DIABETES and NUTRITION

The food that we eat is digested and provides our body with a variety of nutrients and energy measured in kilojoules. Carbohydrate foods are broken down into glucose which is the main source of energy for our bodies. Proteins are broken down into amino acids which are needed for growth and repair of the body. Fats are broken down into triglycerides which are used for energy and a variety of functions within the body for example hormone production and for keeping cell membranes healthy.Following the digestion of food, glucose (from carbohydrates) is absorbed from the small intestine into the blood stream. In response to the increased blood glucose levels, the pancreas releases insulin into the blood stream to assist with transporting the glucose into the cell. This causes the blood glucose levels drop to normal levels again, and so the process repeats itself after each meal.The rise in your blood glucose levels is determined by the amount of glucose entering the blood stream.  This depends on the rate of digestion of the food and amount of food eaten, as well as the rate of clearance from the blood into the body’s cells, via insulin.In people with diabetes the amount of insulin released is inadequate and clearance of glucose into the cells is significantly delayed.

The THREE basic nutrition components that affect your blood glucose levels on a daily basis are:

1. The timing of your meals and snacks.

2. The quantity of foods and drinks you consume daily

3. The types of foods and drinks you consume daily.

1. The timing of your meals and snacks.

The current generation of insulin and other diabetes medications, give people with diabetes flexibility with regard to the timing of meals and snacks. However, it is still recommended that you eat three regular meals per day. This offers the best way to control the size of your meals, and thus your blood glucose and energy levels throughout the day. Regularly skipping meals can cause your blood glucose levels to drop too low. This may cause you to compensate by overeating at the next meal, or needing to snack inappropriately between meals. Depending on the size of your meals, the type of medication you use, your lifestyle and appetite, you can enjoy snacks between meals. Snacking is recommended if the meals are more than 5 to 6 hours apart. When you are overweight be aware not to snack inappropriately due out of the power of habit and the visibility and availability of food.

2. The quantity of foods and drinks

The quantity of foods (portion sizes) you should eat is individual and varies from person to person. The factors that play a role in determining what portions you should eat depends on your weight status, activity levels, the type of medication you use, your gender, age and level of glycaemic control (blood sugar control).

The best way to gain knowledge on how many portions you need to consume of the different foods on a daily basis is to consult a registered dietician. She can calculate a practical nutritionally balanced eating plan taking your lifestyle as well as the above mentioned factors in consideration.

Contact the Association of Dietetics in SA (ADSA) for a registered dietician in your area www.adsa.org.za  

If you are following an insulin regime of injecting before each meal (basal bolus) you can learn to adjust the amount of insulin you need to inject for a meal according to the amount of carbohydrate you plan to enjoy in a meal.  This is called carbohydrate counting. You need to learn the amount of carbohydrate all foods contain and develop your own carbohydrate: insulin ratio. As this can provide you with more flexibility towards the size and composition of your meals, it needs to be done under the supervision of a registered dietician.

3. The types of foods and drinks

3.1  Carbohydrates
The consumption of different types of carbohydrate foods affects our blood glucose levels in different ways. We classify carbohydrate foods on how they affect people’s blood glucose levels using the Glyceamic Index (GI). The fibre in whole grains, fresh fruit and vegetables delays digestion and causes the slow release of glucose into the blood stream that is beneficial. High fibre foods usually have a low GI value. The milling of grains removes the fibre from the grains and produce white flour. This also happens when we remove the fibre from fresh fruit when making fruit juices. Low fibre foods have a high GI value as they are more rapidly digested and glucose is faster absorbed into the blood stream causing higher blood glucose levels.

Including low GI carbohydrates usually high in fibre to the expense of high GI starches usually low in fibre (made from white flour) is recommended. (See list for high fibre, low GI sources) This contributes to improved blood glucose control and consequent improved appetite and weight control.

Whole grains such as rolled oats, barley, brown wild rice, bulgur wheat, pearl wheat (stamp koring) quinoa, health / rye breads, whole grain cereals, legumes (lentils, dry beans, chick peas) contain not only fibre but additional nutrients important towards lowering cholesterol and weight loss

The quantities of starch we eat affect the blood glucose control levels just as much as the type of starches we select into our diet. Thus even when selecting high fibre low GI starches it is advisable to always keep your starch portion SMALL A quarter  of your plate should be filled with whole grains, a quarter with lean proteins and half of your plate should be filled with all types of vegetables. All types of vegetables and fresh fruit consumed in controlled have a low GI and you should try to include five portions of vegetables and fruit (combined) into your diet on a daily basis. If you are not overweight and following a basal bolus insulin regime you can increase your starch and fruit portions and adjust your insulin to cover the amount of carbohydrates you anticipate to consumed in the meal.

