spooner-nutrition

Lowering Cholesterol Naturally vs Statins: What Really Works for Heart Health?

Mon, 23 Mar 2026 16:55:19 GMT

By Spooner Nutrition – Expert Dietitian Advice on Reducing Cholesterol, Preventing Heart Disease & Understanding Statins

High cholesterol is one of the biggest risk factors for cardiovascular disease in the UK. If you’ve recently been told your cholesterol is “too high,” you’re probably wondering:

Should I change my diet?
Do I need statins?
Can lifestyle changes replace medication?
What actually lowers cholesterol effectively?

Drawing on evidence-based guidance, this article breaks down the pros and cons of diet and lifestyle changes vs statins , and explains why (clinically speaking) statins often come out on top for reducing cardiovascular risk.

Cholesterol & Cardiovascular Risk

Cholesterol itself isn’t “bad.” We need it for hormone production and cell structure. The concern lies with elevated LDL cholesterol (often called “bad cholesterol”), which contributes to plaque build-up in arteries increasing the risk of:

Heart attack
Stroke
Peripheral arterial disease

Lowering LDL cholesterol reduces cardiovascular risk. The question is how best to do that?

Diet & Lifestyle to Lower Cholesterol Naturally

Lifestyle is always the foundation of heart health. Whether or not medication is prescribed, dietary and behavioural changes play a crucial role.

Reduce Saturated Fat Intake

One of the most powerful dietary strategies is lowering saturated fat, found in:

Fatty cuts of meat
Butter and ghee
Full-fat dairy
Coconut and palm oils
Processed foods and pastries

Swapping saturated fats for unsaturated fats (olive oil, rapeseed oil, avocado, oily fish) can significantly reduce LDL cholesterol.

Pros:

Improves overall health, not just cholesterol
Supports weight management

Cons:

Requires sustained effort
Cholesterol reduction may be modest compared to medication

Oats and Soluble Fibre

Oats are rich in beta-glucan , a soluble fibre shown to lower LDL cholesterol by reducing its absorption in the gut.

Aim for:

Porridge oats
Oat bran
Oat-based cereals (with minimal added sugar)

Nuts for Heart Health

Almonds, walnuts, hazelnuts and pistachios contain:

Plant sterols
Fibre
Unsaturated fats
Antioxidants

A daily handful (about 30g) has been shown to modestly lower LDL cholesterol.

Soya Protein

Soya foods such as:

Tofu
Soya milk
Edamame
Soya yoghurt

Replacing animal protein with soya protein can help reduce LDL cholesterol.

The effect is modest, but when combined with other changes, it contributes to meaningful risk reduction.

Plant Stanols and Sterols

Plant stanols and sterols (found in fortified spreads and yoghurts) reduce cholesterol absorption in the gut.

Used daily in recommended amounts, they can lower LDL cholesterol by around 7–12.5%.

However:

They must be consumed consistently
They are not suitable for everyone
They are not a substitute for medication when risk is high

Exercise and Physical Activity

Regular physical activity:

Raises HDL (“good”) cholesterol
Improves blood pressure
Reduces insulin resistance

Aim for at least 150 minutes of moderate activity per week.

Stop Smoking

Smoking damages blood vessels and accelerates plaque formation. Quitting smoking significantly reduces cardiovascular risk!

Stress Management

Chronic stress contributes to:

Higher blood pressure
Inflammation
Unhealthy coping behaviours

Stress reduction techniques (sleep, mindfulness, therapy, time outdoors) are an often-overlooked but powerful part of heart disease prevention.

The Clinical Reality: How Much Can Diet Lower Cholesterol?

A well-structured cholesterol-lowering diet combining:

Reduced saturated fat
Oats
Nuts
Soya
Plant sterols

May reduce LDL cholesterol by approximately 10–20% in highly motivated individuals.

That is impressive.

But…

Statins: The Clinical Gold Standard for LDL Reduction

Statins are medications that reduce cholesterol production in the liver. NICE and prescribing practices within the NHS recommended statins when cardiovascular risk reaches a certain threshold.

How Much Do Statins Lower Cholesterol?

Depending on the dose and type, statins can reduce LDL cholesterol by: 30–50%

That is significantly more than diet alone.

Pros of Statins

Large and predictable LDL reduction
Strong evidence for reducing heart attack and stroke risk
Particularly beneficial for high-risk individuals
Often well tolerated

Extensive research shows statins reduce cardiovascular events, not just cholesterol numbers.

Cons of Statins

Possible side effects (muscle aches, digestive symptoms)
Small increased risk of type 2 diabetes in susceptible individuals
Lifelong medication for many people
Psychological barrier to “being on tablets”

However, serious side effects are uncommon.

Diet vs Statins: Which Wins?

From a clinical LDL-lowering perspective , statins are the clear winner.

They:

Lower cholesterol more substantially
Reduce cardiovascular events more reliably
Offer protection in high-risk patients

But this doesn’t make diet irrelevant. In fact, the strongest approach is often both together .

The Ideal Approach: Medication + Lifestyle

Even when statins are prescribed, lifestyle remains essential because it:

Enhances medication effectiveness
Reduces overall cardiovascular risk
Improves weight, blood sugar and blood pressure
May allow lower statin doses

Diet alone may be appropriate when:

Cholesterol is only mildly elevated
Overall cardiovascular risk is low
There is strong motivation for change

Statins are usually necessary when:

LDL cholesterol is very high
There is existing cardiovascular disease
There is diabetes
There is strong family history
Overall cardiovascular risk is elevated

The Bottom Line on Lowering Cholesterol

If you're searching for:

How to lower cholesterol naturally
Best diet for high cholesterol
Do statins really work?
Can I avoid statins?
Cholesterol lowering foods UK

Here’s the honest answer:

✔ Diet and lifestyle are powerful.
✔ They improve overall heart health.
✔ They reduce cholesterol modestly.
✔ They are essential for prevention.

But when cardiovascular risk is moderate to high, statins provide a level of LDL reduction and risk reduction that diet alone cannot match.

The decision is not diet versus statins. It’s about using the right tool for the right level of risk.

Nutrition Strategies for Long-Term GLP-1 Medication Users: A Dietitian’s Perspective

Thu, 08 Jan 2026 16:10:58 GMT

GLP-1 medications such as semaglutide and tirzepatide are increasingly prescribed for weight management and type 2 diabetes, and for many people they can be highly effective. However, as a registered dietitian working clinically, I am becoming increasingly concerned about a growing and under-recognised issue: the risk of malnutrition with long-term GLP-1 use.

While appetite suppression is part of how these medications work, eating significantly less over prolonged periods without appropriate nutritional guidance can come at a cost.

Why nutrition matters on GLP-1 therapy

GLP-1 medications slow gastric emptying and reduce appetite, which often leads to smaller portion sizes and reduced food intake. In the short term this may support weight loss, but over time it can also mean:

Inadequate protein intake , increasing the risk of muscle loss
Insufficient micronutrients such as iron, B12, calcium and vitamin D
Reduced fibre intake , negatively impacting gut health
Low overall energy intake , contributing to fatigue and poor concentration

In clinic, I am increasingly seeing individuals who are losing weight rapidly but are also experiencing weakness, low energy, hair loss, poor wound healing and gastrointestinal symptoms (such as constipation) - all potential red flags for nutritional compromise.

Protein: protecting muscle and metabolic health

One of my biggest concerns with long-term GLP-1 use is loss of lean muscle mass . Weight loss is not just fat loss, without adequate protein and resistance-type activity, muscle loss is common.

Prioritising protein at meals is essential to:

Preserve muscle mass
Support metabolic rate
Maintain strength and functional health, particularly as we age

For many people on GLP-1 therapy, this means being intentional with food choices, as hunger cues alone are no longer a reliable guide.

Micronutrients: small intakes, big consequences

When food intake drops, micronutrient intake often drops with it. Over time, this can increase the risk of deficiencies that may not be immediately obvious but can have significant health consequences.

