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Diet and Diabetes Nutrition tips to support the management of Diabetes at breakfast Throughout 2015, Pick n Pay is publishing a series of leaflets to support people with Diabetes. This supplement is filled with nutritional advice and helpful shopping tips to make navigating Pick n Pay’s breakfast aisles for Diabetes-friendly foods a little bit easier. Be sure to look out for our dinner supplement, which will be published later this year. This information is not intended for use as a substitute for professional medical advice, diagnosis or treatment. Please visit your healthcare professional for advice specific to your individual requirements. 1190839_275 x 210_1 What is Diabetes? During digestion, the carbohydrates or starchy foods you eat are broken down into glucose, a type of sugar. This glucose is absorbed into your bloodstream, and becomes known as your blood sugar or blood glucose. Your pancreas then releases the hormone insulin into the blood, which transports the glucose from the blood to the body cells, to be used for energy. The insulin helps to regulate your blood glucose levels. Diabetes is caused when there is too little or no insulin, or the insulin cannot be used properly by the body. This means that the body cannot control blood glucose levels normally, or use the energy from foods effectively. Instead of feeding the cells with energy, the glucose accumulates in the blood, causing blood glucose levels to rise and, over time, causing damage to the kidneys, eyes, nerves and heart. Know your types There are several ‘types’ of Diabetes: Type 1 Diabetes, Type 2 Diabetes and Gestational Diabetes. Type 1 Diabetes Type 2 Diabetes Accounting for 5 – 10% of Diabetes cases, Type 1 Diabetes is an autoimmune disease ‘caused’ by the inability of the pancreas to make insulin. A combination of daily insulin, a careful eating plan and physical activity is required for its management. Gestational Diabetes Accounting for 90 – 95% of cases, Type 2 Diabetes is a metabolic disorder in which the pancreatic cells do not produce enough insulin, or the body doesn’t respond to insulin normally. Occurring most often in people who are overweight, this type of Diabetes can often be managed through food choices, weight control and physical activity alone. Glucose-lowering medication may help the body to produce more insulin, or better use the insulin the body makes. Insulin injections may be needed too. Resulting from changes in hormone levels, Gestational Diabetes occurs in about 4% of pregnancies and, although it usually disappears after delivery, requires careful control and monitoring during pregnancy. You’ve been diagnosed – Now what? % 20.7 In South Africa, 20.7% of people have a family history of high blood sugar % 18 Around 18% of people are Pre-Diabetic Please consult with a registered dietitian to obtain a meal plan specific to your individual requirements. 1190839_275xx210_2 210_2 1190839_275 9.5 % The good news is that by taking responsibility for your health and wellbeing, Diabetes can be managed. The first step is to develop a treatment plan with your lifestyle in mind. Whether you choose to do this with the help of a doctor, Diabetes educator or Dietitian, your treatment plan needs to take four key factors into account: medication, nutrition, monitoring and exercise. 9.5% of people have been diagnosed with Diabetes Eating for Diabetes Did you know that a diabetic diet isn’t just for people with the condition? In fact, dietary guidelines recommended for people with Diabetes are the same as those recommended for the healthy population. So rather than preparing separate meals for yourself, encourage your family to adopt these healthy habits. Timing is everything Eat three regular meals per day to help control your blood glucose, energy and hunger levels. Size matters It is best to consult with a registered dietitian to learn what portion size is the right fit for you and your health. To find a registered dietitian in your area, visit www.adsa.org.za You are what you eat The nutritional quality of the carbohydrates, proteins