A healthy diet and diabetes

By: Pamela Dyson Specialist Diabetes Dietitian Oxford and Radcliffe Hospitals NHS Trust

A He althy Diet and Diabete s

A Healthy Diet and Diabetes

This leaflet explains why a healthy diet is so important for the treatment of diabetes. It answers the question about what is a healthy diet and explains why you should eat healthily with diabetes. Healthy eating for people with diabetes is important because it can help: Maintain blood glucose control and thereby reduce the risk of complications Reduce the risk of cardiovascular disease and the tissue damage associated with high blood glucose levels Support management of body weight Maintain quality of life A healthy diet should include a wide variety of foods, not too many fatty and sugary foods, not too much salt and plenty of fibre-rich foods including fruit and vegetables.

Carbohydrates

People with diabetes are often encouraged to avoid sugary foods and eat plenty of starchy foods. It is worth remembering that all starchy foods are digested to form glucose and will raise blood glucose levels after eating. The main type of nutrient in food that affects blood glucose levels is called carbohydrate, often referred to as carbs. Carbohydrates are found mainly in starchy and sugary foods. Examples of foods containing carbohydrate are: Starchy foods including all types of bread, potatoes, pasta, noodles and rice. All breakfast cereals. Any product made with flour including pastry, pizza, crackers and baked goods. Dried peas and beans including baked beans and mushy peas. Sugary foods. Including cakes, chocolates, jams, squashes and fizzy drinks. Foods containing natural sugar. All fruit contains a natural sugar called fructose. Milk contains a natural sugar called lactose. Including some of these starchy foods is a useful way of providing your body with the essential energy that it needs. The challenge is to get the balance between meeting your energy needs and maintaining blood glucose levels.

Carbohydrate counting

Many people who have type 1 diabetes have adopted a system known as carbohydrate counting. This involves calculating the total amount of carbohydrate in a meal or snack and injecting insulin to match the amount eaten. Studies have shown that this system can improve blood glucose control and quality of life. Most diabetes centres in the UK offer these structured education programmes and if you would like to take part, see your diabetes health professional.

Glycaemic index (GI)

The GI diet is based on the fact that some carbohydrate foods cause more fluctuations in blood glucose levels than others. Many people find the concept of GI very challenging, but if you would like more details, there are books available, contact DRWF.

What about sugar?

Traditionally, many people with diabetes were advised to avoid sugar. This advice has been adapted as it is now known that small amounts of sugary foods will not have a large effect on blood glucose levels. If you are attempting to lose weight you would be advised to keep sugary foods to a minimum.

Sugar substitutes and sweeteners

There are five non-nutritive sweeteners licensed for use in the UK: aspartame, saccharine, acesulfame K, cyclamates and sucralose. These sweeteners have little effect on blood glucose levels. There are sugar substitutes available of which the best known are sorbitol and fructose. These substitutes do raise blood glucose levels and they provide as many calories as sugar, so are not recommended for weight loss. Sorbitol and similar sugars can cause a laxative effect if consumed in quantity.

Diabetic foods

Products labelled as suitable for diabetics are generally not deemed necessary to use as they are usually more expensive and can have a laxative effect. If you like chocolate or cake, small amounts can be included as part of a healthy diet.

Top tips for healthy eating

Five a day
See Figure 1

Many people are aware that they should be eating five or more portions of fruit and vegetables daily for good health. There is growing evidence that people who eat plenty of fruit and vegetables have a reduced risk of heart disease and cancer. You should try to eat a variety of fruit and vegetables; aiming for at least five portions a day. Fresh, frozen, canned, juices and dried fruit and vegetables all count towards a portion. A portion is equivalent to 80 grams (about 3 ounces). Potatoes are classed as starchy foods and do not contribute to fruit and vegetable intake. Remember fruit contains natural sugar and will raise blood glucose levels, but most vegetables, especially green vegetables, will have a minimal effect on glucose levels.

Lower your risk of heart disease

People with diabetes have a higher risk of heart disease and stroke, and diet can play a part in reducing this risk. The main parts of the diet that affect heart health are fat and salt. Low fat Fat, and especially saturated (animal) fat should be reduced and this can be done by: Grilling, steaming, boiling, casseroling and dry-roasting food rather than frying or roasting in added fat Including less fat in foods by reducing the amount of cream, salad dressings, grated cheese, sauces, butter, margarine or oil added to recipes Pastries, pies, processed and convenience foods are high in fat, cut them down Substituting lower fat versions of high fat foods e.g using half-fat Cheddar. Low salt In addition to high fat intake, high salt intake is also a risk factor for heart disease. People who have a lot of salt in their diet are more likely to have high blood pressure, which increases the risk of heart disease. The most effective way to reduce salt intake is to try to cut out as many processed foods as possible.

Up your omega 3 oils

Figure 2

Studies have shown that people who eat a lot of oily fish such as mackerel, and sardines have lower rates of heart disease. The kind of fat found in oily fish is known as omega 3. Try to eat at least two servings of oily fish per week. See

Figure 1 Eat a rainbow of fruit and vegetables to get your five-a-day.

Figure 2 Studies have shown that people who eat a lot of oily fish have lower rates of heart disease.

Stay i ng w e l l unt i l a cur e i s found . . .

Lower alcohol intake
Department of Health advice on safe drinking applies to all. Men should have no more than 3 units a day, and women 2 units daily. There is often some confusion about how much alcohol constitutes a unit. Here is a rough guide: A pub measure of spirits (25ml): 1 unit Half a pint of ordinary strength beer, lager or cider (4%): 1 unit 1 small bottle (330ml) strong beer, lager or cider (5%): 1.5 units 1 small bottle (330ml) extra strong beer, lager or cider (6-7%): 2 units 1 medium glass (150ml) wine: 2 units It is advisable to drink alcohol with or after foods containing carbohydrate. Alcohol is high in calories and can raise blood pressure, so keep drinking to a minimum. Also, remember that alcoholic drinks containing large amounts of sugar will raise blood glucose levels.

More information
Adopting a healthy diet can help you manage your blood glucose levels, maintain a healthy weight and reduce the risks of cardiovascular disease and cancer. But remember, its not all about the food you eat - activity can help with weight and diabetes management. A wealth of information is available from the Foods Standards Agency. Their main website is: http://www.food.gov.uk/ They also have a website which specifically focuses on a healthy diet: http://www.eatwell.gov.uk/ And salt: http://www.salt.gov.uk As someone with diabetes you are entitled to a consultation with a dietitian, speak to your GP or diabetes healthcare professional.

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Staying Well Untila Cure is found...

The Diabetes Research & Wellness Foundation works towards educating, informing and reminding you of the best and healthiest choices to make. Contact us to join the Diabetes Wellness NetworkTM and request the full series of patient information leaflets.

Source references can be provided on request. All details correct at time of print.

V2.0 published: May 2011 Due for review: July 2012 Printed by Holbrooks Printers Ltd. Portsmouth, Hampshire, UK