Retirement planning: why and how

Did you know only 3% of South Africans will be able to retire comfortably? Ronel Jooste advocates why it is important to start saving from as early as possible.


Only 3% of South Africans retire comfortably

According to the National Treasury, less than 3% of South Africans can retire comfortably, without having to make drastic changes to their lifestyles.

These statistics are worrying. Do you want to work hard all your life, only to struggle financially when you are retired? Or rather work hard and putt away sufficient funds towards your retirement to ensure you can reap the full benefit of your rest period in future.

High cost of living in SA

Living costs in South Africa are high and constantly on the rise. A struggling economy results in several employers no longer being able to reward employees with decent salary increases.

Consequently, many households experience financial strain as their income can no longer keep up with the increase in living costs. If you add to an already trembling budget, a medical condition that requires constant healthcare and medical expenses, budgets are put under further strain.

When expecting this strained budget to also make provision for retirement planning, it becomes crystal clear why retirement planning quite often ends up last on the priority list.

Types of retirement products

Retirement products are designed to help individuals save money towards retirement, usually with tax benefits. The purpose is to provide individuals or their dependents, with an income upon retirement. This income can be paid out in the form of a lump sum and/or a monthly pension until death.

Most employers structure retirement benefits as part of their employees’ remuneration packages. Examples of retirement benefits offered by employers are as follows:

  • Pension fund – on retirement, a lump sum, in cash, equal to one third of the total retirement value, plus an annuity/monthly pension over the rest of the lifetime of the employee are paid out.
  • Provident fund – the full benefit is paid out as a lump sum upon retirement.
  • Preservation fund – when you change jobs, or become self-employed, and don’t cash in your pension, a preservation fund enables you to preserve your pension or provident fund savings in this fund until you retire. A once-off contribution is thus made into a preservation fund once you resign or are retrenched.

Retirement annuities are available for individuals who are self-employed, or who work for a company that doesn’t offer pension benefits, or for employees who want to save for their retirement in addition to their existing pension or provident fund contributions through their employer.

Making your budget work for you

Living with diabetes does have a serious impact on any budget due to expensive medical costs. Therefore, it is important to have a good medical aid or health insurance plan in place to cover most the costs.

Also look out for potential savings:

  • Live a healthy and active lifestyle.
  • Discuss options for generic medication or alternative healthcare options with your medical practitioner.
  • Consider buying medicine online which is often cheaper, and buy medicine from pharmacies who offer discounts and loyalty reward programmes.

Potential cost savings can be allocated to a retirement savings plan. Although diabetes is a serious illness that can have a negative impact on a person’s life expectancy, more and more studies are proving that when diabetes is properly managed through healthy lifestyle programmes there is a minimal impact on the life expectancy of a person living with diabetes compared to a person living without diabetes. This re-emphasises why retirement planning should not be neglected.

Why start saving as early as possible?

Consider a simple example to bring this into perspective. Previous generations generally started working after school at the age of 18. If they had to retire at age 65, they would have had 47 years to save for retirement.

In those days people died on average at a much younger age. If they lived on average to age 75, they had 10 years to live off their retirement savings. Thus, they had 47 years to save and their savings had to last 10 years.

These days many people go to university or college and only start working on average at age 23, which means they have already lost five years of their potential retirement savings period. Current generations tend to live much longer, and it is not uncommon for people to reach 95 years of age. The result is that we have about 42 years to save for retirement, and our retirement savings must last for 30 years should we reach age 95.

This simple example illustrates why it’s important to start saving as early as possible for retirement. If you haven’t started yet or you are not saving enough, don’t wait any longer. Start working towards creating a solid retirement plan today.

Tips to consider for your retirement planning:

  • Calculate how much you will need for retirement and review it annually. As your salary package grows and your standard of living improves, your expectation regarding retirement savings will increase as well.
  • Be realistic and make sure you save enough. If your monthly living costs are R40 000, for example, and you consider your second property providing you with R10 000 rental income monthly as your retirement plan. You must realise that R10 000 will not be enough to cover your living costs. Additional retirement savings will have to be added to your retirement plan.
  • Don’t be tempted to use your retirement savings to start a business or buy a bigger home. Once you have used your savings, it will be extremely difficult to catch up or recover.
  • You can get tax deductions for your monthly contributions towards your retirement savings. Make use of these tax savings to build a tax effective asset portfolio.
  • Younger people can be much more aggressive with the underlying asset allocation of retirement funds. As you get older, it is advisable to be more conservative. You don’t want to invest in high-risk assets a few years before retirement with a risk of losing the money that you worked hard for over many years.
  • Don’t be tempted to buy expensive cars or a holiday home on receiving a lump sum retirement pay-out. Invest your lump sum wisely as you need the money to maintain your required living standard throughout retirement.

This article includes extracts from Financially Fit and Wealthy. The book (hard copy or e-book) can be ordered on roneljooste.com

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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 develops online financial courses and employee financial wellness programmes. Ronel is a chartered accountant, speaker and the author of the award-wining book Financially Fit and Wealthy, a guide to achieve financial success.


