low-GI Archives - Diabetes Counselling Online

D-thoughts on bread

February 9, 2015 by Sally 5 Comments

Bread has become a staple food in our modern diet but can be problematic for those of us with diabetes, especially if it has a high glycemic index, we eat too much of it, or it contains too much of nutrients such as sodium and saturated fat which can affect our heart health and longer term insulin resistance. Today’s blog aims to help to you make better choices by understanding where it fits in the Australian Dietary Guidelines and find a bread that you can enjoy while maximising your glycemic control.

And for those of us who avoid wheat/rye bread due to the gluten content (coeliac disease, wheat intolerance or a FODMAP intolerance) we can take a look at some of those options too.

Probably a good place to start is a look at where bread fits in the Australian Dietary Guidelines, then we’ll go on to a reminder on label reading, which will lead in nicely to a look at some of the better bread choices on the market for people with diabetes based on a comparison table put together by student dietitian Stacey Beech for Dietitian Connection.

Australian Dietary Guidelines

Of course bread fits into the grains and cereals food group in the Australian Dietary Guidelines, and we encourage breads that are full of whole grains which provide extra nutrients and fibre in the bread you’re choosing. This is beneficial for your general health, as well as your diabetes health. And the more whole grains there are, the lower the glycemic index will be to help you avoid those spikes which can be associated with breads for some people.

Click on the image if you need it to be larger

You can read more about grains in this blog on grains prepared earlier for Diabetes Counselling Online. And the recent blog on snacks highlights that a piece of grainy bread can work well as a snack (with a topping) if you haven’t used your suggested serves for the day.

Label reading on bread packs

It’s important not just to think about the amount of carbohydrate in the bread you’re choosing, because often if the carb is low they’ve had to manipulate fat and sodium to make up for it.

As with most products we should be aiming for lower total fat (breads are usually quite low at around 2-6g/100g), lower saturated fat (well under 2g/100g) and lower sodium (less than 400mg/100g). Fibre should be as high as possible, and protein can be higher too (to contribute to lowering the GI).

We discussed this comparison a while ago in the Diabetes and Food – let’s celebrate it! closed Facebook group and the main point made was that although the Helgas low carb seeded loaf is indeed lower in carb with 27.7g/100g compared with 44.5g/100g in the ‘usual’ one, there’s over 10% more energy (kilojoules) meaning it won’t help with weight management because the fat is 10.9g/100g in the low carb version, compared with 2.8 in the grainy one. If you’re not trying to lose weight then it’ll be fine, but it’s worth bearing this in mind as we know that extra body weight contributes to poorer glycemic control.

It’s also worth checking comparison tables (summary of one below) as I noticed there’s a bread called ‘Well Being Lower Carb Bread’ that actually has the same level of carbs as many of the wholegrain varieties – just a reminder to not always believe what it says on the pack!

Helgas low carb 5 seeds bread NIP — Helga’s low carb 5 seeds bread NIP

Helgas mixed grain bread NIP — Helga’s mixed grain bread NIP

Good bread options from the Dietitian Connection bread comparison table by Stacey Beech

This is a mini-table with content taken from Stacey’s more comprehensive table, to show you some of the better bread choices on the market. All values are per 100g.

By no means am I suggesting these are the best breads, but by showing you this comparison I hope to help you to recognise which breads will be better choices for you. I’ve only chosen the ‘mainline’ brands to compare. And I’ve only covered wheat breads here, where rye breads are also a good option.

Bread	Energy (kJ)	Protein (g)	Fat (total) (g)	Fat (sat) (g)	Carb (g)	Dietary Fibre (g)	Sodium (mg)
Burgen Wholegrain & Oats Bread	964	10.7	9.1	0.6	31.9	6.4	280
Helga’s Traditional Wholemeal Grain Bread	1010	9.9	4.0	<1.0	38.0	7.3	400
Coles Smart Buy Multigrain Sandwich	990	8.8	2.4	0.4	47.0	4.3	400
Well Being Lower Carb Bread	952	10.4	2.1	0.6	36.8	8.8	349
Tip Top 9 Grain Wholemeal	1040	12.4	6.4	0.7	30.6	8.7	370

And here are some of the gluten free comparisons if you have an interest here.

