Dietitian, Retha Harmse, encourages us to not see food as our foe but too work on a healthy relationship with food.

A while ago, my husband and I had breakfast at a cafe. Just as we were finishing up and settling the bill, they served the lady next to us the most delicious looking avocado toast topped with some dukkah and chilli flakes. I told my husband, “That looks amazing, I need to order that next time.” I realised I said it a bit louder than I intended because just then the lady then turned around and said, “And I don’t even have to feel guilty because it’s so healthy.”

Standing there, flabbergasted and at a loss for words, I don’t recall if I even responded. Unfortunately, this is not an exception or an isolated incident. This has pretty much become the norm of people’s attitudes towards and relationships with food.

This can be seen in your gym class where people ‘burn off the calories’ or in the grocery store where a mother doesn’t want to buy the ‘bad food’ for her children, or in corporate companies where working through breakfast and lunch is praised (both for productivity and for the will power to maintain intermittent fasting).

How would you describe your relationship with food?

Food has become the enemy, people fear eating and distrust their body’s innate wisdom of what and how much it needs. What food can do for you has taken the backseat and now food the foe is in the driver’s seat.

Well, that is most definitely the case for the majority of clients I see. That is why one of my first questions during my consultations is “How would you describe your relationship with food?”

Evelyn Tribole, author of Intuitive Eating, writes, “The Japanese have the wisdom to keep pleasure as one of their goals of healthy living. In our fury to be thin and healthy, we often overlook one of the most basic gifts of existence – the pleasure and satisfaction that can be found in the eating experience. When you eat what you really want, in an environment that is inviting, the pleasure you derive will be a powerful force in helping you feel satisfied and content. By providing this experience for yourself, you will find that it takes much less food to decide you’ve had enough.”

Improve your relationship with food

So, how do we change this? How do we give back food in its rightful place? How do we improve our relationship with food and grow in eating competence?

• You can’t change something that you aren’t aware of. Therefore you want to become aware of where you may have negative attitudes towards food and eating: food fears, food rules, etc. This might be so deep in your subconscious that you aren’t aware of it or so prevalent in everyday life that it feels like the norm (that is why it’s called diet culture). You want to change this into positive attitudes about eating and food.
• All food can be a part of a healthy diet. You want to grow in becoming more open and accepting towards all food groups, showing acceptance skills that support eating an ever-increasing variety of the available food. If this is not yet the case, you may want to explore what are the barriers standing in your way of achieving this. For example, the way you were raised, your daily habits, lack of mindfulness, your emotional state, etc.
• Growing in listening to your body is extremely important. You want to cultivate internal regulation skills that allow you to intuitively consume enough food that provides you with energy, and stamina and supports a stable body weight. This means not depriving yourself of specific food items, as bingeing is the natural consequence of restriction.
• We all know that eating doesn’t just exist in a silo, most social events have eating linked to it in some way or another. That is why you want to have the skills and resources to manage the food context and organise family meals.

Eating competence

Research has shown that adults with eating competence have body weights that tend toward the average. They are more satisfied with their weight and are less likely to cycle between dieting and non-dieting. They show better health indicators: higher HDL; lower blood pressure, total cholesterol, LDL and triglycerides.

Adults with high eating competence also do better socially and emotionally. They feel more effective, are more self-aware and are more trusting and comfortable both with themselves and with other people.

Encouragement

Don’t stop at this article. This is merely the starting point for improving your relationship with food. Go read up more, make it a priority – the same as a friendship or romantic relationship – choose to work on your relationship with food daily. May you choose to have your avocado toast because you really love it and not just to avoid experiencing food guilt.

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There are currently controversies surrounding the consumption of milk as well as which forms to consume. Annica Rust gives us the facts and clears up any confusion.

