Ask the Dietician

Just diagnosed: your best and worst food choices

Ask the dietician: Genevieve Jardine

When someone is newly diagnosed with diabetes, it’s helpful to start with very simple dietary advice as they come to terms with the necessary lifestyle changes. The spectrum of food choices for diabetics involves “good choices” on one end and “bad choices” on the other. In the middle lies ‘moderation’, which can be adapted to the individual depending on personal factors and other conditions like blood pressure or cholesterol.

Here, we’ll break down what good and bad choices look like in each of the food groups – proteins, starches and sugars, vegetables, fruit, fats and oils, and drinks.

Proteins: meat, chicken, fish, eggs and dairy

Good choices:

  • Fish more frequently (especially fatty fish like salmon, trout and mackerel)
  • Eggs, especially boiled eggs
  • Plain yoghurts, milk and cottage cheese
  • Plant-based protein options like beans, lentils and chickpeas, instead of meat
  • Using chicken that has skin removed (preferably grass-fed)
  • Game meat that is very low in fat

Bad choices:

  • Deep fried meat, chicken and fish
  • Very fatty red meats and processed meats
  • Diary that has been sweetened, like ice cream
  • Imitation cheese and coffee creamers

Starches and sugars

Good choices:

  • Unprocessed, high fibre starches like sweet potatoes, rolled oats, brown rice, wild rice, quinoa, buckwheat and barley.
  • Items made with wholegrain flour with little or no added sugar such as wholegrain bread, crackers and cereals.

Bad choices:

  • Any food item that has a lot of sugar added, like sweets, chocolates and biscuits.
  • Refined flours that have been processed and bleached white such as white flour, white breads, white crackers, white rice and refined cereals (especially if the cereals have sugar added).
  • Deep fried starches such as doughnuts, koeksisters, vetkoek, fried potato chips and crisps.

Vegetables

Good choices:

  • Homegrown, fresh or even frozen vegetables with emphasis on lots of different colours. Try to eat a rainbow of vegetables. Eat them raw, juice them, steam them or bake the root vegetables for maximum nutrient retention.
  • Fresh herbs and spices like garlic, ginger, turmeric, cinnamon, mint, rosemary and coriander.

Bad choices:

  • Vegetables that have been boiled
  • Vegetables with thick sauces
  • Canned vegetables which are higher in salt (for those people who need to watch their salt intake)

Fruit

Good choices:

  • Fresh fruit in season
  • Fruits with a naturally lower sugar content, such as berries, apples and citrus

Bad choices:

  • Fruit juices
  • Dried fruit with sugar coating
  • Fruit canned in a thick syrup

Fats and oils

Good choices:

  • Foods that are naturally high in fats like olives, avocado, nuts and seeds
  • Good quality oils such as extra virgin cold pressed olive oil

Bad choices:

  • Foods that are high in trans fatty acids and hydrogenated vegetable oils (read the food labels to spot these words).
  • High quantities of plant seed oils like sunflower and canola oil (usually deep fried products).

Drink

Good choices:

  • Filtered water flavoured naturally with lemon or mint
  • Herbal teas

Bad choices:

  • Sugary drinks such as sports drinks, fizzy drinks, iced tea, flavoured water.
  • Alcoholic beverages that are high in sugar, such as cocktails, dessert wines and fruity mixed drinks.

National Heritage Day eats

Ask the dietician: Genevieve Jardine

From the community: “Every year I hold a National Heritage Day feast for my friends and serve up all the South African classics: boerewors rolls, koeksisters, samoosas, shisa nyama and curry. This year I have a diabetic friend coming and don’t want him to feel left out. How do I make the feast more diabetes-friendly?” Nashikta Singh

National Heritage Day is about celebrating the mixed flavours of South Africa, and there’s no better way to do this than by showing off our traditional dishes. Coming together around the braai or dining room table lets us share our past and create our future.

