemic control, insulin action, cardiovascular fitness, systemic inflammation, diabetes-related health complications and mental health1. In a study2, the level of HbA1c among diabetic patients was decreased by 0,73% and 1,33% after 16-weeks post-intervention and one-year follow-up, respectively.

Considering the positive health impact of PA, it’s imperative for diabetic and pre-diabetic patients to become and remain physically active. Positive planning and state of mind are two key factors to initiate and achieve sustainable behaviour changes.

Breakdown perceived barriers

Too often PA is neglected, particularly in those with other comorbidities due to perceived barriers. Multiple studies have confirmed lower levels of PA in diabetic patients compared to non-diabetic patients.

In most cases, however, the factors regarded as barriers do not hold true. In a study3, 62% of the study population listed lack of time, workload and other engagements as a barrier to increase PA.

While most people have hectically busy schedules and might find it hard to include an exercise routine into their daily lives, small changes in daily tasks can significantly increase levels of PA. For instance, taking the stairs at work instead of the elevator (which you must wait for in any case), walking to a colleague’s desk to ask them a question instead of sending an email, getting up in your lunch break for a walk instead of staying in to check social media.

Many of us have that one series we just must watch. Why not get on the treadmill while watching or stand up and march during the ad-breaks? If you have time for social media and online streaming, you sure have time to be physically active. Therefore perceiving lack of time as a barrier does not hold true. It’s rather how you choose to spend your time.

As little as 10 minutes of PA each day can improve fitness levels. Although longer exercise durations result in greater improvements, the saying, “Anything is better than nothing” holds true when it comes to physical activity.

Tips for becoming more physically active daily

  • Take more steps throughout the day.
  • Take the stairs instead of an elevator whenever possible. If climbing upstairs is too difficult, start by taking the stairs only going down.
  • Walk on moving walkways instead of standing still.
  • Park at the furthest end of a parking lot instead of searching for the closest parking.
  • After every 30 minutes spent sedentary (sitting down) get up and move for three to five minutes.
  • Take short walks during work breaks instead of remaining seated.
  • For every excess calorie you eat, add 20 steps to your daily total.
  • Minimise screen time (maximum two hours/day) and stand up to change the channel or perform some physical activity while watching TV, such as walking on a treadmill or cycling on a stationary bicycle.

Weakness and illness

Two other factors perceived as barriers toward PA include weakness and illness including joint pain and pregnancy3. It’s important to remember PA doesn’t necessarily mean running, skipping, jumping and heavy weight lifting, but rather increasing incidental activity and engaging in even low-intensity exercise or unstructured forms of PA.

Activities, such as golfing, gardening, dancing and mild walking, done for 30-45 min is beneficial for health, even if it doesn’t improve fitness levels.

In a recent study on adult women, regular, moderate (brisk) walking decreased their risk for developing diabetes similarly to engaging in more vigorous activity, demonstrating that intensity may not be as important as participation in any PA1.

While people with diabetes are more likely to experience comorbidities, such as high blood pressure, heart disease, obesity and other diabetes-related complications, that may limit their ability to participate in more intense activities, they should exercise as intensely as possible but not so excessively hard that they lose the motivation to continue, develop an athletic injury or put their health acutely at risk.

Begin with easy unstructured exercise including taking more daily steps and simply standing up more often. The talk test is another tool to help guide your exercise intensity. If you aren’t able to talk while going for your daily walk, you can slow down the pace a bit enabling you to have a slightly breathless conversation with your workout partner.

Safety tips

  • Always include a proper warm up and cool down (five minutes at lower intensity).
  • Check your blood glucose before and after exercise.
  • Be aware of the signs and symptoms of hypoglycaemia and hyperglycaemia.
  • Always carry a fast-acting sugar drink or sweet.
  • To reduce the risk of hypoglycaemia, make sure to eat one to three hours prior to exercising.
  • Individuals with peripheral neuropathy should consider non-weight bearing activities, such as swimming or stationary cycling, to minimise trauma and potential injury to their feet and lower extremities.
  • Individuals with proliferative retinopathy should avoid any jumping, jarring or breath holding activities including heavy weight lifting.
  • A biokineticist will be able to further assist with any safety concerns you might have with regards to physical activity, exercise and your health condition.

