Dietitian, Annica Rust, educates us on what to purge and what to stock up on while doing a kitchen makeover.

A kitchen makeover for a person with diabetes can be quite daunting. However, by going back to the basics and being able to read and understand food labels can assist when distinguishing between what is healthy and unhealthy foods. Incorporating label reading into your shopping routine will empower you to make the best, healthiest food choiceswhen purchasing groceries. Simply use the following steps to guide your decisions:

Step 1: Back to the basics

The makeover will set out to achieve the following health goals:

• Improve glycaemic control
• Improve and control cholesterol and blood pressure
• Maintain a healthy body weight
• Increase and reach required vitamin and mineral requirements

Kitchen makeover (adapted from SEMDSA guidelines)¹

Step 2: Read the Food Label

Usually, the food label will be located on the back of the product under the heading: Typical Nutrition Information which is represented in a table format.

One of the most important things to remember when reading food labels is to look at the correct column. You will notice that the quantities of all the nutrients and the energy of a product are always listed in two columns: one being ‘per 100g’ (or ‘per 100ml’) and the other ‘per serving’. To accurately compare similar products, you need to look at the quantities listed in the ‘per 100g’ column. The ‘per serving’ column will list the respective quantities of nutrients and energy in accordance with the suggested serving size of the product which is usually set out by the manufacturers.

You can compare the labels of different food to the table below to decide whether a product is high, moderate or low in sugar, total fat, saturated fat and sodium. Foods that fall mainly in the high group should be rarely eaten or kept for special occasions whereas foods that fall mainly in the low group should be eaten as often as possible.

Step 3: Look out for the following logos on food items:

Food items with the ‘green’ mark are endorsed by the GI Foundation of South Africa which certifies that the product has a minimal effect on blood glucose, cholesterol and/or blood pressure levels. Low GI food list can be found on their website.²

Items with the Diabetes South Africa logo are approved products that are suitable for people with diabetes to consume.

Food with the heart logo is approved by the Heart and Stroke Foundation as part of a healthy eating plan. These food items are healthier and will have a lower salt content than similar food items.³

Knowledge is power. When in doubt, contact a registered dietitian for more information.

References:

1. SEMDSA Type 2 Diabetes Guidelines Expert Committee. JEMDSA 2017; 22(1)(Supplement 1): S2-S17
2. GI Foundation: www.gifoundation.com
3. The heart and stoke foundation: www.heartfoundation.co.za

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References

1. ADA, A. D. A. 2004. Gestational diabetes mellitus. Diabetes care, 27,
2. BUCHANAN, T. A. & XIANG, A. H. 2005. Gestational diabetes mellitus. The Journal of clinical investigation, 115, 485-491.
3. DIPLA, K., ZAFEIRIDIS, A., MINTZIORI, G., BOUTOU, A. K., GOULIS, D. G. & HACKNEY, A. C. 2021. Exercise as a Therapeutic Intervention in Gestational Diabetes Mellitus. Endocrines, 2, 65-78.
4. JOHNS, E. C., DENISON, F. C., NORMAN, J. E. & REYNOLDS, R. M. 2018. Gestational diabetes mellitus: mechanisms, treatment, and complications. Trends in Endocrinology & Metabolism, 29, 743-754.
5. KOKIC, I. S., IVANISEVIC, M., BIOLO, G., SIMUNIC, B., KOKIC, T. & PISOT, R. 2018. Combination of a structured aerobic and resistance exercise improves glycaemic control in pregnant women diagnosed with gestational diabetes mellitus. A randomised controlled trial. Women and birth, 31, e232-e238.
6. LUST, O., CHONGSUWAT, T., LANHAM, E., CHOU, A. F. & WICKERSHAM, E. 2021. Does Exercise Prevent Gestational Diabetes Mellitus in Pregnant Women? A Clin-IQ. Journal of Patient-Centered Research and Reviews, 8,
7. MING, W.-K., DING, W., ZHANG, C. J., ZHONG, L., LONG, Y., LI, Z., SUN, C., WU, Y., CHEN, H. & CHEN, H. 2018. The effect of exercise during pregnancy on gestational diabetes mellitus in normal-weight women: a systematic review and meta-analysis. BMC pregnancy and childbirth, 18, 1-9.
8. PLOWS, J. F., STANLEY, J. L., BAKER, P. N., REYNOLDS, C. M. & VICKERS, M. H. 2018. The pathophysiology of gestational diabetes mellitus. International journal of molecular sciences, 19,
9. SHEPHERD, E., GOMERSALL, J. C., TIEU, J., HAN, S., CROWTHER, C. A. & MIDDLETON, P. 2017. Combined diet and exercise interventions for preventing gestational diabetes mellitus. Cochrane Database of Systematic Reviews.

