Healthy eating in diabetes

Why is healthy eating important?

Healthy eating is recommended to all, not just those with diabetes, to help maintain a healthy weight and reduce your risk of high blood pressure and high cholesterol. It can also help to reduce your risk of developing coronary heart disease and some cancers. Eating healthily has many other benefits too. You may find you sleep better, have more energy and better concentration – this all adds up to a healthier happier you!

What is healthy eating?

There are no single foods you must eat or menus you need to follow to eat healthily. All foods can be included in a healthy diet. You just need to make sure you get the right balance.

NHS Eatwell guide (opens in a new tab)

The “Eatwell Guide” shows how much of each food group you should eat to achieve a healthy and balanced diet. This covers everything you eat and drink during the day, including snacks.

For a balanced diet, you should try to eat:

• at least five portions of fruit and vegetables daily
• some bread, rice, potatoes, pasta and other starchy foods – choose wholegrain varieties whenever you can
• some dairy or dairy alternatives
• some beans, pulses, fish, eggs, meat and other plant-based sources of protein
• small amounts of unsaturated oils and spreads
• less often and in small amount foods and drinks high in fat and/or sugar and salt

You don’t need to always get the balance right at every meal, but try to get it right over a longer time such as a whole day or week. Try to choose foods that are lower in fat, salt and sugar where you can.

Fruit and vegetables

Fruit and vegetables are an excellent source of fibre, are low in fat and are packed with vitamins and minerals. They are high in anti-oxidants which help reduce risk of heart and circulatory disease and certain cancers.

We should aim to eat at least five portions of fruit and vegetables per day. A portion is 80g of fresh, frozen or tinned fruit in their own juice or vegetables. For dried fruits 30g is a portion.

Remember:

• Fruit can cause a rise in your blood sugars so portion size is important.
• One portion of fruit can be eaten mid meal as a snack. A portion of fruit is about a handful e.g. one small apple, two small plums.
• More than one portion of fruit may cause your glucose levels to rise above the target range.
• If you are on multiple daily injections of insulin, you can cover extra fruit eaten, i.e. more than one piece as a snack or at a meal, with additional quick acting insulin – discuss this with your diabetes team.

Bread, rice, potatoes, pasta and other starchy foods

About a third of your diet should be starchy carbohydrate foods. This food group is our body’s main energy source and should be a part of all meals.

Choose higher fibre wholegrain varieties when possible – they contain more fibre, vitamins and minerals and provide energy that is released slowly, making you feel fuller for longer and less likely to snack in-between meals.

Dairy and dairy alternative foods

This food group includes dairy products such as milk, cheese, yoghurt and fromage frais and dairy alternative products such as soya milk and yoghurt. These products are an important source of protein, calcium and some vitamins.

Some dairy products affect blood glucose levels – milk (milk in tea and coffee has only a small effect on glucose levels), yoghurt and fromage frais. Aim for recommended portion sizes- no more than three portions of these foods daily with a portion being a small glass (200ml) semi- skimmed or skimmed milk or four tablespoons low- fat natural yoghurt. The fat content varies a lot between different foods in this group. Choose low fat versions where possible – this will mean you can benefit from their protein, calcium and other nutrients, but have less fat to go with it.

Certain dairy alternatives can also affect blood glucose levels. Choose unsweetened options and stick to recommended portion size (a portion is one small glass (200ml) alternative milks).

Beans, pulses, fish, eggs, meat and other plant-based sources of protein

You should eat two-three portions of protein rich foods a day. Protein is important for your body to work properly and these foods will provide you with vitamins, such as B12, and minerals including iron and zinc as well.

Aim for at least two portions of fish every week, one of which should be oily, such as salmon and mackerel. Choose lean cuts, mince and reduce intake of red and processed meat.

As well as eating meat and fish, try alternatives such as eggs, nuts or pulses such as peas, beans, lentils and seeds, Quorn® and tofu.

Food and drinks high in fat and / or sugar

This group includes cakes, crisps, sweets, pastries, chocolate, fizzy drinks and alcohol. These tend to be the foods we need to cut down on. While they can be included in a balanced diet, they are not essential.

You should aim to avoid or have small amounts of foods in this food group – swap them for healthier versions or keep them for special occasions only.

Cutting down on fat

There are several different types of fat and choosing the right type is also important for your health.

It is important to remember that all fats have a similar amount of energy, so while olive oil may be a healthier choice, it has the same calories as other oils and so may still cause weight gain. The quantity matters!

