Diabetes, in particular Type 2 diabetes, is on the increase worldwide. The International Diabetes Federation (IDF) estimates that about 415 million people have diabetes (including 3 million in South Africa) and that by 2030, there could be over 500 million people living with diabetes. The reasons for this include increased urbanization, a growing portion of the population that is ageing, lack of regular exercise and poor eating habits1. As individuals, we can’t halt urbanization or stop the ageing process, but we can take steps to improve our own health. When it comes to managing diabetes, there are several things we can do to achieve optimal blood sugar levels, including changing the way we eat.
• Carbohydrates are a necessary part of our diet. The amount of carbohydrates we need each day depends on factors such as age, activity level and health goals (weight loss, improved blood glucose control, or increased energy). Carbohydrates include breads made from all types of flour (loaves, rolls, flatbreads, wraps), rice, pasta, couscous, oats, quinoa, pap (maize meal, polenta), mealies (maize, corn, popcorn), breakfast cereals, crackers, crispbreads, biscuits, cakes and cookies, and most snack foods. ‘Starchy’ vegetables (potatoes, sweet potatoes, pumpkin, butternut) and fresh fruit also contribute to the carb load or glycaemic load (see below).
It is important to choose appropriate portions. One portion of carbohydrate equals 15–20 grams. A handy guideline is to limit carb your intake to 30–60 grams for main meals and 15–30 grams for snacks.
Your diabetes medication, the amount of exercise you do, and your body size can all impact on the amount of carbohydrate you need to maintain your blood sugar levels within the normal range. To find the right balance, test your blood sugar before and/or two hours after meals until it is stable (after which you can test less often). Doing this will enable you to feel your best and lower your risk of complications. Even if you are on medication to lower your blood sugar, don’t cut out carbs altogether, as this can cause it to drop too low.
• Sugar (sucrose) should not comprise more than 3–4 per cent of total calories in a diabetic diet. You can substitute small amounts of sugar for other carb-containing foods in your meal plan and still keep your blood glucose levels on track.
Sugar substitutes and artificial sweeteners (aspartame, sucralose, stevia, etc.) are much sweeter than sugar, so only a small amount is needed. Non-nutritive sweeteners are usually calorie-free, but you should always check the food labels. Although there is some controversy over sweeteners, they are useful in a diabetic diet because they are weight and blood sugar neutral. Sugar alcohols (mannitol, xylitol) have fewer calories than sugar and therefore less impact on blood sugar levels but they can be quite high in carbs, so may not be ideal if you are trying to lose weight.
• Protein derives from animals and plants. A balanced meal plan incorporates 60–150 grams of animal-based protein per main meal. Meat doesn’t contain carbs so it doesn’t raise blood glucose levels appreciably, but protein-based foods can vary significantly in terms of their fat content. Always choose lean red meat, white fish or skinless white-meat chicken and read the labels on packaged foods to make sure you select the lowest fat options. Limit eggs to 3–4 a week.
Plant-based proteins include legumes (lentils, dried beans, chickpeas), soy beans and tofu, all of which provide quality protein, healthy fats and fibre. However, legumes are high in carbs, so monitor portion size, particularly if you consume carbs and legumes together (for example, if a curry contains chickpeas and potatoes, don’t add rice or roti as well).
• Dairy products include milk, cream, ice cream, yoghurt, and milk- or yoghurt-based drinks and shakes, as well as non-dairy substitutes (such as soya milk or almond milk and non-dairy cream). Choose dairy products that are low fat or fat free to help control your overall sugar and fat levels.
Lactose is a natural sugar found in milk products but the nutritional values stated on product packaging generally don’t distinguish between different types of sugars.
• Fat is energy-dense, so limit the amount you consume to avoid unwanted weight gain, and choose monounsaturated or polyunsatured fats. Saturated fats (butter, cheese, visible fat on meat, chicken skin, coconut oil, and palm kernel oil used in baked goods and confectionary), are responsible for increasing cholesterol and blood sugar levels.
Monounsaturated fats, found in plant-based oils (olive oil, canola oil, peanut butter, avocados), help increase levels of good cholesterol and lower levels of bad cholesterol.
Polyunsaturated fats occur in oily fish (trout, salmon, sardines, tuna, mackerel), seeds (sunflower, flax) and grains. Eating oily fish twice per week can help lower levels of bad cholesterol.
