Low-cal and low-carb: the diet for diabetics
He describes it as the hardest challenge of his life, but Phil Vickery tells Victoria Lambert he’s delighted with his cookbook for diabetics
One of the first questions anyone newly diagnosed with type 2 diabetes will ask is “What can I eat?”, says the charity Diabetes UK. Given that there are an estimated 4.5million people living with diabetes in Britain, 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 on 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 10per cent 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 the risk of developing type 2 increases as we age, if we have a close relative with the condition, 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 Diabetes UK does not suggest that anyone forgo all treats, recognising that it is almost impossible to maintain a sugar-free diet.
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 much 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 ongoing debate between counting calories or carbs, says Dr Partha Kar, a consultant in diabetes and endocrinology at Portsmouth Hospitals NHS Trust, is confusing.
“All kinds of evidence are being provided, which favour one approach or another. We have asked for a formal review from Public Health England to clarify what approach should be taken,” he says. For his own patients, Dr Kar adds: “There are several ways to lose weight and whether you go low carb or low cal is a personal choice. I say, do what works for you, do what is sustainable long term.”
One new resource for those with type 2 diabetes is Phil Vickery’s
Ultimate Diabetes Cookbook, which is published this week to coincide with
‘I took it as a challenge to make meringue without sugar… and it’s very good’
World Diabetes Day on Nov 14. Offering a wealth of thoroughly tested ideas, the book aims to inspire healthier eating that can be enjoyed by all the family – not just the patient – and sits squarely between the low cal and low carb contenders.
It is grounded in science and common sense, says Vickery, the chef who is a familiar face on daytime television, as is his wife, Fern Britton, the presenter.
“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, and has produced several gluten-free recipe books with Bea Harling, a food scientist.
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 that 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 rise 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 that 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 purée: “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.”
One of the aspects of the book that the experts should all agree on is its educational slant.
Says Vickery: “The key to successfully changing the way you eat is having a proper understanding of your condition.
“Each recipe is accompanied by nutritional analysis, traffic light labelling and information about food groups and ingredients, equipping you with everything needed to make the right choices.”
This couldn’t be timelier, agrees Dr Kar. “Currently, the National Institute for Health and Clinical Excellence (Nice) recommends that everyone who is newly diagnosed with type 2 diabetes is offered a three or four-day education programme organised by their local clinical commissioning group. But unfortunately take-up is patchy and poor.
“For now, too many people are diagnosed and then left alone to get on with it.”
Ultimate Diabetes Cookbook by Phil Vickery is published by Kyle (£19.99). To order your copy for £16.99 plus p & p call 0844 871 1514 or visit books.telegraph. co.uk