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Diabetes - Dietary and Lifestyle Recommendations
Diabetes - Dietary Recommendations

Healthy Eating and the Glycaemic Index

 

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Healthy Eating for Diabetes

Balanced, Healthy Eating

A healthy nutritional intake, providing a good mixture of nutrients reduces the risks of many illnesses such as cancer, stroke, constipation, tooth decay and being overweight. 
   

The Eat Well plate depicts the proportions of foods that make up a balanced diet.  This model forms the basis of nutritional advice for those with diabetes
   

Foods are divided into five main groups.  In order to eat a balanced diet, foods need to be eaten from these groups in the proportions shown.
 

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Breads, Other Cereals and Potatoes etc

     
 

Meals should be based on carbohydrate foods.  A food from this carbohydrate group to be eaten at each meal.

 
   

  This section includes all types of;

 
   

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bread, granary, multigrain, seeded, wholemeal and white

 
   

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brown and white pasta

 
   

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noodles and rice

 
   

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chapattis, pitta, tortilla or wraps

 
   

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couscous, polenta

 
   

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potatoes, plantain, yam and sweet potato

 
   

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breakfast cereals

 
         
 

Sources of carbohydrate include all of the foods in the Breads, Other Cereals and Potatoes group and some foods from the other food groups, such as;

 
   

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Fruit  
   

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Milk  
   

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Yoghurt  
   

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Sweet foods  
       
  Total carbohydrate can provide 45 – 60% of energy intake.   
     
   
 
 

Fruit and Vegetables

     
 

At least five portions from the fruit and vegetable group are recommended each day. 

 
   

 

 
 

One portion is equivalent to:

 
   

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1 medium fruit such as an apple or peach or orange or pear or banana

 
   

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2 small fruits such as satsuma or plums

 
   

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1 handful of grapes or cherries

 
   

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1 small glass of fruit juice*

 
   

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2 to 3 heaped tablespoons of vegetables

 
   

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A small bowl of salad.

 
   

 

 

 
 

Fresh, frozen, tinned or dried forms of fruit and vegetables count.

 
   

 

 
 

Any fruit or vegetables are suitable for a person with diabetes and are should be encouraged.

 
   

 

 
 

It is a myth that fruits such as bananas or grapes increase the blood glucose more than many other fruits if eaten in equal quantities.

 
   

 

 
 

People with diabetes may eat more than one of any type of fruit over the course of a day e.g. more than one banana may be eaten.

 
   

 

 
 

Fruit juices should only count once in the day towards the five portions. Fruit juices (including ’natural ‘ fruit juice) increase blood glucose quickly and as such are not an ideal choice for quenching thirst but small amounts with meals may be taken. Large volumes should be avoided.

 
   

 

 
 

Five a day is a minimum not a maximum.  Fruit or raw vegetables are a good choice for those requiring in-between meal snacks.  Another piece of fruit is preferable to a biscuit, which usually contains more fat and less of the vitamins and minerals found in fruit.

 
     
   
 
 

Meat, Fish and Alternatives

     
 

This section includes

 
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lean meat including chicken, lamb, pork and beef

 
   

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fish

 
   

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eggs

 
   

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vegetarian alternatives include soya bean curd, pulses such as beans, lentils and dhal, nuts and textured vegetable protein.

 
 

Include two to three times a day.

 
 

One serving is:

 
   

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60-90g (2-3oz) cooked lean beef, pork, lamb, mince, chicken, turkey or oily fish

 
   

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75-120g (2½ - 4oz) raw meat, poulty or oily fish.

 
   

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2 thin slices of lean cold meat

 
   

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150g (5oz) of cooked white fish or canned tuna.

 
   

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2 eggs.

 
   

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5 tablespoons of baked beans.

 
   

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4 tablespoons cooked peas, beans, lentils or dahl.

 
   

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120g (4oz) of soya, tofu or Quorn.

 
   

 

 
 

Oily fish such as mackerel, herring, sardines, pilchards, and trout are recommended once or twice each week.

 
       
 

Protein intake should not be greater than 1g per kg body weight per day for most adults with diabetes.  
       
 

Milk and dairy foods are also sources of protein.  
 

Meat, eggs, beans and pulses are good source of iron as well as fortified cereal, some leafy vegetable.

