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Why do the nhs give the advice that they do?

Discussion in 'Ask A Question' started by Dippy3103, May 17, 2010.

  1. Dippy3103

    Dippy3103 · Well-Known Member

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    I have been pondering again!
    This time on what the rationale Is behind the current 'eat plenty on starchy carbs' advice currently given out ?
    From my own limited testing/knowledge I know this is exactly what pushes my numbers up.
    But the nhs must have a reason to advise us to, and I was wondering exactly why.
    It is an honest question and I am not looking to start an argument or stir things up. I think everyone knows what suits them personally and this varies from person to person.
    Thanks In advance...... And please remember I am not setting out to start a row, I just want to know!
     
  2. noblehead

    noblehead Type 1 · Guru
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    Oh I believe you Dippy! :roll: :lol:

    Nigel
     
  3. lovinglife

    lovinglife Type 2 · Well-Known Member

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    I don't know the answer to that Dippy - personally I never had the "eat plenty of carbs advice from any of the dietitians and DSN's I have seen.

    I was diagnosed when admitted with an emergency to hospital for another condition - I saw a dietitian and a DSN in there both told me watch the carbs and gave me guidance portions of 2 to 3 golf ball sized potatoes - two tablespoons of rice -brown if I could but they acknowledge it was an acquired taste :lol: otherwise basmati only. Be careful with pasta - very small portions and test - wholemeal bread was better for me health wise but would do the same as white so be very careful and keep it down to a slice a day if I had to have it - best to eat the flax/linseed bread.


    I had similar advice from my GP care team and even on the DESMOND course although it was "veiled" advice - but if you were on my DESMOND course you would have seen why :roll:

    All (not DESMOND) told me to test test test and advised the fasting, before 2 hrs after etc- although my supply of test strips has been greatly reduced now because I am 12 months in and should be aware of what foods do what to me - This is my only grumble but sort of understand what they mean and I do test a little less now unless I introduce something new - change routine etc.

    I have basically followed this advice with a few tweaks of my own - My meds are much reduced since diagnosis although I will probably have to continue on my current regime as I have Diverticulitis and going any lower on the carbs causes flare ups and infections and threats of a big op - so happy to go with it - but will keep trying

    I agree the advice does need to change - "plenty of carbs" is open to interpretation and can be taken to mean lots of things - if you are used to a big pile of rice with your curry even cutting your portion in half is still far too much - things need to be clearer
     
  4. cugila

    cugila · Master

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    Hi Dippy.
    I think this is the sort of advice you mean, this is taken from the NHS Choices website and is about what a Diabetic should be doing.

    The problem I have found is that it all depends where you look and who is answering. I have had very good advice from Dietician's and I have also had absolutely rubbish advice as well. Nobody seems to be 'singing from the same hymn sheet.' I wish that were so.

    Speaking personally the advice given out whilst not applicable to all of us is in fact in the above instance for me.....good advice. I am on medication, Byetta which suppresses the appetite, never been able to control with diet only.

    I am able to eat high fibre foods, bread, fruit, vegetables and stick to low fat, low salt, and this is where I take issue with the advice.....low sugar. It isn't just sugar we need to avoid. We continually tell people on here to reduce or avoid starchy carbohydrates......this is because they convert 100% into glucose in your bloodstream. Why we tell people to count TOTAL carbs as they include sugars.

    If they were to change the wording to read 'reduce starchy carbohydrates' then that would satisfy me.

    We are, as we repeatedley say on here 'all different.' Now that as well seems to have been overlooked by the people who dish out the NHS diet advice. What works for one does not always work for everybody. The principle might be good, in practice it is flawed.

    I can follow some of the dietary advice with no problem, if I try to follow other parts of it I am in trouble. By continually testing is how I found out what affects me, what I can and cannot eat.

    The advice is old advice and needs updating, but who is going to be brave enough to change what we have been told for many years. A brave man/woman is what we need......not afraid to stick their hand up and say, "Excuse me, this is not right. We need to change things a bit."

    Now I am not technically a low carber, mainly because a certain Dr says so ! However I have a reduced carb diet because I say so. It aso includes low GI/GL principles. Now that works great for me. Other's have to cut out carbs drastically and believe that low carbing is the way forward. If that is what they want, who am I to argue. If that works for them.....good. It just doesn't work for everybody, I can't be doing with the restrictions in foods to eat, eating high fat. Not something I believe in. Jersey Royals, Granary Bread, root veggies, rice and pasta are all part of my diet.

    My view is and always has been, do what is best for yourself and ignore those that seek to tell you there is only one way........that is bunkum as shown by my own results. I have a brain and I use it, I don't need leading by the hand to the promised land. I have my way, that is all I need to know. Oh yes, I do not eat low fat / high carbs as a certain individual seems to think people like myself and others on here do. It is low fat and 'reduced carbs.' Seems some people can't tell the difference.

