carb counting for diabetics

The low carb diet debate

Remember when low carb wasn’t as well known as it is today? We do! Here’s an article from Sweet Life magazine published a few years ago that explains all the ins and outs…

Professor Tim Noakes says that a low carb, high fat diet is the way to go. We gathered your questions and asked him how the low carb diet affects diabetics. Here’s what he had to say.

  1. What exactly is this diet?

    A low carbohydrate, moderate protein, high fat diet. This diet is most effective for people with diabetes – either Type 1 or Type 2, or pre-diabetes, like myself. It also helps treat obesity, but it’s obviously not the diet for everyone. The question is whether it’s for 10% of the population, or 90% of the population – I think it’s about 60% or more.

    Low carb means no bread, pasta, cereals, grains, potatoes, rice, sweets and confectionery, baked goods. You have to be resolute – and the more severely affected you are, the more resolute you have to be. If you’re already diabetic, you have every reason not to eat these foods.

  1. Can you explain what carbohydrate resistance is?

    My opinion is different from the traditional teaching. Carbohydrate resistance is traditionally described as someone who is unable to take glucose out of the blood stream and store it in their muscle and liver. I disagree with this explanation: I think we’re all born with varying degrees of carbohydrate resistance, and the children who get really fat very young are the ones who are most carbohydrate resistant. The carbs they take in they simply store as fat. That’s the first group.

    The second group are people who become pre-diabetic at 30 or 40, and then they become diabetic at 50. They are overweight, and that’s a marker of the high carbohydrate diet. They eat a high carb diet, they are carb resistant and it gets more and more severe until they become diabetic. I think it’s genetic, and the reason I think that is because in my case, although I’ve lost weight, I’m still carbohydrate resistant – I can’t go back to eating carbs.

  2. What if you have high cholesterol? Isn’t it dangerous to eat so much fat?

    Firstly, the theory that high cholesterol is a good predictor of heart disease is not true – it’s a relatively poor predictor. A far better predictor is your carbohydrate status. Everyone knows this – if you’re diabetic or pre-diabetic, your risk of heart disease is increased. Diabetes, hypertension and heart disease are linked, but most heart attacks occur in people with cholesterol below 5. It’s very frustrating, because the public has got the wrong idea.
    A high fat diet corrects everything, in my opinion – your HDL goes shooting up, your triglycerides come shooting down and that HDL to triglyceride ratio improves dramatically: that’s one of the better predictors of heart attack risk. The LDL small particles are the killers, and on a high fat diet, those go down. Your total cholesterol can go up, but that’s because your HDL has gone up, and the large, safe LDL particles have gone up. So unless you measure all those variables: HDL and LDL and triglycerides and glucose tolerance, you can’t judge the effects of the diet.

  3. What carbs do you eat?

    The good carbs are veg – that’s it. Sweet potatoes (not regular potatoes), butternut, squash and then I also eat dairy: milk, cheese, yoghurt. I don’t eat any fruit except apples, but that’s because I severely restrict my carbs. You’re not cutting out nutrients if you eat nutrient-dense foods like liver, sardines, broccoli and eggs – those are the most nutrient-rich foods you can eat. You can get vitamin C from meat if it’s not over-cooked. The key is that you eat lots of fat, and you don’t avoid the fat. I eat lots of fish, like salmon and sardines. And you want to eat lots of organ meats – that means liver, pancreas, kidneys, and brains if you can get them, but particularly the liver. Liver is very nutritious.

  4. Is this diet possible for people who don’t have a lot of money?

    You don’t have to eat meat every day – you can eat sardines and kidneys, for example, which are both very cheap.

  5. Could the positive effect of a low carb diet on insulin resistance be because of the weight loss and not because of the new diet?

    No, absolutely not. Because it happens within one meal – your insulin requirements go down within one meal, because you’ve shut off the production of glucose by not eating carbohydrates.

