A toast to bread and all its benefits

Dietitian, Nicola Walters, tells us all the good things about bread and why we should eat it.


Bread is a staple food that has been around for more than 10 000 years. It’s delicious, convenient, and satisfying, sure, but what if I told you it was healthy too?

With advancements in recipe development, the composition of bread has been perfected over many years. What has evolved has created a selection of bread choices that, when eaten as part of a healthy, balanced diet, can add valuable nutrition elements.

A loaf affair

When choosing the perfect bread to suit your needs, look for the nutrition information label and be sure to size up the competition. Not all breads are created equal.

If it’s weight management and weight loss you desire, focus on the overall kilojoule value of the bread.

To lose weight, daily energy intake (measured in kilojoules) from food and fluids should be less than total energy expenditure (energy spent on daily activities, exercise and normal body functions).

A lower total kilojoule content per slice means a lower contribution to total daily energy which means more wiggle room for calorie deficits.

But that’s not all that matters; the quality of the kilojoules is equally important. Quality kilojoules come from foods that offer additional nutrition related benefits over and above the energy they provide.

Fibre is one such nutrition factor that offers huge health benefits, such as controlled blood glucose levels for sustained energy. Fibre also improves gut health; keeping the tummy bloat-free and regular.

Any bread that has more than 6g of fibre per 100 g serving is considered high in fibre and will increase daily fibre intakes and boost health. Well, isn’t that the best thing since sliced bread?

Low GI options

Sustained energy you say, but do we still have your attention? For this, it might be worthwhile to focus on low GI bread options. No, this isn’t a new Wi-Fi speed to rival 5G; the glycaemic index (GI) is referred to as the GI.

The GI of a food indicates how quickly that particular food (normally a food that contains carbohydrates) will raise the amount of glucose in the bloodstream.

A croissant for example, will be considered a high GI food because it increases blood glucose levels as fast as lightening, after being eaten.

A slice of low GI, high-fibre bread on the other hand, is considered a low GI food because it steadily releases glucose into the bloodstream, over a period. This means no more concentration rollercoasters and more stable energy cycles throughout the day.

If it’s health you’re after, you can have your high-fibre, wholegrain bread and eat it too. But when you do, remember the whole truth: no one food or diet can be “best” for health. The true effect of bread, like any other food eaten, must be considered in the context of the diet as a whole.

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Nicola Walters is a registered dietitian and has workedas an associate Dietitian at Nutritional Solutions in Johannesburg since 2013. Nicola is an accredited DNAlysis practitioner and enjoys optimising her patient’s health outcomes through the individualised interpretation of genetic results.


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Healthy Type 2 diabetes summer eating

While welcoming in the warmer weather and Diabetes Awareness Month, it’s a perfect opportunity to re-look at your eating. Are you warming up to good health?


Food and eating means so many different things to each of us. We are influenced by culture, access to foods, emotion, knowledge and personal preferences. There certainly isn’t one ‘diabetic diet’ that will suit everyone.

A person living with Type 2 diabetes does not need to eat any differently (in terms of types of foods) from the rest of the family. Everyone should be eating as you eat.

Enjoy a variety of foods

Variety is the spice of life and enjoying a variety of foods ensures you are getting all the nutrients your body needs. You can enjoy foods that are easily accessible and affordable.

Be creative and experiment with different colours and different preparation methods (boiling, steaming, baking, grilling, and braaing).

Guidelines for healthy eating in diabetes suggest that there is no special need for products marketed as Suitable for diabetics. Some of these, although low in sugar, may still be high/higher in carbohydrates, energy, and/or fat than their non-diabetic alternatives.

Make starchy foods part of most meals

Aim, as the ideal, to select wholegrain carbohydrates (e.g. barley, rolled oats, quinoa, seed/rye breads, high-fibre bran flakes, corn, unrefined maize, wild/brown rice, wholegrain cereals, brown rice). The quality (high fibre, nutrient dense) and quantity of the carbohydrate you eat is very important as carbohydrates are the foods that are likely to affect your blood glucose levels the most. So, remember the two Qs – quality and quantity.

Focus on carbohydrates that are high in fibre. Aim for a fibre intake of between 30-50g per day. Some high fibre foods are: bran flakes/high-fibre cereals, sweet potato (with skin), fruit (eaten with skin where possible), vegetables, beans and nuts.