Top Tips for cutting down on fat:

• Cut down on high fat snacks (crisps, chocolate, biscuits, pastries).
• Change to low fat dairy products (semi-skimmed milk or skimmed milk, low fat yoghurts).
• Buy lean meats and avoid processed meats (sausages and bacon).
• Remove the skin and visible fat from meats before cooking.
• Try baking, boiling, steaming, poaching and microwaving foods rather than frying.
• Measure oils with a teaspoon or use spray oil rather than pouring it straight from the bottle.
• Spoon off fats and oils from casseroles and curries.

Top Tips for cutting down on sugar:

• Choose ‘diet’, no added sugar or unsweetened versions of fizzy drinks, squashes, fruit juices and dairy alternatives.
• Try swapping a high sugar cereal for one that is lower in sugar such as porridge, whole-wheat cereal biscuits or wholegrain cereals.
• Watch for savoury dishes that are high in sugar: sweet and sour sauces, sweet chilli dishes and some curry sauces and salad dressings.
• Reduce consumption of biscuits, cakes, chocolate and sweets.

Artificial sweeteners

These can be used as an alternative to sugar to help sweeten foods. There is a variety of types and forms to choose from. Sweeteners approved for use in the UK are: sucralose, saccharin, aspartame, stevia.

Other sweeteners you may be familiar with are fructose, which is a bulk sweetener and in large quantities can affect blood glucose levels, and the ‘sugar alcohols’ – xylitol, maltitol, mannitol and sorbitol. In large amounts, these can have a laxative effect. These amounts have been associated with weight gain. Common sources are sugar free sweets and chewing gum.

If artificial sweeteners are used frequently in the diet, try to use a variety.

Eating less salt

Eating too much salt can increase your risk of high blood pressure, and this increases your chance of developing coronary heart disease. The recommended maximum amount of salt for adults is 6g daily – this is equivalent to a teaspoon.

Most of the salt we eat is hidden in foods. Foods high in salt include: cheese, pizza, soups, sauces, savoury snacks, biscuits, ready meals and fast foods.

Top Tips for cutting back on the salt:

• Gradually reduce salt on cooking.
• Switch salt for pepper, herbs, spices and lemon or lime seasoning.
• Do not add salt to your food on the table.
• Choose foods labelled ‘no added salt’, ‘less salt’, ‘low salt’.
• Try making your own sauces and seasonings.
• Swap salty snacks such as salted nuts and crisps for unsalted options.
• Avoid saltier foods such as cheese, bacon, ready meals and takeaways.
• Instead of adding salt, marinade your meat with citrus fruits, garlic and olive oil.

Think about drinks!

Drinking enough is an important part of keeping healthy. Water is the best choice, but you can include non-alcoholic drinks during the day such as sugar free squashes or juices, teas and coffees.

Many people enjoy an alcoholic drink. Alcohol is high in sugar and calories. Be wary that alcohol is an appetite stimulant and so some people notice they tend to eat more when they drink alcohol.

The recommendations for alcohol are the same for men and women and both are advised not to regularly drink more than 14 units per week. It is best to spread alcohol intake evenly over three- four days throughout the week rather than save it up for one or two days. It is also recommended to have two- three alcohol-free days.

What about food labelling?

Nutrition Information on the back or side of packaging

You will often see nutrition labels on food packaging giving a breakdown of the nutritional content of the food. Nutrition information must be provided on the vast majority of pre-packaged foods, with a few exemptions for single ingredient products, those with limited nutritional value such as herbal tea blends, and those with a small pack size. Regulations have been set out on which nutrients must be provided, the order they appear and the units that must be given. Table 1 identifies the nutrients that may be set out on food labels and the units that they must be given in. This information can appear anywhere on the packaging but is likely to be given in a table on the back.

The nutrients in bold must be recorded. It is not possible to only give energy, fat and saturates. Other nutrients can be included. For example, if there is a nutrition claim, such as, ‘high in fibre’, then the information must be provided on that nutrient, even if it is not on the mandatory list.

When nutrition information is given on a label, as a minimum it must show the amount of each per 100g or 100ml. In addition to this information, it is possible to voluntary give information on a portion size, for example, half of one pizza, 30g cheese, or a ‘consumption unit’ such as a slice of bread. The portion must be easily recognisable to you. Remember, the manufacturer's idea of what constitutes a ‘serving’ or a ‘portion’ might not be the same as yours.

Nutritional labelling on the front of pack

Most of the big supermarkets and many food manufacturers also display nutritional information on the front of pre-packed food. Although there has been front of pack nutrition information in the UK for the past decade, it is now a requirement. It allows you to easily check what the food contains, compare similar products and choose the foods that best suit your needs.

Front-of-pack labels, such as the label in the below image, provide information on the number of grams of fat, saturated fat, sugars and salt, and the amount of energy (in kJ and kcal) in a serving or portion of the food. Be aware, however, that the manufacturer's idea of a portion may be different from yours.

