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Diabetes mellitus is one of the most common diagnoses in the world and it affects millions of people every year. Diabetes is referred to as a "disease of lifestyle" because it is essentially our lifestyle disorders that make this disease flourish.

Diabetes is a disorder of blood sugar metabolism, which results in abnormally high levels of the simple sugar, glucose, in the blood stream. Glucose itself is what causes the complications associated with diabetes.

All food that we eat gets broken down in our digestive system and enters put blood stream. Foods that turn to glucose quickly- like carbohydrate foods, will have a more immediate affect on blood sugar. A hormone called insulin, which is produced by the beta cells of the pancreas, is responsible for shuttling glucose out of the bloodstream and into the cells, where it is burned for energy. With diabetes, either insulin production or function is low, which means that blood sugar remains high.

The initial symptoms of high blood glucose are rather vague, so most people won’t even know that they have diabetes. Symptoms include:

· Unexplained weight loss or weight gain

· Increased urination

· Excessive hunger and thirst

· Blurred vision

· Fatigue

Diabetes mellitus is generally divided into two categories: type I, called insulin-dependant diabetes (IDDM) and type II called non insulin-dependant diabetes (NIDDM).

With Type I diabetes there is a destruction of the pancreatic cells that manufacture insulin. In this case, daily insulin injections are required for survival. Type I diabetes is an auto-immune disorder whose causes are largely unknown. Type I diabetes can result in deadly high blood sugar (hyperglycemic) if left untreated.

Type II diabetes usually occurs later in life, although younger people are getting this type of diabetes too. With Type II’s, insulin is usually still being produced, but its function at the cellular level is reduced. This is often reffered to as Insulin Resistance. It is more related to lifestyle than Type I diabetes.

Consistently high blood glucose levels produce complications over time. Glucose can damage the retina of the eye leading to blindness. Glucose damages blood vessels making them more susceptible to the harmful effects of cholesterol. Damage to the kidney can result in kidney disease and ultimately kidney failure. Bladder dysfunction, sexual dysfunction and digestive problems can also result.

 

In essence a heart attack is an ischemic event in which the blood supply to the heart organ is cut off (in the case of a stroke it’s the brain’s blood supply that is blocked). The leading cause of heart disease is something known as atherosclerosis, or hardening of the arteries. Cholesterol build-up is one way of blocking up an artery but not everyone with high cholesterol will suffer a blocked artery.

The major RISK FACTORS for heart disease, according to the Heart and Stroke Foundation of South Africa, include:

Alcohol consumption

Moderate consumption. This may have a positive effect and protect against heart disease. Reasonable amounts of alcohol may

Increase HDL (‘good’) cholesterol.

Have an anti-clotting effect on blood.

This protective effect is greatest in men over 40 and post-menopausal women as they are the highest risk groups. There is little protective effect in younger people as they are generally not at high risk for heart disease.

Excessive consumption. Drinking too much alcohol increases health dangers, including high blood pressure, heart failure and increased levels of triglycerides (a type of fat) in the blood. Binge drinking can lead to a stroke.

Other serious effects are heart muscle damage, heart rhythm disturbances and sudden cardiac death. It may also contribute to the development of obesity, diabetes and liver disease.

Smoking

Smoking causes Heart Disease by:

· Increasing blood pressure

· Increasing blood clotting

· Increasing carbon monoxide levels and reducing oxygen levels

Overweight

Carrying excess weight simply puts strain on the heart that has to work harder to pump blood around the body. It also increases the risk for hypertension and diabetes.

Stress

There is a direct link between heart disease and stress although the exact mechanisms are largely unknown

Lack of Exercise

A lack of physical exercise is a risk factor for both heart disease and high blood pressure. In comparison to those who exercise regularly, inactive people have twice the risk of suffering a heart attack and three times the chance of dying immediately after such an attack.

High Cholesterol

Cholesterol is a waxy, fatty substance in the blood that plays an important role in our cells and hormones. The liver produces all the cholesterol the body needs, but is encouraged to produce excess amounts by the fat (particularly saturated fat in meat/dairy products) that we eat.

A high blood cholesterol level is seen as dangerous to our health because excess amounts are deposited on the inside of arteries, eventually blocking blood flow to the heart.