and fats you eat has a direct impact on your blood sugar and your ability to control it. Use this leaflet for tips on how to spot foods of higher nutritional quality. To build a balanced breakfast meal, choose one food from each of the following food groups to build your plate: • • • • Food examples of each group Group 1 High-fibre carbohydrates 1/4 High-fibre carbohydrates 1/4 Lean proteins 1/2 Vegetables and fruit Small amount of healthy fats • Oat bran • Bran cereal • Low GI, low fat muesli • Wholegrain bread Group 2 Lean proteins 1. High-fibre carbohydrates 3. Vegetables and fruit 2. Lean proteins 4. Healthy fats • • • • Low fat milk Low fat yoghurt Baked beans Egg Group 3 Vegetables and fruit • Raw vegetables • Raw fruit • Dried fruit (in small servings) Group 4 Healthy fats • • • • • • • Seeds Nuts Avocado Peanut butter Humus Olive oil Canola oil Please consult with a registered dietitian to obtain a meal plan specific to your individual requirements. 1190839_275 x 210_3 Don’t skip brekkies Leanne Tee Pick n Pay Registered Dietitian [email protected] After 8–12 hours without a meal or snack, breakfast is your body’s first chance to refuel its energy levels and replenish its blood glucose stores. Eating a balanced meal with the right mix of carbohydrates, proteins, healthy fats and vegetables or fruit helps to provide a sustained release of energy, keep your blood sugar levels stable and delay hunger symptoms for several hours. Plus, research has shown that breakfast eaters tend to have improved nutrient intake, a healthier body weight and improved ability to concentrate. So, if you’re not eating breakfast regularly, consider this your wake-up call. Please consult with a registered dietitian to obtain a meal plan specific to your individual requirements. 1190839_275 x 210_4 Diabetes and breakfast PRICES VALID 16 - 29 MARCH 2015 19 80 Parmalat Low Fat or Fabulite Fat Free Yoghurt Assorted 1kg Each 49 90 Vital Original Muesli 1kg 18 90 Clover The One 1% Low Fat Fresh Milk 2 Litre 99 90 Douwe Egberts Pure Decaff Instant Coffee 200g 1190839_275 x 210_5 10 50 PnP Light Hummus 120g SAVE 7.90 SAVE 5.60 22 24 R 90 Ryvita Assorted 250g Each Bakers Provita Assorted 500g Each 19 95 PnP Golden Delicious Apples 1.5kg SAVE R8 27 R PnP Mozzarella Cheese 300g 24 90 PnP Bran Flakes 500g 20 90 Jungle Oats 1kg 29 95 10 85 PnP Ripe & Ready Avocados 2s SAVE R5 17 R PnP Cottage Cheese Assorted 250g Each Sasko Low GI True Whole Wheat Brown Loaf 800g 28 90 PnP Large All Grain Eggs 18s 11 95 Albany Superior Low GI Seeded Brown Bread 700g Products advertised in this catalogue serve as a guideline only. Please consult with your health practitioner. 1190839_275 x 210_6 69 28 90 90 PnP Canola Oil PnP Extra Virgin 2 Litre Olive Oil 1 Litre 34 19 90 Colman’s Olive Oil Spray and Cook 300ml 24 10 R 90 R PnP Raw Cashew Nuts or Raw Almonds 100g Each PnP Dried Mango Sulphur Free 100g 59 PnP Sunflower Seeds 100g 90 18 90 Twinings Green Tea Assorted 25s Each 89 90 Black Cat Peanut Butter Assorted 400g Each 7 90 Dürsots Bean-a-Betic 410g Douwe Egberts Instant Coffee Assorted 200g (Excluding Decaf) Glen Rooibos Tagless 14 Each Teabags Pouch 80s 90 Nomu Skinny Hot 39 Chocolate 200g 90 Nestlé Pure Life Still Mineral Water 6 x 750ml Sport Bottle 39 R PnP Soda Water 9 2 Litre 50 1190839_275 x 210_7 FREE + 192 99 75 R R Diabion 100mg MNI AntaGolin Capsules 30s R PEDI-Relax Diabetic’s 279 45 Galvus Met 50/850mg Tablets 60s 27945 Diaglucide 80mg Tablets 60s 50 70 Diaglucide MR 60mg Tablets 30s 5815 Schedule 3 prices advertised are for cash-only purchases Doctor’s script required for scheduled prescription medication. SAVE R10 149 149 R Foot Care Cream100ml Each 60s Galvus Met 50/1000mg Tablets 60s SAVE 8.90 SAVE 7.50 SAVE R14 SAVE 20.90 Foodstate Sugar Balance Formula 60s Solal Glucose Regulating & Diabetes Formula Capsules 90s Probetix Capsules 60s Solal Naturally Sweet 250g Diabesol Softgel Capsules 60s 95 Homemed Glucocheck Strips 50s with Free Meter SAVE 25.20 225 R SAVE 13.80 159 R SAVE 10.60 70 R SAVE 18.50 57 R Pick n Pay cares about you and our environment, and that is why we now have a safe and