A positive mind-set is needed

It might be easy to list constraints and limitations when it comes to PA but this is where a positive mind-set is important. Instead of placing your focus on what you can’t do rather focus on what you can do and the benefits derived from PA.

Factors that enable and encourage individuals to perform some form of PA are called enablers. These include: health related benefits, such as blood pressure control, diabetes control, reduced joint pain and weight management as well as feeling good, social support and professional advice.

Knowing the risks associated with a sedentary lifestyle and changes that can be brought about by PA can encourage a lifestyle change. One study1 suggested that PA participation is higher when individuals are made aware of what constitutes an unhealthy lifestyle and when they perceive themselves as being more susceptible to diseases that can result from inactivity.

Serotonin and endorphins, better known as the happy hormones, are also released during PA. These makes one feel good, which in turn further encourages engagement in PA.

Social support is another vital factor when it comes to sustainability. Participating in activities, such as walking, as a family not only creates support but also a feeling of accountability, connection and a common goal.

Obtain professional advice

Lastly, obtaining professional advice and encouragement for lifestyle change can often be the determining factor towards behaviour change.

As a biokineticist, I’ve dealt with many patients who started a supervised physical activity routine due to doctor’s orders. In this regard, a study4 found positive changes in physical fitness levels were greater for individuals given an actual exercise prescription with a detailed regimen. Conducting a fitness assessment prior to starting such a programme and supervised participation therein also had a positive effect.

Biokineticists are health professionals concerned with health promotion, the maintenance of physical abilities and final phase rehabilitation by means of individualised scientifically-based physical activity programme prescriptions. Therefore, they can assist by prescribing the appropriate duration, intensity and type of exercise. Plus, educate you about certain safety precautions at stake for a variety of medical conditions. To find a biokineticist, visit If you live in a remote area or when on holiday, you can always consider an online consultation.

Remaining physically active

Becoming and remaining physically active is crucial to living well with diabetes. Frequent regular exercise of any type is the key to effective blood glucose control because the heightened insulin action in exercised muscle persists only for one to two days1.

Although most clinical trials follow improvements after an exercise intervention over a six to 16-week period, improvements are likely to result from exercise with a duration of one or more years. One can conclude that incorporating PA as an integral lifestyle behaviour over a lifetime will have the greatest benefits. Luckily all PA accumulated during the day counts. Change your mind-set, plan for exercise, set realistic goals and focus on what you can do.

Improve sustainability of a physically active lifestyle

  • Set realistic short-term and long-term goals.
  • Keep an activity diary.
  • Set up non-caloric rewards for achieving short- and long-term goals.
  • Schedule physical activity into your daily routine and keep these appointments.
  • Exercise with someone to increase motivation and safety.
  • Include variety in your daily activities: alternate higher intensity activities with lower intensity and more fun activities.
  • Set up a good support system by making it a family or team effort.
  • Increase incidental activities (those that form part of your daily life) to accumulate a greater total exercise time.
  • Ensure slow and steady progression in the duration and intensity of structured physical activity to prevent overuse injuries and demotivation.
  • Include both aerobic and resistance training.
  • Undergo periodic fitness assessments and revision of physical activity programmes and self-management goals for PA to provide reinforcement and continued motivation for participation.


  1. Colberg, S.R.   Encouringing patients to be physically active: What busy practitioners need to know.  Clinical diabetes, 26(3):123-127.
  2. Najafipour, F., Mobasseri, M., Yavari, A., Nadrian, H., Aliasgarzadeh, A., Abbasi, N.M., Niafar, M., Gharamaleki, J.H. & Sadra, V.   Effect of regular exercise training on changes in HbA1c, BMI and VO2max among patients with type 2 diabetes mellitus: an 8-year trial.  BMJ Open Diabetes Research & Care, 5(e000414):1-7.
  3. Pati, S., Lobo, E., Desaraju, S. & Mahapatra, P.   Type 2 diabetes and physical activity: barriers and enablers to diabetes control in Eastern India.  Primary Health Care Research & Development, 20(e44):1-6.
  4. Nielsen, P.J., Hafdahl, A.R., Conn, V.S., Lemaster, J.W. & Brown, S.A.  2006.  Meat-analysis of the effect of exercise interventions on fitness outcomes among adults with type 1 and type 2 diabetes.  Diabetes Research and Clinical Practice, 74:111-120.

This article was written by Michelle Jonck on behalf of Biokinetics Association of South Africa (BASA).

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