Key nutrients of concern include:

Iron and B12 – particularly important for energy and red blood cell production
Calcium and vitamin D – essential for bone health
Folate and zinc – important for immune function and tissue repair

This is where dietetic assessment, monitoring and, where appropriate, supplementation may become critical.

Fibre, gut health and long-term tolerance

GLP-1 medications can also impact gut function, commonly causing nausea, constipation or bloating. A diet that is too low in fibre, or too restrictive overall can worsen these symptoms and negatively affect the gut microbiome.

Careful, gradual inclusion of fibre-rich foods, alongside adequate fluid intake, is key to supporting gut health and improving medication tolerance.

A dietitian’s concern: are we creating a new nutrition problem?

My concern as a dietitian is not about GLP-1 medications themselves, as they have a valuable role when used appropriately, but about how little nutritional support many people receive alongside them .

Without guidance, there is a real risk that we are sleepwalking into a wave of diet-related malnutrition, muscle loss and poor long-term health outcomes, particularly if these medications are used for years rather than months.

The role of dietetic support

Long-term GLP-1 use should never be “medication only”. Nutrition education, regular review and personalised advice are essential to ensure weight loss is:

Safe
Sustainable
Protective of long-term health

Working with a registered dietitian ensures that nutritional adequacy is maintained, risks are identified early, and individuals are supported to nourish their bodies, even when the appetite is reduced.

For more guidance on how to effectively nourish your body while using weight-loss medication, see our previous blog: How to Nourish Your Body Effectively on GLP-1 Medications Like Ozempic and Mounjaro.

How Nutrition Can Transform Workplace Wellbeing and Boost Employee Productivity

Sat, 11 Oct 2025 08:39:49 GMT

Why Nutrition Matters at Work

In today’s busy workplaces, employee wellbeing is no longer a luxury it’s a business essential. More UK companies are realising that healthy, energised staff perform better, take fewer sick days, and contribute to a positive company culture.

Yet, while many wellbeing programmes focus on mental health and fitness, nutrition is often the missing link . What and when we eat directly affects concentration, mood, energy levels, and overall productivity.

As a registered dietitian specialising in corporate nutrition and workplace wellbeing , I help businesses across the UK bring practical, engaging nutrition solutions into the working day.

As a registered dietitian , I specialise in delivering practical, engaging nutrition workshops, both face-to-face across the North East of England (including Newcastle, Durham, and Northumberland) and online to businesses throughout the UK. Whether you're based in London, Manchester, Birmingham, Bristol — or anywhere in between we have you covered.

The Hidden Cost of Poor Nutrition

Skipping meals, grabbing a quick sandwich at your desk, or relying on caffeine to power through the afternoon, these habits are common, but they can come at a cost.

Poor nutrition can lead to:

Afternoon fatigue and loss of focus
Increased absenteeism
Mood swings and stress
Higher risk of chronic illness

Research from the British Nutrition Foundation shows that employees with healthier diets are 25% more likely to have higher job performance and yet, nutrition remains one of the most overlooked aspects of workplace wellbeing.

How Can a Nutrition Workshop Help?

Nutrition workshops for employees are one of the most effective ways to bring awareness and positive change to your organisation.

Whether delivered online or in person, these sessions can:

Help staff understand the link between food, mood, and performance
Offer realistic strategies for healthy eating at work (even when time is short)
Support wellbeing initiatives around stress, sleep, and mental health
Create team engagement through interactive, science-based learning

At Spooner Nutrition , workplace wellbeing sessions are fully tailored from 30-minute “Lunch and Learn” talks to half-day nutrition workshops all designed to inspire sustainable habits that support health and performance.

Key Topics Companies Often Choose

��️ Food and Mood – how nutrition affects stress, focus, and mental wellbeing
�� Eating for Energy – balancing meals to prevent the afternoon slump
�� How to Design a Healthy Plate – getting the balance right
��‍�� Menopause and Nutrition – practical advice for women’s health in the workplace

These sessions are ideal for wellbeing weeks, staff away days, or ongoing corporate wellness programmes.

The Business Benefits

Investing in workplace nutritional wellbeing doesn’t just help employees feel better — it supports your organisation too.

Companies that integrate nutrition into wellbeing programmes often see:
✅ Higher employee engagement
✅ Improved productivity and focus
✅ Fewer sick days
✅ Enhanced morale and company culture

Ready to Bring Nutrition into Your Workplace?

If your company is looking to boost staff wellbeing, improve performance, and create a healthier, happier workplace, I’d love to help.

Get in touch to discuss tailored nutrition workshops for employees or corporate wellbeing programmes across the UK.

Locations We Cover

We offer face-to-face wellbeing workshops in the North East of England, including:

�� Newcastle upon Tyne
�� Durham
�� Northumberland (including Hexham, Morpeth, and Alnwick)
�� Sunderland and the wider Tyne & Wear area

�� Middlesbrough and Teesside (on request)

For companies outside the North East, whether you're in Leeds, York, Bristol, Glasgow or even remote teams spread across the UK, we offer high-quality, interactive online wellbeing sessions that bring the same value, energy, and evidence-based advice directly to your screens.

Contact Spooner Nutrition to start your workplace wellbeing journey today.

How to Nourish Your Body Effectively on GLP-1 Medications Like Ozempic and Mounjaro

Tue, 02 Sep 2025 11:11:22 GMT

If you’re taking a GLP-1 medication such as Ozempic, Mounjaro , or similar, you’ve likely noticed one of the most immediate effects: a significant reduction in appetite. While this appetite suppression is helpful for weight loss and blood sugar management, it also brings new challenges when it comes to getting enough nutrition .

In this blog, we’ll explore how GLP-1 medications change your eating habits , what to prioritise when eating with a reduced appetite, and how to avoid common nutritional pitfalls. Whether you’re managing type 2 diabetes , or looking to lose weight, maintaining a balanced, nourishing diet is essential.

�� How Do GLP-1 Medications Affect Appetite?

GLP-1 receptor agonists like Ozempic and Mounjaro work by mimicking the GLP-1 hormone, which affects several areas of your digestive system and brain. These medications:

Slow gastric emptying (food stays in your stomach longer)
Suppress hunger signals in the brain
Improve insulin sensitivity and glucose control

The result?
You feel full faster, stay full longer, and are likely to consume fewer calories overall, a key reason why many people see success with weight loss using GLP-1s.

However, less hunger doesn’t mean less need for nutrients . In fact, eating less can put you at risk of nutritional deficiencies , muscle loss , and low energy especially if meals aren’t carefully planned.

��️ What to Eat While Taking a GLP-1 Medication

Prioritise Lean Protein

When you're losing weight it’s easy to lose lean muscle mass alongside fat. Consuming enough protein is vital to preserve muscle, support metabolism, and promote satiety.

�� Aim for 20–30g of protein at each meal.

Great sources of protein:

Chicken breast, turkey, fish (including oily fish like salmon)
Eggs, tofu, tempeh, edamame
Greek yogurt, cottage cheese, milk, cheese
Beans, lentils, hummus

�� Try to limit processed meats (e.g., bacon, sausages, chorizo) due to their high levels of salt and saturated fat.

Eat Fibre-Rich Foods to Support Digestion

A common side effect of GLP-1s is constipation , due to slower digestion and reduced food intake. Fibre helps keep things moving and supports gut health.

Include fibre at every meal and snack:

Wholegrain bread, brown rice, oats, quinoa
Fruits (berries, apples, pears) and vegetables (leafy greens, carrots, broccoli)
Nuts and seeds (almonds, chia, flaxseeds)
Legumes (lentils, chickpeas, kidney beans)

�� Snack ideas: Oatcakes with nut butter, veggie sticks with hummus, a small handful of mixed nuts, or wholegrain crackers with cheese.

Stay Hydrated

Fluid intake often drops when you're eating less but staying hydrated is crucial for digestion, energy levels, and preventing constipation .

�� Aim for 6–8 glasses or mugs per day.

Best choices:

Water (still or sparkling)
Herbal teas
Black tea or coffee (in moderation)
No-added-sugar squash or cordial

Avoid sugary drinks where possible, as they provide unnecessary calories and little nutritional value.