How do I know if a food is high in fat, saturated fat, sugar or salt?

There are guidelines (as shown in Table 2) to tell you if a food is high in fat, saturated fat, salt or sugar, or not.

Some front-of-pack nutrition labels use red, amber and green colour-coding. Colour-coded nutritional information tells you at a glance if the food has high, medium or low amounts of fat, saturated fat, sugars and salt.

The colour coding is determined by criteria developed by the UK government based on 100g of product however use of it, is voluntary. If the nutrition labels use colour coding, you will often find a mixture of red (high), amber (medium) and green (low). So, when you are choosing between similar products, try to go for more greens and ambers, and fewer reds, if you want to make a healthier choice.

Check claims such as ‘light’ or ‘reduced’ with care. Reduced fat or calories is a legal definition and means that the product contains at least 30% less fat or calories compared to the standard version you can buy. In addition, ‘contains less fat’ does not make it a low fat product either. Products labelled as fat free mean they contain no more than 0.5g of fat per 100g or 100ml. Claims expressed as ‘x% fat free’ shall be prohibited.

Keep your eye on the portion size

While a balanced diet is the most important thing for your health, it is very easy to eat too much so keeping an eye on your portion sizes is very important.

Your hands can be very useful in estimating appropriate portions. When planning a meal, you can use the following portion sizes as a guide:

Fruits, grains and starches

Choose an amount the size of your fist.

Vegetables

Choose as much as you can hold in both hands

Meat and alternatives

Choose an amount up to the size of your palm and the thickness of your little finger.

Fats

Limit fat to the size of the tip of your thumb.

Top Tips to reduce your portions:

• Put snacks in a bowl and put the rest away so you don’t eat them all.
• Eat off a smaller plate – you are likely to eat less food.
• Check the recommended portion sizes on food labels as many products are packaged for sharing.
• Remember you do not have to finish all the food on your plate – stop when you feel full.
• Put leftovers in the fridge or freezer straight away so you are not tempted to have seconds.
• Think about your intake over the day – if you know you are going to have a big dinner, have a smaller lunch.

The better controlled your diabetes becomes, the less glucose or energy is lost via the urine and the more the body can absorb, utilise and/or store. This is the reason why weight gain can be experienced on the same diet that previously maintained weight, when glycaemic control improves eg. when new medication is introduced. This is why someone whose diabetes has been poorly controlled for some time may be advised to reduce their food intake at a time when their diabetes control is being improved to prevent weight gain.

Don’t forget about physical activity

Regular activity improves your heart health, diabetes control and mood. It also helps to reduce the risk of some cancers.

We should all aim for 150 minutes of exercise a week- that’s about 20 to 30 minutes of moderate intensity exercise a day. A moderate intensity is activity which involves moving different parts of the body, makes you breathe a bit harder (but still able to talk) and feel warmer and sweaty. This does not mean going to classes or taking up jogging. It is more about finding something which suits you and which is safe and enjoyable.

Good ways to increase activity are to take a brisk walk, swim, cycle, gardening, housework like vacuuming. You can also make little changes in your daily lifestyle to increase your physical activity, which would also be beneficial such as taking the stairs instead of the lift, getting off the bus one stop earlier and walking the rest of the way as well as parking further away from the shop entrance.

You can also ask your GP to refer you to your local Exercise referral service if you would like professional support and guidance when starting an exercise programme.

Do I need to lose weight?

It is very important to keep your weight within an acceptable range for good health. The Body Mass Index (BMI) is a useful tool to work out which category you fall into – underweight, desirable weight, overweight, obese. Your BMI is calculated using your height and weight measurements.

To work out your BMI:

Find your weight across the top or bottom of the chart and then follow a straight line up or down until you find your height on the left or right of the chart. Put a mark where the two lines meet and this should show you which weight category you are in.

Being overweight can make your diabetes more difficult to control. It can also increase the risk of developing heart disease as well as other weight-related problems, such as high blood pressure.

To keep to a healthy weight, the amount of energy (calories) we eat needs to balance with the amount of energy we use.

Eating less energy (calories) and increasing physical activity can reduce weight.

Who do I contact for further information?

If you have any concerns or questions about any of the above please contact your Dietitian.

Your dietitian is: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Telephone number: 01223 216655

Diabetes UK is the leading UK charity that cares for, connects with and campaigns on behalf of all people affected by diabetes.

The charity can be contacted at:

Wells Lawrence House
126 Back Church Lane
London
E1 1FH

Telephone number: 0345 123 2399

Fax number: 0207 424 1001

E-mail Diabetes UK

Diabetes UK website (opens in a new tab)

The website is a useful source of information for those with Diabetes. It also provides additional information on diet and offers recipe ideas.