Ask the Dietician
Ask the dietician: Genevieve Jardine
From our community: “My daughter is on insulin injections and can’t inject for every cold drink she wants. Everybody says aspartame is bad for you, so what can she drink except water?” Di-ann Reid.
A lot of the excess sugar in our diet comes from drinks that are high in sucrose and fructose: regular fizzy drinks, energy drinks and also fruit juices. These not only have an effect on blood sugar, but also increase overall energy intake, which can lead to weight gain. That’s why these drinks aren’t a good idea for diabetics.
So what else can you drink?
Artificially sweetened diet drinks
These are pretty much kilojoule free and don’t raise blood sugar levels, but most of them contain aspartame – the topic of a lot of debate for many years. Although aspartame has been linked to increased risk of cancer, mood disorders and even diabetes, nothing has been proven and the FDA (Food and Drug Administration) has approved diet drinks with aspartame, with a limited daily intake. So it’s a good idea to reduce the number of artificially sweetened drinks you have, especially if you’re using other sweeteners in tea and coffee.
These often confuse people with diabetes, because they say “no sugar added” on the label. Although there is no added sugar, fruit juices are high in fructose sugar that can push up blood glucose levels. They are a concentrated form of natural sugar from the fruit – you get all the sugar, but none of the fibre that’s good for you. A small glass of fruit juice can have twice as much sugar as a piece of fruit!
Tip: When looking at food labels, always check the total carbohydrate content (per serving size) and not just the sugar content.
Here are some ideas for drinks with and without artificial sweeteners:
One-a-day drinks – low carb, with artificial sweeteners
- Diet fizzy drinks (Tab, Coke Light, Coke Zero, Sprite Zero, Fanta Zero etc.)
- Diet cordials (Brookes Low-Cal etc.)
- Light iced teas (Lipton Iced Tea Lite etc.)
- Light flavoured mineral water (aQuelle Lite etc.)
Everyday drinks – low carb, no artificial sweeteners
- Freshly squeezed lemon juice in ice-cold water.
- Hot or cold flavoured herbal teas (no sugar added).
- All unflavoured sparkling water.
- Chopped up fruit pieces (like strawberries, lemon or orange) soaked in water for the fruity flavour without the sugar.
Treat drinks – medium carb
These drinks have 6 to 8g of carbohydrate per serving – half the amount of normal drinks!
- 200ml tomato juice (low GI).
- 150ml Lamberti’s low GI juice.
- 100ml Energade Champ (low GI).
Ask the dietician: Genevieve Jardine
From our community: “With Christmas coming up I know I’m going to want to eat what I shouldn’t… What are the ‘safe’ foods to snack on at parties?” Jabu Hlazo
The festive season is a great time of year when the hard work is over and it’s time for fun and feasting. The question is, how do you celebrate with everyone else, but still maintain healthy blood glucose levels? Here are some holiday points to ponder.
Watch your weight
Most people tend to gain about 2 to 5kg over the festive season only to make a New Year’s Resolution to lose it again. Prevention is better than cure, so make it your goal not to gain any weight this festive season.
Using your bonus money to buy special treats is tempting – nothing says Christmas like mince pies or brandy pudding. This year, why not use your money to buy healthy treat alternatives: exotic fruit, nuts or delicious lean biltong. Better yet, spoil yourself with non-edible treats like a magazine, a new recipe book or a pair of running shoes.
Use your free time and the sunny weather to try a new activity. Play a game of tennis, hire a bike, do that hike you’ve always wanted to do. Take the focus off food and get adventurous. Touring a new city on foot or playing with the kids on the beach allows you to burn off kilojoules and improves your body’s ability to use insulin more affectively. The result? Better blood sugar control.
Re-gift the chocolates
It’s the season of giving and granny’s homemade biscuits or that box of chocolates can become very tempting. The truth is that you don’t have to eat the whole box in order to celebrate or appreciate the gift. This year, rather re-gift the biscuits and spoil someone else.
