- About this section..seeing your dietician
- Health food: fibre, fruit and vegetables
- Vegetarians and other issues
- Glycaemic index
- Examples of low glyaemic index foods
- Energy from starchy foods..bread, potatoes, rice or pasta
- Cut down fat, reduce meat, increase pulses & fish
- Healthy oils/margarine
- Protein...fish, pulses, red meat, white meat
- Reduce sugar
- Cut out salt
- DAFNE training
- Carbohydrate counting
- Website...carbohydrate counting
- work out if you are overweight
- Atkins diet/low carbohydrate diet
- Diet Jigsaw
- diet jigsaw full screen
- Surgery for obesity
A Healthy Diet
We all need a healthy diet, whether or not we have diabetes, and this page describes a standard healthy diet. Many of us need to lose weight, and this page describes a plan.If we are trying to lose weight, we often need small portions. If we are trying to eat healthy and need recipes and links to wonderful websites, these are here.
Everyone with diabetes should see a dietician once a year, and certainly at the time of diagnosis, shortly after that, and at regular intervals. This page should supplement the individual advice that a dietician can provide.
Unless you have an excellent understanding what you need, and practice it, make sure you see a dietician. A dietician is available to every NHS patient..if not, insist your Primary Care Trust ensures you have an appointment. A careful diet is very helpful, BMJ 2010. A low calorie and salt diet reduces retinopathy progression (Archives 2010)
New Zealand healthy food pyramid
People who overweight tend to eat less fibre....foods high in fibre are not very fattening but they help to fill you up more easily. For instance a brown bread salad sandwich is just as filling (but less fattening as it has fewer calories) than a white bread plain cheese sandwich.
The US National Cancer Institute now recommends 9 portions a day of fruit and vegetable...and eating this much fibre will mean you will not be as hungry and therefore eat less bread, meat etc.
The Guardian (2005) reviewed healthy diets etc, here, here , here , here and so on. A Mediterranean diet has been proven to reduce the risk of becoming diabetic, as well as helping people with diabetes itself.
Current advice is that a third of the days day should be vegetables, a third complex carbohydrate, and perhaps a third protein. This may include small amounts diary and small amouts of unsaturated fat. In 80% type 2 weight is the major issue, and portion size has to be addressed.
A portion: a fruit portion may be a handful of grapes, medium size bananana, not all at once..shoud be spaced out during the day. The amount of carbohydrate needed depends on the amount of exercise taken.
Other dietary issues are important:
- a diet that includes plant sterols, soy protein, viscous fibers, and nuts lowers cholesterol significantly JAMA 2011. report 2005
- 1 g of plant sterols per 1000 kcal of diet in a plant sterol ester–enriched margarine;
- 10 g of viscous fibers per 1000 kcal of diet from oats, barley, and psyllium;
- 22.5 g of soy protein per 1000 kcal as soy milk, tofu, and soy meat analogues;
- 22.5 g of nuts (including tree nuts and peanuts) per 1000 kcal of diet.
- Peas, beans, and lentils was also encouraged.
- Vegetarians have lower blood pressures and healthier lipid levels, see , and live longer.
- Red meat increases blood pressure 1.2mmHg, & increases risk of death 30-50%.
- high levels of vitamin D reduces the risk of many conditions, particularly in younger people. It is found in fish but is also made on our skin with sunlight exposure. It prevents type 1 diabetes, multiple sclerosis, and colorectal & prostate cancer, just as examples.
- Long chain Omega 3's are helpful preventing renal disease. Fish and sea food has long chain omega 3s and is of proven benefit. Pulses (lentils, beans, chick peas etc) have short chain omega 3s, although some experts say these are not quite as beneficial.
- Health benefits are not unique, but there are ecological benifits (less CO2 used), BMJ 09
- Some studies suggest restricting carbohydrate improves cardiovascular outcomes (Foster 2010). The opposite was found here Yancy 2004! Review 2006
- a 'stepped-care approach' is effective JAMA 2012
- spicy foods help BMJ 15
- sugary drinks..no BMJ 15
- the actual cholesterol level is not so important with a healthy Mediterranean diet
- Blueberries help to protect against the risk of diabetes, cantaloupe melon increases the risk (fruit juice, not illustrated, increases the risk significantly more) see www.bmj.com
Food with a high glycaemic index GI (red) cause a dramatic rise in blood glucose. Lower glycaemic foods are healthier (green)
Generally foods with a low glycaemic index (GI) are healthy, because insulin (injected or natural) has enough time to redistribute the glucose to the body's tissues. These have a glucose profile shown in green. These make people feel 'full' after a meal and help keeping weight down. See
Generally foods with a high glycaemic index are unhealthy, as the glucose rises too quickly to be redistributes and will do some damage (shown in red). They may even may you more hungry as their effect wears off, as in eating hamburgers....you may still fell hungry even if you have had far more calories than you need.