Bread	Energy (kJ)	Protein (g)	Fat (total) (g)	Fat (sat) (g)	Carb (g)	Dietary Fibre (g)	Sodium (mg)
Helga’s Sunflower and Red Quinoa GF Bread	1100	6.3	8.0	<1.0	40.1	4.2	400
Coles GF Chia & Seed Bread	1130	7.3	7.5	1.5	41.2	3.7	280
Country Life Gluten & Dairy Free Lower GI	1030	6.0	7.2	<1.0	37.2	4.2	400
Pure Bred Multigrain Farmhouse (added Iron)	717	5.1	2.3	0.3	32.6	9.7	534
Burgen GF Sunflower and Chia Bread	1190	7.0	9.7	1.4	39.7	4.2	400

I included a variety of breads here for you consider what type of bread will suit your personal needs, but of course you should consider how you personally enjoy the taste of the bread you’ve chosen. Trying a few different varieties is often a good idea in that respect to find what works for you, for taste, glycemic control and long term health.

Sourdough and Wraps

These types of breads can be beneficial for people with diabetes, especially for those who really don’t like the grainer options.

With sourdough it’s important to check that it is ‘real’ sourdough as the term ‘sourdough’ is often misused as a marketing word on some breads. If it’s real sourdough, then the glycemic index should be lower (due to the fermentation process involved).

Wraps

There are a few good wraps around, although there aren’t many actually listed in the Low GI Shoppers Guide 2014 with a low-GI. The only one I could spot was the Diego’s low-carb wraps which have 11.g carb per serve. But I’d be checking the fat and sodium levels on that label before buying them…

One of our often discussed favourites in the Diabetes and Food – Let’s celebrate it! Facebook group is the Goodness SuperFoods Barley Max wrap which does tick all the boxes, so is a great one to try if you haven’t already.

I don’t want bread!

Of course no-one is suggesting that we *have to* eat bread. Many people I know choose to avoid it for various reasons, and that’s what suits you, then it’s easy to meet your grain serve guidelines in other foods.

It’s also worth mentioning that everyone is different as to how different carbs affect your BGLs, so a little self-experimenting with testing your BGLs before and 2 hours after meals can go a long way with various foods so you can have a better feel as to how those foods effect you personally.

I hope you’ve found this blog on bread helpful in making your choices best for your diabetes and general wellbeing. Sally

Sally is the Social Media Dietitian with Diabetes Counselling Online, owner of her private practice (Marchini Nutrition), has had type 1 diabetes for close to 40 years and coeliac disease for many years too. You can access a linked list of all Sally’s Diabetes Counselling Online blogs here.

Please Share!

Breakfast with diabetes

November 17, 2014 by Sally 13 Comments

Many people have been asking me about their breakfast choices lately, so hopefully this blog will help to answer some of your own breakfast questions. They usually want to know how to choose a good breakfast cereal, how much of it to have to keep them feeling satisfied til morning tea without disrupting their blood glucose results too much, what they can have instead of cereal that is quick and easy and still healthy and how to enjoy a breakfast out without tipping the scales too much.

Before starting though I’d like to remind you to not make any changes to your current diabetes routine without first checking with your own health care professionals. These are meant as general guidelines only.

Why do we need it?

As people with diabetes, breakfast is important to us for several reasons:

It helps to get our blood glucose levels of to nice level start, especially when we include a moderate amount of low-GI carbs
It helps us to manage our appetite better as the day progresses, especially so we don’t end up very hungry and tempted to make poor choices
It fuels our brain so we can mentally function better and cope better with the curve-balls that diabetes can throw at us
It helps to reduce insulin resistance by providing us with the low-GI energy that our bodies need to function better

What should be in it?

