A series of infographics depicting the glycaemic response to common foods as the equivalent teaspoons of table sugar has had its National Institute for Health and Care Excellence (NICE) endorsement removed because it ‘infers support for low carb diets’.

The infographics were devised by Dr. David Unwin, Royal College of GP’s Expert in Type 2 Diabetes and Obesity and NHS Innovator of the Year 2016 alongside Dr. David Haslam, Chair National Obesity Forum, Luton University Hospital, United Kingdom and Dr. Geoffrey Livesey, Royal Society of Medicine, United Kingdom. 

The infographics provide a visual representation of the glycaemic index of common foods in terms of teaspoons of sugar equivalent. The infographics were published in the peer-reviewed journal, the Journal of Insulin Resistance.

The infographics are used as teaching aids by GPs with patients diagnosed with type 2 diabetes or prediabetes in the UK and around the world and have been translated into Russian, Arabic and Polish. 

For many patients, this visual aid has resulted in a greater understanding of how certain foods can impact on blood sugar readings and how their reduction or omission from a diet can result in significant improvements in blood sugar control.  

An excerpt from Dr David Unwin’s peer-reviewed publication reads that it “is possible that a teaspoon of glucose might achieve a similar goal; however, patients perceive the importance of table sugar more readily and are without confusion about what glucose is. It should be pointed out to patients that table sugar contains fruit sugar (fructose) as well as glucose, and fructose has health concerns all of its own when consumed in excess.”

NICE seeks to improve outcomes for people using the NHS and other public health and social care services by providing national guidance, advice, and recommendations. 

NICE guidelines for Type 2 diabetes in adults recommend that patients are encouraged to eat “Encourage high‑fibre, low‑glycaemic‑index sources of carbohydrate in the diet, such as fruit, vegetables, wholegrains and pulses; include low‑fat dairy products and oily fish; and control the intake of foods containing saturated and trans fatty acids.”

The infographics were endorsed by parliamentary ministers and were shortlisted for the NICE Shared Learning Awards in 2019 for using a clearer explanation of the glycemic index for type 2 diabetes to improve results and save money. 

The infographics that have been used by patients and health care professionals help patients make more informed food choices and identify low-glycemic-index sources of carbohydrate. The infographics had been endorsed by NICE since 2018 but were removed from the NICE website earlier in August.

A Freedom of Information request available here demonstrates NICE removed the infographics after receiving an email informing them that the infographics were not evidence-based and threatening that “If you don’t give a full and relevant statement that doesn’t simple [sic] reiterate what we have set out to be inaccurate and misleading advice, we will FOI you, and also highlight the fact you have been obstructive. It may not come to that, depending on your response.”

Neither Dr. David Unwin nor his fellow co-authors on the infographics were provided an opportunity to respond to the NICE endorsement removal.

NICE’s revocation was confirmed in a letter that stated endorsement was given in “error” and “failed to take into account the conclusion others could make that the resource implies support for a low carbohydrate diet.” 

In a statement, Dr. David Unwin said “The infographics represent the glycemic index and are evidence-based visual representations of the glycemic index. They have been very helpful in supporting dietary choices by my patients and primary care patients.”

“Cutting carbs and sugar is helpful and people, particularly those diagnosed with type 2 diabetes and prediabetes, should be aware of that.” 

A petition requesting the reinstatement of Dr. David Unwin’s sugar infographics as a NICE endorsed resource has been launched by Public Health Collaboration and has amassed over 4,500 signatories.

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