NHS Diet Advice for Diabetes

NHS advise that there is no special diet advice for people with diabetes
NHS advise that there is no special diet advice for people with diabetes

The NHS has started to embrace low carb as a healthy diet for people with diabetes, which marks a change having previously recommended a higher carb approach.

In January 2019, NHS digital accepted Diabetes Digital Media’s Low Carb Program app into the NHS apps library, and in 2018 the program was awarded QISMET approval, meaning it can be commissioned as structured education on the NHS.

A change in direction

Over the past 40 years, the NHS’s dietary advice had been to eat a healthy, balanced diet that was low in fat, sugar and salt and contained a high level of fresh fruit and vegetables.

However, people with diabetes have in recent years been able to achieve not just tight blood glucose control, but also lose weight and improve their HbA1c by reducing the carbohydrate content of their meals.

This is now starting to be acknowledged by the NHS. The change in approach is significant because particular focus has been placed on the need to amend dietary guidelines to help people with type 2 diabetes to manage and even put the condition into remission, and to prevent people from developing type 2 diabetes.

People with type 1 diabetes could also benefit from a change to the dietary guidelines because research shows that lower carbohydrate intake leads to improved control in type 1.

What does the NHS advise?

The NHS’s nutritional advice for people with diabetes is generally to follow the dietary guidelines that it recommends to everyone in the UK.

These guidelines advise people to:

  • Have roughly half of calorie intake coming from carbohydrate
  • Limit intake of fat
  • Keep saturated fat intake low
  • Keep sugar intake low
  • Keep salt intake low

The NHS's Eatwell Guide states:

  • "eat 5 [portions of fruit and vegetables] per day"
  • "base meals on starchy foods like potatoes, bread, rice or pasta"
  • "have some dairy or dairy alternatives (such as soya drinks)"
  • "eat some beans, pulses, fish, eggs, meat and other protein"
  • "choose unsaturated oils and spreads and eat in small amounts"
  • "drink plenty of fluids"

This approach still favours a higher carb, lower fat approach, but it appears that the NHS is embracing alternative dietary approaches to tackle rising diabetes rates.

Why is this significant? It’s all because of how carbohydrate impacts the body, and the effects it can have on our health.

Carbohydrates, such as starch and sugar, break down directly into glucose in the body, unlike protein or fat, which means people with diabetes can experience higher blood glucose levels from eating large amounts of carbohydrate.

Because insulin is required to process blood glucose and move it into cells, eating carbs and raising blood glucose raises insulin, and can worsen insulin resistance, one of the hallmark characteristics of type 2 diabetes.

People with type 2 diabetes face the additional challenge of insulin resistance, which is negatively impacted by high carb intake, meaning the body has difficulty responding to the hormone insulin.

Conversely, eating low carb, healthy fat (LCHF), as advocated on our award-winning Low Carb Program, has been shown to keep glucose levels well-controlled, leading to improved HbA1c levels, weight loss, reduced medication dependency and even remission of type 2 diabetes.

Therefore, eating foods that have no minimal impact on blood glucose levels is a positive step for people with diabetes to take.

Breaking down the NHS advice

There are several NHS recommendations that hold value for people with diabetes. These include:

  • Eat plenty of vegetables
  • Have sufficient fibre in your diet
  • Cut down on sugar
  • Cut down on processed meat
  • Eat fish regularly
  • Cut down on energy dense, processed food - such as crisps, cakes, biscuits and pastries
  • Cut down on alcohol
  • Cut down on salty processed foods

However, some of the recommendations could inadvertently lead to poorer dietary choices.

Carbohydrate

Studies confirm that carbohydrate-focused diets require more medication to treat, result in higher blood glucose levels and result in higher levels of insulin in the body. [367] [368]

The NHS’s recommendations for people with diabetes to eat plenty of starchy carbohydrate, such as potatoes, pasta, cereal, rice and bread could worsen insulin resistance in people with type 2 diabetes, and requires people with type 1 diabetes to administer more insulin as a consequence.

Even starchy carbohydrates with a low Glycemic Index (GI), such as brown rice and pasta, can have a pronounced effect in raising blood glucose levels.

High fat or low fat?

While the NHS recommends low fat intake, a wide array of research studies have shown eating full fat dairy to be just as healthy, if not more healthy.

A notable point about products labelled as low fat or lite is that many of them contain added sugar, salt or other unnatural additives to replace the fat.

Saturated fat

The decades-old claim that saturated fat intake leads to heart problems is not backed up by rigorous research. In 2014 and 2015, well-run and large-scale research studies found no association between saturated fat intake and heart disease.[369] .[370]

Unfortunately, the NHS’s recommendation to eat less saturated fat makes no distinction between different sources of saturated fat.

Saturated fat should be regarded as a healthy form of fat as long as it comes from natural sources such as:

  • Meat (unprocessed)
  • Fish
  • Dairy
  • Olives and olive oil
  • Nuts (unsalted) and nut oils
  • Seeds
  • Avocados
  • Coconut

Rather than focusing on saturated fat, cutting down on ‘processed sources of fat’ has far more implications for better improve. Processed sources of fat include:

  • Cakes
  • Biscuits
  • Crisps
  • Chips
  • Pastries
  • Hot dogs

Rallying call

Many leading doctors in the UK have spoken out stating that the dietary guidelines need to be updated if the health of the nation is to be improved.

The Public Health Collaboration is a charity that has a number of the UK’s most forward-thinking doctors and healthcare professionals on its advisory panel.

The PHC states: "Arguably, the current advice has got us into our current sticky situation. A complete overhaul is needed for our dietary advice based on the scientific evidence in order to improve our nation's health..."

In the US, the American Diabetes Association recently updated its dietary guidelines to recognise the benefits of eating low carb. The guidance addressed how eating low carb could improve blood glucose levels and reduce the need for blood glucose-lowering medication. 

Meanwhile, the health regulator NICE (The National Institute for Health and Care Excellence) states that nutritional advice should be appropriate for the individual.

The future of the NHS’s dietary advice

Until longer-term low carb research trials are run, it is hard to know exactly how the NHS diet advice will change for people with diabetes.

However, what we know from shorter-term research studies that carbohydrate-focused diets may encourage:

  • Greater reliance on diabetes medication
  • Increased likelihood of developing diabetes complications – as a result of higher blood glucose levels
  • Worsening of weight gain and metabolic syndrome factors – as a result of higher insulin levels in the body

One diet which has found common ground for agreement, between the NHS and the healthcare professionals that have criticised the NHS diet, is the Mediterranean diet.

The agreement is undoubtedly a result of the Mediterranean diet, a lower carb diet, being based upon fresh, unprocessed food, includes natural sources of fat and is a flexible diet to follow.

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