These medications have been heralded for their ability to suppress appetite and aid weight loss, but did you know that GLP-1 is a natural hormone you can stimulate without injections or prescriptions?

Glucagon-like peptide-1 (GLP-1) plays a vital role in regulating metabolism, the intricate system responsible for managing your energy, weight, and blood sugar levels.

With the right habits, you can enhance your body’s natural GLP-1 production, helping you manage weight and maintain overall health sustainably.

Understanding GLP-1s and their role

GLP-1 is a hormone released in the gut in response to eating.

It has several important roles:

• Regulating blood glucose: GLP-1 increases insulin secretion and reduces glucagon levels, keeping blood sugar steady.
• Controlling appetite: It signals your brain to reduce hunger and enhances feelings of fullness.
• Slowing digestion: By delaying gastric emptying, GLP-1 ensures a steady release of nutrients and energy.
• Promoting energy balance: GLP-1 helps the body decide when to store or use energy.

Medications that mimic GLP-1 can be effective for weight loss, but their side effects such as nausea, muscle loss, and gastrointestinal discomfort make them unsuitable for everyone.

Research published in The Lancet warns that 40% of weight lost using these medications is lean muscle mass which can be difficult to regain.

Additionally, weight often returns once the medication is discontinued.

Natural methods of enhancing GLP-1 not only sidestep these issues but also offer long-term benefits for metabolic health.

• Rise of dangerous weight loss black market sparks concern
• W8Buddy app paves the way for enhanced weight management in the NHS
• MHRA: 68 people hospitalised with weight loss injections

How to naturally boost GLP-1 levels

Research suggests that lifestyle choices can significantly impact GLP-1 production and effectiveness.

1. Optimise your diet

Excessive sugar and refined carbohydrates flood your system with glucose, causing blood sugar spikes and crashes, so you want to reduce digestible glucose.

“Glucose rollercoasters” disrupts hormonal balance, including GLP-1.

Replacing sugary snacks with complex carbohydrates like whole grains, beans, and lentils can help stabilise blood sugar levels and improve GLP-1 activity.

2. Prioritise high-protein foods

Foods such as eggs, fish, poultry, and plant-based proteins are known to stimulate GLP-1 secretion.

Studies show that meals high in protein can significantly increase satiety by enhancing GLP-1 release.

Starting your day with a protein-rich breakfast sets the tone for steady energy throughout the day.

3. Increase fibre intake

Dietary fibre, particularly from fruits, vegetables, and whole grains, slows digestion and promotes the release of GLP-1.

Research from The American Journal of Clinical Nutrition highlights that fibre-rich diets not only support GLP-1 but also improve insulin sensitivity and gut health.

4. Engage in regular physical activity

Exercise is a powerful, natural stimulant for GLP-1. Studies in Diabetes Care have shown that both strength training and aerobic exercise can enhance GLP-1 levels improving appetite regulation and glucose metabolism.

Even simple activities like a brisk 10-minute walk after meals can help stimulate GLP-1 release.

5. Prioritise sleep

Sleep and hormone regulation go hand in hand. Poor sleep disrupts GLP-1 production and increases levels of ghrelin, the hormone that stimulates hunger.

Research from The Journal of Clinical Endocrinology & Metabolism suggests that getting 7–8 hours of quality sleep each night supports hormonal balance and reduces cravings.

6. Manage stress

Chronic stress elevates cortisol which can interfere with GLP-1 production and other metabolic processes.

Incorporating stress-relieving practices like mindfulness, yoga, or breathing exercises can help maintain a balanced hormonal environment.

• Reason why GLP-1 receptor agonists impact muscle mass explained
• Mounjaro comes out top in battle of the weight loss drugs
• Intermittent Fasting: Guide to Fasting and How it Works

Habits for long term GLP-1 optimisation

Changing your lifestyle can feel overwhelming but habit formation is the key to long-term success.

By linking new behaviours to existing routines – a technique known as habit stacking – you can make sustainable changes.

For example, pair your morning coffee with a short walk or add a handful of fibre-rich seeds to your breakfast.

It’s also important to rely on habits rather than willpower.

Research from Psychological Science highlights that willpower is a finite resource which diminishes throughout the day.

In contrast, habits are automatic behaviours that require less mental effort allowing you to maintain healthy routines effortlessly.

Boosting GLP-1 naturally isn’t just about appetite control; it’s about creating a lifestyle that supports your body’s natural processes.

One Meal A Day (OMAD) is a form of intermittent fasting that has gained popularity for its simplicity and prospect of significant health benefits.

Unlike traditional eating patterns which typically involve 3 meals a day, OMAD involves eating all of your daily calories in a single meal.

By doing this, you restrict food intake to a very short window of approximately 1 hour each day.

This is an extreme version of intermittent fasting, grounded in the belief that prolonged periods without food can lead to improved health outcomes and weight management.

• Time Restricted Eating: Beginner’s Guide
• Low Carb Diet and 7-day Meal Plan
• Carnivore Diet: The All Meat Diet

How OMAD works

The concept of OMAD is quite straightforward: eat once and then fast until the next day’s mealtime.

This approach is not just about limiting food intake to one meal a day.

It is also key to adhere to the same eating window daily to stabilise the body’s internal clock.

Flexibility in choosing the mealtime allows individuals to align their eating window with their lifestyle, making it a theoretically accessible approach to weight management and health improvement.

Advantages of OMAD

As with any eating approach, there are a range of potential advantages and disadvantages.

Potential for weight loss

OMAD’s restriction to a single daily meal can naturally lead to a reduction in calorie intake, thereby facilitating weight loss.

This aspect of OMAD can be particularly beneficial for weight management.

However, it’s important to acknowledge that OMAD may not suit everyone and that individual experiences can vary.

Limited research suggests that intermittent fasting can improve insulin sensitivity, thereby potentially aiding in blood sugar regulation.

• Intermittent fasting can help reach remission for type 2 diabetes
• Rishi Sunak follows intermittent fasting diet: “I don’t eat on Mondays”

Save time

Planning and preparing one meal a day is simpler and less time-consuming than traditional diets.

Disadvantages

Sustainability

The strict nature of OMAD makes it challenging for many to sustain long-term. Some people may find this approach leads to increased hunger.

Nutritional deficiency risks

With only one meal to provide daily nutrients, there’s a heightened risk of deficiencies.

Potential for binge eating

The restriction can lead to overeating during the eating window, negating some of the diet’s benefits.

Potential blood glucose fluctuations

For people with diabetes, OMAD poses potential risks including significant blood sugar fluctuations.

Lack of food intake for extended periods may lead to hypoglycemia (low blood sugar) while the consumption of a day’s worth of calories in one meal might cause hyperglycemia (high blood sugar).

Therefore, individuals with diabetes considering OMAD should do so under medical supervision.

Research

While studies on intermittent fasting show promise for weight loss and improved metabolic health, research specifically targeting OMAD is less abundant.

Some evidence suggests potential benefits in weight management and insulin sensitivity, which are critical for people with diabetes.

Nevertheless, the research is ongoing, and current findings should not be seen as conclusive.

• Beyond weight loss: health benefits of prolonged fasting investigated
• Fasting diet that concentrates on eating early in the day could lower type 2 diabetes risk
• Fasting-mimicking diet: how it benefits our heart health

While OMAD presents a simplistic and potentially effective approach to dieting, it requires careful consideration and is not universally suitable.

The diet’s extreme nature means it may offer benefits for some, particularly in terms of weight loss and metabolic health.

However, it also carries risks. Speak to your doctor before adopting this dietary approach.

Unlike time-restricted eating which focuses on eating within specific daily windows, intermittent fasting involves various patterns of eating and fasting cycles.

Fasting cycles can range from daily 16-hour fasts to full-day fasts a couple of times a week.

People with type 2 diabetes are known to use this approach to manage insulin levels and subsequently blood glucose levels, helping to support a healthy weight.

What is intermittent fasting?

Intermittent fasting refers to alternating periods of eating and fasting (not eating).

The aim is to time meals in a way that allows the body to use its stored fat for energy more efficiently.

Common intermittent fasting methods include:

• 16/8 method: fast for 16 hours and eat during an 8-hour window.
• 5:2 diet: eating normally for five days of the week while restricting calories on the other two days.
• Time-restricted eating: which focuses on limiting your daily eating periods to specific windows of time with less emphasis on what you eat and more on when you eat.

How does intermittent fasting work?

Intermittent fasting helps improve insulin sensitivity.

During fasting, insulin levels drop which prompt the body to switch from glucose to stored fat for energy.

This process burns body fat and supports weight loss.

During extended fasts, the body increases autophagy – the removal of damaged cell components – and increases growth hormone levels.

• Rishi Sunak follows intermittent fasting diet: ‘I don’t eat on Mondays’
• Fasting-mimicking diet: how it benefits our heart health

Benefits of intermittent fasting

Research indicates that intermittent fasting can improve various aspects of health.