Benefits of dairy (milk)

Dairy is a versatile food item, with numerous benefits, such as shown in Figure 1. Diary contains all the macronutrients, including carbohydrates, fats and protein as well as vitamins and minerals.¹

Dairy contains fat-soluble vitamins A, D and E as well the water-soluble B-complex vitamins and vitamin C. The fat content of milk will determine the number of fat-soluble vitamins, therefor the amounts may differ in low-fat and fat-free milk. Although the fat component is removed in low-fat or fat-free milk, some manufactures will fortify milk, with vitamin A & D.^1,3

Dairy is also an excellent source of calcium and contains minerals, such as phosphorous, magnesium, potassium and zinc.^1,3 One serving of dairy (250ml milk, 200ml yoghurt or 40g cheese) contains 300mg of calcium. This is a large portion of the daily recommended allowance for adults, which is 1000-1200mg of calcium per day. The role of each component can be viewed in Figure 1 below.¹

Figure 1: The functions of macro and micronutrients from Rediscover dairy

Food and dairy matrix

Food is more than simply nutrients. We don’t eat individual nutrients (vitamins and minerals), however, we consume different food items in a variety of meals which contain the nutrients our bodies require.¹

The unique food structure can influence the digestion and absorption of nutrients. Milk fat globule membranes (MFGM) may have a significant influence on the digestion of dairy and the absorption of dairy fat. MFGM may prevent the negative effect of saturated fatty acids on low-density lipoprotein (LDL) cholesterol, or simply known as the bad cholesterol, but the protective effect needs to be further investigated. The structure of milk and fermented dairy will also have a positive effect on digestion and absorption. This may partially explain why the benefits of whole foods will always exceed supplementation.¹

Milk and diabetes

A positive association has been found between dairy, more particularly low-fat or fat-free dairy and the risk of diabetes. The positive effect may be contributed to the food matrix which suggests that the combination of nutrients in dairy seem to have a more positive effect for people living with diabetes when compared to individual nutrients. The calcium, magnesium, vitamin D and whey protein in dairy may all through different mechanisms of action play a role to lower blood glucose levels.¹

Milk and cardiovascular disease (CVD)

People with diabetes have an increased cardiovascular risk which can’t be ignored. High cholesterol and high blood pressure as well as unhealthy lifestyle factors (obesity, inactivity and smoking) are common risk factors associated with CVD.

The intake of saturated and trans fatty acids have a significant impact on increasing LDL cholesterol levels. Dietary strategies will therefore aim to substitute saturated fat with polyunsaturated fatty acids as shown in Table 1.

Table 1: Types of fats

Products that are higher in fat also tend to be high in saturated fats, dietary recommendation will therefore recommend low-fat or fat-free dairy, to reduce saturated intake. The difference in milk can be seen in Table 2.

Table 2: Comparison of milk per 100g/ml

The recommendation is to aim for less than 1.5g per 100g of saturated fats (Table 3). However, based on the food matrix dietary, approaches can be more open to move away from nutrient-based approaches and to move more toward food-based dietary patterns (looking more at your diet as a whole vs one single food items). But most importantly dairy intake shows to have a protective to neutral effect on CVD risk.¹

Table 3: Recommended fat and saturated intake

*Milk, yogurt and ice-cream products, the aim is for less than 2g of saturated fats per 100g. For cheese, the target is for less than 15g of saturated fats per 100g.             

Milk and glycaemic index (GI)

Dairy contains lactose, which is the main carbohydrate in milk. Low-fat dairy has a low glycaemic index and is ideally used in combination with other foods items for meals or for a snack.¹ Visit the GI foundation site to look at endorsed products.

Visit www.gifoundation.com/food-list/dairy/²

Conclusion

There are numerous factors to take in consideration when deciding whether full cream, low-fat or fat-free milk or dairy will be most beneficial for your health. It therefore remains the best to contact a registered dietitian for individualised advice.

References:

1. Rediscover Dairy: https://www.rediscoverdairy.co.za/evidence-based_reviews/
2. The Glycemic Index Foundation of SA: https://www.gifoundation.com/food-list/dairy/
3. Mahan, L.K. & Raymond, J.L. (eds).2017. Krause’s food and the nutrition care process. 14th ed. St Louis. MO: Elsevier Saunders.

