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.
- 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.
- 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
- 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.
- 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!
- 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.
- 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.
- 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.
- 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!
- 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.
- 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.
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:
- 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
Ask the dietician: Genevieve Jardine
From our community: “My favourite food isn’t very good for me… I love braais and chips, hamburgers and hot dogs. Is there any way to make these delicious foods better for me? Help!” Thabo Duma.
All of us like a bit of pleasure in life, and nothing beats a treat now and again. The attraction of junk food lies in its “quick fix” ability to satisfy food cravings. Unfortunately, what makes junk food so delicious is also what makes it unhealthy. Junk food tends to be high in kilojoules, bad fats and refined carbohydrates. Because it tastes so good, it’s also hard to stop eating. You may get away with one biscuit, but 4 or 5 will cause a significant increase in blood sugar.
When relaxing with family and friends, you want to be able to enjoy holiday food: take-outs, braais and easy meals. There are definitely ways to enjoy these times without feeling left out – and without packing on the extra kilograms!
For take-out options, choose grilled chicken breast or beef hamburgers with salad (no chips!) Or try grilled chicken breast, spicy rice, coleslaw and green salad. Choose water or a diet fizzy drink to go with your meal, and obviously skip the dessert. Try to avoid food that’s high in fat and refined starch and sugar – pizza, deep fried chips and sugary drinks are all a bad idea.
Who said a braai couldn’t be healthy? Bring chicken or beef kebabs and braaied corn on the cob, with carrot salad and green salad on the side. These are a much better choice, and much lower in fat and carbs than boerewors and chops, garlic bread, pap and gravy or white bread rolls. And they’re delicious!
If you’re looking for delicious snacks, here are some yummy diabetic-friendly options:
|Snack||Portion||Energy||Carbohydrate (including sugar)||Fat|
|Popcorn (lite)||2 cups popped||636kj||15g*||7g|
|Dried fruit||2-4 pieces||381kj||21g||0g|
|Low GI biscuit||1 biscuit (30g)||440kj||15.3g||5.8g|
|Lean biltong||Handful (30g)||346kj||1g||2g|
* Remember that one carbohydrate portion = 15g.
Compare those to regular snacks and you’ll see the difference:
|Snack||Portion||Energy||Carbohydrate (including sugar)||Fat|
|Chocolate||1 bar (50g)||1120kj||30g||15g|
|Energy bar||1 bar (40g)||739kj||22g||7g|
|Biscuits (with icing)||2 biscuits (33g)||676kj||30g||7g|
|Sweets (boiled)||125g packet||316kj||18g||0g|
|Potato crisps||1 packet (30g)||766kj||24g||12g|
We all know that a healthy diet is key to managing your diabetes. But should you also be taking a diabetic supplement? Andrea Kirk asks the experts.
Living with diabetes can be challenging, so when you hear about a natural supplement that works wonders, it’s easy to get excited. “A number of supplements have been said to play a role in improving insulin sensitivity, blood sugar control, and helping to prevent complications of diabetes,” says endocrinologist Dr Joel Dave. “Although there is some observational evidence to suggest that some of these may be beneficial, unfortunately there are no large, long-term, placebo-controlled studies that prove any supplement is effective when it comes to diabetes.”
Dietician Cheryl Meyer agrees: “In some cases benefits have been shown, but at this stage there is just not enough scientific evidence.” Both experts believe that a well balanced diet should provide all the essential minerals and vitamins you need.
“I don’t recommend routine supplementation,” says Dr Dave, “but if someone is deficient in a specific vitamin or mineral, then I would recommend they take a supplement of that particular vitamin or mineral.”
When a supplement may be necessary
If you are experiencing specific symptoms and suspect you are deficient in a vitamin or mineral, speak to your doctor about having a blood test. Your doctor will make a recommendation based on the test results and may prescribe a supplement. Keep in mind that the type and dosage your doctor prescribes may be different from what is found on the shelf. Stick to your prescription rather than self-medicating.
Be careful of drug interactions
Dietary supplements can have adverse interactions with prescription drugs, other herbal products or over-the-counter medications, warns Meyer. The effects range from mild to potentially life-threatening, so it is important to disclose everything you are taking to your doctor.
Never replace your conventional prescription
“Don’t replace a proven conventional medical treatment for diabetes with an unproven health product or practice. The consequences can be very serious,” says Meyer.