⚠️ Foods That May Worsen Side Effects

You don’t need to cut out any food groups completely, but some may worsen common GLP-1 side effects like nausea , acid reflux , or bloating .

Be mindful of:

Spicy or heavily seasoned foods
Carbonated drinks
Very high-fat meals (even healthy fats like avocado or cheese can feel heavy)

Everyone is different. What triggers discomfort for one person may be fine for another. Keeping a food and symptom diary can help identify your personal triggers.

�� What Does a Balanced Meal Look Like with a Low Appetite?

If your appetite is significantly reduced, you may not be able to manage three large meals per day. That’s okay. The key is to ensure that each eating opportunity is nutritionally dense .

✅ Aim to include:

Wholegrain carbohydrates for energy and fibre
Lean protein to support muscle and satiety
Vegetables or fruits for vitamins, minerals, and fibre
Healthy fats in moderation (olive oil, nuts, seeds)

�� If full meals feel overwhelming, try eating 4–5 smaller meals or snacks spaced throughout the day.

�� What Happens If You Don’t Get Enough Nutrition?

Under-fuelling your body, even unintentionally can lead to:

Fatigue or low mood
Hair thinning or dry skin
Weakened immune function
Loss of lean muscle
Nutritional deficiencies (e.g., B12, iron, calcium, protein)

Even if you’re eating less, it’s important to eat well .

��‍⚕️ How a Dietitian Can Help While You're on a GLP-1 Medication

At Spooner Nutrition , I work with clients using GLP-1 medications to ensure they’re meeting their nutritional needs , managing side effects, and building habits for long-term success .

As a registered dietitian , I can help you:

Develop a personalised meal plan that suits your appetite and goals
Address digestive side effects like constipation or nausea
Prevent nutrient deficiencies and muscle loss
Feel confident with food while taking Ozempic, Mounjaro, or similar medications

�� Contact me to book an appointment (see below)

Dietitian vs Nutritionist - what's the difference?

Sun, 27 Jul 2025 21:24:32 GMT

Dietitian vs. Nutritionist in the UK: What's the Difference and Who Should You Trust?

When it comes to nutrition advice, there's no shortage of opinions online. Whether you're managing a medical condition or just looking to eat healthier, it’s important to know who you’re getting your information from. In the UK, the terms “dietitian” and “nutritionist” are often used interchangeably, but they’re not necessarily the same. Here's what you need to know.

Dietitian vs. Nutritionist: Understanding the Difference

Dietitian is the only legally protected title in the UK when it comes to nutrition professionals. That means only those who are registered with the Health and Care Professions Council (HCPC) and have completed an approved degree in dietetics can call themselves a dietitian.

Nutritionist , on the other hand, is not a protected term. Anyone can technically call themselves a nutritionist, regardless of qualifications. However, Registered Nutritionists (RNutr) are regulated by the Association for Nutrition (AfN) and must meet strict educational and professional standards.

➡️ Bottom line: For safe, evidence-based nutrition advice, it’s best to consult a Registered Dietitian (RD) or a Registered Nutritionist (RNutr) .

Why You Might See a Dietitian

Dietitians work across a wide range of settings from NHS hospitals to private clinics and even in public health or research. You might be referred to a dietitian if you:

Have a diagnosed medical condition such as diabetes, heart disease, kidney disease, coeliac disease, IBS, or cancer
Need support with weight management , whether its weight loss or weight gain
Recovery following surgery or illness, needing tailored nutrition support
Struggle with eating disorders or disordered eating
Are pregnant or planning pregnancy and need specialist dietary guidance
Have allergies or intolerances and need help planning a safe, balanced diet

Dietitians are trained to provide clinical nutrition advice based on the latest scientific evidence, and they often work as part of a multidisciplinary healthcare team, working alongside doctors, nurses, physiotherapists, occupational therapists and podiatrists.

Social Media Isn’t a Clinic

In a world where “wellness” is big business, it’s easy to fall into the trap of trusting influencers with large followings but little (or no) real qualifications. While some may offer helpful tips or share personal experiences, there are serious risks in taking unqualified advice, especially if you have specific health needs.

Here’s why you should think twice:

❌ No regulation: Many influencers use the term "nutritionist" without formal training.

❌ One-size-fits-all advice: What works for one person might not be safe or effective for another.

❌ Misinformation: Fad diets, detox teas, and miracle supplements are often pushed for profit, not your wellbeing.

❌ Potential harm: Poor advice can worsen health issues, especially for those with chronic conditions.

How to Check if Someone Is Qualified...

If you're seeking trustworthy advice, ask:

Are they a Registered Dietitian ? (Check the HCPC register )
Are they a Registered Nutritionist ? (Check the Association for Nutrition register )
Do they provide evidence-based information tailored to your needs?

Remember your health deserves more than a trendy TikTok reel.

Final Thoughts

Navigating the world of nutrition can be confusing, but choosing who to trust doesn’t have to be. Dietitians are highly trained, legally regulated professionals equipped to give you safe, science-backed advice. Be wary of flashy fads and unqualified influencers.

Stay Hydrated in Hot Weather: Tips for Everyone (Especially with Diabetes)

Thu, 03 Jul 2025 13:56:43 GMT

When temperatures rise, so does your risk of dehydration. Whether you're spending time outdoors, exercising, or just going about your day during a heatwave, staying properly hydrated is essential for your health and well-being. And for those living with diabetes, the risks of dehydration are greater, making hydration a key part of blood glucose management.
In this post, we’ll explore practical ways to stay hydrated using both fluids and hydrating foods, and dive into why people with diabetes need to pay more attention during hot weather.

Why Hydration Matters

Water plays a vital role in almost every function of the body, from regulating temperature and lubricating joints to supporting digestion and maintaining blood volume. In hot weather, we lose more fluid through sweat, and if we don’t replace it, dehydration can quickly set in. Even mild dehydration can lead to fatigue, dizziness, headaches, and impaired concentration.

Signs of Dehydration

Some early signs to watch for:
• Thirst
• Dry mouth
• Dark yellow urine
• Headache
• Fatigue
• Dizziness or lightheadedness
Severe dehydration can lead to heat exhaustion or heat stroke, which require immediate medical attention.

Smart Tips to Stay Hydrated
1. Drink Regularly, Not Just When You’re Thirsty

Don’t wait until you’re parched to drink. Sip water consistently throughout the day, especially in the morning, before going outside, and during physical activity.

2. Choose Water First

Plain water is always a great option, but you can also hydrate with:
• Herbal teas (iced or warm)
• Sparkling water
• Infused water with citrus, cucumber, or berries
• Milk or fortified plant-based milks (which also provide micronutrients)
Limit sugary drinks, as they can contribute to blood sugar spikes and worsen dehydration in people with diabetes.

3. Eat Hydrating Foods

Many fruits and vegetables have a high water content and can contribute significantly to your daily fluid intake:
• Watermelon (92% water)
• Cucumber (96%)
• Strawberries (91%)
• Tomatoes (94%)
• Celery (95%)
• Oranges (86%)

These foods also supply vitamins, minerals, and fibre and they’re naturally low in calories and added sugars.
For fruit limit to 2-3 80 gram portions per day.

4. Cool Down with Healthy Snacks

Cold snacks like frozen grapes, fruit pops made from lemon slice and zero lemonade, or yogurt with berries are refreshing and hydrating. Avoid salty snacks, which can increase fluid loss and thirst.

5. Be Cautious with Alcohol and Caffeine

Alcohol is dehydrating, and while moderate caffeine intake is generally fine, too much (especially in hot weather) can contribute to fluid loss in some people. Balance caffeinated drinks with extra water.

Hydration & Diabetes: Why It's Even More Important

People with diabetes are more prone to dehydration for several reasons:
• High blood glucose levels can lead to increased urination, causing the body to lose more fluid.
• Medications like diuretics may increase fluid loss.
• Heat can impact glucose readings , making hydration even more critical to stability.