Traditional South African dishes have a lot of flavour and nutrition. Many of the classic dishes are naturally diabetes-friendly, while others may require some simple changes.

Chakalaka

Made with onions, tomatoes, carrots, chillis, garlic, cabbage and cauliflower. It is packed with nutrients, fibre and flavour.
Tip: Don’t use too much oil while making chakalaka.

Pap

Mielie meal is a starch, so it will affect blood sugar. For better blood glucose control, you can cook it the night before and then reheat it on the day. This lowers the GI (glycemic index) of the pap.
Tip: Mix pap with cooked beans to further reduce the GI.

Potjiekos

Use lean cuts of meat and fill the pot with a wide variety of vegetables. This method of cooking keeps the nutrients locked in the sauce.
Tip: Add plenty of non-starchy vegetables like baby marrows and green beans.

Curry and bobotie

The beauty of Indian cooking is all the herbs and spices. Garlic, onion, fresh chilli, turmeric, coriander and clove are all great for your health. Try to use lean cuts of meat (extra lean mince) and serve with small portions of brown basmati rice and vegetables.
Tip: Bean or lentil curry make an excellent starch alternative.

Shisa nyama or braai

Traditionally, braai meat is fatty (brisket, boerewors, chicken wings) and served chargrilled. Try to use leaner cuts of meat like skinless chicken or sirloin, with different marinades to keep the meat tender. Don’t only think meat when it comes to a braai: mielies, butternut, sweet potatoes and madumbes are also delicious.

Some traditional foods, like lean biltong or air-fried samoosas, can be altered to make them healthier. But when it comes to things like vetkoek and koeksisters, there’s not much you can do!

Diabetic superfoods

Ask the dietician: Cheryl Meyer

From our community: “Sometimes it feels like I’m constantly trying to juggle what I want to eat and what I should be eating. Are there certain foods I must include in my diet because I’m diabetic?” Gracie Monaheng

The term “superfood” has become very popular in the language of food and health. We know that Mother Nature offers a wonderful selection of healthy foods, but research has yet to prove any of them magical. No single food, no matter how “super,” can take the place of the important combination of nutrients from a diet based on a variety of nutritious foods, including plenty of fruits and vegetables.

Some tests to help you decide whether a certain food is worth trying:

  • How does it taste? No food is worth eating if it doesn’t taste good. There are plenty of options to choose from that offer both health benefits and flavour.
  • Where was it grown? Has it had to travel long distances from where it was grown to where it was sold?
  • How much does it cost? Has its “super” title brought with it a “super” price tag?
  • Has it been researched? Check with your healthcare team.
  • What value does it add to my overall diet? Variety is an important measure of diet quality, but bear in mind that adding variety doesn’t necessarily mean trying wildly new things: even just a slight change can wake up your taste buds.

Think positive when planning your diet — focusing on foods to add, rather than avoid. Aim to include*:

  1. Omega-3 rich foods: like salmon, mackerel, pilchards, tuna, canola oil, flaxseed oil, flaxseeds and walnuts.
  2. Leafy green vegetables: like spinach, kale, lettuce and bok choi. These powerhouse foods are low in kilojoules and total carbohydrate.
  3. Wholegrains: easily trump their paler, refined counterparts. Choose brown or wholewheat options for a source of protein, fibre and B vitamins.
  4. Berries: sweet, yet low in calories and packed with antioxidants, vitamins and fibre.
  5. Nuts: plenty of flavour, very versatile and with a good dose of fibre and selenium. Although they are high in fat and calories, a few nuts go a long way to adding taste to all kinds of meals.
  6. Legumes: delicious, low in fat, high in fibre and rich in protein.

*As with all foods, you need to work these into your individual meal plan in appropriate portions.