“I generally advise my patients to steer clear of supplements unless we know for sure that it’s necessary,” says Dr Dave. “Rather focus on sticking to a healthy diet and lifestyle, monitoring your blood glucose and taking the medication your doctor has prescribed.”
Supplements and their claimed benefits
Alpha-lipoic acid (ALA) is an antioxidant made by the body. It is found in every cell, where it helps turn glucose into energy. Several studies suggest ALA helps lower blood sugar levels. Its ability to kill free radicals may also help people with nerve damage, which is a common diabetes complication. For years, ALA has been used to treat diabetes-related nerve damange in Germany. However, most of the studies that found it helps were based on using intravenous ALA. It is not clear whether taking it orally will have the same effect.
Source: University of Maryland Medical Centre
Chromium is an essential mineral that plays a role in how insulin helps the body regulate blood sugar levels. For many years, researchers have studied the effects of chromium supplements on those with Type 2 diabetes. While some clinical studies found no benefit, others reported that chromium supplements may reduce blood sugar levels, as well as the amount of insulin people with diabetes need. Good food sources of chromium include whole grain breads and cereals, lean meats, cheese, some spices (like black pepper and thyme), and brewer’s yeast.
Source: University of Maryland Medical Centre
Fenugreek seeds may be helpful to people with diabetes because they contain fibre and other chemicals that are thought to slow digestion and the body’s absorption of carbohydrates and sugar. The seeds may also improve the way the body uses sugar and increase the amount of insulin released. An Iranian study found that a daily dose of fenugreek seeds soaked in hot water may be helpful in controlling Type 2 diabetes. Another study from the US suggests that eating baked goods, such as bread, made with fenugreek flour may help to reduce insulin resistance in people with Type 2 diabetes.
Several studies have shown that American ginseng lowered blood sugar levels in people with Type 2 diabetes. The effect was seen both on fasting blood sugar and on glucose levels after eating. One study found that people with Type 2 diabetes who took American ginseng before or together with a high sugar drink experienced less of an increase in blood glucose levels.
Source: Penn State Milton S. Hershey Medical Center
Magnesium deficiency has been associated with increased risk of Type 2 diabetes. Some studies suggest that supplementing may be beneficial, but other studies have shown no benefit. A healthy diet should provide all the magnesium you need, so have your doctor check for deficiency before you consider supplementing. Good food sources of magnesium include legumes, whole grains, broccoli, green leafy vegetables, dairy products, seeds and nuts.
Source: Oregan State University and WebMD
From our community blog:
I am in urgent need of assistance to help me get my diabetes / blood sugar levels in control and I’m actually almost on the brink of losing it… I’m struggling with sky high sugar levels and very low sugar levels, but it’s never between 4 and 6, it’s either lower, very low, or very-very high! I don’t know what to do anymore…
Please give me some advice. I am 28 years old, and have been diabetic since I was 9 years old.
Do not give up. If you are in a position to visit a Provincial Hospital do so. I want you to see a doctor please, for expert advice, as you need to undergo tests.
Sorry to hear that you are struggling with your diabetes. It is difficult to know how to help unless I have some information about types, doses and frequency of injections as well as some glucose values. You need to test and establish a pattern as to when the problems occur and in relation to what. Blood sugars that swing up and down cause more problems than those that are more stable. I suggest you establish a testing profile and then post again.
I have been a diabetic for 9 years as well and I am also 28 years old. You need to take a look at your diet and your lifestyle. From your email you sound like you are under a lot of stress and that is not helping your diabetes. With your sugar levels being so out of control your moods get affected badly. So strange how sugar levels have this effect on us but very true. You need to eliminate as much stress from your life as you can. You can get back to where you need to be as long as you take the day by day steps.
Your eating is very very very important and if you can try to exercise you must. When I was first diagnosed mine used to sit in the 30′s NOT GOOD! But now I am between 5-8 most days. I know that there are days when it is hard to keep your sugar levels under control but YOU CAN DO IT!
Please let me know if I can help with anything!
Whether you battle to lose weight, or struggle to gain it, maintaining a healthy weight is a constant battle for many people with diabetes. Joanne Lillie explains how to make lasting changes.
Putting on weight
Controlling blood sugar levels is the starting place for achieving your target weight with Type 1 diabetes, as high blood sugar levels will cause glucose to be lost in the urine and result in weight loss, says dietician Genevieve Jardine. Many people find that once their glucose levels are under control, weight management becomes much easier.