  6. What is wrong with the old fashioned idea of a balanced diet? Why does it have to be so extreme?

    If you’re diabetic, you have a problem with metabolising carbohydrates. You have to understand that if you want to live a long life and have minimal complications, you want to minimise your carb intake. Start at 50g a day. What that looks like is two eggs for breakfast, with some fish – salmon or sardines, and some veg. And dairy: cheese or yoghurt. That will sustain you until early afternoon. For lunch, I think you should have salad and some more protein and fat – and exactly the same for dinner. Chicken, cheese, nuts, salad, tomatoes, broccoli. It’s an incredibly simple way to eat, but you don’t get bored.

Last words:

Once you’re on this diet, you feel so good, and you get rid of all these aches and pains and minor illnesses: you won’t want to go back. If you do go back to eating carbs you’ll put on the weight again. It’s not a diet, it’s a lifelong eating plan. It’s not a quick fix.

I think the diabetics who live to 80, 90, 100 are the ones who eat this kind of diet.

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!

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

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.

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!

 

“Cheat” treats


Ask the dietician: Genevieve Jardine

From our community: “I know that as a diabetic I should always try and be good, but sometimes it’s hard… What can I snack on without feeling too guilty about it (but that will also be a treat)?” Charne Smith.

A treat is something that tastes great, is normally high in fat and refined carbohydrate, and is eaten to either celebrate or make you feel better… But how do you have your treat and prevent it from totally messing up your blood sugar levels for the day?

Treats are not forbidden, but they should not be too often or too big. It all comes down to self-control and portion control. The occasional block or two of chocolate should not mean disaster for your blood sugar: it’s when you eat the whole slab that things spiral out of control. Everything in moderation is the key.

If you battle with cravings, you need to understand that the last bite never tastes as good as the first bite. The feel good rush you get from the first bite of a treat starts to fade as you continue eating, but your blood sugar levels start to increase.

What does this mean? You only need a small amount to feel like you’ve had a treat. You don’t need the whole slab, packet, bowl or slice…

How to cheat:

  • Split a dessert with your partner. It might drive them nuts, but it will keep your blood sugar and weight down. Better yet, plan ahead and choose a light main course so that you can have a small dessert on those special evenings out.
  • Choose biscuits and cakes that don’t have icing, or remove the icing and jam from cakes. Icing has twice the amount of sugar as the cake or biscuit.
  • Choose a dessert like apple crumble (without the ice-cream or cream) or two small scoops of ice-cream. Just remember to keep portions small.
  • Spoil yourself with some good diabetic-friendly ice-cream (low fat/low sugar), lite custard and diabetic friendly puddings.
  • Opt for small “bite” sized chocolates or chocolates with wafer inside (e.g. Kit Kat Fingers).
  • Dark chocolate with a high percentage of cocoa is better for you as it is higher in antioxidants. Dark chocolate is also bitter so people tend to eat less of it: usually a block or two is enough.
  • Salt and vinegar popcorn instead of crisps will keep your fat content low and help with salt cravings. When going to the movies, choose a small popcorn and a diet drink.

Remember: Spoiling yourself on the odd occasion is allowed. Always test your blood sugar levels to see how they react and you will learn to better control these situations.

10 FAQ about the diabetic diet

Ask the dietician: Cheryl Meyer

We asked our community what they most wanted to know about diabetes and food – here are 10 frequently asked questions, answered by our expert dietician.

  1. Must I cut sugar out of my diet completely?

Small amounts of sugar can be included in your diet, but too much sugar or sweet food is not recommended as part of a healthy eating pattern.

  1. What can I eat when I feel like chocolate?

Treats like chocolate can fit into a healthy diet, as long as you keep these points in mind:

  • Try to have treats with a meal, e.g. as a dessert.
  • Watch your portion size: choose a small portion or share.
  • Put a healthy twist on treats – check out these great recipes for ideas
  1. Do I have to buy special sugar replacements, or can I just use less sugar?

Small amounts of sugar, jam, and honey have little effect on blood glucose levels, so small amounts of sugar can be included in your diet, e.g. a scrape of jam on wholewheat bread.