If you are needing to increase your fibre intake, do so gradually so to avoid unnecessary side effects.

Food Quantity Fibre content (g)
Hi-fibre bran ½ cup 11
Orange 1 9
Apple with skin 1 5
Sweet potato (with skin) ½ cup 4
Brussels sprouts ½ cup 4

Try to eat carbohydrates at the same time and in the same quantities each day to help control your blood glucose levels and weight.

Interest in the microorganisms found in our guts (gut microbiome) is growing. The gut microbiome may have a role in obesity, how sensitive you are to insulin, and how glucose is used in your body. However, a lot of human research still needs to be done to understand the impact of different dietary approaches in changing gut microbiome and its effect on the management of diabetes. This is definitely a space to watch.

Please note, it’s best to work with a registered dietitian to establish the ideal amount of carbohydrate in your diet as individual responses to carbohydrate containing foods can vary greatly.

Eat plenty of vegetables and fruit every day

Vegetables and fruit are great in that they are fibre-rich (provided you eat the skin where possible) and rich in vitamins and minerals.

South African guidelines suggest a minimum of five portions per day. These can be fresh, frozen or tinned (in own juice). You need to be more careful with quantities of dried fruit. Try and stay away from fruit juices as these are concentrated sources of carbohydrates.

Think of a traffic light when planning your fruit and vegetable intake throughout the day – aim to include red, yellow/orange and green colours each day.

Vegetables are very versatile. They can be included in soups, stews, curries, salads, dips, crudités; as isigwamba* (spinach and mealie meal), mixed into protein dishes or eaten by themselves (e.g. imfino (wild spinach) with onion).

Fruit can be added to smoothies, eaten with wholegrain cereals or porridge, combined with savoury snacks (e.g. apples and cottage cheese/peanut butter), eaten with plain yoghurt or eaten on its own.

*Ensure mealie meal is cooked, then cooled and reheated as this is likely to have a better effect on blood glucose levels than cooked mealie meal.

Eat beans, split peas, lentils and soya regularly

These are very good sources of fibre and protein and are also extremely versatile. Different beans (e.g. kidney beans, butter beans, cannellini beans, black beans, sugar beans), chickpeas, lentils, split peas and soya beans can all be used in soups, stews, curries and salads or dips (e.g. chickpeas in hummus).

Beans can also be eaten in the form of baked beans or made into isigwagane* (sugar beans and rice) or mashed with a small amount of margarine or lite mayonnaise as an alternative for bread spreads.

* You will need to watch your portion size of isigwane as both the rice and sugar beans contain carbohydrate. Try and use brown rice if possible.

Fish, chicken, lean meat and eggs can be eaten daily

Good protein choices include lean meat cuts, organ meats, lean biltong, skinless chicken, eggs, fresh or tinned fish (mackerel, sardines and pilchards are rich sources of omega 3 fatty acids). Limit your intake of processed meats (e.g. luncheon meats, bacon, and polonies).

Use fat sparingly: choose vegetable oils rather than hard fats

The type of fats that you enjoy is important. Focus on fats that come from foods, such as plant oils (sunflower, canola, olive), avocado pear, olives, nuts, seeds and soft margarine.

If you are eating lots of saturated fat (animal fats and tropical oils), replace these with fats indicated above rather than refined carbohydrates (e.g. flour, sugar) to decrease your risk of heart disease.

Try to stay away from trans fats. Government legislation restricts the trans-fat content of any oils or fats on the market, or used in food production (shops, catering business, restaurants, bakeries, etc.).

Have milk, maas or yoghurt every day

Milk, maas and yoghurt are good sources of protein and provide vitamin D, calcium, magnesium and potassium. Include plain, low-fat yoghurt and low-fat milk. Milk can be fresh, long life or powdered. Remember a coffee/tea creamer is not the same as powdered milk.

Use salt and foods high in salt sparingly

Limit your intake of sodium to no more than 2300mg/day (approximately 1 teaspoon of salt) as high intakes may lead to high blood pressure. Remember this 1 teaspoon of salt includes the salt added to manufactured food products.

