Diabetes UK’s ‘10 tips for healthy eating with diabetes’ · 2020. 9. 9. · ‘10 tips for...
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Update Autumn 2020 23 PHOTO: ADOBE STOCK Fact file 42 Diabetes UK’s ‘10 tips for healthy eating with diabetes’ the evidence base There are different types of diabetes, and no two people with diabetes are the same. So there isn’t a one-size-fits-all ‘diabetes diet’. But we have devised 10 tips that you can use to help guide your patients to healthier food choices. They focus on specific foods, to make it easier for people to put them into practice and to complement whatever diet they decide to follow. Senior Clinical Advisor Emma Shields discusses these healthy eating tips and the evidence behind them ow and what we eat is complex, evolving and difficult to capture, so dietary research can be mixed and hard to interpret. We know not everyone agrees on what is the best diet. That’s why we carefully reviewed all the evidence to create these tips. The recommendations underpinning them come from Diabetes UK’s ‘Evidence- based nutrition guidelines for the prevention and management of diabetes’ 1 . The order of the tips was chosen by the strength of the evidence. The tips are based on research involving people with type 1 and type 2 diabetes; however, some of the tips will still be relevant for people with other types of diabetes, such as gestational diabetes or MODY. But whatever kind of diabetes is involved, people should be referred to a registered dietitian when specific advice is needed. Many of the tips are drawn from the features of two dietary patterns – the Mediterranean diet and Dietary Approaches to Stop Hypertension (DASH) – that have good evidence to show they can help manage blood glucose 2 , blood pressure and cholesterol levels 3 . They can also help manage weight and reduce the risk of diabetes complications, such as heart problems and strokes. h 23-25_Factfile_SA3.indd 23 23-25_Factfile_SA3.indd 23 25/08/2020 16:31 25/08/2020 16:31
Transcript of Diabetes UK’s ‘10 tips for healthy eating with diabetes’ · 2020. 9. 9. · ‘10 tips for...
Update Autumn 2020 23
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Fact fi le 42
Diabetes UK’s ‘10 tips for healthy eating with diabetes’the evidence baseThere are different types of diabetes, and no two people with diabetes are the same. So there isn’t a one-size-fi ts-all ‘diabetes diet’. But we have devised 10 tips that you can use to help guide your patients to healthier food choices. They focus on specifi c foods, to make it easier for people to put them into practice and to complement whatever diet they decide to follow. Senior Clinical Advisor Emma Shields discusses these healthy eating tips and the evidence behind them
ow and what we eat is complex, evolving and diffi cult to capture, so dietary research can be mixed and
hard to interpret. We know not everyone agrees on what is the best diet. That’s why we carefully reviewed all the evidence to create these tips. The recommendations underpinning them come from Diabetes UK’s ‘Evidence-based nutrition guidelines for the prevention and management of
diabetes’1. The order of the tips was chosen by the strength of the evidence.
The tips are based on research involving people with type 1 and type 2 diabetes; however, some of the tips will still be relevant for people with other types of diabetes, such as gestational diabetes or MODY. But whatever kind of diabetes is involved, people should be referred to a registered dietitian when specifi c advice is needed.
Many of the tips are drawn from the features of two dietary patterns – the Mediterranean diet and Dietary Approaches to Stop Hypertension (DASH) – that have good evidence to show they can help manage blood glucose2, blood pressure and cholesterol levels3. They can also help manage weight and reduce the risk of diabetes complications, such as heart problems and strokes.
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Fact fi le 42
Choose healthier carbohydrates
Carbohydrates have the biggest impact on blood glucose levels after eating. But although everyone with diabetes needs to think about the type and amount of carbohydrates, the literature doesn’t support a low-carb diet for everyone with diabetes. There’s some evidence to show a low-carb diet confers better type 2 diabetes management in the short term, but this effect disappears over time4. What is clear is that carbohydrates are a heterogeneous group, and that this alone is a poor judge of its nutritional content. So, choosing healthier carbohydrates – those with more fi bre and micronutrients such as wholewheat pasta, whole oats, chickpeas, beans and lentils – is encouraged.