A good starting place is a reminder that with each meal we should include low-GI carb sources, preferably 2 carbohydrate serves as a minimum, and a protein serve to ensure we have the slow release of glucose to keep our brain fuelled for peak performance and our tummies happy so we don’t crave poor food choices by morning tea. Extra fibre also doesn’t go astray.

How to choose a good breakfast cereal?

If you recall our earlier blog on label reading, when reading cereal packet labels we should be looking for whole grains, nuts and fruit with little or no added sugar or oil in the ingredients listing if possible. Ideally we’d like the fibre to be at around the 10-15g/100g level, but if it isn’t then extra can be added in the form of bran, psyllium or chia seeds to boost it.

Remember too that if you have nuts included in your cereal it may fall outside of the total fat value of 10g/100g, saturated fat 2g/100g targets that we aim for, but as long as there are no other fats listed then all the fat is from the nuts so it’s okay.

So if you’ve got the whole grains and the nuts and the dried fruit and the low-fat milk or plain yogurt for added protein and low-GI carb, you should find all the reasons listed above satisfied for the importance of your breakfast.

How much of it should I have?

Certainly an important consideration as too much could upset your glycemic control, rather than helping it, and could also contribute to unwanted weight gain.

Everyone is different and the answer will depend on your activity levels, on your hunger and of course on your diabetes management objectives.

This is where it’s important to check with your own d-team, preferably an Accredited Practising Dietitian, about how much is right for you.

What can I have instead of cereal?

So many clients I see tell me they don’t like cereal, and that’s fine. We all have different tastes. There are many other breakfast options that are suitable for people with diabetes.

Multigrain toast and muffins with an egg or baked beans for added protein and extra veggies to help you meet your 5 veggie serves are awesome. Avocado and fresh tomato on toast (no need for a spread) is also a great way to get started. And peanut butter works on toast to give you the extra protein serve to keep you feeling fuller for longer.

Fruit smoothies also work well for those of you who struggle to eat in the mornings.

Cooked breakfasts are also wonderful when you have a little more time, and including veggies in there is a great idea.

I actually really like the ideas included in this blog by one of our Diabetes Counselling Online Facebook group members, Dr Lyndal Parker Newlyn: The Beauty of Breakfast that also talks about why it’s so important to get into this healthy habit.

What about eating out for breakfast?

Eating out can work well if you remember the diabetes basics about low-fat, low sodium and whole grains.

Choose meals like a bircher museli with fresh fruit and plain yogurt, or spinach, mushrooms and tomatoes on multigrain toast, or served with baked beans for that low GI carb with protein included.

And enjoy a coffee made on low-fat milk for the good low-GI carb and protein hit.

Traditional breakfast ideas that should be reviewed for better diabetes management

The first thing that springs to mind is fruit juice. Traditionally many Australians enjoy a glass of juice with their breakfast. With diabetes it’s not an ideal option when you consider that we’re aiming for two pieces of fruit per day and a glass of juice provides the carb energy of closer to 4 pieces of fruit without the fibre.
Avoid crumpets – yes, even the wholemeal ones. Not only do they have a high glycemic index but they’re also high in sodium (sodium bicarbonate is used to make the holes) and most people like to have butter or margarine on them which adds unneeded extra fats.
Doubling up – Some of my clients tell me they have both cereal and toast, and unless you’re having a half serve of each, you probably don’t need to have both. This is where many of my clients see a rise in their BGL readings 2 hours after breakfast, when basically they’ve just had too much for their system to manage.

What do you eat for your diabetes breakfast?

Please share below what your favourite breakfast ideas are, in case they spark someone’s tastebuds into action. We have different tastes, so the more ideas we can share the better!

Sally is the Social Media Dietitian with Diabetes Counselling Online, owner of her private practice (Marchini Nutrition), and has had type 1 diabetes for close to 40 years and coeliac disease for many years too. You can access a linked list of all Sally’s Diabetes Counselling Online blogs here.

Please Share!

