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.

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.

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.

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.