These include:

• Enhanced insulin sensitivity and improved insulin resistance
• Lower blood sugar levels
• Improve blood pressure
• Reduce cholesterol levels
• Reduce inflammation
• Weight loss

This makes it particularly appealing for people with type 2 diabetes, or those seeking to lose weight.

Additionally, fasting can improve metabolic efficiency, reducing oxidative stress and inflammation.

Fasting for people with diabetes

Many people with and without diabetes practice fasting.

For people with diabetes, intermittent fasting can provide a method for controlling blood sugar levels and reducing dependency on medication.

However, it’s essential to approach intermittent fasting with caution and with medical supervision, especially for those on blood glucose-lowering medications in order to avoid hypoglycemia.

Tailoring fasting schedules to your health needs and monitoring your blood sugar levels closely are crucial steps for safely integrating intermittent fasting into your diabetes management plan.

• Water fasting: benefits of a water fast disappear soon after it ends
• Intermittent fasting can help reach remission for type 2 diabetes

Practical tips for success with intermittent fasting

To succeed with intermittent fasting:

• Start slowly with shorter fasting periods and gradually increase the duration as your body adjusts.
• Stay hydrated during fasting periods by drinking water, black coffee, or tea.
• Break your fast with balanced meals that include a mix of proteins, fats, and low in carbohydrates.
• Listen to your body and adjust your fasting schedule as needed based on how you feel.

Make sure you go at a pace that suits you, and speak to your doctor before incorporating intermittent fasting into your lifestyle.

Unlike traditional diets that focus on ‘what’ to eat, TRE focuses on ‘when’ to eat.

What is time-restricted eating?

Time-restricted eating is a dietary strategy that limits food intake to a specific number of hours each day.

The core principle is synchronising your eating patterns with your body’s circadian rhythms. The circadian rhythm is a natural process that regulates the sleep-wake cycle and repeats roughly every 24 hours.

By limiting the eating window, people can potentially improve their metabolic health parameters by aligning nutrient timing with the body’s internal clock.

Example eating windows:

Common frameworks within TRE involve 8-hour eating windows followed by 16-hour fasts (16:8 method), or more extended fasting periods such as a 20-hour fast with a 4-hour eating window (20:4). These are not one-size-fits-all, as the efficacy and comfort of these methods can vary significantly among individuals.

You may have heard of the 5:2 diet where calories are reduced for a number of days, rather than a number of hours each day.

How does time-restricted eating work?

During periods of fasting, the body shifts its energy source from glucose to stored fat, promoting fat loss.

The focus on time-restricted eating is not about reaching ketosis.

• Nutritional ketosis vs diabetic ketoacidosis (DKA)

Concurrently, aligning food consumption with daylight cycles optimises your body’s metabolic processes as the endocrine system and metabolic regulation are closely tied to circadian rhythms.

TRE works by minimising exposure to food and hunger hormones like ghrelin and potentially correcting insulin resistance by reducing the frequency of insulin release.

What does the science say?

Research into TRE has shown several potential health benefits:

• Fasting diet that concentrates on eating early in the day could lower type 2 diabetes risk
• Intermittent fasting can help reach remission for type 2 diabetes
• Combining time-restricted eating and HIIT brings health benefits for women with obesity
• Better benefits for fasting females discovered

Studies have demonstrated time restricted eating’s potential in reducing the risk of chronic conditions including type 2 diabetes, heart disease, and neurodegenerative diseases.

Beyond weight management and metabolic health, TRE has benefits, including:

1. Improved mental clarity and concentration due to the production of ketone bodies during fasting
2. Enhanced cellular repair and resilience through the removal of waste material from cells
3. Potential extension of lifespan and reduction in the risk of age-related diseases

While findings are promising, more extensive human studies are necessary to establish comprehensive guidelines and recommendations

What is autophagy?

One of the pivotal biological processes linked to TRE is autophagy.

Autophagy is a cellular mechanism that involves the breakdown and recycling of damaged cell components. Autophagy is triggered during periods of fasting and is akin to your body cleaning up  dysfunctional cellular components and reducing the likelihood of pathological cell growth.

This process is crucial for cellular rejuvenation, homeostasis, and defense against various diseases.

By promoting autophagy, TRE potentially supports the body’s natural defense mechanisms, contributing to overall health and longevity.

How do I break a fast?

Break your fast with nutrient-dense, low-carb, and real foods to maximise the benefits of TRE.

Ideal food choices include:

1. Lean proteins (chicken, turkey, tofu) to support muscle health.
2. Healthy fats (avocado, nuts, olive oil) for sustained energy.
3. Fibre-rich vegetables (leafy greens, cruciferous vegetables) to enhance digestive health.
4. Berries and other low-glycemic fruits for antioxidative benefits.

As with any dietary approach, consult your healthcare team before starting time restricted eating to ensure it aligns with your health and goals.

Is time restricted eating and intermittent fasting the same thing?

Time-restricted eating (TRE) and intermittent fasting (IF) are terms that are used interchangeably in the media but they refer to slightly different fasting strategies.

Time-restricted eating focuses on limiting your daily eating periods to specific windows of time with less emphasis on what you eat and more on when you eat. Most TRE protocols advise a fasting period of 12 to 16 hours, which includes the time you are sleeping, and a feeding window of 8 to 12 hours.

The primary goal of TRE is to align eating patterns with the body’s natural circadian rhythm.

Intermittent fasting comprises of a broader range of eating patterns that alternate between periods of fasting and eating.

These patterns can be daily, as in TRE, or over longer cycles, such as 24-hour fasts once or twice a week, or alternate-day fasting. This approach doesn’t always connect eating patterns to circadian rhythm. Instead, it focuses on longer periods of calorie restriction, which can lead to weight loss and other health benefits due to reduced calorie intake and factors like improved insulin sensitivity.

Time-restricted eating is essentially a form of intermittent fasting with a specific focus on circadian biology.

Apple cider vinegar (ACV) has been a type of vinegar made from fermented apple juice.

TikTok has been rife with claims about apple cider vinegar gummies affecting blood glucose management and weight loss – so what is the truth?

Apple cider vinegar, like many natural remedies, has its place in the discussion of diabetes management. However, it’s essential to approach it with a balanced perspective, understanding its potential benefits and limitations.

What is apple cider vinegar (ACV)?

Apple cider vinegar is a liquid made from fermented apples combined with yeast, which ferments the sugars and turns them into alcohol. Bacteria is added which turns it into acetic acid, the main active compound in vinegar.[1]

You can buy ACV as a liquid, pills, powder, or gummies.

Does apple cider vinegar affect diabetes?

Several studies have suggested that apple cider vinegar may have benefits for blood glucose control.

Improved insulin sensitivity

A study published in the journal Diabetes Care found that vinegar can improve insulin sensitivity during a high-carbohydrate meal in individuals with insulin resistance or type 2 diabetes.[2]

• Apple Cider Vinegar: research “scratches the surface” of ACV’s benefits
• Apple cider vinegar shown to significantly reduce post-meal blood glucose

Reduced blood sugar levels

A study found that consuming a small amount of apple cider vinegar before bed may reduce fasting blood sugars in the morning.[3]

While these findings are promising, it’s essential to note that ACV is not a replacement for medications. Always consult with your healthcare provider before making any changes to your health.

Weight loss

A small study following 39 people for 12 weeks found that consuming ACV twice daily helped people leading a low-calorie diet to lose extra weight.[6]

A study from 2018 found that apple cider vinegar helps with weight loss in rats eating a high-fat diet by making them full more quickly, resulting in weight loss.[7]

• Fewer carbs for breakfast can improve blood glucose levels

Who should avoid apple cider vinegar?

Most people can consume apple cider vinegar without issue. However, people taking medications that affect potassium levels or diuretics should avoid ACV as it may interact with the medications they are taking.[4]

People who have had weight loss surgery should also avoid ACV due to its acidic nature which can exacerbate symptoms in individuals with ulcers or acid reflux.[5]

Debunking myths

It’s crucial to approach the topic of apple cider vinegar and diabetes with a discerning eye. While ACV may offer some benefits for blood sugar control, it is by no means a cure for type 2 diabetes or a miracle weight loss drug.

Managing diabetes (regardless of type) requires a holistic approach, including a low-sugar, real-food diet, regular exercise, and, if you are prescribed it, medication.

People following the carnivore diet eat a diet of meats, fish, eggs, and dairy products, but exclude all vegetarian, or plant-based foods.

As such, followers of a strict carnivore diet avoid fruits, vegetables, grains, and legumes.

The meat only diet has gained popularity in recent years, particularly on social media, as a way to improve health, lose weight, and alleviate certain medical conditions.

• Cancer-related mortality risk reduced by eating meat
• High intake of eggs and red meat make your farts smell worse

The carnivore diet is also referred to a as a zero carb diet, made famous by Shawn Baker, MD, an orthopedic surgeon and influencer in the carnivore diet movement.

Other proponents include Kelly Hogan and Jordan Peterson (whose daughter Mikhaila Peterson introduced him to the carnivorous diet).

This is presumably as the carnivore diet is a form of a low carb diet.

Does research support a carnivore diet?