    My diet is varied and balanced, full of vitamins and minerals, my Bg numbers are all low throughout the day, sometimes too low ! I feel healthier, fitter, livelier, lost over 5 stone, all whilst following the NHS principles but with some minor adaptations. So, I suppose to some it might seem strange to be advised eat plenty of starchy carbs........for some of us we can, NOT plenty though, just all things in moderation. Makes life so much more interesting. :D

    Ken
    P.S. Dippy........not start a row ! Yeah, right !! :wink:
     
  5. lovinglife

    lovinglife Type 2 · Well-Known Member

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    Ken - thank god for you! - you always say what I was trying to say :mrgreen: :lol: - that's why you are a monitor and me a mere minion I suppose :lol: :lol: - me - never even made milk monitor at school when everyone else was off!!!!! :lol: :lol: :lol: :lol:


    Well Said :)
     
  6. Debloubed

    Debloubed Type 1 · Well-Known Member

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    This is the advice I was given by the DSN team 25 years ago at diagnosis. I will never forget the words ' a diabetic diet is a healthy diet for everyone!' and I have used the words many times over the years when people have asked questions about my 'diet'. Now, I have changed in that I no longer 'dose up' to my meals as I have learned how to carb count so I can eat meals with little or no carbs if I choose to do so. Or not! :lol: I don't like the words 'diet' plan. I prefer 'eating' plan or 'food' plan :D :p
     
  7. timo2

    timo2 · Well-Known Member

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    Hi Dippy,

    The "eat plenty starch" advice is designed to keep the population down now that we don't have world wars any more.
     
  8. sugarless sue

    sugarless sue · Master

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    As Ken quoted this is the advice from NHS Choices. What strikes me is the phrase, ‘right amount of glucose for the insulin you are taking’.

    The advice for type 2’s is basically a modification of the advice for type 1’s but that advice is flawed when you are not taking insulin to level out your blood sugar levels.

    The NHS could give better advice simply by changing one word in their advice to type 2, in fact any diabetics, and that word is ‘sugar’.

    Change it to ‘Carbohydrate’ and teach people to be careful of the amount they are eating and many would benefit from this.

    All diabetics need to watch the amount of carb they eat because diabetes is a condition where you have impaired metabolism of carbohydrate.

    Now, I low carb, my choice, because I am on diet only and do not take any medication. I have to be careful of the carb intake because I have no way of correcting a ‘high’ if I eat too many carbs.

    Others , on oral medication can learn, by testing, what they can eat to the amount of medication they use but again, if they go too high they cannot bring the levels down other than by taking more medication to cover it.

    Those on insulin and Byetta or Victoza have more control but also need to watch what they eat. Many insulin users have found that by reducing their carbs they can reduce the amount of insulin and by doing this also reduce weight gain.

    In my opinion the advice needs to be tailored to fit each individual person because that is what we are, individuals.
     
  9. MaryChristine

    MaryChristine · Well-Known Member

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    I suspect the advice has become distorted over time and as it is passed down to patient level like that whispering game that children used to play at parties. Maybe they still do?

    For example - the advice "Spread your carbohydrate intake out over the day in several small meals and snacks" has become "Eat carbohydrate at every meal".

    Or "Cut down on foods containing animal fats and replace them with carbohydrates which are low in fat and half the calories" has become "Eat plenty of carbohydrates".

    Or "Substitute whole grain pasta, bread, cereals, rice for white varieties and new potatoes for mash and balance your intake with your physical activity" has lost the second part of the message.

    Combined, the message received is "Eat plenty of carbohydrate at every meal, so long as it is wholegrain/high-fibre/low GI." The bit about portion size and activity gets lost altogether.

    At the end of the children's game the distorted message is announced to great hilarity. The result of following the NHS advice may not be so amusing!

    Best wishes
    MaryChristine
     
  10. hanadr

    hanadr · Expert

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    Dippy
    the historical reason for the NHS diet advice is based on false assumptions.
    Firstly, that Fats are uniformly bad,especially the saturated ones.
    secondly, diabetics often have defective kidneys and excess protein is bad for kidneys. For patients on dialysis, proteins have to be restricted, but there's no need if kidneys are totally or even fairly healthy.
    Hence what is left?
    both those assumptions are NOT supported by EVIDENCE. You'll see I get shouted down for saying that, but I challenge anyone to provide proper peer reviewed evidence.
    Hana
     
  11. noblehead

    noblehead Type 1 · Guru
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    That is precisely the point Sue! :D

    As we are all individuals, our reaction to certain foods will have produce variable results, as we can see on the forum where some people can tolerate more carbs than other members, despite having the same type of diabetes and insulin, meds and diet regime.

