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Staggered and saddened by this information!

On a lark I thought I’d pop on over to the Canadian diabetes site and check out their meals plans….it’s no better and kind of embarrassing. All meals were over 50 carbs each, and they really push low fat foods and vegetable margarine….ahhh. Lots of pasta, oatmeal, sweet potatoes, mashed potatoes and whole wheat bread.
 
I am quite a conventional person by nature and more inclined to accept expert advice at face value than to reject it. So I experience real discomfort when I see a seemingly respectable site encouraging people who are by definition carb-intolerant to eat lots of carbs. I just can’t get my head around it.
 
I volunteer with Diabetes UK on various things, which has given me a broader view about their dietary advice.
Especially talking to people representing Asian communities.
Whilst acknowledging that giving up things like rice would make a major difference, there are enormous cultural pressures against this.
When the whole traditional cuisine is based around rice, telling people to give it up and change to a (Western?) low carbohydrate diet would not be acceptable culturally.
The diet advice has to take gentle, achievable steps like swapping whole grain rice for white rice.
Cutting down on the rice and eating more vegetables.
Trying cauliflower rice for some meals.
That kind of thing.

Likewise the "healthy eating" plate might be acceptable to people who have a very unhealthy diet and might be a great improvement which they can more or less accept.

Remember that most people on this forum are a determined and motivated minority who take a keen interest in their condition and how to best manage it.
We know that the best way to manage T2 especially is to cut right down on the carbohydrates.
We also know how hard this can be.

Diabetes UK have to take a pragmatic view.
Their advice has to be pitched at their majority audience, and has to be acceptable.
Small improvements are better than no improvements.
Who knows, small improvements may lead to bigger improvements.
However the initial targets have to be achievable.
Cut down is more achievable than cut out.

Trying to think of an exercise comparison.
For example, couch to 5k is generally achievable.
6 weeks to a half marathon is significantly harder (did this decades back) and only practical for the determined and already at least minimally fit.
If the exercise part of "diet and exercise" was a 6 week course to a half marathon I don't think many people would go with the plan.

I don't agree with a lot of the DUK diet advice, but I can see why they might offer some of it.
 
I wish public health recommendations and guidelines would just give the facts as they are known, instead of babying everyone. People can make their own decisions based off that.

I'm sure you will get some more people following a 'more attainable' level. But you'll also have some people who would have gone further, misled in to thinking that they are already doing everything they need to.

I feel it's similar to the premise of rather letting 100 guilty people go free than locking up 1 innocent person.
 
LittleGreyCat said:
I volunteer with Diabetes UK on various things, which has given me a broader view about their dietary advice.
Especially talking to people representing Asian communities.
Whilst acknowledging that giving up things like rice would make a major difference, there are enormous cultural pressures against this.
When the whole traditional cuisine is based around rice, telling people to give it up and change to a (Western?) low carbohydrate diet would not be acceptable culturally.
The diet advice has to take gentle, achievable steps like swapping whole grain rice for white rice.
Cutting down on the rice and eating more vegetables.
Trying cauliflower rice for some meals.
That kind of thing.

Likewise the "healthy eating" plate might be acceptable to people who have a very unhealthy diet and might be a great improvement which they can more or less accept.

Remember that most people on this forum are a determined and motivated minority who take a keen interest in their condition and how to best manage it.
We know that the best way to manage T2 especially is to cut right down on the carbohydrates.
We also know how hard this can be.

Diabetes UK have to take a pragmatic view.
Their advice has to be pitched at their majority audience, and has to be acceptable.
Small improvements are better than no improvements.
Who knows, small improvements may lead to bigger improvements.
However the initial targets have to be achievable.
Cut down is more achievable than cut out.

Trying to think of an exercise comparison.
For example, couch to 5k is generally achievable.
6 weeks to a half marathon is significantly harder (did this decades back) and only practical for the determined and already at least minimally fit.
If the exercise part of "diet and exercise" was a 6 week course to a half marathon I don't think many people would go with the plan.

I don't agree with a lot of the DUK diet advice, but I can see why they might offer some of it.
Click to expand...
There’s a difference between what they do (pragmatically) and doing that along with giving the fuller picture.

I could be more supportive of their position if they also advised that some people may need to go further with the changes if they don’t get the results they hope for ie this advice is a starting point but not necessarily the end point and certainly not a limitation to how diet can be adjusted.
 
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DEBBIESCOTT said:
Surely everybody eats an whole avocado not 2 slices, or is it just me
Click to expand...
I'd put a whole avocado in the bin, right where it belongs! :)

I guarantee the advice on serving size for avocado comes from the continuing insistence that "carbs are awesome for diabetes, but watch out for those fats!"

My diabetes training used lasagne as an example, where it was recommended to reduce the cheese portion and use low fat mince, but any suggestion of removing the pasta sheets or white sauce was scoffed at. It's ridiculous to the extreme.
 
