Slightly perplexed by NHS diet advice

[Feathers]

Just had an appointment with the diabetic nurse as my recent HbA1C was up (61), and got handed a leaflet with diet advice that is making me question myself (and/or the NHS). So am looking for opinions, and I guess reassurance - I think what I am doing is the right thing, but it's making me question myself.

Background:
I wasn't surprised by my HbA1C increase, as I ate abysmally in Feb/early March (new job = stress = comfort eating). But the last 6 weeks I've been doing pretty well: moderate carb (~120g) and ~1700cal (which, as I'm very overweight, gives me ~500 cal deficit. I am losing a nice steady pound a week and feeling fine while doing it) After getting the results I did some fingerprick tests for a few days and they were higher than I'd like, so I've knocked some more carb out of the diet. I'm not aiming for full keto, but getting down to ~65g-80g of carb most days.

The nurse wanted to add a new medication, and see me again in 3 months, which sounds fine. But she also gave me the "Diabetes Everyday Eating" booklet, which contains 4 weeks' worth of sample meal plans. I'm baffled by it!

1. The calorie counts are all over the place - with some days being as low as 1000cal, the vast majority under 1500, and none reaching 1800. This seems like pretty extreme weight loss. When I've tried 1200 or below my energy has gone through the floor and I've felt awful. I know it works for some people, but steering people into large calorie deficits without warning/support seems iffy. And 1000cal a day would be low for anyone, even someone carrying much less fat than me.
2. The carb counts seem very high. For example, in week 1 the lowest day has 160g of carb, and the highest has 220g.

Those two combined have made me question:

1. Should I be pushing to lose weight faster? But I am losing weight, and feeling better on it than I have on any other diet. This feels like something I can do for the months/years it will take to get to a healthy weight. But maybe I should be pushing a bit harder?
2. And then on the flip side, am I being unecessarily restrictive of my carb? Except . . . I treated myself to enchiladas last night. Still under the carbs of many of the sample dinners on here, but my fingerprick test two hours after eating was 11.6 (leading me to reluctantly decide future texmex nights need to happen without the tortillas) The nurse said the aim was to stay under 10 (I tend to aim a bit lower). I just don't see myself staying under 10, let alone somewhat closer to my own goals, on the meal plan in this booklet.

So yeah, tell me I'm not insane for carrying on my own way? Or tell me I am, if I am.

 

[rebrascora]

Unfortunately NHS dietary advice is rather behind the curve when it comes to Type 2 diabetes and it is a one size fits all whereas your BG meter will tell you what your individual body can tolerate.
It sounds to me like you know where you went wrong and you are now back on track and putting it right again. It sounds like you are taking a sensible approach. Very few people need to go full Keto and it takes quite a lot of thought and preparation to do so at least until you get into the swing of it. Personally I find low carb relatively easy and sustainable long term and it works for me.
You are obviously doing well so I would just encourage you to keep doing what you are doing because you already know it works for you (when you aren't derailed by stress from a new job) Good luck and keep us posted with your progress.

 

[daxsmith05]

its dangerous to lose weight too fast
can cause ketones
in my case that can cause lots of problams
hope your not PKU Epileptic OCD ADHD Autistic Schizophrenic etc as ketones include phenylalanine and thats what causes te problems in aspartame (linked to cancer and lots of other things too)
There is also DKA that can be caused in Diabetics
Plenty of reasons to not lose more than 1-2lbs a week

 

[Leadinglights]

Just had an appointment with the diabetic nurse as my recent HbA1C was up (61), and got handed a leaflet with diet advice that is making me question myself (and/or the NHS). So am looking for opinions, and I guess reassurance - I think what I am doing is the right thing, but it's making me question myself.

Background:
I wasn't surprised by my HbA1C increase, as I ate abysmally in Feb/early March (new job = stress = comfort eating). But the last 6 weeks I've been doing pretty well: moderate carb (~120g) and ~1700cal (which, as I'm very overweight, gives me ~500 cal deficit. I am losing a nice steady pound a week and feeling fine while doing it) After getting the results I did some fingerprick tests for a few days and they were higher than I'd like, so I've knocked some more carb out of the diet. I'm not aiming for full keto, but getting down to ~65g-80g of carb most days.

The nurse wanted to add a new medication, and see me again in 3 months, which sounds fine. But she also gave me the "Diabetes Everyday Eating" booklet, which contains 4 weeks' worth of sample meal plans. I'm baffled by it!