Proponents of the carnivore diet argue that it is a natural and evolutionarily appropriate diet for humans. It is proposed that our ancestors ate mostly animal products and our bodies are well adapted to digesting and utilising them.

However, as it is a relatively new diet, there is limited scientific research on the long-term effects of a carnivore diet.

Some small studies have suggested that a carnivorous diet may improve markers of health, such as weight loss, blood sugar control, and inflammation.

However, it is important to note that these studies have been small and short-term, and more research is needed to fully understand the potential benefits and risks of such a diet.

Additionally, a carnivore diet can be nutritionally inadequate and lacks essential nutrients found in plant-based foods, that’s why it’s important to consult with a doctor or a dietitian before adopting such a diet.

Carnivore diet menu

A carnivore diet can comprise:

• Red meat such as lamb, pork, and beef
• Organ meats
• Chicken and turkey
• Fish
• Eggs
• Lard
• Bone marrow
• Butter or ghee
• Salt and pepper
• Water
• Bone broth
• Sauces are permitted if they are made only with meat drippings and no additional binding ingredients

What to avoid on a carnivore diet

Foods to avoid are:

• Fruit and vegetables
• Nuts and seeds
• Legumes
• Bread
• Pasta
• Grains, including whole grains
• Alcohol

The diet is low in unhealthy processed foods and thus naturally low in added sugar.

Concerns with a carnivore diet

The carnivore diet is also low in fibre. Fibre is important for maintaining healthy digestion and preventing constipation.

Fibre is only found in plant-based foods and lack of fibre in the diet can lead to digestive issues and an increased risk of colon cancer.

The carnivore diet is also low in essential micronutrients such as vitamins and minerals, which are important for maintaining overall health. These micronutrients are found in plant-based foods and a diet lacking in these nutrients can lead to deficiencies and an increased risk of chronic diseases.

• High intake of red meat linked with cognitive decline
• High intake of processed meat increases risk of type 2 diabetes

Another concern is that the carnivore diet is low in antioxidants and phytochemicals, which are compounds found in plant-based foods that have been shown to have anti-inflammatory and anti-cancer properties. These compounds help to protect against chronic diseases such as cancer and heart disease.

The diet may not be sutiable for certain groups of people. People who must limit their protein intake such as those diagnosed with chronic kidney disease should not follow this dietary approach.

Conclusion

In conclusion, the carnivore diet is a dietary pattern that consists of only animal products and excludes all plant-based foods.

While proponents argue that the diet is natural and evolutionarily appropriate for humans, there is a lack of scientific evidence to support the long-term safety and efficacy of the carnivore diet.

Portion control can be useful for people with different types of diabetes to help regulate body weight as well as to help manage

blood glucose levels

We look at why portion control is useful and the techniques you can use as well as the to manage the size of portions at meal times.

Benefits of exercising portion control

Exercising portion control can be particularly useful for people with diabetes and can help us to:

• Manage calorie intake – important for those of us carrying extra body weight
• Manage carbohydrate intake

Managing calorie intake

Keeping to sensible portion sizes will help in managing calorie intake and this also has benefits for blood glucose control. It is well noted that increased waist size is associated with decreased sensitivity to insulin.

A number of studies suggest that the associated

insulin resistance
grows in direct proportion to a rising waist circumference.

So keeping portion sizes moderate can help keep calorie intake under control, helping you to

manage your weight
and therefore making diabetes easier to control as well.

Managing carbohydrate intake

Managing portion sizes is also an important part of managing the amount of

carbohydrate
we take in and this is useful for all people with diabetes (aside from

diabetes insipidus
).

Having a good grasp of portion sizes is needed in order to be able to count carbohydrate intake, which is particularly important in

type 1 diabetes
whereby the amount of insulin taken needs to balanced against carbohydrate intake.

For people with

type 2 diabetes, controlling portion sizes of foods that contain carbohydrate can help you to ensure you are not taking in more carbohydrate than your body (in co-operation with any medication you take) can cope with.

Use the plate method

The plate method involves dividing up your plate into sections for different food groups. The plate method helps you to keep control of portion sizes as well as helping you to enjoy a well balanced diet.

• Find out more about
  
  The Plate Method

Controlling plate size can help to control portion size

Researchers, Brian Wansink and Koert van Ittersum, looked at the size of dinner plates in 1900 and compared them with dinner plates in the 21st Century. In 1900, plates were around 9 inches in diameter, whereas nowadays plate sizes are exceeding 11 inches.

The researchers noted that average plate sizes had grown by 23% since the start of the 20th Century.

Take a look at the plate sizes in your kitchen cupboards and see if you might benefit from having a smaller plate.

Higher blood sugar levels can make us hungry

Those of us with diabetes, may actually be more prone to feeling hungry soon after meals than people without diabetes. This is because blood sugar levels usually rise directly after eating and a common symptom of higher than normal blood glucose levels (

hyperglycemia
) is hunger.

An advantage of keeping to smaller portion sizes, particularly of foods that are higher in carbohydrate, is that our blood glucose levels will not rise so high and therefore we are less likely to feel hungry following a meal.

Avoid having seconds

Following on from the advantages of keeping sizes moderate, it’s therefore also advisable to forgo having second helpings of meals if you need to manage your weight, or if your blood glucose levels tend to be on the high side after meals.

You don’t have to clear your plate

Many of us grew up at a time whereby we were told to make sure we finished off our plate of food.

Times have changed and whereas in previous decades there may have logic to finishing meals, it’s recommended that people do not feel compelled to finish their plate.

Finishing meals completely may be deeply ingrained in our habits and even in our beliefs.

Some of us feel that not finishing meals is wastage but there are two ways to look at this. Firstly, meals can often be stored as leftovers for the next day and, secondly, if food has to be thrown away, it is better to get into the habit of doing this than to regularly compromise your health.

Avoid unconscious eating

Unconscious eating is when you eat with your attention focused elsewhere. Typical examples of unconscious eating include eating when watching television and eating when using a computer or phone.

Many of us will be familiar with the fact that when eating with the TV on we will often consume much bigger portions of foods, particularly

snack foods, as a result.

To help prevent this from happening, make a habit of eating at the dinner table and away from tablets, televisions and laptops.

Beating compulsive eating

Another source of taking in larger portions of food than we’d like is if we have trouble with compulsive eating.

There are a number of reasons for why we may compulsively eat with many of the factors being linked with emotions.

• 
  Dealing with compulsive overeating
• 
  Binge eating disorders

Portion control is a major part of the Low-Carb Program. If you want to learn more about carbohydrate and portion control

sign up today »

Low carb diets are flexible and can be followed by people with different types of diabetes.

The diet has allowed many people with type 2 diabetes to reverse type 2 diabetes, that is to get their blood sugar levels into a non-diabetes range without the help of medication.

People with type 1 diabetes have also reported much more stable blood sugar levels, making the condition easier to predict and manage.

The diet is a healthy way of eating as vegetables and natural, real foods are integral to the diet.

Low carb guidance and support

The low carb diet forum has been cited as a leading resource in providing support and encouragement for people that are looking to achieve lower HbA1c levels and sustain effective weight loss.[127]

Why follow a low carb diet?

Carbohydrate is the nutrient which has the greatest effect in terms of raising blood sugar levels and requires the most insulin to be taken or be produced by the body.

Lowering sugar levels is clearly a benefit for people with diabetes. Lower need for insulin is also particularly useful as lowering insulin in the body can reduce insulin resistance which can help towards reversing type 2 diabetes.

Insulin is also the fat storage hormone in the body, so reducing insulin in the body with a low carb diet can help with losing weight.

Benefits of low carb diets

The benefits of a low carb diet typically include:

• Lower HbA1c
• Improved weight loss
• Less chance of high sugar levels occurring
• Lower risk of severe hypos
• More energy through the day
• Less cravings for sugary and snack foods
• Clearer thinking
• Lower risk of developing long-term health complications

What counts as low carb?

Low carb is a flexible way of eating that allows you as an individual to choose a level of carbohydrate that works well for your diabetes and lifestyle.

The following brackets are used to categorise daily carbohydrate intake:

• Moderate carbohydrate: 130g to 225g of carbs
• Low carbohydrate: under 130g of carbs
• Very low carbohydrate: under 30g of carbs (also known as a ketogenic diet)

Generally speaking, the lower your carbohydrate intake, the more likely you are to lose weight and the lower sugar levels you are likely to have.

It’s important you choose a level of carbohydrate that works well for you.

For example, people with type 1 diabetes that do not need to low weight may wish to aim for a low or moderate carbohydrate intake.

Someone with type 2 diabetes, or needs to lose weight, may wish to aim for a low carbohydrate intake.

Take precautions

It is important that you speak to your doctor before significantly lowering your carbohydrate intake.

This is especially important if you are on medication that can cause hypoglycemia (low blood sugar), such as insulin, sulphonylureas or glinides.

How carbohydrates affect the body?

Carbohydrates, as do proteins and fats, provide energy so they help to fuel the body.