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Getting life insurance when you have diabetes

Did you know that you could qualify for life insurance even if you have diabetes? Janette Rooney tells us more.


If you have a financial advisor, he/she needs to be fully informed about your health and financial status to apply for life insurance for you. Your financial advisor will then conduct a financial needs analysis to ascertain what type of cover you require and how much cover you require under each element.

If you do not have a financial advisor, you, as the client, would deal directly with the insurance company regarding the new business requirements and adverse offers. You don’t have to have a financial advisor, but it’s always better to utilise one as you would be given best advise by an expert who conducts a financial needs analysis. Plus, a financial advisor often negotiates with the insurance companies regarding adverse decisions, as they have the knowledge of the product and the client.

Types of cover

Here are a few examples of the types of cover available:

Life Insurance

Lump sum amount payable in the event of a person’s death. Usually this cover is taken out to cover any financial impact of the person dying:

  • Debt
  • Estate Duty
  • Executors Fees
  • Replace lost income of the person dying for a specific period of time.

Disability

Lump sum amount payable in the event of a client being disabled.

  1. Debt
  2. Revamping of clients lifestyle post disability
  • Apparatus, such as wheelchairs.
  • Modifying vehicle changing to an automatic vehicle.
  • Modifying changes to house, for example, changing a bathroom.

Income Protection

Monthly income replacement in the event of a disability.

Severe Illness

Lump sum amount payable in the event of a server illness, such as cancer.

Life insurance

When it comes to initially applying for life insurance, various initial factors are taken into consideration when generating a life quote, such as age, sex, income, education and smoker status. The initial quote is usually generated with what is called an A1 rating, which is a “healthy life” rating.

The next step is to complete the application form with your financial advisor, where most life insurance companies require full medical history. This is the most important element and it is vital to disclose all health information.

The application form is submitted through to the life insurance companies underwriting team. The application is assessed based on the various risk factors disclosed. The underwriters will then generate a list of requirements. The type of requirements generated would depend on each client’s individual health status.

For people living with diabetes, again depending on the type, the life insurance companies would usually call for glycated haemoglobin (HbA1C) blood test. Depending on the results of this blood test and any other tests required, if the client has any other high-risk health conditions, the life insurance company would then decide on whether to offer the client cover.

Should cover be offered, the offer could be subject to terms and conditions. For example, the premium being loaded, certain ancillary benefits (Disability, Severe Illness and Income Protection) may not be offered, or offered subject to certain exclusions, such as dread disease.

If the life insurance company is not prepared to offer life insurance, some companies are prepared to offer accidental life insurance cover, where you could be covered as the result of accidental death. There are also some life insurance companies who specialise in higher risk clients and it would be best to contact your financial advisor to get guidance in this regard.

Note to remember

All of the insurance companies that I deal with will offer quotes to clients who have diabetes. These include Momentum Life, Discovery Life, Hollard Life, Old Mutual and Brightrock. However, I have had different diabetic clients accepted and other clients declined by the same insurance company. This is because each client is unique and their factors are different compared to the next one. 

Remember, the life insurance company would look at the overall health of the client; what type of diabetes the client has; how controlled the diabetes is. This is determined, for example, by blood tests conducted prior to the company making a decision. Lastly, does the client have any other conditions besides diabetes and how much risk does the other conditions impose? All those factors determine the decision.

Diagnosed after commencement of life insurance

If the client’s health status changes after taking out life insurance, it is always recommended to advise the life insurance company from a disclosure perspective. However, the underwriting was conducted at application stage in accordance with the client’s health status when the cover was taken out. The premiums and conditions cannot be changed due to additional conditions contracted after cover commencement date. The premiums and conditions of cover can be amended when the client adjusts their cover i.e. increases the cover or adds additional cover.

The life insurance companies usually request a health review and depending on the updated health conditions can then underwrite in terms of increasing the premium or exclusions, etc.

Janette-Rooney

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Janette Rooney is an independent financial advisor and owns her own brokerage, Le Forge Financial Consultants. She started her career, in 1993, in the medical aid industry, working for Medscheme and then for Discovery. 


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Mindful eating vs gulping down food

Dietitian, Retha Harmse, educates us on why we shouldn’t gulp down our food but rather practise mindful eating.


We all have those days when we are strapped for time to sit and savour a meal. Sometimes we eat in the car in traffic. Other times we eat on our laps in front of the television, or while working in front of the computer.

Unfortunately, in our fast-paced lifestyle these scenarios mentioned are often the norm and not the exception. And, unfortunately, gulping down of food and quickly devouring meals come with a cost.

Recent research, from Japan’s Hiroshima University, identified the link between gulping down food and metabolic syndrome.

What is metabolic syndrome?

Metabolic syndrome is a group of metabolic risk factors that exist in one person. Some of the underlying causes of this syndrome that give rise to the metabolic risk factors, include being overweight, having insulin resistance, physical inactivity and genetic factors.