Foods higher in sodium include: biltong, dried sausages, salty snacks (chips, pretzels, etc.), fast foods like pizza, processed meats (luncheon meat), packaged sauces, condiments (tomato sauce, pickles), stock cubes and salty seasonings, packet gravies, many breakfast cereals and breads.

Government has passed legislation to limit the salt content in packaged foods. But still be aware of extra salt added to food. Try and use fresh and dried herbs, spices, garlic and lemon juice as alternatives to dousing your food in salt.

Use sugar and food and drinks high in sugar sparingly

Guidelines with regards to added sugar intake in diabetes differ around the world. There seems to be agreement that sucrose can be used in line with the World Health Organisation Guidelines (10% of total energy intake (±50g) or 5% (±25g) for additional health benefits)*. Remember these guidelines also include any sugar that is added to food and beverages during the manufacturing process.

If you do wish to enjoy sugar, minimise your intake of foods, like sweets, chocolates, cakes and biscuits and pastries that are rich in sugar and fat. Rather focus on more nutrient dense foods that may have sugar e.g. baked beans, peanut butter, or a small sprinkling on your porridge. Peanut butter that contains no added sugar and tinned baked beans that are low glycaemic-index are also available.

There is, however, unanimous agreement that you should not consume sugar-sweetened beverages if you have diabetes.

Non-nutritive sweeteners (NNS) are safe to use provided they are used within the daily acceptable levels established by the Joint FAO/WHO Expert Committee on Food Additives (JECFA). While NNS do not seem to have a significant effect on blood glucose control, they can reduce your overall energy and carbohydrate intake.

*Please note 5% is a WHO conditional recommendation (see WHO website for more information on conditional recommendations).

Be active

Physical activity helps to improve effectiveness of the diet and your medication. An exercise specialist should be part of your care team. He/she can advise on suitable physical activity.

Drink lots of clean, safe water

Water should be the drink of choice for you and your family.

Do you need to take supplements if you have Type 2 diabetes?

A balanced diet should always be your priority. Routine supplementation of micronutrients, antioxidants (e.g. vitamin D, E and C, chromium), cinnamon or curcumin is not recommended unless you have a known nutrient deficiency or have additional requirements.

If you are following a diet low in energy, are pregnant or breastfeeding, are a strict vegetarian, or your intake of nutrients may be compromised or reduced, you may require supplementation.

Supplementation with omega 3 fatty acids has not been shown to improve blood glucose control in those with Type 2 diabetes.

Guidelines suggest that there are several different eating patterns that can be adopted to maintain good health and blood glucose control. There is also a lot of current research interest in intermittent fasting and low-carbohydrate diets so these are areas to watch too!

A registered dietitian can assist you in finding a dietary pattern that best suits your needs and goals to ensure you are eating a diet that is of good quality and energy controlled. Visit www.adsa.org.za to find a registered dietitian in your area.

Warm up to good health this summer!


References

American Diabetes Association. 5. Lifestyle Management: Standards of Medical Care in Diabetes – 2019. Diabetes Care 2019: 42(Suppl 1):S46-S60.

Diabetes UK. Evidence based nutrition guidelines for the prevention and management of Diabetes: March 2018.  (www.diabetes.org.uk)

Sievenpiper JL, Chan CB, Dworatzek PD, Freeze C, Williams SL. 2018 Clinical Practice Guidelines Nutrition Therapy. Canadian Journal of Diabetes 2018: 42:S64-S79.

The Society for Endocrinology, Metabolism and Diabetes of South Africa. Type 2 Diabetes Guidelines Expert Committee.  “Medical Nutrition Therapy” in 2017 SEMDSA Guideline for the Management of Type 2 Diabetes Guideline Committee. JEMDSA 2017: 21(1)(Supplement 1):S1-S196.

Vorster HH, Badham JB, Venter CS. An Introduction to the Revised Food-Based Dietary Guidelines for South Africa. S Afr J Clin Nutr 2013: 26(3):S1-S164.

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Wendy Girven is a registered dietitian. She has worked in private practice, academia (community nutrition) and in the food industry and has an interest in the nutritional management of non-communicable diseases.


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Rethink your drink this summer

Dietitian, Retha Harmse, educates us with facts so we can rethink our drink this summer.


With summer here, it’s not only imperative to keep sipping to prevent dehydration due to the heat, but it’s also such a good way of refreshing and cooling down.