Eat less saltPeople with diabetes are at greater
risk of cardiovascular disease (CVD), so dietary advice needs to refl ect this. Reducing salt – specifi cally sodium – reduces blood pressure and therefore CVD risk5. Individuals can take actions to reduce their salt intake by reducing it in cooking or at the table, and by comparing food labels to choose lower salt options. But signifi cant action is also needed by policymakers and the food industry to see major reduction in salt intakes as it is present in many processed foods.
Eat less red and processed meat
People cutting down on carbs should be careful not to replace these with red and processed meat, as these tend to be higher in saturated fat and salt. They’re also limited in dietary patterns, such as the Mediterranean diet, associated with better health outcomes6. Healthier protein options include fi sh, especially oily types, eggs, poultry and pulses.
Eat more fruit and vegFruits and vegetables feature in both
DASH and Mediterranean diets. Lower in calories, yet high in fi bre and micronutrients, they have a range of cardioprotective benefi ts. But many people with diabetes are told to avoid fruits because of the sugar content. While it’s true they do contain sugar in the form of fructose, they also contain fi bre and most fruits have a low to moderate glycaemic index – meaning they do not lead to a sharp rise in blood glucose compared to other carb-containing foods. Special concerns have
been raised with regards to fructose, but there’s no evidence that fructose consumed naturally in foods, like fruit, in average intakes has any detrimental effects7.
Choose healthier fatsAdvice around fat has evolved and
research now shows that the type of fat in the diet is more important than the amount. There’s strong evidence that reducing saturated fats and swapping for unsaturated fats reduces the risk of CVD8. So our tip focuses on choosing healthier types of fat from plant oils in place of fats derived largely from animal sources like butter.
Cut down on added sugar
There’s currently no specifi c guideline for added (free) sugars for people with diabetes, but it’s recommended these are reduced in line with general guidance. Sugary drinks, in particular, are linked with poorer weight management9. There’s also some evidence large intakes of sugars worsen heart health10.
Be smart with snacksEncourage sensible portions of
yogurt, unsalted nuts, seeds, fruit and vegetables over crisps, chips, biscuits and chocolate.
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10 tips for healthy eating with diabetesThere are different types of diabetes, so there isn’t a one-size fits all way of eating. But we’ve come up with tips that you can use to help you make healthier food choices.
They can help you manage your blood glucose (sugar), your weight and reduce the risk of diabetes complications.
If you have Type 1 diabetes, carb counting is really important to keep your blood glucose levels steady.
If you have Type 2 and you’re overweight, finding a way to lose weight is important. It really improves diabetes management because it can help to lower your blood glucose and reduce your risk of other complications.
www.diabetes.org.uk/10-eating-healthy-tips
1 Choose healthier carbohydrates
5 Choose healthier fats
6 Cut down on added sugar
2 Eat less salt
3 Eat less red and processed meat
10 Get your minerals and vitamins from foods
7 Be smart with snacks
9 Don’t bother with so-called diabetic foods
8 Drink alcohol sensibly
4 Eat more fruit and veg
The British Diabetic Association operating as Diabetes UK, a charity registered in England and Wales (no. 215199) and in Scotland (no. SC039136). © Diabetes UK 2018 1512
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25Update Autumn 2020
high in calories and saturated fat. Because of the legacy effect, we still need to encourage people to avoid foods specifi cally targeted to people with diabetes.
Get vitamins and minerals from food
Although there’s research to show that people with diabetes have an altered micronutrient status, the impact of this remains unclear. Data from randomised control trials investigating vitamin and mineral supplementation is limited. Furthermore, some supplements may interfere with medications or worsen complications like kidney disease. For these reasons, dietary supplements are not recommended for diabetes
management and instead people should be encouraged to eat a variety of foods to get their essential nutrients.
References 1 Dyson PA, Twenefour D, Breen C, et al (2018).
