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.
MEET OUR EXPERT
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.