The problem is these guidelines are flawed and are also not shared with patients. Have you see what Diabetes UK puts on their website? There is still a one-size-fits-all attitude that still calls for starchy carbs to form the basis of meals and recommendations to cut fat as much as possible.
Look, I've deconstructed these guidelines before.
intervention studies have failed to show any association between the type and amount of fat in meals and post-prandial glucose response
In other words, fat has NO EFFECT on blood glucose control.
It is unclear what ideal proportion of macronutrients to recommend for optimal glycaemic control for Type 2 diabetes
...but we'll continue to tell you to base your meals around starchy carbs, despite the fact we honestly don't know if it is a good or bad thing.
Monounsaturated fat can be substituted for carbohydrate without detrimental effect to either lipids or glycaemic control
...but obviously we won't be recommending you base your food around monosaturated fats because fat is bad, right...even though we know it doesn't actually affect you negatively.
When protein is substituted for carbohydrate, short-term glycaemic control improves
....and we won't be recommending you eat more protein either because the last thing you want is your glycaemic control to improve.
A modest reduction in carbohydrate intake is associated with improvements in glycaemic control and low carbohydrate diets can be particularly effective if associated with weight loss.
...but despite this, we'll still be telling you to base your meals around starchy carbs.
Although the total amount of carbohydrate ingested is the primary
determinant of post-prandial blood glucose response, there is little evidence to support specific strategies for recommendations about carbohydrate intake in Type 2 diabetes.
...largely because it's so overwhelmingly obvious that the more you have of something that is known to majorly affect your BG, the more it'll affect your BG. I suspect there hasn't been any specific research into whether or not large amounts of rain cause flooding either.
It has been shown that the main mode of action of low carbohydrate diets is simply a reduction in energy intake due to carbohydrate restriction
So it has nothing to do with glycaemic control then, despite the fact that we already accept that the amount of carb intake is the primary determinant of post-prandial blood glucose response?
Concern has been expressed about the potential adverse effects of these diets, especially on cardiovascular risk, but there remains no evidence of harm over the short term
So in other words, there's no evidence that they're harmful, yet certainly some evidence that suggests they're beneficial? Under those circumstances, you'd expect someone to do some research or at least maintain an open mind, right?
http://www.diabetes.org.uk/Guide-to-...o-eating-well/
2. Include starchy carbohydrate foods as part of your diet
3. Cut down on the fat you eat, particularly saturated fats
Oh! How stupid of me! There was me, reading the actual evidence Diabetes UK presented, saying that reducing your carb intake and replacing it with monounsaturated fats probably helps manage diabetes better, and thinking that meant cutting down on carbs and eating more mono fats would help make diabetes management better. How stupid of me! Why on earth did I not realise what that actually meant was that cutting down on fat and basing my meals on starchy carbs was the right option.
Oh, wait, it's because I can read.
Seriously, you can literally hear whoever drafted this report internally cringing. It's ALMOST as if whoever put together this report 'knew' the right answer or conclusion they were supposed to draw and then found the evidence didn't quite stack up as neatly as they liked. And then decided to write things WITHIN THE SAME REPORT that directly contradicted each other as if that wasn't a problem.
Small, short term intervention studies investigating the relationship between macronutrients and glycaemic control have reported contradictory results
In other words, the studies we did actually showed our conventional approach was WORSE. Let's just pass that off as 'contradictory' and say they were small, rather than do something like, oh, I don't know, a full proper study that would settle the issue. And then there's all the mealy-mouthed fudging about being aware of carb intake without daring once say, "you know what? Maybe we don't need quite as much bread." There's all these constant references saying that carb reduction and fat intake change 'need more study' despite the fact there seems to have been as much research done into these as the alternatives ie. very little.
And the final bit says it all.
In terms of dietary strategies for weight loss, encouraging the individual to adopt their diet of choice may well improve outcomes. It is the degree of adherence that will predict outcomes rather than type of dietary strategy [145]. It is intuitive that a diet an individual enjoys and finds acceptable is more likely to succeed
In other words, we don't really have a clue, so you might as well take your pick and accept the consequences.
