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 raw honey. Honey should be used in the same limited quantities as sugar.
Replacement of sugar in recipes
Read the information on the container of the specific sweetener. The label should also state whether the sweetener is heat resistant and is suitable for baking and cooking. How much of the sweetener should be used to replace the equivalent amount of sugar is usually indicated in millilitres or grams.
Where possible I have indicated in the recipes in this book how much sugar each specific sweetener represents, so that you can replace it with another sweetener according to your circumstances and preference.
The fat content of your diet
Too much body fat and the excessive use of fat in the diet can stimulate insulin resistance because it suppresses insulin activity and can cause an increase in blood glucose.
Hyperlipidaemia
Diabetics have an increased risk of narrowing of the arteries and of developing cardiovascular diseases because of an increase in blood fat values in relation to total cholesterol, triglycerides and LDL cholesterol (which are deposited on the artery walls). This condition is called hyperlipidaemia. A fat intake of 20% to 30% (and in some cases even as high as 35%) of the total energy of the diet, is regarded as desirable. The body requires essential fatty acids because it cannot manufacture them. Fats are also important carriers of fat-soluble vitamins A, D, E and K. Research indicates that the high monounsaturated fatty acid content of olive oil, canola oil, nut oil, carotino oil (palm fruit oil), avocado and avocado oil, is advantageous for diabetics, particularly for the treatment of raised triglyceride levels. Despite claims to the contrary that do the rounds from time to time, reliable research studies continue to show that the intake of saturated fats and trans-fatty acids should be limited and that they should be replaced with mono- and polyunsaturated fats. It is a good idea to talk to your dietitian about this when she designs your meal plan.
Tips to reduce your fat intake
Make the following part of your lifestyle:
•Select small portions of lean red meat, chicken and fish. Remove the skin from poultry and cut all the visible fat off all meat. Steam, stew or grill food with a small quantity of oil at a lower temperature. When you stir-fry, add a few drops of boiling water as necessary to complete the stir-fry process with less oil.
•Oven roast meat on a grid in a roasting pan to collect the fat and meat juices.
•Make low-fat meat gravy from the meat juices in the pan by adding ice cubes to the juices to coagulate the fat. You can then remove the coagulated fat and ice cubes from the meat juices.
•Use minimal fat or oil when preparing food and, where possible, avoid using any fat at all.
•Use a spray bottle containing oil or lightly brush the pan with oil to prevent sticking, or use cooking utensils with a non-stick lining.
•Use soft butter or margarine sparingly and avoid whenever possible.
•Rather spread low-fat cottage cheese, low-fat dipping sauce, chutney, tomato sauce or low-oil mayonnaise on bread instead of margarine.
•Use “lite” or low-oil salad cream, lemon juice, balsamic vinegar and a few drops of olive oil instead of rich, fatty salad dressings.
•Replace cream in recipes with plain low-fat yoghurt, low-fat evaporated milk or soft tofu (soya curds).
•Replace cream cheese in recipes with ricotta or smooth fat-free cottage cheese.
•Replace a melted cheese topping with grated cheese that has been mixed with dry breadcrumbs, or mix some sesame seeds with the cheese and scatter over the dish.
•Replace rich puff or short-crust pastry with phyllo pastry. Brush the phyllo sheets lightly with milk or spray them with non-stick food spray.
•Use low-fat milk, yoghurt, cheese and ice cream.
•Read the labels of food products carefully to find out what fats they contain – including “hidden” fats.
•Restrict your intake of trans-fatty acids, which are formed when oil used for deep frying is heated. Hard margarine also contains trans-fatty acids, which are often indicated as “partially hydrogenated fat” on food labels.
High blood pressure
High
