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Dietary advice; what's the evidence?

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wildfind

New Member
Relationship to Diabetes
Type 2
The standard diet advice for T2s that NHS and Diabetes UK give out recommends making starchy foods the basis of every meal, despite the fact that this must inevitably result in higher blood sugar levels.

I have to assume that the people responsible for this advice are basing it on solid scientific evidence. As seems on the face of it to be contrary to common sense, I think Diabetes UK has a duty to spell out precisely what this evidence is.

And endlessly repeating the mantra 'a healthy diet' tells us precisely nothing.
 
Their most recent evidence based guidelines are here
http://www.diabetes.org.uk/nutrition-guidelines
There is a brief comparison between the older 2003 guidelines (which were evidenced based also) and the more recent ones here
http://www.york.ac.uk/media/healths... Guidelines for Practice Paul Pipe Thomas.pdf

They have changed many of their pages since;for example this one was reviewed in May 2012 . The advice differs in emphasis from the earlier advice.
http://www.diabetes.org.uk/Guide-to...ith-Type-2-diabetes/Ten-steps-to-eating-well/

Not all the pages have been reviewed though.
 
evidence for the standard high-carb advice

Thanks Helen

I have of course read the 'evidence based' report you mentioned. The problem with it is that nowhere does it offer any evidence whatsoever to justify the standard high-carb dietary advice, despite the enormous human and financial cost society will have faced if it turns out to have been wrong - or maybe that's the very reason it's so hard to confront the issue.

I think that we are entitled to know whether the advice we are given on this vitally important subject is well founded on good research. In this respect we should be able to look to Diabetes UK as a body primarily looking out for our interests, rather than merely acting as a conduit for the views and interests of the huge diabetes industry.

David Wilson
 
Whilst I am not party to the inner thoughts of DUK and never have been, I think you are more likely to find, should you care to look into it, that they are (and usually do, which is no surprise) following the NHS line.

I don't mean that in any sarky way - DUK wouldn't expect to have to double check what the NHS say, now would they? I should think they'd actually get a lot of complaints if they suddenly started doing that because people would want to know 'why they were wasting their resources when the NHS have already done all the work before'.

If my hypothesis is correct, then you need to cross examine the NHS on where they got the evidence from, rather than DUK.

The crux of it as far as I have ever been able to tell, is the alleged 'heart healthy' diet plate. Which is remarkably similar to the 'diabetes' plate. LOL Well - we are all supposed to be 'at risk' for CVD, so it's obvious we need to follow a 'heart-healthy' diet, isn't it?

Ergo, here's your diet, mate.

I don't know if it IS healthy for your heart.

I do know it isn't very healthy for a great number of diabetics, esp T2 diabetics.
 
Don't Diabetes UK to some extent advise the NHS? I always looked on it in a cross-pollination sort of way.

There's some more interesting evidence here. Ever heard of double-think?:

http://www.diabetes.org.uk/Documents/Reports/Nutritional_guidelines200911.pdf

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.

...so 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...ith-Type-2-diabetes/Ten-steps-to-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.
 
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I haven't read any of the details provided, so feel free to shoot me down! :D

It is possible to base a meal around starchy carbs, but it depends on how much of the starchy carbs you base your meal around doesn't it?

For example, I continue to include potatoes in my main meals. However, I tend to only have two or three small new potatoes (depends on their size).

Prior to diagnosis, I could easily have had half a plateful of potato mash equivalent to two or three LARGE potatoes!

I guess with the reluctance of GP's to prescribe test strips though, working out how much starchy carb is ok will prove problematic.

Andy 🙂
 
ROFL

Entry in my personal dictionary, definition of the word 'Cynical = DeusXM' - and funnily enough Deus, 'and me'.

methinks a medical researcher wrote dem guidelines, since we often find (LOL) that the 'findings' in research papers are 99.9% at odds with the 'Conclusions' at the end, don't we, children?

:D
 
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