LittleGreyCat said:
Diabetes UK have to take a pragmatic view.
Their advice has to be pitched at their majority audience, and has to be acceptable.
Small improvements are better than no improvements.
Who knows, small improvements may lead to bigger improvements.
However the initial targets have to be achievable.
Cut down is more achievable than cut out.

Trying to think of an exercise comparison.
For example, couch to 5k is generally achievable.
6 weeks to a half marathon is significantly harder (did this decades back) and only practical for the determined and already at least minimally fit.
If the exercise part of "diet and exercise" was a 6 week course to a half marathon I don't think many people would go with the plan.

I don't agree with a lot of the DUK diet advice, but I can see why they might offer some of it.
Click to expand...
I'll start by saying none of this is aimed at you @LittleGreyCat. You've raised some very interesting and balanced points, and you've made your personal position very clear.

My issue with the standard dietary advice for diabetics is that it's the easy route out for those offering it. It's likely fair to say that many of those diagnosed with diabetes don't want to hear that they have to cut carbs, but that doesn't change the fact it's the advice that should be given. The advice doesn't even need to go as far as low carb and keto, but just for starters it definitely needs to rein in the amount of bread, pasta, rice and potato being pushed.

To use an analogy, kids like exploring. It would be easier to let them just freely explore, and even if they approach the cupboard with the cleaning supplies and chemicals, you could take the easy route and not intervene. You could avoid those pesky tantrums, arguments and the battle of trying to tell them what they don't want to hear, but it's not the responsible approach. In fact, if you just allowed the toddler to merrily root through the cleaning cupboard and drink bleach, you'd be prosecuted for child neglect as a minimum. Parents aren't paid or trained, yet they're legally responsible for not being negligent to children in their care. Meanwhile, medical professionals are trained and paid, and charities rake in millions, yet they're allowed to freely recommend diabetics just bang 50g+ of carbs per meal down their necks without any caution or responsibility for that whatsoever.

It just doesn't sit right with me to be honest. Professional responsibility and accountability should be a concern at some stage along the way, rather than avoiding difficult conversations with people that don't want to hear it.
 
In the UK it's NICE that set the guidelines and their direction is to follow the NHS Eat well guide. I think any doctor or organisation that recommends differently would have to be brave:

1.3.3 Encourage adults with type 2 diabetes to follow the same healthy eating advice as the general population, which includes:
  • eating high-fibre, low-glycaemic-index sources of carbohydrate, such as fruit, vegetables, wholegrains and pulses
  • choosing low-fat dairy products
  • eating oily fish
  • controlling their intake of saturated and trans fatty acids. [2009]

Recommendations | Type 2 diabetes in adults: management | Guidance | NICE

www.nice.org.uk www.nice.org.uk

NICE do publish some info on why they come to their recommendations. E.g. why they removed Unwins 'teaspoons of sugar' infographic from the list of NICE resources. (Because patients may interpret it as advocating a low carb diet).

I haven't come across Eatwell's reasoning behind it's recommendations. If anyone has any links or articles they could share.


 
Just to add, because we are mainly anonymous here.
Are there many members of the Asian community here?

If so, is your traditional cuisine mainly based around rice and/or breads?

If so, how easy is it to persuade others that they should cut right back on the carbohydrates?

My traditional Northern diet was heavy on spuds and bread, but at least there were meat + 3 veggies and Sunday joints of meat and stews to form a basis for cutting out or reducing carbohydrates.
Oh, and lots of cheese!
It was only when I was in Zoom meetings with people from other backgrounds that I realised how hard it might be for some people to change their way of eating.
 
Guilty said:
I wish public health recommendations and guidelines would just give the facts as they are known, instead of babying everyone. People can make their own decisions based off that.

I'm sure you will get some more people following a 'more attainable' level. But you'll also have some people who would have gone further, misled in to thinking that they are already doing everything they need to.

I feel it's similar to the premise of rather letting 100 guilty people go free than locking up 1 innocent person.
Click to expand...
I agree with a lot you are saying and especially with reducing carbs and portions, exercise.

But for me, it puts everyone in the same place. One size fits all, which doesn't address the difference in diagnosis, the multiple reasons why they are diagnosed with T2.
Everyone is different and should be treated as such.

You wouldn't expect someone with gluten intolerance, and T2, to be advised to eat wheat products?
So why would advice to eat the day well plate be advised for all T2s?
Intolerance to carbs and sugars, are the reason for spikes, which do not help with health issues, the dysregulation of BG levels in T2, is the reason why T2 has been thought of as a disease that will always get worse!
We know different.

Helping with a charity is great, maybe you could maybe change the policy.
Best wishes.
 
Lamont D said:
<snip>

Helping with a charity is great, maybe you could maybe change the policy.
Best wishes.
Click to expand...

I'm sure this wasn't meant to sound patronising, but there is the implication that I (and other like minded individuals) haven't already been doing this.

The issue is raised constantly by the volunteers and there now seems to be at least acceptance (if not enthusiastic support) that LCHF is a valid way to manage your diet.