Metabolic syndrome is a serious health condition. The reason why this is an area of concern is that people with this syndrome are also more likely to develop Type 2 diabetes.

What is mindful or intuitive eating…and how does it help?

Eating is a natural, healthy and enjoyable activity to satisfy hunger and fuel the body. But in our diet-obsessed, food abundant culture, many individuals struggle with a love-hate relationship with food.

Eating is too often mindless, overwhelming, and guilt-inducing instead. This troubled relationship with food often lies at the heart of some of the most common health problems in our society. Or, it can be a ‘symptom’ of unmet needs in other areas of one’s life.

Mindful eating is an ancient, mindfulness-based practice with profound implications and applications for resolving problematic eating behaviours and troubled relationship with food. It also fosters the development of self-care practices that support optimal health.

Although the concept has grown in popularity recently, mindful eating is still widely misunderstood and underutilised. So, let’s talk it through.

What exactly is mindful eating?

One very simple and practical way to think about mindful eating is with intention and attention. Eating with the intention of feeling better when you’re finished than you did when you started, and with the attention necessary to notice food and its effects on your body and mind.

Research on mindful eating and mindfulness as it relates to eating behaviours is accumulating quickly, with promising results. The evidence demonstrates a positive impact on a wide variety of food- and well-being related issues, including emotional eating, binge eating, food cravings, nutrient intake, blood glucose regulation, and more.

Often narrowly understood as ‘eating slowly’ or ‘eating without distraction’, mindful eating may also incorporate thoughts, feelings, and behaviours throughout the entire process of eating. The goals of mindful eating can be broadly summarised as follows:

  • Cultivating awareness of physical and emotional cues.
  • Recognising non-hunger triggers for eating.
  • Learning to meet non-hunger needs in more effective ways than eating.
  • Balancing eating for nourishment and enjoyment.
  • Increasing satisfaction from eating.
  • Using the energy you consume to live vibrantly.

Dr. Michelle May states it perfectly, in the book series Eat What You Love, Love What You Eat: “When a craving doesn’t come from hunger, eating will never satisfy it.”

Eating is so much more than what you eat or even in the manner you eat. Mindful eating helps us look beyond the superficial reasons why we eat.

How does mindful eating help improve health and quality of life?

  • Increases consciousness of unrecognised or unexamined triggers.
  • Creates space between triggers and response.
  • Interrupts old, unconscious and ineffective patterns and habits.
  • Empowers decision-making that supports optimal well-being.
  • Develops skills that positively influence other areas of life.

Who benefits from mindful eating?

Mindful eating is a simple concept that can be applied in any setting – home, work, dining out, travelling, and special occasions. It’s a flexible approach that doesn’t depend on a limited list of foods. So, it works well across cultures and socioeconomic conditions. It doesn’t require weighing, measuring, reference lists, logging, or other time-consuming practices, so it fits into even the busiest lifestyle. Unlike dieting which becomes more difficult over time, mindful eating becomes easier and more natural with practice.

In addition, mindful eating is an effective approach for resolving issues related to food and physical activity that diminish well-being and quality of life for people across the health spectrum. Those who have struggled with yo-yo dieting or weight cycling and have tried numerous programs (including weight loss surgery) are especially likely to benefit from this approach because it’s not based on restriction, deprivation and willpower.

People who are at risk for or affected by chronic conditions impacted by nutrition, such as metabolic syndrome or diabetes, benefit greatly by learning sustainable self-management skills through mindful eating.

So, in short, anyone who eats can benefit from bringing greater intention and attention to their decisions.

How to get started with your first mindful eating practice:

  • Start with a favourite: Choose a favourite food or dish you really enjoy and have eaten often.
  • Sense it: Observe the look, touch, texture, and smell. Appreciate the appearance and scent of your food and begin to perceive any sensations happening in your body, particularly stomach and mouth.
  • Observe before you chew: Once you take a bite, observe the sensation of food in your mouth without chewing. Carefully think about the taste of the food.
  • Go slow and think: Chew slowly and pause briefly. Think about the location of the food in your mouth, as well as the taste and texture. Concentrate on how the taste and texture changes as you continue chewing.
  • Pause: Before you swallow, pay attention to the urge to swallow. Do so consciously and notice the sensation of the food travelling down the oesophagus to the stomach. Pay attention to any physical sensation.
  • Be grateful: Take a moment to express gratitude for the food, for those who provided it for you, and for how it was made. The concept of gratitude will help in the overall process of mindful eating.

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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 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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Highs and lows of diabetes

Aiden Nel, a teenager living with Type 1 diabetes, tells us about the highs and lows with diabetes.


The highs and lows of diabetes is a well-known term for any household that houses a person living with diabetes.

How many times have you, as a person living with diabetes, heard, “Is your reading high or low?” from a member of your family or friends. Yes, we have all experienced this at some stage and will continue experiencing it.