But with so many drinks fighting for your attention and so many controversies regarding sugar-free drinks, and trying to keep your total energy and glucose levels down, it might be necessary to rethink your drink.

Looking at the facts

Studies found that among respondents 15 years and older, they consumed large amounts of sugary drinks daily, in the form of carbonated beverages and fruit juices.

However, is the sugar-free alternative better? It turns out it doesn’t matter if the soft drink you’re consuming is the normal or sugar-free alternative, scientists say both kinds are associated with an increased risk of early death.

JAMA Internal Medicine

This shocking fact is according to a recently published (September 2019) study in JAMA Internal Medicine. The study looked at more than 450 000 people from across 10 European countries, including the United Kingdom, Germany and France.

Using data from the European Prospective Investigation into Cancer and Nutrition (EPIC), the research team looked at what participants ate and drank for an eight-year period.

They found one or more glasses of sugar-sweetened beverage a day were positively associated with deaths related to digestive diseases. While having two of more artificially sweetened drinks a day were positively associated with deaths related to circulatory diseases.

The findings are in line with previous studies that found a connection between sugary drinks and risks of early death. Another study has associated soft drinks to other health issues, such as having higher risks of having a stroke and dementia.

What are the options now?

Eat your water

Pile your plate high with vegetables and salad. Most vegetables are between 90 – 95% water. This additional to fibre, vitamins, minerals and antioxidants makes them the perfect accompaniment for every meal.

Try to ensure that at least half of your plate is vegetables and/or salad, and that they represent all colours of the rainbow, from purple eggplants, yellow peppers, red radishes, orange butternut to green spinach.

Be wary of fruit juices

These often confuse people living with diabetes, because they read “no sugar added” on the label. Although there is no added sugar, fruit juices are high in fructose sugar that can push up blood glucose levels.

Fruit juices are a concentrated form of natural sugar from the fruit. You get all the sugar, but none of the fibre that’s good for you. A small glass of fruit juice can have twice as much sugar as a piece of fruit! Rather eat fresh fruit or see the next point for new fresh ideas.

Infused waters

Fresh fruit, herbs, and some vegetables make great flavours for water. While any combination can be tasty, here are my go-to resources for flavour pairings:

  • Apple, lemon, carrot
  • Strawberry, lemon, mint
  • Apricot, raspberry, mint
  • Orange, lime
  • Strawberry, pineapple
  • Peach, plum, mint
  • Cucumber, lemon, celery
  • Apple, cinnamon stick, red pear
  • Lemon, mint, ginger, cucumber
  • Cucumber, thyme, lime

Infused water is best two to four hours after you’ve made it. Or, you can let it infuse overnight in the refrigerator. Some ingredients last better than others. With herbs, for example, fresh basil lasts two to three days but rosemary can last up to a week.

Normal water

Last but not the least, your normal straight-forward water. It’s always a winner and so refreshing! If you feel it looks a bit bland, remember that you can always freeze edible flowers into your ice-cubes and serve in a beautiful glass.

What are the benefits of water?

  • Metabolic and biochemical reactions
  • Breaking down food through hydrolysis
  • Internal creation of water
  • Prevents constipation
  • Transport nutrients
  • We have approximately five litres of blood in our body. Our two kidneys filter about 180 litres of blood volume a day (125 ml/minute), performing this filtration some 50 to 60 times a day.
  • Body temperature regulation

Therefore, please enjoy a wonderful refreshing drink of any of the healthier options to keep the blood glucose levels in check. Manage your weight and prevent unnecessary weight gain over the holiday season as well as keeping dehydration at bay.

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


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How to stay healthy on a budget

Ronel Jooste offers practical tips for potential savings and how to  stay healthy on a budget.


Medical care is expensive, not only in South Africa but worldwide. The costs are constantly on the rise. The lifestyles people are accustomed to in the modern era, as well as increased stress levels also contribute to more people having to spend more money on medical expenses at a progressively younger age.

Unfortunately, there is not always much that we can do about the costs of medical expenses and the rates medical aids are charging. So, we need to look for alternative ways to save money and make our budget work for us.

Your health is your biggest asset and most people will agree that we need to take care of our health, even if it is at the expense of other things.