Key points to remember when selecting carbohydrate foods for your daily eating plan:

1. Aim for a minimum of five portions of fresh fruit and vegetables per day, as they all have a low GL and are high in fiber.

2. Select high-fiber /low-GI starches and limit your intake of refined starches (those with a high flour and sugar content). Remember that GI only applies to starches.

3. Eat one to two portions of whole grains each day.

4. Control your portions. The quantity of carbohydrate foods you eat affects your blood glucose levels.

5. Fresh fruit is the best snack to enjoy.

3.2  Proteins

As protein foods contain fats the main objective is to select protein foods lean to lower the total saturated fat content of the diet. (See list for lean protein sources) Including proteins into the diet enable you to keep the quantity of starches small that enhance glycemic control.

Dried beans, peas and lentils are not only low-fat sources of protein, but also contain soluble fibre that has a cholesterol-lowering effect. Replacing some animal proteins with legumes can help to lower your intake of saturated fats. The high soluble-fibre content in legumes is also responsible for a slower digestion and absorption of carbohydrates, which contributes to an improved blood glucose response after a meal.

As white fish contains significant less saturated fat as red meat and fatty fish contains essential fats with health benefits make fish is an excellent protein source to include into your diet. Find tasty innovative ways to prepare fish.

Key points to remember about proteins:

1. Lower your intake of saturated fats by avoiding protein and dairy foods that are high in saturated fats such as fatty meats, processed meats and hard cheeses.

2. Select all low fat milk and milk products and low fat cheese. Lean protein total fat content is less than 10 g fat / 100 g food

3. Use skin less chicken when using stir frying and stewing as cooking methods. Remove the skin afterwards when roasting chicken in the oven or on the coals.

4. Eating protein enables you to consume smaller portion of starch, which will improve your glycaemic control.

5. A small amount of protein is sufficient to sustain our body’s growth and metabolic processes.

6. Choose your proteins lean. The most to least desirable protein foods are fatty fish, white fish, legumes, lean meat and chicken, eggs, low-fat soft cheeses and hard cheese.

3.3 Fats

Fats play an essential role in your diet and support many metabolic functions in the body. The fats that increase blood cholesterol levels and decrease the insulin sensitivity of the cells originate from animal sources. These fats are solid at room temperature and are saturated of nature (see list of unhealthy fats). Unsaturated fats from plan origin especially mono unsaturated fats does not increase cholesterol, keeps your cells healthy and sensitive to insulin.  It is thus recommended that you replace all saturated fats in your diet with unsaturated fats. Tran’s fats are a type of fat the food industry sometimes use when manufacturing baking items as well as in Fast foods. Tran’s fats do have the same unhealthy qualities than saturated fats and should be avoided

All types of fats are calorie dense and can contribute to weight increase if consumed fats without discretion. It is thus important to control the amounts of healthy fats include into your daily diet.

The essential fatty acids we found in fatty fish such as sardines, pilchards, mackerel and salmon have numerous health benefits that protects you against heart disease. It is recommended that you include a minimum of three portions of fatty fish per week into your diet.

Key points to remember when selecting fats for your daily eating plan:

1. Limit your intake of saturated and trans-fats and choose unsaturated fats when possible.

2. Oleic acid (a monounsaturated fat found in olive oil, canola oil, avocados and some nuts) has superior health benefits and should be the oil of choice in our diet.

3. Avoid exceptionally low-fat diets, as your body needs a certain amount of healthy fats to enable it to function normally.

4. Eat fatty fish at least three times a week for the beneficial effects of Omega 3 fatty acids.

5. Control the quantity of all fats in your daily eating plan, as all fats are calorie dense and will add weight.

3.4 Salt

A high salt intake can aggravate high blood pressure. Avoid adding salt to food after cooking. Cook with adding the minimal salt to food by using a variety of herbs and spices. Use salty condiments such as soy sauce and Worcester sauce sparingly.

