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DiABETES UK Nutritional Guidelines

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This thread is now closed. Please contact Anna DUK, Ieva DUK or everydayupsanddowns if you would like it re-opened.
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.



In other words, fat has NO EFFECT on blood glucose control.



...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.



...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.



....and we won't be recommending you eat more protein either because the last thing you want is your glycaemic control to improve.



...but despite this, we'll still be telling you to base your meals around starchy carbs.



...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.



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?



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/



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.



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 other words, we don't really have a clue, so you might as well take your pick and accept the consequences.
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.



In other words, fat has NO EFFECT on blood glucose control.



...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.



...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.



....and we won't be recommending you eat more protein either because the last thing you want is your glycaemic control to improve.



...but despite this, we'll still be telling you to base your meals around starchy carbs.



...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.



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?



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/



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.



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 other words, we don't really have a clue, so you might as well take your pick and accept the consequences.
 
Thank you so much DeusXM. I haven't laughed so much in a very long time.
Your deductions were brilliant and very pointed.
It looks like it is 'carry on as usual'. Regards.
 
So a low GI diet shows an improvement in Hba1c of half of one percent.

On LCHF my Hba1c fell from 91 to 41 - so 50 points and as a percentage that is 5000 divided by 91 - which is almost 55 percent, and it seems to indicate that eating low carb is a hundred and ten times more effective - though possibly half of one percent is within the margin of error for the testing.
 
Hi, please can someone advise on how many grams of carbs, fats and protein a diabetic 2 woman should have a day?

Unfortunately there is no single answer to that question - it is something you have to work out for yourself, ideally by using a BG meter to see which meals, and more specifically the types and amounts of carbohydrate in different meals result in better blood glucose.

Having said that, from reading the posts by other members here it seems like something between 50 and 100g of carbohydrate per day is likely to be where you end up.

One of the frustrating things is that different carbs behave differently for different people (something complicated to do with the gut biome I think). So one person might be OK with small amounts of bread or potato, while for others those would be a complete disaster.

The only thing you can really do is to use a BG meter to see how you body reacts. This ‘Test Review Adjust’ post is well thought of by members here: http://loraldiabetes.blogspot.com/2006/10/test-review-adjust.html

Fat and protein you can be a little more relaxed about, particularly if concentrating on ‘good’ natural fats (oily fish, olive oil, full fat dairy) rather than highly processed ‘factory made’ foods.
 
Well I think its all smoke and mirrors. TBH I decided to avoid heavy carbs altogether. ANYTHING that grows below ground, wheat and rice. I will admit my fat intake is way higher but considering March Last Year my HBA1c was 99 and today its 38. Cholesterol is now 4.4 BP 125/70 pulse 54 at rest and I am 5olb lighter, I don't think a more fats bias diet is doing me much harm!
 
To go from fully diabetic to normal took me 6 months at no more than 50 gm of carbs a day.
I am now setting a maximum of 40 gm of carbs in the hope of losing more body fat - contrary to the established mantra I lost weight after normalizing my blood glucose and Hba1c. I am eating the same foods as when doing Atkins to control my weight, and in the same amounts, though with tighter control as there is more at stake.
 
I can only speak from my own experience
Diagnosed september 28th 2017 HbA1c 78 put on Metformin
Immediately put myself on a Low Carb/ High Fat/ High Protein diet
1st review at 3 months Jan 3rd 2018
HbA1c 33, wweight loss in kilos down from 98 to 82
Cholestrol 3 BP normal.
Taken off Metformin
2nd review Juy 3rd
HbA1c 36
No Metformin
Weight 78.8 Kilos
CH stable, BO normal
I eat like a horse
LCHF Worked for me and ther eis no arguement about that .
 
Just read the DUK post about "What is a Healthy Balanced Diet for Diabetics" DUK still seem to be stuck with UKs NICE/ Healthy Eating advice despite recent and older research evidence. They recomend 'a banana in in a child's lunch box, fresh dates, low fat yoghurt and canned fruit in juice. I could go on and include the other carby/sugary suggestions but I won't.
Now how on earth anyone can suggest fresh dates at 68gm/100g is a healthy diet for for a diabetic is beyond me, as is including a banana @ 20g/100g as a snack for children not to mention the massive amount of carbs/sugars in canned fruit in juice. And then there's' low fat' yoghurt too which is usually high in carbs. Could go on, but won't.
Now if DUK really want to promote a "Healthy Balanced Diet", please include the research evidence your diet is based upon and sponsors for any assocated research.
 
It is still important to include fruit in the diet as it contains important nutrients. But the focus should be around portion sizes and frequency rather than removing it from the diet completely, or making healthy swaps, so having tinned fruit in juice, rather than in syrup or having yoghurt that is low in fat.

@Dave W , you are referencing the page, 'What is a healthy, balanced diet for diabetes?'

All our dietary advice follows our 'Evidence-based nutritional guidelines' which are referenced at the beginning of this thread. All research and evidence has been cited in the document in 'References' from pages 40-56.

Children who use insulin to control type 1 diabetes will have different dietary needs to an adult living with type 2 diabetes. Therefore, children are not included in the scope of these guidelines. The International Society of Paediatric and Adolescent Diabetes (ISPAD) clinical practice guidelines have been adopted by us for dietary guidance for children. More details on this page of our website.

https://www.diabetes.org.uk/profess...for-the-prevention-and-management-of-diabetes
 
Just read the DUK post about "What is a Healthy Balanced Diet for Diabetics" DUK still seem to be stuck with UKs NICE/ Healthy Eating advice despite recent and older research evidence. They recomend 'a banana in in a child's lunch box, fresh dates, low fat yoghurt and canned fruit in juice. I could go on and include the other carby/sugary suggestions but I won't.
Now how on earth anyone can suggest fresh dates at 68gm/100g is a healthy diet for for a diabetic is beyond me, as is including a banana @ 20g/100g as a snack for children not to mention the massive amount of carbs/sugars in canned fruit in juice. And then there's' low fat' yoghurt too which is usually high in carbs. Could go on, but won't.