Hypertension

Blood pressure is the pressure of the blood in your arteries that is needed to keep blood flowing through your body. High blood pressure develops if the walls of the larger arteries lose their natural elasticity and become rigid, and the smaller blood vessels become narrower. High blood pressure can also force cholesterol and plaque into the artery walls

Diabetes

Heart disease is the leading cause of diabetes-related deaths because the constant high blood sugar is associated with narrowing of the arteries, increased blood triglycerides (a type of fat), decreased levels of HDL (“good”) cholesterol, high blood pressure and heart attack.

Genetics

Some people are more prone to heart disease (or heart disease risk factors) because of genetic predisposition. A family history of heart disease is the first clue towards a genetic predisposition.

Heart disease is the leading cause of diabetes-related deaths because the constant high blood sugar is associated with narrowing of the arteries, increased blood triglycerides (a type of fat), decreased levels of HDL (“good”) cholesterol, high blood pressure and heart attack.

 

 

Certain lifestyle practices could be putting you at increased risk for the bone degenerative disease knows as osteoporosis. About one in three women over the age of fifty will experience osteoporotic fractures, as will 1 in 5 men. Although osteoporosis is often a genetically linked condition, lifestyle factors play a major role in its progression. Preventing osteoporosis is all about a good diet and lifestyle programme.

 

The strength of our skeleton is determined by the mass of the bones, which is dictated by the degree of bone mineralization. Bone mineral density (BMD) increases throughout childhood and adulthood and reaches its peak between the ages of 30 and 35 years. After that, it begins a decline. From the ages of 55 to 70, women typically experience a 30-40% BMD loss.

 

In osteoporosis the BMD is reduced, bone micro architecture is disrupted, and the amount and variety of proteins in bone is altered. Osteoporosis is defined by the World Health Organization (WHO) in women as a bone mineral density 2.5 standard deviations below peak bone mass.

 

Osteoporosis is most common in post-menopausal women, because of the link between estrogen depletion and bone loss. Osteoporosis in men is often due to the presence of particular hormonal disorders and other chronic diseases or as a result of medications, specifically glucocorticoids.

Most women with osteoporosis do not know they have the disease until a minor accident causes a broken bone, often a wrist or hip. Osteoporosis is thus often refereed to as the “silent thief”. Preventing osteoporosis is about both optimising peak bone mass and slowing the decline. Lifestyle and nutrition play a very important role in preventing osteoporosis.

Are you at Risk for developing Osteoporosis?

Certain risk factors for osteoporosis such as family history, being female, being small boned, being of white or European decent, or being over the age of 50 are non-modifiable. Menopause and post menopause is a major risk factor for osteoporosis, and women in this stage of life need to be particularly vigilant about osteoporosis treatment. Other risk factors and risky behaviours include:

A low calcium diet

Most of the bone matrix is composed of calcium, and calcium deficiency has been linked to bone loss and osteoporosis. The National osteoporosis foundation recommends 1000mg calcium per day for adults under fifty years and 1200mg calcium per day for over fifties.

 

Dairy products are the richest sources of calcium but are not always the best choice for preventing osteoporosis. Dairy however, is low in magnesium, which is needed for optimum calcium absorption Combining dairy with magnesium rich foods like wholegrains (for example, cereal and milk) or green vegetables (for example, broccoli and cheese sauce), will enhance its absorption. Nuts, such as almonds and sesame seed contain calcium as do animal sources such as salmon and sardines (fish tinned with bones). Soya products are also a good source of calcium. Vegetables sources of calcium include spinach, broccoli, kale and turnip greens. However, the calcium found in vegetable sources is less available due to the presence of substances called oxalates, which can interfere with calcium absorption. An example

 


One of the more universal features that I see with my clients, and especially corporates, is their lack of good blood sugar control. Waking up hungry, stimulant reliance, sugar cravings, lapses in concentration, mood swings and that four o clock energy slump are all-too-common symptoms of poor control. Diagnoses of hypoglycemia, the clinical term for low blood sugar, are on the rise. While hypoglycemia can cause many relatively benign albeit unwanted symptoms, it can be a precursor for full-blown diabetes later in life is left unmanaged. Hypoglycemia treatment is about learning to control the peaks and troughs to create a flatter blood sugar curve involves dietary and lifestyle adjustments.