Discussion on low carb diets

July 28, 2014 by Sally 8 Comments

Australian Guide to healthy eating poster

By popular demand through a thread in our Facebook group Diabetes and Food – let’s celebrate it!, this topic deserves a blog to help explain some of the ‘stuff we hear’ around carbohydrates and type 2 diabetes. I’d also encourage people with type 1 diabetes to read this though, because some of the points made are also relevant for us! Up front I will remind you that everyone has individual requirements and should see an Accredited Practising Dietitian for a personalised consultation, so this is a ‘general guide’ only.

Firstly we need to understand what ‘low’ means in such a context as in my experience as an Accredited Practising Dietitian, people tend to associate ‘low’ with ‘virtually no’ carbohydrate. We’ll also look at some of the evidence that shows that ‘low’ carb diets can help with glucose control in type 2s, and why when drugs (other than metformin or SGLT2-inhibitors) are introduced it’s important to ensure more (quality) carb intakes as advised by your health professionals. And lastly (but certainly not leastly) we’ll review how, based on the Australian Dietary Guidelines, it’s possible to have a nutritionally balanced diet while watching your carb intake.

What does ‘low’ carbohydrate mean?

If you ask some people what they think ‘low carb’ means, you may hear that it’s about cutting carbohydrates out as much as possible. Straight up as a dietitian my alarm bells ring as carbs feature in all five of the food groups that we need for nutrients to ensure our wellbeing: vegetables (starchy vegetables like potato, sweet potato and corn), fruit, dairy, protein (when the likes of legumes are included, and especially in vegetarian diets) and of course, the important grain/cereal foods.

The American Diabetes Association defines a low-carb diet as 130g of carb per day. Does that surprise you?? The ‘trick’ with low carb diets is therefore to know how to choose your carbs wisely so that you’re still meeting your nutrient requirements, and also to know what to replace that carb energy with (remembering that carbs, proteins and fats make up our daily energy intake) so you don’t get too hungry and be encouraged to ‘cheat’.

Remembering that there’s 15g of carbohydrate in an ‘exchange’ or ‘serve’ that gives us close to 9 carb serves across the day.

If you’re on medication that helps your body to produce more insulin, or you’re providing insulin yourself on a fixed dose then this idea is dangerous to your health so please speak to your health professionals before making any changes to your diet.

Some benefits of lower carbohydrate diets

Of course we know that all carbohydrates break down to glucose which is the fuel needed by our bodies, but in modern diets often too much (and poor quality) of this ‘fuel’ is provided which can cause stress to our organs and worsen our diabetes control. So understanding the benefits of a lower carbohydrate diet can help us to stick with it for longer and balance the rest of our diets more easily.

Some of those benefits may include:

Lower incidence of high blood glucose levels (hyperglycemia)
Lower amounts of medications need to control hyperglycemia
130g/day is a sustainable amount, meaning it’s easier to stick to in the longer term
Putting your pancreas under less stress to produce insulin, thereby helping it to keep working for longer
By ensuring your 130g/day is nutritious and low-GI carb you may also improve your blood fat levels (cholesterol/triglycerides) which will lower your risk of cardiovascular disease
It doesn’t necessarily lead to weight loss – that depends on your total energy intake.

How do you manage it best?

Again I will mention how important having a personalised consultation with your Accredited Practising Dietitian is because everyone is different in many ways. Here I will make suggestions that I hope will help to get your head around combining the idea of low carb into your daily routine while still meeting the nutritional requirements as outlined in the Australian Dietary Guidelines foundation diet (see page 2).

In a nutshell, it’s about only choosing your carb sources from the 5 food groups and balancing that out with quality proteins and healthy fats. I encourage you to re-read the previous blogs I’ve written on those topics as highlighted.

