Diabetes

If lifestyles can pave the way to developing diabetes, that could also be the best means for fighting back. For many people with diabetes, lifestyle changes make all the difference. Eating better and being more physically active can have major effects on your blood-glucose levels. Staying on top of diabetes, then, is all about living well. By following healthy eating guidelines and making regular activity a part of your life, by taking medications or insulin as prescribed and by staying in touch with your diabetes care team, you are taking an active role in managing your diabetes, rather than letting it manage you.
Diabetes is an endocrine condition where the body is either unable to make enough insulin or it is unable to use the insulin it does make, properly. Insulin is a hormone made by the pancreas that controls the amount of glucose (sugar) in the blood. As a result from the insufficient amount /effectiveness of insulin, blood glucose cannot move into cells to be changed into energy. Blood glucose builds up in the bloodstream (hyperglycaemia).

Because the glucose stays in the blood and does not enter the cells, the cells have no fuel to burn for energy. The brain reacts to this by causing a feeling of hunger. Eating food, does not correct this, because there is still not enough insulin, or the insulin is not working properly.

When there is a large amount of blood glucose in your blood (more than 10mmol/L) it spills over into your urine, causing more urine to be passed than normal. Because of the large amount of fluids lost while passing urine the diabetic person will constantly feel very thirsty.

General Dietary Guidelines

1.      Limit the amount of fats, especially saturated fats in the diet.

2.      Avoid the use of refined sugars e.g. fizzy drinks, sugar, jam, syrup, sweets in the diet.

3.      Have three balanced meals daily which are low in fat, high in fibre with a controlled portion of starch (size of a fist)

4.      Make water your preferred drink

5.      Include exercise as part of your daily schedule.

6.      Include fibre into the diet by adding sufficient amounts of fresh vegetables, low GI starches and fruits (limit to 3 per day)

Heart Disease

Cholesterol is a necessary part of every cell in the body.  Problems arise when there are high levels of cholesterol and fat circulating in the bloodstream, as they deposit on the sides of the blood vessels or arteries causing damage and simultaneously clogging them up. In other words, the vessels become narrower and narrower until eventually no blood can flow through them. This leads to a heart attack or stroke.

Total cholesterol is made up with Low-density lipoprotein particles (bad cholesterol), high-density lipoprotein particles (good cholesterol) and Triglycerides.  High triglyceride levels put you at higher risk of developing heart disease. The main contributing factors towards cholesterol levels and triglyceride levels are the amount and type of fat we eat.

DIFFERENT TYPES OF FAT

MONOUNSATURATED FATS (mufa's) :  These are the best choices of fats and should be included into the diet daily in controlled portions.  Foods high in mufa's are avocado, olives, olive oil (contains Omega 3 as well), canola oil, peanut butter, raw, unsalted nuts, nut oils; macadamia oil, avocado oil, peanut oils

POLYUNSATURATED FATS (Omega 3 and Omega 6) is sometimes classified as an "essential fat" because the body can not produce it. When eaten as part of a healthy diet, polyunsaturated fats can help to reduce the amount of total cholesterol in the blood.  Foods high in OMEGA-3 FATS are pilchards, herring, trout, sardines in water/brine, salmon in water/brine, mackerel in water/brine, omega 3 enriched eggs, walnuts and soya beans

Foods high in OMEGA 6 FATS (helps to keep the cell membranes healthy and control cholesterol) are sunflower oil (when heated it forms trans fatty acids that is more detrimental to your health), polyunsaturated soft tub margarines, sunflower and sesame seeds, walnuts (contains Omega 3 as well), most salad dressings, mayonnaise, seed oils; sesame seed oil, grape seed oil, linseed oil (flaxseed)

The intake of foods containing saturated fats/trans fatty acids should be limited.  These foods include all visible fat on meat, processed meats e.g. polony, viennas, salami, organ meats (liver, kidneys etc.), patè, liver spread, chicken skin, cheese, butter, cream, full cream milk, full cream ice cream, full cream yoghurt, coffee creamers & any product containing palm-kernel oil, chocolate & cocoa butter, fudge, coconut and coconut oil, brazil nuts, hard brick margarine, pies and pastries, cakes, biscuits, desserts, croissants and other commercially baked goods, take aways, fried foods and "burnt" fat

The Glycaemic Index and Glycaemic Load

Glycaemic index (GI)

Carbohydrate containing food like starches, fruit, vegetables, dairy products and legumes or sweet food, are digested in the stomach and intestines and are then absorbed into the blood stream in the form of glucose. The glucose in the blood then stimulates the pancreas to secrete insulin into the bloodstream. Insulin, a hormone, helps to regulate blood glucose levels by taking up glucose from the blood, so that the cells can use the glucose for energy.