The hormone that controls our blood sugar levels is the key to understanding blood sugar control and hypoglycemia treatment. All food that we ingest eventually gets converted into a usable form of energy for the body- glucose. Protein and fats take a longer time to get there and carbohydrates are our main or immediate source of glucose energy. Once carbohydrates have been digested, they enter the bloodstream in the form of glucose, and this impacts on what we call our blood sugar. Insulin is the hormone responsible for getting the glucose shuttled out of our blood and into our cells for use as energy. It is like the “key that unlocks” the door

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to our cells allowing energy to enter. When the body gets a load of glucose, a subsequent rise in insulin levels follows; glucose gets taken into the cells and blood sugar drops.

 

Most of us can maintain a fairly even keel when it comes to blood sugar, however there are many factors that contribute to poor control. For better blood sugar control, the following changes need to be implemented:

Eat smaller, more regular meals

If we go for extended periods, and especially if we start the day off on a bad footing by skipping breakfast, blood sugar levels will naturally fall. To avoid this, try following the 3-hour rule, which means to eat within 3 hours of waking up and eat a meal or snack every 3 hours. The biggest problem I find is lack of planning, so make an effort to plan your meals and snacks so that you are not left with nothing to eat during busy or challenging times.

Eating the right types of carbohydrates

The glycemic index (GI) is a ranking of carbohydrates based on their immediate effect on blood glucose levels. It compares foods gram for gram of carbohydrate. Carbohydrates that breakdown quickly during digestion have the highest GI’s and are referred to as high GI. Carbohydrates that breakdown slowly, releasing glucose gradually into the blood stream, have low GI’s. Glycemic index scores are calculated relative to the GI of glucose, which is 100. High GI foods have a GI of greater than 55, and low GI foods are below 55 GI points. When we eat high GI foods, like white bread or cornflakes, our blood glucose levels rise higher and faster than they would with low GI foods, like wholegrain seed breads or wholewheat pasta. This means more insulin is secreted in response and blood sugar levels fall faster than they would with low GI foods. Although blood sugar may not drop below what is considered normal, the speed of the drop causes symptoms similar to that of hypoglycemia. Eating low GI foods on the other hand will help prevent your blood sugar levels from spiking and result in a more sustained release of glucose energy. The GI can only be applied to foods that contain carbohydrate, which includes fruit, vegetables, sugars, starches, milk and yogurt. Meats and oils have no glycemic index value.

Basic Glycemic Index Guide

 

Higher GI Food Examples

Lower GI Food Examples

White, brown and wholewheat breads

Low GI seed breads and sourdough rye breads

Most breakfast cereals, regular and quick cook oats, and regular mueslis

Bran flakes, rolled oats, and Low GI cereals and mueslis that are labeled as such

Pasta: lasagna, penne, fussilli

Pasta: spaghetti, fettuccine, angel hair, any wholewheat pasta

Refined mielie meal

Cold or reheated mielie meal, samp and beans

Baked and mashed potatoes

Boiled potatoes in the jacket

Wild rice, brown rice, Tastic Rice, Basmati rice

Short grain sticky rice

Tropical fruits (e.g. papaya, banana)

Deciduous fruits (e.g. Apples, pears, plums), citrus fruits, berries

Most vegetables including greens

Butternut, pumpkin

Fructose, xylitol

Sucrose, glucose

All legumes and dry beans

 

Eat protein at every meal

The presence of protein in a meal lowers the GI of that meal. For example a plain baked potato with a salad is a high GI meal compared to a baked potato filled with tuna salad. Eating 1 apple on its own will produce a more rapid glycemic response than combing it with some almonds, which contain protein.

Good sources of protein to include at meals and snacks include:

 

Lean red meats

Skinless chicken

Fresh fish

Tinned fish

Eggs

Soya

Legumes and dry beans

Dairy products

Nuts and seeds

 

Avoid reliance on stimulants

The use of stimulants like caffeine can lead to problems with blood sugar control. Caffeine simulates the liver to release stored glucose, giving us a sense of feeling energized. However, at the same time we produce more insulin, and blood sugar levels drop again. The higher the dose of caffeine the more pronounced the drop in blood sugar becomes. Caffeine can also mask feelings of hunger, which leads to a decrease in food intake and a lowered blood sugar.