I eat bananas. Nowt wrong with them and no, I'm not sponsored by Fyffes. You can't compare a Type 1, particularly a child, with a Type 2. Different conditions entirely.
 
In addition to what @Hannah DUK said, I would also say that a child’s body is still developing. It needs a balanced diet which includes fruit and veg in good quantity. For the 98% of children with diabetes who have type 1, carbs can be dealt with by administering the correct amount of insulin. It isn’t necessarily about the amount of carbs consumed, but how long the carbs take to act. Technology allows us to plan accordingly. For example, pasta will hide in the body for hours, then BOOM! A child with an insulin pump can bolus so that the insulin is timed to be delivered when the carbs are likely to hit.

A banana containing 20g of carb is a perfect snack for a T1 child who walks home from school. My daughter has suffered hypos on the way home despite eating an 18g carb cereal bar before leaving school. Low fat yogurt is perfectly ok. The low fat content allows the insulin to work more effectively.

While a low carb diet may work for many type 2 adults on this forum, it really wouldn’t work for a child with T1 due to the nutritional needs of their body. As long as they are not eating too much unhealthy food, the amount of carbs in their diet is not something to worry about as long as it is reasonable.
 
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Yes indeed @Matt Cycle and @Bronco Billy, I am very aware that there is a vast difference between what someone with T1 and can or ought to eat, though as a T2 I'm not up on the intricate details of managing T1.
What rather niggled me with the article I commented on was that it was titled - What is a heathy balanced diet for diabetics and there was no differentiation (as far as I could see) between T1 or T2. I read it as a one size fits all dietary guide. Though I may perhaps have missed something.
I have a very good friend who was diagnosed T1 just a couple of weeks before my T2 diagnosis and he reckons he's more fortunate than I am as he can eat more or less what he wants and injects to compensate, though personally I'd rather not jab myself anymore than I already do when checking my BG!
I do know that for me at least, consumption of carbohydrates elevates my BG and that to consume carbs to the relative percentage of my total diet as is currently recommended in NHS/NICE advice results in a significantly higher Hba1c. But that's just me; we all react differently.
I'm well aware of the importance of including fruit in a diet @Hannah DUK, but I'm also aware that fruit can range considerably in 'carb/sugar' content and that anyone with T2 needs to be a bit careful with what and how much they consume and there were no caveats regarding this. Similarly no caveats regarding low fat yoghurts as many low fat yoghurts have sugars added to enhance taste.
 
I understand @Dave W, but I was responding to your comments about what should be in a child’s lunch box and what constitutes a healthy snack. As 96% of children with diabetes have type 1, I felt it was worth clarifying in case any parents were following the thread.
 
From digging around in various international dietary guidelines, there's obviously a lot of commonality & one focus is on whole grains: increase these in preference to white bread, pasta etc for all sorts of health benefits, supported by a wealth of evidence.

But I don't think it's straightforward to square this with the individual requirements of diabetics. In terms of BG control, I think it's simply a tactical error to make claims like eg "lower GI so less spiking". People's actual experience, including mine and plenty of others' I've seen, can run counter to this, impacting the credibility of the whole guideline framework.

This is just one study, but a really interesting one IMO, from Feb this year: http://austinpublishinggroup.com/clinical-medicine/download.php?file=fulltext/ajcm-v5-id1031.pdf

Looking at postprandial glucose, GI and other factors for a range of whole grain breads.

upload_2018-9-28_11-13-37.png

- A really wide range of individual responses
- At a grouped level, no statistically significant difference in glycemic response between white bread and many whole grain breads.
- The very wide range of GI's calculated amongst different individuals for each type of bread seems to make the notion of a single GI number for any bread quite misleading.
- Overall, the proportion of fibre and protein seems to make the biggest difference for glycemic response.
- No evidence found for any significant impact from differences in degrees of milling fineness. In contrast to the coarser = better recommendation you often see.
- Adding oil-seeds appears to achieve nothing. Again, in contrast to comments you often see.

In the end, you can't get away from the need to individualise, which obviously makes writing useful guidelines difficult!

Whole-grain products are reported to have several positive effects on human health [30], including reducing coronary heart disease [26,31,32], T2DM [25,27,33] and metabolic syndrome [7,34].
This study reports large variations in the impacts of various wholegrain-based breads on relevant T2DM-related parameters and indicates complex nutritional relationships and individual response
characteristics. Therefore, it is difficult to provide recommendations for effective food-based dietary guidance for patients. In general,bread with reduced carbohydrate content in combination with high fiber, protein and fat content seems to be preferable, but dietary optimization for each individual is necessary.
 
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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.



In other words, fat has NO EFFECT on blood glucose control.



...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.



...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.



....and we won't be recommending you eat more protein either because the last thing you want is your glycaemic control to improve.



...but despite this, we'll still be telling you to base your meals around starchy carbs.



...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.



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?



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/



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.



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 other words, we don't really have a clue, so you might as well take your pick and accept the consequences.
Just signpost people to Diabetes.co.uk if you want a sensible and effective way of managing T2 Diabetes!!
 
Just signpost people to Diabetes.co.uk if you want a sensible and effective way of managing T2 Diabetes!!

Well, a seriously final "one size fits all" diet, an offer to buy the book, and a serious slanging match if you suggest its not the only approach seems to the the way on there.
Here is a far better ideology.
 
Status
This thread is now closed. Please contact Anna DUK, Ieva DUK or everydayupsanddowns if you would like it re-opened.
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