Therefore, it’s important to adopt a healthy lifestyle. Taking precautionary measures is always the cheaper option over the long run. We also know that a healthy lifestyle is associated with expense.

Save money on your food bill

So, how can we stay healthy on a budget? Firstly, a healthy lifestyle starts with a balanced diet. Here are some tips to save money on your food bill:

  • Convenience food, restaurants and take away food are expensive and, in most instances, not very health conscious. Get in the habit of preparing your own food and cooking at home. Not everyone is a great chef but there are loads of healthy recipes available on the internet, and investing in a cooking course will also save money in the long run.
  • Buying produce that are in-season is more cost effective.
  • Plan your menu in advance and prepare a shopping list. This will assist in not wasting money on items that go off and going to the shops unnecessarily.
  • Keep to a shopping list when going to the shops to avoid buying items that you don’t need.
  • Buying food in bulk often seems cheaper but this might not always be true. It is important to know your prices. Use the price per unit that is indicated on the price label and compare different items, different volumes and different brands by using a consistent basis. Also shop around at other stores that might offer better prices on certain items. But, keep into account the time and petrol you spend when driving from shop to shop. Quite often the time and petrol spent on driving to another shop is not worth the saving on the food.
  • Growing your own produce is also a great cost-saving idea. Not only will you save money but you are guaranteed to eat fresh produce that are free from chemicals and other preservatives.
  • Smoking and excessive alcohol are also culprits impacting negatively on both your health and budget.

Exercise

Exercise is equally important in maintaining a healthy lifestyle. There are plenty of exercises you can do on a budget. Walk your dog around your neighbourhood, running, hiking or cycling.

If you are a gym member who hardly ever goes to gym, you might have to reconsider if it isn’t more cost effective to cancel your gym membership and use the money to buy a treadmill or stationary bike to exercise in the comfort of your own home, at a time that is convenient for you.

Tips to stay within your budget

These cost-saving tips can help you to pay less for medical expenses and stick within your budget:

  • Discuss with your doctor or pharmacist if there are other alternatives to your prescribed medication. Buying generic medicine can be a lot cheaper than buying the brand name medicine. But, get advice from an expert before making this decision.
  • In South Africa buying medicine online might not yet be as popular, freely available and well-regulated as in other countries. It’s, however, worthwhile to explore the option of buying medicine online. Many service providers in South Africa do already offer legitimate online shops with cheaper prices than buying in-store.
  • Negotiate with your pharmacist for cheaper prices on prescription medicine. There are pharmacists who will be happy to match lower prices if you discuss it with them.
  • Make use of pharmacies or stores that offer loyalty reward programmes and discounts. You can save a significant amount when making use of these rewards and discounts.

It is worthwhile to adopt a savings mind-set and constantly look out for potential savings. Even small savings will add up and can quickly put more money back into your pocket. Take proper care of your health and be money savvy.

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Ronel Jooste is a director at FinanciallyFiT Group (Pty) Ltd, a company specialising in financial consulting and training for businesses and individuals. She developed online financial courses and employee financial wellness programmes. She is a chartered accountant, speaker and the author of the award-wining book Financially Fit and Wealth, a guide to achieve financial success. www.roneljooste.com


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Living positively with diabetes

Hannie Williams, a dynamic diabetic nurse educator, shares tips on how to live positively with diabetes.


How do you do? What a pleasure to have an opportunity to ‘meet’ on the pages of Diabetes Focus.

This article is all about you – the person living with diabetes, or the spouse/significant other of a diabetic person. We, as healthcare professionals, learn so much from you, our patients. So, thank you for sharing your experiences gained from living with diabetes with us.

Let’s look at the individual words used in the topic of this article: living; positively; diabetes. I want to tackle the last word first.

Diabetes

This requires lifelong management, including the use of various medications (tablets, insulin injections, etc.), diet, exercise, testing your blood glucose, annual checks of your eyes and feet. And, the list goes on.

Add some other chronic diseases, such as high blood pressure and raised cholesterol (more tablets!), the fear of complications of diabetes and, of course, the cost of medical treatment. Wow! It is overwhelming! I am exhausted from listing all of this and you must deal with this daily.