1. The calorie counts are all over the place - with some days being as low as 1000cal, the vast majority under 1500, and none reaching 1800. This seems like pretty extreme weight loss. When I've tried 1200 or below my energy has gone through the floor and I've felt awful. I know it works for some people, but steering people into large calorie deficits without warning/support seems iffy. And 1000cal a day would be low for anyone, even someone carrying much less fat than me.
2. The carb counts seem very high. For example, in week 1 the lowest day has 160g of carb, and the highest has 220g.

Those two combined have made me question:

1. Should I be pushing to lose weight faster? But I am losing weight, and feeling better on it than I have on any other diet. This feels like something I can do for the months/years it will take to get to a healthy weight. But maybe I should be pushing a bit harder?
2. And then on the flip side, am I being unecessarily restrictive of my carb? Except . . . I treated myself to enchiladas last night. Still under the carbs of many of the sample dinners on here, but my fingerprick test two hours after eating was 11.6 (leading me to reluctantly decide future texmex nights need to happen without the tortillas) The nurse said the aim was to stay under 10 (I tend to aim a bit lower). I just don't see myself staying under 10, let alone somewhat closer to my own goals, on the meal plan in this booklet.

So yeah, tell me I'm not insane for carrying on my own way? Or tell me I am, if I am.

You sound to be on exactly the right track, it is better to have a slow consistent weight loss as you are more likely to sustain it although it does seem painfully slow at times. As you have observed the NHS diet suggested is far more carbs than many can tolerate and reduce their blood glucose. It is easier to just consider the carbs and not bother too much about the calories and as long as you are looking at the total carbs not just the sugars then what you are having sounds a sensible amount but as you have a monitor as people often say 'Eat to your monitor' and adjust what you are having to keep within the range you feel comfortable with, but aiming at 4-7mmol/l before meals and either no more than 2-3mmol/l increase from your meal after 2 hours and no more than 8.5mmol/l post meal.
Keeping as far as possible within that should see your HbA1C reducing.
This link may help you with some ideas for modifying your diet so you could see how it compares to what you are doing. https://lowcarbfreshwell.co.uk/ It is a low carb approach which has had some success.

 

[Feathers]

You sound to be on exactly the right track, it is better to have a slow consistent weight loss as you are more likely to sustain it although it does seem painfully slow at times. As you have observed the NHS diet suggested is far more carbs than many can tolerate and reduce their blood glucose. It is easier to just consider the carbs and not bother too much about the calories and as long as you are looking at the total carbs not just the sugars then what you are having sounds a sensible amount but as you have a monitor as people often say 'Eat to your monitor' and adjust what you are having to keep within the range you feel comfortable with, but aiming at 4-7mmol/l before meals and either no more than 2-3mmol/l increase from your meal after 2 hours and no more than 8.5mmol/l post meal.
Keeping as far as possible within that should see your HbA1C reducing.
This link may help you with some ideas for modifying your diet so you could see how it compares to what you are doing. https://lowcarbfreshwell.co.uk/ It is a low carb approach which has had some success.

Yup am counting total carbs. And yeah, I had in my memory that 8 or 8.5 post-meal was the goal, but nurse said keeping it under 10 (which also startled me) Thanks for confirming/sanity checking! I'm seeing some fasting 8s (and 9s post meal), which is why I thought I wasn't doing great - so can't imagine what it'd be if I had 200g of carb a day!

 

[daxsmith05]

imcidentally also on diet
it says to lose 1-2lbs a week
lost approx 6.5-7lbs in 11 days
it says you lose a lot at first is there a limit to how much is safe in the first few weeks before it shists down to steady weight loss?

 

[Leadinglights]

imcidentally also on diet
it says to lose 1-2lbs a week
lost approx 6.5-7lbs in 11 days
it says you lose a lot at first is there a limit to how much is safe in the first few weeks before it shists down to steady weight loss?

Usually if you cut down on carbs, weight loss initially can be quite quick as you are losing fluids as carbs hold onto water.

 

[Deleted member 21371]

I did the 800 calorie Newcastle diet, shake based.
Many of us on here have done it.

 

[Kreator]

I have also - a 12 month NHS Program involving 3 months of 800 Calorie shakes...

It's worked ok so far for me...