Diabetes UK evidence-based nutrition
guidelines for the prevention and management
of diabetes. Diabetic Medicine 35(5),541-547
2 Esposito K, Maiorino MI, Bellastella G et al
(2015). A journey into a Mediterranean diet and
type 2 diabetes: a systematic review with
meta-analyses. BMJ Open Aug 10, 5(8):
e008222
3 Azadbakht L, Fard NR, Karimi M et al (2011).
Effects of the Dietary Approaches to Stop
Hypertension (DASH) eating plan on
cardiovascular risks among type 2 diabetic
patients: a randomized crossover clinical
trial. Diabetes Care 34(1), 55–57
4 Snorgaard O, Poulsen GM, Andersen HK et al
(2017). Systematic review and meta-analysis of
dietary carbohydrate restriction in patients with
type 2 diabetes. BMJ Open Diabetes Research
& Care Feb 23, 5(1): e000354
5 He FJ, MacGregor GA (2011). Salt reduction
lowers cardiovascular risk: meta-analysis of
outcome trials. Lancet 378(9789), 380–382
6 Mozaffarian D (2016). Dietary and policy
priorities for cardiovascular disease, diabetes,
and obesity: A comprehensive review.
Circulation 133(2),187–225
7 Livesey G, Taylor R (2008). Fructose
consumption and consequences for glycation,
plasma triacylglycerol, and body weight:
meta-analyses and meta-regression models
of intervention studies. American Journal of
Clinical Nutrition 88(5), 1419–1437
8 Hooper L, Martin N, Jimoh OF et al (2020).
Reduction in saturated fat intake for
cardiovascular disease. Cochrane Database
of Systematic Reviews 5
9 Scientifi c Advisory Committee on Nutrition
and Health. Carbohydrates and health. SACN.
2016; London: TSO
10 Te Morenga LA, Howatson AJ, Jones RM et al
(2014). Dietary sugars and cardiometabolic risk:
systematic review and meta-analyses of
randomized controlled trials of the effects on
blood pressure and lipids. American Journal of
Clinical Nutrition 100(1), 65–79
11 Ahmed AT, Karter AJ, Warton EM et al (2008).
The relationship between alcohol consumption
and glycaemic control among patients with
diabetes: the Kaiser Permanente Northern
California Diabetes Registry. Journal of General
Internal Medicine 23(3), 274–282
For a full reference list and evidence grading, please
see reference 1 and for the full list and infographic,
go to www.diabetes.org.uk/healthy-eating
Drink alcohol sensibly The UK low-risk alcohol guidelines
of no more than 14 units a week should be applied to people with diabetes. Although some research has linked alcohol with improved glycaemic management11, hypoglycaemia is a well-known side effect of alcohol. Furthermore, alcohol has other negative effects, such as being high in calories, so people wanting to lose weight may wish to cut back further.
Don’t bother with so called diabetic foods
Marketing foods as ‘diabetic food’ is now against the law. There’s no evidence they improve glycaemic management, and they may still be
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10 tips for healthy eating with diabetesThere are different types of diabetes, so there isn’t a one-size fits all way of eating. But we’ve come up with tips that you can use to help you make healthier food choices.
They can help you manage your blood glucose (sugar), your weight and reduce the risk of diabetes complications.
If you have Type 1 diabetes, carb counting is really important to keep your blood glucose levels steady.
If you have Type 2 and you’re overweight, finding a way to lose weight is important. It really improves diabetes management because it can help to lower your blood glucose and reduce your risk of other complications.
www.diabetes.org.uk/10-eating-healthy-tips
1 Choose healthier carbohydrates
5 Choose healthier fats
6 Cut down on added sugar
2 Eat less salt
3 Eat less red and processed meat
10 Get your minerals and vitamins from foods
7 Be smart with snacks
9 Don’t bother with so-called diabetic foods
8 Drink alcohol sensibly
4 Eat more fruit and veg
The British Diabetic Association operating as Diabetes UK, a charity registered in England and Wales (no. 215199) and in Scotland (no. SC039136). © Diabetes UK 2018 1512
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