I often notice how stressed patients are when attending their visit as they so want to please the doctor with good results and reduction of weight. If they don’t achieve this, they feel guilty for not doing what was expected, for example, more frequent blood glucose testing, adjustment of insulin dosages, etc. When asked how they are, some will respond, “I will be able to answer you once I have seen doctor.”

Stop. Take a deep breath. We must acknowledge that you are dealing with health issues and the treatment thereof, but let’s look at the other words.

Living

This does not mean to just exist. To exist is just doing what one must do while being alive i.e. paying tax, paying more for food, petrol and electricity.

Living is to be alive. It’s an active process asking us to be involved in life around us. You are a unique human being, with your own special talents. Acknowledge this and use it to make your world a better place.

Get involved – visit a care centre in your town and volunteer your help. You may be an excellent gardener and can help them creating their garden. You may like to read to those with bad eyesight, or just visiting the people in the centre.

Make sure to pass your life experiences, lessons learned and family traditions to the next generation. Write a letter(s) to your children and grandchildren and share your valuable unique life experiences. One of my most treasured items is a handwritten letter from my mother to me.

Sing Happy Birthday to family and friends. I can promise you that this will be a gift more special than anything you can buy. I always do this (to the annoyance of my husband and sons). But last year I was surprised when I was away from home on my birthday and I got a phone call from my oldest son, and guess what, he sang Happy Birthday to me. I felt such an accomplishment that my tradition is rubbing off on the next generation.

Do not let a day pass without doing or noticing something special in your surroundings.

Positively

“I can BE optimistic by showing a positive attitude.”

Abraham Lincoln said, “Most people are as happy as they decide to be.” How true this is?

Is the glass half full or half empty to you? The choice is yours.

Nobody wants to be around someone who is constantly criticising everything and moaning about what is wrong. We avoid people like this. Let us not be the person that others want to avoid.

Changing is difficult. But just start by being the person that will try to make an effort to change a negative conversation to something positive. It’s not that we do not acknowledge that things do go terrible wrong; that bad things happen to good people and that times are tough. Rather try to make everyone in the conversation realise what a privilege it is to be together as family or as friends, sharing a cup of coffee or glass of wine.

Take time to notice the everyday miracles happening around us. How day becomes night. Change of seasons – green leaves quietly changing to beautiful autumn colours. The same tree that provides us with shade against summer heat, shed its leaves in autumn to let warm sunshine through in the cold of winter.

So, if life handed you a lemon tree, what will you do with it? How about making the most wonderful lemonade or pickles from the fruit of the lemon tree? Forget the thorns and smell the heavenly scent of the lemon blossoms.

Do what you can with what life hands you. You will be amazed how much this is once you start embracing your own unique self.

Your legacy in life should not be the ‘Oompie or Auntie’ who had diabetes. You have much more to offer this world.

Active in decision making

I want to encourage you to be actively involved in the decision making about your treatment. Ask as many questions as needed for you to understand why you should take that medication.Don’t just exist. Live your life to fullest with your available resources.Attitude is everything!

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Hannie Williams (B Nursing (Stell) 1987) has been working as diabetic nurse educator since 2004, alongside the specialist physician, Dr G Podgorski and his wife, Alice, in Port Elizabeth. She is married to Kobus.


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The 5 healthiest cooking oils

Fats are an essential part of the human diet, helping synthesise hormones, promoting overall brain- and mental health, and keeps us full. But what are the healthiest cooking oils to cook with?


In addition to thinking about the overall nutrient profile of cooking oils and how they are processed, you must consider another factor: the smoke point (which is the temperature at which an oil begins to smoke).

Every type of cooking oil has a different smoke point, and heating an oil beyond its smoke point causes it to oxidise, resulting in the release of harmful free radicals and other compounds.

  1. Avocado oil

Surprisingly, avocado oil has a high smoke point, making it a smart cooking choice if you’re scaling back on saturated fats. Avocado is comprised mostly of the monounsaturated fatty acid, called oleic acid, which has potent anti-inflammatory properties and promotes heart health. It also contains lutein, a carotenoid, that can improve eye health. By virtue of it’s high smoking point, it’s suitable for all cooking. But because it’s pricey, it would not be wise to use it for deep- frying and may lose flavour due to prolonged exposure to heat.