Carbohydrate is broken down into glucose so when carbohydrates are consumed, an increase in blood sugar levels occurs to a greater or lesser extent according to the amount of carbohydrate.

By reducing carbohydrate intake, you can help to reduce the rise in blood glucose levels after meals.

How will low carbing affect my weight?

Low carbohydrate diets have been found to be successful in aiding weight loss.

The reduction in carbohydrates means that people need not produce, or inject, so much insulin.

As insulin helps to store fat, less circulating insulin could help to prevent, reduce or reverse weight gain.

Also, by restricting the amount of carbohydrates, people often lower their calorie intake at the same time as the focus on eating real foods and the satiating effect of fat means people are less likely to snack and overeat in general.

How to follow a low carb diet

A healthy low carb diet should have the following features:

• Strong vegetable intake
• Modest increase in fat intake from natural sources
• Moderate protein intake
• Low reliance upon processed food, sugar and grains

Read more on following a healthy low carb diet.

Low carb meal plan

You can browse a range of free 7 and 30 day low carb meal plans and cookbooks as a free Diabetes.co.uk member.

The Low Carb Program is an NHS-trusted app for people with type 2 diabetes and prediabetes shown to support weight loss, improved diabetes control and reduction in type 2 diabetes medication through adoption of a low carbohydrate diet.

The program was developed with Dr David Unwin and uses a real food approach, minimising ultra-processed and refined foods where possible.

Fats and protein

If you are significantly reducing the amount of carbohydrate in your diet, you may need to make up some of the reduced calories with either protein or fat.

It is advisable to ensure the fat content of your diet comes from natural sources, such as:

• Meat
• Fish
• Dairy
• Eggs
• Nuts
• Avocado
• Olives
• Olive oil

Natural sources of fat, such as the above, will provide a balance of monounsaturated, polyunsaturated and saturated fat.

Try to avoid processed foods and takeaways as the fat in these are generally either man made or highly processed.

When choosing protein, aim to have unprocessed cuts of meat as processed meats have been consistently linked with higher rates of heart disease and even insulin resistance.

What is the argument against low carb diets for people with diabetes?

If low carb diets can help to reduce blood glucose levels and aid weight loss, then why are low carbohydrate diets not advocated by the NHS? The truth is, they are – the Low Carb Program is an NHS certified education programme and used in the NHS.

The reason that is commonly cited is that there is not enough evidence to support the effectiveness and safety of low carbohydrate diets.

The question is a hotly debated one which has seen disagreement from both sides as to which diet is more safe and effective.

However, research in favour of low carb diets is growing and consistently shows low carb diets are superior to the low-fat diet typically advised by the NHS.

Further research demonstrates:

• Low carb diet shown to reduce high blood pressure
• Low carb diet could prevent type 2 diabetes even without weight loss
• Low carb diet to combat type 2 diabetes and obesity

What side effects exist on a low carb diet?

Side effects that can be commonly experienced on a low carb diet include:

• Fatigue
• Brain fog
• Headaches
• Constipation
• Possible nutrient deficiencies

Hypoglycemia (low blood sugar) may occur if you take insulin or tablets that can cause low blood sugar.

If you take medications that can cause hypos, it’s particularly important to discuss precautions to prevent hypos before starting a low carb diet.

• Read more on Low Carb Diet Side Effects

Is a low carb diet suitable for everyone?

Low carb diets are suitable for most people. As noted above, if you’re thinking of reducing your carbohydrate intake by a large amount, it’s best to check with your doctor if any precautions need to be made.

If you are pregnant, or planning pregnancy, a very low carb diet may not be appropriate as the safety of very low carbohydrate diets in pregnancy is not currently known.

For other questions, ask the low carb diet community on the Low Carb Forum.

Carbohydrate is one of the body’s main sources of energy.

Carbohydrate is broken down into glucose relatively quickly and therefore has a more pronounced effect on blood sugar levels than either fat or protein.

This makes awareness of carbohydrate a particular important factor in management of diabetes.

Which foods contain carbohydrate?

Carbohydrate is found, to varying degrees in a wide variety of food, notably in starchy foods such as rice, pasta and flour (therefore including pastry, bread and other dough based foods).

Sugar
is also a form of carbohydrate.

Carbohydrate is generally found in all

fruits and vegetables, however, the amounts of carbohydrate can vary substantially.

Carbohydrate is generally found, at least to some degreen, in all

fruits and vegetables

However, the amounts of carbohydrate can vary substantially with vegetables such as celery having almost negligible carbohydrate whilst potatoes and citrus fruits typically have a higher amount of carbs.

Fruit and vegetables with relatively high carbohydrate content include:

• Potatoes
• Root vegetables (such as parsnips and beetroot)
• Mangoes
• Bananas
• Pears

How much carbohydrate is recommended for diabetics?

The optimum level of carbohydrate consumption for people with diabetes has been one of the hottest diabetic debates in the last few decades.

The recommendation of the Scientific Advisory Committee on Nutrition (SACN) for carbohydrate intake for people with diabetes is

no different

to people without diabetes.

The SACN recommend that 50% of our daily energy comes from carbohydrates. This amounts to about 225 to 300g of carbohydrates for people on a diet of



2,000 to 2,500 calories

The recommendations are typically passed down to patients through the NHS.

However, the

NHS carbohydrate advice
has come under a lot of criticism from those who feel that for people with type 2 diabetes, in particular, the level of carbohydrate intake is too high for many people with diabetes to maintain good blood glucose levels without progressing onto stronger diabetes medication.

Carbohydrate and blood glucose levels

Because carbohydrate directly influences

blood sugar levels, it is important to be aware of how much carbohydrate you are having at each meal.

It is often easy to underestimate exactly how much carbohydrate you’re having, particularly when eating starchy foods such as pasta, rice and potatoes.

Referring to the nutrition information and weighing out certain foods will help you to see how much carbohydrate you are having.

Types of carbohydrate

There are different types of carbohydrate which are broken down quickly or less quickly because of their chemical structure.

• Simple carbohydrates are sugars and are broken down quickly by the body and therefore raise blood sugar levels quickly
• Complex carbohydrates are starches and broken down more slowly than simple carbs and will raise sugar levels more slowly.

Note that eating highly refined starches such as white bread will usually result in a sharp rise in blood sugar levels.

Whole grain foods, which have a greater level of fibre, are a much better choice of starches as the fibre helps to slow down how quickly the food affects your blood sugar levels.

• Read more:
  
  Simple and complex carbs

Carbohydrate and type 1 diabetes

In type 1 diabetes, the amount of insulin you will produce is likely to be either a small or negligible amount. As a result, people with

type 1 diabetes
will need to inject insulin and pay close attention to matching the dosage with the amount of carbohydrate eaten.

To match the insulin dosage with carbohydrate intake as closely as possible, people with type 1 diabetes will need to learn to estimate and count the amount of carbohydrates in each meal.

Correctly estimating carbohydrate content can be a difficult skill to pick up; as a result, a number of carbohydrate counting courses, such as the

DAFNE course, have been developed to assist with carbohydrate counting as well as other key aspects of insulin dosing decisions.

Carbohydrate and type 2 diabetes

People with type 2 diabetes are able to produce their own insulin but are not able to respond to insulin as effectively as people without the condition. This is called

insulin resistance
The body’s natural response is to produce more insulin to help get glucose from the blood into the cells that need it.

Generally, the higher the amount of carbohydrate eaten, the more likely it is that the body will struggle to produce enough insulin. As a result, people with type 2 diabetes on a relatively high carbohydrate diet are more likely either to have too

high blood glucose levels
or to need larger doses of stronger diabetes medication.

There are two main ways to combat and cope with insulin resistance. The primary way is to reduce your body’s need to produce insulin by lowering your calorie intake, including the amount of carbohydrate eaten, and by exercising.

Some people will also require the additional measure of taking

diabetes medication
to ensure sugar levels stay at healthy levels.

Note that the greater your dependence on medication, the greater the extent of medication side effects therefore it’s important to make sure you’re working hard in meeting the first option.

As noted above, the NHS does not generally advise people with type 2 diabetes to go onto a

low carb diet, however, many patients have opted to go for this approach of their own accord.

Carbohydrate and weight gain

When carbohydrates are broken down into glucose within the blood, the body will:

1. Use
   
   insulin
   to help fuel the body’s cells
2. Use insulin to turn any remaining excess of glucose in the blood into fat for storage

Carbohydrates provide energy and therefore if you have too high a level of carbohydrate in your diet this can lead to weight gain.

It is important therefore to ensure you are having an appropriate level of carbohydrate and overall calorie intake to ensure weight gain is prevented.

The amount of calories you need varies from person to person and your doctor and dietitian can help with setting an appropriate level for you personally.

Carbohydrate and high cholesterol

Whilst it is often high fat diets that are most commonly mentioned as being associated with unhealthy

cholesterol
levels, the true cause of blame for high cholesterol is any form of excessively high calorie diet.

Having a high calorie diet, whether that comes from too many carbohydrates or too much fat, will lead to the storageof excess

body fat
as well as the development of high triglyceride and cholesterol levels.

