Women and Diabetes in the Spotlight this November

Over the past decades, the rise of diabetes around the world has been so prevalent and extreme, it is sometimes referred to as the epidemic of our modern times. In 2017, the diabetes focus theme is Women and Diabetes. Globally, diabetes is the ninth leading cause of death in women, resulting in 2.1 million deaths each year. It is estimated that there are currently more than 199 million women living with diabetes, and by 2040, this total is expected to reach over 310 million.

Registered dietitian and ADSA (the Association for Dietetics in South Africa) spokesperson, Ria Catsicas says, “According to the latest mortality report for South Africa released earlier this year, diabetes is ranked as the leading cause of death in women, and the most important risk factor for developing Type 2 diabetes is obesity. At this time, more than 60% of South African women are either overweight or obese, putting them at higher risk than men of developing diabetes in the future.”

Gender also means that women experience additional health risks due to obesity. As Ria notes: “Almost 17% of pregnant South African women experience gestational diabetes which is directly related to obesity. This condition puts them at risk of experiencing high blood pressure during their pregnancy, miscarriages and still birth. In addition, the babies of mothers-to-be with gestational diabetes tend to be large which can contribute to complications during birth and are themselves at a higher risk of developing type-2 diabetes later in life. Obesity also plays a role in increasing the risks of female infertility.”

Optimal nutrition is key for the person with diabetes; it is also crucial for those who may not have diabetes yet, but are insulin-resistant and those with a family history of diabetes, as genetics are also a risk. Optimal nutrition is also essential for all women – up to 70% of cases of Type 2 diabetes can be prevented by following a healthy lifestyle.

Type 1 diabetes is managed by medication (injectable insulin and or tablets),a controlled diet and exercise; but when it comes to Type 2 diabetes, good nutrition along with other healthy lifestyle changes are usually the first line of treatment to manage diabetes, and if medication is required, a healthy diet can complement and often influence the medicine, to help avoid experiencing the life-threatening complications of diabetes. Tabitha Hume, also a registered dietitian and ADSA spokesperson, points out that common-sense healthy lifestyle changes can be a vital safeguard. “Balanced meals that are made up of a combination of high fibre, low-GI carbohydrates, lean protein and healthy plant fats with generous helpings of vegetables and salads and some fruit (in controlled portions) can be a general guide. However, plasma glucose control is very individual, depending on the severity of the diabetes, and the type and dosage of medication being used. Diabetics will need the help of a registered clinical dietitian who can support them in translating these guidelines into the practical meal plans that best suit their food culture, their taste preferences, daily routines and lifestyles.’’

ADSA spokesperson, Nasreen Jaffer agrees, “There is no ‘one size fits all’. In order to make a sustainable change to a healthier eating plan, all aspects of a person’s life must be taken into account. A working mom with kids at school does not have the same amount of time for food planning and preparation compared to a stay-at-home mom. It is the role of the dietitian to help tailor an eating plan that is healthy – as well as practical, affordable and do-able for the individual.”

All three experts agree that this year’s World Diabetes Day focus on women is relevant to the adoption of healthy lifestyles across South Africa’s population.   While many men play a prominent nurturing role in the home, and many are becoming increasingly interested in the impact of nutrition on health and physical performance, it is still common for women to take the dominant role in the nourishing of the family, and ensuring health and disease prevention.

Tabitha points out: “Since women are most often the home chef, the grocery shopper, and the planner of meals and snacks for children and the family, if nutrition education is targeted at women, there is a higher chance that healthy nutrition guidelines filter through the whole family and have the biggest impact. Family traditions, practices and cultures most often derive from the mother in a family which is why children often adopt the religion and language of the mother. This is where the ‘Mother Tongue’ phrase originates. South African women are encouraged to develop a ‘Mother Meal’ concept moving forward, helping to instil healthy eating habits in children from a young age.”

World Diabetes Day on 14 November aims to shine a light on the risks for developing diabetes; as well as the needs for regular screening, access to information, self-management education, treatments and support, which includes optimal nutrition.


What your dietitian wants you to know about diabetes

There were 2.28 million cases of diabetes in South Africa in 2015 according to the International Diabetes Foundation and around 1.21 million people with undiagnosed diabetes. Considering these numbers it remains vitally important to continue educating South Africans about diabetes and to address the myths that are often associated with this lifestyle disease.