The Glycaemic index (GI) of food is simply a ranking of carbohydrate food based on their immediate effect on blood glucose levels. Carbohydrate foods include vegetables, fruit and starch as well as legumes and dairy.

Glyc = glucose   aemic = blood   index = indicator

The Glycaemic index of pure glucose is 100 and every other food is ranked on a scale from 0 - 100 according to its actual effect on the blood sugar levels.  Foods with a LOW GLYCEMIC INDEX or slow release carbohydrates (0 - 55) are broken down slowly and results in much lower blood glucose level increases after consumption. These lower increases are maintained for a longer period.  Carbohydrates that are broken down a little faster than low GI carbohydrates are called INTERMEDIATE GI (56-69). In controlled portions these carbohydrates will still control blood glucose and insulin levels.  Foods with a HIGH GLYCEMIC INDEX or quick release carbohydrates (>70) are absorbed the quickest and therefore produce a high increase in blood glucose levels. This triggers a large insulin secretion

Glycaemic load (GL)

This is the glucose load (the amount of glucose) the body have to deal with in a specific period of time

The Glycaemic load (GL) of a specific food portion is an expression of how much glucose the body has to deal with, to keep blood glucose levels within normal ranges. Note that the GL is portion specific and the larger the portions of food, the bigger the Glycaemic load for that portion of food. This new concept takes into account the GI (absorption rate of the carbohydrate food) as well as the portion size (the amount of glucose) to give us an idea of the glucose load the body has to deal with. Thus the more carbohydrates (bigger portion) the more work it is for the body to keep blood glucose levels well controlled.

GL recommendations for weight loss

It is advisable to keep the GL of a typical meal at 20. The GL of a typical snack should preferably be between 10 and 15, preferably closer to 10. Thus the total daily GL should be 80 to 120 for the average person.

By using the GI and GL concept in combination with a low fat eating plan, people with diabetes, low blood glucose (hypoglycaemia), people at risk of heart disease and sports people can all benefit from more optimal blood glucose levels. For those wanting to lose weight, the increased satiety, and less insulin production when lower GI foods are consumed, results in better body fat loss.

PRACTICAL WAYS TO LOSE WEIGHT

Achievers choose what losers want and pay the price that others don't

Traditionally South Africans prepare meals with the emphasis on the meat and starch part of the meal. This mindset needs to be changed to considering the vegetable and fruit part of the meal first, before considering the meat and the starch. Ideally a plate of food, whether it is put together at home, in a restaurant or in a lunch box, should have half the volume filled with vegetables and /or fruit. To this, one then adds a small portion of lean protein. Add one fistful (of the person who is to eat the meal) of lower GI starch and then one fat may be added to the meal.

(insert plate model please)

Examples of balanced meals:

Breakfast: A high fibre cereal with low fat or skimmed milk and a fresh fruit cut into the

Snack: Fresh fruit is the best snack

Lunch: Salad (lettuce, cucumber, tomato, carrots, broccoli etc.) with grilled chicken and small portion of salad dressing with a slice of low GI bread

Snack: 4Provita with fat free cottage cheese

Supper: Beef stir fry with pasta (large serving of stir fry vegetables)

Ask yourself these questions and listen very seriously to your answers.

• What do I really want?
• What will it cost?
• Am I willing to pay the price?
• When should I start?

If you don't answer the last question and make a commitment to a starting date, the first 3 questions do not matter. The best answer is NOW

Do you want to loose weight?

Ask yourself the following questions and give honest answers.

1.  Have you learnt to eat enough calories per day?  Yes/NO

2.  What is motivating you?

3.  What is going to motivate you for the next 6 weeks?

4.  Do you still get hungry?  Yes   NO

5.  When and why?

6.  Is your family supporting you to reach your goal? Yes   NO

7.  Are you eating according to your mood? Yes   NO

8.  Can you imagine yourself at you goal weight? Yes   NO

9.  What is the next strategy to reach your goal?

Setting goals to change eating habits

Step 1: Acknowledge the need to change

It is very important that before you try to lose weight, you realize that you need to lose weight or that there is a problem with your eating habits and that they need to be changed.

Step 2: Formulate your goal

It is very important to set a goal that is specific, challenging and attainable, rather than one that is vague, boring and unattainable.

