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Diet management for people with diabetes in Africa: Principles for a diabetic Diet

Diet is a corner stone to the management of diabetes. People with Diabetes have to take extra care to make sure that their food intake is balance with their diabetes medications. A well balanced meal should help improve blood glucose, which is the main sugar found in high amounts in the blood of people with diabetes. Blood glucose is the main source of energy for our bodies. People with diabetes usually have problems with the utilization of the sugars and carbohydrates (starch) that they consume with meals. This is due to the fact that they do not produce enough insulin and/ or their cells do not respond to insulin as they should (insulin resistance).

Every time we eat food, we consume calories. If the amounts of calories we consume are higher than the amount of calories we use during the day, the extra is converted to fat and stored. This leads to weight gain. On the other hand, if we consume fewer calories, the stored fat is converted to energy that is used and we lose weight.

People with certain medical conditions are unable to appropriately break down and use some food types. People with diabetes are unable to appropriately use sugars and carbohydrates (starch) to transform them into energy. If foods rich in sugars or starch are consumed, they can lead to high levels of sugar in the blood.

High blood sugars damage blood vessels leading to stroke, heart disease, eye problems, kidney disease and nerve problem. The effects of persistent high blood glucose can also cause problems with the teeth, gums, feet and skin. Keeping blood sugars, blood pressure and bad cholesterol levels close to normal can help prevent or delay heart disease and some cancers. Eating healthy will improve your overall health and can prevent these harmful complications of diabetes.

The main goal of a healthy diet in people with diabetes is the consumption of an adequate amount of calories for each person’s life style. Foods have to be broken down when consumed, and what they are broken down into is the main key to making diet choices.  People with diabetes should make the maximum effort to substitute foods that are broken down into sugars and carbohydrates with food rich in fiber like vegetables.

The main food items consumed in sub-Sahara African countries like Cameroon include high carbohydrate foods like plantains, corn, corn flower (corn fufu) flour, cocoyam, white rice, yellow yam, cassava and gary. Kidney beans which are rich in protein, soya beans, cow peas, egusi and groundnuts are also widely consumed. Major vegetables are amaranth leaves (also known as green), cabbage, eru leaves, water leaf, solanum scabrum (njama njama) and carrots. Major fruits include, avocado (pear), orange, paw-paw (papaya), banana, mango, and passion fruit (adam fruit). Beef, fish, egg and milk are also highly consumed in Cameroon.  Palm oil, groundnut oils and sunflower oils are some of the most commonly used oils.

Most foods contain more than one type of nutrient. One food type could contain a high amount of one nutrient and a smaller amount of another nutrient. For example, Mangos or bananas are very high in fiber, but they are also high in sugars, so people with diabetes should consume moderate amounts of sweet fruits like mango, bananas or oranges because of the high sugar contents.  

A balanced meal should contain fibers, proteins, carbohydrates and fat. Not every type of sugar or fat is the same.

Note that carbohydrates and sugars are interchangeable as carbohydrates are converted into sugars.

People with diabetes should avoid simple sugars like honey, jam, fruit juice with added sugars or sweet drinks.  These types of foods usually cause a rapid rise in blood sugars which could be very damaging to the blood vessel, and lead to severe complications. Sugars from foods like sweet potatoes, yam, and even fruits like paw-paw (papaya) are a better option, but should be consumed in very moderate amounts.The sugars in these foods take a longer time (about 20 minutes) to reach the blood system.

As with sugars/carbohydrates or starch, unsaturated fats such as fat found in fish, pear(avocado) and nuts are much better than saturated fats. Saturated fats are found in red palm oil, fried vegetable oils, fired foods generally, fatty meat, butter, and even milk. Note that most delicacies like cake or sweet bread are not only very rich in sugars/carbohydrates but they are notably very rich in butter (saturated fats). These foods should be completely avoided.

Proteins also need to be consumed as they are a great source of energy and they are good at making you feel full.

Several people tend to eat foods or some sort of foods from their roots or where they come from, and so it is more difficult to use the standard calorie counters available. It is important to pay attention to what you eat, the portions and possibly write down what you eat in a day.

(see the food composition link below for African foods)

Good to know

.    Every food consumed is some form of calorie. Do not overconsume anything. Eating 6 mangoes a day is a bad nutrition choice. Too much of a good thing can become a bad thing.
.    Trade off!  Trade off!  Trade off! Substitute one food item with a better one from the nutrition stand point.
.    Substitute fried food with grilled or baked food (not cakes)
.    Serve food in small plates
.    Put all the food you have to eat in front of you and actually pay attention to portions and nutrition continents before you start eating
.    Never go for a second or third round
.    Avoid over snacking, that is where most of the un needed calories and poor food choices come from
.    Schedule you meals and fast in-between your scheduled meals
.    Avoid any over processed food or foods you cannot visibly tell what is inside because they have been processed
.    Avoid alcohol
.    Washing your rice well after partially boiling will cut down the amount of carbohydrates
.    Eat 3 balanced meals a day about 4 to 6 hours apart
.    Eat your calories instead of drinking them
.    Eat your fruits rather than drinking fruit juice
.    Drink water instead of juices, low calorie soft drinks tea, coffee…
.    Avoid adding margarine , butter or sugars (jam) to your foods
.    Exercise! Move around! Walk each day!
.    If you are overweight, try to lose at least 5%  to 10 % of your weight
.    Make:
.    breakfast :1/3 grains, 1/3 fruits(starch/fiber),1/3 proteins
.    Lunch : 1/2 vegetable, 1/4 starch, 1/4 proteins
.    Dinner : 1/2 grains, 1/4 fruits, 1/4 proteins
To put things in prospective:   I cup is a bit less than a pick milk tin
You need 30 to 40 grams of carbohydrates a meal which could be found in:
.    2 slices of bread (the size of a CD case)
.    1 cup of cereal  
.    One large orange
.    1  mango
.    1 cup of milk
Make sure you know your hemoglobin A1c number and monitor the trend every 3 months with your doctor
Great Resources
1.    Fadupin GT. Food exchange lists of local foods in Nigeria. African J Diabetes Med 2009, 17; 2: 215–19.

2.    Food Composition Table For Use In Africa

Prof. Joyce Akwe

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