There is no need for people with diabetes to give up alcohol simply because of their diabetes.

Although alcohol does have an effect on blood sugar levels, with a few precautions and careful management, people with diabetes can also enjoy a drink.

There are also

alcohol substitutes
for those who abstain.

In fact, diabetes alcohol guidelines are the same as for the general population.

• Read about
  
  alcohol’s effect on blood sugar

What are the recommended alcohol guidelines for people with diabetes?

The guidelines are two units for women and three units for men. However, it is worth being aware how many units a drink contains.

In some cases, a glass of wine will constitute two units, and a pint of beer can even reach three units.

How much alcohol do drinks usually contain?

If you have diabetes and are wondering how much alcohol you should drink, it is worth reading the following list to see how much alcohol is contained in each type of drink.

One unit (approximate measure)

:

• 1/2 pint of standard strength beer, lager or cider
• 1 pub shot/optic/measure (50ml) of sherry or vermouth
• 1 pub shot/optic/measure of spirit (25 ml), eg gin, vodka or whisky.

So if I have diabetes I can drink as usual?

Not quite. People with diabetes need to be extra careful with alcohol.

Alcohol intake significantly increases the risk of

hypoglycemia
(low blood sugar levels). If your diabetes is already well under control, a moderate amount of alcohol may be fine either before, during or soon after a meal.

Even if you have a drink, this may not influence short-term blood glucose levels. However, there are some precautions to be taken care of.

What do I need to be careful of when it comes to diabetes and alcohol?

Avoid drinking on an empty stomach, as this will quickly increase the amount of alcohol in your bloodstream. Also avoid binge-drinking or sustained drinking, and never substitute alcohol for your meals. All of this can increase the risk of hypoglycaemia.

How will alcohol affect my blood sugar control?

Different alcoholic drinks will have varying effects on your

blood sugar
It also depends how much you drink. A single alcoholic drink (a 330ml bottle of beer, medium glass of wine) may not have a huge effect on your overall blood sugar.

If you have more than a single drink, most alcoholic drinks will tend to initially raise your blood sugar.

Typically beers, lagers, wines, sherries and liqueurs will have this effect. However, alcohol inhibits the liver from turning proteins into glucose which means you’re at a greater risk of

hypoglycemia
once your blood sugars start to come down. If you have a number of these drinks, you can expect to see a rise in blood sugar followed by a steady drop a number of hours later, often whilst asleep. People who take

insulin, in particular, therefore need to be wary of hypoglycemia.

Each person will have a slightly different reaction to alcoholic drinks so it’s well worth using

blood tests
to check how your body responds to it.

Is drinking alcohol with diabetes dangerous?

Drinking lots of alcohol is dangerous for anyone. However, with larger amounts of alcohol, serious hypoglycaemia can occur.

Some sources (including

Diabetes UK
) advise strict carbohydrate management, perhaps even chips or pizza, if a large amount of alcohol has been consumed.

However, avoiding alcohol in large quantities is the best recourse.

Will I have a hypo whilst drunk?

The symptoms of drunkenness can be very similar to a hypo, which can lead to very dangerous confusion.

Furthermore, if you have been drinking heavily, there may be a risk of hypos for up to 16 hours (or even more) after you have stopped drinking.

Monitoring

blood glucose levels
closely is an essential part of managing your diabetes in this situation.

What other dangers does alcohol pose for people with diabetes?

Drinking alcohol in high quantities regularly can cause an increase in blood pressure. Furthermore, alcoholic drinks contain calories, and therefore can lead to weight gain. Drinking alcohol can exacerbate neuropathy by increasing pain and numbness.

Low carbohydrate and low-alcohol drinks may be better than standard alcohol, but the dangers still need to be considered.  Often alcohol is mixed with fizzy, sugary drinks that can impact on blood sugars.

So should I drink or not?

Drinking moderately in accord with the recommended guidelines, should definitely not be ruled out. Some alcohol, red wine in particular, may even offer health benefits, not that that means you should take up drinking.

• Healthy eating, low alcohol intake and reduced sun exposure can combat cancer, evidence suggests
• Just one alcoholic drink can increase risk of heart rhythm condition, study shows
• Experts call for ‘vague’ health warnings on alcohol to be updated
• Daily beer and wine intake beneficial for middle-aged adults, study reveals

Cost of drinking

Calculate the cost of drinking below or visit our

Cost of Drinking Calculator
for more information.

The dietary advice generally given to people with type 1 diabetes is not much different to the dietary advice for people without diabetes.

The main issues to consider are how sharply different foods are likely to impact on your blood glucose levels and how to balance the quantity of carbohydrate with the right amount of insulin.

Carbohydrate counting

Carbohydrate counting plays a key role in helping to balance insulin intake with the food you eat.

A number of carbohydrate counting courses are available including the

DAFNE course
(dose adjustment for normal eating) which is widely recommended by people who have been on it.

Another carbohydrate counting resource which is quickly growing in popularity is the

Carbs and Cals
book which shows, in pictorial form, how many carbohydrates are in a huge variety of different meals and portion sizes.

Healthy eating for type 1 diabetes

Eating healthily comes highly recommended and can play a part in helping to prevent the development of complications.

Eating a balanced diet, containing a variety of different vegetables, will help to provide many nutrients that the body needs.

Try to include foods containing unsaturated fats such as nuts, avocados and oily fish.

We recommend limiting the amount of

processed foods
you eat and try to include home prepared or freshly prepared food wherever possible.

• Read more on
  
  healthy eating for diabetes

Low carb diets and type 1 diabetes

Some people with type 1 diabetes may wish to adopt a reduced carbohydrate diet. Low carb diets can be helpful for people who are struggling to keep control on a carb centered diet or for those who are otherwise looking to tighten their control.

One of the benefits of reducing your

intake of carbohydrate
is in reducing the extent of post meal high blood sugar levels.

Lower carb diets will require a reduction in insulin and could result in hypoglycemia if doses are not changed correctly. It is recommended to speak to your doctor before going onto a significantly different diet.

Nutrition is a critical part of diabetes care. Balancing the right amount of carbohydrates, fat, protein along with fibre, vitamins and minerals helps us to maintain a healthy diet and a healthy lifestyle.

Getting the balance right can help the body to stay in prime condition, but what is the right balance of nutrients? People have been arguing over the ideal mix for generations and the discussion still rages today.

For people with diabetes, there is at least one extra consideration for our nutritional needs and that is the question of how our blood sugar levels will respond to different diets.

Macronutrients

The macronutrients referred to in human diets are the three food groups that provide us with energy, namely: carbohydrates, fat and protein. The three major nutrients are more than simply providers of fuel for our bodies.

Fats and protein are both vital for building cells and helping the cells carry out their duties. Each of the macronutrients are versatile allowing the body to break them down into a number of uses.

Carbohydrate can be stored as fat and fat and protein can both be converted into glucose for example.

Read more on macronutrients and their relevance to diabetes:

• 
  Carbohydrates
• 
  Fat
• 
  Fibre
• 
  Protein
• 
  Salt

In addition, we have guides on the differences between carbohydrate types and sugar and fat.

• 
  Simple carbs vs complex carbs
• 
  Sugar vs fat

Read more about

trans fats
and their relation to fats as well as guides to vitamins and supplements:

• 
  Dietary supplements
• 
  Vitamins and minerals
• 
  Vitamin D
• 
  
  Chromium

Micronutrients

Micro may mean small, but micronutrients are far from insignificant. Without a regular supply of micronutrients, our bodies would literally starve.

Micronutrients include all vitamins and minerals we take it i, often without realising, and are an essential part of a diabetic diet.

As an example, celery contains well over a dozen different micronutrients including a number of vitamins, potassium, calcium, iron and more.

If you feel you may be missing out on any particular nutrients, you can arrange to speak with a dietitian who will be happy to discuss your dietary needs.

Don’t forget dietary fibre

Last but not least, there’s also fibre which helps to move food through our digestive system, can help to delay the absorption of carbohydrate and also help us to feel full.

News stories can in the same week tout the benefits coffee can have on diabetes and shoot down coffee as being unhelpful for blood sugar levels.

This doesn’t mean the articles are contradictory though.

Put slightly more simply, coffee contains different chemicals, some of which have beneficial effects whereas others can have a less beneficial effect, such as caffeine which can impair insulin in the short term.

Caffeine and blood sugar levels

Regular high caffeine consumption, over a 4 week period, has been shown to

impair insulin sensitivity
in people with type 2 diabetes.

Whilst the researchers found a relationship between higher coffee consumption and lower sensitivity to insulin, they recognised that the rapid transition to having more coffee may have produced an atypical or emphasised response by the body.

Benefits of coffee

Coffee has been shown to lower risks of the following conditions:

• Type 2 diabetes
• 
  Cancer
  – such as
  
  endometrial cancer
  and aggressive prostate cancer
• 
  Cardiovascular disease
• 
  Strokes
• 
  Alzheimer’s disease
• Parkinson’s disease

Coffee contains polyphenols, which are a molecule that anti-oxidant properties which are widely believed to help prevent inflammatory illnesses, such as

type 2 diabetes, and anticarcinogenic (anti-cancer) properties.