Being overweight negatively impacts teenagers physical and psychological well-being. This is why it is so important to help them maintain a healthy weight.

It’s a little more difficult to tell if a teen is overweight than it is for adults. This is due to the fact that teenagers are still developing and growing.

Excess fat is something millions of teenagers battle every day. According to The South African National Health and Nutrition Examination Survey (NHANES-1), adolescence is a critical period for onset obesity and obesity-associated morbidity in later life.

Further studies cite that being overweight negatively impacts your teen’s physical and psychological well-being. It increases their risk of developing diabetes, high blood pressure, heart disease, high cholesterol, depression, and many different types of cancer.

Other conditions associated with being overweight and obese in adolescence include:

• The risk of developing asthma
• An increase in the severity of existing asthma
• Low-grade systemic inflammation
• Obstructive sleep apnoea
• Early onset of puberty
• Skeletal abnormalities
• Fatty liver disease

The not-so-good weight loss solutions

While many different weight loss solutions are offering a quick fix, most are not suitable for teenagers. Many diet pills, for example, have been banned by the FDA because of harmful side effects. The associated dangers include an increased risk for heart attack and stroke, as per the Compounding Pharmacy of America.

Restricted eating may also be a concern for some teens. This is because eating disorders, such as anorexia, bulimia, binge eating, and avoidant/restrictive food intake disorder (AFRID) occur most frequently in this age group. Global Citizen states that hunger can also affect a teen’s education, as they may find it difficult to concentrate in class.

Healthy habits count

If your teen is trying to shed extra kilos, it’s essential to lose weight the healthy way by making diet and lifestyle changes that nourish growing bodies and can be followed long term.

“If your teen is trying to lose weight, it’s important to ensure they are still getting their recommended daily nutrient quota. Failing to do so could have an impact on their growth and development,” says Murray Hewlett, CEO of Affinity Health.

Murray continues to say that encouraging your teenager to adopt healthy lifestyle habits rather than restricting their food intake is the best, and safest, weight-management strategy.

“The best way to find out if your teen is at a healthy weight or if they need to lose weight is to talk to an expert on diet and nutrition. They will compare your teen’s weight with healthy norms to help them set realistic goals.”

10 tips for healthy weight management 

In addition to talking to your family doctor, try these 10 tips:

1. Having a realistic weight goal can be helpful for some teens. This will improve the quality of their diet and increased physical activity can be much more effective overall.
2. Instead of investing in a weight scale, track your teen’s progress by their favourite pair of jeans. If they start to feel looser around the waist, your teen will know they’re on the right track.
3. Perhaps one of the easiest ways to lose excess weight is to cut back on sugar. High-sugar foods and sweetened beverages not only drive hunger but may negatively impact academic performance, sleep, and mood in teens.
4. Encourage your teen to increase their overall daily activity, which can help their body burn calories more efficiently. Arranging fun family walks outdoors can entice your teen to get more active.
5. Rather than focusing on calorie content when shopping for household groceries, choose foods based on their nutrient density. This refers to the number of nutrients – including vitamins, minerals, and fibre – that a portion of food contains.
6. Replace unhealthy fats in your teen’s diet with nuts, seeds, avocados, olive oil, and fatty fish can promote healthy weight loss.
7. Encourage your teen to eat more vegetables. Veggies are packed with fibre and water, which can help your teen feel full and more satisfied after meals. This decreases the chances of overeating by keeping your teen’s appetite stable throughout the day.
8. Always ensure your teen eats a well-balanced breakfast. Although skipping breakfast may seem like it would help your teen lose weight, it may cause them to eat more throughout the day due to hunger.
9. Make take-outs an indulgence, not an everyday occurrence, and be mindful of your teen’s sodium intake. Trade processed foods for fresh foods whenever possible.
10. Ensure your teen gets eight hours of sleep a night. Getting adequate, quality sleep is an integral part of a healthy weight loss plan.