Well, the term ‘highs and lows of diabetes’ is not only associated with the blood glucose readings. To me, the highs and lows of diabetes can also be associated with experiences of living with diabetes but have the opposite meaning.

The ‘highs’ of living with diabetes can include the attention and concern that you receive from family and friends. It is a good feeling when your family and friends check on you and show concern. However, a ‘low’ would be when this is overdone and you feel that your family and friends don’t trust you.

Another ‘high’ is that you can control what you eat as a meal. If you don’t like the food that is being served then you can always say that you should not be eating that particular food. (Sneaky I know!)

The ‘low’ is that there are food items that you really want to eat, but these are the food items that you should not eat.

Though, regardless of how we feel about the highs and lows of diabetes, it’s a very important part of living with diabetes. If we are experiencing a high or a low in our readings or experiences, this statement of highs or lows will not change or disappear from our lives. Therefore, embrace this statement and live your life to the fullest.

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Aiden Nel lives in Port Elizabeth. He is 15 years old and has Type 1 diabetes.


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Breastfeeding with diabetes

As a mom to be, we all want what is best for our baby. There is a huge amount of research that shows breastfeeding is best for baby and for mom. But, is this true when it comes to a mommy who is living with diabetes? The good news is, absolutely! 


Firstly, we know that breastfeeding can reduce the risk of the baby developing diabetes, as well as less likely to be overweight later in life.1It has been shown that breastfeeding protects against both Type 1 and Type 2 diabetes.2,3 Breastfeeding is also thought to play a role in reducing the risk of a mom developing Type 2 diabetes later in life.1

However, a mom already living with diabetes may be concerned that she may face different challenges when it comes to breastfeeding.

Mothers with gestational diabetes

When a mom develops diabetes during pregnancy (known as gestational diabetes mellitus), the impact can be a delay in her mature milk (growing milk baby needs until the day they wean) coming in.4 Under normal circumstances the mature milk comes in on day three. However, a mom who has developed gestational diabetes – her mature milk may only come in on day five to seven.

This means that baby gets colostrum (first stage of breast milk) for the extra few days, resulting in baby feeding often, or not settling after feeding. Although colostrum contains many nutrients, it isn’t really growing milk and some babies on colostrum will lose weight. Up to 10% weight loss is considered normal. Because of this, parents introduce formula top-up which can further delay the mature milk coming in. Formula top-ups can also result in lower milk supply long-term.

  • Differences in colostrum and mature milk

Mature milk and colostrum differ in the nutrient content. Colostrum being higher in fat and certain minerals whereas mature milk has a higher carbohydrate percentage. Colostrum comes in very small volumes with baby needing only about 5ml a feed whereas mature milk is found in much greater volumes.

On day 3, when the mature milk comes in, baby needs about 30ml per feed. However, a baby getting colostrum at this stage won’t be getting this volume from the breast. So, they don’t fill their tummy as easily. These babies need to eat more often to keep their tummy full on the smaller volume of colostrum.

Your body will provide what baby needs with slightly more frequent feeds and a mom who is aware of this will be happy to give baby the extra feeds needed. A mom not aware of this change may feel she is not making enough milk for her baby and may be tempted to give formula top-up. Working with a lactation consultant at this stage can help give mom peace of mind and a plan to ensure baby receives enough breast milk.

  • Caesarean section

Another challenge we see with moms who have gestational diabetes is that they are more likely to need a caesarean section birth. This can cause delays in initiating breastfeeding and contribute to a delay in the milk coming in. The good news is that this isn’t always the case, but it is important to be aware that it may happen.

To help with milk supply, mommy needs to feed baby often after birth, about every 2 – 3 hours. This will also help with the other challenge we find with baby after the birth if a mom has gestational diabetes: hypoglycaemia (low glucose levels).5

Feeding often will help to keep baby’s blood glucose levels up. When we look at a mom who had gestational diabetes, her post-birth glucose levels stabilise, and breastfeeding has an additional benefit in that it can help prevent the onset of Type 2 diabetes later in life. This is a known risk factor of gestational diabetes.6,7

Mothers with Type 2 diabetes

Studies have shown that mothers with Type 2 diabetes are more likely to experience low milk supply or at least a delay in increased milk volume.8 This is because insulin plays a role in milk metabolism.5,9

Breastfeeding, however, may help to stabilise a mom’s blood glucose levels. Mothers with Type 2 diabetes may be able to reduce their hypoglycaemic medication while breastfeeding. Most medication required to treat Type 2 diabetes is safe to take while breastfeeding.8

To be certain though, discuss this with your healthcare providers before your baby is born. Moms do need to monitor their glucose levels closely to start with, as breastfeeding can reduce maternal glucose levels which may in turn lead to mom experiencing hypoglycaemia.5As with gestational diabetes, we do find a delay in the onset of mature milk in moms living with Type 2 and Type 1 diabetes.10

Mothers with Type 1 diabetes

Breastfeeding rates in moms with Type 1 diabetes have been shown to be lower. The reasons are usually related to caesarean birth; delay in initiation of breastfeeding; and babies being born earlier in the pregnancy.