The juggernaut does take a long time to turn.

Memo to self: check who the current main sponsors are, and how they align with "healthy carbohydrates".
 
Guilty said:
In the UK it's NICE that set the guidelines and their direction is to follow the NHS Eat well guide. I think any doctor or organisation that recommends differently would have to be brave:

1.3.3 Encourage adults with type 2 diabetes to follow the same healthy eating advice as the general population, which includes:
  • eating high-fibre, low-glycaemic-index sources of carbohydrate, such as fruit, vegetables, wholegrains and pulses
  • choosing low-fat dairy products
  • eating oily fish
  • controlling their intake of saturated and trans fatty acids. [2009]

Recommendations | Type 2 diabetes in adults: management | Guidance | NICE

www.nice.org.uk www.nice.org.uk

NICE do publish some info on why they come to their recommendations. E.g. why they removed Unwins 'teaspoons of sugar' infographic from the list of NICE resources. (Because patients may interpret it as advocating a low carb diet).

I haven't come across Eatwell's reasoning behind it's recommendations. If anyone has any links or articles they could share.
Click to expand...
A lot of the dietary recommendations are aimed IMO at preventing disease, rather than promoting health. However the main disease they are intended to prevent is/was CHD: and it flatlined and fell anyway from the 1970s because so many people stopped smoking. It left the UK with large numbers of trained up cardiologists who had literally no patients.

Diabetes wasn't a concern back then, and as a good example of the law of unintended consequences, we may be getting to the point where the cost of dealing with uncontrolled T2 diabetes and its complications is in the same ballpark as the estimated cost of dealing with the CHD epidemic that didn't happen.

In a previous life I used to work with a lot of these types of people, and I have as you might expect asked the question. It's very well known that low carb works very effectively, and many of these individuals have themselves used it or a variation (like Atkins) themselves. There's an increasing body of research on low-carb, keto, VLC, whatever you want to call it, demonstrating its effectiveness. However it's also believed - at least, this was the reason given to me - that it's much too difficult a way of eating for most people to follow.

Yes, I know, and I don't agree either.

Also, I'm not sure I buy any part of that explanation.

It goes without saying that low-carb cuts right across 35 years of "eat more carbs" and I have to wonder if there is some anxiety about what might happen if many thousands of people were to complain to Government and the NHS that they'd followed the official advice and ended up with T2 and complications. It would be a very brave politician or official who first took the lid off that one.
 
LittleGreyCat said:
I'm sure this wasn't meant to sound patronising, but there is the implication that I (and other like minded individuals) haven't already been doing this.

The issue is raised constantly by the volunteers and there now seems to be at least acceptance (if not enthusiastic support) that LCHF is a valid way to manage your diet.

The juggernaut does take a long time to turn.

Memo to self: check who the current main sponsors are, and how they align with "healthy carbohydrates".
Click to expand...
They're shown on the website. Britvic has gone but Tesco is still there.
 
LittleGreyCat said:
I volunteer with Diabetes UK on various things, which has given me a broader view about their dietary advice.
Especially talking to people representing Asian communities.
Whilst acknowledging that giving up things like rice would make a major difference, there are enormous cultural pressures against this.
When the whole traditional cuisine is based around rice, telling people to give it up and change to a (Western?) low carbohydrate diet would not be acceptable culturally.
The diet advice has to take gentle, achievable steps like swapping whole grain rice for white rice.
Cutting down on the rice and eating more vegetables.
Trying cauliflower rice for some meals.
That kind of thing.

Likewise the "healthy eating" plate might be acceptable to people who have a very unhealthy diet and might be a great improvement which they can more or less accept.

Remember that most people on this forum are a determined and motivated minority who take a keen interest in their condition and how to best manage it.
We know that the best way to manage T2 especially is to cut right down on the carbohydrates.
We also know how hard this can be.

Diabetes UK have to take a pragmatic view.
Their advice has to be pitched at their majority audience, and has to be acceptable.
Small improvements are better than no improvements.
Who knows, small improvements may lead to bigger improvements.
However the initial targets have to be achievable.
Cut down is more achievable than cut out.

Trying to think of an exercise comparison.
For example, couch to 5k is generally achievable.
6 weeks to a half marathon is significantly harder (did this decades back) and only practical for the determined and already at least minimally fit.
If the exercise part of "diet and exercise" was a 6 week course to a half marathon I don't think many people would go with the plan.

I don't agree with a lot of the DUK diet advice, but I can see why they might offer some of it.
Click to expand...

I find the attitude of Diabetes UK quite patronising in their attitude. They were teasing asian community like children in not telling them the full facts and leaving them to make the decision on how much they change their diet with the benefit of full knowledge.
 
I'm going to interject with another interesting thought.

It's a what if.

What if the million or so diabetic patients in this country abided by the NEW NHS (if it happened) guidance avoiding wheat, grains, starchy carbs and rice?
Could you imagine the outcome?
 
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