2018 Diabetes and Diet update

Jane McClinchyDietitian

University of Hertfordshire

And my collaborators Angela Dickinson and Wendy Wills

Content

• Research study –themes relating to sources, information and context.

• Diabetes UK Nutrition Guidelines update

• Low Carbohydrate diets what are they and are they any good?

Themes arising from study • Sources Theme

• Groups Rationing of education • Healthcare practitioners Variable experiences• Newspapers ’The first casualty is the truth’• Television ‘…more could be done’• Technology Wide range of sources

• Information• Recipes ‘…but is it good for me?’• Biomedical feedback ’..something to hang on to’• Food labels ‘I haven’t got a clue’

• Context• Christmas You must treat yourself!

• Diary experiences

2/11/2018Jane McClinchy Nutrition Information

Behaviour T2DM3

Groups-rationing of diabetes education

‘…there are some of us who've been offered it and some who haven't.’ (Gary interview).

Groups-rationing of diabetes education

(Theresa diary)

Healthcare practitioners-variable experiences ‘

I asked … can you give me a diet sheet or some

pointers, “no we don't do that anymore.”

(Jennifer interview)

HCPs-variable experiences

‘She went through everything. Words of one syllable

that I could understand, that [we] could understand,

we were making notes, and we came out feeling a

hundred percent motivated.’

(Christopher interview)

Newspapers- ‘the first casualty is the truth’

‘…they just do

that to sell copy.’

(Andrew

interview)

Television- ‘…more could be done’

‘…you know I get a lot of information either from the

media or I'll watch programmes like Horizon or

something like that just to find out information, but

those are more, they're informative rather than kind

of telling you what to do.’

(Lisa interview)

Technology –wide range of sources

(Yvonne diary )

Technology –wide range of sources

….she told me to go on the Diabetics.uk website on

the thingy but I'll tell you what, it scares the pants of

me. Especially if you're not 100% on, on what you're

reading, and what you're doing.

(Jennifer interview)

Recipes- ‘…but is it good for me?’

2/11/2018Jane McClinchy Nutrition Information

Behaviour T2DM12

(Theresa diary)

Recipes- ‘…but is it good for me?’

2/11/2018Jane McClinchy Nutrition Information

Behaviour T2DM13

…it was a chocolate cake one and various other

recipes, and some cookie recipes, and I thought, hang

on a minute… this is still talking about using sugar.’

(Susan interview)

Biomedical feedback –’something to hang on to’

(Ruth diary)

Biomedical feedback –’something to hang on to’

‘…it was my birthday recently. I decided I was having

cake on my birthday and I didn't care, but I decided. I

was in the frame of mind where I didn't want to be

overly naughty and I had a cream-filled bun, choux bun,

and it was just lightly drizzled with chocolate sauce,

thoroughly enjoyed it and the blood sugar, 1.5 up.’

(Frances interview)

Food labels- ‘I haven’t got a clue’

‘…you don't realise that sugar is hidden until you

start reading the food labels’

(Theresa interview)

Food labels- ‘I haven’t got a clue’

(Jennifer diary)

It’s Christmas, you must treat yourself!

(Theresa diary)

It’s Christmas, you must treat yourself!

[The adverts have] calmed down...

You don’t have them throwing roast dinner at you, a

full roast dinner round a table of sixteen people, and

trying to get you to buy all their cakes on a table, and

all their roast dinners with everything you could wish

under the sun…

(Theresa interview).

It’s Christmas, you must treat yourself!

I'm going to wait until after the Christmas period

because that's difficult. Christmas parties and events

and things like that you do tend to end up with

higher carbohydrate amounts, when you go to

restaurants and places like that.

(Matthew interview)

Diary experiences

(Ruth diary)

Diary experiences

I found it interesting actually it's made me, it's been

thought provoking, it's made me think about it …

(Christopher interview).

Diary experiences

(Frances diary)

Diary experiences

Theresa diary

Conclusion

Image 1 no known copyright, fruit bowl: http://jigsawpuzzles.online/1673/fruit-bowl; https://c1.staticflickr.com/6/5708/22083806881_6a1814503a_o.jpg; Tulips https://www.1800flowers.com/blog/flower-facts/holland-tulips-history-dutch-trade/Annheathen https://www.flickr.com/photos/annethelibrarian/with/33189455933/

Puzzling it out

Desolate information landscape Ordered information landscape

Puzzled out

Diabetes UK Nutrition Guidelines 2018

• Not one size fits all.

• Based on foods rather than nutrition.

• Based on YOUR food preferences.

• Eat MORE vegetables, fruits, wholegrains, fish, nuts and pulses.

• Eat LESS red and processed meat, refined carbohydrates and sugar sweetened beverages.

What is low carb?

Source: British Dietetic Association Low Carbohydrate Policy Statement

20 to 50g of carb ???2-3 of these per day

But small amounts of carbohydrate are in a lot of foods and so 20-50g is effectively none of these

20-50g Very Low Carb meal plan

• Breakfast: Fried egg, 2 rashers of bacon, grilled tomato and mushrooms

• Lunch: Mackerel salad (lettuce, tomato, mayonnaise)

• Snack: Almonds

• Evening meal: Roast chicken with carrots and broccoli followed by strawberries and cream

• Snack: Cheese

50-130 g Low Carbohydrate

Source: Diabetes UK

Includes some starchy carbohydrate

200g Moderate Carbohydrate

• Breakfast: Fruit, nuts and Yoghurt

• Lunch: Feta cheese salad with bread

• Snack: Fruit

• Evening meal: Mackerel with vegetables, lentils and rice followed by fruit

• Snack: Crackers

More fruit, and starchy carbohydrate

British Dietetic Association policy statement November 2018

• Low Carbohydrate (50-130g) can help with weight loss in type 2 diabetes

• But we don’t know how effective this is in the long term

• The very low carbohydrate diets especially may mean an increased consumption in saturated fat and we don’t know the long term effect of this

• Seek advice from a dietitian

https://www.bda.uk.com/improvinghealth/healthprofessionals/policy_statements/policy_statement_-_low_carbohydrate_diets_t2_diabetes

Questions?

• Research –themes relating to sources and Christmas

• Diabetes UK Nutrition Guidelines update

• Low Carbohydrate diets what are they and are they any good?

• Happy