Recommendations will change in time as new data becomes available and consensus and views on emphasis differ. Any recommendations require careful interpretation and communication for the maximum benefit of those individuals with diabetes.
The biggest change in emphasis of the recommendations currently in use compared to previous recommendations focuses on a greater flexibility between the proportion of energy from carbohydrate and fat, with promotion of the use of monounsaturated fat.
Diets rich in monounsaturated fat reduce total and low-density lipoprotein cholesterol without adverse effects on highdensity lipoprotein cholesterol or triglyceride levels. It is necessary to restrict the total fat content of the diet where obesity is an issue and calorie intake needs to be limited. Otherwise, a range of carbohydrate (45 – 60%) and fat (25 – 35%) intakes is compatible with good diabetes control provided that low glycaemic index carbohydrates and foods high in monounsaturated fat are promoted.
Other significant changes in the recommendations include:
- There is less emphasis on the benefits of cereal fibre other than for gastrointestinal health and its satiety value.
- The precise effects of antioxidant nutrients with regard to being potential cardio-protective factors is still uncertain and so clear guidance is not possible in the light of the evidence available.
- In most European countries, the average intake of protein is in excess of the recommended intake and for those people with Type 1 diabetes, especially in those with hypertension, intakes of protein should not exceed 10 – 20% total energy because of the increased risk of nephropathy.
- The benefits of physical activity for people with diabetes are becoming increasingly evident. Regular, moderate intensity exercise is associated with a reduced risk of developing Type 2 diabetes in men, women and individuals who are overweight. Exercise can produce a reduction in plasma triglycerides, increases HDL and can also aid weight loss. The overall impact of exercise on blood pressure is also beneficial.