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Christine Manga advocates why keeping a diabetes diary is of benefit; it assists with accountability and in achieving the best possible health outcomes.

Not all of us kept diaries as teenagers, but those who did would recall recording the happenings of each day. Looking back at these, we gain insights into ourselves: what we did, how we felt and how we reacted to situations. Perhaps the most important aspect is that journal keeping leads to accountability to ourselves, helping us take responsibility for our actions.

A diabetes diary is similar. It gives us an insight into the effects of daily food, exercise, stress, medication, menstrual cycle and mood have on our blood glucose readings.

In today’s modern world, diary keeping can be done with ease on a number of different platforms and devices. There are hundreds of specific diabetes diary apps, but we should not overlook the good old-fashioned book and pen.

There are advantages and disadvantages to both. For instance, carrying a book around is certainly not as convenient as a cell phone. Certain apps will require specific data to be captured before an entry can be created, this is certainly not the case with a manual journal. Ultimately the decision is a personal one, it should be a choice which encourages active record keeping.

What should be logged

Food

Food logging can be really simple or extremely detailed. This helps both you and your healthcare practitioner (HCP) to learn about your habits and actions. For instance, emotional eating can be detected in this manner.

Some of the basic information you should include: the time of meals, snacks and any beverages consumed (coffee has a particularly deleterious impact on glucose levels). Some additional details which can be recorded are the type of food, quantity, calorie content and carbohydrate amounts.

Food is an integral part of our lives, and perhaps one of the most pertinent information to record is the reason for eating. For example, feeling sad or depressed, being hungry, a regular meal, pre-exercise or correcting a hypo.

With food journaling, digital options are frequently better as many apps have the functionality to add photos of your meals. This is extremely helpful when visiting your HCP. Your HCP is often better equipped to assist you with carb counting when they can see what you have eaten.

Diaries can help shed light on the reason your weight may be fluctuating. Studies have shown that people who regularly keep a food journal are far more successful in losing weight than those who don’t or do so irregularly. Food diaries increase your awareness of the food you eat and helps inculcate a culture of mindful eating.

Medication

The mere action of keeping a medication journal mitigates the chance that you may omit a dose of any of your medicines. As a basic, you should be tracking the timing and dosage of oral medications. Doing the same for injectables will improve your understanding of the efficacy of a drug on your glucose control. As each person will react differently to different medications, this can help you and your HCP reach the optimum drug regimen for you.

The recording of medication should not be restricted to diabetic-related medication. Certain medications, such as corticosteroids, have been shown to elevate blood glucose levels.

Continuous glucose monitoring systems show how important it is to administer insulin timeously.

Exercise

Exercise can frequently be a double-edged sword for people living with diabetes. It’s always held to be one of the cornerstones of a good diabetes management strategy. While its benefits can’t be overstated, it often can leave you feeling frustrated by an adverse response in your glucose levels.

By journaling the time of day, intensity of your exercise and the duration of your exercise and comparing it to your glucose levels, you will, over time, be able to alter the amount of carbohydrates you need to eat before and after exercise. You will also learn how to adjust your insulin accordingly. This information will help you and your HCP to get the most benefit from exercise as part of your treatment.

Emotional state

It’s often underestimated what a significant impact mood has on blood glucose levels. When we are stressed or anxious, hormones, such as cortisol, are released causing spikes in glucose levels even in the absence of food. Excitement and elation often have similar effects.

By recording these emotional responses and comparing them to glucose readings can often explain an otherwise inexplicable glucose excursion. As noted earlier, this is also very helpful in identifying whether or not you eat in response to emotional extremes.

Menstrual cycle

Having a section in your diary to record your menstrual cycle is beneficial. By doing so you note the impact of the stage of your cycle on your blood glucose levels. For example, many women experience elevated blood glucose when pre-menstrual. If you are using insulin and are comfortable titrating your doses, you can proactively increase or decrease your dosage accordingly.

Glucose

It goes without saying that anyone living with diabetes should be recording their blood glucose levels whenever they test. This will be used by your HCP for analysis and trend identification. The type of diabetes and the treatment you use will determine the frequency of testing that is required.