Nasreen Jaffer, Registered Dietitian and ADSA (Association for Dietetics in South Africa) spokesperson has a special interest in diabetes. She debunks some of the myths surrounding diabetes and nutrition:

People with diabetes have to follow a special diet or have to eat special diabetic foods.

People with diabetes do not have to follow a ‘special’ diet. People with diabetes need to make the same healthy eating choices as everyone else. Healthy eating choices include vegetables and fruit; whole grains; fish, lean meats and poultry; dairy products; seeds, nuts, legumes and plant oils. Everyone needs to limit fatty red meats, processed meats, salt and foods high in salt, and foods and beverages with added sugar.

There are foods that should be avoided completely.

The answer, is ‘no’. Moderation is key, the minute you’ve banned a certain food entirely, you’re likely to start craving it intensely. Your health and weight are more affected by what you do daily than what you eat once or twice a week, so if you’re in the mood for a piece of cake once in a while, buy a small one and share. If you deprive yourself of something you’re craving, it’s just a matter of time until your binge on it and sabotage your motivation. However, crisps, chocolates, and sweets are high in saturated and trans fat, while sugar-sweetened beverages like soft drinks, iced tea and energy drinks contain a large amount of sugar, so these have to be limited.

 If I am diabetic, my diet is going to be more expensive.

It is not necessary to buy expensive foods marketed to diabetics. Healthy eating can be economical, and is often cheaper than buying unhealthy treats. Buying seasonal fresh fruit and vegetables is cheaper than buying fruit juices and sugar-sweetened beverages. If you replace sweets, chocolates, crisps, puddings and cakes with fruits, yoghurt and salads as your snacks and desserts, you’ll find you will save money. Legumes, such as lentils and beans, are cheaper alternatives to red meat, while providing numerous health benefits.

Eating too much sugar causes diabetes.

Too much sugar does not necessarily cause diabetes, but because foods and drinks with added sugar are often energy-dense (high in kilojoules), consuming too much of these on a regular basis can lead to weight gain. This can put us at risk for type 2 diabetes. Sugar-sweetened beverages seem to have the strongest link to type 2 diabetes. ‘Sugar’ doesn’t only refer to the sugar added to tea and coffee, but also includes sugar and sweetened products added when cooking and at the table. Look out for hidden sugars in pre-prepared and processed foods, like some breakfast cereals, sweetened drinks, dairy products, sauces and sweet treats. People with diabetes should limit or avoid adding sugar as it can have a negative effect on blood sugar levels.

 People with diabetes cannot eat carbohydrates.

No, this is not true. While all foods that contain carbohydrates will affect your blood sugar levels, people with diabetes can still eat carbohydrate foods. There are healthy types of carbohydrates that you do want to include in your eating plan, and the type or quality of carbohydrate foods is important. Therefore, for optimal blood glucose control it is important to control the quantity, and distribute carbohydrate foods equally throughout the day. For example, choose wholegrain or high-fibre carbohydrate foods as they don’t increase blood sugar as quickly as refined grains, and make sure that each meal is balanced, containing not only carbohydrate foods, but also protein or dairy, non-starchy vegetables or healthy fats.

People with diabetes should restrict their fruit intake.

Because fruit contains natural sugars, too much fruit can contribute to an increase in blood glucose levels. However, eating fruit also adds fibre, and essential vitamins and minerals to the diet, so while people with diabetes should not eat excessive amounts of fruit, fruit should not be completely eliminated. Portion control is important, and people with diabetes should choose whole fruit rather than fruit juice. It is recommended that you consult your dietitian to calculate the amount of fruit that you should include in your daily diet.

If one of my parents has diabetes, there is nothing I can do about it – I will develop diabetes eventually.

If you have a genetic predisposition to type 2 diabetes, you have all the reason you need to embrace a healthy lifestyle. While genetics may contribute 30 to 40% to the development of any condition, including diabetes, environmental and lifestyle factors may have a 60 to 70% impact. If you maintain a healthy body weight, stick to a healthy eating plan, avoid tobacco use and keep physically active regularly, you have a very good chance of not developing diabetes.