convenient way for you to dispose of your diabetic related medical waste. Ask your pharmacist for more details. Bedworth Park: Tel: 016 985 1279, Boksburg: Tel: 011 826 2981, Brackenfell: Tel: 021 981 3276, Brentwood: Tel: 011 568 0173, Centurion: Tel: 012 621 7025, Claremont: Tel: 021 674 5867, Durban North: Tel: 031 564 2300, Faerie Glen: Tel: 012 991 3207, George: Tel: 044 871 1523, Greenstone: Tel: 011 452 1473, Helikon Park: Tel: 011 693 5374, Hurlingham: Tel: 011 998 3330, Key West: Tel: 011 273 0716, Lonehill: Tel: 011 465 2899, Mall of the North: Tel: 015 265 1478, Middelburg: Tel: 013 244 1088, Montana: Tel: 012 543 6200, Newcastle: Tel: 034 326 1028, Norwood: Tel: 011 483 3390, Ottery: Tel: 021 703 0291, Pavillion: Tel: 031 265 8478, Plattekloof: Tel: 021 558 0219, Promenade: Tel: 021 376 0488, Somerset Mall: Tel: 021 851 8256, South Coast: Tel: 031 904 7737, Southgate: Tel: 011 941 2452, Soweto: Tel: 011 938 4518, Steeledale: Tel: 011 613 5935, Tableview: Tel: 021 521 5840, The Falls: Tel: 011 958 1113 and Woodmead: Tel: 011 656 9570. PRICES VALID 16 - 29 MARCH 2015 AT PICK N PAY SUPERMARKETS AND HYPERMARKETS Excluding Express, Franschhoek Daily, Pick n Pay Local stores. Visit www.picknpay.co.za, or call 0800 11 22 88. Cellphone rates apply. Promotional stocks are limited. Prices include VAT. smart shopper terms and conditions apply. No traders. E&OE. 1188613_275 1190839_275x 210_4 x 210_8 Interpreting food labels B A C One of the best ways to determine whether a product is suitable for someone with Diabetes, is to learn to interpret food labels. Once you understand what to look out for on food labels, you will begin to navigate the store aisles with ease, while choosing suitable products for your needs. In South Africa, the way manufacturers label nutritional information on food packages has been standardised, which means that no matter which food you are looking at, the same method of interpreting labels always applies. A The information per 100g allows you to compare how much of each nutrient is found in different products. This means that you can choose the higher fibre, lower sugar and lower sodium products by comparing their nutrition tables. B The recommended serving size indicates how much of that product you should eat at one time, while the information per serving indicates how much of the various nutrients you will get from one serving of that food. C This is a measure of the amount of energy a food provides. Taking in more energy than your body needs or uses will result in weight gain, so it is important to balance your extra energy intake with regular physical activity. D People with Diabetes are permitted to have some sugar, provided it is consumed in a small serving, in the context of a balanced meal. Eating too much sugar in one go can have an impact on your blood sugar levels, so aim for products with a lower sugar content wherever you can. D E F G H E Eating too much fat can cause excess energy intake and weight gain, so it is best to choose lower fat products wherever possible. F A high intake of saturated fat has been linked to increased risk for heart disease. Choose products lower in saturated fats as a general rule of thumb. G The higher the fibre content, the better! Fibre is important for digestive health and helps promote a more gradual impact on your blood sugar levels. Our Department of Health stipulates that a food must contain at least 6g fibre per 100g in order to be classified as high in fibre, or at least 3g per 100g to be a source of fibre. H A high sodium intake is linked to increased blood pressure. Ensure that your total sodium intake from processed foods and added salt is not more than 2000mg per day. Breads Top tips for healthier choices when shopping by category • Choose breads which claim to be ‘whole-wheat’ or ‘wholegrain’ • Opt for breads which are low GI • Your breads should be high in fibre (>6g per 100g) • Examples: Heavy breads such as health breads and seed loaves, pumpernickel bread, rye breads, low GI breads Breakfast cereals • Choose high-fibre options (>6g per 100g) • Compare and choose options with lower