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Dietitian, Rhodene Leydekkers, shares basic steps to help you on your winter meal planning journey.

The winter cold is here, and with winter typically comes warmer, hearty and comforting food. But just because the season is changing doesn’t mean that you should stop nourishing your body with good nutrition.

Planning your meals for the week can save you some money, time and stress. It can also make healthy eating a bit easier and prevent food waste. But if the thought of meal planning overwhelms you, here are basic steps to help you on your meal planning journey this winter

First decide what works for you

There are different styles to meal planning, so you need to decide for yourself what will work best for you. Although planning and meal prepping a perfect week sounds amazing, sometimes you need to ask yourself whether that is realistic for you.

Some people prefer to only plan their meals to know what to get from the shops, and other people like to meal prep and cook some or all of the meals in advance to lessen the load during the week. Some people only plan their dinners for the week, while others prefer to plan for breakfast and lunch as well. Your food preferences are also important to take into consideration when planning for the week.

Focus on balance

Before we plan our meals, it’s important to know what to aim for. Balancing our meals is important to ensure that we are getting all our nutrients in that our body needs to function optimally.

An ideal plate would be: ½ your plate full of vegetables, ¼ of your plate lean protein (skinless chicken, fish, lean beef, beans, lentils or eggs), and ¼ of your plate high-fibre carbs (brown rice, whole-wheat couscous, quinoa, barley, sweet potato or whole wheat bread or pasta), and then to include some fats that will usually come from using a little bit of oil in preparing the meal, or by adding fats to a meal like avocado, nuts or seeds.

If you want to enjoy a warm soup, stew or curry (because who doesn’t enjoy a warm meal on a cold day), you can still apply this model to that meal. Soups, stews and curries are a great meal to add lots of veggies in, a lean protein like mentioned above, and enjoying that meal with some brown rice, barley or a slice of whole wheat bread.

Evaluate your week

Now that you know what to aim for, the next step would be to evaluate your week and plan your meals according to your schedule. There might be upcoming social events, work functions or other obligations that can influence your meal planning. If these events include food (which honestly is the best, am I right?), then you don’t have to plan for that day. Or it could mean that you will not have a lot of time to prepare a meal, so then a quick heat-and-go left-over meal would be best to plan for those days.

Make a menu for the week

So, now that you know what to plan for, you can start colouring the picture in. Have a list of go-to balanced meal options that you know will work for you and your family. Choose recipes with simple ingredients that you can use in different dishes, and that is quick and easy to make. This makes it easier to pick the meals for the week without thinking too much about it.

Food should also be an adventure, so continue to add recipes to this list, and even experiment here and there with new flavours if you have the time.

Ideas for meals

• Chicken or canned black bean stir-fry with whole wheat noodles.
• Lentil curry with lots of vegetables and brown rice.
• Baked fish, boiled potato and roasted vegetables.
• Chicken soup (again with lots of vegetables) with a slice of whole wheat bread.
• Whole wheat spaghetti bolognaises made with lean mince and bulk it up with tomatoes, onions, mushrooms, carrots, zucchini and spinach.

Make a shopping list and stock your kitchen

This is my favourite part, the shopping. From your meal plan for the week, you can now make a shopping list for what you might need for the week to prepare the meals.

Stock your pantry and fridge with some staples like salt, pepper, herbs, spices, olive oil, etc., and then go and buy the necessities for the week.

If you find that you just don’t have the time to go to the shops, or it is just too cold to leave the house, then there are other options. Most of our favourite grocery stores have online options available to help you stock your kitchen for the week without putting a foot in the shops.

Prepping your meals

Now remember, meal planning and prepping looks different for everybody, so this step depends on what will work best for you. One way of meal prepping is to choose a day, like Sunday, to prepare some of the meals in advance. The pre-prepared meals can then either be refrigerated and eaten over the next few days, or frozen to eat over the next few weeks or even months.

Meal prepping can also include preparing ready to cook ingredients for a specific meal, like chopping vegetables or cook starches, like rice, to save some time on cooking. By doing this, it can really save you a lot of time in the kitchen, especially now that your days are shorter with the sun setting much earlier.

