New NICE Guidelines for Diabetes
This week the National Institute for Clinical Excellence (NICE) has finalised its advice for Type 2 Diabetes. With regards to the diet advice in this new guideline, it is disappointing that the new research on low carbohydrate diets have not been given due credit as another tool available in the management of diabetes.
Confusion in terminology
The common misconception that if a diet is low in carbohydrates than automatically it will be low in fibre and low in micronutrients which are essential for daily living. This however is not true. A quick glimpse at a well designed low-carb meal plan, one can see that it is balanced, natural, low in trans-fat, low in sugar and low in salt. It also provides omega 3 and 6, and essential amino acids. It is full of food containing antioxidants, vitamins, minerals, as well as fibre.
So, what advantages are there to following a low carb ketogenic diet for diabetes management?
- Research shows that this way of eating is beneficial and is an effective method to help manage and prevent diabetes. (please see references below)
A number of dietary intervention studies have compared the effect of carbohydrate restriction (minimising the amount of sugars and starches in one's diet) and its effect on blood sugar levels when compared to a low fat low calorie diet - the standard dietary prescription for diabetic individuals. In all these studies, carbohydrate restriction came out as the clear winner showing it to be the more effective dietary treatment for the management of diabetes.
In the UK, the SIGN (2010) guidelines have now acknowledged the safe use of low carbohydrate diets for the treatment of diabetes in the short term. Whilst in 2013 the American Diabetes Association (ADA) recognised that carbohydrate restriction is indeed a viable therapy for the management of diabetes
The key points of these studies include:
- A low carbohydrate lifestyle dramatically lowers both fasting blood glucose levels and glycosylated haemoglobin levels (HbA1c).
- A low carbohydrate lifestyle can offer a reduction in, or complete elimination of, all types of anti-diabetic medications.
- Individuals with diabetes experienced a greater overall improvement in Quality of Life (QOL) following a low carbohydrate lifestyle.
- It lowers inflammation levels in individuals suffering from diabetes.
- Research has also shown that this way of eating can help with losing and managing weight.
Insulin is extremely good at instructing our fat cells to store energy and to not release it. So how do you get your body to use its fat stores for energy?
The answer to this is keep insulin spikes to a minimum. Low levels of insulin in the blood will allow other metabolic hormones such as glucagon to instruct the fat cells to release stored fat for energy. In doing so, your body will switch to using mainly the energy being released from your fat stores. This process is known as dietary ketosis, and it is via dietary ketosis that you are ensuring that your body is using stored body fat for fuel whilst preserving muscle mass.
- This way of eating is an efficient way of meeting your vitamin and mineral requirements as it is based on real foods which are naturally nutrient dense.
A well formulated ketogenic meal plan, one can notice that it is balanced, natural and low in sugar. It also provides omega 3 and 6 fatty acids as well as essential amino acids. It is full of food containing antioxidants, vitamins, minerals, and most importantly dietary fibre to ensure minimal blood sugar spikes in the progress and optimal gut health as well.
- A low carb ketogenic way of eating is a lifestyle and not a quick fix. Change your habits and you’ll start seeing the benefits.
Start by looking at the items in your shopping basket. Processed foods are very easily digested and do not require a lot of effort whilst green vegetables, nuts and meat require a lot more energy to be properly digested and generally provide much better amounts of vitamins, minerals and nutrients, both for your body but also for your gut bacteria.
Hence, base your meal choices around dietary fibre options such as lovely green vegetables and berries for those mighty antioxidants. Choose full fat dairy options as these contain fat-soluble vitamins that our body needs for optimal function.
Stay away from items that say low in sugar and low in fat, these will have artificial additives added to them and have little to no nutrient content. Base your food choices on quality rather than quantity.
The Natural Low Carb Store
The Natural Low Carb Store way of doing things is quite simple. We promote a low-carb, high-protein, moderate-fat diet. Although we are in the same school of thought as Atkins, our approach to diet and lifestyle is different.
It is not only about being healthy but also about making the right choices. Feel free to get in touch with us if you have any further questions. We’ll answer any questions you have and help you make an informed decision.
Medical Disclaimer: This blog is provided for your information only and may not be construed as medical advice or instruction. No action or inaction should be taken based solely on the contents of this blog. Readers should consult appropriate health professionals on any matter relating to their health and well-being.