Tips for People with Diabetes

• Check blood glucose more frequently in hot weather, especially if you’re active outdoors.
• Carry water at all times , and drink before, during, and after any physical activity.
• Watch for early signs of dehydration, which can mimic symptoms of high or low blood sugar.
• Avoid sugary sports drinks , unless you're treating low blood sugar, in that case, use them purposefully and in moderation.
• Talk to your healthcare provider about how to adjust medication or insulin dosing in the heat.

Quick Daily Hydration Checklist

✅ Start your day with a glass of water
✅ Include fruits/vegetables in every meal
✅ Sip water between meals and snacks
✅ Drink extra if you're sweating, active, or outside
✅ Monitor urine colour, pale yellow is ideal
✅ Listen to your body, act early if you feel off

Final Thoughts

Hydration is about more than just drinking water, it’s about nourishing your body with the right foods and fluids, paying attention to signs of dehydration, and adjusting habits to fit your health needs. As temperatures rise, let hydration be part of your daily self-care, especially if you live with diabetes.

Mounjaro - why cant I get hold of this on the NHS?

carolyn@spoonernutrition.co.uk (Carolyn Jackson) — Wed, 12 Mar 2025 16:51:11 GMT

It feels like a day doesn't pass when weight loss injections aren't featured on the news or social media. So why is it so hard to get hold of them via the NHS for weight loss?

You may have heard in the media about a new weight loss medicine - Mounjaro, also known as Tirzepatide being the newest one. As of February 2025, Mounjaro is not yet widely accessible through the NHS for weight loss management. The National Institute for Health and Care Excellence (NICE) has approved its use and plans to roll it out gradually over the next three years, prioritising patients with the highest clinical need. This phased approach aims to manage the financial impact and ensure safe implementation. Its estimated over 64% of the adult population in England lives with overweight or obesity (a body mass index or BMI over 25 and 30kg/m2), therefore the potential demand for this medication as a weight loss treatment is expected to be enormous. At first those with a BMI over 35, with at least one health problem relating to their weight will be prioritised. The NHS expects to be able to give it to some people to help with weight loss from April 2025.

Currently, Mounjaro is primarily available on the NHS for individuals with type 2 diabetes. For weight management purposes, access through the NHS is limited, and many patients may face extended waiting periods. Consequently, some individuals are turning to private healthcare providers to obtain the medication, despite the higher costs associated with private prescriptions. It's important to consult with a healthcare professional to determine if Mounjaro is suitable for your weight loss needs and to discuss the most appropriate and safe avenues for accessing the medication.

When using Mounjaro for weight loss or diabetes management, following a well balanced, nutrient-dense diet can enhance its effectiveness and help you achieve the best results. Mounjaro slows digestion, reduces appetite and helps people to feel more satisfied with food eaten. Having a smaller appetite means its imperative to follow a well balanced diet, helping to prevent nutritional deficiency. Here’s a general dietary guideline:

1. Prioritise Protein Intake

Protein helps maintain muscle mass and keeps you full longer. Aim for:

• Lean meats (chicken, turkey, lean beef)

• Fish & seafood (salmon, tuna, cod)

• Eggs

• Dairy (Greek yogurt, cottage cheese)

• Plant-based proteins (tofu, tempeh, lentils)

2. Choose Healthy Fats

Fat slows digestion and helps you to feel satisfied:

• Avocados

• Nuts & seeds (almonds, chia, flaxseeds)

• Olive oil & rapeseed

• Fatty fish (salmon, mackerel)

3. Include Fibrr-Rich Foods

Mounjaro can cause constipation, fibre helps digestion:

• Vegetables (broccoli, spinach, kale)

• Fruits (berries, apples, pears)

• Wholegrains (quinoa, brown rice, oats)

• Legumes (chickpeas, black beans)

4. Limit processed foods

A diet higher in processed foods, containing more sugar, salt and saturated fat is associated with poorer health outcomes. Try to avoid or limit:

• Sugary drinks & snacks (pop, jelly sweets, cake, chocolate, pudding)

• Pies, pastries and crisps

• Processed meats; bacon, sausage, chorizo, salami

5. Stay Hydrated

Aim for 1.5 - 2 litres per day. In warmer weather or if exercising, consider more. Water is your optimum form of hydration

6. Eat Smaller, Frequent Meals

Mounjaro slows stomach emptying, overeating can cause discomfort so eating little and often maybe a solution if you are struggling to eat your usual 2-3 meals per day. Try:

• Smaller portions

• Eating slowly

• Stopping when full

Here’s a sample meal plan for someone using Mounjaro for weight loss. It focuses on high protein, fibre, and healthy fats while limiting processed foods.

Breakfast:

• Scrambled eggs with spinach & feta

• 1-2 slices whole grain toast

• Herbal tea or coffee

Snack:

• Greek yogurt with a handful of berries and chia seeds

Lunch:

• Grilled chicken salad with mixed greens, avocado, cherry tomatoes & olive oil dressing

• A handful of quinoa

Snack:

• 30g almonds or 1 boiled egg

Dinner:

• Chilli flavoured salmon with roasted butternut squash & green beans

Evening snack (optional):

• Herbal tea and/or 25g dark chocolate

Tips:

✔ Eat slowly & stop when full (Mounjaro slows digestion)
✔ Drink plenty of fluids
✔ Prioritise lean protein, wholegrains and fibre containing foods
✔ Avoid/Limit sugary snacks & processed foods

Mounjaro is a medication used for type 2 diabetes and weight management. While effective, it can lead to nutritional concerns, including:

• Reduced Appetite and Nutrient Intake – Mounjaro suppresses appetite, which can result in lower calorie and nutrient consumption, potentially leading to deficiencies in vitamins and minerals.

• Protein Deficiency – Significant weight loss can lead to muscle loss if protein intake is inadequate. Maintaining sufficient protein intake is important to preserve lean body mass.

• Vitamin and Mineral Deficiencies – Reduced food intake may cause deficiencies in essential nutrients such as:

• B vitamins (B12, B6, folate) – Important for energy metabolism and neurological function.

• Iron – Essential for red blood cell production; low levels may lead to anaemia.

• Gastrointestinal Issues – Common side effects like nausea, vomiting, diarrhoea, or constipation may lead to poor nutrient absorption and dehydration.

• Fat Malabsorption (in rare cases) – If dietary fat intake is significantly reduced, there could be issues with fat-soluble vitamin absorption (A, D, E, and K).

Ways to Mitigate Nutritional Concerns

• Eat Nutrient-Dense Foods : Prioritise lean proteins, healthy fats, whole grains, fruit and vegetables.

• Monitor Micronutrient Levels : Consider blood tests to check for deficiencies, especially B12, iron, and electrolytes.

• Hydration : Drink plenty of water.

• Protein Intake : Aim for adequate protein to prevent muscle loss (e.g., lean meats, dairy, eggs, tofu, legumes).

• Consider Supplements : If necessary, supplement key vitamins and minerals based on medical advice.

Are you using Mounjaro or considering it? Do you need help managing your diet to help maximise its use? Want to talk to an expert to understand its use and how it could benefit you? See below to book a FREE 15 minute discovery call.

HELP! I’m not losing weight

Fri, 14 Feb 2025 20:59:55 GMT

Energy density – things to consider if I’m not losing weight

Since starting your weight loss journey, you may have noticed your weight loss is slow or not occurring as you thought it would. For weight loss to be as effective as possible it’s important to follow a healthy, yet calorie-controlled diet. Following a calorie-controlled diet helps to create a calorie deficit. Weight loss without a calorie deficit is simply not possible. With this in mind its also important to remember the dietary changes you put in place are realistic and not too restrictive. Think of this as a lifestyle change rather than being on a diet!

When thinking about losing weight, most of us think about eating less, constantly feeling hungry and missing our favourite foods. However, research indicates that eating foods with a low energy density makes you feel full, whilst helping you to lose weight.

What is energy density?