Remembering that 130g/day equates to close to 9 carb exchanges/serves, your day might start to look a bit like this:

Breakfast: ¼ cup of raw rolled oats (1 serve carb) served with 125ml light milk (half a serve), a small banana (85g – 1 carb serve) and a tablespoon of LSA mix (for extra fibre/protein) = 2.5 serves total

Morning Tea: A 100g tub of low-fat yogurt = 1 serve total

Lunch: A sandwich made on wholegrain bread (the grainer the better – 2 serves) made with a protein serve and as much non-starchy veg as you can handle, either on the sandwich or as a side, using half an avocado as the spread (for your good fats), and a piece of fruit such as an apple or pear (both good low-GI fruits – 1 serve) = 3 serves total

Afternoon Tea: A 30g handful of mixed unsalted nuts = not worth counting carb-wise

Dinner: Remembering the balanced plate being one quarter carb, one quarter protein and half non-starchy vegetables, this works with so many meals. Aim for your carb serve to = 2 serves total

Supper: You’ve still got half a carb serve up your sleeve. I would encourage something like half a slice of grainy toast with peanut butter on it to give you the energy to get you through the night, but half a serve of low-fat dairy would also work well, or even a couple of squares of dark chocolate if you fancied it = 0.5 serves total

In this example you can see that we’ve incorporated 9 carb serves/exchanges and yet have included quality carbs at every meal.

Some final tips

Remember to include protein and some non-starchy veg with every meal.
Rice and pasta can be problematic a serve size is so small. Something I recommend that works for many people is to include the carb serves in the form of legumes (lentils, chickpeas, kidney beans, etc) in the pasta sauce and use low-carb alternatives such as those made from konjac root, or make pasta/rice out of vegetables such as grated zucchini or carrot or cauliflower. I sometimes serve my pasta sauces on mashed cannellini beans and frozen spinach (warmed of course!) and find it’s very satisfying.
Don’t forget to exercise! If the point of minimising your carbs is to control your BGLs, then even as little as ten minutes exercise after meals can make a fantastic difference to your readings. Do some self-experimenting about how much your BGLs drop after say 10, 20 or 30 minutes walking after meals, and then if you want to include more quality carbohydrates in some meals, you’ll know how to manage better.

I hope this has proved useful for you, and that you have a better understanding of how a low-carb (130g/day) might help with your diabetes control. Of course please ask any questions below and I’ll be happy to address them for you.

Sally is the Social Media Dietitian with Diabetes Counselling Online, owner of her private practice (Marchini Nutrition), and has had type 1 diabetes for close to 40 years and coeliac disease for many years too. You can access a list of all Sally’s Diabetes Counselling Online blogs here.

Please Share!

My d-holiday in Thailand

July 7, 2014 by Sally 2 Comments

Wow! I really needed that break! I had concerns about my diabetes and coeliac disease before I left, but other than a few minor hiccups, they were fine. I prepared well, and was mindful of my activities (as much as possible) so thought I’d share some of the highlights with you.

You probably all know how I feel about routine being so important for diabetes control. I really didn’t know how I’d go with a complete break from my usual routine. I was also concerned about the impact of the high-GI foods in Thailand, and from a coeliac perspective, the availability of low-GI gluten free foods. So, I decided to be organised and ensure I took with me what I needed:

10 measured packets of my low-GI GF cereal
2 loaves of my low-GI GF bread
A few juice poppers in case of night-time hypos
Mixed unsalted nuts for snacks

And I was glad I did that as it did make a big difference! Of course I also took a spare BGL meter and loads of extra fast acting and Lantus insulin and Glucagen but fortunately didn’t need them.

The Flights

I also had to think about the plane flights, as we flew with Jetstar and they don’t provide gluten free meals. For the way over I made a frittata with lots of veggies, sweet potato and cannellini beans (for low-GI carb) which was very tasty, and my Mum (who I was travelling with) was envious as her in-flight meal was not nearly as appealing. I also took a couple of pieces of my low-GI GF bread and a jar of peanut butter, an apple, a box of nuts and a juice popper for the flight. Worked out perfectly, but I didn’t need the popper (no hypos).