    I eat a reduced carb, low-fat diet, but use the low gi method together with portion control. My carb intake can vary from 80-130g of carbs a day, as I match my insulin to the carbs I eat. Since changing my diet I find that I can still tolerate potatoes and bread without any problems, although I use a low-gi loaf (burgen).

    Yesterday I had a roast dinner and had 3 homemade roast potatoes and 1 Yorkshire pudding with my dinner, before my bg was 5.6, one hour after 7.2, two hours after 6.5, and after four hours I was 5.4, so I can't see any reasons to cut these foods out altogether.

    I think the NHS advice does need updated regarding carbohydrate intake, a more clearer interpretation is needed, but overall I think the advice is good regarding eating a diet high in fibre, fruit and vegetables and low in salt and sugar.

    Regards

    Nigel
     
  12. phoenix

    phoenix Type 1 · Expert

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    Guidelines for diet are fairly similar internationally, it's not just the NHS.
    If you look at research from the 60s and 70s, people with diabetes did not stick to their prescribed low carb, complicated (' lines' and exchange systems) and expensive diet.
    Studies in the UK found only about 10% of people actually followed their diet. Moreover, there was abosolutely no difference in control and outcomes between those who complied with the diet and those that didn't.
    Reliability and Cost of Diabetic Diets
    SIR RONALD TUNBRIDGE,* M.D. M.SC., F.R.C.P. ; J. H. WETHERILL t M.B., CH.B., M.R.C.P.
    British Medical journal, 1970, 2, 78-80

    It was also evident that the biggest killer of people with diabetes was CVD .
    One book I have says
    'The (previous)dietary advice had a number of problems, boredom, constraint, sadness, exclusion. It forced the diabetic into eating far too much fat, which wasn't good either for the control of his weight or for the prevention of cardiovascular disease'(translation from the French)Prof G SLAMA
    In the decades that followed there was a whole series of dietary experiments. Several of the earlier ones were conducted in closed metabolic wards with the subjects used as their own controls by swapping diets half way through the trials ( far more rigorous than many of the trials I read today). As today, long term trials are difficult so there aren't many.
    The emphasis of the new research was on high fibre, higher carb diets and trial after trial showed that these diets had greater beneficial effects on glucose levels and negative or slightly better effects on lipids and trigs than the standard diabetic diets of the day. There was a great interest in the benefits of legumes.
    There were conclusions like this
    A
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(81)90112-4/abstract
    or this
    Long-term effects of high-carbohydrate, high-fiber diets on glucose and lipid metabolism: a preliminary report on patients with diabetes. . J W Anderson and K Ward Diabetes Care March 1978 vol. 1 no. 2 77-82
    It was studies like this that changed the idea of what would work best for people with diabetes.
    (actualy, its far more complicated, with long term epidemiological studies suggesting positive benefits for things like fruit, veg, wholegrains, and negative ones for red and processed meats , and the effect of high protein on already damaged kidneys... as many with diabetes have on diagnosis but this is already far too long)

    When advice is distilled into leaflet form, all too often its oversimplified. There is a world of difference between a high percentage carb diet (where the diet is fairly low in overall calorie content) and 'plenty' of starchy carbs. All the original studies emphasised legumes/beans,fibre, latter ones the glycemic index. Both of these are mentioned in the DUK advice but people just seem to hang onto that word plenty( which I think has now been removed from the website) and interpret it as large amounts of manufactured cereals, pasta and refined rice. I don't think I have ever read someone saying that they have now changed their diet to one based on high fibre starches such as beans and legumes.(though I do know of a person that was in one of the original trials and continued his 'bean' diet succesfully for 30 years)
     
  13. hanadr

    hanadr · Expert

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    I've read that paper and it's logic is full of holes. One thing about it is that it is looking at 2 variables at once [starch and fibre]. It includes indigestible fibre in its carbs, which we no longer do in the UK.
    I'm all for a "high fibre" diet.
    It is an oldie[somewhere round 1982 and predates home BG testing] and it's just possible that if all your carb is fibre in beans and pulses, you actually only get a small amount of digestible starch.. Which is not what most people nowadays would call a higher carb diet.
    YES fibre is a carbohydrate [cellulose], a polymer of glucose, but its structure makes it insoluble and indigestible. Starch is also a polymer of glucose and insoluble[in strict chemical terms] However, we do have mechanisms for digesting cooked starch, where we can't digest cellulose in any form.
    so if your high carb diet is a high fibre one, you'll be fine. High starch needs a lot of medication to deal with.
     
