Chewing the fat: a review of Diabetes UK’s 2018 nutrition guidelines

Jack Woodfield
By Jack Woodfield
19th March 2018
In Depth, Opinion
 
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The Diabetes UK nutrition guidelines for people with diabetes have been updated, and there is no shortage of talking points.

Chief among the positives are the recommendations to restrict carbohydrate intake, a significant moment for Diabetes UK following years of advocating moderately high carb consumption, with the charity recognising that limiting carbs, particularly those refined, can help people achieve remission from type 2 diabetes.

The guidelines, which were presented at the Diabetes UK Professional Conference 2018, also acknowledge that “one size of diet does not fit all”, and dietary advice needs to be tailored to account for differences between individuals, particularly among ethnic minorities.

However, the issue of fat remains pertinent and divisive. At Diabetes.co.uk we are advocates of eating a low carb diet alongside healthy fats, with an array of studies illustrating how low fat dieting is not only ill-advised, but also plausibly quite dangerous. Diabetes UK has maintained its stance that low fat is preferred to high fat foods, and persists in recommending people with diabetes avoid saturated fat, irrespective of food source.

The 114-page document covers a formidable amount of research, with more than 500 scientific studies analysed by a team of researchers from Oxford University alongside Diabetes UK and while, on one hand, there is much to admire about the progress these new guidelines have made, it is unfortunate that the charity’s stance on fat remains rooted in the 1980s.

Chewing the fat

Long-time Diabetes.co.uk readers will likely be aware that in recent years numerous researchers have debunked the 1980s dietary guidelines introduced in the UK. Leading nutritionist Dr Zoë Harcombe is the one of the prominent voices in this field, and she has alluded to alarming figures revealing rising rates of obesity and type 2 diabetes can be traced back to the origins of the low fat guidelines.

In these new guidelines, the first major nutritional update Diabetes UK has made since 2011, there is a focus on eating low fat dairy products, particularly yoghurt and cheese, as a means of preventing type 2 diabetes from developing. Reducing saturated fat is also advised.

This anachronistic advice refers back to the 1980s guidelines which claimed saturated fat increased the risk of heart disease. Since then no long-term studies have indicated any harms from eating high fat dairy products.

Any food that contains fat, such as dairy, comprises not just saturated fat but also monounsaturated and polyunsaturated fat. There are a number of studies which suggest a protective effect of saturated fat from dairy products, while full fat has shown to improve cholesterol levels and even improve heart health when compared to low fat.

Moreover, there is the salient issue of what encompasses low fat dairy. If the fat is being removed then what replaces it? Quite often it is starch and/or sugar, and this is counterproductive for people with diabetes. Tesco’s Half Fat Crème Fraiche, for example, compensates for the extraction of fat by stabilising it with tapioca starch and pectin, an ingredient in gelling sugar. Per 100ml, Tesco’s low fat version contains almost 50% more carbs than its full fat version.

This occurrence is far from isolated to Crème Fraiche. A systematic comparison of sugar content in low fat vs. regular versions of food in 2016 reported “that food that is lower in fat may contain more sugar”.

The consistent low fat advocacy of the new Diabetes UK guidelines is therefore particularly disappointing.

Focus on food

Blueberries are among the fruits Diabetes UK recommends to ward off the risk of type 2 diabetes

Interestingly, the updated guidelines are the first to specify which foods could help to ward off type 2 diabetes, with a focus on weight loss, lowering obesity rates and the foods which can help and hinder this progress.

Among the recommended foods include wholegrains, fruit (particularly apples, grapes and blueberries), green leafy vegetables, low fat dairy, tea and coffee. Foods in the ‘avoid’ list include red and processed meat, potatoes (especially chips), sugary drinks and refined carbohydrates such as white bread and white rice.

This eclectic mix of carb quantities is baffling. Berries, green leafy vegetables, tea and coffee are objectively reasonable recommendations, and all highly promoted in our Low Carb Program, but wholegrains, apples, grapes can all contain higher carbs, negating Diabetes UK’s moderate advice to lower carb intake as a means of regulating blood sugar, and thereby directly recommending people with diabetes consume foods which could elevate their blood sugar.

However, the foods listed in the ‘avoid’ category are reassuring, aside from red meat and high fat dairy, and will inexorably serve to improve people’s health.

Remission

A theme of tremendous encouragement is Diabetes UK’s acknowledgement that type 2 diabetes can be put into remission. Referencing the 2017 Diabetes Remission Clinical Trial (DIRECT) where 46% of patients with type 2 diabetes achieved remission having followed a very low calorie liquid diet of around 850 calories a day for 3-5 months, the charity highlighted the benefits of diet and weight loss.

Talking at the Diabetes UK Professional Conference, Dr Pamela Dyson, research dietician at Oxford University and co-chair of the guidelines, said: “Based on these results, it is possible to say that in patients with newly diagnosed [type 2] diabetes, there is around a 50% chance of remission, if this low calorie diet is followed.”

Diabetes UK is not completely convinced of one particular diet as a means of treating type 2 diabetes. Whilst it admits the low carb has generated a remarkable following, the charity identifies a variety of diets which have yielded success.

“There’s a whole raft of different strategies and no one magic diet, but there is a way of eating that suits your life, family, and culture, and it could be a Mediterranean-style, low-glycemic, or low-carb diet,” added Dr Dyson. “They all work, so we need to give people the choice.”

Tailored interventions

A pertinent reason Diabetes UK has steered clear from advocating one specific diet is explained in their information regarding ethnic minorities.

Diabetes UK is not completely convinced of one particular diet as a means of treating type 2 diabetes. Whilst it admits the low carb has generated a remarkable following, the charity identifies a variety of diets which have yielded success.

The guidelines consider that ethnic minorities tend to have cultural barriers that limit access to healthcare, and due to variances in advice on prevention or management, tailoring advice based on multi-component lifestyles is pivotal.

Louise Goff, PhD, senior lecturer, King’s College London, UK, who was also speaking at the Diabetes UK conference, said: “Diabetes is diagnosed on average 10 to 12 years earlier in Afro-Caribbean and South Asian populations. Around 30% of South Asian patients with diabetes are under 40 years old, compared with 9% of white European patients. South Asians and Afro-Caribbean patients are living for a long time with type 2 diabetes.

“Evidence suggests that culturally sensitive programs…ultimately improve patient outcomes, and diabetes prevention programs have been shown to improve engagement and be effective in ethnic minority groups, but there is a paucity of them in the UK.”

One example of these guidelines is a section which provides details of diabetes management during Ramadan.

What else?

Other recommendations and key notes include:

  • People at risk of type 2 diabetes should aim for at least 5% weight loss, where appropriate
  • Those at risk of type 2 diabetes should strive to lose weight and increase their daily physical activity and exercise levels
  • The focus among dietitians should be in terms of ‘foods’ rather than nutrients, wherever possible.
  • The guidelines were prepared earlier than normal, usually a 10-year gap, due to the wealth of data and diabetes research published in recent years
  • The guidelines also cover education and care delivery, glycemic control for type 1 and type 2 diabetes, cardiovascular disease risk management and management of diabetes-related complications for adults and children with diabetes
  • Because people with type 2 diabetes are living longer and experiencing more health complications, eating a healthy diet is of the upmost importance

What do you think?