  1. How important is fibre in a diabetic’s diet?

Fibre keeps your digestive tract working well, can help lower your cholesterol level and can improve blood glucose control if eaten in large amounts. Another benefit of fibre is that it adds bulk to help make you feel full. Given these benefits, fibre is important to include in a diabetic’s daily diet – and in the diets of those who don’t have diabetes!

  1. How many vegetables should I be eating in a day?

The amount of vegetables you need depends on your age, gender and level of physical activity. On average, an adult woman will need 2½ cups a day, while an adult man will need 3 cups, and children will need between 1 to 2 cups a day.

  1. How much protein do I need to balance out carbohydrate?

Protein should account for about 15 to 20% of the total calories you eat each day – roughly a fist-sized portion at each meal.

  1. Is too much fruit bad for diabetics? And grapefruit?

Fruit (any kind, grapefruit included) can be included as part of your diet, but controlling portion size is vital. Limit your portions to a fist-sized or tennis-ball sized portion at a time.

  1. How do I manage food for my diabetic child?

Provide structured, nutritious meals and snacks for your child and make healthy eating and lifestyle changes as a family (don’t single out one family member). Remember that they are a child first and a diabetic second. Work with your child’s diabetes health care team to help your little one grow up healthy and happy!

  1. My sugar is always high – am I eating wrong?

Diabetes is managed with diet, exercise, tablets and/or injections. Check in with your doctor to make sure your food choices, exercise levels and medication are on track to keep your sugar within your target range.

  1. How can a diabetic lose weight in a healthy way?

The best way to lose weight for good is to find an approach to eating that makes sense, doesn’t cut out whole food groups and has you eating regularly and feeling well.

 

Proudly South African portion sizes

Ask the dietician: Cheryl Meyer

From our community: “Can anyone tell me about madumbis for diabetics – good or bad for us, and how much can we eat?” Lynette Hitchcock.

Madumbis, amadumbe, African potato or taro – call them what you will, they are delicious! They have a rich, nutty, earthy flavour and a stickier texture than potatoes. Like potatoes, they fall into the carbohydrate group of foods and can be roasted, mashed or boiled.

The key to eating proudly South African carbohydrates like madumbis, roti, pap or samp in a healthy diabetic diet is portion control! Counting the carbs in your meals and being aware of the carbs you eat can help you match your medication or activity to the food you eat. This can lead to better blood sugar control.

Remember: Everyone needs a different amount of carbohydrate at each meal and/or snack – the amount that is best for you depends on your:

  • age
  • height
  • weight
  • physical activity
  • current blood sugar
  • blood sugar targets

Not sure how many carbs you should be eating? Ask your doctor or dietician for help.

A general guide:
  Carb limits for women Carb limits for men
Meal 30 – 60g 45 – 75g
Snack 15 – 30g 15 – 30g

What does this mean? A food that has 15g carbohydrate is called “one carb serving”. One slice of bread or a small piece of fruit each have around 15g carbohydrate, so they are equal to one carb serving.

One carb portions of Proudly South African foods:

1 carb serving 50g madumbi
1 small roti (35g)
⅓ cup pap (60g)
⅓ cup samp (75g)
½ cup sweet potato (100g)
1 medium mielie (140g )
½ cup rice (50g)
1 x 15cm tortilla or wrap (35g)
½ cup pasta (100g)
1 slice bread (30g)
1 small apple (115g)

As much as possible, try to stick to this portion size, with a serving of protein (meat, fish, chicken, eggs, beans) and half a plate of vegetables or salad.

How to cook amadumbe: Scrub them clean and steam or boil until soft. Drain and cool slightly before removing the skins. Serve dusted with black pepper, a dash of salt and a drizzle of olive oil. Yum!

Amadumbe in numbers:
100g portion boiled amadumbe has: *

  • 600 kJ
  • 5g plant protein
  • 1g fat
  • 5g of carbohydrate
  • 1g fibre

* According to The SA Food Tables