During the festive season the social calendar fills up. Be wise and plan around your daily ‘eating commitments’. It is still important to eat regular meals (even while on holiday) and you may need to adjust meal sizes and snacks around social engagements. For example, if you know that you have a family braai in the afternoon, you may want to plan a light lunch with a healthy snack just before you leave to help stabilize blood sugar levels and avoid binging on snacks. When invited out, offer to contribute to the meal and bring your own healthy alternative. You will be amazed how grateful people are when you arrive with an extra plate of fresh veggies and dip, or a fresh green salad or diabetic-friendly dessert.
Watch the alcohol
Holiday celebrations often involve excessive drinking, which can send blood glucose levels soaring with an inevitable crash in the early hours of the morning. Be sensible and opt for alternatives like light beer or light wine, and watch how much you drink: the recommended amount is two alcoholic drinks per day for men and one per day for women. Never drink on an empty stomach and don’t drink and drive. There is more at stake than just your blood glucose levels.
If the festive season means endless office parties and end of year functions, don’t hesitate to find out more about the food. Chat to the person in charge of catering the office party to ensure there will be snacks like chicken pieces, fruit kebabs, diced vegetables and sandwiches, as well as diet drinks and light alcohol. For restaurant dining, phone ahead for the menu and decide what to order so you’re not tempted when you get there. If you choose wisely and stick to reasonable portions, you’ll get through the festive season just fine.
Ask the dietician: Genevieve Jardine
From our community: “I find myself worrying about food a lot, as a diabetic… What are the essentials I should always have on hand for healthy lunches or quick food on the go?” Kriveshen Moodley.
Life is busy, with many demands that distract us from healthy eating. So how do we make good food choices? It starts with the right attitude and being prepared. As a diabetic, it’s important to remember that food is part of your treatment, so it needs to be a priority – but it doesn’t need to be hard.
Some helpful tips for simplifying food choices:
- Plan meals for the week and do a big weekly shop.
- Take a bag full of fresh food to work on Monday morning to use as lunch for the week.
- Keep healthy snacks stashed in your car.
- Have a back-up meal replacement drink for those times you don’t have time to eat.
Great tip: Wake up earlier so that you have time for breakfast at home – always a good idea!
- Bake some diabetic-friendly muffins as a breakfast option.
- A poached egg in the microwave (even at work) on a slice of low GI toast with a piece of fruit is a healthy choice.
- Microwave oats (they’re low GI!) with a chopped apple or ¼ cup (30g) raw nuts and seeds to make a quick nutritious breakfast.
- A sandwich made with low GI bread filled with lean protein (cottage cheese / low-fat meat / tinned fish). Stuff with lettuce, tomato, cucumber and other salad.
- Vegetable soup with 1 to 2 slices of low GI bread or a small wholewheat roll.
- A picnic lunch with wholewheat crackers, hummus for a dip and cucumber chunks, carrots sticks, baby tomatoes or snap peas instead of a salad.
- A salad made with lean protein (chicken or tuna) with very little dressing and no high fat toppings (croutons, bacon bits, cheese etc).
Great tip: Cook meals for the week or cook double portions and freeze the food so that you have meals ready when you don’t have time to cook.
- Make simple meals that don’t need lots of attention: roast chicken or baked fish with roasted vegetables. A steaming net is a handy tool that fits into any pot and steams all your vegetables at one time.
- Always have a stash of frozen vegetables in the freezer for when you run out of fresh vegetables. When life gets busy, the first food groups to suffer are vegetables and fruit.
- Always have salad ingredients handy. Salad is a quick side dish that takes up room on the plate so you can’t fill it with more carbs!
- An omelette filled with vegetables like tomatoes, onion, mushrooms and peppers is a quick and healthy meal.
Get more fantastic meal ideas here.
Ask the dietician: Genevieve Jardine
From our community: “Being newly diagnosed, I am learning about foods that I can and can’t use. I cannot find an article explaining what to look for. It’s all a bit confusing. Help would be greatly appreciated.” David Staff.