Energy density is the number of calories per gram of food. Foods lower in energy density provide less energy per gram, which means we can eat more of them while consuming fewer calories compared to foods with a higher energy. Foods with a high water and high fibre content often have a lower energy density, e.g. fruit and vegetables. Foods which are higher in fat tend to have a higher energy, e.g. butter and oil. If we eat more calories than our body requires, we either gain weight or our weight stays the same.

How to be more calorie aware

It’s useful to understand the energy density of specific nutrients:

Carbohydrate = 4 kcals per gram

Protein = 4 kcals per gram

Fat = 9 kcals per gram

Alcohol = 7kcal per gram

As each nutrient has a different energy density, by altering what we put more or less of into our body, we can affect the total calorie intake.

It’s not necessary to count all the calories we consume in a day, however being calorie aware is very useful. Understanding what is higher, or lower energy density can help you on your weight loss journey. There are many apps and book guides that can support your understanding, as well as checking food labels regularly and taking note of the calories content.

Foods which are filling

Foods which are lower in energy density include those which are naturally high in water such as fruits and vegetables: oranges, apples, berries, broccoli, spinach, tomatoes, cucumber, onions, peppers, aubergine, courgettes. Soups, stews and casseroles filled with non-starchy is a great choice.

Fibre containing foods

Fibre bulks up food but can’t be fully digested. It also helps us to feel full as it slows the rate at which we digest foods. Foods rich in fibre include fruits and vegetables, wholegrains cereal/pasta/bread, oats, barley, beans, lentils and pulses.

Low fat foods

By reducing the amount of fat we eat or add to our meals, the total energy density can be reduced. As fat is the most energy dense nutrient, if we are using less it may lead to a reasonable energy saving. Easy ways to reduce fat content:

Leaner cuts of meat/removing visible fat
Use less oil when cooking
Spread less butter/margarine on bread/toast
Avoiding ultra processed foods which are high in fat e.g. chocolate, cake, pizza, fried chicken
Switch to lower fat versions e.g. change mayonnaise to low fat version

High protein foods

Foods rich in protein can decrease hunger and help us to feel full. Fish, lean meat/poultry, eggs, tofu, soya mince, beans and pulses are all foods which contain good levels of protein.

How to set out your plate when eating a meal

Fill half your plate with non-starchy vegetables
Aim for ¼ of your plate to be lean protein
Aim for ¼ of your plate be wholegrain starchy carbohydrates
Its ok to add a little healthy fat to your plate, this can help you feeler but keep the amount small, e.g. a drizzle of olive oil or thumb size amount of peanut butter

Top tips for lowering energy density

Choose lean cuts of meat, trim off any excess fat, remove skin from poultry
Avoid adding too much fat during cooking
Add plenty of lower energy dense foods to a meal e.g. have a side salad with a smaller portion of lasagne or add lots of chopped veg into bolognaise
Opt for higher fibre starchy carbohydrates e.g. wholemeal pasta or rice
If you drink alcohol, do so in moderation
Avoid high sugar drinks, switch to diet or zero versions. Water is the best form of hydration
Limit pudding. If having, keep the portion small and infrequent
Avoid biscuits, chocolate, crisps, and sweets or enjoy less often. If you find yourself snacking on these foods often ask yourself if this is out of hunger or habit. Often, we eat when we are not hungry and such foods can quickly add calories, e.g. 6 digestive biscuits equal 500 kcals. If you do feel hungry between meals and need to snack, consider healthier alternatives, e.g. 2 wholegrain crackers with 30 grams of cheese, 30g unsalted nuts, 1 boiled egg, small handful of fruit
A great way to understand your food choices and behaviours is to keep a food diary. Capturing what you eat on paper or via an app can help you make decisions around what changes you would like to make and also helps you keep track. See our separate factsheet on ‘keeping a food and exercise diary’

Need help with your diet? Get in touch below or book your FREE 15 minute discovery call.

What is gestational diabetes?

Mon, 04 Nov 2024 08:31:34 GMT

Gestational diabetes is diabetes that can happen during pregnancy. It means the pregnant person has high blood glucose levels and additional care will be needed to help manage this. Eating the right kind of diet, keeping active and taking medication (for some) can be very effective steps in the management of gestational diabetes.

Gestational diabetes occurs when the body cannot produce enough insulin during pregnancy to meet increased demands. Factors that contribute to its development include:

Hormonal Changes: Pregnancy hormones can interfere with insulin function.
Insulin Resistance: Increased body weight and changes in metabolism can lead to higher insulin resistance.
Genetic Factors: A family history of diabetes can increase risk.
Obesity: Living with overweight or obesity prior to pregnancy raises the likelihood of developing gestational diabetes.
Age: The older we are the higher the risk.
Previous Gestational Diabetes: A history of gestational diabetes in prior pregnancies increases the risk in future pregnancies.

Managing these factors can help reduce the risk.

What tests determine gestational diabetes?

Women at risk of gestational diabetes will usually be checked between 24 to 28 weeks of pregnancy.

The main test is an oral glucose tolerance test (OGTT). The test usually takes over 2 hours to complete. A fasting blood glucose is checked before the test. The person is then given a sugary drink. Following this the person is asked to rest for 2 hours, before another blood glucose test is taken. This then determines how well the body has dealt with the sugary drink.

If either the fasting blood glucose was 5.6 mmol/l or above 7.8mmol/l 2 hours after the sugar drink, gestational diabetes will be diagnosed.

What are the associated risks of gestational diabetes?

Getting a diagnosis of gestational diabetes during pregnancy can be worrying. But the good news is managing blood glucose levels well can still mean an enjoyable and healthy pregnancy.

If gestational diabetes is left untreated it can lead to serious health problems for the mother and baby:
*induced labour
*caesarean section
*the baby could be at risk of living with overweight/obesity and developing type 2 diabetes in later life.
*the baby may have jaundice after birth
*infant death.

Diet advice for gestational diabetes

If you have gestational diabetes, a balanced diet can help manage blood sugar levels. Here are some dietary guidelines to follow:

Carbohydrate Control: Choose complex carbohydrates with a low glycemic index, like whole grains, legumes, and vegetables. Limit refined sugars and simple carbs.
Regular Meals: Eat smaller, more frequent meals to help stabilize blood sugar levels. Aim for three main meals and some snack (as needed).
Fibre Rich Foods: vegetables and some fruit, whole grains, and legumes.
Lean Proteins: Incorporate lean proteins such as chicken, fish, eggs, beans, and tofu to promote satiety.
Healthy Fats: Focus on sources of healthy fats, such as avocados, nuts, seeds, and olive oil, while limiting saturated.
Monitor Portion Sizes: Be mindful of portion sizes to avoid spikes in blood sugar. Especially for carbohydrate foods, e.g. bread, pasta, rice, potatoes.
Stay Hydrated: Drink enough water and avoid sugary drinks.
Consult a Dietitian! Work with a registered dietitian for personalised plan that fit your needs.

Want more help? Get in touch ....

Diabetes, chronic kidney disease, and British food culture

Wed, 09 Oct 2024 07:24:34 GMT

The prevalence of diabetes around the world has reached epidemic proportions. The International Diabetes Federation estimated that 537 million people were living with diabetes in 2021. This number is expected to increase to 784 million by 2045.

It has been estimated that 40% or more of people with diabetes will develop chronic kidney disease (CKD), including a significant number who will develop kidney failure requiring dialysis or transplantation. These are scary statistics, however the good news is so much can be done from a diet and lifestyle perspective to reduce the risk.

What is chronic kidney disease (CKD)?

It's a common condition often associated with getting older. It can affect anyone, but it's more common in people who are black or of south Asian origin. Also, conditions like diabetes, high cholesterol and high blood pressure put us at a higher risk of CKD.

The stages of CKD are based on how well your kidneys are able to filter out waste from your blood. The stages range from very mild (Stage 1) to kidney failure (Stage 5).