- The only exception is fruit. Fruit has a high glycaemic index, but is still considered healthy, as above. 1-2 portions of fruit eaten over 10 minutes are unlikely to be harmful (100gm/portion, the same size as a medium size apple.) Fruit is therefore ideal as a desert or a snack.
- Even fruit is fattening in very large amounts, but 5-9 portions of vegetables or fruit should be part of everyone's diet.
- There are many leaflets which indicate the glycaemic index of foods. Here are some recipes see and here. A low glycaemic index (high protein) diet maintains weight loss NEJM 2010.
- A table of glycaemic index.
- whole grains reduce glycaemic index see
- Brown rice
- Bulgur (cracked wheat)
- Whole-wheat bread, pasta or crackers
- Wild rice
- Beans, lentils, and oats...low GI
- Brown bread has a much lower glycemic index than white.
- A salad sandwich a higher index than one without salad. The brown bread or salad slows down absorption, so the body can cope with the release of glucose from the digested food.
- Brown rice similarly has a lower glycaemic index than white.
Our daily energy requirement should come from starchy foods, such as bread, potatoes, rice or pasta. Rice and potatoes particularly have a low glycaemic index, and are ideal.
- Too much fat, even healthy fats, are harmful.
- Cut down on fried and fatty foods such as butter, margarine, cheese and fatty meats.
- Choose reduced-fat spreads and cheeses instead. Try skimmed or semi-skimmed milk.
- Trans-fats ('hydrogenated' which may be in hard margarine, biscuits, cake for instance) are considered very harmful.
A little fat is helpful, such as polyunsaturated fat (sunflower oil). The fats in nuts are healthy, but nuts are 'fattening' as they have a lot of calories, so they are best in small amounts, perhaps replacing the saturated fat of red meat and full-fat dairy food. A new paper reviews 'healthy fats' here .
There is lots of fat in cheese (half fat)...large amounts of cheese are likely to be harmful. Meat also has plenty of fat. You only need very small portions of meat (50g)...the size of half a weetabix, and not more than once a day. Your other meal could be a brown bread salad sandwich, for example, perhaps with hummus. There are recent reports (2014) that saturated fats are not that harmful to the heart, but there is no dispute that the amount of fat is harmful; transfats are harmful; and red meats increase the risk of bowel cancer.
|when used cold||olive oil (mono-unsaturated, healthy at low temperature; it becomes saturated and is not as beneficial if cooked at high temperatures)|
|when used for cooking||best
next sunflower oil (very little difference between them)
|margarines||most of these seem to have unhealthy fats such as transfats, and too much salt. Of these Flora seems the healthiest. The Olive Oil margarines are not as healthy as olive oil itself. Why not replace these with a dressing made with olive oil.|
|butter||has saturated foot and is best avoided in large amounts|
We need 0.8-1gm/kg/day. Pulses and fish are the healthiest sources of proteins.
Most UK diets would be much healthier if protein with pulses replaced most of the red meat (lamb, pork, beef), and probably white meat (chicken & turkey) .
Small amounts of nuts have healthy proteins..but too many are fattening.
|Pulses /recipes include|
Cheese, whilst a good source of protein, is 50% saturated fat...best avoided on a strict diet. (Advice changes according to the latest research!).
Portion sizes for each meal: 75 gm pulses (pulses: beans, lentils), 50 gm fish/meat & others.
Sweet foods and refined carbohydrate, such as a hamburger or even a sandwich, may actually may you hungrier, Brown bread has a lower glycaemic index, and is healthier. But most UK bread has too much salt...it is best in small amounts.
If you cannot avoid foods such as hamburgers, at least have them with a salad or some fruit in addition. You can use artificial sweeteners such as saccharin and aspartame, and diet drinks.
|Sources of salt in our diet|
|15% of contribution from salt||natural in fresh food|
|15% of contribution from salt||what we add at the table|
|70% of contribution from salt||from convenience and processed food, most of which have salt added|
|Amount in processed food|
|1% of the foods content||in cereals, such as corn flakes|
|>2% of the foods content||vegetarian canneloni (tesco's); Special K cereal|
Reduce salt added in cooking by using more herbs and spices instead. Gradually cut down on the salt you add to your food at the table. Remember, most salt comes from processed food, so eat the minimum processed food.