Earlier birth dates are associated with challenges with sucking coordination and latching issues.10 However, breastfeeding can assist in stabilising glucose levels in moms with Type 1 diabetes. These moms can then reduce the amount of insulin they are using.11

Managing milk supply with galactagogues

When looking at managing milk supply, many moms want to take medication to increase their milk supply. This is especially common when the milk is delayed as with diabetes. This medication is known as a galactagogue and it may be medical or natural.

Moms living with diabetes need to be particularly careful about taking galactagogues, unless guided by a healthcare provider. Many of the natural forms are readily recommended and easily available. However, some of them can impact a mom’s blood glucose levels.

Goat’s rue is an herbal medication used to increase milk supply, but it is also used to lower blood glucose levels. It may present as a benefit to moms living with Type 2 diabetes, but moms living with Type 1 diabetes should not use it. 12,13

Likewise, fenugreek, milk thistle and alfalfa to name a few have been used to increase milk supply and are also associated with reducing glucose levels. 14,15,16,17 It is strongly recommended that moms consult with their healthcare providers before taking any form of natural supplements to increase milk supply.

Lactation consultant

Working with a lactation consultant is important to rule out any other underlying issues that may cause low supply, such as a poor latch. Lactation consultants can also guide mothers with practical steps she can take to increase her milk supply, as well as assist in making sure baby is exclusively breastfed. Most importantly, moms living with diabetes can breastfeed and will reap the rewards of doing so.


References

  1. Erica P Gunderson. Breastfeeding and diabetes: Long-term impact on mothers and their infants. 2008 Aug: 8(4): 279-286 [NCBI]
  2. Gouveri E, Papanas N, Hatzitolios Al, Maltezos E. Breastfeeding and diabetes. Curr Diabetes Rev 2011 Mar; 7(2):135-42 [PubMed]
  3. Stage E, Hogardd H, Damm P, Mathiesen E. 2006. Long-term Breast-feeding in women with type 1 diabetes. Diabetes care 2006 Apr; 29(4): 771-774
  4. Wallenborn JT, Perera RA, Masho SW. Breastfeeding after gestational diabetes: Does perceived benefits mediate the relationship
  5. Diabetes and breastfeeding. https://www.laleche.org.uk/diabetes-and-breastfeeding/#gestational
  6. Diabetes and breastfeeding: what to know. https://www.webmd.com/diabetes/breastfeeding-and-diabetes#1
  7. Wein, H. Breastfeeding may help prevent type 2 diabetes after gestational diabetes. 2015. NIH research matters. National Institute of Health.
  8. Thursday’s tip: Breastfeeding if you are Diabetic or Insulin resistant. 2015. https://www.lllc.ca/thursdays-tip-breastfeeding-if-you-are-diabetic-or-insulin-resistant
  9. Factors leading to diabetes may contribute to milk supply problems for new mothers. 2014. https://www.sciencedaily.com/releases/2014/05/140505211037.htm
  10. Sparud-Lundin C, Weenergren M, Elfvin A, Berg M. 2011. Breastfeeding in women with type 1 diabetes. Diabetes Care 2011 Feb; 34(20): 296-301
  11. Breastfeeding with type 1 Diabetes. https://beyondtype1.org/breastfeeding-type-1-diabetes/
  12. Using Goats rue to increase your milk supply. Very well family. https://www.verywellfamily.com/goats-rue-and-increasing-the-supply-of-breast-milk-431841
  13. Goat’s rue. Drugs.com. https://www.drugs.com/npp/goat-s-rue.html
  14. Fenugreek and Diabetes. https://www.diabetes.co.uk/natural-therapies/fenugreek.html
  15. Ranade M, Mudgalkar N. 2017. A simple dietary addition of fenugreek seed leads to the reduction in blood glucose levels: A parallel group, randomized single blind trial. Journal List Ayu v.38(1-2); Jan-Jun 2017 PMC5954247
  16. Kazazis CE, Evangelopoulos AA, Kollas A, The therapeutic potential of milk thistle in diabetes. 2014. Rev Diabet Stud. 2014 Summer; 11(2): 167–174. Published online 2014 Aug 10. doi: 10.1900/RDS.2014.11.167
  17. Amraie E, Farsani MK, Sadeghi L, Khan TN, Babadi VY, Adavi Z. 2015. The effects of aqueous extract of alfalfa on blood glucose and lipids in alloxan-induced diabetic rats. Interv Med Appl Sci. 2015 Sep; 7(3): 124-128.
Laura Sayce

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Laura Sayce is a certified lactation consultant (IBCLC) and doula in private practice. She is also the mom of two gorgeous girls. With both personal and professional experience, Laura has a passion to help moms meet their breastfeeding goals. She has been working in the birth and breastfeeding industry for 11 years.


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What are the best sweeteners for people living with diabetes?

There is a lot of controversy regarding  sweeteners (sugar substitutes) and which is better for people living with diabetes. Retha Harmse simplifies the facts.


