Christine Manga, a diabetes nurse educator, upskills your label lingo so you know what to look out for when buying food items.

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Look familiar? Sugar-free, low-fat, healthy, lite, natural, low kilojoule, free range, and the list goes on. This is just on the front of food packages then there is a mound of information on the back as well.

Companies use these slogans and phrases to make you believe that their food is healthy, better than other brands, good for you, and will give you everlasting energy. It’s called marketing. A number of these claims have some truth in them but can be very misleading, confusing, and have even been known to be unsubstantiated. Do not rely on the front of the package only. The back nutritional label and ingredient list are far more informative.

Why is it important to be able to read and understand food labels?

Well, labels give information allowing you to make informed, healthier food choices that will impact not only on glucose management but weight, cholesterol, and overall health. It empowers you, the consumer.

Nutritional label and ingredients

One of the main nutrients people living with diabetes need to be aware of is carbohydrates. These are the nutrients that cause elevation of blood glucose levels. This is not a bad thing. A carbohydrate (carb) is a sugar molecule made-up of starch, sugar, and fibre. These will be converted into glucose as energy for the body.

Fibre is a non-digestible carbohydrate and therefore has no effect on blood glucose levels. As a matter of fact, if the fibre content is >5grams this can be subtracted from the total carbohydrate amount. The more fibre, the better. It’s the total amount of glycaemic carbohydrates/carbohydrates to be considered when making food choices, not the sugar content.

Key pointers

Whilst perusing the nutrition label and ingredients there are key pointers to keep an eye on.

Serving size

On a nutrition label, there are usually two columns showing nutritional information, one for 100g and one for an individual serving of the product. The product package size is not necessarily the serving size. If a package says low kilojoule, it may be because the serving size listed is very small and unlikely that someone would only have a single serving.

As a South African, you surely know Romany Cream biscuits. The serving size is two biscuits. There are very few people I know who only have two biscuits. The small jelly sweets or gums sold in 75g bags are in fact three servings of 25g each. So, in future, please remember the packet should be spread over three days.

A certain South African brand of flavoured water contains 4g of carbohydrates per 100ml and 62,76kJ. That means 20g of carbohydrates and 313.8kJ per bottle of water.

The label may list that you will be eating a certain percentage of a daily recommended amount of nutrients or kilojoules based on an 8368kJ diet. Remember to multiply by number of servings. Not everyone should be consuming 8368kJ a day.

Ingredients

Ingredients are listed in descending order by weight, meaning the first ingredient is the largest amount of the product. Some foods have a boundless list of ingredients.

It’s safe to say, the fewer ingredients, the more natural and less modified a food is. If a product claims to be whole wheat, then whole wheat must be the first ingredient listed. Anything on the ingredient list means it has been added in the production of the food item.

“Sweets for my sweet, sugar for my honey” come in many disguises. Sucrose, corn syrup, fructose, maple syrup, molasses, and nectar are all forms of sugar. The list of sugars is endless. The names of many sugars end in -ose.

Caffeine can also be masked in the ingredient list. Guarana commonly used in energy drinks is high in caffeine, but it’s not always added to the total caffeine amount.

Ingredients necessary to give colour, thickness, anti-caking agents, gelling, and preservatives are some food additives categorised by E numbers. E249 – E250 indicate the use of nitrites. The less of these consumed, the better.

Substitutes

Manufacturers want their food to taste good and appear healthy. This can be done by using substitutes so that the labels low-fat or sugar-free can be used. These claims may be true, but to replace the sugar and fat, other ingredients are added to maintain flavour, very often salt or sugar (to low-fat).

Checking salt (Na) is important as this should be avoided in people with hypertension. Sugar substitutes and artificial sweeteners have been linked to an increase in appetite in some studies. This defeats the object.