Very enthusiastic patients make their own bread without salt, adding cinnamon, sunflower seeds, caraway seeds, and ginger to make it taste good. Genes and salt 2013.
NICE have recommended that everyone using insulin should have training to allow them to achieve good control of their diabetes. One course is the DAFNE course, for users of multiple dose insulin regime who want their diabetes well controlled. But very few people have had DAFNE training, and very few diabetes nurses and doctors.
The DAFNE (and other courses) course teaches you how to measure how much carbohydrate you eat, so you can match this as accurately as possible with your insulin. In this way, if you use a rapid acting insulin, if you eat 2 portions of pizza instead of one, you have extra insulin as you eat the second portion. If you have an apple, you have a tiny extra dose on insulin.
This method helps you achieve better diabetic control without more hypos. NICE recommend a programme of structured diabetes education in the months after diagnosis, and recommend patient education should be available when needed annually; most of this should be educational and interactive, but it also needs to include a formal review of self monitoring/insulin adjustment.
To achieve good control, insulin users need to be able to determine the carbohydrate content of a meal, and adjust the insulin dose accordingly. This is discussed here (University of Leicester, permission to use applied for) clearly explains how to count carbohydrate. (Page 8 onwards).
Essentially you have to start to weigh the carbohydrate for each meal for a while, until you learn the portion sizes. You work out how much insulin you need for 50g of pasta, or 50 g rice, and so on. You then inject different amounts of insulin of adjust your insulin pump according to the type of carbohydrate, the amount, and so on.
Even fatty foods will need some extra insulin, and you can learn how much. This site teaches you to count your carbohydrates, so you can work out your insulin dose (you need to register and log in).
Use this graph to work out if you are overweight:
If your overweight, trying losing weight will improve your diabetic control and slow down or prevent retinopathy. See a larger chart . Use the calculator to get a rough idea which BMI range you are in. Your weight in relation to your height gives an estimate of how much of your body is made up of fat. This measure is known as the body mass index (BMI). When you get more energy from your food and drink than you burn up in day-to-day activity, the spare energy is stored as fat and you put on weight.
The DiRECT Study for type 2 diabetes
See A strict diet can make the type 2 diabetes go into remission, and is recommended by many professionals.
This is a high protein diet. The original form, such as eating protein such
as red meat and excluding carbohydrate such as potatoes and rice, is NOT recommended
by most dieticians treating people with diabetes (or even without). Replacing
the meat with fish will make it a little healthier, but it is still NOT recommended.
This is a very controversial area, but it is believed that a long-term Atkins diet will lead to unhealthy fat levels, or at least much less healthy than a regular diet and weight loss.
There are principles of the Atkins diet that are important though, and this is limiting portion sizes. If you are putting weight on you are exercising too little, or eating too much junk/incorrect food, or eating too much of otherwise healthy foods.
So if you exercise, cut out junk food, and eat small portions of regular food, you will usually lose weight. The Atkins diet is a high protein high fat diet NOT recommended by most professionals.
See 2010: A low-carbohydrate diet based on animal sources was associated with higher all-cause mortality in both men and women, whereas a vegetable-based low-carbohydrate diet was associated with lower all-cause and cardiovascular disease mortality rates.
This can be very helpful. An excellent review for professionals , NICE guidelines for patients, patient.co.uk. Bariatric surgery can be better than conventional therapy NEJM 2012 and another NEJEM 2012 if obese.
These are for type 2 patients only, and are discussed here. (Exenatide (Byetta) & Liraglutide (Victoza) are new drugs that lower glucose levels and aid weight loss.)
University's Overall Nutritional Quality Index (scores out of 100)
Type 2 diabetes may be caused by being overweight, and because we are all getting heavier there is expected to be twice as many people in the world with diabetes in 10 years time. So although it is probably no consolation, you are not alone, as there are already millions of people in the world in a similar situation.
See some recent research here, (prevention of diabetes increased with weight and smoking), here and here which includes prevention with metformin. So there are many reasons to lose weight, but like many things in life, losing weight is often a very hard battle.
However, if you avoid all the food that is very fattening, like cakes, chocolate
and full fat dairy food, and have small portions of fattening food like meat
and fish, and combine this with an hours walking a day (perhaps 2 x half hour
walks), most people will make good progress.
This page has more specific advice that everyone, even if they do not have diabetes, needs to follow to keep healthy.