“Eat the right type of food, in the right amount, at the right time of the day”
It’s important to make dietary changes that are simple and progressive. First you need to learn what foods should be in your trolley, fridge and kitchen cupboards: that will make good eating decisions easier to choose.
I have one simple rule: eat food that is as close to its natural form as possible! This helps to reduce the amount of processed, high sugar, high-fat foods that cause problems with weight and blood sugar control. Try not to focus on what you can’t have (it is very depressing) and rather be adventurous in experimenting with healthy nutritious meals.
Once you know which foods are suitable, you need to get specific and work out how much to eat. Portion control is very important. The good news is that almost all foods are allowed in correct portions.
Here are some general rules:
Starch: Use low GI, high fibre starches. Reduce foods made with lots of white flour and sugar (doughnuts, biscuits, cakes ). For your main meal, the portion size of starch should be the size of your fist (approximately 2 portions of starch).
Protein: Opt for low-fat protein. Remove visible fat from meat and skin from chicken. For your main meal, the portion of protein should be the size of the palm of your hand and the same thickness as your baby finger (less at other meals)
Dairy: Choose low-fat or fat-free dairy. Try for 2 portions of dairy a day.
Vegetables: Choose a variety of colours and serve raw, steamed and roasted. Eat lots – double portions where possible!
Fruit: Try to eat a variety of fruits. The size should be that of a tennis ball and you should aim for 2 servings of fruit a day.
Fat: Try to reduce the use of fats in your cooking. Rather grill, bake, boil, steam, microwave or stir-fry your food. The portion of fat should equal the size of the tip of your thumb.
Specific portion sizes:
- ½ cup wholewheat cereal / muesli
- ½ cup cooked, cooled and reheated mealie meal / oats porridge
- 1 slice seed loaf
- ½ wholegrain seed roll / low GI bread roll
- 3 Provita / 2 Ryvita
- ½ cup (2 Tbs) beans or whole corn
- 1 small mealie on the cob
- ½ cup cooked, cooled & then reheated samp
- ½ cup pasta / long grain rice / wild rice
- ⅓ cup white rice
- ½ cup brown rice with added lentils
- ½ medium sweet potato
- 2 – 3 baby potatoes
- ½ cup cooked lentils
- 1 egg
- 30g grilled chicken / ostrich / extra lean mince / grilled beef or pork
- ¼ cup tuna
- 30g steamed / poached / grilled / baked fish
- 2 tbs peanut butter
- 50g raw soya
- 90g tofu
- ½ cup cooked lentils / beans
- 1 cup low-fat / fat-free milk
- 100ml low-fat / fat-free sweetened yoghurt
- 30g low-fat cheese (Lichten Blanc, Dairybelle InShape, Elite Edam, Woolworths, Mozzarella)
- 50g low-fat feta cheese (Pick n Pay Choice Danish Style / Traditional, Simonsberg)
- 50g low-fat cottage cheese (Dairybelle, Lancewood, Parmalat, In Shape, Clover)
- Green pepper
- Baby marrow
- Bean sprouts
- Mixed vegetables
- Green beans
- 1 medium apple / peach / pear / grapefruit / orange
- 1 large naartjie
- 3 small apricots
- 10 – 12 grapes (only!)
- 1 small to medium nectarine
- 1 tablespoon dried fruit
- ½ cup fruit salad
- 2 teaspoons low-fat margarine / mayonnaise / dressing
- 4 olives
- ¼ avocado
- 80ml low-fat gravy / sauce
- 1 teaspoon olive / canola oil
Ask the dietician: Genevieve Jardine
From our community: “My average blood sugar over the past few months was higher than it should have been, so I’m trying really hard not to eat the wrong foods. Any tips for healthy snacks?” Lynnae Daniel
Getting creative with your snacks can really help make your daily meal plan more exciting. We all get into a rut with our meal choices, and adding different (healthy) snacks can improve variety, colour, flavour and even add valuable nutrients to your daily intake.