Stage 1 CKD: Mild kidney damage, eGFR 90 or higher. Your eGFR is above 90ml/min (normal) but some other tests suggest you may have some kidney damage – for example, you have protein in your wee.
Stage 2 CKD: Mild loss of kidney function, eGFR 60-89.
Stage 3a & 3b CKD: Mild to severe loss of kidney function, eGFR 30-59.
Stage 4 CKD: Severe loss of kidney function, eGFR 15-29.
Stage 5 CKD: Kidney failure or close to failure, eGFR less than 15.

Scientific studies show that if recognised early, CKD in diabetes can be effectively slowed down. Diet and lifestyle play a fundamental part. Almost 1 in 5 people with diabetes will need treatment for diabetic nephropathy. Diabetes unfortunately remains the single most common cause of kidney failure in the UK.

One of the best ways to help prevent CKD or control it is to have as good as possible blood glucose control. One of the most common blood glucose tests is called HbA1c. Having a HbA1c of 48mmol/mol or less is associated with lower diabetes complication risk. HbA1c looks at the glucose attached to our red blood cells. Red blood cells live for 8-12 weeks, therefore a HbA1c can tell us what our levels have been for up to a 3-month period.

Diabetes nephropathy

High blood glucose levels cause extra blood to flow through the tiny filters in your kidneys, so they have to work harder than normal to clear it. Over time this can damage the filters, causing them to leak.

Renovascular disease

Diabetes and elevated blood pressure are risk factors for renovascular disease as they both cause a ‘furring’ of the artery to the kidney, reducing the blood supply and causing scarring.

What can we do to prevent or control CKD?

We should ideally get at least 150 minutes of exercise per week at moderate-intensity, or to a level compatible with your cardiovascular and physical tolerance. Recommendations for physical activity should consider age, ethnic background, presence of other comorbidities, and access to resources.

Avoiding sedentary behaviour is key! How long are you sat at your desk, lying on the sofa watching TV, generally sitting? If we can break this behaviour up it all counts. For example, moving your legs and arms for a few minutes when sat at your desk, or getting up for a cuppa whilst the TV ads are on and doing some gentle dancing whilst the kettle is boiling.

Smoking – its advised people with diabetes and CKD who use tobacco to quit using tobacco products to reduce the risk of associated premature mortality from cardiovascular disease, as well as risk of respiratory diseases and cancer.

Smoking can

Increase risk of developing some kidney cancers
Damages blood vessels leading to poor blood flow to kidneys
Causes or advances diabetic kidney disease
Leads to surges in blood pressure

Diet

People living with diabetes and CKD should consume an individualized diet looking at the below factors …

The number of randomised control trails (RCTs) analysing the effects of diet amongst people with diabetes and CKD is small. Most RCTs have a limited number of participants. Application of large, multicentre studies and their results is needed in the context of diabetes, CKD, and diet.

The benefit of consuming fewer refined and processed foods in the general population is well-established, and hence why it's reasonable to apply to those with diabetes and CKD.

Nutrition therapy can decrease HbA1c levels similar to, or better than, those obtained with glucose-lowering medications (in type 2 diabetes). Simple advice such as increasing your intake of non-starchy vegetables, decreasing intake of added sugars and refined grains, and increasing intake of whole foods over highly processed foods can be implemented for most people across wide geographic and economic strata.

Ultra processed foods such as sugar-sweetened beverages, fast foods, frozen meals, and pastries are generally high in salt, sugar, and/or fat, and low in nutritional value. A plant-based diet is rich in anti-inflammatory nutrients, fibre, and phytochemicals. This has been shown to reduce proteinuria and decrease metabolic acidosis. The probiotic nature of plant-based foods may also support the microbiome and reduce inflammation and intestinal production of uremic toxins.

A recent systematic review evaluated the association of dietary patterns and kidney-related outcomes. Dietary patterns that include more plant-based unprocessed protein have been demonstrated, to slow the trajectory of eGFR decline, reduce the risk of kidney failure, reduce risk of mortality, and improve quality of life.

Why are Omega 3 fats good for health?

There has been lots of research into omega 3 fats and oily fish and how they can improve heart health.

In countries where people eat more oily fish, such as in the Mediterranean, Greenland and Japan, fewer people have heart disease compared to countries where people eat very little oily fish, such as the UK.

The Omega 3 fats (EPA and DHA) can help protect the heart and blood vessels from disease: They can help:

lower triglycerides
improve circulation
prevent blood clots
lower blood pressure
keep the rhythm of your heart steady

Research suggests omega 3 has beneficial effects for oxidative stress, inflammation and lipid levels. We know conditions like diabetes and CKD are pro-inflammatory, so this is good news.

If you have CKD causes by IgA nephrology (autoimmune conditions which affect the kidneys) omega 3 is often recommended as it has shown to reduce inflammation and thus slow down progression in CKD.

The recommended amount per week is 140g of oily fish eg salmon, mackerel, swordfish. Although renal dietitians may recommend upto 2-3 portions per week for some patients.

Salt

High salt intake raises blood pressure and increases the risk of stroke, cardiovascular disease, and overall mortality.

For those living with CKD, it is recommended we have 5g or less per day. 5g or less per day can be difficult, due to the amount of added salt in processed and ultra processed foods. 6g or less is recommended for general public. The average UK adult has 8g per day, however this may not be that surprising when common foods contain high levels of salt:

2 x average slices of bread contains 0.8g salt

1 x bagel 0.5g salt

Instant noodle pot 2.22g salt

Individual ready meal (spaghetti Bolognese) 1.93g salt

1 shop bought pepperoni pizza 2.9g salt

The other obvious way of reducing salt is not adding it at the cooking stage or at the table. Items such as stock cubes, gravy granules, soy sauce, fish sauce, capers, and olives can all contribute.

Making use of lemon, paprika, chilli, pepper, lime zest, vinegar, cumin etc are all great ways of adding flavour instead of salt.

British food culture

If you search British way of eating on the internet, things like fish and chips, English breakfast, and bangers and mash appear regularly. The above items contain fat, salt, and some sugar. No vegetables are in sight apart from the Sunday roast. Fun or ‘sole foods’ like these are fine to include occasionally, however health could be affected if foods like the ones listed above were an everyday thing.

Many of the above foods fall into the processed or ultra processed food (UPF) category. For more information about ultra processed foods, take a look at Ultra processed foods and type 2 diabetes (spoonernutrition.co.uk)

There is no definitive evidence about the health impact of eating ultra-processed food. However, a recent study in the British Medical Journal- based on information from 9.9 million people worldwide – linked them to:

a higher risk of death from cardiovascular illnesses
obesity
type 2 diabetes
sleep problems
anxiety and depression

The study could not prove it was the processing of food that caused the illnesses, or simply the fact that most of them are high in fat, sugar and salt. These are a known cause of weight gain, type 2 diabetes, heart disease and some cancers.

Consumption of UPF may be an indicator of other unhealthy dietary patterns and lifestyle behaviours. Diets high in UPF are often energy dense, high in saturated fat, salt or free sugars, high in processed meat, and/or low in fruit and vegetables and fibre.

In more advanced stages of CKD further dietary changes may be required, such as reducing the amount of phosphate or potassium in the diet. Hyperphosphatemia may occurs in CKD stage 4-5 and is associated with mineral bone disease. Properly functioning kidneys remove extra phosphate that ends up in the body, but with CKD, the kidneys can’t remove the phosphate, causing it to build up.

Phosphate is regularly found in meat, fish, diary and very commonly found in food additives in UPFs, eg E338 (phosphoric acid) E339 (sodium phosphates) and E340 (potassium phosphates). Phosphate containing food additives are often in cakes, biscuits, processed meats, spreadable and slices processed cheese, dried powdered sauces or soups. They often have 90-100% bioavailability and are readily absorbed into the body.

So, as you can see UPF pose an even higher risk for more advanced levels of CKD.

Managing diet whilst away on holiday

Mon, 05 Aug 2024 07:17:02 GMT

Whether it's a different country or a staycation it's generally accepted that most of us will eat differently and usually eat more when away on holiday. It’s a time for relaxation, switching off and not having to live by certain rules, potentially around food. Whether its managing blood glucose levels, weight management, blood pressure or cholesterol control, our nutrition health goals do tend to get side lined whilst taking a break from the real world.