The carbs-fat-protein debate

Ask the dietician: Genevieve Jardine

From the community: “I don’t understand the whole ‘low carbs high fat or high protein’ idea – how do carbs, fat and protein work together? Is there a happy middle ground, or does it need to be all or nothing?” Wessel Jones

To understand what all the fuss is about, we need to look at the history of diabetes treatment. Treating diabetes (both Type 1 and Type 2) by lowering carbohydrates (carbs) has come and gone out of fashion over the last century. This debate is not a new one and it is probably not going to go away.

Before the invention of insulin, the only way for a diabetic to survive was to cut out the foods (carbs) affecting blood glucose. With the advent of insulin, the focus switched from lowering carbs to lowering fat to help reduce heart disease. Fast forward a couple of decades and we can see that we have failed in reducing obesity, diabetes or heart disease. It’s not as simple as just diet: it’s about physical activity, stress, diet and environment.

How do carbs work in the body?

What is quite simple is that carbs cause blood sugar to rise and the more carbs you eat, the higher the blood sugar goes. If a person wants to control their blood sugar, it’s a very good idea to reduce carbs. The big question is: how low do you go? A “low carbohydrate diet” can have anything from 20g to 130g of carbohydrate per day.

Remember: One portion of carb (a medium apple, a slice of bread) = 15g carb

The amount of carbs depends on the individual, their control, their medication and their weight. There is a growing amount of scientific evidence that low carb diets improve glucose control and help with weight loss.

Where do fat and protein fit in?

When carbs are cut, the amount of protein or fat (or both) go up. And this is where the debate heats up. The concern is not the low carb, but the increase in saturated fat or fat in general. Remember that not all fat is the enemy and there are good fats that play a very important role in the body.

A benefit of protein and fat is that in the immediate, they do not cause the same spikes in blood sugar. When you lower carb intake you have an immediate blood sugar lowering effect. When this happens, and you have fewer spikes and dips in blood sugar, your appetite is better controlled. The fuller you feel, the less likely you are to snack and the fewer kilojoules you consume. The fewer kilojoules you consume, the more likely you are to lose weight.

The problem with the low carb approach is that, like everything else, it needs to be a lifestyle. When you add carbs back into your diet you will put on weight, especially if you have increased your fat and/or protein. You can’t have it all: full fat products and also carbs. The most important goal is to increase your vegetable intake and try to eat as close to nature as possible. Eat foods in their most original form.

When it comes to deciding on the right ratio of carbs : fat : protein, work with a dietician. It may take time to find your correct balance and you need to be monitored properly with blood tests and possible medication adjustments.

Making the right food choices (at work)

Ask the dietician: Cheryl Meyer

From our community: “I get invited to lots of business meetings and workshops that are catered… Needless to say, none of the catering is healthy! What do I choose or how do I deal with this situation?” Rene Prinsloo.
Many of us consume at least half of our meals and snacks during work hours, which makes our food choices in catered meetings and workshops very important. Here are three steps to consider:

Step 1: Build your plate

  1. Aim to fill half your plate with vegetables or salad. Look out for vegetable skewers, veggie sides, crudités (chopped raw veg), soup or salads.
  2. Next, add a healthy carbohydrate: either a wholegrain/high fibre starch or a piece of fruit.

Look out for:

  • Wholewheat bread
  • A seeded roll
  • Wholewheat pita
  • Wholewheat pasta/noodles
  • Wholewheat wrap
  • Brown or basmati rice
  • Fresh fruit
  1. For long-lasting brain and body power, add a source of protein.

Some good protein choices:

  • Lean cold meats
  • Grilled chicken
  • Mini meatballs
  • Legumes like beans or lentils
  • Fish like tuna, sardines or pilchards
  • Cottage cheese
  • Boiled eggs

Sauces like low-fat mayonnaise, sweet chilli sauce, hummus or guacamole are optional but not essential.