sugar levels • Choose cereals with lower sodium levels • Examples: oats, rolled oats, oat bran, wholegrain breakfast cereals like bran flakes, shredded bran, low GI low fat muesli Crackers • Choose crackers which claim to be ‘whole-wheat’ or ‘wholegrain’ • Your crackers should be high in fibre (>6g per 100g) • Aim to choose the crackers lower in total fat and sodium • Examples: Provita, Ryvita, Finn Crisp Cheeses • Choose fat-free or low fat cheeses • For hard cheeses, aim for a fat content of less than 13g per 100g • Restrict your intake of hard cheeses to twice a week • Examples to choose from: Low fat or fat-free cottage cheeses, Ricotta cheese, low fat feta or reduced fat cheeses Milk and yoghurt • Choose lower fat dairy products • Be aware that sweetened yoghurts may contain added sugar Choose plain or artificially sweetened yoghurt more often • Examples: Skim or low fat milk in liquid or powder form, low fat buttermilk, plain low fat yoghurt, artificially sweetened fruit and flavoured yoghurts Please consult with a registered dietitian to obtain a meal plan specific to your individual requirements. 1190839_275 x 210_9 Building your cooked breakfast Use your plate model to build a balanced cooked breakfast that is: 1/4 High-fibre carbohydrate • Swap your chips for a slice of whole-wheat toast. • Use whole-wheat flour instead of white flour when making home-made baked goods like crumpets. 1/4 Lean protein • Prepare your eggs without adding additional fat to them by boiling, poaching, microwave scrambling or cooking an omelette without cheese. • Try poached haddock, grilled kippers or fresh salmon instead of bacon. • Choose baked beans as your protein serving over processed meats such as sausages and bacon, which tend to be high in fat and salt. 1/2 Veg • Add volume to your plate with grilled vegetables such as tomatoes, mushrooms and onions. • Feel like an omelette? Include mainly grilled vegetables for a filling, healthy choice. • Remember to use fat sparingly when preparing your veggie sides. Small amount of healthy Fats • Use fat sparingly in your cooking by aiming to use only 1 teaspoon of fat per person sharing the meal. • Use oils such as olive, canola and sunflower oils in place of brick margarine, butter and other solid fats. • Look out for canola, olive or vegetable oil sprays, which allow you to use less oil in your frying pan. High-fibre carbohydrates Vegetables and fruit Healthy fats Lean proteins Did you know? Research has shown that replacing saturated and trans fat with poly- and monounsaturated fats helps to protect against heart disease. Beans are legumes, which are a source of protein and fibre – good for people with Diabetes as they help control your blood glucose levels. Just be sure to eat beans in the serving size appropriate to your meal plan as they do contain some carbohydrates. Please consult with a registered dietitian to obtain a meal plan specific to your individual requirements. 1190839_275 x 210_10 Quench your thirst Choosing hot and cold beverages When it comes to Diabetes, food often takes centre stage. However, it is important to remember that what you drink has as much of an effect on your waistline as it does on your blood glucose. Water is the most readily available and healthy beverage, which is why it should make up most of your daily fluid intake. Craving a little liquid variety? Here’s what you can sip on: Need to drink more water? Here’s how… • Take water breaks instead of coffee breaks throughout your day. • Keep a bottle of chilled water on your desk at work. • Choose water over other beverages when buying from a vending machine or convenience store and opt for sparkling water at special occasions. • Have a glass of water with all your meals and snacks (this will also help to fill you up to prevent overeating). • Flavour your water with a squeeze of lemon or lime juice for a light, refreshing drink. • Make your own flavour-infused water at home by simply putting water in the fridge with cucumbers, strawberries or fresh mint for a refreshing low-calorie drink. • Up to 3 cups of caffeinated tea or coffee per day, using