Practice effective stress management

The way in which stress effects blood sugar is closely linked to a hormone called cortisol. Cortisol forms part of our “flight or fight” response to stress by stimulating the release of glucose from the liver. The body, in turn, releases insulin in an attempt to shuttle that glucose into the cells where it is used for that extra energy we need to perform in stressful situations. Intermittent stress throughout the day will send us on somewhat of a rollercoaster as blood sugar levels rise and fall. Chronic stress can lead to more pronounced problems, as the adrenal glands (the glands that produce cortisol) become exhausted. The result is a decreased production of cortisol and a lowered blood

Avoid excessive alcohol

Alcohol directly causes hypoglycemia by blocking the release of stored glucose from the liver. Drinking on an empty stomach is particularly troublesome. Alcohol

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should always be taken with meals and in moderation, which means no more than two standard drinks per day for women and three standard drinks a day for men.

 

Correct nutritional deficiencies

Certain supplements can also help with hypoglycemia treatment. Chromium (a B vitamin-like substance) found in high concentrations in wholegrains and green vegetables is probably the most common nutrient deficiency linked to poor blood sugar control. The mineral magnesium (found in similar food sources to chromium) is another common deficiency that impacts on blood sugar. Modern food processing is one of the major causes of such deficiencies because these nutrients are generally found in the husk of wholegrains, which is removed during processing. Supplements containing chromium, magnesium and another mineral vanadium are commonly prescribed to help balance blood sugar levels.

Author: Ashleigh Caradas

*This article also appeared in Business Day Health News

 
What is the Glycemic Index? PDF  | Print |

The Glycemic Index (or GI) represents one of the most significant medical breakthroughs with implications for weight management, disease management and general wellbeing. Before the discovery of the Glycemic Index, we were led to believe that all simple carbohydrates, like fruits and sugars broke down quickly in the body, and that complex carbohydrates, like breads and potatoes, broke down more slowly. We were therefore advised, that for health and energy, we should be eating more complex carbohydrates and in fact, that we should be making these the basis if our diets. The food guide pyramid, developed by the United States Department of Agriculture in 1992, suggests that we should be eating six to eleven servings of complex carbohydrates per day for health. The problem is, this very same starchy diet advocated for health, has been shown to be a major contributor to obesity, diabetes and other modern day diseases of lifestyle. Then came Dr. Atkins, who went against the grain by advocating his low carbohydrate, high protein diet for weight loss and so the pendulum swung from one side to another. What we know now, is that we can take both rather extreme dietary theories and create a new way of eating that is more balanced, more moderate and all together more healthy. Enter the world of GI diets.

What is the Glycemic Index?

The GI is simply a ranking of foods based on their immediate effect on blood glucose levels. It is a physiological measure of how fast, and to what extent, a carbohydrate food affects blood glucose levels. The GI can only be applied to foods that contain carbohydrate. Meats and oils, which are carbohydrate free, do not have a glycemic index.

After you eat a meal, all food (but particularly carbohydrate foods) gets broken down into a usable form of energy for the body called glucose. Protein foods, like meats are converted to amino acids and fatty foods, like oils are converted to fatty acids and glycerol. When these foods are eaten in excess though, the remainder will eventually get converted to glucose too. Glucose is the main energy source for our body and brain cells. Insulin is the hormone responsible for getting the glucose shuttled out of out blood and into our cells for use as energy. It is like the “key that unlocks” the door to our cells allowing energy to enter.

When the body gets a load of glucose, a subsequent rise in insulin levels follows; glucose gets taken into the cells and blood sugar drops. The faster blood sugar rises, the faster it falls, and the slower it rises, the slower it falls. Carbohydrates that breakdown quickly during digestion have the highest GI’s and are referred to as high GI. Carbohydrates that breakdown slowly, releasing glucose gradually into the blood stream, have low GI’s. Glycemic index scores are calculated relative to the GI of glucose, which is 100. High GI foods have a GI of greater than 55, and low GI foods are below 55 GI points. When we eat high GI foods, like white bread or cornflakes, our blood glucose levels rise higher and faster than they would with low GI foods, like wholegrain seed breads or wholewheat pasta. This means more insulin is secreted in response and blood sugar levels fall faster than they would with low GI foods. Eating low GI foods on the other hand will help prevent your blood sugar levels from spiking and result in a more sustained release of glucose energy.

Factors affecting the Glycemic Index

The GI is not always so clean cut and there are many factors affecting the GI if foods that need to be taken into consideration before planning your diet. These include:

Acid.

Adding some acidity from vinegar or lemon juice to food helps decrease the GI of the meal. So if you must have that high GI baked potato, add some balsamic vinegar to help lower the GI.

Food preparation.