Not every person with diabetes needs to snack. Some people are happy with three square meals a day, while others prefer small snacks throughout the day. Your unique eating style largely depends on your own natural eating patterns, medication, blood sugar control, and how active you are.
Remember: If you go for more than 4 or 5 hours between meals you may need to snack in order to prevent your blood sugar from dropping too low. But snacking on the wrong kind of food can cause blood sugar levels to rise and also cause unwanted weight gain.
So what does a healthy snack look like?
- A snack should be between 300 to 600 kilojoules otherwise it is more like a meal.
- Snacking is a good chance to increase your vegetable or fruit intake (remember, the aim is 5 servings of vegetables a day).
- Plate your snack to help control portion size: don’t eat straight out of a bag, box or packet – or straight from the fridge!
- Portion your snacks into snack-size packets, or buy suitable snack portions.
Ask yourself: are you actually hungry? Don’t snack because you’re bored, stressed or worried.
Healthy snack ideas:
- One piece of fruit (carb 15g, fat 0g, 300kj)
- 100ml low-fat flavoured yogurt (carb 16g, fat 2g, 400kj)
- 2 cups popped popcorn sprinkled with fat-free parmesan cheese (carb 15g, fat 7g, 636kj)
- 30g lean biltong (carb 0.7 g, fat 2g, 346kj)
- 3 Provitas or 2 Ryvitas with cottage cheese, tomato and gherkin (carb 20g, fat 2g, 382kj)
- ½ an apple with 20g sliced low-fat cheese (carb 8g, fat 5g, 430kj)
- Raw veggies (carrot sticks, cucumber, baby tomatoes, gherkins, baby corn, snap peas) with cottage cheese, hummus or avocado dip (carb 8g, fat 7g, 540kj)
- 30g nuts/seeds (carb 3g, fat 14g, 735kj)
Tip: Nuts and seeds are high in fat and kilojoules. However, the type of fat is much healthier than that found in a chocolate bar.
Unhealthy snack choices:
- 50g bar of chocolate (carb 30g, fat 12g and 1120kj)
- 30g packet of potato crisps (carb 24g, fat 12g, 766kj)
- 300ml bottle of drinking yoghurt (carb 45g, fat 5.6g, 1140kj)
- 25g packet of sweets (carb 18g, fat 0g, 316kj)
Tip: It might seem like this snack is within the recommended carb, fat and kilojoule allowance, but they are empty kilojoules with no fibre and very little vitamins and minerals.
Snacking for exercise:
Remember that exercise can also cause low blood glucose. It is important to check blood glucose before and after you exercise. People react differently to exercise depending on the type, duration and intensity: some people see a rapid drop and others an increase in blood sugar levels, so it is important to test and see what your individual response is.
As always, you should see a dietician to help you plan suitable snacks for different situations. Fresh snack ideas can bring a sense of fun into your daily eating plan.
Ask the dietician: Genevieve Jardine
From the community: “I would like to understand the nutritional information printed on food labels – I’m new to it all and don’t know what I should and shouldn’t be looking for.” Lynnette Hitchcock.
Food labels are certainly not the simple list of ingredients they used to be – they’ve evolved into complicated beasts that don’t make sense to most people. So what information is actually useful? What makes you decide to put a product into your trolley?
Let’s take a look at an example: Jungle Energy Bar (Yoghurt)
At the top of the label is the nutritional breakdown for 100g/ml and the breakdown per serving size. Make sure that you read the label clearly and understand the difference – this example is clear because it gives the nutrients for 100g and for the 40g bar.
There should also be a list of ingredients with the highest ingredient by weight listed first. You can then check the nutritional value of a particular ingredient by referring to the nutrition information panel.
When it comes to Energy, look at the serving size. This energy bar contains 760kj per bar. People with diabetes who are trying to manage their weight should compare total energy of a few products to get perspective. For example, this energy bar is a snack, but when you compare it to the energy content of an apple (273Kj) or low-fat yoghurt (425Kj) you will notice that it contains twice the amount of kilojoules. There is no reference for energy content because you have to take into account your total energy intake across the day.