Top tips to build mass:
- Go for low GI: To balance your glucose levels, lower-GI carbs such as wholegrains, beans, sweet potatoes and some fruit (like plums and apricots) are great choices, as they are less likely to spike your blood glucose. Milk and yoghurt also have a low GI. Just remember that low GI food still has to be eaten in the right portion.
- Eat more often: Rather than three meals a day, eat six smaller meals a day. Check your blood sugar more often and inject accordingly if you decide to try eating this way. Don’t skip meals as you will miss opportunities to increase your calorie intake.
- Fat has more calories than carbohydrates or protein: fat contains 9 calories per gram, while carbs and proteins contain 4 calories. So it makes sense to eat more fat when you’re aiming to put on a few pounds. Just be aware that you need to choose healthy fats. Cook with more olive or canola oil, get plenty of nuts and seeds, and add avocado and olives to salads.
- As long as your kidneys are in good shape, you can add protein powder to yoghurt or smoothies. This helps you gain weight as lean muscle mass rather than fat.
A normal body mass index (BMI) is vital for people with diabetes. “As the BMI increases, the amount of insulin required to maintain a normal glucose level also increases because patients become more insulin resistant,” explains endocrinologist Dr Joel Dave. An elevated BMI is also associated with high blood pressure (hypertension) and high cholesterol (dyslipidemia).
Healthy eating, regular physical activity, and medicine (if prescribed), are the key elements of Type 2 diabetes management. For many people with diabetes, the most challenging part of the treatment plan is working out what to eat.
Top tips to lose mass:
- Aim to reduce your energy intake while sticking to a healthy eating pattern. This means getting all the nutrients you need, in as few calories as possible. How? By focusing on nutrient-dense foods such as green vegetables, some fruits (especially berries) and beans.
- Carbohydrates from vegetables, fruits, wholegrains, legumes and dairy products are better than from other sources, especially those with added fats, salt and sugar. The most carb-dense foods include those with refined white flour: breads, biscuits, pastries, cakes, as well as white rice and potatoes. Limit these as much as possible!
- A Mediterranean-style diet may boost weight loss and benefit blood sugar control and cardiovascular risk factors. This means:
- Eating mostly plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts
- Keeping carbohydrate levels as low as possible
- Using healthy fats, such as olive oil
- Using herbs and spices instead of salt to flavour foods
- Limiting red meat to no more than a few times a month
- Eating fish and poultry at least twice a week
Ask the expert: Genevieve Jardine, dietician
“Learn to respond to hunger and not appetite. Often a high carbohydrate diet makes people hungry whereas enough protein and healthy fats helps make people feel fuller for longer.”
It might seem as though being a restaurant chef would be too tempting a job for a Type 1 diabetic, but 30-year-old Vanessa Marx has made an art out of making healthy food delicious – and accessible.
When did you find out you were diabetic?
I was about sixteen and in high school – seriously bad timing! I had all the usual symptoms. I was drinking about four litres of water a day and falling asleep during class because I was so exhausted. My mom eventually suspected diabetes and I had to be hospitalised. It was a traumatic experience. I’ve always loved food, and I remember lying in my hospital bed naming all the foods I could never eat again… It was a long list!
How has diabetes changed your daily life?
That’s a hard question, because it’s so much a part of my daily life. It can be difficult, sometimes, explaining to people who don’t have diabetes how you’re feeling. If I wake up with low blood sugar, for example, I’m exhausted before the day begins. People understand a throat infection, but they often don’t understand what waking up low feels like. As a head chef, I need to be alert every day, taking charge of the kitchen. There’s no room in a busy kitchen for feeling tired or unwell because of high blood sugar or needing time out to have something sweet because of low blood sugar.
Isn’t it difficult to be around food all day? How do you resist sweet treats?
It is quite tricky! Often just the act of making sweet treats for someone else satisfies the urge for me but other times I’m pretty tempted: what puts me off is that I know how I’ll feel later. I do believe in “everything in moderation”, so I allow myself a treat now and then. As long as it’s a once-off, and I’m not doing it every five minutes!
What advice would you offer to other diabetics?