Slightly undercooked or raw foods have a lower GI than cooked or over cooked foods. So, lightly steamed vegetables will have a lower GI then vegetable soup for example.

Ripeness.

Slightly under ripe fruit has a lower GI than overripe fruit, however, ripe fruit is more nutritious.

Protein and fat content.

The presence of protein or fat in a meal lowers the GI of that meal. For example a plain baked potato with a salad is a high GI meal compared to a baked potato filled with tuna salad. Eating a peach on its own will produce a more rapid glycemic response than combing it with some almonds.

Glycemic Load (GL).

Just because a food is low GI, it doesn’t mean that you can eat these foods freely; and just because a food is high GI it doesn’t mean that you have to stay away from it totally. The GL was developed by scientists from Harvard University and fine-tunes the GI concept. The GI is a quality rating, while the GL is a quantity rating. The GL of a specific food portion is an expression of how much impact or power the food will have in affecting blood glucose levels. It is calculated by taking the percentage of the food’s carbohydrate content per portion and multiplying it by its GI value. So eating just a small portion of a high GI food, like watermelon, could affect your blood sugar as much as eating too much of a low GI food, like apples. So it’s quality and quantity that affects overall blood sugar control.

Applications for the Glycemic Index

Choosing lower GI foods over higher GI foods can help you achieve better blood sugar control, which means that low GI diets have applications in diabetes prevention and management as well as in the management of hypoglycemia. Sports people and very active people can benefit from the sustained release of energy that lower GI diets can help one achieve. High GI foods are also useful in sports during or after exercise to help correct exercise induced low blood sugar. Stress affects blood sugar control, so people in high stress environments, like corporates will benefit from the effects on low GI diets. The GI has also been used with great success in weight loss diets, because they help reduce the insulin load that can lead to weight gain. Children, and particularly those with learning difficulties and attention deficit disorder do better on lower GI diets.

Making The Glycemic Index Work For You

It is important to remember that the purpose of the GI is not to classify foods as “good” or “bad” but rather to help you learn how to make the right combinations that help you get the most out of your food. While it is always a better choice to choose lower GI foods, you can still make relatively good choices with higher GI foods.

At breakfast time, give preference to low GI breads or cereals. Should you prefer the higher GI varieties, you can add some protein (like an egg), oat bran, or some milk or yogurt, which lowers the GI further.

If high GI foods, like white bread are your thing, combining them with lower GI foods to help balance the meal out. So instead of 2 slices of white bread, you could try eating just one slice and replacing the other slice with a few tablespoons of baked beans and some salad greens. Salads should include a large amount of vegetables and balanced out with a lean protein (like fish, low fat cheese or chicken for example) and accompanied by a low GI starch (like a slice of low GI bread, some legumes, some barley or brown rice, for example).

Make up the bulk of your main meals (about half of your plate) with low GI vegetables and fill about one quarter of your plate with low GI starch (like some wholewheat pasta or sweet potato, for example). Then include some lean chicken, meat or

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fish, or a vegetable protein source from legumes or soya to fill the remaining quarter of your plate.

 

Most fruits are relatively low GI so they are an ideal between meal snack. Higher GI fruits, like melons, can be combined with some nuts and seeds to help lower the GI. Low GI crackers with protein or fat toppings are also good snack choices

Basic Glycemic Index Guide

 

Higher Glycemic Index Food Examples

Lower Glycemic Index Food Examples

White, brown and wholewheat breads

Low GI seed breads and sourdough rye breads

Most breakfast cereals, regular and quick cook oats, and regular mueslis

Bran flakes, rolled oats, and Low GI cereals and mueslis that are labelled as such

Pasta: lasagne, penne, fussilli

Pasta: spaghetti, fettuccine, angel hair, any wholewheat pasta

Refined mielie meal

Cold or reheated mielie meal, samp and beans

Baked and mashed potatoes

Boiled baby potatoes in the jacket, slightly undercooked

Short grain sticky rice

Wild rice, brown rice, Tastic Rice, Basmati rice

Tropical fruits (e.g. papaya, banana, melons)

Deciduous fruits (e.g. Apples, pears, plums), citrus fruits, berries

Butternut, pumpkin

Most vegetables including greens

Sucrose, glucose

Fructose, xylitol

All legumes and dry beans

Milk and yogurt

 

Author: Ashleigh Caradas

* A copy of this article appeared in BUSINESS DAY HEALTH NEWS

 
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