Boden G, Sargrad K, Homko C, Mozzoli M, Stein TP. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Annals of Internal Medicine, 2005, 142: 403–411
Daly M.E, Paisey R, Millward B.A et al. Short-term effects of severe dietary carbohydrate-restriction advice in type 2 diabetes-a randomized controlled trial. Diabetic Medicine, 2006, 23: 15-20.
Dyson P.A., Beatty S., & Matthews D.R. A low-carbohydrate diet is more effective in reducing body weight than healthy eating in both diabetic and non-diabetic subjects. Diabetic Medicine, 2007, 24: 1430-1435.
Feinman, R., Pogozelski, W., Astrup, A., Bernstein, R., Fine, E., Westman, E., Accurso, A., Frassetto, L., Gower, B., McFarlane, S., Nielsen, J., Krarup, T., Saslow, L., Roth, K., Vernon, M., Volek, J., Wilshire, G., Dahlqvist, A., Sundberg, R., Childers, A., Morrison, K., Manninen, A., Dashti, H., Wood, R., Wortman, J. and Worm, N. (2015). Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base. Nutrition, 31(1), pp.1-13.
Gardner CD, Kiazand A, Alhassan S, Kim S, Stafford RS, Balise RR, Kraemer HC, King AC: Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. JAMA 2007, 297(9):969-977.
Gibson, A., Seimon, R., Lee, C., Ayre, J., Franklin, J., Markovic, T., Caterson, I. and Sainsbury, A. (2014). Do ketogenic diets really suppress appetite? A systematic review and meta-analysis. Obes Rev, 16(1), pp.64-76.
Guldbrand, H. et al., 2012. In type 2 diabetes, randomisation to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss. Diabetologia, 55(8), pp.2118–2127.
Guldbrand, H., Lindström, T., Dizdar, B., Bunjaku, B., Östgren, C., Nystrom, F. and Bachrach-Lindström, M. (2014). Randomization to a low-carbohydrate diet advice improves health related quality of life compared with a low-fat diet at similar weight-loss in Type 2 diabetes mellitus.Diabetes Research and Clinical Practice, 106(2), pp.221-227.
Jenkins, D.J.A. et al., 2008. Effect of a low-glycemic index or a high-cereal fiber diet on type 2 diabetes: a randomized trial. JAMA: the journal of the American Medical Association, 300(23), pp.2742–2753.
Jonasson, L. et al., 2014. Advice to follow a low-carbohydrate diet has a favourable impact on low-grade inflammation in type 2 diabetes compared with advice to follow a low-fat diet. Annals of medicine, 46(3), pp.182–187
Mayer, S., Jeffreys, A., Olsen, M., McDuffie, J., Feinglos, M. and Yancy, W. (2013). Two diets with different haemoglobin A1c and antiglycaemic medication effects despite similar weight loss in type 2 diabetes. Diabetes Obes Metab, 16(1), pp.90-93.
Nuttall, F., Almokayyad, R. and Gannon, M. (2015). Comparison of a carbohydrate-free diet vs. fasting on plasma glucose, insulin and glucagon in type 2 diabetes. Metabolism, 64(2), pp.253-262.
Rossi M, Turati F, Lagiou P, Trichopoulos D, Augustin LS, La Vecchia C, Trichopoulou A .2013. Mediterranean diet and glycaemic load in relation to incidence of type 2 diabetes: results from the Greek cohort of the population-based European Prospective Investigation into Cancer and Nutrition (EPIC). Diabetologia.56(11):2405-13
Saslow, L.R. et al., 2014. A randomized pilot trial of a moderate carbohydrate diet compared to a very low carbohydrate diet in overweight or obese individuals with type 2 diabetes mellitus or prediabetes. PloS one, 9(4), p.e91027.
Tay, J., Luscombe-Marsh, N., Thompson, C., Noakes, M., Buckley, J., Wittert, G., Yancy, W. and Brinkworth, G. (2015). Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial. American Journal of Clinical Nutrition, 102(4), pp.780-790.
Unwin, D. and Unwin, J. (2014). Low carbohydrate diet to achieve weight loss and improve HbA 1c in type 2 diabetes and pre-diabetes: experience from one general practice. Practical Diabetes, 31(2), pp.76-79.
Yamada, Y. et al., 2014. A non-calorie-restricted low-carbohydrate diet is effective as an alternative therapy for patients with type 2 diabetes. Internal medicine , 53(1), pp.13–19.