 
    See - Iron Fact Sheet  
     
   
 
 

Milk and Diary Foods

     
 

Milk, yoghurts and cheese are included in this section.

 
 

Good calcium sources

 
 

Include two to three portions a day

 
 

A portion is equivalent to

 
   

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A third of pint of milk (200ml)

 
   

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a small pot of low sugar / diet yoghurt (125g)

 
   

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30g cheese (small matchbox size).

 
 

Choose the lower fat options for healthier food choices  
  See - Calcium Fact Sheet  
     
   
 
 

Foods Containing Fat and Foods Containing Sugar

     
 
 

  Fatty Foods

  Sweet Foods

           
• cream • sweets  
• fried foods • cakes  
• chips • biscuits  
• pastry • puddings and desserts  
• pies • sugar  
• crisps      
• butter      
  • margarine      
• oils      
         
 
       
 

Sugar and fat should form the smallest part of the diet but do not have to be completely excluded by those with diabetes.

 
   

 

 
 

Vegetable fats, in particular monounsaturates such as olive oil and rapeseed oil are preferable to other fats. NB These are high in calories and should be used in moderation.

 
   

 

 
 

Minimise intake of fats such as those in butter, ghee or hydrogenated vegetable fats and trans fatty acids found in products such as biscuits, pastries and pies.

 
   

 

 
 

There is no need for a completely sugar free diet.

 
   

 

 
 

Solid sugary foods such as cakes, biscuits, puddings and chocolate do not increase the blood glucose more than the equivalent amount in carbohydrate of many simple starchy foods such as bread. 1 small bar of chocolate (30g) has the same effect on the blood glucose as 2 medium slices of bread but yields far more calories and fat. Therefore these types of food should be taken in small quantities.

 
     
   
 
 

Fluids

     
 

Encourage adequate fluid intake, average 6-8 cups daily or 1 to 1.5L daily.

 
 

 

 

 
 

This can be in form of tea, coffee, diet drinks, no added sugar squash, high fluid content foods such as watermelon, soup.

 
 

 

 

 
 

Tea and coffee can be sweetened by non-nutritive sweeteners. This will not increase blood sugars.

 
 

 

 

 
 

Diet and low calorie drinks do not increase blood glucose.

 
 

 

 

 
 

There is little evidence on moderate coffee consumption and blood sugar control.

 
 

 

 

 
 

Sugary drinks such as cola, lemonade and squash will increase blood glucose quickly.

 
 

 

 

 
 

Fruit juice will increase blood glucose quickly as sugary drinks so therefore limit to a small glass with a meal.

 
 

 

 

 
 

Care should be taken with beverages; some fruit waters have sugar added. A check on the ingredients list is sometimes useful. Less than 1gm carbohydrate / sugar per 100ml of prepared drink is acceptable.

 
 

 

 

 
 

Alcohol intake is not included in the fluids requirement

 
 

 

 

 
 

See - Alcohol Fact Sheet

 
     
   
Fibre
 

Fibre can be divided into two categories, soluble and insoluble.

 

 

 

 

Soluble fibre is found in oats, fruits, vegetables including beans and pulses. This type of fibre is beneficial for glycaemic control and lipid metabolism.

 

 

 

 

Insoluble fibre is found in foods such as wholemeal bread, brown rice, wholemeal pasta, high fibre breakfast cereals and wholemeal flour. These foods offer minimal benefits to glycaemic control or lipid metabolism. But as they have high satiety content they may assist weight loss, reduce inappropriate snacking which can impact on diabetes control, are rich in vitamins, are advantageous to bowel health including prevention of constipation.

 
   
Carbohydrate and Diabetes
 

Carbohydrate is one of the main nutrients and is an important source of energy. All eaten carbohydrates are broken down and absorbed into the blood stream into glucose. The total amount of carbohydrate consumed is a strong predictor of glycaemic response and monitoring total carbohydrate intake remains a key strategy in achieving glycaemic control.
For more information on which carbohydrate are bests and how much is needed to achieve a healthy diet. Please read the carbohydrate factsheet
 

 
See - Carbohydrate Factsheet  

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Glycaemic Index

 

Definition of Glycaemic Index ranks carbohydrate foods based on the rate at which they raise blood glucose levels. Each food is given a number or value. The GI can have value as a broad guide for food choices in term of stratifying foods into low, medium and high.