Meal planning might seem a bit overwhelming at first, but the moment you start doing something, you might notice how easy it makes your life. So, go make yourself a warm cup of tea, grab a pen and get planning.

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We hear why BASA advocates that a healthy body is made through consistency and why exercise is imperative in cooler months.

It’s so easy to get active and exercise when the sun is shining and the sky is blue. But what happens when the winter months start to roll in, temperatures start to drop, and the sky becomes dark and grey? Even the most dedicated of fitness enthusiasts can struggle to get out of bed in winter, let alone get moving.

Winter can be very disruptive to our regular exercise routines. Typically, as temperatures start to decrease, so does physical activity. Light levels are also a contributing factor. With the sun rising later and setting earlier, our days become shorter, and so does the perceived window period for physical activity. Many people find the dark to be demotivating and a barrier to physical activity participation.

Why to keep moving in winter

Despite these difficulties experienced during winter, movement and physical activity remain a central and essential component in the management and prevention of diabetes.

There is an abundance of research which demonstrates that regular physical activity improves blood glucose, decreases cardiovascular risk factors and reduces reliance of chronic medication in individuals with diabetes.^1,2

Additional benefits include improved cardiovascular fitness, improved blood pressure, improved cholesterol and triglyceride levels, decreased abdominal fat, improved body mass index (BMI) and enhanced well-being.

During winter, the benefits of physical activity for people with diabetes don’t change. However, there are some additional reasons that you might benefit from getting active in the cooler months.

• Increased Core Body Temperature

With physical activity, we typically observe an increase in both muscle and core temperature. This is because not all of the energy produced in our muscles is used for muscular contraction, and the remainder of the energy is converted to heat energy which increases the muscle temperature and eventually core body temperature.³ The greater the exercise intensity, the greater the heat production. Essentially, exercise of sufficient intensity will help you become your own human heater during winter.

• Reduced depression and anxiety

Although the exact mechanisms are complex and multifactorial, there is ubiquitous agreement in scientific communities that exercise is beneficial for the treatment and management of symptoms of depression and anxiety.⁴

Physical activity leads to the release of endorphins or ‘feel good chemicals’, such as serotonin and dopamine. These endorphins help to better regulate mood and promote feelings of well-being, whilst reducing feelings of depression and anxiety. Exercise can therefore help you to beat the winter blues and protect against Seasonal Affective Disorder (SAD).

• Preventing winter weight gain

During the cooler winter months, the average person tends to eat more and do less. With this human hibernation, comes the dreaded winter weight gain. Exercise helps to boost your metabolism and increase the number of calories you burn each day, which allows you to better maintain your weight and help you avoid packing on the pounds.

With the above benefits of exercise, the goal during winter should be to reduce the number of barriers to physical activity and commit to small, sustainable changes that make staying active easier until the return of the warmer months.

Five tips to help keep you active in the cold

1. Create a support structure

Create a support structure that will encourage you and help you remain focused on your goals. It’s much easier to stick to a habit if you have someone to keep you accountable to your goals. Get active with a friend or family member or sign up for regular exercise sessions with a healthcare professional, such as a biokineticist.

2. Get active in your lunch breaks

Does going to the gym or for a walk before work in the pitch-dark sounds like a nightmare to you? Try to squeeze in some activity into your lunch breaks whilst it’s still light outside. Try a brisk walk around the block if the weather is tolerable, or, if you’re lucky to have a gym close by or at the office, try to fit in a quick 30-minute workout.

Here is a great balance and mobility exercise to try, which we have called the #teatimetactic challenge. Here is the explainer video on YouTube:

Challenge yourself and nominate others. Practice it, film it, upload it to social media and tag others you would like to nominate to take up the challenge and include hashtags #TeaTimeTactic and #biokineticssa!