Typically, someone with Type 1 diabetes using multiple daily insulin injections should be testing at least four times per day: before each meal and at bedtime, and in between if feeling unwell.

On the other hand, for someone with Type 2 diabetes, using one oral medication is only required to test two or three times per week. A good exercise for these people would be to conduct a twelve-point test. This entails four tests over three days: one before each meal and at bedtime. This has the potential to expose, otherwise, hidden hyperglycaemia and allow the linking of test results to food, exercise, etc.

In conclusion

Using a diabetes diary should encourage people to set their own goals. This diary will identify what works for each individual, it also helps highlight what changes and improvements can be made.

It’s of critical importance that HCP be involved in the assessment and decoding of the diary with patients. Our guidance and professional experience help provide better healthcare outcomes, and help you become better equipped to interpret your records and to adjust your behaviour and medication accordingly.

Understandably, thorough diabetes diary keeping can be time consuming and cumbersome. If necessary, take a break from a detailed diary, but do keep a record of blood glucose readings.

A diary should be honest and kept primarily for yourself and secondly for use with your HCP. Journal keeping assists with holding yourself accountable and should be there to help you take responsibility for your actions and ultimately assist in achieving the best possible health outcomes.

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Nutrition consultant, Ana-Paula Agrela, explains the difference between a nutritionist and dietitian and when you should see a nutritionist.

Many people make the mistake of thinking that a nutritionist and dietitian are one and the same thing, although both are related, there are distinctive differences.

Both dietitian and nutritionist professions require a four-year BSc. degree registered with the Health Professions Council of South Africa (HPCSA). Similarly, they both assist people with eating plans and food choices.

Dietitians

If the food you are eating is causing you a physiological problem. For example, many people suffer with irritable bowel syndrome (IBS) where certain foods can cause digestive discomfort, this would be a good time to see a dietitian who can advise you on removing gluten and wheat from your diet and supply you with a weekly meal plan to restore your digestive system.

Clinical dietitians generally work in hospitals, long-term care facilities, medical clinics and with medical professionals. Doctors generally refer patients who have chronic health conditions to a dietitian for specific diet plans. In this incidence, the doctor and the dietitian may work together to monitor the patient’s health and progress. Clinical dietitians may specialise by only working, for example, with patients who have digestive diseases.

Nutritionist

A nutritionist is an expert in the field of food nutrition which impacts on health and well-being. They may, for example, plan a diet with reduced fats and sugar and in this an overweight person can achieve weight loss.

Nutritionist’s will assess a client’s health needs and develop meal plans as well as explain the nutrients found in food, which improve health. Nutritionists are informed with the latest nutritional science and research and give talks to promote the relationship between good eating habits and preventing or managing specific diseases. They generally consult in-person or online, or they join integrative healthcare clinics. Some nutritionists work in community, journalism, coaching, corporate wellness, and develop health products.

Why and when you should see a nutritionist?

Conflicting information available on the internet and other media may leave you feeling overwhelmed and confused. Some articles will say eat fat, while others tell you to eat carbohydrates. Health experts will suggest fasting while others suggest eating small meals every three hours. The value of a nutritionist will be in the interpretation of context and information and how to apply to your specific needs, by way of consultation with targeted questions about your health, your food preferences and body type.

A nutritionist will provide support, helping you to stay accountable to your health goals by coaching at weekly meetings with encouragement in overcoming any challenges you may face. It’s one thing to have the perfect diet plan but another altogether to follow it consistently.

Dietary changes need to be sustainable, or they won’t produce a healthy outcome. Staying motivated can be difficult at times, so having a professional guiding you, keeping you motivated and focused will help you to achieve the desired result.

Lastly, a nutritionist can supply you with recipe ideas and a personalised menu, tailored to your lifestyle and unique needs.

Small changes make a big difference

When facing health or weight related issues, it’s recommended that you consult with your doctor or healthcare advisor regarding diet and lifestyle and then getting the help you need in making the appropriate dietary changes, improving your health and well-being.

A healthy diet is the foundation to good health, unfortunately we don’t always make this connection until we are faced with heath issues.