Be disciplined! Pay attention to your diet: what you eat plays a huge role in how you feel. Also don’t feel like you’re on your own, don’t be afraid to ask for help – talk about your diabetes, and explain to those around you what it feels like. There’s still a stigma around diabetes, that it’s only people with weight problems who are diabetic. But the only way we’re going to change that is by talking about it.
What makes your life sweet?
My family and friends, and my work.
Get in touch with Vanessa: @vanessajaynem on Twitter and Instagram
Together with Pick n Pay, we’ve designed a cookbook specifically for people with diabetes who want ideas for every meal of the day. Breakfast, lunch, dinner, snacks and treats – there’s something for everyone!
Get nutritional advice on how to build balanced meals, and delicious recipes the whole family will enjoy – whether or not they have diabetes.
From our community blog:
Petunia has a question for us about lowering high blood sugar:
“I would like to know what can I do to bring down my sugar. I have Type 2 diabetes, I’m on Actraphane 30/70 and I don’t have a proper diabetes diet.”
What do you suggest?
The obvious ones that spring to mind are:
- Eat lots of fresh vegetables, wholegrains, lean protein and no refined carbohydrates.
- Steer clear of sweet treats.
- Drink lots of water.
- Exercise a little every day – even if it’s just a walk around the block.
- Lose weight if necessary.
What do you have to add? Let’s help Petunia out!
I am also Type 2 – I find the best thing is exercise. Sometimes you can’t avoid the carbs, but if you walk, run or cycle 30 min per day – you can reduce your sugar levels significantly.
Diabetes is not an easy quick fix ever. It is important to manage this condition in the best way always and this means getting a lot of HELP! I suggest you find a dietician or a diabetes educator in your area and schedule an appointment a soon as possible. In order to understand this condition it’s important to understand how food and your medication impact on your glucose levels. It becomes so easy with this help!
Richard English has Type 1 diabetes – but that hasn’t stopped him from embarking on all kinds of adventures, including a seven day, 1000km cycle across England and Scotland. We ask him for his secrets to a healthy life with diabetes.
When did you find out you were diabetic?
Eight years ago, when I was 25. I had been feeling incredibly under the weather and stressed, but I blamed work and too much partying – I just thought I was run down. Then I started getting all the symptoms: extreme thirst, dramatic weight loss, drinking 2 litres of water a night and needing to pee every hour.
How has diabetes changed your daily life?
Obviously I have to inject insulin before I eat anything, and I test my blood sugar more or less before every meal. Exercise is also more of a need than a want – I always used to exercise, but now I can see the effect on my blood sugar results, immediately. That’s very motivating.
I went cold turkey on a lot of things when I was diagnosed, and I haven’t kept any bad habits. I’m 20kg lighter than I used to be, and I don’t over-indulge any more. I suppose, in my case, diabetes could be seen as a positive thing. I wasn’t living a healthy life before I was diagnosed, and I have a better quality of life now.
I don’t think I could have adapted so well to life with diabetes if it weren’t for my wife, Casey. She never left my side, and all the dietary changes I adopted she did too. She also helped a lot in the early stages, when there was just too much information for me to absorb. She got behind the science of it and now knows more about low GI and its effect on blood sugar than I do!
Have you always been a cyclist?
I got my first bike when I was 5 years old, and I’ve almost always had a bike. Cycling is a big part of my life, and I really love it. I stopped exercising for about 6 months after my diagnosis, because I was uncertain about what it would do to my blood sugar, and every so often I have to cut a ride short because I’m going low. But most of the time diabetes doesn’t get in the way of my cycling at all.
Can you tell us about the Ubunye Challenge?
The Ubunye Challenge is a triathlon event organised by an old Rhodes friend of mine, Cameron Bellamy in 2012. He decided to raise funds for the Angus Gillis Foundation by doing an extreme cycle, swim and rowing challenge. I joined him for the cycle – I rode for seven consecutive days and covered 1000km through howling gales, rain, sleet and snow. It was in April, which was supposed to be spring, but it was shockingly cold. By the third day, we outran the weather and I saw my shadow for the first time. That was a good moment! 1000km seems like an unbelievable distance, but if you do it in 120km chunks it’s not that bad.
What advice would you offer to other diabetics?
To me, the most important thing is that you have to stay positive and optimistic, because diabetes is not going to go away. As soon as you can smile at it and look it in the eye, you’re on your way to living a happy life with diabetes. The sooner you can get positive about it, the better.
What makes your life sweet?
