diabetic diet

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.

Finding the right food for diabetics

Sometimes the biggest challenge to eating a healthy diet is finding the right ingredients: here’s how Annora Mostert, the founder and group owner of Anja’s Pantry, and Alliyah Geldenhuys, who just opened Anja’s Pantry Plumstead, did just that.

Do you have a special interest in diabetes?

“It soon became clear that people with diabetes have the biggest need for healthy low carbohydrate and sugar-free food,” explains Annora. “So we involved trained nutritionists to guide us in what the right type of products should be for diabetics, and started to change the content of our pantry.” The result? All the products in Anja’s Pantry stores are now diabetic friendly. Some of the store owners also have close family members with diabetes, so as a team they work together to stock the right kind of products.

Do you think awareness is growing around healthy food alternatives?

“Absolutely! Social media is the biggest contributor creating awareness, but the awareness is now affecting policies. The research is so clear and the problem is so great that the South African government has followed the UK government in introducing a sugar tax next year on foods to try to curb the high sugar content in processed foods,” says Annora. As a result, all their stores offer a wide range of food products that are sugar-free and low carb so that those who want to avoid sugar can still have a variety of foods to choose from. “Our range of food products is now over 200 items with more being added all the time. This becomes a mini grocery store for the large percentage of the population that are either diabetic or pre-diabetic, those who have allergies or those who just want to lose weight while enjoying their food.”

How did you choose the location of Anja’s Pantry Plumstead?

Anja’s Pantry in Plumstead is right next door to a number of fast food restaurants. “We chose the location on purpose,” explains Alliyah, the owner of the store. “We want to provide healthier options to those in Plumstead and surrounds. It’s often difficult to prepare home cooked meals and so called ‘proper food’ with the fast paced lifestyles that many of us lead today. We end up simply settling for the quickest and easiest option available, but often these are unhealthy food choices. With our easy to prepare premixes and pre-prepared items such as pizza bases and meals, we are hoping to make it much easier for those wanting to enjoy a more nutritionally sound meal.”

Do you think there’s a particular need for healthy alternatives in the Muslim community?

“Yes! Traditional Muslim food is well known for being loaded with unhealthy fats, excessive carbohydrates and sugars. Diseases such as diabetes, high blood pressure and cholesterol are rife within the Muslim community and have sadly become a way of life for many within the community. I think it’s possible to ‘eat yourself healthy’, and that if we can share this vision and all that it stands for it will change the lives of many and allow Muslims to re-think their food choices.”

Do you have any advice for those who are struggling with their diabetes?

“Living a sugar-free and low carb life shouldn’t be that difficult,” says Annora. “We know that it is more expensive since real food items aren’t mass produced and made with lots of chemicals, but it saves so much on unnecessary medical bills.” Alliyah agrees. “An important part of managing your condition is to eat healthy meals and steer clear of certain items. Always read labels and check the ingredients of items that you purchase, as product packaging can often be misleading!”

What makes your life sweet?

For Annora, it’s feeling healthy and eating without feeling guilty. For Alliyah: “My amazing family, who made the opening of this shop a reality. It would never have happened without their help, guidance and support.”

Get in touch with Anja’s Pantry: Anja’s Pantry – the Food Farmacy on Facebook, @Anjas_Pantry on Twitter or www.anjaspantry.co.za

Diabetes-friendly kids menu

Ask the dietician: Genevieve Jardine

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

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

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

Breakfast:

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

Lunchboxes:

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

Dinner:

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

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

Living the low carb life

When Vickie de Beer’s son Lucca was diagnosed with Type 1 diabetes, she started a journey that ended with her publishing an award-winning cookbook and lifestyle guide: The Low Carb Solution for Diabetics.

Looking back, what do you wish you’d known when Lucca was first diagnosed with Type 1 diabetes?

That insulin takes much longer to reach the blood stream than we were told. I had a lot of anxiety about Lucca going into a hypo after eating, and it was completely unnecessary. I also wish I knew what a huge impact carbohydrates had on his blood sugar! We did carb count and test and inject diligently, but there were always unexplained highs and lows that frustrated me and made Lucca feel awful.

What inspired you to write The Low Carb Solution for Diabetics?

We have always, from the first day, taken Lucca’s diabetes seriously. We did everything the doctors and dietician told us. We adapted our diet to eating only low GI foods and tested Lucca’s blood sugars diligently. Every time we went to the doctor they congratulated us on his great HbA1c result and said that we were doing everything possible for Lucca’s health.

The doctor always said that the next step would be to control the extreme fluctuations between high spikes and lows in Lucca’s blood sugar. I could never get clear information on how we were supposed do that though, apart from doing what we were already doing. About a year ago I met Prof Tim Noakes at the book launch of Real Meal Revolution. We significantly reduced our carbohydrate intake, but did not remove carbohydrate completely from our diet.

I didn’t understand how we could remove all the carbohydrates from Lucca’s diet as suggested by the LCHF (Low Carb High Fat) movement. We were taught that children needed carbohydrates for energy, growth and brain function and I also knew that Lucca needed to get insulin. If we took away the carbohydrates how would he get the insulin he needed? I still gave the children small amounts of Low GI carbs like brown rice and brown pasta with their evening meals. Lucca’s blood sugar did not improve significantly – I would say that we were on a moderate carb diet.

