www.diabeticretinopathy.org.uk

General

A Healthy Diet

David Kinshuck

 

Your dietician

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)

 

Healthy food, fibre, fruit and vegetables

New Zealand healthy food pyramid

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.

A Mediterranean-style diet leads to better diabetic control (better than a low fat/low carbohydrate diet) Esposito 09. Guardian 09. Fruit lowers blood pressure 2011. See eatwellplate, large .

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.

Vegetarians and other issues

Other dietary issues are important:

 

Glycaemic index (GI)

graph of glycaemic index (glycemic)

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.

Examples of low GI foods

 

Energy from starchy foods..bread, potatoes, rice or pasta  

energy should come from carbohydrate

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.

 

 

 

 

Cut down on fat.  

cut down on fats, especially processed transfats and saturated fats

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.

 

Healthy oils & margarines

 

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 rapeseed oil
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

 

Protein...fish, pulses, red meat, white meat .

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
  • low salt/sugar baked beans,
  • lentil stew, lentil curry
  • vegetable stew with beans,
  • vegetable curry with beans
  • vegetable hot pot, hummus, and so on.
  • chick-pea
  • broad beans
  • recipes

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.

 

 

 

 

 

 

Cut down on sugar and refined carbohydrate.  

a mars a day makes the sight go away

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.

 

Cut down on salt

 

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.

 

Food & insulin training and the DAFNE regime

 

Diabetes education courses

 

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.

 

Carbohydrate counting

Carbohydrate Counting: www.goodcontrol.org

 

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).

 

Working out if you are overweight

 

content provided by NHS Choices

Use this graph to work out if you are overweight:

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.

Sometimes surgery may be helpful and anti-obesity surgery can reduce complications. Obesity increases the risk of cancer.

 

Atkins Diet/low carbohydrate diet.

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.

 

Diet Jigsaw ...use your mouse & click (BMJ Oct 2006)

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Surgery for obesity

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.

 

New drugs

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.)

 

Preventing diabetes

Guardian Yale University's Overall Nutritional Quality Index (scores out of 100)
A high score..healthier

  • Broccoli 100
  • Blueberries 100
  • Okra 100
  • Orange 100
  • Green Beans 100
  • Pineapple 99
  • Radish 99
  • Summer squash 98
  • Apple 96
  • Green cabbage 96
  • Tomato 96
  • Clementine 94
  • Watermelon 94
  • Mango 93
  • Red onions 93
  • Non-fat milk 91
  • Fresh figs 91
  • Grapes 91
  • Banana 91
  • Avocado 89
  • Oatmeal 88
  • Atlantic salmon fillet 87
  • Blackberries 83
  • Cod fillet 82
  • Raw almonds 82
  • Iceberg lettuce 82
  • Raw pecans 82
  • Rocket 82
  • Brown rice 82
  • Snapper 82
  • Milk (1% fat) 81
  • Oysters 81
  • Prawn 75
  • Couscous 72
  • Clams 71
  • Raw pistachios 70
  • Unbuttered, unsalted popcorn 69
  • Canned tuna in oil,
  • drained 67
  • Monkfish fillet 64
  • Vegetarian split-pea soup mix 63
  • Instant oatmeal 61
  • Canned pineapple in juice 60
  • White rice 57
  • Sodium-free sparkling water 56
  • Milk (2% fat) 55
  • Canned kidney beans 53
  • Milk (whole) 52
  • Scallops 51
  • Pasta 50
  • Canned peas 49
  • Prunes 45
  • Vanilla yoghurt 43
  • Orange juice 39
  • Skinless chicken breasts 39
  • Canned peaches in light Syrup 37
  • Lobster 36
  • Flank steak (beef) 34
  • Dried apples 34
  • Tomato juice 32
  • Condensed split-pea soup
  • with ham 32
  • Minced sirloin 30
  • Tomato juice 32
  • Condensed split-pea soup
  • with ham 32
  • Minced sirloin 30
  • Chicken drumstick 30
  • Enriched white bread 29

 

  • Whole chicken with skin 28
  • Leg of lamb 28
  • Ham (whole) 27
  • Raisins 26
  • Hamburger (75% lean) 25
  • Apple chips 24
  • Coconut 24
  • Green olives 24
  • Pork baby back ribs 24
  • Bagel 23
  • Condensed tomato soup 23
  • Peanut butter 23
  • Sherbet 23
  • Reduced-fat sour cream 22
  • Condensed cream of
  • broccoli soup 21
  • Salted, dry-roasted peanuts 21
  • Instant chocolate pudding 20
  • Fried egg 18
  • Swiss cheese 17
  • Diet fizzy drinks 15
  • Non-streaky bacon 13
  • Pretzel sticks 11
  • Dark chocolate 10
  • White bread 9
  • Salami 7
  • Hot dog 5
  • Cheese puffs 4
  • Milk chocolate 3
  • Apple pie 2
  • Crackers 2
  • Fizzy drinks 1
  • Popsicle 1

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.

 

 

Weight loss programs

These can be very successful BMJ 11 & here.  Locally WeightWatchersHealthier Weight Centre Ltd.

 

Help from other organisations & websites

 
Local
International
National