Sugar consumption

The dangers of excessive consumption of sugar is well-documented. Including how it negatively affects the health status of individuals but even more so for people living with diabetes.

The typical South African consumes 24 teaspoons of sugar daily. More than double of the World Health Organization guidelines for daily intake. Added to that, 7% of the South African population has diabetes (3,85 million people, aged between 21 – 79 years old).

In 1985, 30 million people had diabetes. Its prevalence has increased six-fold and today  425 million people worldwide are currently. If nothing is done now to prevent this, this number will continue to increase to 629 million people by 2045.

Sugars that increase blood glucose levels

Some foods will be labelled “no added sugar” but will still be high in natural sugar (e.g. fruit sugars). These natural sugars also raise blood glucose levels and should be monitored for people with insulin resistance and diabetes.

Sugar Forms & uses Other things you should know
  • Brown sugar
  • Maltodextrins
  • Icing sugar
  • Agave syrup
  • Invert sugar
  • Brown rice syrup
  • White sugar
  • Corn syrup
  • Dextrose
  • High fructose corn syrup
  • Fructose
  • Maple syrup
  • Glucose
  • Fruit juice concentrates
  • Lactose
  • Honey
  •  Maltose
  • Molasses
  • Sucrose
  • Barley malt
  • Used to sweeten foods and beverages.
  • May be found in certain medications.
  • There is no advantage to those with diabetes in using one type of sugar over another (in other words, one teaspoon of sugar has the equal effect of one teaspoon of honey).
  • Sugars may be eaten in moderation. Up to 5% of the daily caloric requirement can come from added sugar.
  • High-sugar diets are not recommended, since such foods could replace more nutritious foods and lead to deficiencies.

Sugars that don’t affect blood glucose levels

Non-nutritive sweeteners, such as aspartame, sucralose, saccharine, stevia, xylitol, and neotame, are so popular due to it being approximately 300 to 13 000 times sweeter than sugar. Though, they don’t have any nutritional value (meaning no or low kilojoules).

Although artificial sweeteners may help to reduce total energy intake, the effectiveness in weight loss or diabetes management has not yet been established. We think fewer calories consumed equals less weight gained or more weight lost, right?

However, according to a recent review, regular consumption of non-nutritive sweeteners is related to an increase in BMI. This might be explained by sweeteners being associated with an amplifying of general cravings and appetite.

Despite this, and this is imperative: sweeteners are not all the same. They have different biochemical structures, with different routes of metabolisation and absorption. Certain sweeteners metabolise differently and are therefore better than others in maintaining blood glucose and weight management. Let’s look at a few different sweeteners and how they weigh up.

Sucralose

Sucralose (sold as Splenda) is 600 times sweeter than normal sugar. It’s mostly secreted which means it does not get absorbed in the body.

Although this might sound great, don’t be so quick to jump on the bandwagon. Sucralose has been associated with inflammation, and there is still ongoing research on whether it increases blood glucose level. The data is leaning towards a ‘no’ for people living with diabetes, as long-term use can cause insulin resistance.

It’s also worth mentioning that added table sugar, if consumed in excess, also causes inflammation and has also been associated with insulin resistance.

Conclusion: Consuming sucralose (or normal sugar) in excess over a long period of time has been linked to inflammation. Sucralose should rather be avoided if you’re diagnosed with any inflammatory diseases such, as rheumatoid arthritis or Crohn’s disease, as it can worsen the inflammatory state.

Aspartame

Aspartame is mostly used in sugar-free or low-sugar drinks and Iced Tea lite.

After the big media frenzy of aspartame causing cancer, recent human studies proved aspartame had no carcinogenic effect. However, it’s worthwhile to note that it’s still not beneficial for your health. More specifically gut health, as aspartame increases certain bacteria in your gut that are directly associated with weight gain.

Furthermore, the long-term (more than 10 years) use of aspartame has been negatively associated with cardiac health. Lastly, aspartame also leads to an increase in carbohydrate cravings, which can lead to increased appetite.

Conclusion: Although aspartame was set-free from being cancer causing, it still increases carbohydrate cravings and the effect it has on gut- and cardiac health shouldn’t be neglected.

Remember that moderation is key. Try to replace diet drinks with infused water or homemade iced teas (rooibos is such a good option). But if you still plan to consume aspartame, be sure to include extra fibrous vegetables, or even a probiotic, to keep the microbiota in balance.

Stevia, erythritol and xylitol

These three sweeteners have been categorised as natural sweeteners. The benefits of these sweeteners are that they don’t need insulin to be metabolised. Therefore, improves glucose tolerance and reduces insulin levels.

Stevia does have an undesirable bitter aftertaste, and erythritol and xylitol are quite expensive (roughly R150-160p/kg). But it seems worth it, because when consuming these natural sweeteners, the rewards system is activated leaving you feeling satisfied. And, in contrast to the previous mentioned sweeteners, they do not increase cravings.

