Organic acids and fermented foods
Organic acids such as lemon juice and vinegar, as well as fermented foods like traditional fermented porridge (suurpap), lower the GI. By adding an acidic salad dressing and/or vinegar to salads, you can lower the GI of not only the dish, but the entire meal.
Where does sugar fit into the diabetic diet?
Cane/table sugar (sucrose) has an intermediate GI, which means that a diabetic does not need to totally avoid sugar, because a small amount will not cause the blood sugar to rise drastically. However, the concept of “less sugar” can be very misleading. From a more scientific point of view, it is recommended that not more than 10% of the total carbohydrates in your diet should be derived from sugar and sugar products.
A more practical guideline is that you should not consume more than 10 ml sugar per meal, that it must be part of a mixed meal and that it must be eaten with fibre. It is important to keep in mind that each teaspoon of sugar contributes both to your carbohydrate and kilojoule intakes of the day, but that it does not make any other contribution to your nutrient intake – such as fibre, minerals or vitamins.
Tips to reduce your sugar intake
•Learn to gradually use less sugar so that you lose your craving for sweet foods.
•Read the labels of products. Food legislation determines that the ingredients in a product must appear in descending order on the ingredients list. If an ingredient such as sugar appears at the end of the list, this probably means that the product contains only an insignificant amount of sugar.
•Avoid sugar in drinks such as tea, coffee and cold drinks.
•Avoid fruit that has been canned in sugar syrup. Rather choose fruit canned in fruit juice or artificially sweetened canned fruit.
•Clean, safe water should be your first choice to quench your thirst. You can also drink soda water and artificially sweetened cold drinks.
•Use low-kilojoule jelly.
•Enjoy a scraping of jam or honey on wholewheat or rye bread. There are a variety of jams on the market that are artificially sweetened or sweetened with fructose or which contain less sugar. Always keep your portion size small and rather store this type of jam in the fridge after opening it, to increase its shelf life. Also refer to the notes about fructose.
•Choose recipes with the least sugar, fructose or honey. In some recipes sugar can be replaced with fresh fruit, dried fruit, fruit purée, fruit juice or vegetables such as carrots, beetroot or pumpkin.
•Be aware of the sugar content of yoghurt and choose low-fat or fat-free, artificially sweetened yoghurt.
•Replace sugar in dishes with artificial sweetener or sugar substitutes in limited quantities.
Artificial sweeteners and sugar substitutes
Artificial sweeteners
Every so often a story does the rounds about how dangerous the prolonged use of certain artificial sweeteners can be. These findings are usually based on single cases and they are often not thoroughly investigated by means of additional research. In general, the consequences of obesity are regarded as a greater health risk than the possible negative effects of artificial sweeteners. It is, however, important to keep the use of these products to a minimum.
In my practice we use the guideline of not using more than eight to ten pills of artificial sweetener (which equals eight to ten teaspoons of sugar) a day. Heat (such as the boiling water you add to instant coffee), reduces the sweetness of sweetener pills. Test the sweetness of your tea or coffee by only adding the artificial sweetener when the beverage has reached drinking temperature. Artificially sweetened cold drink is also limited to not more than 500 ml per day.
Some artificial sweeteners consist of a combination of sweeteners, while others contain a filler, such as lactose or dextrose, which does provide some kilojoules and can have an effect on the blood glucose level. Read the labels of the products to obtain the necessary information. The brand names, contents of the products and combination of sweeteners change from time to time and new research results will appear in the lifetime of this cookbook. Where possible, I have indicated the amount of cane or table sugar in a recipe to enable you to work out a ratio to the sweetener of your choice.
Non-nutritive or artificial sweeteners include acesulfame-K, aspartame, sucralose, saccharin and cyclamate. These sweeteners do not contain any energy (kilojoules) and are very sweet even in small quantities. In pill form they often lose their taste when heated and in some cases they can cause a bitter taste in baked goods and cooked dishes. Sucralose is one of the sweeteners that is heat stable in any form.
Liquid sweeteners and some of the newer types of powder sweeteners are recommended for baking because they do not undergo taste chances during heating.
The safety of saccharin and cyclamate during pregnancy has not yet been determined and these sweeteners should preferably be avoided.
Stevia is a natural sweetener made from the leaves of the stevia plant. Like the artificial sweeteners, it does not provide any energy (kilojoules) and is currently being marketed in pill, liquid and powder form.
Sweeteners which provide energy (kilojoules)
Sugar alcohols such as lactitol, maltitol, mannitol and xylitol are more difficult to digest and are absorbed into the bloodstream more slowly than sugar, and therefore have a lower GI. In excessive quantities sugar alcohols sometimes cause abdominal discomfort and diarrhoea and should preferably be avoided by those suffering from irritable bowel syndrome. A limited intake of 20 g per day is recommended. Food containing xylitol should not be fed to dogs.
Fructose
Fructose occurs naturally in fruit and honey, but it is also available in powder form and as high-fructose corn syrup (HFCS). Fructose is slightly sweeter than cane/table sugar (6 ml fructose = 10 ml sugar), but it provides just as many kilojoules per ml/g as cane/table sugar. Fructose is absorbed slowly from the digestive tract into the bloodstream, it is metabolised in the liver and has a low GI. Research in the past indicated that fructose is possibly associated with the incidence of retinopathy (eye damage) in diabetics. More recent studies also indicate that excessive use of added fructose and particularly of high-fructose corn syrup can contribute to an increase in blood fats (cholesterol, LDL cholesterol, triglycerides), that it can result in an increase in blood clotting and because of its kilojoule content, also contribute to obesity. In the same way that diabetics are allowed to include cane/table sugar and artificial sweeteners in their diet in controlled quantities, depending on personal circumstances, limited use of fructose (not more than 20 g or 25 ml powder per day) is recommended as an aid in food preparation. This limited amount, however, does not allow diabetics to add teaspoonfuls of fructose to beverages or porridge. As a responsible dietitian I must warn against the excessive use of fructose powder and high-fructose corn syrup in particular, which is often used in commercial products such as flavoured water, sports drinks, jam and cordial syrup for making cold drinks. This warning does not apply to natural fructose as found in fruit.
Oligosaccharides
Oligosaccharides are not digested and are regarded as fibre. They ferment in the colon and form short-chain fatty acids. When ingested in excessive amounts, they can cause abdominal discomfort, including flatulence, stomach cramps and diarrhoea. People suffering from irritable bowel syndrome and spastic colon are advised not to use them. Oligosaccharides, which include inulin and FOS (fructo-oligosaccharides), are also known as prebiotics (food for gut-friendly probiotics or micro-organisms) and are increasingly being used in food preparation.
Honey
Honey is a natural product, it is nearly twice as sweet as sugar and contributes to the softness and moisture content of baked goods. Commercial honey often contains glucose syrup, which increases its GI. Make sure that the honey you use is pure, unprocessed