Drink the right amount of water

Small changes can make a big difference. For example, not drinking the right amount of water can lead to dehydration, headaches, and fatigue. While drinking too much water can drop blood glucose levels and dilute the bodies electrolytes. Knowing how much water to drink based on your weight and activity level is a good start.

Taking your body weight multiplied by 2,2, giving you the weight in pounds. Then divide it by 2 to get kilograms. Take that total and multiply by 29ml.This is the total ml of filtered water you should be drinking per day. Example: 50kg x 2,2 =110/2 = 55 x 29ml =1,595 litres 

If you are very active, you can add 500ml – 1000ml extra during activity. Water should ideally be sipped gradually throughout your day. Drinking a glass or two at a time will cause your kidneys to flush out your salts and sugars too quickly.

References:

1. Dietetics and Nutrition https://www.hpcsa.co.za/?contentId=0&menuSubId=10&actionName=Professional%20Boards
2. BANT. Career options. https://bant.org.uk/career-options/

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Planning meals ahead of time can make life easier and healthier. But don’t stress if the idea of meal planning overwhelms you; Jessica Pieterse shares a few tricks to get you going.

You may have seen professionals posting meal plans on social media and thought that they are very unrealistic. However, anyone can become a meal-planning champion with everyday foods, even if you have a busy lifestyle.

• Look at your calendar

Check your schedule to see what upcoming social events, work commitments or other ad hoc obligations you may have. Do any of these involve food that is already catered by someone else? Will these situations influence meal choices or times?

• Write a menu

You don’t need to write a restaurant menu though, just a “list of meals” menu.

Write the list of meals according to what your calendar looks like.

Thinking ahead about what meals you will eat will guide your grocery shop, avoid wastage of food not eaten, optimise preparation time and save time.

You can plan a particular meal for a specific day or compile a rough framework of 5-7 meals. As the week goes along, you can decide what meal suits you on that day.

• Build a repertoire

Make a list of meals you know how to make. It will be faster to draw up your weekly meal plans if you have a more extensive list to get ideas from. Add to your repertoire list as you find new meal ideas.

• Shop wisely

Use times on a weekend, like a Sunday afternoon, when family commitments may be less, then grocery shop for the week. Sunday shopping may also allow you to leave the kids with your partner to get shopping done quicker.

Use the gift of technology and shop online. This will save time and is a very convenient option for making meal planning more attainable.

Check your freezer and pantry before you shop to use what you already have and save a few pennies.

• Share the labour

If you have a Jamie Oliver moment and you want to make your own meatballs from scratch, then enjoy the cooking. However, for most days make your life easier by buying foods where the shop has taken some of the prep away from you. Buy peeled and chopped vegetable packs, buy broken-down meat pieces, etc.

• Cook in bulk

Besides using the quieter moments in your week to grocery shop, use these times to bulk cook. Set aside 1-2 hours and take your kitchen by storm. Have multiple things on the go. Food cooking in the microwave, stove and oven. Storing already prepped or cooked food in the fridge can help you stick to your meal planning for the week.

• The layover method

If you make unhealthy food choices because you often arrive home late in the evening, try the layover method. The layover method is when you refrigerate the meal you’ve cooked tonight for eating tomorrow night and eat tonight what you made yesterday. This leapfrog approach allows you to come home to a healthy homemade meal that you can eat straight away without being tempted to veer from your meal planning.

• Freeze meals

Buy food in larger quantities, cook the meal in bulk and freeze a portion. The time spent cooking is not that much longer when you cook in bulk and then you can have a freezer meal ready without any cooking needed at a later stage. Doing this regularly will mean you won’t need to cook every night and will have a set freezer meal weekly in your meal plan.

• Eat a balanced meal

Meal planning in itself is a great step to being healthier. You can bump it up a notch by trying to plan meals that are healthy and balanced. Aim for your meal to consist of the following healthy options:

• Lean proteins like chicken, fish, legumes, cottage cheese, etc.
• High fibre starches like brown rice, barley, spelt, millet, quinoa, baby potatoes, sweet potatoes with skin, legumes (beans, chickpeas, lentils), fibre crackers, etc.
• Vegetables in large portions and in a variety of colours.
• Healthy fats like nuts, seeds, nut butters, olives, olive oils and avocado.

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