Dave,
And there you have it, yes the course makes reference to the eatwell plate, what does the FSA say about the plate? Well
here it says the eatwell plate does
not include references to frequency of serving and ‘recommended’ portion sizes, other than in relation to fruit and vegetables – at least five portions of a variety a day – or fish – eat two portions a week, one of which should be oily
and goes on to say
The eatwell plate is intended as a tool suitable for use with most adults, and therefore it would be misleading to include specific frequency or proportion advice when people have individual requirements. However, registered dietitians, who work with individuals, should still tailor their advice in consultations based upon the individual's current diet and food preferences.
The BDA says, in its factsheet for people with diabetes:
What you eat or don't eat and your physical activity level are vital in controlling all these factors
and goes on to say
Include some carbohydrate foods with a lower glycaemic index at each meal
The way I read the information from both sources is that the eatwell plate is a good starting point, however because of our diabetes, we need to pay careful attention to the quantity and quality of carbohydrates we stuff into mouths. Which is what I meant when I said that I don't consider the NHS recommendations are as simplistic as eat loads of starches and consume less fat.
There have been too many posts on this forum where people have just been shown the eatwell plate and told to eat according to that with no discussion about changing the quality or quantity of carbohydrates, and that is what I mean by the recommendations have been badly delivered.
Far too often we see people reporting good HbA1cs who have been told that they are far too low and that the person should aim for a higher A1c. Which is arrant nonsense, it seems to me that whoever is passing that advice on isn't bothering to find out any information about the individual concerned. There appears to be an underlying assumption that a person with diabetes who has a normal or near-normal A1c must be experiencing some hypoglycaemic episodes. The fact that type 2s on diet alone or diet and glucophage may experience low blood glucose levels - but can recover from them by switching off insulin production - seems not to occur to some of our HCPs. The simple question, "Have you experienced any disabling hypos?", should be asked. To get someone to decrease their meds which by inference will raise the A1c is, I have to say, absolute madness.
I have to say here that I think that the NHS is at fault, the move of services to primary care means that some of us are dealing with GPs who have not had any specialist training in diabetes. Our GPs are following the NICE playbook which, it has to be said, leads them to treat patients in a general way rather than the truly unique individuals we are.
George