• Fruit and vegetables should play a major role in our diets. Everyone should aim to eat five or more portions of fruit and/or vegetables each day (although diabetics should limit fruit to one portion per meal or snack). Eat plenty of ‘low carb’ green vegetables and salads, but watch out for ‘high carb’ starchy veg, like butternut, pumpkin, carrots and sweetcorn; you don’t have to exclude them, but you do need to factor them into the total carb content of the meal. Vegetables are packed with vitamins and minerals, and can make a meal more filling. To avoid adding extra kilojoules, use low-fat cooking methods (grill, roast, braai, sauté, stir-fry) and don’t add butter, cream, sour cream or sugar to your vegetables.
• Salt has been linked to high blood pressure. Use it sparingly in cooking and limit the amount you add to food. Beware of ‘hidden’ salt in many convenience and pre-packed foods. Rather, flavour foods with fresh or dried herbs, pepper and pure spices (not spice blends, which often have a lot of salt). One way to cut down on salt is to use it either when preparing food, or add it at the table, but not both.
• Water is the best drink for quenching thirst: tap water, or still or sparkling mineral water (not flavoured water, which is often sweetened). Diabetics can consume sugar-free cordials or carbonated drinks as part of a meal plan. Tea and coffee contain caffeine, so should be limited to four cups a day, but caffeine-free rooibos and herbal teas can be freely enjoyed.
Avoid pure fruit juices and fruit juice blends, carbonated soft drinks (cola, ginger beer, lemonade, etc.) and energy drinks. Beware of beverages that proclaim ‘no added sugar’; just because sugar isn’t added doesn’t mean it isn’t present!
Alcohol should be consumed in moderation. Alcoholic drinks made from grain (beer, whisky, vodka) or fruit (wine, brandy, cider), can add unwanted carbs, sugars and kilojoules; not ideal if you are trying to lose weight. Most nutritional guidelines suggest no more than one drink per day for women and 1–2 drinks per day for men (1 drink = 125 ml wine, 340 ml ‘lite’ beer, or one 25 ml tot spirits with sugar-free mixer).
Nutritional analysis of the recipes
Nutritional analysis is a measurement of kilojoules, proteins, carbs and fats in any given meal. In this book, the nutritional analysis is calculated ‘per serving’, so consider the number of servings specified when dishing up. Values are also given for GI (glycaemic index) and GL (glycaemic load).
Glycaemic index (GI) is a measure of how quickly or slowly a single food or a full meal is absorbed into your system. The lower the GI, the slower the absorption of food into the blood stream. A GI of less than 55 is considered low; 56–69 indicates intermediate GI; above 70 is high GI. For ‘normal living’, a GI at the bottom end of the low–intermediate range will ensure that food is absorbed slowly, with less potential to cause an unwanted spike in blood sugar. Fast-acting, high-GI foods are best left to people who need a quick source of energy during high intensity training or endurance exercise.
Glycaemic load (GL) is a measure of the carbohydrate load delivered by a single food or a full meal. GL relates directly to portion size. The GL for breakfast or a light meal should be ± 20 (definitely under 25), for a main meal ± 25 (definitely below 30), and for a snack below 15 (2).
People living with diabetes should consult a dietician who specializes in diabetes because each individual’s dietary intake needs to be personalized to match their nutritional needs, medication regime and lifestyle. Monitoring carbohydrate intake – whether by carb counting, food-based exchanges or experience-based estimation – is the key to good blood sugar control. To achieve optimum results, this needs to be done in conjunction with an experienced dietician.
Notes on recipes
• All the recipes have been adapted to be lower in fat than the equivalent ‘normal fat content’ version. Small amounts of fats have been used for cooking, and where possible, ‘lite’ or reduced-fat versions of products have been used.
• The author recommends eating lean meats. The nutritional analysis for all chicken recipes is for the white meat only, with any skin and visible fat removed before eating.
(1)2012 SEMDSA Guidelines for the Management of Type 2 Diabetes. (Society for Endocrinology, Metabolism and Diabetes South Africa.)
(2)The South African Glycaemic Index and Load Guide, Gabi Steenkamp and Liesbet Delport. 2013–2015 edition. Glycaemic Index Foundation of South Africa.