low fat milk and an artificial sweetener if required. • Unsweetened rooibos, black, green and herbal teas. • Most diet drinks (like diet soda or diet tea) have zero grams of carbohydrate per serving, so they will not raise blood glucose on their own. If drinking diet-fruit squashes and artificially sweetened diet cold drinks, have no more than 3 – 4 cans per week. • Cocoa powder can be used to make a hot chocolate drink with boiling water, some skim milk and a little artificial sweetener. And what you shouldn’t Avoid sugary drinks like regular fizzy drinks, fruit punch, fruit drinks, energy drinks, sweet tea, and sugar-sweetened smoothies. These will have an impact on your blood glucose levels and can provide several hundred calories in just one serving. The benefits of exercise Regular activity is as key a part of managing Diabetes as proper meal planning, regular monitoring and taking medication as prescribed. When you are active, your cells become more sensitive to insulin, which means that your body can work more efficiently. During exercise your cells also remove glucose from the blood using a mechanism totally separate from insulin. So, not only does exercising consistently lower blood glucose, it also improves your blood glucose control overall. Top tip: Get moving and get the most out of your exercise routine by incorporating strength training (to build muscle and body structure), cardiovascular training (to improve heart health) and flexibility training (to ensure supple limbs and range of movement). Is there such a thing as a bad egg? Eggs are relatively high in cholesterol, yet there is now enough evidence to suggest that we can eat an egg a day without a detrimental effect on our blood cholesterol levels. The South African food-based dietary guidelines allow for 4 eggs per week and here’s why: • Eggs are a source of protein and several essential nutrients. • Although eggs are relatively high in cholesterol - 210mg per large egg (50g) they have a low saturated fat content. • Many of the studies linking eggs to high blood cholesterol levels and poor heart health are now criticized and considered to be weak. • New evidence suggests that eating eggs is associated with satiety (feeling fuller for longer), good weight management and better diet quality. So, if you enjoy eggs, go ahead, include them in your diet. Just remember: • Prepare your eggs with no extra fat by boiling, poaching or scrambling them. • Limit your egg intake to 1 egg per day. And, if you have raised blood cholesterol levels, limit your intake of animal fats and increase your vegetable, fruit and fibre intake. • Egg whites contain no cholestrol. So, if a recipe calls for a few eggs, moderate your cholestrol intake by using two egg whites in place of one whole egg. Please consult with a registered dietitian to obtain a meal plan specific to your individual requirements. 1190839_275 x 210_11 Pick n Pay health hotline Did you know that Pick n Pay has a registered Dietitian to provide free food and nutrition-related advice to the public? Whether you’re looking for advice on managing your condition, weight loss, healthy eating tips for kids, managing food allergies, interpreting food labels or just have a food-related question you’ve always wanted answered, our registered Dietitian is just a phone call away. Contact Leanne via the Health Hotline 0800 11 22 88 or email her directly on [email protected] to start your nutrition conversation. References and useful links: • Duyff RL (2012). American Dietetic Association Complete Food and Nutrition Guide, 4th Ed. John Wiley & Sons Inc, USA. • Catsicas R (2009). The Complete Nutritional Solution to Diabetes. Struik Lifestyle, South Africa. • Shisana O, et al. (2013). South African National Health and Nutrition Examination Survey (SANHANES-1). Cape Town: HSRC Press. • Diabetes South Africa: www.diabetessa.co.za/Content.aspx?ContentID=1&CatID=1 • American Diabetes Association: www.diabetes.org/?loc=bb • Association for Dietetics in South Africa: www.adsa.org.za • Pick n Pay Nutrition and Wellness: www.picknpay.co.za/health-corner-articles 1190839_275 x 210_12