One of the first things to say in this article is eating and taking pleasure from food whilst in holiday mode is perfectly acceptable. Going away for a week or two and eating differently will not cause lasting damage or break health goals, however it can be useful to think ahead and plan out some structure around eating when away. Here are my dietitian top tips on how to eat well, but also *eat well*!

Buffet style

Alot of establishment will host buffet style in their hotels. Isn’t it a pleasing sight seeing all the beautiful foods in abundance. There can be an urge to fill our plates high and visit over and over, we are after all wanting to get our monies worth! The issue with overfilling our plates and bellies is it can leave us feeling too full, lethargic and possibly abit nauseous. The other common feeling is guilt, at the time we get pleasure from the tastes and flavours however we may start to feel guilt after eating too much as a result of feeling physically too full. A great way to feel satisfied and nourished is to fill your plate with lots of non-starchy vegetables, e.g. green salad, roasted Mediterranean vegetables, griddled aubergine, sliced tomatoes. Usually, buffets have plenty of these options and ideally should cover half of your plate. Then select your protein. Ideally avoid foods that look particularly fatty, eg red meat with lines of white fat such as lamb or pork chops, however if you do choose these, simply cut that fat away.

Fish is a great option, seabass, salmon, grilled prawns, are all high in protein. Protein helps to fill us up and satisfy hunger. The benefit of including oily fish (salmon, mackerel, swordfish) means we are getting our weekly dose of omega 3. A portion about the size of your palm or 140g once weekly delivers the right amount of omega 3 the body needs. Including omega 3 has been shown to help lower blood pressure, reduce triglycerides, and improve circulation.

Another great protein option is cheese, particularly some of the Mediterranean ones, for example mozzarella, halloumi and feta. Generally, these cheeses are on the lower end of the fat content side of things when compared with other cheeses such as cheddar and parmesan. They are still however all technically high in fat, so the portion size is key. Including cheese not only means we are getting a good source of protein, but also, we also get a healthy dose of calcium which is important for bone health.

The final part of your plate should be left for starchy carbohydrates. Bread, potatoes, rice, pasta, cous cous and noodles are all suitable choices. If you can choose the grainier, seeded, brown versions it means we are choosing carbohydrate which has fibre and usually is lower in glycaemic index which can be helpful for blood glucose control if living with diabetes.

3 Courses

Can I eat a three course meal on holiday and still maintain my health? ... The answer ... yes absolutely! Here are my top tips on how to manage things:

Before ordering food, be mindful of what you will drink. Fizzy pop, fruit juice, cocktails and cider all contain alot of sugar content, so try to avoid them or keep the amount smaller. Rehydrate with water, especially if you are in a warm country. We need 1.5 to 2 litres of fluid per day. In warmer weather we need more.

A better time to have a three-course meal is lunchtime. We are more likely to be active after lunch than dinner. Movement can help with blood glucose regulation, burn some additional calories we may have consumed, improve digestion and increase circulation. So try going for a stroll on the beach or a swim mid-afternoon.

Pick a low-key starter. Low key doesn’t need to be boring though, think lower carb or no carb starter, e.g. mussels, Greek salad, prawns, soup with a small amount of bread, calamari, garlic mushrooms, cold meats, cheese based starters. We are bound to have carbohydrate in with our main and definitely with dessert, so starting on the low side helps to reduce the overall carbohydrate load.

For mains aim for your plate to be 1/4 starchy carb, 1/4 lean protein, and 1/2 vegetables or salad. Filling up on vegetables and salad means we are working more towards our 5 a day. Only 33% of the UK population reach there 5 a day goal every day. Eating 5 a day is associated with low cardiovascular risk. Including enough fruit and vegetables provides a healthy dose of fibre which is helpful for our gut health. In particular fibre helps to keep our bowels regular and helps prevent constipation. Constipation can be more common when on holiday as a result of dietary changes, drinking less water and an increased amount of alcohol.

Opting for lean protein mean a low saturated fat intake. We know the consumption of saturated fat can increase LDL (bad) cholesterol, which can increase the risk of developing atherosclerosis (plaque building up inside the artery wall). Other great heart healthy protein sources include beans, lentils, tofu, edamame beans and oily fish.

Theres not really any getting away from sugar when it comes to dessert. So, pick what you know you'll enjoy. You are on holiday after all. Try and find something that's a sensible sized portion and if the pudds are on the larger side then consider sharing. Another option is to go for fresh fruit. By doing so you are adding to your 5 a day goal and you'll leave the meal feeling satisfied you ate another nutritious item.

Alcohol

Before we get started on advice on alcohol it’s important to always follow the advice of the healthcare professionals that know you. Although in general the recommendation is 14 units or less per week, the advice about alcohol can be different for some individuals, so always check with your healthcare professional first.

If you like a tipple, and particularly like one on holiday, it's likely you'll drink a bit more when away.

Try to make sure you are hydrated before you dive into the first drink. Chances are you'll drink it a lot quicker if you're feeling thirsty. Get a glass of water in beforehand.

Alcohol percentages vary. A typical beer or cider has 4-5% alcohol, whereas a glass of wine can vary from 11-14%. The greater the volume of alcohol the higher the consumption of units. Alot of people won’t realise a large glass of wine can contain up to 5 units of alcohol, which is just over a third of our allowance limit per week.

Alcohol makes us hungry, and we dont tend to crave salad and vegetables. It's usually foods higher in fat, salt, sugar or starchy carbohydrates foods. So be mindful of not overindulging.

Get plenty of water in during and after alcohol. Alcohol is a diuretic, which means it can dehydrate us. For this reason, alcohol can also promote constipation, meaning getting in the fluids and fibre sources is even more important.

Type 2 diabetes and fruit, too much banana drama

Fri, 07 Jun 2024 08:57:47 GMT

As a practising dietitian for many years working in the NHS and private practice, one consistent misconception I've found is fruit should be avoided when living with type 2 diabetes. In fact, fruit is absolutely fine to consume in moderation and comes with a whole host of benefits.

When living with type 2 diabetes the aim is to have optimum blood glucose levels (BGLs), preventing diabetes related complications such as retinopathy (complications to the eyes) and cardiovascular disease which can result in stroke or heart attack. The most common blood glucose test is called HbA1c. Having a HbA1c of 48mmol/mol less is associated with lower diabetes complication risk. HbA1c looks at the glucose attached to our red blood cells. Red blood cells live for 8-12 weeks, therefore a HbA1c can tell us what our levels have been for up to a 3-month period.

Diet is a key component to managing BGLs. Having a balanced and healthy diet is fundamental. Most understand carbohydrate in the form of starch or sugar should be consumed carefully to help aid BGLs, however there are many important factors to diet that will lower our cardiovascular risk. Less salt can help to control our blood pressure and reducing saturated fats from meats and baked goods can help to manage cholesterol.

A lot of the time in diet, people are told to eat less foods which contain higher amounts fat, salt, and sugar. Its seems so much focus is going into what we shouldn’t do, we spend less time discussing what we can include. Fruit is very often demonised and said to be 'bad' for BGLs. In my experience certain types of fruit like bananas, pineapple, grapes and melon get a hard time. It's true that some fruits have higher carbohydrate content when compared to others however the key is the amount we serve ourselves. It's very easy to sit down with a punnet of grapes and before we know it, they have disappeared.

What's a portion size?

When it comes to portion size, we are all individuals. It’s accepted by many dietitians and nutritionists that a portion of fruit is approximately what fits into the palm of your hand. The below images demonstrate a rough portion guide.

Aiming for 2-3 portions of fruit per day is ideal. It is also worthwhile spreading your fruit consumption out over the course of the day.

Numerous patients have told me that they have been advised by friends, family and even some healthcare professionals (HCPs) to either not eat certain fruits or avoid all together! For those testing their BGLs at home with a BGL meter or a continuous blood glucose monitor report certain fruits appear to cause BGLs spikes. It’s important to note rises in our BGLs are perfectly normal and anticipated, certainly within the first 1-2 hours following consumption. This even occurs in people living without diabetes. What’s important is how long it takes your blood glucose to return back to normal. Most HCPs working in diabetes are more concerned if BGLs are regularly raised following a period of fasting, e.g. first thing in the morning on waking, or many hours after eating lunch.