Avoid:

  • Deep-fried foods (like samoosas, spring rolls or vetkoek)
  • Sausage rolls and pies
  • Croissants, muffins or other pastries

Step 2: Choose portions with caution

  1. Be sure to start the day with a balanced breakfast and keep healthy snacks or a packed lunch on hand to avoid arriving at a meeting hungry.
  2. Use smaller plates and serving utensils to help manage how much you dish up.
  3. Sit far away from the food to avoid “picking”.
  4. Use the size of your hand to determine sensible and healthy portion sizes and curb overeating:
  • A fistful is equal to one cup and can be used to estimate the portion size for carbohydrates (starches and fruits).
  • The size of the palm of your hand can be used to estimate the portion size for protein. For a stew, curry or casserole this would be about half a cup.
  • The tip of the thumb is equivalent to one teaspoon and can be used to estimate the portion size for all oils, butter or mayonnaise.
  • The thumb can also be used to estimate the portion size for peanut butter or hard cheese.

Step 3: Carefully consider your choice of drink:

Some good choices are:

  • Still or sparkling water
  • Tea or coffee
  • Vegetable juice
  • Low-fat milk
  • Sugar-free fizzy drinks

Diabetes-friendly kids menu

Ask the dietician: Genevieve Jardine

From our community: As the mom of a diabetic child, I’m constantly wondering what to make her that is delicious but won’t spike her blood sugar. Could you give me some basic guidelines please?” Bernadette Simons.

As a mother of three (constantly hungry) young boys I am kept on my toes when it comes to healthy eating. Although my children are not diabetic, I practice “diabetes-friendly” eating in my household. The bottom line is that you want your children to eat real, whole foods. This means no foods that are manufactured, processed and refined: time for a cupboard clear-out!

For children with diabetes, you need to make meals novel, colourful and exciting, while reducing refined carbohydrates and harmful fats. It’s important to break away from the rut of cereal for breakfast, sandwich for lunch and one-pot meal for dinner. Parents need to constantly focus on increasing fresh foods and not wait for dinner to try and make up the daily vegetable intake…
Here are some menu options:

Breakfast:

  • Bring back eggs for breakfast! Make eggs more interesting and nutritious by adding vegetables and baking in a muffin tray as mini crustless quiches. Serve with chopped strawberries or other brightly coloured fruit.
  • Try making your own cereal out of nuts and seeds, coconut shavings and some rolled oats. This can be eaten with plain yoghurt or milk. Use vanilla, cinnamon and half a grated apple to sweeten it naturally.

Lunchboxes:

  • Move away from a daily sandwich for lunch. Try choosing other low GI starch like baby potatoes or corn on the cob.
  • Add some protein – chicken drumsticks, hard-boiled eggs, meatballs, homemade fish cakes or cheese. Remember protein makes you feel fuller for longer and doesn’t spike blood sugar levels.
  • Add a small amount of colourful fruit like a fruit kebab or fruit salad.
  • All lunchboxes should have vegetables! If your child doesn’t like salad, give some cucumber and carrot sticks, baby tomato kebabs or cucumber sandwiches (two slices of cucumber with cheese or cream cheese in the middle).

Dinner:

  • Most traditional South African dinners are one-pot meals like curry, stew, cottage pie or spaghetti bolognaise that are high in starch and low in vegetables. Try adding more vegetables to stew, curries and mince. Make the mashed potatoes with added cauliflower, add lentils to brown rice, and use baby marrow or aubergine instead of pasta.
  • Always serve dinner with vegetables on the side. Raw carrot sticks, sliced cucumber or snap peas are kid-friendly. Children need to get used to eating vegetables that are not hidden in food but out in plain sight!

Remember: Children learn eating habits from their parents so you need to set the example. Tastebuds are influenced early on by processed foods with hidden sugars and fats, so it’s up to you to encourage your kids to eat – and love – real food.

Top tips for a pregnancy diet

Ask the dietician: Cheryl Meyer

From the community: “Being both diabetic and pregnant makes it difficult to know what to eat – there are so many things I have to avoid! And I’ve been craving sweet things. Any advice?” Sameshnie Naidoo.