My wife Casey, my wonderful son Robbie, weekends with friends, good food, my bike, and exploring my new home city of London.
Get in touch with Richard: email@example.com
- Half of South African adults are overweight or obese. What that means is increased risk of heart disease, Type 2 diabetes, certain cancers and premature death.
- Our eating habits have changed so much that South Africans now spend more money on beer than on vegetables and fruit combined. What?!
- 45% of South African women are obese, as opposed to only 15% men. In 2013, South African women were the most obese in sub-Saharan Africa. So South African women are the most at risk for obesity.
I asked why that was and apparently there are three reasons:
- Women who were nutritionally deprived as children are more likely to be obese as adults (men who were deprived as children are not).
- Women of higher adult socioeconomic status (which is income, education and occupation) are more likely to be obese, which is not true for men.
- And possibly: in South Africa, women’s perceptions of an ‘ideal’ female body are larger than men’s perceptions of the ‘ideal’ male body – it’s seen as a status symbol to be a heavier woman.
Are you a South African woman? I am… Let’s make sure we’re informed and don’t let obesity happen to us and our sisters, mothers, daughters, friends.
Vitality gathered data from half a million Discovery members to give us these results:
- Their weight status (BMI and waist circumference)
Cape Town scores highest, with 53.5% of Capetonians in a normal weight range. Cape Town also topped the healthy purchasing score (which shows a positive relation between what you buy and whether your weight is in range or not.)
Fruit and vegetables
Cape Town purchased the most portions of fruit and vegetables compared to other cities – see the ranking above. In general, though, South Africans are only eating 3 servings of fruit and vegetables a day, as opposed to the 5 servings we should be eating.
Durban purchased the least amount of salt in SA, with Cape Town purchasing the most. We are eating twice as much salt as we should be in a day: it should only be 5g (1 teaspoon).
Durban came out top of this test too, with the lowest average number of teaspoons of sugar purchased – Bloemfontein purchased the most sugar. And again, we’re eating twice as much sugar as we should be – a staggering 100g a day! (That’s 24 teaspoons – in the food and drink we consume.)
There are a number of factors that play into this, of course. The way we buy our food – the impulse buys, the treats, emotional eating. Fast food is also a huge problem, because it’s loaded with salt, sugar and bad fats. Cooking at home with whole foods (not convenience foods or ready-made meals) has been proven to have an enormous impact on health and weight.
So what should we be eating? Here are some excellent guidelines.
What do you think? This information made me take a closer look at how I shop and what we eat… Not even because I’m diabetic, but just because I want my family to be as healthy as we possibly can.
Are dietary supplements really necessary if you have diabetes? Nicole McCreedy asks the experts.
Like many other people with diabetes, you may be wondering whether you need to take supplements to help manage your condition. Dietary supplements can be vitamins, minerals, herbs or other plants, amino acids (the building blocks of protein) or a combination of the above. They can be in pill, capsule, powder or liquid form.
Despite some of the claims being made, there is not enough scientific evidence to suggest that any dietary supplements can help prevent or manage Type 2 diabetes. That said, dietary supplements may provide extra nutritional benefit to people with special health problems, including diabetes. In such cases, they are usually recommended when there is a specific lack of something in the body.
Do: Eat correctly
It’s important to try and get the nutrition your body needs from a balanced diet. Making healthy food choices and choosing fruit, vegetables and whole grains over carbohydrates, refined sugars and foods high in saturated fats can make a big difference. Compared with supplements, whole foods provide a variety of different nutrients for health in one package, whereas single vitamin supplements are most often for a single purpose. An apple, for example, contains vitamin C, fibre, and antioxidants – all in one crunchy package!
Dr Claudine Lee, a GP from Hilton, says that following a balanced and healthy diet is essential. “If you think you’re not getting the vitamins and minerals you need from your diet, consult with your GP whether it is necessary to take a supplement,” she advises. Eating correctly, being physically active and taking your prescribed medication is vital for maintaining good control of blood sugar levels to avoid serious complications like strokes, heart and kidney disease, limb amputation and blindness.
Don’t: Go it alone
Talk with your doctor. That is the first step in deciding whether or not to use a dietary supplement. He or she can discuss the possible benefits of dietary supplements, and check that any supplements you take will not interact dangerously with your medications.
