Updated 15 February 2017

Diabetic diet no longer dull

Thanks to the latest research, diabetics can now enjoy a perfectly normal, varied diet.


Being diagnosed with diabetes certainly isn't a gastronomical prison sentence anymore. Thanks to the latest research, diabetics can now enjoy a perfectly normal, varied diet.

Information presented at a recent symposium on ‘Sugar & Health’, which was jointly organised by the SA Sugar Association and the University of the Free State, made this quite clear.

One of the papers on “Dietary Management of Diabetes Complications”, presented by Dr Renée Blaauw of the Department of Human Nutrition at the University of Stellenbosch, was particularly significant.

The goals
Dr Blaauw pointed out that the goals of medical nutrition therapy or the dietetic treatment of patients with both type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes are to achieve and maintain blood-glucose levels that are as close to normal as possible, to reduce raised blood-fat levels, and to prevent or manage increased blood pressure.

In addition, dietary treatment of diabetes aims to prevent, or delay and treat any of the multiple complications associated with diabetes. It was particularly encouraging to hear that modern diabetes diets also set out to ensure the pleasure of eating for patients.

Logically, diabetic diets should help diabetics to maintain their ideal body weight or assist with weight loss if they're overweight or obese. In children, the energy and nutritive contents of the diet must ensure that the child or teenager will grow and develop normally. In the case of special needs, such as those of pregnant and breastfeeding diabetic women, the diet must provide adequate intakes of energy and nutrients required for the health of the mother and the child.

Let’s have a look at recent dietary recommendations for diabetics:

While each diabetic needs to have his or her energy intake worked out by a dietician to take into account factors such as age, gender, level of activity, type of diabetes, type of diabetes medication (insulin or anti-diabetic medications) and food preferences, it's generally a good idea to reduce energy intake if the person is overweight or obese.

Even a 5-7% loss of weight (for example, a patient weighing 70kg should lose at least 3,5 to 5kg in weight) will cause significant improvements in blood-glucose and insulin levels, lower blood fat levels and reduce high blood pressure.

Many newly diagnosed diabetics believe that they're not allowed to eat carbohydrates and that they should certainly not eat any sugar. This is not the case. Diabetics are allowed to eat carbohydrates and some sugar, provided that they select the correct types of carbohydrates and spread them over the six small meals a day that are best suited to a diabetic diet.

Research has shown that carbohydrates with a low glycaemic index (GI) are beneficial for patients with diabetes. The advantages of using low-GI carbs is that they improve blood sugar control, lower raised blood fats, make patients feel satisfied for longer (thus preventing cravings), and sustain energy levels.

When it comes to sugar, researchers have found that table sugar or sucrose, which has an intermediate GI of 68, doesn't increase blood sugar levels more than the same amount of starch.

Diabetics can use approximately 50g of sugar (10 teaspoons or 3 tablespoons) a day to make their diet more palatable (for example, using sugar with low-GI porridges or cereals, or jam on seedbread).

Dr Blaauw emphasised that it's important to keep in mind that diabetics shouldn't eat sweet products that have a high fat content (e.g. chocolates, cakes, pastries etc.) as this would push up the energy content of the diet and could cause weight gain. So, be selective when you use plain table sugar or jam or honey to make foods taste better and don’t take this recommendation as permission to have a whole slab of chocolate at one sitting!

Your dietician will indicate how many low-GI portions you need on a daily basis, depending on the type of insulin or blood-glucose-lowering medication you use and how active you are. She/he will also indicate how you can include some sugar to make your diet taste better.

Dr Blaauw stressed that fat intake shouldn't be higher than about 70g per day for a normal-weight diabetic following a diet that contains about 8400 kJ/day.

What is particularly important is the type of fat that diabetics eat. Saturated fats (found in foods derived from animals such as fatty meat, cream and butter, and hydrogenated fats like hard margarine, cakes, pies and pastries) should be reduced to 5g per day.

Trans-fats, which occur in commercial products such as certain hard margarines, baking fat, biscuits, high-fat snacks and coffee creamers, should be avoided.

The healthiest fats for diabetics are monounsaturated fats and oils, which are mainly found in olives, olive oil, avocados, avocado oil and fatty fish. Nowadays, you can also purchase margarine made from olive oil in most supermarkets.

To obtain the benefits of both the monounsaturated fats and omega-3 fatty acids that occur in fish, it's a good idea to eat fatty fish such as tuna (canned or fresh), sardines, mackerel, snoek or salmon (canned or fresh) 2-3 times a week.

Diabetic diets shouldn't contain more than 200mg of cholesterol per day, which means that you should cut down on fatty meats, chicken skin, sauces made from dripping, full-cream milk and yoghurt, cream, butter and hard cheeses.

Diabetics often think that they should replace carbohydrates with proteins in their diet. This is not the case. Dr Blaauw indicated that an adult diabetic eating 8400kJ of energy a day only requires about 90g of protein a day or slightly more than an average person without diabetes.

The problem with eating too much protein is that many protein foods are also rich in total fat, saturated fat and cholesterol (see lists above). Stick to eating lean meat with all the visible fat removed, eat the white meat of poultry without the skin, eat more fish, use fat-free milk and dairy products and always rely on legumes to provide at least half your daily protein needs.

Legumes include dry, cooked or canned beans, peas, lentils or soya (soya mince, milk, tofu). Not only are legumes low in fat and saturated fat, but they also don’t contain any cholesterol and are rich in dietary fibre and plant components called sterols, which are beneficial to diabetics.

Try to eat at least one portion of legumes a day or use cooked legumes to ‘dilute’ meat dishes. You can add 50% cooked legumes to mince or meatballs or stews to lower the fat content, without reducing the protein content.

Dr Blaauw pointed out that diabetics are now able to eat a much more normally and that it's no longer necessary for them to have a ‘separate’ diet. In fact, if the entire family adopts these diet recommendations, everyone will benefit.

- (Dr I.V. van Heerden, aka DietDoc, June 2008)

(Blaauw, R (2008). Dietary Management of Diabetes Complications. Paper presented at the ‘Sugar & Health Symposium’, University of the Free State, Bloemfontein, 11-12 June 2008


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Dr. May currently works as a fulltime endocrinologist and has been in private practice since 2004. He has a variety of interests, predominantly obesity and diabetes, but also sees patients with osteoporosis, thyroid disorders, men's health disorders, pituitary and adrenal disorders, polycystic ovaries, and disorders of growth. He is a leading member of several obesity and diabetes societies and runs a trial centre for new drugs.

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