  1. Ghee (clarified butter)

Many people love cooking with butter for obvious reasons: flavour! But it has a relatively low smoke point at 300°F. When you remove its milk solids to create ghee, however, that smoke point jumps to a safe level for most cooking applications while retaining its amazing flavour. Bonus: It’s lactose-free; contains vitamins A, E, and K2; and is rich in conjugated linoleic acid (CLA) and butyrate, which may help lower body fat and decrease inflammation.

  1. Algae oil

Algae oil is high in monounsaturated fats and low in saturated fats. It’s a great option to add to the rotation if you’re looking for a neutral-tasting high-heat oil, as it’s incredibly versatile and a great option for cooking, baking, and salad dressings. The one downside; it tends to be a bit expensive.

  1. Olive oil

Olive oil is high in the monounsaturated fat oleic acid, which is anti-inflammatory and promotes heart health. Extra virgin olive oil (EVOO), specifically, is packed with polyphenol antioxidants as well, which are thought to contribute a range of benefits.

However, EVOO is only suitable as a finishing oil and for low- to medium-heat cooking (sautéing vegetables), as it has a smoke point of 325 to 375°F.

Refined olive oil, on the other hand, has a smoke point of 425°F but does not contain nearly as many beneficial polyphenol compounds.

  1. Unrefined coconut oil

Coconut oil is mostly saturated fat, which makes it more stable, and it also contains medium-chain triglycerides, a fat source that converts to energy more quickly.

As an added benefit, coconut oil contains an antimicrobial compound, called lauric acid, which has also been shown to have beneficial effects on cholesterol. Refined coconut oil has an even higher smoke point, but it’s thought to lose many of its beneficial health effects.

Oils are a vital component of every meal, more so people with chronic disease, such as diabetes and heart disease.

Matsepo Manyokole

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Matsepo Manyokole is a registered nurse with more than 20 years of international nursing experience. She has worked in a variety of settings, including maternity, infectious diseases, public health and medical units with special emphasis on chronic diseases, such as diabetes and heart disease.



Header image credit by Freepik 

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Diabetes and financial stress

Daniel Sher educates us on how to deal with the psychological burden of financial stress when living with diabetes.


Case study of patient with financial stress

Doug (not his real name) is a 33-year-old Capetonian who visited me looking for a bit of extra support in meeting his diabetes-related goals.

What was Doug struggling with exactly? Well, it wasn’t entirely clear. It never is. When it comes to thriving with diabetes, there are always complex interacting factors that need to be considered. In Doug’s case, however, financial stress was one of the biggest factors leading him to neglect his health.

Doug most certainly isn’t alone in this regard. As a person living with diabetes, how frequently have financial concerns negatively affected your ability to cope? Research has backed up what so many of us know all too well: diabetes is expensive! This, in turn, can create a whole lot of stress and anxiety that makes it even harder for us to thrive.

A tale of two cities

In South Africa, historically-based economic inequality means that a large proportion of people rely on public health to manage their diabetes. Research has consistently shown that public clinics and hospitals are overburdened – and people with diabetes struggle as a result.

However, even for those who are lucky enough to have access to private medical aid, there are hidden costs that hold many back.

The hidden costs of diabetes

  1. Your endocrinologist is really good at what she/he does. She/he is now charging above medical aid rates, meaning that you must front a co-payment.
  2. Lantus insulin isn’t covered by medical aid, even though your doctor has motivated for it.
  3. Having diabetes means that you’re more susceptible to colds and bugs. You find that you’re spending a fortune on vitamins, cold remedies and doctor visits.
  4. You have maxed-out your sick leave at work and need to take unpaid leave.
  5. When your blood glucose levels are out, you struggle with fatigue and low motivation. This means that at work, you’re not meeting your targets.
  6. It’s not cheap to eat healthily.
  7. You would love to be able to test more frequently, but extra strips are very pricey. What about that shiny new Dexcom? That would cost the equivalent of three months of rent.
  8. You have developed an additional chronic condition, such as hypertension, kidney disease, psoriasis or coeliac disease. People with diabetes are at a higher risk of developing these sorts of conditions. This means more specialist visits and expensive medications.
  9. You’re depressed or anxious. As people with diabetes, you’re two to three times more likely to have a psychological disorder. This means extra fees for therapy or psychiatry visits, as well as reduced productivity at work.