On the way back we slept most of the way, but I took a baby banana (provided every day in our room as part of a fruit platter) and boiled egg from the resort and had those with bread and peanut butter for my on-board breakfast. Very satisfying – a peanut butter and banana sandwich with an egg on the side!

The Resort Food

We had breakfast included in our package which was an enormous buffet of cereals, breads, pastries, European food and Thai food as well as the usual cooked breakfast options. I missed my coffee as, although they offered coffee, it was different to the coffee we have here. Of course, I had brought my own cereal, and I indulged in a freshly made omelette most days – most delicious. I also tried some Thai breakfast options including a clear broth with pork and cabbage with a fish sauce-based chilli seasoning. Very zingy and tasty!

I found that being coeliac wasn’t much of an issue there, but was glad to have my own cereal and bread. For lunch we took a selection from the European breakfast option of cold meats/cheeses and salad to make our own sandwiches in our room.

The night time meals were pretty easy to manage other than having a higher glycemic index/load than I’m used to. Most of the seasonings were based on fish sauce, tamarind, lime juice and coconut milk, so I really only had to watch out for soy sauce. And the noodles – some were wheat based, but they’re pretty easy to spot so I just avoided those, and of course there rice and mung bean/glass noodles always available.

When we ate at the buffets in the Resort, the staff were only too happy to have the chef prepare me special meals to my liking, so I felt very spoilt and had no accidental glutenings.

Food outside the Resort

We had only one day excursion from the hotel (other than local restaurants in the evenings) and although I checked 3 times with the hotel tour operator that there would be gluten free food available on the day, when we were on the bus on the way to lunch the guide asked if anyone had any special food requirements. When I advised I needed gluten free food, he really had no idea. There were ten Australians on our bus and everyone tried to explain on my behalf (how sweet), but when we got there they’d misunderstood ‘wheat’ as ‘sweet’ lol. Suited me too, but the 3 dishes offered, one was sweet & sour pork (too sweet for my taste), one was spring rolls (not gluten free) and the third was a chicken and eggplant green curry. The restaurant made me an extra serving of the green curry very kindly, so all was good including my BGLs as the coconut milk lowered the GI of the high-GI rice they served with it!

We also went to a market one day which was fascinating to see the various vegetables available as well as the meats and even insects. We didn’t eat anything there as it was very hot and didn’t look clean, but wished we could have tried some of the fruits and vegetables on offer. In the resort the only real green vegetable dish offered was called Morning Glory that was served stir fried. Vegetables were one of the foods I missed most on this holiday, and I normally eat about 6 serves every day of fresh veggies.

The local restaurants were fantastic and I had no issues with any of their meals, other than perhaps eating too much

My diabetes control

As mentioned at the top, I had concerns about how my diabetes would cope with a complete change of routine. With the weather being in the high 30s and very high humidity, it was really too hot to exercise. My usual exercise routine helps to keep my BGLs steady across the day, and that was reflected in higher BGLs than I would usually have. I had a few up around 16mmol/l, but these were easily corrected using my insulin pump. I used more insulin than usual, but not much more.

I spent hours relaxing in the pool, just sitting or sometimes chatting with other guests. With an insulin pump, you can take it off for up to two hours at a time, but I was often there for longer than that. The solution I found was to attach my pump to my cap, which also made for a good discussion topic I just couldn’t quite stand up straight as the tubing was slightly too short to reach from the cannula on my tummy up to my cap lol.

One day, I was zoned out after a massage and went for a swim in the pool, forgetting to take my pump off. Fortunately I remembered only about a minute into the swim and jumped out in a bit of a panic thinking I’d wrecked my pump (as I’d done to a phone before that never recovered). It was fine, but certainly shocked me out of my zoned out state of mind!

I only had one minor hypo after going for a walk on the beach one day without notice, but it was only 3.6mmol/l and the juice box was cool from the mini-bar fridge so very welcome. I carried my hypo treatments and my BGL meter everywhere with me.

I went there with the idea of running my BGLs slightly higher than usual, okay since it would only be ten days away. I didn’t actually do anything to achieve that but the lack of exercise and higher GI foods naturally did it for me, and everything’s fine.