The diet for pregnant women with diabetes should be a healthy, well-balanced eating plan aimed at supporting the pregnancy and promoting blood sugar control. This is essential for the wellbeing of both mom and baby.

Of course, pregnancy and diabetes means that there are more foods on the “Do Not Eat” list, as your normal diabetic diet has a new list of things to avoid. But bear in mind that it’s only for nine months, and that it’s for the best possible cause: your healthy child.

Foods to avoid:

Here’s a list of foods that you shouldn’t eat when you’re pregnant because they pose a potential food safety risk and might make you ill or harm your baby.

  • Soft cheeses e.g. brie, camembert, and blue-veined cheeses unless the label says they are made with pasteurised milk.
  • Processed cold meats or deli meats unless they are reheated until steaming hot.
  • Refrigerated paté or meat spreads (canned options can be eaten).
  • Refrigerated smoked seafood unless as an ingredient in a cooked dish e.g. a casserole.
  • Raw or partially cooked eggs and dishes that contain these e.g. homemade mayonnaise.
  • Raw or undercooked meat and poultry
  • Unpasteurised juice
  • Raw sprouts
  • Raw or undercooked fish or shellfish
  • The American Academy of Nutrition and Dietetics (AND) recommends pregnant women avoid fish high in mercury e.g. shark, swordfish, marlin. And limit intake of fish and shellfish lower in mercury e.g. prawns, canned light tuna and salmon, to 360g or less per week.

The good news? You don’t need to give up caffeine entirely. The AND recommends keeping your intake below 300mg/day, which is about one or two servings of coffee or tea. And of course rooibos is naturally caffeine free, so you can have as much as you like!

Being both diabetic and pregnant can feel restrictive from a diet point of view… When you’re lacking motivation, just remember that everything you eat your baby is eating too: so put down the junk food and pick up a carrot!

A note on cravings:

Whether it’s pickles and ice cream or other odd combinations, both cravings and food aversions are common during pregnancy. Although the exact cause is unknown, taste perceptions may change with hormonal changes. Cravings are generally harmless*, unless foods you crave replace more nutritious foods, or all you want is junk food. If broccoli loses its appeal, for example, substitute another vegetable that you enjoy and tolerate.

*Cravings for non-food substances like sand or chalk (a condition called pica) can be dangerous as they contain lead or other toxic substances. If you’re craving non-food items, consult your doctor.

Sundowner snacks

Ask the dietician: Genevieve Jardine

From the community: “My wife and I love having friends over for sundowners but never know what drinks to offer and what snacks to serve so that I can actually enjoy myself too. Any advice?” Riyaaz Benjamin.

Luckily, there is a way to enjoy (guilt-free) sundowners… It just takes a little planning. Let’s take a look at the when, what and where of it.

When?

The main problem with sundowners lies with the timing. As the name suggests, they usually occur long after lunch and just before supper. This means that you may arrive hungry and tired with low blood sugar levels: a recipe for overeating, drinking (sugary) alcohol on an empty stomach, and filling up on unhealthy snack food. After sundowners, you may then go for supper, which means even more food and alcohol.

The key? Sundowners are best handled when prepared. Make sure you have an afternoon snack just before arriving (preferably one that contains protein to help stabilise blood sugar levels). Upfront, decide to either have the snacks as a replacement dinner (only a good idea if there are healthy snack options) or hold back and leave room for a light supper.

What?

What is being dished up? The good news is that sundowner snacks are usually savoury and not sweet. The bad news is that savoury snacks – like chips and cream dip, sausage rolls and salty peanuts – are often high in starch and fat. Try to choose the healthiest options on the table, and don’t forget to dish up a plate rather than snacking so that you know exactly how much you’re eating.

Sundowners are also synonymous with cocktails (not the right choice of drink for anyone with diabetes!) When it comes to alcohol, good options are light beer, a wine spritzer made with Sprite Zero or soda water, or single spirit tots with diet mixers. Sparkling water with ice, lemon and cucumber is a refreshing drink if you’re not in the mood for alcohol.