Conclusion: Stevia, erythritol, and xylitol are superior. They can improve glucose levels and aid in weight management, in comparison to the other artificial sweeteners.

Still, moderation remains a key factor in any healthy diet. Therefore, using it sparingly will benefit your health as well as your wallet.

MEET OUR EXPERT


Retha Harmse (née Booyens) is a registered dietitian and the ADSA public relations portfolio holder. She has a passion for informing and equipping 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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Make time to move

Physiotherapist, Saadia Kirsten Jantjes, gives us practical moves to up your everyday exercise and move.


A few weeks ago, while scrolling through social media, I came across the following quote: “If you do not make time for your wellness, you will be forced to make time for your illness.”

It dawned upon me that so many of us wait to be told by a doctor or medical professional, “You have diabetes/high cholesterol/high blood pressure, so you need to move and start exercising and taking better care of your health.”

After attending a diabetes workshop last month, I realised how much time and effort really goes into managing diabetes. Constantly checking blood glucose levels; being conscious of the amount of food consumed; how eating different food groups will affect your blood glucose at different times of the day; and adjusting doses accordingly. It definitely is time consuming.

Add that to all your day-to-day activities, means that you have very little ‘me-time’. Yet, your doctor and dietitian constantly tell you to add exercise to your routine. So, when and where are you meant to do this?

Make movement a part of your lifestyle

Our bodies are meant to move and not be sedentary. If we look back to our old friends, the cavemen, they were hunting, dancing around fires and exploring their surroundings. Ah what a life!

Unfortunately, in this day and age, we must schedule time for movement otherwise our day just runs away with us. But it shouldn’t have to be like that. Making movement an integral part of your daily living will result in more active calories been burnt throughout the day and, essentially, more time for yourself.

Start with baby steps…literally. Take the stairs.

Skip the lift and elevators and take the stairs whenever and wherever you can. Studies show that climbing just eight flights of stairs lowers early mortality risk by 33%; seven minutes of stair climbing a day can half the risk of heart attack over 10 years; and just two minutes of extra stair climbing a day is enough to stop middle age weight gain.

There are numerous other benefits like improving muscular tone, strength and balance as well as increasing your cardiovascular fitness. Riding the elevator up three flights burns 3kcal while walking up three flights of stairs burns over 20kcal.

Get in touch with Mother Nature…in your backyard

Gardening can be a relaxing and rewarding and it is particularly exerting. Using a leaf blower for 30 minutes burns 115kcal but raking leaves for 30 minutes burns 175kcal.

Add some simple exercises to your gardening regime to increase your calorie count. For example, performing a deep squat every time you bend down to water the flowers. Standing on your toes to pair the leaves. Doing some overhead presses with the watering can. Or, if you’re up for it, add a jog around the garden or some high knees on the spot. So, not only are you working out while gardening, but you’ll reap the benefits of some fresh air too!

Move at work

You probably spend most of your waking hours at work. So, what if you could workout while you work, without having to carve out a big chunk of your time?Try these quick moves in the workplace:

  • If you sit at a desk, make it a habit to stand up every time you make or answer a phone call. March on the spot or pace in a circle to keep moving.
  • Need an energising break? Stand up and do some basic strength and balance exercises. For example, squats, desk push-ups, wall sits, calf raises, tree pose and chair pose.
  • Walk to a nearby restaurant for lunch instead of driving or ordering in.
  • Alternate sitting and standing throughout the day, with lots of walking and stretching breaks.
  • Explore your options for using a standing desk, treadmill desk or sit-stand desk riser.

These are all practical tools to get you moving throughout the day. It can also be a great way to figure out what you may actually enjoy in terms of exercise. So, that when you’re able to set time aside for exercise, you’re able to do so with something that you enjoy.

MEET OUR EXPERT


Saadia Kirsten Jantjes is a physiotherapist with a passion for health and wellness. With a second degree in Sport Science, exercise is one of her favourite rehabilitation tools, to not only rehab injuries but prevent injuries too. Saadia has her own private practice in Morningside, Gauteng, SKJ Physiotherapy while working at a Sub-Acute Clinic and furthering her studies in Pilates.

 


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The keto diet – what you need to know

Recently, the ketogenic diet (keto for short) has been in the spotlight as the new diet to try. With that dietitian, Retha Harmse, educates us on the ‘latest craze’ diet.


The keto diet is everywhere; it’s difficult to avoid seeing it on influencers’ Instagram stories; keto options in supermarkets and on restaurant menus; and even friends or relatives speaking about their wonderful results. But, let’s take a closer look at the ketogenic diet.

What it the keto diet?

The ketogenic diet is a high fat, low carbohydrate and low to moderate protein diet that changes the body’s metabolism into ketosis. Any diet where fat is metabolised instead of carbohydrate is essentially a ketogenic diet.

Understanding ketosis

During a ‘normal’ or well-balanced diet, the body’s main source of energy is carbohydrates. More specifically, glucose which is the end-product of carbohydrate metabolism/digestion.