Laws

International laws are changing to make labels more user friendly and less misleading. Traffic light colour coding is currently used in the UK. Red means high, amber means medium, and green means low. These are for fat, saturated fat, sugar, and salt. This system allows you to see at a glance which is a healthier option. Helpful for people with low numeracy and literacy

In 2023, the South African Department of Health drafted new restrictions on food marketing, food labelling, and health claims on packaged food and drink. Hopefully, it will be law soon. In our multi-cultural country with eleven official languages, it’s sad that our food labels are written in English only.

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Meagan Achteson, a dietitian, explains how diabetes develops after a Whipple procedure and offers guidelines to healthy eating thereafter.

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During a Whipple procedure (pancreaticoduodenectomy), the following are removed: part of the stomach, the small bowel (duodenum), the head of the pancreas, the lower end of the bile duct, and the gallbladder.

After these organs are removed, the surgeon attaches the remaining pancreas, bile duct, and stomach to the intestine. This allows pancreatic juice, bile, and food to flow back into the gut, so that digestion can happen normally.

This surgery normally lasts between four to eight hours. The procedure is used to completely remove pancreatic cancer and give you the best outcome. This lowers the chance of the cancer coming back. However, the chance of the cancer coming back also depends on the type of tumour that you have and stage of the cancer.

Type 3c diabetes

If you’ve had a Whipple procedure to remove pancreatic cancer, you’ll most likely develop Type 3c diabetes (a type of diabetes caused by damage to the pancreas that isn’t autoimmune which affects its ability to produce insulin).

You may also need to take pancreatic enzymes to digest food and insulin or oral medication to control your blood glucose levels.

After surgery, you’ll have to be on a fat-free diet for some time, but you’ll be able to gradually increase healthy fats. Talk to your surgeon and dietitian.

After you’ve recovered from surgery, you may find that your appetite improves and you start to put on weight and get stronger.

It’s recommended to adopt a healthy balanced diet that keeps your blood glucose level in your target range and helps keep you well.

Eating well with Type 3c diabetes 

The aim is to follow a diet that you enjoy that keeps your blood glucose levels stable. Please note: this advice is only for people who are a healthy weight.

• Aim to have three meals a day with two snacks in between.
• Don’t skip meals.
• Cut out added sugars and avoid chocolates, biscuits, sweets, fruit juice, etc.
• Aim to have at least two fruits and three portions of colourful vegetables a day.
• When you use fat, use olive-, avocado oil, sugar-free nut butters rather than animal fats, such as butter, lard, or ghee.
• Eat regular portions of oily fish. Aim for one to two portions each week.
• Use small amounts of unsalted nuts and seeds as snacks or as part of a meal.
• Have protein in each of your main meals. Food containing protein include beans, pulses, nuts, seeds, tofu, soya, meat, fish, dairy, and eggs. Eat fruits with a protein (like plain yoghurt) as a snack.
• Read the nutritional information on packaged foods. Aim for foods that have low or medium levels of sugar, fat, and salt.
• If you take pancreatic enzymes, make sure you take these when you eat.
• If you take oral tablets or insulin to manage Type 3c diabetes, make sure you take these as recommended.
• If you’re struggling with your weight, appetite or blood glucose levels, please see a registered dietitian as soon as possible to help with a meal plan that is individualised to you and your needs.

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Kate Bristow, a diabetes nurse educator, simplifies what the portion plate wheel is and how you can make the most of achieving it.

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Diabetes is a challenging condition where a one-size-fits-all approach does not necessarily work. Medical nutrition therapy, regular physical activity, and medication are important components in managing the complex condition that is diabetes. The American Diabetes Association (ADA) recommends that every person with diabetes engages actively in education about the condition. This includes compliance with medication, a suggested applicable regime of exercise, a plan for long-term treatment, and learning how to self-manage the condition.

Medical nutrition therapy

The ADA suggests that medical nutrition therapy has the greatest impact on the condition following diagnosis and the aim should be to provide a balanced meal plan to provide energy, achieve ideal body weight, and to encourage healthy eating. This will help to achieve good blood glucose control and best outcomes.

