Eating well with diabetes – what should you do? – by Douglas Twenefour


i logo 80x80When it comes to food, we could talk all day. The media love a foodie fad, and it’s not unusual to see some new trend or superfood splashed across our papers each week.

But when it comes to food and diabetes – what’s the deal? What should you be eating? What shouldn’t you be eating?

We sometimes hear claims that Diabetes UK is against a low-carb diet. This is not true. We understand personal preferences and that different diets work for different people. We hope this blog explains our thoughts on diets like the low-carb diet and highlights why we prioritise the humble healthy, balanced diet as our general message.

Whether you have Type 1 or Type 2 diabetes, eating well can help you manage your diabetes and reduce the risk of health complications. But there isn’t a one-size-fits-all approach. What works for Mr X, won’t work for Mrs Y or Miss Z. But it could work for Miss A. And that’s the nature of diabetes in general – even though certain aspects can be generalised, many are hard to predict and it’s very personal.

This makes it difficult to suggest a single dietary approach that will help everyone manage their diabetes.

At this point it’s important to highlight that most of the research around diets for people with diabetes use studies with people who are trying to lose weight and tend to include people with Type 2 diabetes. This means that the results of these studies may not apply to people of a healthy weight.

Is the low-carb diet right for you?

The amount of carbs we eat has the biggest effect on our blood glucose (blood sugar) levels after eating. If you have Type 1 diabetes, it is crucial to know the amounts of carbs you are eating at each meal, so that you can match these correctly with insulin doses. Carb awareness is also important for people with Type 2 diabetes, especially those who are on insulin and/or medications that put them at risk of hypos.

For people with diabetes who need to lose weight there are lots of suggested diets, including the low-carb diet. These have been reviewed and tested in head-to-head studies to see which diet really is best. But the long-term results are very varied and inconsistent.

What we can say from these studies, is that the best diet for an individual tends to be the one that they can stick to in the long term.

Diabetes UK is not against diets such as the low-carb diet. The low-carb diet is one of the many diets that we have reviewed in our nutritional guidelines to healthcare professionals so that they can support people with diabetes who want to try it.

If someone with Type 2 diabetes needs to lose weight, we know that the low-carb diet can be an effective way to do this and control blood glucose. If you have Type 1 diabetes, while there is not much published evidence for the low-carb diet in Type 1, we are aware of anecdotal reports from people with Type 1 diabetes who have reduced their carb intake to control their blood glucose levels, reduce their insulin doses or lose weight.

If you’d like to try a diet pattern such as the low-carb diet, we strongly recommend that you speak to your healthcare team. This is because, for many people, a low-carb diet will require support to adjust diabetes medication and will need more frequent blood glucose testing. Also, people who already have diabetes complications such as kidney disease may need to follow extra cautionary advice not to increase their intake of certain nutrients such as protein.

In some cases, following a low-carb diet may also be unnecessary. For people who are underweight and need to gain weight, especially the elderly with poor appetite or younger people with Type 1, the priority may be to eat more of the foods you like, rather than cutting out certain food groups. This could mean eating more fats, protein and carbs. If this applies, your diabetes team can help you make sure you are getting enough calories from your diet and adjust your medications to control your blood glucose levels.

So why does Diabetes UK only talk about a healthy, balanced diet?

To support as many people with diabetes as we can, the food advice we give is based on evidence that is widely accepted as being effective and safe long term. There is lots of research showing that a diet low in saturated fat, salt and sugar is beneficial to health. We also know that a healthy, balanced diet will apply to, be easier to understand, and help the majority of people with diabetes.

This doesn’t mean that we don’t recognise other approaches like low-carb and very low-calorie diets, which also have evidence for being effective. We believe that to safely follow these diets a healthcare professional should be involved, and for this reason our communications about these diet patterns (PDF, 71KB) are directed at healthcare professionals, rather than directly to people with diabetes.

For long-term health, our recommendation is to look at your overall diet rather than focus on any single nutrient, like carbs, alone. Carbs are important because the amount you eat has an immediate effect on your blood glucose levels but it is important to remember that managing diabetes means more than keeping your blood glucose levels under control. In fact, managing diabetes often means managing blood pressure and blood cholesterol as well. This is because these factors are linked with many of the diabetes health complications that we are trying to avoid, such as heart disease. Following a healthy, balanced diet helps to keep these factors on target, reducing the risk of any complications.

To help people follow a healthy, balanced diet we have developed Enjoy Food. It provides practical tips and recipes to help people make simple changes to their current diet to improve their diabetes management.

So are Diabetes UK recipes not low-carb?

We recognise individual preferences. That’s why we have provided a wide range of recipes with different macronutrient mixes in our Recipe Finder, to help people make informed choices.
We currently have more than 90 recipes that contain less than 30g of carb per portion, with about 20 recipes that contain less than 5g carbs per portion, so there is plenty of choice for people who want to follow a low-carb diet.

As a diet containing less than 130g carbohydrate per day is classified as low-carb, it is also possible for some people to have a meal from a supposedly ‘high-carb’ recipe, but modify the rest of their meals during the day to achieve a total daily carbohydrate intake that is still classified as low-carb. We also expect that people can tweak some of the recipes to meet their individual needs and nutritional goals.

If you have any questions, please email us at enjoyfood@diabetes.org.uk.

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