The Protein content per serving may come with a percentage next to it (not found on this example). This is merely to indicate how much of the product contributes to the recommended daily allowance of the average individual: about 55g protein per day.
This is important for diabetics, especially those who are carbohydrate counting or watching their carbohydrate intake. On most labels you will see two categories “Total Carbohydrates” and “of which are sugar”. This information can be tricky to interpret: the total amount of carb is more important than how much sugar and starch there is, as all sugar and starch eventually ends up as glucose in your blood stream. The “sugar” indicated on the food label could mean added sugar or natural sugars found in the food. If we look at the list of ingredients, we see that oats appear first (highest in weight) followed by sugar and golden syrup. This would indicate that oats make up most of the carbohydrate amount, with a smaller contribution made from sugar and golden syrup. The sugar is therefore added sugar.
If you look at the label, there are 25g of total carbohydrate in the energy bar. 15g of carb is one portion, so this energy bar is closer to two servings (30g) of carbohydrate. The bar therefore has a much higher carb content than an apple, 3 Provitas or 100ml low-fat flavoured yoghurt – all 1 carb.
When looking at the fat content, take a look at the values per 100g/ml. Take note of the total fat content and then the saturated fat and trans fatty acid.
For a product to be labeled “low-fat” there needs to be less than 3g of total fat per 100g (solids) or 1,5g per 100ml (liquids). Fat-free means less than 0,5 g total fat per 100 g/ml.
Saturated fat is part of total fat and is a key player in raising cholesterol. Low saturated fat is less than 1.5g per 100g (solids) or 0.75g per 100ml (liquids). This energy bar is not low in fat or saturated fat.
Trans fatty acids have a similarly harmful affect and also lower your HDL (good) cholesterol. For a product to be called “trans fat free” there should be less than 0,1g per 100g/ml.
Fibre is very important to help improve gastro-intestinal health, prevent cancers, help lower cholesterol and delay the release of glucose into the blood stream. It also helps you feel fuller for longer. These are all very positive benefits which make a high fibre product very desirable. The recommended daily intake for fibre is 25g per day (for women) and 30 to 45g per day (for men). As a general estimate, a high fibre product would be more than 5g of fibre per 100g. This energy bar just makes the grade.
Sodium comes from salt: a high salt intake has been linked to raised blood pressure in some people. The recommended daily intake of salt is 240 to 300mg per day. A low sodium product should contain less than 120mg per 100g. A sodium free product should contain less than 5mg per 100g. This energy bar is not too bad.
So overall how does the energy bar fair? The energy and total carbohydrate content of the energy bar are similar to that of a Bar One chocolate, with slightly less total fat. On the plus side the fibre content is good and the sodium content is low. I would suggest this energy bar as a treat.
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*:
- Omega-3 rich foods: like salmon, mackerel, pilchards, tuna, canola oil, flaxseed oil, flaxseeds and walnuts.
- Leafy green vegetables: like spinach, kale, lettuce and bok choi. These powerhouse foods are low in kilojoules and total carbohydrate.
- Wholegrains: easily trump their paler, refined counterparts. Choose brown or wholewheat options for a source of protein, fibre and B vitamins.
- Berries: sweet, yet low in calories and packed with antioxidants, vitamins and fibre.
- 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.
- 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.
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.
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.
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.
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!
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
- 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
- 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
- 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.
- 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.
- 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.
- 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)
- Fresh fruit in season
- Fruits with a naturally lower sugar content, such as berries, apples and citrus
- Fruit juices
- Dried fruit with sugar coating
- Fruit canned in a thick syrup
Fats and oils
- Foods that are naturally high in fats like olives, avocado, nuts and seeds
- Good quality oils such as extra virgin cold pressed olive oil
- 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).
- Filtered water flavoured naturally with lemon or mint
- Herbal teas
- 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.