Diabetes is a growing health concern that affects many people worldwide. It occurs when your body cannot produce or use insulin effectively. Insulin is a hormone that regulates blood sugar levels, and when it’s not functioning correctly, it can lead to various complications.
South Africa has the highest prevalence of diabetes in Africa, with over 4.2 million people suffering from the condition. Diabetes is also characterised by hyperglycemia, which occurs when there is too much sugar in your blood.
There are three main types of diabetes: type 1 is when the pancreas produces little or no insulin; type 2 is the most common and happens when the body does not use insulin properly and it resists insulin; and pre-diabetes is when the blood sugar is high but not high enough to be type 2 diabetes.
While there is still no cure for diabetes, a good and healthy diet plays a crucial role in managing it. KwaZulu-Natal-based dietitian Amanda Josephson explores some food and diet management strategies for diabetes.
Josephson says there are many misconceptions about diabetes and people should take heed of what is the truth and what is not.
- A lot of people think that people with diabetes should not eat any carbohydrates. In fact, carbohydrates can and should be included as part of a healthy, balanced diet for people with diabetes. A dietitian can suggest the right types of carbohydrates and suitable portion sizes.
- Diabetes is only caused by eating too much sugar. While it may be a contributing factor, the major causes of diabetes include genetics, a sedentary lifestyle, obesity, a high waist circumference, insulin resistance, and endocrine disorders. A dietitian can advise on a suitable diet to reduce risk factors such as obesity, high waist circumference, and insulin resistance.
- People with diabetes need to eat small, frequent meals throughout the day. There is no one-size-fits-all approach to meal timing for people with diabetes. A dietitian can work with individuals to determine the best meal timing and frequency for their unique needs and lifestyle.
- Some diabetics who are insulin dependent think that they can eat more sugary foods or drinks because they can inject more insulin, which will keep their blood sugars down. Yes, insulin can balance out the sugar levels in the blood, but doing this regularly can be harmful. It can cause weight gain, which can further increase the risk of developing heart disease and stroke. Overuse of insulin can also cause insulin resistance and the need to increase the dosage of insulin.
A dietitian can advise on the correct portion sizes according to the type of insulin and insulin dosages. should not eat any carbohydrates. It is also important to pair carbohydrates with lean protein and healthy fats to help balance blood sugar levels.
What to enjoy and avoid
“Dietitians do not like to label foods as ‘bad’,” says Josephson.
All foods can fit into a healthy diet, but there are foods that cause higher and quicker spikes in blood sugar levels than other foods. These are the foods that people with diabetes need to be aware of and limit portion sizes and intake.
“Balance is key! Include all the food groups at each meal: whole grain carbohydrates, lean proteins, a small number of healthy fats, and plenty of vegetables,” she advises.
Josephson makes the following distinctions of which foods are good and what you should avoid:
- Whole grain carbohydrates: oats, brown or basmati rice, bulgur wheat, barley, quinoa, and whole wheat bread and pasta These are all low-GI and release energy slowly, preventing a spike in blood sugar.
- Lean proteins: chicken breasts, fish, pork, eggs, legumes (beans, chickpeas, lentils), low-fat cottage cheese.
- Healthy fats: avocado, olives, olive oil, canola oil, olive oil, nuts, and nut butter.
- Vegetables: starch-free vegetables such as broccoli, cauliflower, spinach, kale, cabbage, brinjal, baby marrow, mushrooms, gem squash, cucumber, lettuce, celery, and tomatoes can be eaten freely without affecting blood sugar levels.
- Fatty fish such as pilchards, sardines, salmon, herring, mackerel, and trout are high in Omega-3 fatty acids. Omega-3 fatty acids can help reduce inflammation, lower triglycerides, and improve overall heart health. This can lead to a reduced risk of heart disease, heart attack, and stroke.
Food to avoid:
Refined sugars can spike blood sugar levels and then drop just as quickly, Josephson says. Diets high in refined sugars can increase triglyceride levels in the blood, causing high total cholesterol and further increasing the risk of heart disease as a diabetic.
Refined sugars include sugar (brown and white), honey, syrup, and jam. Substitute these with an artificial sweetener such as Stevia. Also avoid foods high in sugar, such as sweets, chocolates, ice cream, desserts, and sauces such as tomato sauce, chutney, and chocolate/flavoured milk.
Tips for a diabetic-friendly diet
Josephson says there is no need to choose “diabetic” foods; these are often very expensive and offer little nutritional value compared to regular foods. She recommends the following:
- Choose low GI carbohydrates – and remember that even though it is low GI, portion size is still important.
- Avoid saturated fats and opt for mono- and poly-unsaturated fats.
- Don’t eat a fruit or carbohydrate on its own; pair it with lean protein or healthy fat.
- Pay attention to the portion sizes of all food groups, not just carbohydrates.
- Don’t skip meals. This can have negative consequences for people with diabetes. When you skip a meal, your body does not get the energy it needs from food, which can cause blood sugar levels to drop too low (hypoglycaemia). This is particularly important for people with diabetes who take insulin or other medications that lower blood sugar levels, as they are at increased risk of hypoglycemia.
Josephson also advises that all drinks that contain sugar be avoided by reading the label. Sugar in foods and beverages is empty calories (providing no nutritional value in micronutrients or fibre), and the sugar will cause a spike in blood sugar. Diet sodas and diet cordials are suitable alternatives, but not to the detriment of water.
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