As well as polyphenols, coffee contains the mineral magnesium and chromium. Greater magnesium intake has been linked with lower rates of type 2 diabetes.

The blend of these nutrients can be helpful for improving insulin sensitivity, which may help to offset the opposite effects of caffeine.

Coffee and prevention of diabetes

Coffee and its effect on risks of developing type 2 diabetes have been studied a number of times and has indicated a notably lower risk of type 2 diabetes being associated with coffee drinkers.

A 2009 study of 40,000 participants noted that consumption of 3 cups of tea or coffee a day lead to a 40% lower risk of type 2 diabetes developing. A study of healthcare professionals in the US and UK, five years later, showed that those thatincreased their consumption of coffee experienced an 11% decrease in risk of type 2 diabetes over the next 4 years.

More recently, research found in 2022 that drinking two coffees a day reduces risks of cardiovascular disease and early death and that it may may reduce the risk of developing Alzheimer’s disease.

In addition, drinking coffee has been shown to boost physical activity levels.

Decaffeinated coffee and blood glucose

So whilst caffeine may hamper insulin sensitivity, other properties in coffee have the opposite effect.

It is therefore believed that decaffeinated coffee may present the best option for people with diabetes as researchers find it includes the benefits of coffee with some of negative effects that are associated with caffeine.

Lattes and syrups in coffee

Some varieties of coffee need to be approached with caution by those of us with diabetes.
Coffees with syrup have become a much more popular variety of coffee within the 21st Century but could be problematic for people either with or at risk of, diabetes.

If you have diabetes or are at

risk of diabetes, it is advisable to reduce your exposure to too much sugar. If you wish to enjoy a syrupy coffee from time to time, pick the smaller sized cups and drink slowly to better appreciate the taste without dramatically raising your blood glucose levels.

Another modern trend in coffee is in the popularity of lattes, very milky coffees. Lattes present two considerations: the number of calories in the latte and the amount of

carbohydrate
in them.

Whilst skinny lattes are usually made with skimmed milk, some of them may be sweetened which will raise their calories.

Milk, whether full fat or skimmed, tends to have around 5g of carbs per 100g. A regular, unsweetened skinny latte can typically contain anywhere between 10 and 15g of carbohydrate.

Carb counting is a way of better understanding how carbohydrates affect your

blood sugar, medication requirement and insulin requirement.

For people with type 1 diabetes and those with type 2 diabetes who require insulin, carbohydrate counting is a way of matching insulin requirements with the amount of carbohydrate that you eat or drink.

For people with

type 2 diabetes
who don’t require insulin, carbohydrate counting is a way of regulating the amount of carbohydrate you consume and monitoring how this affects your blood glucose control,

weight management
and medication intake.

Carbohydrate counting requires patience and diligence. Learning it successfully means understanding carbohydrates, learning how to adjust your

insulin
or medication accordingly, and measure your blood glucose levels regularly for clarity.

What are carbohydrates?

Every carbohydrate we eat is converted into glucose and has an impact on blood sugar levels.

Carbohydrates are commonly found within the following foods:

• Grains (breads, pasta, cereals)
• 
  Fruits
• Vegetables
• Root crops (potatoes, sweet potatoes, and yams)
• Most alcoholic drinks (
  
  Beer, cider, lager, most cocktails)
• Desserts and sweets
• Most dairy products, except cheese,
• 
  Sugars
  including sucrose, fructose, dextrose, maltose

How should I count carbohydrates?

Most people count carbohydrates using grams, with one serving equal to 15 grams of carbohydrate.

Most foods are only partially carbohydrate (although some foods are entirely carbohydrate), but the effect of 15 grams carbohydrate will be the same whether it is from bread, biscuits or other foods.

To ascertain the

carbohydrate content
of these foods, it is necessary to use food labels, reference books or computer programs, and a scale and list of carbohydrates.

There are two methods of counting carbohydrates: basic carb counting and consistent carb counting. Both ways involve calculating the total carbohydrate of a food, knowing how many carbs you can eat, and then matching this up with the portion size and any medication you take.

Basic carb counting

Basic carb counting can help you learn how certain foods affect your

blood glucose levels, and the aim is to eat a consistent amount of carbs each day. This is most likely to be adopted by people with non-insulin treated type 2 diabetes.

A dietitian can advise you on how much carbohydrate you should eat at each meal based on your medication, weight goals and overall diabetes control. In the interim, you could ask your doctor for an appropriate amount of carbs (e.g. 45-60 grams per day) to eat at each meal before your meeting with a dietitian.

Consistent carb counting

Consistent carb counting, also known as advanced carb counting, can be used by people with diabetes who are treated with rapid-acting insulin. To count carbs, you will use an insulin-to-carb ratio, which calculates how much insulin you need to cover the carbohydrate in your meal.

A commonly used ratio is one unit of rapid-acting insulin per 10g of carbohydrate, or 1:10. This can vary from person to person, and your ratio might end up being 1:15, 2:10, or something else. So, if your ratio was 1:15, eating 45g of carbohydrate with a meal would require you to inject three units of insulin.

You can also have different ratios for different times of day.

Carb counting example

John has the following insulin to carb ratios.

• 
  Breakfast:
  
  2 : 10 (2 units of rapid acting insulin per 10g of carbs) [space either side of colon because I’ll introduce a decimal point next which might cause confusion in too cramped a ratio]
• 
  Lunch:
  
  1.5 : 10 (1.5 unit per 10g carbs)
• 
  Dinner:
  
  1: 10 (1 unit per 10g carbs)

Your health care team should help you assess your own insulin-to-carb ratio. Make sure you log your blood glucose levels to see how your ratio affects your readings. It may be you need to inject correction doses of insulin in case your blood sugar climbs too high. You should discuss correction doses with your doctor.

Counting carbohydrates can take a while to become competent, and for some time it will be necessary to weigh and measure

foods

What carbohydrate counting equipment do I need?

Many people with diabetes have scales, as well as weighing and measuring equipment to measure volume. Mostly, food labels give both

weight and volume measurements, but some do not.

The following techniques can help in understanding carbohydrate counting:

• Use of food labels, scales and a calculator make it possible to identify carbohydrate content in food.
• Using a scale is useful for measuring carbs in a range of different foods from fruit and vegetables to rice and cereal. Refer to the food packaging or you can get carb counts from nutrition books or the Internet.
• Take your time with carb counting as it is easy to make mistakes if maths is not a strength or if you’re rushing.
• Be aware that some foods have different carb counts depending on whether the food is cooked or uncooked. This can sometimes make a big difference so be careful with this.
• Nutrition books and online resources can provide useful information and a quick and easy way to look up brand-name food information. Many recipe books include detailed
  
  carbohydrate information

• The

  Carbs and Cals
  book (or app) is a popular book for helping with carb counting as it provides images of a range of foods and serving sizes along with the associated carb counts.

There is a vast amount of real-life experience on the topic of carb counting in the

Low Carb Forum

How do I understand more about carbohydrate counting?

The best way to learn carbohydrate counting is to take part in a carbohydrate counting course.

If you are on insulin, would like to go on a carbohydrate counting course and have not been on one of these courses in recent years, your GP, diabetes consultant or diabetes specialist nurse can refer you onto one of these courses.

Examples of nationwide carbohydrate counting courses include:

• 
  Low Carb Program
• 
  DAFNE
• 
  X-PERT
• 
  BERTIE

Your diabetes health team should also be able to arrange one-to-one guidance on carbohydrate counting if you need help at any time.

The

Low Carb Program
is an online education program that is used in the NHS to support people with prediabetes and type 2 diabetes control and potentially reverse their condition through a low carbohydrate diet.

What the community have to say about carbohydrate counting

• Carbsrok: You need to be counting the carbohydrate in your food. Please go back to your Diabetes team and say: ‘look, I am completely confused. I need help sorting this.’ Take pen and paper with you so you can write things down. Ask for guidance on Carbohydrates. And how to match your insulin to food intake. A low GI/ Glycaemic load need to be considered. Take one day at a time otherwise you will feel completely overwhelmed by it all.
• Copepod: Most food packets have carbohydrate content in the nutritional information – you need to count total carbohydrate, not just the sugar, and also bear in mind some foods have different values for raw & cooked food. Having said that, once I’ve weighed a food once, I just estimate by sight after that, which is useful when eating away from home. For fruit and vegetables, you’ll need a guide, either book or online.
• Gazhay:I would highly encourage every diabetic to go on DAFNE course, even the ‘carb counting haters’. As it can be a very individual thing, and surely getting all the education about it is a good thing, whether you choose to continue it or not.
• Wallycorker: Over the last 5 months after attending sessions on carbohydrate management she had attained a magnificent HbA1c of 5.6 – down from readings near to – or in – double figures. What’s more by following the techniques explained to her she had lost a massive five stones in weight in the same period of time. Yes five stones in five months – I am certain that is what she said – just through carbohydrate management or carb counting as it is sometimes known.
• Hellsbells: I was diagnosed with T2 almost 2 years ago. I waited 5 months to see dietician who advised me to eat carbohydrate based meals. In fact, when I told her I was carb counting as a way of controlling my bg levels she told me my medication (metformin) would not work if I didn’t eat plenty of carbs! I also asked about portion control. She replied that she would discuss this with me at our next meeting which would be in 3 months time. Needless to say, I didn’t go back.