3. Try hydrotherapy

If exercise in the cold is something you’re just not willing to subject yourself to, hydrotherapy in a heated pool is a great option. Hydrotherapy has many benefits, including improved circulation, reduced pressure on joints, reduced joint and muscle pain, muscle relaxation, improved muscle strength, improved joint range of motion and improved balance. Not only will you be warm, but you will reap all these other benefits too.

4. Invest in new gym wear

Nothing motivates people like some new active wear. Putting on gym gear is not unlike putting on a uniform, or an actor putting on a costume. By putting these specific clothes on, you remind yourself of the specific task or job you have to perform, and you become more psychologically ready for the task at hand. Invest in some warmer gym clothing, not only to help keep you warmer during your workouts, but to help motivate you to get active.

5. Try new indoor activities

If you regularly exercise outdoors but can’t bring yourself to go for your usual morning walk in winter, it may be time to try some new indoor activities. This doesn’t necessarily require you to take out a gym membership. With the global COVID-19 pandemic, there are now many options available online to help get you moving within the very comforts of your own (warm) home.

A healthy body is made through consistency

There is a saying that goes “summer bodies are made in the winter”. But we like to think that a healthy body is made through consistency, which means putting in the work every day, regardless of the weather outside.

Biokineticists are registered healthcare practitioners that treat injury and disease through individualised, evidence-based exercise prescription. They are specifically educated to prescribe and supervise exercise to individuals for the management and prevention of non-communicable diseases, such as diabetes. To find out more about biokinetics, or to find a biokineticist near you, visit https://www.biokineticssa.org.za

References 

1. Gill, Jason MR, and Dalia Malkova. “Physical activity, fitness and cardiovascular disease risk in adults: interactions with insulin resistance and obesity.” Clinical science 110.4 (2006): 409-425.
2. Way, Kimberley L., et al. “The effect of regular exercise on insulin sensitivity in type 2 diabetes mellitus: a systematic review and meta-analysis.” Diabetes & metabolism journal 40.4 (2016): 253-271.
3. Takeda, R., & Okazaki, K. (2018). Body Temperature Regulation During Exercise and Hyperthermia in Diabetics. In (Ed.), Diabetes and Its Complications. IntechOpen. https://doi.org/10.5772/intechopen.74063
4. Drew, E. M., Hanson, B. L., & Huo, K. (2021). Seasonal affective disorder and engagement in physical activities among adults in Alaska. International journal of circumpolar health, 80(1), 1906058. https://doi.org/10.1080/22423982.2021.1906058

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Dr Louise Johnson offers hacks for healthy winter living for people with diabetes.

Professor Elliot Joslin was the first doctor specialising in diabetes in the United States. He was involved in diabetes for seven decades (June 6, 1869 – January 28, 1962) and first recognised the management of diabetes as the management of diet, exercise and correct medication to prevent complications. He coined it the “three wild horses of diabetes running each in its own direction.” To live healthy, it’s important to get the balance between diet, exercise and the correct medication. Either too little or an excess of any of the three can throw the scales over and cause havoc.

Diet 

A well-balanced diabetes diet that has adequate portions of starch, lean protein, vegetable, fruit and fat in the form of nuts and avocado is important.

Note, it’s vital to take in all your vitamins, especially in winter or during stress and illness when the immune system is down. Oral supplementation may be necessary. In winter and during stress and illness there is a need for more vitamin C, zinc and vitamin D.

Diet hacks

• Vitamin C in dosage of 500 to 1000 mg per day improve the immune system.
• Zinc is a nutrient that is important in the body for a healthy immune system, good wound healing and prevention of age-related macular degeneration. It’s found in chicken, red meat and fortified breakfast cereals. It’s good to supplement in winter: a dosage of 8 mg for women and 11 mg for men.
• Vitamin D is more important in winter since we get less sun exposure.
• Adequate calcium (600mg/d) is also important for good bone health throughout life in both men and women. Osteoporosis is four times more prominent in people with diabetes and can be prevented by calcium supplementation, sunlight and exercise.
• During winter or sometimes watching TV, snacking is a problem amongst many people. Try to minimise this or do healthy snacking with cucumber or popcorn.
• Water is always important. The calculated amount of water is your weight without the naught. For example: 60 kg person will need six glasses of water per day. This can be divided between tea, juice and water. Remember that coffee doesn’t hydrate. To get access to healthy water, use a water filter or boiled and cooled down water.
• Don’t forget your probiotics for a healthy gut. The best form is in the form of yoghurt. Should you not get enough yoghurt, a supplement can also help but natural is always better.