But the body is also able to burn fat for energy, and this is utilised in the form of ketones. Ketones are molecules produced by our liver when fat is metabolised; this metabolic switch is called ketosis.

However, the body doesn’t go into ketosis if there is enough carbohydrates available. Consequently, carbohydrates need to be drastically reduced or eliminated to move towards ketones as the primary energy source.

What does it involve?

Generally, on the ketogenic diet, the macronutrient ratio varies within the following ranges:

  • 65 – 80% of calories from fat.
    • Fat-intake is often over 150 grams (double the usual intake of fat).
  • 20 – 25% of calories from protein.
  • 5 – 10% of calories from net carbohydrate.
    • Roughly 20 – 50 grams a day (compared to the recommended daily amount of 200 – 300 grams per day).

What does this mean in non-dietitian language?

The keto diet prescribes high amounts of fat (both animal and plant sources), low-carbohydrate vegetables, nuts, seeds, and modest protein in the form of meat, fish and eggs. It excludes grains, dairy, legumes, soy, most fruits and starchy vegetables.

Meticulous planning

Ketogenic diets require meticulous planning to ensure the liver continues producing a constant supply of ketones to supply the body with energy.

To maintain ketosis, an individual’s diet needs to be precisely planned and tracked daily, as limiting carbohydrates and increasing fat is not the only focus of the ketogenic diet.

It’s also imperative not to consume protein in excess, as proteins can also be broken down to glucose (through a process called gluconeogenesis). This will in turn inhibit the ability for the body to move into ketosis. Also, if carbohydrates are not restricted enough, it might result in ketonuria (ketones in the urine and not used as energy). This is detectable by urinary dipstick analysis.

The history of keto diets

Although ketogenic diets might seem like the new ‘craze’; they are nothing new. Ketogenic diets have been around from the early 1900s, when they were discovered to have an efficacy in the treatment and management of epilepsy in children.

It is still used for this purpose; although more recently these diets have gained popularity for the management of obesity and Type 2 diabetes.

However, it’s important to note that the macronutrient ratios and recommendations for the ketogenic diet in the management of paediatric epilepsy are substantially different than those advocated for the management of obesity and Type 2 diabetes.

What are the benefits?

In terms of weight loss, evidence suggests quicker initial weight loss. This might be due to the initial use of glycogen stores (glucose stored in the muscle and liver), or reduced energy intake due to increased satiety from eating a large amount of fat and protein.

But long-term differences in weight lost showed no significant difference in comparison to other diets.

As mentioned previously, ketogenic diets have been used for decades to treat epilepsy. But, more recently, research has suggested that they might have a role in treating Type 2 diabetes and inflammatory conditions, such as chronic pain. That been said, there isn’t sufficient evidence just yet to support ketogenic diets for these conditions in terms of its long-term safety and efficacy.

Lastly, research has found that people consuming fewer calories from carbohydrate tend to eat fewer foods high in added sugars, such as soft drinks, doughnuts, etc. Yet, other research has found that the more carbohydrate consumption is restricted, the greater risk there is for poor nutrient intake. 

Potential side effects

  • High fat diets, especially when it’s high in saturated fat, increases total cholesterol. More specifically LDL cholesterol which is the “bad” cholesterol.
    • Both total and LDL cholesterol are both biomarkers for poor cardiovascular health.
  • Reduced energy and decrease in performance in activities that use short bursts of power, because ketogenic diets depletes the energy stores in your muscles (glycogen as mentioned previously).
  • Fatigue, general weakness, headaches and sluggishness, or brain fog.
  • Due to the very low fibre intake of ketogenic diets, you may experience constipation, increased risk of digestive problems and microbiota imbalances.
  • Limited fruit, vegetables and grains consumption – thereby limiting nutrient intake that might lead to deficiencies.
    • Nutrients (lack of) of particular concern on the ketogenic diet are calcium, vitamin D, selenium, magnesium, zinc and phosphorus.
  • Increased oxidation and inflammation in the body.
    • Recent evidence has shown that high fat diets, especially saturated fat, may promote inflammation and lead to the progression of inflammatory diseases, such as Alzheimer’s disease.
  • Possible loss of lean muscle mass.
  • Dry mouth, frequent urination, halitosis (bad breath = acidic, fruity odour).

Take-home message

Currently, there is a lack of strong evidence for ketogenic diets, based on their health claims about longevity, gut microbiome and heart health. Diets that are higher in carbohydrates and lower in protein, in fact, have the strongest links to longer lives and happy guts.

There are various probable side effects when following a ketogenic diet, which is why there is a need for ongoing monitoring and consistent assessment by a qualified dietitian.

Overall, unless medically indicated, I do not recommend following a ketogenic diet. Considering fat and carbohydrates, it’s all about balance.

  • The types of fat you include and the quantities you consume does matter.
  • Carbohydrates does form part of a healthy balanced diet.

My tactic is always to look at sustainable changes you can make that doesn’t include elimination of entire food groups.

MEET OUR EXPERT


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


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