What can you do about financial stress?

So, what can you do to cope with these sorts of feelings and barriers to healthcare?

  • Get healthy

If you want to manage the costs and financial stress of diabetes, your best bet is to become as healthy as possible.

You’ve heard all of this before. It’s important to think about diet, exercise, testing, medication adherence, mental health, self-care and so on. This is more than just behavioural change. This is a shift in mindset that is going to save you money and allow you to be the happiest and healthiest version of yourself.

Let’s address the elephant in the room: it’s not easy to simply ‘get healthy’. This is a process; and a challenging one at that. It can also be expensive to maintain healthy habits.

But it’s important to see this as investing in yourself. By adopting a healthy lifestyle now, you’re going to avoid developing complications that could cost you more in the future. You’re also going to increase your emotional and financial well-being in the present moment.

  • Shift your mindset

When Doug came to see me, he benefited from analysing and altering some of his thinking patterns. As mentioned, one of Doug’s biggest challenges was that he was not all that well-off, financially speaking. Of course, compared to many in our country, Doug was in a very privileged position. Nonetheless, he often made unhealthy choices based on his financial worries. These included:

  • Buying cheaper meals rather than opting for low-carb options.
  • Seeing his doctor once per year, rather than every six months.
  • Choosing not to test in the morning because he wanted to deny the fact that his glucose level was high, so that he could avoid having to up his Lantus dose.

In therapy, we worked on a skill, called cognitive restructuring. This forms a part of cognitive behavioural therapy (CBT), which is a powerful psychological approach that has been shown to help people with diabetes cope better.

In Doug’s case, cognitive restructuring helped him to catch subtle thoughts that lurked just below the level of conscious awareness. These thoughts reminded him of his financial stressors, triggering anxiety and leading him to make unhealthy choices.

Once Doug could identify these problematic thoughts, he was able to replace them with healthier thinking patterns. Often, this involved him reminding himself that it was worth spending that extra bit on his diabetes care so that he could reduce costs in the long run.

If you want to learn more about the basics of CBT and changing unhelpful thinking patterns, you can visit this page.

  • Talk to your doctor or therapist

If you’re struggling financially, this is nothing to be ashamed of. It is vital to speak to your treating team so that they can help you find creative solutions. At times, doctors and therapists may be willing to negotiate a reduced rate. Alternatively, they may be able to provide pointers for reducing expenses by, for example, taking full advantage of chronic cover possibilities.

What about counselling and psychotherapy?

Once I had met with Doug, it became clear that he was suffering from clinical depression. Just like many other people with diabetes. Together, we filled out an application form and his medical aid agreed to help cover treatment of depression as a chronic (Prescribed Minimum Benefit) condition.

If you know that you can improve your diabetes control by seeing a therapist, don’t let the costs involved hold you back. Chat to a therapist about applying for chronic cover. This applies to anyone who is on a medical aid, including hospital plans.

Invest in yourself

Diabetes is a complicated and challenging condition to manage. A big part of this challenge involves the hidden costs that we have discussed. Just another one of the many factors that we need to consider and address as a part of our everyday management plans.

Remember, though, that by addressing these concerns, we can learn to take our coping skills to the next level. At times, this may simply be a matter of shifting your mindset, adopting healthier lifestyle habits, or speaking to your treating professional to find creative solutions.


Reference:

  • Endocrine Society. (2014, June 23). High blood sugar causes brain changes that raise depression risk. ScienceDaily. Retrieved June 19, 2019 from sciencedaily.com/releases/2014/06/140623092011.htm
  • Ismail, K., Winkley, K., & Rabe-Hesketh, S. (2004). Systematic review and meta-analysis of randomised controlled trials of psychological interventions to improve glycaemic control in patients with type 2 diabetes. The Lancet, 363(9421), 1589-1597.
  • Pinchevsky, Y., Raal, F., Butkow, N., Chirwa, T., Distiller, L., & Rothberg, A. (2018). Quality of care delivered to type 2 diabetes mellitus patients in public and private sector facilities in Johannesburg, South Africa. International journal of general medicine, 11, 383.

Additional Reading:

* Not his real name

MEET OUR 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 patients to help them thrive. Visit danielshertherapy.com


Header image credit by Freepik 

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