Carbohydrates are sugars that come in 2 main forms – simple and complex. This is also referred to as simple sugars and starches.

The difference between a simple and complex carb is in how quickly it is digested and absorbed – as well as it’s chemical structure.

Most carbohydrates can be broken down by digestion into glucose and these are the carbohydrates we shall look at in this article.

For examples of carbohydrates that do not get fully broken down into glucose, see

insoluble fibre
and

sugar alcohols

Simple carbohydrates

Simple carbohydrates are called simple sugars. Sugars are found in a variety of natural food sources including fruit, vegetables and milk, and give food a sweet taste. But they also

raise blood glucose levels quickly

Sugars can be categorised as single sugars (monosaccharides), which include glucose, fructose and galactose, or double sugars (disaccharides), which include sucrose (table sugar), lactose and maltose.

Many processed foods contain added sugars but currently there is

no UK law that requires manufacturers to state how much sugar has been added in processing

The

NHS advises
adults to consume

less than 70g a day of sugar for men

and

under 50g of sugar a day for women

However, people with diabetes will benefit from better blood glucose levels if sugar intake can be limited to lower levels.

Because sugars provide no nutrition aside from energy (hence why they are often referred to as empty calories), people looking to lose weight will also benefit from eliminating sources of added sugar from their diet.

Note that if you are at

risk of hypoglycemia, never worry about

taking sugar if it is to avoid or treat a hypo

Complex carbohydrates

Complex carbohydrates, also known as polysaccharides, are starches formed by longer saccharide chains, which means they take longer to break down.

Chemically, they usually comprise of three or more linked sugars.

Strictly speaking, the term complex carbohydrate refers to any starches, including the highly refined starches found in:

• White bread
• Cakes
• Most pastries and
• Many other food sources

When dietitians and nutritionists advise having complex carbohydrates, however, they are usually referring to whole grain foods and

starchy vegetables which are more slowly absorbed
than refined carbohydrate.

Whole grain foods

Whole grain starches
include the wheat grain and kernel which provide the majority of fibre and nutrients to be found in starchy foods.

When it comes to picking starchy foods, such as rice, bread and any other products made from flour, it’s best to opt for whole grain versions of these products.

Whilst whole grain foods impact upon blood glucose levels more slowly than other forms of carbohydrate, higher levels of carbohydrate can still raise blood sugar levels substantially.

Blood glucose testing before and meals
is a good way to assess how much carbohydrate your body can adequately cope with.

Refined carbohydrates

Refined carbohydrates refer to carbohydrates that have been processed.

In grain products, the bran and kernel are stripped out, leaving just the starch.

With much of the fibre removed in this way, the carbohydrate is broken down by the body more quickly and can sometimes raise blood glucose levels as quickly as simple sugars.

Simple sugars can also be refined. A prominent example of a processed sugar is glucose-fructose syrup, also known as high fructose corn syrup. Glucose-fructose syrup is corn syrup which has been treated with enzymes to turn a proportion of the syrup’s glucose into fructose.

Fruit juice contains a large amount of sugar which raises blood sugar levels very quickly. Therefore, people with diabetes are usually best to avoid drinking fruit juice.

As a general rule, eating whole fruit is healthier than drinking fruit juice or fruit smoothies.

Once regarded as a healthy drink, recent research indicates that that regular consumption of fruit juice may increase the

risk of developing type 2 diabetes

What’s in fruit juice?

Aside from

vitamin C
and calcium, fruit juice contains:

• Calories – 250ml glass of unsweetened orange juice typically contains around 100 calories, compared to the 60 calories in an actual orange
• 
  Fructose (a form of sugar)
  – half a pint of fruit juice contains more sugar than the World Health Organisation recommends ideally having in a day (30g of sugar for men, 24g for women)
• 
  A lack of fibre
  – juice always contains less fibre than whole fruit and highly processed juices may not contain any fibre

How does fruit juice affect blood sugar?

Sugar levels in fruit juice can cause a significant spike in blood sugar levels, increasing the risk of

hyperglycemia
(too high blood sugar levels).

The glycemic index, which is used to reflect the impact on blood sugar levels of individual foods, places orange juice between 66 and 76 on a scale of 100. This makes fruit juice a high GI drink and high GI foods and drinks are best avoided by people with diabetes under most circumstances.

One situation in which fruit juice can be useful is to raise blood sugar quickly in response to

hypoglycemia
(too low blood sugar).

Fruit juice and fructose

Fruit juice is high in a form of sugar called fructose. Fructose needs to be processed by the liver and research suggests that a diet that is high in fructose may cause the liver to be overwhelmed, leading to problems such as

non-alcoholic fatty liver disease
and type 2 diabetes.

It is important to note that table sugar is made up of 50% fructose and 50% sucrose. There a diet high in sugar will also be high in fructose.

These points are significant because it means that over-consumption of fruit juice or having fruit juice in addition to a high sugar diet may increase the risk of health problems.

Benefits of fruit juice

Fruit juice has some benefits, however the benefits are generally outweighed by the disadvantage of the sugar content.

Fruit juice is a good source of nutrients such as vitamin C. However, it is better to get vitamin C from eating small portions of whole fruits or eating leafy green vegetables.

Leafy greens have a strong advantage over fruit or fruit juice in that they have much less effect on raising blood sugar levels.

Whole fruit is a better option than fruit juice

It is better to consume whole fruit than fruit juice. Whole fruit has the advantage of having soluble fibre for instance.

Soluble fibre
can helps to improve digestion and slows the rate of the rise in blood sugar. It also means that whole fruit represents a less concentrated form of sugar.

It should be noted that people with diabetes should approach whole fruit with some caution too as many whole fruits have a lot of carbohydrate.

The bottom line is that whole fruit is better than fruit juice but should be eaten in moderation. Small portions of fruit are better.

Does drinking fruit juice increase the risk of diabetes?

Studies have found that drinking three portions of fruit juice a week was associated with an eight per cent increase in diabetes risk.

Conversely, eating blueberries, grapes, apples and pears was associated with reduced risk. The researchers found that replacing fruit juices with three helpings of certain

whole fruits
a week would lower the risk by seven per cent.

Some whole fruits reduced the risk more than others. For grapefruits and bananas, there was a five per cent decrease, whereas blueberries reduced the risk by 26 per cent.

What about vegetable juice?

Juiced

non-starchy vegetables
have a lower glycemic index and contain fewer carbohydrates than juiced fruit. The glycemic index of whole vegetables is lower still.

As with fruit, a proportion of the fibre from whole vegetables is likely be lost during the juicing process. Juiced vegetables can play a part in a healthy diet, particularly if juiced vegetables do not replace having whole vegetables.

Diets for type 2 diabetes should be built around the principles of healthy eating with a focus on foods that do not adversely affect

blood glucose levels

As a general guide, your diet should include a good variety of vegetables, sources of unsaturated fats such as nuts, avocados and oily fish, while processed foods should be avoided.

Type 2 diabetes and the NHS diet

NHS

diet advice
generally recommends eating starchy carbohydrates with each meal, as well as more fruit and vegetables, at least two portions of oily fish a week, and less saturated fat, salt and sugars.

The most disputed part of the advice is the recommendation to eat starchy carbohydrates at each meal.

Many people with type 2 diabetes find that even

low GI sources
of starchy carbohydrate (such as basmati rice and whole grain bread) tend to significantly increase blood glucose levels.

Performing blood glucose tests before and two hours after meals can help you see which foods, and in what quantities, are appropriate for you.

• Read more on
  
  pre and post meal blood testing

Low-carb diets and type 2 diabetes

Low-carbohydrate diets tend to be popular with people with type 2 diabetes, with many people reporting improved blood glucose levels on a

low carb diet, which can also help to reduce dependency on medication.

But despite their popularity and apparent effectiveness, low-carb diets, have yet to be endorsed by the NHS. Read more about

low-carb diets and NHS recommendations.

The

Low Carb Program provides education on diet and in particular a lower-carb lifestyle which helps people with type 2 diabetes reduce their HbA1c and weight and is the highest rated diabetes app used in the NHS.

People who are taking medication for type 2 diabetes should be aware that low-carb diets could raise the likelihood of

hypoglycemia
so it’s recommended to speak with your doctor before starting such a diet.

Raw food diets and type 2 diabetes

Raw food diets can be viewed as effective detox diets.

Some of the health advantages of

raw food diets
are a result of the reliance on freshly prepared food and the high amount of fruit and vegetables involved.

Raw food diets are quite restrictive and it’s recommended that you check with your doctor before starting a raw food diet to ensure you get a good balance of nutrients.