Healthy snack ideas:

  • Lean proteins like nuts, lean biltong and grilled strips of chicken or beef.
  • Fresh vegetables like cucumber strips, baby carrots, baby tomatoes and celery sticks, served with a low-fat cottage cheese, avo or salsa dip.

Where?

The last thing to consider is where the sundowners are being held. If you’re hosting or going to a friend’s house, you can simply bring along what you would prefer to eat and drink. Restaurants can be more challenging, but easily overcome with a bit of forward planning. Call the restaurant beforehand and make sure that there are snacks or drinks on hand that you can enjoy. Most restaurants are more than willing to help – if not, at least you know and can plan for the evening.

Having diabetes doesn’t mean you can’t enjoy a cold drink and a delicious snack as the sun goes down, it just means you need to forward plan a little to enjoy it!

The basic diabetic pantry

Ask the dietician: Cheryl Meyer

From our community: “I’ve just been diagnosed and have no idea what to eat. Please help me! I just need some basic ideas of what to keep in my cupboard so I can make easy healthy meals…” John Tabenga.

Stocking your pantry is a fantastic place to start – healthy eating isn’t only about your kitchen, it begins when you wheel your trolley down the aisles of your local supermarket. Arming yourself with a well-planned grocery list will not only get you in and out of the shops quickly, it will also keep your healthy eating plan on track.

To help get you started I have put together a basic list to help you stock your fridge, freezer and pantry with healthy options:

Breakfast cereals

  • Oat bran
  • Rolled oats
  • Low GI muesli

Cooked starches

  • Baby potatoes
  • Sweet potatoes
  • Wholewheat pasta
  • Brown rice
  • Barley
  • Quinoa
  • Mealies
  • Corn: frozen, canned or fresh

Breads & crackers

  • Rye, wholewheat or low GI bread
  • Wholegrain crackers: Provitas, Ryvitas, Finn Crisp
  • Multigrain melba toast
  • Wholewheat wraps
  • Wholewheat pita bread

Legumes

  • Canned beans, lentils and chickpeas (drain and rinse well)
  • Dried beans, lentils and chickpeas

Dairy products

  • Low-fat milk
  • Low-fat yoghurt
  • Low-fat cottage cheese
  • Ricotta cheese
  • Hard cheeses: mozzarella or reduced fat cheddar

Tip: When choosing hard cheese, aim for less that 25g fat per 100g.

Meat, poultry, fish & eggs

  • Lean beef and pork, trimmed of fat
  • Chicken, trimmed of skin
  • Ostrich
  • Lean cold meats
  • Eggs
  • Fish rich in omega 3s: Fresh, frozen or tinned salmon, trout, tuna, pilchards, sardines, mackerel
  • Hake or kingklip fillets

Fats and oils

  • Olive / canola / avocado oil
  • Seeds
  • Unsalted nuts
  • Peanut butter
  • Avocado
  • Low oil dressings and mayonnaise (less than 5g fat per 100g)

Vegetables

  • Frozen vegetables: green beans, peas, carrots, cauliflower, broccoli.
  • Fresh vegetables
  • Tinned tomato
  • Tinned asparagus

Fruit

  • A variety of fresh fruit
  • Pre-cut frozen fruit
  • Canned fruit (in juice) for treats

Spreads

  • Hummus
  • Tzatziki
  • Olive oil

Snacks

  • Unsalted nuts
  • Lean or game biltong
  • Popcorn kernels to prepare homemade popcorn with a dash of oil and salt

Store cupboard basics

  • Non-stick cooking spray: Spray n Cook
  • Beef, chicken and vegetable stock powder
  • Lots of herbs and spices

Tip: Read food labels and compare different brands within each food category.

With these pantry essentials, you should be able to whip up all kinds of delicious diabetic-friendly meals… Check out our recipes here if you’re looking for inspiration!