I remember the story of 90 year old, Edna who was diagnosed aged 20, so 70 years of diabetes, who said “I don’t worry about my diabetes, I just say to myself to do my testing, to get rest every day and to enjoy life and stop wasting time worrying about my health. If you look after yourself you will have a long, happy life like I have.” Wise words methinks!

The language barrier

The Thai people are so lovely and helpful, but there were occasions when language caused confusion, such as the gluten free issue on the bus ride. Also, I had taken 2 loaves of my low-GI GF bread and when we got there I asked the kitchen to put one into the freezer for me to keep it fresh until I needed it later in the visit. Two days before the end I went to collect it and found they’d only kept it in the refrigerator, so it wasn’t as fresh as it could have been, but lasted the two days and the flight home so there was no drama.

I explained to the manager how asking for something to be kept in the freezer, meant the deep freeze where ice is made, not just the refrigerator, to ensure it is kept fresh. He seemed to understand so hopefully others won’t have this issue in future.

Happy Ending

The main goal of my holiday was to completely relax and switch off, which is exactly what I did. I didn’t even get around to reading any books. We just hung by or in the pool and the beach, had massages, ate yummy food, drank a few Mojitos (with little sugar and a big garden of fresh lime and mint in the glass) and lots of water, and chatted with other guests. I’m usually an adventure holiday type of girl, but to spend this relaxing time with my Mum was definitely what the doctor ordered.

We finished off with one day of adventure on rafting down a river on bamboo rafts, and trekking with elephants to make a perfect holiday. Wishing you all the opportunity to enjoy such a holiday yourselves one day. It was a once in a lifetime experience for me, but you never know what’s ahead!

Please Share!

Dairy Foods – health benefits for us with diabetes

February 3, 2014 by Sally Leave a Comment

There seems to be some discussion in our Facebook groups relating to Dairy, and it’s a huge topic for us to consider. So today I’ll begin with the first in a series of blogs on dairy foods and their alternatives.

I’d like to start by making the point that as an Accredited Practising Dietitian my job is to provide you with evidence-based information to you to help you to wade through the minefield of claims made by others for your best health interests.

As I hope you know by now, dairy and alternatives (mostly reduced fat) is one of the five key food groups in the Australian Dietary Guidelines, so in this first blog I thought we’d do a Professor Sumner-Miller and take a closer look at ‘Why Is It So?’.

In the other blogs to follow this one I’m considering taking a closer look at the nutritional differences between dairy and its alternatives as well as ways to incorporate more into your diet if you’re not meeting the guidelines. If you have specific questions relating to dairy and alternatives, please let me know and I’ll do my best to answer them within the blogs. Let’s get started!

This snip is from the Healthy Eating Guidelines for Adults brochure. In the first instance you’ll notice in this snip that women aged over fifty need 1.5 more serves than other adults. Children and pregnant women also have different requirements, so click on the links if you’re interested in these groups. We all need different amounts for different reasons, but for us with diabetes it’s a really important food group for many reasons including that they have a low-glycemic index.

Other reasons listed in the Australian Dietary Guidelines that relate to people with diabetes are:

• Coronary heart disease: It is probable that the consumption of at least two serves per day of dairy foods (milk, cheese and yoghurt) is associated with reduced risk of ischaemic heart disease and myocardial infarction (Grade B; Evidence Report, Section 5.3).

• Stroke: It is probable that the consumption of two or more serves of dairy foods per day (milk, cheese and yoghurt) is associated with reduced risk of stroke (Grade B; Evidence Report, Section 5.4) particularly reduced fat varieties.

• Hypertension: It is probable that consumption of three serves of low fat dairy foods (milk, cheese and yoghurt) is associated with reduced risk of hypertension (Grade B; Evidence Report, Section 5.5). The evidence also suggests that consumption of three serves of any milk, cheese or yoghurt products per day is associated with reduced risk of hypertension (Grade C; Evidence Report, Section 5.5).