Glycaemic load is another method for ranking foods. This takes account the amount of the foods eaten as well as its glycaemic index. Both have their advantages and limitations.

 

Foods that break down quickly will raise blood glucose quickly,
and are given high GI values

 

Foods that break down slowly will raise blood glucose slowly,
and are given low GI values

 
           
• Lucozade

•

Granary, multigrain and seeded breads  
• Sugary drinks  
• Sweets • Wholemeal and white pasta  
• Fruit juices • Brown and white basmati rice  
    • Porridge, muesli  
    • Pulses, sweet potatoes  
         
Application of Glycaemic Index

Choice of foods based on glycaemic index can have benefits with exercise and sport.

Evidence exists for the benefits of increased consumption of low glycaemic index foods in the diets of obese and insulin resistant individuals (Hba1c reduction up to 6mmol/mol) including those with gestational diabetes.

Use of foods with a low glycaemic index may improve glycaemic swings in type 1 diabetes.

Foods with a high glycaemic index such as fruit juice and sugary soft drinks such as lemonade and cola are useful for treating hypoglycaemia.

Referral to a Dietitian is recommended for those requiring more detailed information of the application of glycaemic index.

Evidence does not exist for the sole use of low glycaemic index carbohydrates in those with diabetes. Glycaemic index principles should not divert attention away from other nutritional aspects such as total carbohydrate intake, fat content, portion control.

See - GI Factsheet

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Functional Foods
 

Stanols and Sterols

Daily consumption of foods fortified with plant sterols or stanols (2-3g/d) significantly improve total and LDL cholesterol for people with diabetes, irrespective of statin treatment. This may be recommended.

There is no evidence that higher doses are beneficial and a possibility that high intakes may induce undesirable effects.

Plant sterols may interfere with the absorption of fat-soluble vitamins and carotenoids such as ί-carotene. Pregnant and breastfeeding women and children under the age of five years should avoid these products.

For the reminder of the population a diet rich in fruit and vegetables should be taken to counterbalance any reduction in vitamins caused by the long-term consumption of plant sterol fortified foods.

They can be expensive. 1 pot cholesterol lowering yoghurt drink a day is equivalent of 2-3 g of plants stanols and sterols. If the cholesterol lowering spreads or other yoghurts are chosen, significant amount of those may be needed to achieve the recommended amount, which may mean having extra calories.

See - BDA Food Fact Sheet on Sterols

 

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Artificial Sweeteners

 

‘Diabetic’ Foods

‘Diabetic’ foods are not recommended. They still contain lots of calories. They are expensive, may cause diarrhoea and offer no benefits to an individual with diabetes.

 

Artificial Sweeteners

These are grouped into nutritive and non-nutritive sweeteners

Nutritive sweeteners include fructose and polyols such as sorbitol, maltitol, xylitol, Isomalt. They have a lower cariogenic and laxative effect but offer no further advantage over sucrose. They may cause diarrhoea. They still contain calories.

Fructose occurs naturally in fruit and there is no reason why an individual with diabetes should avoid any fruit.

Non-nutritive sweeteners licensed in the UK are aspartame, saccharin, acesulfame potassium (acesulfame K), cyclamate, stevia derivatives and sucralose. Only very small amounts are needed because they are so intensively sweet. They are virtually free of calories and do not affect blood glucose levels.

They are useful for sweetening beverages and are found in no added sugar and diet drinks.

Stevia product can be found with mixed of nutritive or non- nutritive sweetener. Checking food labelling is required.

There are guidelines on acceptable daily intakes (ADI) and those using many products with sweeteners are advised to use a variety of the different types.

 

For further guidance on ADI and safety

visit the Food Standards Agency website

Important note People with phenylketonuria must not use products, which contain aspartame.

Sugar is acceptable in baking and for those who like a regular intake of cakes and baked desserts or trying to reduce calories most recipes can be adapted to lower the sugar content.

 

Visit Diabetes UK for recipe ideas

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Useful External Links & Resources

View

Eat Well Plate

View

Diabetes UK

View

Food Standards Agency

PDF File

Alcohol Fact Sheet

PDF File

Iron Fact Sheet

PDF File

Calcium Fact Sheet

PDF File

GI Fact Sheet

PDF File

Carbohydrate Fact Sheet

PDF File

Nutritional Guideline

PDF File

BDA Food Fact Sheet on Stanols & Sterols
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