Dairy in the diabetic diet

You don’t have to miss out on the goodness of milk and dairy if you have diabetes. Rediscover Dairy tells us why.

Diabetes is one of the most common chronic illnesses worldwide. In SA, its prevalence is close to 13% and more than 20% of the population has impaired glucose homeostasis (6.1% < HbA1c < 6.5%). Of the estimated 4.58 million South Africans between the ages of 20 and 79 years who have diabetes, about half (52.4%) are undiagnosed.

Poor diet and lifestyle factors (overweight/obesity and a lack of exercise) seem to be major contributing factors in the development of Type 2 diabetes.

Medical nutrition guidelines for the management of diabetes recommend a healthy, balanced eating plan that includes an individualised combination of carbohydrates and fats and a variety of protein sources. Reducing the intake of red meat and increasing the intake of nuts and low-fat dairy products are recommended.

Milk and dairy

Consuming milk and dairy products are recommended as part of food-based dietary guidelines around the world. The South African guidelines encourage us to ‘have milk, maas or yoghurt every day.’

A growing body of scientific evidence has linked dairy consumption to several health benefits and a reduced risk of lifestyle diseases.

Dairy products are convenient, versatile and delicious; they are a great way to help achieve a balanced, nutrient-rich diet and stay healthy and strong. They provide many important nutrients, such as good quality protein; minerals such as calcium, potassium, magnesium, phosphorous and zinc; and vitamins A, B2 and B12. These nutrients are important for supporting brain function, bones, muscles and the immune system.

Dairy matrix

Apart from the nutrient contribution of food, science shows that the whole-food effect is even more important. In recent years, nutrition science has shifted focus from single nutrients to researching the effect that whole foods have on your health. For many foods, the nutrient content doesn’t necessarily predict the related health effects or outcomes.

Foods consist of many different nutrients and components that works within complex physical structures. For example, a fluid (milk), a semi-gel or spoonable structure (yoghurt) or a solid (cheese). The ‘food matrix’ describes a food in terms of both its physical structure, its nutrient content and how these interact.

This is especially true for dairy foods (milk, cheese and yoghurt), and research shows that the health effects of dairy foods go well beyond the benefits of their individual nutrients.

In the case of dairy, the whole is greater than the sum of the parts: it’s the unique interaction of nutrients within dairy, referred to as the dairy matrix, that is responsible for its many health benefits. These include keeping your bones and teeth healthy as well as helping to reduce the risk of stroke, hypertension and Type 2 diabetes.

Components of dairy foods

Sugar in dairy

The main source of carbohydrates in milk is lactose, also called milk sugar. Lactose is naturally present in all mammalian milk and is generally defined as intrinsic sugar. It’s therefore not considered to be an added sugar.

Milk and other dairy foods generally have a low glycaemic index (GI). Carbohydrates are digested and absorbed at different rates and the GI is an indication of whether a food raises blood glucose levels quickly, moderately or slowly. It’s useful to help you manage your diabetes.

The low GI of milk and dairy foods is due to the moderate glycaemic effect of lactose combined with the effect of milk protein which together slows down the rate of stomach emptying.

Cow’s milk naturally contains approximately 4.8g lactose per 100g. The lactose content varies slightly in other dairy products. For example, fermented cow’s milk products (yoghurt, buttermilk and other cultured dairy products) generally have a lower lactose content than liquid milk because of the conversion of lactose to lactic acid by live bacterial cultures.

Hard cheese like gouda or cheddar generally contains very little lactose (<1 g per portion). Lactose-reduced or lactose-free products contain little or no lactose.

Milk and dairy products are an ideal choice for people with diabetes as lactose provides energy without raising blood glucose levels excessively. This is due to the combination of a moderate glycaemic effect of lactose and the slower gastric emptying resulting from the dairy matrix.

Protein in dairy

Cow’s milk typically contains approximately 3.4% protein and is an important protein source in the diet, owing to its high quality and biological value. It contains both whey and casein proteins and so provides all the building blocks (amino acids) your body requires.

The protein in milk helps with maintaining muscle and bone health and contributes to insulin response and blood glucose control. It also improves satiety and is therefore a great choice for people who prefer to have smaller, more frequent meals.

Fat in dairy

Milk is much lower in fat than people think. Full-cream milk typically contains 3.4% fat, while low-fat milk contains 1.5% fat and fat-free milk has ≤ 0.5% fat.

Although a large portion (66%) of dairy fat is saturated, studies have shown that using low-fat dairy to reduce saturated fat intake isn’t necessary, as not all saturated fats are the same. Research shows that consuming dairy fats, such as cheese and fermented dairy products (yoghurt, buttermilk and maas), has no negative effects on cardiovascular health, nor does it raise cholesterol in healthy individuals. However, people with diabetes should choose low-fat dairy products as these choices prevent unnecessary energy intake and so can help to limit the risk of weight gain.