How much carbohydrate is in fruit?

1x banana (no skin) weighing 85g = 17g carb

1 x apple (with core) weighing 131g = 13g carb

80g grapes = 12g carb

80g blackberries = 4g carb

2 x clementines weighing 160g = 10g carb

80g mango = 11g carb

3 x choc chip cookies (60g) = 36g carb

Bowl of muesli (50g) = 29g carb

9 squares of milk chocolate (50g) = 28g carb

1 prawn mayo sandwich on wholegrain bread (164g) = 35g carb

½ pint orange juice (284ml) = 30g carb

1 bagel (86g) = 50g carb

As we can see from the above examples, fruit is generally lower in carbohydrate when compared to other common snacks.

Fruit juices and smoothies

Most people don’t like to be told to avoid or ban anything in their diet. As soon as we are told not to do something, or it becomes taboo, this can generates an urge to want to break the rules. When it comes however to fruit juices and shop bought smoothies, I generally urge patients to avoid them and ideally go for whole fruit. When fruit is blended the sugar within becomes freer and the glycaemic index higher, meaning the body can absorb glucose quicker, which can lead to a potential spike in BGLs. The other thing to be aware of is the amount of carbohydrate in a glass of juice vs a whole orange. In half a pint of orange juice there is 30g carbohydrate, where in 1 orange (140g) there is only 8g carbohydrate. The other difference is the fibre content, there is 2g fibre in the whole orange, whereas there is 0g in the glass of juice.

What's the health benefits of fruit?

The benefits of fruit are widely documented. They provide fibre, as well as an array of essential vitamins and minerals. Fruit counts towards our 5 a day and including fruit forms what is called a cardio protective diet. Studies have found that consuming at least 5 portions of fruit and vegetables a day is associated with a reduced risk of cardiovascular disease (heart attack and stroke). Only a third of the nation consume the recommended 5 portions a day. Cutting fruit out or avoiding particular types could be a reason you are not meeting the UK’s 5 a day recommendation.

What does this mean for me living with type 2 diabetes?

Living with diabetes does not mean you need or must cut out all sugar or carbohydrate. Not all sugar or carbohydrate containing foods are equal. If we compare 2 digestive biscuits and a medium sized banana the carbohydrate content is almost the same, however the biscuits contain added sugar, saturated fats and would classify as a processed food. The banana contains natural sugars (which are seen as less concerning in sensible amounts), fibre, and a range of essential vitamins and minerals.

A palm size amount of fruit, 2-3 times per day, spread out over the course of the day is perfectly acceptable.

Ultra processed foods and type 2 diabetes

Tue, 28 May 2024 14:53:19 GMT

The term ultra processed food (UPF) has become more popular in the media in recent years, but what is an UPF and what does it mean for those living with type 2 diabetes? Should they be avoided, or can they be included in everyday diet?

The term 'processed foods' has been around for some time. Its widely accepted too much processed food, containing fat, sugar and salt can lead to a less nutritious diet. Too many may also mean we in turn consume less of the nutritious whole foods like fruit, vegetables, and wholegrains. The term UPFs is fairly new, developed by researchers at the University of Sao Paulo in Brazil. They develop the NOVA food classification system, which categorises foods/processed foods into four sections:

What is ultra processed food?

The system places food into four categories based on how much they have been processed during their production:

Unprocessed or minimally processed foods: This includes produce such as seeds, nuts, fruit, vegetables, milk, chicken, fish, meat, pulses, and eggs as they have no added ingredients and have been minimally altered from their natural state.
Processed culinary ingredients: This group includes foods that are added to other foods rather than eaten by themselves, such as vegetable oil, salt, and sugar.
Processed foods: Most processed foods have two or three ingredients and are made by combining foods from groups 1 and 2, which are altered in a way that home cooks could do themselves. They include foods such as salted nuts, pickles, tinned fruit and vegetables, jam, cheeses and homemade or bakery fresh breads.
Ultra-processed foods: Ultra-processed foods typically have more than one ingredient that you never or rarely find in a kitchen. They tend to include many additives and ingredients that are not typically used in home cooking, such as preservatives, emulsifiers, sweeteners, and artificial colours and flavours. These foods generally have a long shelf life. They include foods such as mass-produced bread, cake, pastries, some breakfast cereals, instant soups/sauces, ready meals, chicken nuggets, burgers, and hotdogs.

Although the NOVA food classification system provides an outline for UPFs, it’s worth noting there is currently no common agreed definition for an UPF. This means we could see this change in the future.

Are UPFs safe to eat?

There was recently a large systematic umbrella review of existing meta-analyses performed by the British Medical Journal. This study looked at nearly 9.9 million people and their consumption of UPFs. The review linked that those consuming more UPFs were at higher risk of developing obesity, type 2 diabetes, depression, sleep problems and higher risk of death from cardiovascular illness. The study could not prove the processing of the food caused these conditions however it is widely accepted eating foods that contain more sugar, salt and saturated fats are related to more adverse health outcomes, like obesity and cardiovascular disease.

Are all UPFs equal?

In a word, no and here’s why …

Overall nutritional value

Some UPFs will have significantly more nutritional value, for example baked beans, mass produced wholegrain breads and canned soup contain more nutrient value than pizza, crisps and biscuits. When we consume baked beans, we are adding fibre, plant-based protein and a portion of vegetables that count towards our 5 a day into our diet.

Shelf life

For anyone who has previously baked their own bread, or regularly shops at the fresh bakery selection in the supermarket, you’ll know the bread only lasts 1-2 days before it goes passed its best. Mass produced breads have a longer shelf life due to certain additives and emulsifiers which are added at the production stage. Given the time it takes to make things from scratch and the rising cost of food and ingredients, foods with preserved shelf life are useful.

Hidden nutrients

Unfortunately, in the UK not many of us manage to hit the 5 a day target recommended. In fact, its thought as little as 32% of adults aged 16 years and over eat 5 a day.

Another hidden benefit of some UPFs is the fruit and veg they can contain. Canned vegetable soup, baked beans and some ready meals include vegetable sources which count towards our 5 a day.

Many breakfast cereals would count in the UPF category. In the UK many breakfast cereals are fortified with additional nutrients which are commonly lacking. Folic acid, vitamin D, thiamine, and iron are a few examples of nutrients added to cornflakes.

Often these are cost effective options, and arguably in the UK individuals could potentially be in nutrient deficiency if they were not widely available.

What does this mean for people living with type 2 diabetes? Should UPFs be avoided?

When it comes to type 2 diabetes there is no specific diet which has a more superior benefit for blood glucose control, instead finding a dietary approach the individual can stick to long term is often more beneficial.

In the UK the government uses the Eatwell Guide. This is aimed at the general adult population and demonstrates what a balanced diet should look like. It includes fruit and vegetables, wholegrains, lean protein, diary and alternatives and heart healthy fats. The Eatwell Guide discourages foods containing saturated fats, salts and free sugars. Excess amounts of free sugar for someone living with type 2 diabetes will likely cause dramatic rises to blood glucose levels, and in the long term may lead to long term complications such as retinopathy and renal disease.

Excess salt is also concerning as it is known to increase blood pressure, whereas including too much saturated fat can lead to higher cholesterol. Both factors increase the risk of cardiovascular disease, which is already heightened when living with type 2 diabetes.

Although some UPFs have some better qualities, high proportions contain increased amounts of saturated fats, salt, and sugar. Some also contain very little nutrients, for example pizza, crisps and cookies have far fewer nutrients when compared to wholegrain bread, some breakfast cereals, and baked beans.

If living with type 2 diabetes consuming less UFPs wherever possible is likely to be beneficial. What is clear is more research is needed to understand the effects of consuming UPFs. Regardless, a diet low in salt, saturated fats and sugar will be favourable.