One example is a loss of 5 - 10% of body weight in 12 weeks. If you weight 100kg, that will be 5 - 10 kg in 12 weeks. That will be 400 - 800 g per week. After that goal is reached you set the next 10% goal for the next 12 weeks, and the total loss within the year.  The advantage of setting more than one goal (short and long term) is that it focuses your attention and activities on your actions and habits, which means you can mobilize personal and social support systems. One is inclined to put in effort once a goal has been set than when one has no goal at all.

Step 3: Monitor the activities that help you achieve your goals

Every plan must have checks and balances, and it is the same with goals. If you are not reaching your goal as planned, you may need to go back to step 1 and consider whether you are indeed convinced the need to change. You may also have to rethink your goals (step 2) and perhaps simplify it, or adapt it to your eating behaviour so that it is possible to achieve.

Step 4: Reward yourself for goals reached (not food related)

People who get rewards for achieving goals fare better than those who get no rewards.

• New bubble bath/A bubble bath with candles
• New nail polish/New lipstick
• A nap on a Sunday afternoon
• Lie flat on your back with your favourite magazine - the one you never buy.

Eating is not a good hobby for the following reasons:

• If you eat too much, you end up fat
• If you eat too much, you'll feel guilty. This means you'll end up hating yourself, or eating even more because - your reason - you've already overdone it, so you may as well make a good job of it.
• Overeating doesn't give you any sense of achievement. What give you sense of achievement?
• You're supposed to eat only when you're hungry, not to pass the time !!

Make an effort !!

You have to start making changes, and see them as permanent, not part of a "diet"

THE ROLE OF NUTRITION IN HIV/AIDS

The nutritional status of an individual is known to play an important role in decelerating the progression of HIV to AIDS, improving quality of life and decreasing the prevalence and severity of the infectious complications of HIV/AIDS.

NUTRITIONAL TREATMENT OF HIV/AIDS

¨        Nutritional assessment

Although body weight per se, may underestimate the degree of wasting in HIV/AIDS, it is important to keep track of the changes in body weight. The patient's weight should be charted regularly to assess whether the weight loss is acute (a lot of weight lost within a short time) or chronic (slow progressive weight loss). Dietary intake should also be assessed regularly in combination with physical and work related activity as well as employment status to determine food and nutrient intake.

¨        Nutrient needs: Energy

Acute infectious illness, such as HIV/AIDS, is accompanied by a complex variety of nutritional and metabolic responses within the body. The response to infection is associated with an increase in the energy requirements of the patient and various degrees of lean tissue breakdown.

¨        Protein

HIV/AIDS patients are known to have high losses of protein (nitrogen), which may result in malabsorption due to diarrhoea, loss of fluids, electrolytes and other nutritional reserves. The breakdown of protein and other reserves due to fever may also worsen under nutrition and further impair resistance against the infection. An increase in protein breakdown for example leads to muscle wasting in these patients.

¨        Fat

Tolerance of fat varies from person to person. In the presence of malabsorption or diarrhoea, a low fat diet may relieve some of the symptoms.

¨        Vitamins and Minerals

The response to infection includes a profound impact on the micronutrient status of the patient. Vitamins and minerals are compounds that are essential for normal growth and maintenance of body functions, playing key roles in many different metabolic processes in both health and disease.

Food Safety

Food safety is important, since immuno suppressed people are highly susceptible to food- born pathogens. Therefore, special care should be taken with uncooked food products such as eggs, fish, meat and un-pasteurised milk. The following can be used to increase the safety of food and drinking water:

¨        Always wash your hands before touching food or water

¨        Wash all vegetables and fruit thoroughly

¨        Avoid touching farm animals

¨        Boil water for one minute at rapid boil and store in a clean, closed container or use bottled water

¨        Cook all meat fish and eggs completely before eating in a hygienically prepared kitchen

¨        Use only pasteurized milk and dairy products

¨        Thaw all foods in the refrigerator and not at room temperature

¨        Keep shelves, counter tops, other kitchen utensils, sponges and towels clean at all times

¨        Use different cutting boards for foods intended to be served raw than for foods that will be cooked

¨        Exercise caution consuming foods or beverages out of home or when travelling

BASIC PRINCIPLES TO REMEMBER

Enjoy a variety of foods

Be active

Drink lots of clean, safe water

Make starchy foods the basis of your meals

Eat plenty of fruit and vegetables every day

Eat dry beans, lentils, split peas and soya regularly

Try to eat chicken, fish, meat, milk or eggs daily

Use salt sparingly

Don't take alcoholic drinks, they are bad for your liver and can affect the medicines that you take