• Type 2 diabetes: The evidence suggests that consumption of two to four serves of dairy foods (milk, cheese, yoghurt) per day is associated with reduced risk of metabolic syndrome (Grade C; Evidence Report, Section 5.7) and that consumption of at least one and a half serves of milk, cheese and yoghurt per day is associated with reduced risk of type 2 diabetes (Grade C; Evidence Report, Section 5.6).

• Excess weight: The evidence suggests that consumption of dairy foods is not associated with weight change or risk of obesity in adults (Grade C; Evidence Report, Section 5.8) and consumption of milk is not associated with BMI or change in BMI in childhood (Grade C; Evidence Report, Section 5.9). Total energy intake is always important in weight management.

I really like this table that outlines the benefits of dairy consumption with evidence levels.

Aside from specifically diabetes related benefits, there are others listed here that show the benefits for health in general including some cancers and bone mineral density issues. If you want to understand more about the Evidence Levels, they’re explained early on in the pdf document of the Australian Dietary Guidelines.

You may ask, ’So what’s in it that makes it so valuable from a nutritional point of view?’

Direct from the guidelines as it’s explained so well: “Milk, cheese and yoghurt have various health benefits and are a good source of many nutrients, including calcium, protein, iodine, vitamin A, vitamin D, riboflavin, vitamin B12 and zinc. These foods provide calcium in a readily absorbable and convenient form. However, in reflecting on Australian consumption patterns and ensuring all nutrient requirements are met within energy requirements, it is recommended that reduced fat varieties should be chosen on most occasions. The inclusion of mostly or all full fat milk, cheese and yoghurts proportionally increases total fat, saturated fat and overall energy components of the diet. Unmodified milk from animal sources such as cows, goats or sheep, should not be given as a main drink before 12 months of age.”

It should be noted that reduced fat varieties of milks and/or plant-based drinks are not suitable as a drink for children under the age of 2 years due to energy requirements for growth and they may also not be appropriate for adults over the age of 70 years due to reduced body weight and energy intake.”

The Guidelines advise for those with Lactose Intolerance that: “The rate of lactose intolerance is relatively high in many Asian communities compared with Caucasians. High rates of lactose intolerance have been described among Aboriginal and Torres Strait Islander groups. Lactose-intolerant adults and children often avoid milk and milk products, however up to 250ml of milk may be well tolerated if broken up throughout the day and consumed with other foods. Cheese contains little lactose and the lactose in yoghurt is partially broken down by bacteria that thicken the yoghurt, so should be well tolerated. Lactose-free dairy products and calcium-fortified beverages are also available.”

And for people who are Vegan or Vegetarian, the Guidelines read: “The 2003 edition of the dietary guidelines addressed vegetarian and vegan diets and their influence on calcium needs because of the relatively high oxalate and phytate content in some plants. However, lacto-ovo vegetarians appear to have calcium intakes similar to those of omnivores. Those who follow a vegan or vegetarian diet and avoid milk products, should consume alternative calcium-fortified products and seek advice from a health professional about whether they need to take supplements.

So I hope you can see good reasons here to meet your dietary targets for dairy and alternatives.

It’s as easy as including a glass of milk or a fruit smoothie made on low-fat milk (or alternative) or a small tub of yogurt as snacks through your day, plus the milk on your breakfast (probably half a serve), a serve of cheese (preferably low-salt) either on a sandwich or in your salad, and/or enjoying a low-fat dairy based dessert like icecream (preferably without the added ‘discretionary choices’ toppings) if you need to boost your serves.

How do You ensure You get Your serves of dairy or alternatives?

Tune in next week to continue the dairy story, and don’t forget to let me know if you have dairy questions that need answering in the meantime!

Sally Marchini.

Sally is the Social Media Dietitian with Diabetes Counselling Online, owner of her private practice (Marchini Nutrition), has had type 1 diabetes for close to 40 years and coeliac disease for many years too.

Please Share!