Very-low calorie diets and the Newcastle study diet

A study known as ‘the Newcastle diet study’ showed that a very-low calorie diet could be particularly effective at reversing the symptoms of type 2 diabetes. Then, in 2016, the diet was shown to

reverse type 2 diabetes for up to six weeks

Since the results were published, a significant number of people with

type 2 diabetes
have been keen to give the eight-week long diet a try.

Very-low calorie diets such as the Newcastle diet are viewed as being quite extreme and are not recommended without supervision from a doctor.

• 
  Very low calorie diets
• 
  The Newcastle diabetes diet

Tea is one of the nation’s favourite drinks and research suggests it’s also a healthy drink. Tea brings a number of health benefits including improving insulin sensitivity.

However, research notes that some the benefits are best experienced if you drink your tea without milk.

Benefits of tea

Research suggests the following benefits may be enjoyed from tea:

• Improving insulin sensitivity
• Maintaining healthy blood pressure
• Preventing blood clots
• Reducing risk of cardiovascular disease
• Reducing risks of developing
  type 2 diabetes
• Reducing risks of developing
  
  cancer

How does tea help diabetes?

Teas such as black tea, green tea and oolong tea contain polyphenols which researchers believe may increase insulin activity. A number of studies have shown positive effects of tea:

• Drinking two cups of tea each day could help you live longer
• Green tea and coffee found to reduce risk of death among type 2 diabetes

Can tea prevent diabetes?

Polyphenols are known to have anti-oxidative properties which can help protect against inflammation and carcinogens.

In other words, the properties in tea can help to prevent type 2 diabetes as well as

cancer.

Other factors for preventing type 2 diabetes include:

• Eating minimal amounts of
  processed foods
• Eating fresh vegetables regularly through the day
• Including physical activity into each day
• Not smoking
• Keeping alcohol intake low

Tea and stress relief

Tea also contains tiny micronutrients called flavonoids which can help parts of the body to function better.

There are many different types of flavonoid and each have different health properties.

One flavonoid of interest that is found in tea is theanine which can help to control blood pressure and lower stress.

Which type of tea is best to drink?

The latest research indicates that green and black teas are as effective as each other in providing health benefits.

Other type of tea which have been found to have benefits include:

• Oolong tea
• Chamomile tea
• Rooibos tea
• Ginger tea

Effective
management of diabetes cannot be achieved without an appropriate diet.

People with diabetes represent a large subsection of society and there will be range of variety in terms of dietary requirements from person to person.

As a result, there is no one diabetic diet that will work for everyone and people should pick a diet that matches their individual needs.

Ideally, patients with

newly diagnosed diabetes
should receive advice from a dietitian soon after diagnosis.

Which diet is right for me?

There are a wealth of diets that have proved to be either popular with or of interest for people with diabetes.

We’ve compiled some of the more prominent of these diets, looking at both the benefits and disadvantages of each diet.

• 
  Diet for type 1 diabetes
• 
  Diet for type 2 diabetes
• 
  5:2 diet
• 
  Acid-alkaline diet
• 
  Atkins diet
• 
  Carbohydrates and diabetes
• 
  Carnivore diet
• 
  DASH diet
• 
  Detox diet
• 
  Dukan diet
• 
  Gluten free diet
• 
  Glycemic index diet (GI diet)
• 
  Glycemic load
• 
  Ketogenic diet
• 
  Low calorie diet
• 
  Low carb diet
• 
  Low carb high fat diet
• 
  Low fat diet
• 
  Meal replacement diet plans
• 
  Mediterranean diet
• 
  Newcastle study diet
• 
  NHS diet advice
• 
  Paleolithic diet
• 
  Raw food diet
• 
  South beach diet
• 
  Vegan diet
• 
  Vegetarian diet
• 
  Very low calorie diet
• 
  Zone diet

What are the aims of dietary advice?

When you receive advice from your doctor or diabetes team about your diet, they will often make suggestions in order to:

• Provide a knowledge of healthy eating
• Encourage lifestyle changes in order to reduce obesity and
  ensure optimal weight
• Maintain blood glucose and lipids as near normal as possible
• Reduce the acute (short term) complications of diabetes such as
  
  hypoglycemia
  and
  
  hyperglycemia

Dietary
Goals

• Ensure an adequate and balanced nutritional intake
• Limit rapidly absorbed carbohydrate intake
• Monitor body weight encouraging weight maintenance and weight
  reduction when necessary
• Avoid hypoglycemia

Weight Reduction

If you are carrying extra weight, and are classed as either

overweight or obese, weight loss has been shown to improve insulin sensitivity and glucose tolerance.

Modest weight loss of 5-10 kg in one year can significantly improve health outcomes.

General guidance on healthy eating

General guidance on healthy eating from the NHS will generally be based upon the following set of guidelines:

• Increasing intake of
  
  low GI carbohydrate
  foods
• Increasing fruit and vegetable intake.
• Reducing
  
  saturated fat
  intake
• Reducing sugar intake
• Reducing salt
• Safe and sensible alcohol consumption

The NHS advice on carbohydrate intake in particular has met a fair amount of criticism from people with diabetes.

Read more on the

debate surrounding NHS dietary advice

Lifestyle

Patients should follow dietary advice as part of lifestyle modification
including appropriate exercise regimes and smoking cessation.

When choosing what to drink, there are a couple of main considerations relevant to your diabetes to take into account.

The first consideration is whether, or how much, the drink will

affect your blood sugar levels

The other main consideratio, which will be relevant to all of us to some degree but of particular relevance for those of us watching our weight, is to consider the calorie content of drinks.

Water

You can’t go too far wrong with pure water. It provides the hydration your body needs and is, of course, zero carbohydrate and zero calories.

Milk

Moderate carbohydrate content which may need to be accounted for, particularly in people with type 1 diabetes, if drinking close to or more than 100ml.

Milk tends to be a good source of energy and people that wish to watch their weight will need to take into account the calorie content of milk. Skimmed tends to have around half the calories of whole milk.

Fruit juice

Fruit juice is usually regarded as a healthy option but it should be noted that fruit juices have a relatively high carbohydrate content. The calorie content of fruit juice is similar to that of skimmed milk.

Despite being quite high in carbohydrate content, fruit juice needn’t be totally avoided and can be a good option before taking a sustained period of exercise as the activity may help to balance out the rise in blood sugar levels from the juice.

To ensure you get good nutritional value from fruit juice, ensure you have real, unsweetened fruit juice.

Fruit squash and cordials

Fruit squash and cordials tend to be sweetened but some sugar free versions may be available. Squash and cordials don’t carry the nutritional benefits of real fruit juice but can be a lower carbohydrate and lower calorie alternative to sugar soft drinks.

Sugary soft drinks

Sugary soft drinks
are high in both carbohydrate and calories and generally contain no nutritional value aside from energy, which can lead to taking in more energy than the body needs, or leading to not taking in enough vitamins and minerals.

Sugary soft drinks are generally best avoided but can be useful if you specifically need to raise your blood glucose levels, such as before, during or after exercise or to help treat a hypo.

Diet soft drinks

Diet soft drinks
tend to be popular with people with diabetes as they are low in carbohydrate and low in calories.

Diet soft drinks tend to use artificial sweeteners and other artificial agents to provide sweetness, flavour and colour. Whilst soft drinks are recognised as safe for consumptio, research has raised some questions over potential health issues and some people may prefer to limit or avoid their exposure to soft drinks as a precaution.

Tea

Research into the effects of non-milky tea has identified a range of health benefits, including improving insulin sensitivity and helping maintain healthy blood pressure. Lovers of milk in tea will be disappointed to know that the health benefits generally aren’t realised when milk is added to

tea

Coffee

There are probably few foods or drinks that get such a mixture of good and bad headlines as coffee. Confusingly,

coffee
has been linked with both increased and decreased risks of developing type 2 diabetes.

Studies looking into moderate coffee consumption (2-3 cups a day) have shown some health benefits, including a lower risk of type 2 diabetes, whilst high coffee consumption (5 or more cups a day) has been linked with a higher risk.

Note that milky coffees such as lattes can be high in calories, with larger lattes sometimes varying between 100 and 300 calories.

Sugar in hot drinks

Many people enjoy sugar in hot drinks but people with diabetes are better off having drinks without sugar where possible as one or two teaspoons of sugar in each drink can add up over the course of a day.

2 spoons of sugar in 5 hot drinks a day is as much calories and carbohydrate as a can of full sugar cola.

Alcoholic drinks

When having alcohol, there are a few things to consider:

• How the drink will affect blood sugar levels
• The calorie content of the drink
• Whether alcohol will interact with any medication you take

Alcoholic drinks
can be responsible for raising and lowering blood glucose levels so it’s useful to understand how different alcoholic drinks can affect your sugar levels.

For those keeping an eye on their weight, it’s important to note that alcohol is significant source of calories. For example, a single pint of regular beer has 200 calories, which is as many calories as a large slice of pizza.

Some medications interact with alcohol. It is advisable to check the patient information leaflet enclosed with your medication and consult your doctor if you have further questions.