Diary and dairy products

Fats

Avocado pears, all types of nuts, peanuts, peanut butter (sugar free) olive oil, olives, canola oil, canola margarine, olive oil margarine.

Vegetable oils: sunflower oil, Low oil or no oil salad dressings. Homemade salad dressings prepared with above mentioned oils, lemon juice and herbs. Polyunsaturated, “lite margarine`s “in a tub. Olive oil margarine, Low oil mayonnaise

All types of seeds: sunflower seeds, linseeds, sesame, and pumpkin seeds.

Proteins

Fish: All types – smoked, fresh or frozen (not fried in oil).  All types of tinned fish (oil drained) e.g. tuna chunks, sardines, salmon. Pilchards in tomato sauce. Pickled fish. All white fish e.g. hake, kingklip, and haddock. All oily fish e.g. yellow tail, salmon, I and J lite and crispy oven baked fish. Seafood: Crab, oysters, mussels, shrimps, prawns, calamari( grilled not fried)Poultry: Chicken and turkey without skin – not fried.Legumes: Beans, peas, chick peas and lentils (cooked/canned)

Red meat: lean beef, lean pork, lean veal, extra lean mince meat (remove all visible fat before cooking or eating).

Lean cold meats: lean ham, silver side, pastrami and lean roast beef.

Organ meats: Liver, kidneys (not fried).

Lean biltong ( fat removed)

Eggs: Boiled, poached, omelette, scrambled – limit to two to four eggs per week.

Cheese: low fat cottage cheeses – all flavours. Ricotta cheese. Medium fat hard cheese e.g.low fat feta, “reduced fat cheese” slimmers choice”. All cheeses fat content should be lower than 13 g fat per 100g cheese. (Restrict the use of hard cheese to 2 x per week).

Soya products: soya mince (frozen/ dry) soya patties, Tofu- fat should be less than 10 g per 100g product.

Chicken: chicken and turkey with skin. Fried crumbed chicken e.g. Kentucky.

Red Meat: Fatty beef, pork, mutton and lamb. Meat drippings should not be used for making gravy.

Processed meats: polony, meat loaf’s e.g. olive loaf, salami, Beef and pork sausages e.g. Russians, Frankfurters, Vienna’s, Boerewors.  Like it lean sausages, and polony. Fatty fried bacon, dry beef sausage (dry wors) Biltong with fat. Liver spreads, fried liver, liver pate, and liver sausages.

Fried eggs.

High fat cheeses: Cheddar, Tussers, and Gouda.  Cream cheeses. Processed cheeses: cheese spreads and wedges. Low fat cream cheese e.g. Simon’s berg and regular cream cheese.

Crackers: Pro-Vita, Rye Vita, Fin Crisp, Cracker mate lite.

Pasta made from durum wheat

Pearled wheat, “stamp koring “, corn on the cob, samp and beans, couscous. Quinoa,                                                        Rice – white, brown rice, wild rice, basmati rice, barley, bulgur wheat, Crushed wheat, Popcorn. Baby potatoes, sweet potato – boiled

Legumes: dried beans, peas, lentils, chick peas, soya beans

All baking products made from white bread and white cake flour: rusks, meat pies and sausage rolls, samoosas, cakes, pastries, focaccia breads, tramezini, pita breads, naan breads, wraps, roti’s, pizza’s.                                             Scones, doughnuts, Chelsea and hot cross buns. All sweet biscuits and baking products containing cream, creamy fillings and icing sugar e.g. cup cakes, muffins.

Baked desserts, jelly, custard

Low fibre crackers e.g. rice cakes, cream

Crackers, Bacon kips, Tuc, Zap, Cheddar’s, etc.

Potatoes – baked, fried, mashed, Instant mash potato

Sushi rice, risotto rice

Non durum wheat pasta, samp, mealie rice. Instant noodles.

All spices, herbs and condiments: Vinegar. Lemon juice, salt, pepper. Worcester and soy sauces, sweet chilli sauce, HP sauce. Beef, chicken and vegetable extract cubes or powders. Olive oil spray. Curry powder Condiments: chutney, tomato sauce, mustard – gherkins, pickles pepperdews. Vegetable and meat spreads: Marmite, Bovril. Fish paste.