Exercise hacks

The importance of aerobic exercise can’t be overstated. This increases insulin sensitivity and helps you use less insulin more effectively, burn fat and prevent osteoporosis. Any form of aerobic exercise (walk, swim, run or cycle) for 30 minutes per day is recommended.

• Exercise in the morning is better for glucose control since insulin resistance is at its highest value then. Be careful of hypoglycaemia after exercise, especially if you do it in the evening.
• Anaerobic exercises (weightlifting) can push up glucose due to the stress response of the body. It’s wise to do a combination of aerobic and anaerobic exercises dependent on the glucose level to help with control. For example, if glucose is above 10 mmol before exercise start with aerobic training (walking or running) and end with squats and weights. The reverse works well too when glucose is between five and 10 mmol to start with weights and end with aerobic exercise.
• Always have a sugar snack handy and remember to hydrate well. Drink enough water and stretch well before and after exercises.
• Proper shoes are important for people with diabetes, especially if you already have nerve damage with loss of sensation and burning feet. Don’t forget proper socks are as just important as shoes.

Medication hacks

To control the three wild horses, the correct medication is important. Remember that medication changes continually and better medication become available as well as devices (insulin pumps and glucose sensors). Visit your diabetes specialist regularly for an evaluation.

Other general hacks

Sleep

It’s important for good control of glucose and a healthy immune system to sleep at least six hours per night uninterrupted. If you have trouble sleeping talk to your doctor. Avoid caffeine (coffee) before bedtime. Daytime sleepiness can be a sign of sleep apnoea and can be diagnosed with a sleep apnoea test and managed with sleeping with a special mask. This will also improve glucose control and weight issues.

Seasonal affective disorder

Many people suffer from seasonal affective disorder (SAD) when the weather changes to cold. Symptoms include feeling tired, depressed, down or lethargic. Care for your mental health. Depression is 50% more common in people with diabetes and if symptoms persist despite healthy living, seek professional help.

Reduce shower/bath time

There is nothing better than a long hot shower or bath especially during winter times. You shouldn’t exceed this time with 10 minutes since all the healthy oils of the skin can be washed away. This can increase weakness and peeling of nails.

Relax

When we are stressed out, our immune system is compromised, and this can give viruses and bacteria space to cause problems. To help prevent this, spent time meditating daily in whatever form relaxes you. Reading, listening to music, drawing, sitting and reflecting.

Stay warm

The more constant we keep our body temperature, the easier it will be to fight of infections. Remember a scarf. Cold viruses spread in the cold. Your nose is the highway to your lungs. Keep it warm.

Remember to wash your hands

This is now second nature to us in the COVID era but don’t forget when inside and touching your face, wash your hands regularly. Travel with wet wipes when touching all those surfaces that are unavoidable and full of germs.

Gargle

Gargle regularly with warm water and a teaspoon of salt. This is anti-inflammatory and good for teeth and throat health. Gargle and spit with warm water until the salty taste is gone.

Laugh

I can’t think of a better stress reducer than laughing. Watch your favourite movie and start laughing.

Garlic

In the Middle Ages, it was tied around the neck to ward off evil. It still helps with those evil viruses by boosting your immune system. Be sure to crush whole garlic to get all the goodness that comes from its health-giving compound: allicin. Add it to your soups and stews for a healthy winter.

Immunisation

It’s good practice for people older than 50 years of age and those living with diabetes to be up to date with vaccines. Don’t forget the annual flu vaccine that is very effective against flu.

Do everything in moderation from diet, exercise to taking supplements. Remember too much is just as harmful as too little.

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