How much milk and dairy do you need per day?

Milk and other dairy products are important for everyone. These foods are excellent sources of calcium and contain a unique combination of many valuable nutrients that lack in the diet of most South Africans, especially children. To meet your daily calcium needs, you should have three servings of dairy a day.

The average adult needs 1000mg of calcium per day. Teenagers (between nine and 19 years old) need more, as 50% of a person’s adult bone mass is built up during this life stage. Pregnant women and people older than 60 years also need more calcium and should consume 1200 – 1300mg a day.

It can be challenging to meet your calcium requirements without consuming any dairy foods. Vegetables, such as spinach, broccoli, and almonds, contain notable amounts of calcium but also contain components that inhibit its absorption. These components are oxalates (found in spinach, nuts, cabbage, sweet potatoes, rhubarb and beans) and phytates (found in wheat bran, beans, seeds, nuts, soya isolates and fibre-containing wholegrain products). These bind to calcium and form insoluble substances, which decrease calcium absorption. You therefore need to consume large amounts of these foods to get the same amount of calcium than found in milk or dairy products (1 cup (250 ml) milk provides 300mg of calcium). To equal that you need to eat two cups of cooked spinach or seven cups of cooked broccoli.

One glass of cow’s milk (250ml), two small tubs of yoghurt (2 × 100ml) and two tablespoons of grated cheese (40g) provide 300mg of calcium each, almost a third of what you need daily. Therefore, aim for three portions of milk or dairy every day to get almost all the calcium you need. You can choose milk, maas, yoghurt or cheese. It doesn’t matter whether you have only one of these or many.

Make healthy dairy choices

It doesn’t matter if you use fresh milk, long-life milk (UHT milk) or milk powder. They are all equally nutritious and will provide you with the same important nutrient package and health benefits of dairy.

For people with diabetes, using low-fat milk is a good start. Low-fat milk has all the goodness of full-cream milk, including calcium; the only thing you lose is the fat and some vitamin A (which sits in the fat).

How much energy do you get from a glass of milk?

This table shows how much energy you can get from a glass of milk (250ml) with different fat contents. 

Nutrient	Full-cream milk	Low-fat milk	Fat-free milk
Carbohydrates (g)	12	12	12
Protein (g)	8	8	8
Fat (g)	8	4	1
Energy (kJ)	640	518	318

Milk

Including milk in your diet, whether you drink it just as it is or use it in food dishes, ensures that you add good-quality protein and an array of vitamins and minerals to your diet. Next time you cook oats, replace half of the water with milk. This not only improves the GI of the meal but also adds some protein and gives the porridge a creamier taste.

Yoghurts

Yoghurts can vary widely in their fat and sugar content. It’s best to avoid sugar-sweetened yoghurt if you’ve diabetes, but the fat content doesn’t matter so much as yoghurt is never very high in fat (vary between 0.5 g and the highest fat content is 6g per 100g). It’s the combination of the protein and fats in yoghurt that contributes to satiety and slowing the gastric emptying, which makes a small portion keeping you fuller for longer.

Yoghurt above all also supports a healthy gut and immune system. This makes yoghurt an ideal snack between meals. Plain yoghurt or Greek-style yoghurt are versatile choices and you can sweeten it by adding fresh fruit, which will also help you increase your daily intake of fruit. Adding some raw oats to yoghurt and leaving it overnight makes for a pleasant, fibre-rich breakfast option, especially if you add some fresh fruit, a tablespoon of nuts and some cinnamon.

Cheese

Make hard cheese (cheddar or gouda) go further by grating it instead of slicing. Opt for mature cheese, as a little goes a long way due to the stronger taste. You can also try reduced-fat cheeses or use low-fat or fat-free cottage cheese as a spread on bread.

Remember to keep an eye on the portion sizes of cheese, especially because it can be high in salt (more than 1.5g salt per 100g is considered high). A healthy portion of cheese is 40g, about the size of a matchbox or two tablespoons of grated cheese.

Should children have low-fat dairy foods?

Until the age of two, it’s best for children to have full-cream dairy and milk to ensure that they get all the essential fatty acids and vitamins they need. Don’t give children fat-free milk until they are at least five years old. Children without weight problems should preferably always have full-cream milk and dairy.

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Make dairy part of your daily diet

You don’t have to miss out on the goodness of milk and dairy if you have diabetes. Plan your day, and meal plan, ahead of time and make sure you include milk and dairy in your diet. It’s a winning choice.