If I have diabetes, I can’t exercise.

On the contrary, diabetes is a compelling reason to exercise regularly. The reason for this is that physical activity plays a very important role in lowering blood glucose levels. Exercise also predisposes your body cells to being more sensitive to insulin, and of course, it helps to achieve and maintain a healthy body weight. Aim for at least 150 minutes of moderate intensity activity a week, such as brisk walking, while doing some resistance or strength exercises at least twice a week. If you use insulin it is important to check your blood glucose levels before and after physical activity. If you get results below 6 mmol/l it is recommended that you lower your insulin dose or eat a healthy snack to prevent a hypoglycemic attack during or after exercise.

Early diagnosis of diabetes is vitally important. This year the theme of World Diabetes Day is “Eyes on Diabetes”, focusing on the screening for type 2 diabetes to ensure early diagnosis and treatment, which can in turn reduce the risk of serious complications. The sooner that elevated blood glucose levels can be treated and returned to normal, the better. If you are diagnosed with either pre-diabetes or diabetes, you need to start moving towards a healthier lifestyle that focuses on regular physical activity, good nutrition and weight-loss if you are overweight or obese.

Everyone over the age of 45 years should be screened for diabetes every 2 to 3 years, or earlier if you are overweight and have other risk factors for diabetes (such as a family history, high blood pressure or previous diabetes during pregnancy). If you haven’t yet been screened, visit a healthcare professional to find out if you are at risk.

Should you experience any of the following symptoms contact your doctor as soon as possible – sudden weight loss, hunger, blurred vision, tiredness, excessive thirst and frequent urination.

To find a registered dietitian in your area who can assist you with a diabetic-friendly lifestyle plan, visit www.adsa.org.za.

 


GETTING THE FACTS RIGHT ABOUT DIABETES

Diabetes remains a major cause of death in South Africa, and the prevalence of the condition continues to rise. ‘People with diabetes have to follow a special diet or have to eat special diabetic food’ is just one of the common misconceptions surrounding diabetes. In commemoration of World Diabetes Day (14 November) ADSA (Association for Dietetics in South Africa) spokesperson and Registered Dietitian, Ria Catsicas, looks at some of these misconceptions that can result in people avoiding health testing or seeking treatment.

Ria has a special interest in the medical nutrition management of diabetes, metabolic syndrome and obesity and is the author of the book “The Complete Nutritional Solutions to Diabetes”.

#1: People with diabetes have to follow a special diet or have to eat special diabetic foods
“Actually, people with diabetes do not have to follow a ‘special’ diet. The whole family should eat healthy unprocessed foods such as fresh fruit and vegetables; whole grains; lean meats and poultry; low fat milk and dairy products; seeds, nuts, legumes and plant oils. Everyone should avoid or limit eating processed foods such as fatty red meats, processed meats, all foods made from white flour and foods with a high sugar content. Healthy eating is good for all of us as it is essential for supporting our immune systems and protecting us against disease, as well as to ensure that we have optimal energy levels throughout the day.”

#2: If I am diabetic, my food is going to be more expensive
“It is not necessary to buy expensive foods marketed to diabetics. Healthy eating can be economical, and is often cheaper than buying unhealthy treats. Buying fresh fruit and vegetables that are in season is certainly cheaper than buying processed fruit juices and soft drinks. If you eat fruits and salads as snacks and as dessert, you can save on the money you would have spent on buying biscuits, rusks, cakes, desserts, sweets and potato crisps.   Legumes, such as lentils and beans, are cheaper than red meat and high fat hard cheeses. A tasty bean curry is, for instance, a much cheaper meal than a red meat alternative.”

#3: Eating too much sugar causes diabetes
“There is truth in this statement, but it is too simplistic. Research shows that there is a correlation between the high intake of sugar-based soft drinks, energy drinks and fruit juices and the development of obesity. And, obesity, in turn, can be a significant contributing factor in the development of T 2 diabetes. However, a person’s complete diet must be taken into account. A diet that is characterized by the high intake of sugar, such as soft drinks, chocolates and sweets; as well as a high intake of refined starches, such as white or brown bread, pap, fast foods, biscuits, rusks and potato fries; while also poor in healthy foods such as fresh fruit, vegetables and whole grains, can contribute to the development of diabetes.”