 

[Chris45]

Just had an appointment with the diabetic nurse as my recent HbA1C was up (61), and got handed a leaflet with diet advice that is making me question myself (and/or the NHS). So am looking for opinions, and I guess reassurance - I think what I am doing is the right thing, but it's making me question myself.

Background:
I wasn't surprised by my HbA1C increase, as I ate abysmally in Feb/early March (new job = stress = comfort eating). But the last 6 weeks I've been doing pretty well: moderate carb (~120g) and ~1700cal (which, as I'm very overweight, gives me ~500 cal deficit. I am losing a nice steady pound a week and feeling fine while doing it) After getting the results I did some fingerprick tests for a few days and they were higher than I'd like, so I've knocked some more carb out of the diet. I'm not aiming for full keto, but getting down to ~65g-80g of carb most days.

The nurse wanted to add a new medication, and see me again in 3 months, which sounds fine. But she also gave me the "Diabetes Everyday Eating" booklet, which contains 4 weeks' worth of sample meal plans. I'm baffled by it!

1. The calorie counts are all over the place - with some days being as low as 1000cal, the vast majority under 1500, and none reaching 1800. This seems like pretty extreme weight loss. When I've tried 1200 or below my energy has gone through the floor and I've felt awful. I know it works for some people, but steering people into large calorie deficits without warning/support seems iffy. And 1000cal a day would be low for anyone, even someone carrying much less fat than me.
2. The carb counts seem very high. For example, in week 1 the lowest day has 160g of carb, and the highest has 220g.

Those two combined have made me question:

1. Should I be pushing to lose weight faster? But I am losing weight, and feeling better on it than I have on any other diet. This feels like something I can do for the months/years it will take to get to a healthy weight. But maybe I should be pushing a bit harder?
2. And then on the flip side, am I being unecessarily restrictive of my carb? Except . . . I treated myself to enchiladas last night. Still under the carbs of many of the sample dinners on here, but my fingerprick test two hours after eating was 11.6 (leading me to reluctantly decide future texmex nights need to happen without the tortillas) The nurse said the aim was to stay under 10 (I tend to aim a bit lower). I just don't see myself staying under 10, let alone somewhat closer to my own goals, on the meal plan in this booklet.

So yeah, tell me I'm not insane for carrying on my own way? Or tell me I am, if I am.

I've just joined the forum today and interested in what you have said. Diagnosed T2 Sept 2020 with HbA1c 66 and advised by doctor to use the Fast 800 diet. Took some facts from the book and managed to lose 1 stone and drop my HbA1c to 51. I was not particularly overweight, only a bit of belly fat. I have not been medication having tried to do it my way. My recent reading was 53 and have a telephone appt with the diabetic nurse this week. My doctor was ok with the 51 reading but I believe the nurse is keen for me to go on meds. Who do I believe, doctor or nurse?

 

[Mrs Mimoo]

I did the 800 calorie Newcastle diet, shake based.
Many of us on here have done it.

me too. Lost 11kg. Now eating 950 cals a day as because I am a fairly inactive office working lady I don't need more. Focus on low carb, quality food, lots of greens and lots of lean protein and full fat dairy. I just don't need more.

 

[Feathers]

I've just joined the forum today and interested in what you have said. Diagnosed T2 Sept 2020 with HbA1c 66 and advised by doctor to use the Fast 800 diet. Took some facts from the book and managed to lose 1 stone and drop my HbA1c to 51. I was not particularly overweight, only a bit of belly fat. I have not been medication having tried to do it my way. My recent reading was 53 and have a telephone appt with the diabetic nurse this week. My doctor was ok with the 51 reading but I believe the nurse is keen for me to go on meds. Who do I believe, doctor or nurse?

That's an interesting one! My understanding was you generally only come off meds if you get uour numbers back into pre-diabetic range (i.e. below 48) But given how close you are, you could maybe plead for another 3 months to try diet and exercise some more?

 

[Leadinglights]

There is really not a huge difference between 51 and 53 and I believe the result is weighted towards the more recent weeks so if you have drifted off your dietary regime where you were reducing your level that could explain it. It would be wise to review your diet and make a food diary estimating the carbs in what you are eating and drinking and see where savings can be made.
You don't mention having a home blood glucose monitor which would be a good investment so you can test the effect of meals and foods to see if there are any particular problems there either in content or quantity.
Reducing carbs a bit more should get you on track again. Low carb less than 130g per day is successful for many people.