Be sure to list any dietary supplements you take whenever you tell your doctor or any other healthcare professional about your medications. Most importantly, keep in mind that a dietary supplement is not a replacement for the diabetes treatment and care advised by your doctor.
So who could benefit from a vitamin supplement?
- Those on low calorie diets, who do not eat a variety of foods.
- Those following vegan diets.
- Those with certain food allergies, kidney disease or diseases of the gastrointestinal tract that interfere with nutrient digestion or absorption.
- Pregnant women.
An A to Z of supplements and their benefits
Ask the expert: Andrea Jenkins, nutritionist.
“The following supplements have been shown to improve blood sugar control or limit diabetic damage.”
Carnitine (L-carnitine), a nutrient made from amino acids that helps the body turn fat into energy, has been found to be deficient in people with diabetes. Almonds, egg and cottage cheese are rich in this nutrient.
Antioxidants can help reduce oxidative stress and lower the risk of diabetic complications. Choose brightly coloured fruits and vegetables in smoothies, salads and soups to ensure a variety of antioxidants.
Digestive enzymes help ensure that mineral uptake is strong and can aid the management of diabetes. Pre- and probiotics are also helpful to maintain digestion and immunity.
Lipids and essential fatty acids
Omega-3 fatty acids lower blood pressure and triglyceride levels, and can help to relieve many of the complications associated with diabetes.
Magnesium, common in leafy green vegetables, is frequently lacking in people with Type 2 diabetes, as is chromium. Brewers yeast, mushrooms and non-refined grains all contain chromium. Zinc improves insulin function, and potassium (found in all fruits and vegetables), can improve insulin sensitivity.
A vitamin B complex improves the metabolism of glucose, and vitamins C and E can improve eye health.
Remember that dietary changes are important to treat diabetes successfully. Many foods can have a positive impact on blood sugar, for example artichokes, garlic, nuts, onions, olives, cinnamon, blueberries, avocado and fenugreek. Try to include some (or all!) of these in your next meal…
Ask the expert: Faaiza Paruk, dietician
“Some people believe that by taking a supplement they won’t need to exercise or take any medication. This is untrue. You need a balanced diet as well as exercise to help control your sugar levels. A balanced diet includes five servings of fruit and vegetables a day, a low intake of salt and fat, lean meat and complex carbohydrates found in foods such as brown rice, potatoes, beans and lentils.”
I don’t know about you, but cooking dinner is one of the things I wish I could just wave a magic wand at.
Wouldn’t it be lovely if somebody else did it for you? But not in a take-out way: I’d love it if somebody else made the kind of delicious, fresh, healthy food I try to make every day.
That’s why I was so excited to find out about UCOOK – seasonally inspired recipes, with all the ingredients delivered to your door.
You choose three meals a week, and they deliver a box full of fresh vegetables, meat, spices and everything you need to whip up a fabulous meal – including these recipe cards, which detail exactly what you need to do and when. The menu changes dramatically every week, but always in three sections: Health Nut (which is mostly low carb), Easy Peasy (20 minutes to make) and Veg (all vegetarian).
I let my husband choose the meals so (surprise surprise!) we had a lot of meat – but it was absolutely fantastic meat, organic and ethical, from locally sourced farmers. The vegetables were also top class – fresh and abundant, and the recipes are interesting and unusual (but not so unusual that I couldn’t get my kids to eat them!)
This is the Middle Eastern lamb with rustic baba ganoush and tzatziki – amazing! It took all of half an hour to prep (a little longer to cook) and it’s the first time I’ve ever successfully cooked lamb at home.
So what did I love about UCOOK?
- Not having to think about what’s for dinner.
- Not having to shop for dinner.
- Having all the ingredients for a delicious meal without worrying I’d forgotten something.
- Having a recipe to follow that is guaranteed to turn out well!
- Fresh, fabulous flavours – not the same old meals.
Of course, all this comes at a price. There are no sneaky costs – shipping is free and you don’t have to subscribe, you can just pay week by week if you like the meals (which I like a lot, because who knows what the week after next might bring?) They claim it’s cheaper than buying groceries, but I think that depends how you shop. I’m a pretty frugal shopper and I don’t think it would be cheaper for us, but it would certainly be more exciting and possibly healthier, as it would force our whole family to try new flavours, vegetables and ideas for dinner.
If you’re looking to add a little spice to your meals, I’d highly recommend giving UCOOK a try…
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.