#4: People with diabetes cannot eat carbohydrates
“Not all carbohydrates are unhealthy. Both the type and the amount of carbohydrate foods you eat at a meal will affect your blood glucose levels afterwards. Therefore, for optimal blood glucose control it is important to control the quantity, and be aware of the type of carbohydrates you are going to eat. Small portions of whole grains, fruit and vegetables that are evenly distributed throughout the day can contribute to optimal blood glucose control. Research has also shown that the consistency of your carbohydrate intake from day-to-day can help to optimize blood glucose control.”

#5: People with diabetes should restrict their fruit intake
“Yes, too much fruit can contribute to an increase in blood glucose levels. However, portion size is important. It is recommended that you consult your dietitian to calculate the amount of fruit that you should include in your daily diet.”

#6: People with diabetes should be on a high-fat diet
“There is no research to date which has proved that a high fat diet can contribute to either weight loss or improved blood glucose control. To lose weight, your calorie intake from both foods and drinks must be less than your energy expenditure on both voluntary and involuntary activity. The restriction of any food group, whether it is carbohydrates or fats or proteins can contribute to weight loss. To achieve successful weight loss, people with diabetes need to adhere to an eating plan that restricts their usual calorie intake. Research has shown that diets promoting extreme macronutrient manipulation, whether it is carbohydrates or fats or proteins actually lessen people’s adherence to the eating plan. It is much wiser for people with diabetes to develop sustainable healthy eating habits that can easily be incorporated into lifestyle for the long term. The best diet for a person with diabetes is a healthy eating plan that the person can adhere to. To facilitate adherence, a dietitian would take into consideration the individual’s cultural preferences; their budget constraints; their age and gender; the logistics of their daily life, such as their work circumstances or travel requirements; as well as their weight status, the medications they use and their activity levels.”

#7: There are no proven health dangers of consuming too much saturated fat
“It is well-established that a high intake of saturated fats can contribute to increased LDL cholesterol levels in some individuals. While it has not been proven is that increased LDL cholesterol levels contribute directly to cardiac events, this is because there are NUMEROUS compounding factors that would cause a heart attack. Atherosclerosis is an inflammatory condition and a high intake of saturated fats in a nutrient poor diet can aggravate inflammation. It has been proven that a high saturated fat intake in a nutrient poor diet can also contribute to decreased sensitivity of the body cells to the action of insulin.”

 #8: If I am diabetic, I should stop my medication and go onto a low-carb high-fat diet
“As a person with diabetes you should never stop your medication without your doctor’s recommendation and agreement that this is the best medical course for you. It has been established that when diabetes is diagnosed most individuals would have already lost 50% of the insulin-producing capacity of the Beta cells in the pancreas. Therefore, the optimal way to manage diabetes is to follow a healthy diet; to lose weight if overweight; to engage in physical activity, such as walking three to five times a week for 40 to 60 minutes at a time; and, to take appropriate medication on your doctor’s advice.”

#9: If one of my parents has diabetes, there is nothing I can do about it – I will develop diabetes eventually
“If you have a genetic predisposition to diabetes, you have all the reason you need to embrace a healthy lifestyle. While genetics may only contribute 30 to 40% to the development of any condition, including diabetes, environmental and lifestyle factors may have a 60 to 70% impact. If you maintain a healthy body weight, stick to a healthy eating plan, manage your stress and get regular physical exercises, you have a very good chance of not developing diabetes.”

#10: If I have diabetes, I can’t exercise
“This is not true at all. Diabetes is a compelling reason to exercise regularly as physical activity plays a very important role in lowering blood glucose levels. Exercise also predisposes your body cells to being more sensitive to insulin, and of course, it helps to achieve and maintain a healthy body weight. If you use insulin it is important to check your blood glucose levels before and after physical activity. If you get results below 6 m mol/l it is recommended that you lower your insulin dose or eat a healthy snack to prevent a hypoglycemic attack during or after exercise.”
To find a dietitian in your area who can assist you with personalised nutrition advice, visit www.adsa.org.za