A few months ago I made contact with a group in the USA that follow a low carb high protein (not high fat) diet with great success in managing steady blood glucose levels in Type I diabetic children. This way of managing diabetes is based on a book: Dr Bernstein’s Diabetic Solution. Dr Bernstein has been a Type 1 diabetic for 69 years. After reading his book and studying various other low carb websites and books, we decided to change the way we eat.

Do you have any tips for people who feel overwhelmed at the thought of changing their way of eating?

Do it gradually. We started with breakfast (because the boys love bacon!) and then did dinners – lunchboxes were the last!

What advice would you offer to people living with diabetes who are struggling?

Diabetes is in the details. The best tool is to test constantly and diligently. The bottom line is that cutting carbs makes diabetes easier to manage. All the hundreds of reasons I used to give to explain Lucca’s unstable sugar – the heat, stress, tiredness – it was always the carbs!

What makes your life sweet?

Hugs from my boys! Playing board games with them (and winning), swimming and braaing with them, reading with them… The fact that Lucca’s blood sugar is under control has changed our lives. We had a lot of anxiety in our life beforehand. Although we still test and inject diligently, the anxiety is gone. I think we have finally taken control of diabetes, and diabetes has lost its control over us.

Get in touch with Vickie: @Vickiefantastic on Twitter

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 low carb diabetic pantry

Ask the dietician: Keri Strachan

We recently published an article called The basic diabetic pantry, which focuses on a dietary pattern rich in wholegrains / high fibre grains and starches, fruits, vegetables, legumes and nuts; moderate in alcohol consumption; and lower in refined grains, red/processed meats and sugar-sweetened beverages.

Some of our readers asked if we could provide the low carb alternative to the diabetic pantry, so here it is!

Low carb pantry guidelines

When you start a low carb lifestyle, you’ll be struck by how you no longer visit certain parts of the supermarket, only the areas of fresh produce, and limited packaged items. When buying real food there is no need for a label, but there are some that are still worth checking: this will help you to identify which brands are better than others to suit your needs.

Buy basic food ingredients and cook from scratch and you are unlikely to be fooled into hidden carbs sneaking in. Here’s a basic list of what to eat:

Protein

  • Meat (beef, pork, lamb)
  • Fish (especially omega-3 rich such as sardines, pilchards, salmon, fresh tuna, salmon, trout)
  • Free-range eggs
  • Cheese
  • Chicken

Vegetables and fruit

  • Low carb veggies, excluding butternut, all potatoes, peas and corn
  • Low carb nutrient dense fruit such as berries

Dairy

  • Full-cream milk
  • Full or double-cream plain yoghurt (but in limited amount due to natural carb content)

Nuts and seeds

  • Almonds
  • Macadamia nuts
  • Walnuts
  • Pecans
  • Sunflower seeds
  • Pumpkin seeds
  • Linseeds
  • Sesame seeds

Natural fats

  • Olive oil (not for cooking)
  • Olives
  • Avocado
  • Macadamia nut oil
  • Coconut oil and cream
  • Cream
  • Butter
  • Lard (no vegetable oils)

Other items:

  • Olives
  • Canned tomatoes
  • Tomato paste
  • Almond flour and coconut flour (but avoid replica foods too often, they are not as low carb as you think)
  • Stevia, erythritol (but try to avoid sweetness)
  • Cocoa
  • Coconut flakes/ desiccated coconut
  • Salt
  • Pure herbs and spices e.g. paprika, turmeric, cayenne pepper, cumin, rosemary, basil, thyme, parsley
  • Vinegar
  • Mayonnaise made from non-vegetable oil e.g. macadamia, avocado
  • Fresh herbs (rocket, basil, origanum)

Remember a few tips:

  • Do not snack!
  • Get enough fat to replace your carbs, and ensure that you last between meals without snacking
  • Avoid over-eating protein
  • Bulk meals with boldly colourful vegetables, herbs and spices
  • Drink mostly water, limit milk through hot drinks

 

Sundowner snacks

Ask the dietician: Genevieve Jardine

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

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

When?

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

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

What?

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

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

Healthy snack ideas:

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

Where?

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

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

The basic diabetic pantry

Ask the dietician: Cheryl Meyer

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

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

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

Breakfast cereals

  • Oat bran
  • Rolled oats
  • Low GI muesli

Cooked starches

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

Breads & crackers

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

Legumes

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

Dairy products

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

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

Meat, poultry, fish & eggs

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

Fats and oils

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

Vegetables

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

Fruit

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

Spreads

  • Hummus
  • Tzatziki
  • Olive oil

Snacks

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

Store cupboard basics

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

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

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

 

“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

“Junk” food for diabetics

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!

Healthy take-out

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.

Braai menu

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

 

Natural supplements for diabetics

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
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
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
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.
Source: Healthline

American ginseng
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
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

Crazy blood sugar fluctuations?

From our community blog:

Good morning,

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.

Please help!

– Vasti

Comments:

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.
Krish

Dear Vasti
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.
Regards
Lyn

Hi Vasti,

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!
Thanks
Angela

Maintaining a healthy weight with diabetes

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.


Losing weight

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.”