  14. Debloubed

    Debloubed Type 1 · Well-Known Member

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    Will I? Super! I was worried there for a minute that I wouldn't be fine :wink: :twisted: :p
     
  15. hanadr

    hanadr · Expert

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    Deb
    high fibre and NOT high starch though
    Hana
     
  16. phoenix

    phoenix Type 1 · Expert

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    Hana , how do you unlink the fibre from wholefoods? The beta glucan in oats and pulses is integral and the bran is part and parcel of whole grain flour. You can't have one without the other. I actually find it impossible to concieve of a diet trial in which all variables are controlled. We eat mixed diets not individual nutrients.In this one they were comparing one diet with another. The old diabetic diet, with their experimental one. They found the high carb/high fibre one superior.

    The papers are old, they show what the thinking was when diabetes diets changed...ie answered the question.

    There are plenty of newer peer reviewed papers. Here a meta analysis reviewing international guidelines for carb and fibre in diabetes diets. http://www.jacn.org/cgi/reprint/23/1/5 Knowledge, research findings also progress, hence the changes to include a cautious acceptance of a 130g 'low' carb diet in the 2008 ADA guidelines, also an evidence based document)


    I do agree with some of the earlier posters on individualisation ( studies show better results with individual prescriptions and continued advice) and the way guidelines are sometimes (miss)interpreted .
     
  17. Debloubed

    Debloubed Type 1 · Well-Known Member

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    I get it Hana, I was being mildly sarcastic :wink: :twisted: believe it or not, I do know about starchy carbs seeing as carbs rule my life! :lol:
     
  18. Synonym

    Synonym · Well-Known Member

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    I think the main reason is the entire culture so prevalent nowadays which makes people ‘do just what the script says so that you don’t put yourself in danger of being sued or disciplined or even lose your job’. Nobody rocks the boat even to say that the ‘script’ needs to change for the same reasons. There does not even seem to be an understanding that the very fact that the advice is so faulty is actually a reason for patients to seek restitution.

    The other constricting factor is the budgets that are imposed, which understandably make the number crunchers divvy up the available cash to stretch as far as possible. This begs the question as to when they are going to stop being penny wise and pound foolish since stopping the complications must be cheaper than allowing them to happen.

    Whilst there is a clear necessity to look after T1s since the condition is life threatening I would argue that T2s should not be forced into taking a back seat until the inevitable complications make their condition also life threatening.

    The culture in the NHS needs to change now. There is free access to information via such assets as the internet and patients can now clearly see that one size does not fit all and that there are other options which are not being utilised to the benefit of both the users and the taxpayers. Patients who have gained knowledge and understanding through the modern mediums now know enough to distrust those who still maintain the old notions and old advice.

    It is difficult, however, to see how the NHS advice will change given the power of the pharmaceutical companies. They are the ones who fund the research to ensure a profitable market for their medication products so it is not really in their interests to promote the ‘exercise and diet’ way of controlling T2 condition and/or assisting control in T1 & T2 condition.

    The advice not to test is absolutely cost driven. The prices charged by the manufacturing companies might well be described as ‘criminal’ if all the facts and figures were in the public domain. It seems that we consumers are being used beyond what is reasonable, given that it is our health and lives at stake, merely to increase their profits. It is doubtful whether any of the new ways of testing will be allowed to come on stream and into the market place unless expensive consumables are put into the system to ensure large continuing profits.

    I was going to say that it might be helpful to all if patients were allowed to buy their testing strips through the NHS at cost price but this is what is actually happening through the prescription system to a certain degree at present - so why can that not be tweaked to make it possible for more people to test without it costing anyone the earth.

    It is a wonder that the NHS has not put its own testing systems and consumables in place so that it is not held to ransom.

    One can only hope that new brooms with pioneering ideas, attitudes and new ways of looking at things will be put in place to get a grip on the way in which our taxes are spent to the LONG TERM benefit of us all, patients and taxpayers alike.
     
  19. hanadr

    hanadr · Expert

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    Phoenix
    One point I was making is that the diet described in the Simpson paper, ISN'T what would be called high carb nowadays, since we don't,any more, count the indigestible carbs. We would probably call it a moderate carb diet, since it concentrates on beans and pulses.
    As to separating the components of wholefoods, That doesn't happen[hence the term "wholefoods". It's also why I can't tolerate some wholefoods such as porridge and brown rice. Both send my BG sky high.
    I do however bake bread with oatbran and soya protein and wheat gluten,with minimal starch in the bran, which is fine.It's a slight variation of Fergus's recipe.
    If I can use refined bran, so could Simpson et al If you read the complete paper, you will find the holes in it too.
    Hana
     
  20. sugarless sue

    sugarless sue · Master

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    Hana, your post is confusing. :roll:

    Do you mean you subtract fibre from the total carbs ??

    In the UK this is already the case so you would be subtracting and getting a falsely low number of carbs, or have I got it wrong ?
     
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