Rewriting the menu for diabetics
225,000 Irish people live with diabetes and must watch what they eat. TV chef Phil Vickery has written a book just for them, he tells Victoria Lambert
One of the first questions anyone newly diagnosed with type 2 diabetes will ask is “what can I eat?”, says the charity Diabetes Ireland. Confusion over what can and can’t be consumed is a key worry and given that there are an estimated 225,000 people living with diabetes in Ireland (with up to one million suspected of being in a pre-diabetes state), that’s an awful lot of worried — and probably pretty hungry — people.
That concern may well have been compounded by being given a whole raft of healthy living advice in one sitting: stop smoking, get active, check blood glucose levels, take medication. Not to mention the fact that, for many, a love of food might have been a contributing element. Being overweight or obese is a significant risk factor in developing the illness. No wonder diagnosis can be a bit overwhelming.
Even more confusing can be a basic lack of understanding of what diabetes is. Most of us know that it centres around insulin — a hormone released by the pancreas that helps move glucose (the sugar produced when our bodies digest carbohydrates) into our cells, where it is used as fuel for energy.
But the disease comes in two forms: type 1 is a serious, autoimmune condition where blood glucose levels are too high because the body can’t make insulin. It affects just 10pc of those with the illness. In those with the more common type 2, the body stops making insulin properly, which can cause blood glucose levels to fall too low, or get too high.
Although neither strand is fully understood, we know that the risk of developing type 2 increases if we have a close relative with the condition, as we age and if we put on too much weight, especially around the middle. This is because fat around the abdomen, in particular, releases chemicals that can upset the body’s cardiovascular and metabolic systems. So a weight loss diet may well be placed at the top of your new ‘to do’ list.
Yet anyone diagnosed with type 2 — and consequently expecting a strict list of nutritional dos and don’ts — is likely to be surprised. Yes, sugary drinks and fruit juices, which can send blood glucose levels soaring, are definitely out. But that doesn’t mean cutting out all treats.
“Not only is it almost impossible to maintain an entirely sugar-free diet, but it’s also not desirable,” says Anna Clarke, health promotion and research manager for Diabetes Ireland. “At present, most people don’t understand that there is sugar in all food and we need sugar for life — it’s a vital source of fuel and energy. But we want it in its natural state, in complex form rather than refined.”
That means yes to eating wholegrain pastas, meals, milk, fruit and veg, but no to processed foods, cakes, biscuits and sugary drinks. “The occasional treat is not a problem,” adds Clarke. “Where you need to be paying attention is to your overall consumption over the day and where your sugar is coming from.”
A study of 65,000 women released last week found that a diet rich in foods such as prunes and berries, as well as moderate consumption of red wine, was linked to a lower diabetes risk, with the antioxidants in the foods being credited for making the body’s ability to process insulin easier.
While emphasis is now placed on eating a healthy, balanced diet, there are splits in opinion as to whether attention should be on reducing calories in general, or dramatically limiting carbohydrates. This debate between counting calories or carbs is confusing for everyone, says Clarke.
“Some evidence shows that a low calorie diet is a good way of losing weight, but it depends on how sustainable it is. If you’re meeting your nutritional needs and social requirements, then it is something you can continue for life, but if it’s not meeting your needs and you’ve to stop then that’s when many people put the weight back on.”
With regard to carbs, Clarke believes intake should be based on age and activity level but not cut out entirely. She recommends adhering to a balanced diet as outlined by the food pyramid. “The evidence strongly shows that it’s an excess of calories that lead to weight gain,” agrees Walsh. “Over the years our intake of carbohydrates, fat and protein has increased. No single food group or food is to blame.”
One new resource for those with type 2 diabetes is Phil Vickery’s Ultimate Diabetes Cookbook, which is published this week to coincide with World Diabetes Day today. Offering a wealth of thoroughly tested ideas, the book aims to inspire healthier eating that can be enjoyed by all the family and sits squarely between the low cal and low carb contenders.
It is grounded in science and common sense, says chef Vickery, who is a familiar face on daytime television, as is his wife, the presenter Fern Britton. “It’s important to stay clear of scaremongering,” he adds. “People who say you can’t have this or that. Everything comes down to a balanced diet.”
Indeed, Vickery is not in the business of demonising foods. “It’s a pointless exercise,” he says. “Just look back a bit. Fat was demonised, then eggs, now it’s sugar. There’s nothing wrong with sugar in small amounts.” The idea for the book came almost by chance. Vickery is well known for his work for coeliacs — he has produced several glutenfree recipe books, with food scientist Bea Harling.
It was her idea to create recipes for type 2 diabetes, and Vickery says: “We decided to give it a bit of a punt. But it has been the hardest challenge of my life. It hasn’t just been about removing added sugar — it’s been about controlling all types of carbohydrate.” One of the aims of following a diet which works for type 2 diabetes is avoiding foods which cause a sudden surge or spike in blood sugar levels.
Vickery and Harling researched various carbohydrates to see which had least impact. Perhaps not surprisingly, that meant choosing brown over white rice. But they also learnt that pasta which has been cooked, chilled and then reheated causes less of a spike than pasta eaten straight away after cooking.
They took advice from Diabetes UK and were warned against over-salting dishes, as this can cause a raise in blood pressure. As type 2 diabetes can also cause high blood pressure, it was important to be mindful of not exacerbating that risk. “So that meant avoiding stock cubes with high sodium content, fish sauce and using salt itself sparingly,” says Vickery. “We compensated by adding lots of fresh herbs and spices. But as a chef, giving up salt is much harder than giving up sugar.”
He also experimented with sugar alternatives, settling on the sweetener xylitol — which is low in calories and has a very low glycemic index and so doesn’t spike blood sugar — as his favourite. “I was told I wouldn’t be able to make meringue without sugar and I took that as a personal challenge,” he explains. “Using xylitol was so successful I was able to create a recipe for a floating island meringue in a chocolate sauce. And it’s very good. Light as a feather.”
Another “revelation ingredient” he found was date puree: “Although dates still contain a lot of sugar, it’s bound up in fibre and it metabolises a lot more slowly than refined sugar,” says Vickery. He has found ways to incorporate it into both pudding recipes and savoury sauces. The 56-year-old chef also learnt that it was important to reduce the amount of animal protein in the average meal, as this can raise the risk of developing type 2. “We’re so used to the 8oz steak or eating large portions of white meat. I found myself cutting back the amount of nuts I was using, too. We need to educate our minds to expect smaller quantities.”
Diabetes Ireland also has an excellent online education resource on its website (diabetes.ie) and details of the free educational programme, Code, available to type 2 diabetics. But Anna Clarke fears many people are put off attending Code courses in their area. She explains: “A big issue for people with type 2 diabetes is, because of the way diabetes is often portrayed in the media, people aren’t accessing education programmes. They’re either not attending or travelling long distances to a course outside their area. There’s a tendency for type 2 diabetes to be portrayed as a lifestyle condition but being overweight isn’t selfinflicted. There are a lot of reasons why someone might eat more than they require and they need support, not to feel stigmatised.”