There are many ways of learning to manage an eating plan, and various recommended dietary approaches, such as carb counting, Intermittent fasting, and the Mediterranean diet to name a few.

The portion plate wheel

To try to simplify dietary approaches and allow for flexibility for the greater population self-managing their diabetes, the plate model or portion plate wheel was devised.

The portion plate wheel is designed to promote healthy eating habits in a simple visual way. It allows you to create a healthy low-carb meal for better blood glucose control. There is no counting, calculating, or weighing food and all that is needed is a 9-inch (23cm) plate to create a healthy balanced meal which includes protein, vegetables, and carbs.

So, how do you achieve the balance required for a healthy yet interesting eating plan in diabetes?

First, fill half the plate with non-starchy vegetables. These are lower in carbs so have little effect on blood glucose and they are high in fibre and vitamins. They are an important part of a healthy diet.

Examples include: broccoli, cauliflower, Brussel sprouts, cabbage, carrots, celery, cucumber, tomatoes, egg plant, leafy greens (kale and spinach), onions, leeks, green beans, peppers and squash (gems and zucchini).

Second, fill ¼ of your plate with food high in protein, such as fish, chicken, lean beef, cheese, eggs. Soya products, beans, lentils hummus, tofu and edamame are examples of plant-based proteins.

The other ¼ of the plate is for starch or carbohydrate foods.  Keeping the portion of carbs on your plate to this amount can help prevent the rise in blood glucose levels after a meal. Recommended choices would be those carbs that are high in fibre and whole grains.  Remember the bigger the portion of starch on your plate, the higher your blood glucose levels will be.

Examples include: brown rice, bulgur wheat, oats, oatmeal (rolled oats if possible). Any products made with whole grains (low-GI bread or rye bread). Popcorn, quinoa, beans, legumes, lentils, fruit, dried fruit; dairy products, and milk substitutes.

Some vegetables have starch in them too. These include butternut, green peas, potatoes, pumpkins, and sweet potatoes. Take this into account when planning your meal.

Tricky dishes

Some meals like curries, soups, and casseroles, as well as my personal favourite pizza, combine the food groups which make getting that balance more difficult. Try to mindfully break the meal down in your head and work towards where each food type fits on the plate and how you could still achieve that balance that you are looking for.

Let’s look at pizza, for example.

Choose what protein you are having as a topping and then choose a thin base to minimise the carb portion. Balance your plate with two slices of pizza and a big green salad on the other half of your plate.  Obviously, something like pizza is still a high-GI carb but if you can manage the portion size and plate balance, you can improve how you do the treat meals.

Finish off your meal with a low kilojoule or kilojoule-free drink.  Water is always first choice, but other options could include an infused water or sparkling water, unsweetened tea or coffee, or diet sodas or diet squash. Remember that fruit juice, although no sugar is added contains natural fruit sugar, so it’s not a great choice.

In between meals, healthy snacks such as popcorn or nuts are good options to keep hunger at bay.  A small handful of nuts is key into getting healthy fats into your eating plan. They are also good sources of magnesium and fibre. Try to go for unsalted options as too much salt is not good.

Zimbabwe Hand Jive

Another way of making sure that you are getting the correct balance along with mindfully setting up your plate is to use your hands as measures. This is called the Zimbabwe Hand Jive and it goes something like this.

• Your palm is the size of the protein you should be eating.
• A closed fist is one portion of carbohydrate (grains and starches) Remember to choose these wisely.
• Your thumb is equal to a tablespoon of fat-heavy foods, such as peanut butter or mayonnaise.
• Cupped hands or two handfuls is the portion of non-starchy vegetables.
• Combining this way of measuring your portion size with the 9-inch portion plate will ensure that you don’t overdo your meal size.

 PHOTO CREDIT: umassmed.edu

References

https://diabetesfoodhub.org/blog/what-diabetes-plate

https://diabetes.org/food-nutrition/food-and-blood-sugar/diabetes-superstar-foods

https://sweetlife.org.za/download-your-free-healthy-eating-portion-plate/

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