Conflicting diet plans: I am wondering... - British Heart Fou...

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Conflicting diet plans

Daggerton profile image
Daggerton

I am wondering if anyone can give me some dietary advice.

I am type 2 diabetic, so need to avoid sugars. I have had heart attack, stents and bypass surgery, and was advised to follow a low carb, high protein diet. But now I have developed a gall bladder problem and am told I need to go on a low fat diet. Getting balanced information on what that means is difficult. My 3 specialist nurses all seem to give conflicting advice. Basically i want to get back to being able to live as normal a life as possible. I would be pleased to hear any suggestions for a sensible diet or even recommendations of a good book / reference material which combines the needs for all three conditions.

Thanks.

Tony

28 Replies

Many people here would recommend the Mediterranean diet for heart purposes, and it’s liked for diabetes, too, but that tends to be quite high in fat, which is no good with a dodgy gallbladder. Low carb, high protein, low (saturated) fat, low sugar is what I followed alongside exercise to lose 10 stone, continue to follow to a greater or lesser degree now, and a low carb diet is generally what’s recommended in the U.K. for type 2 diabetes, not just low sugar. Low carb is also not no carb, it just means restricting carb intake, usually to a level below 130g a day (or whatever the medics have recommended if they’ve suggested a figure to you). This link may be somewhat useful to you:

diabetes.org.uk/guide-to-di...

What you would have to watch with that menu though is the fat content, and they don’t actually list those values, but substitutions/alternative methods of cooking can help there. I would also struggle with the menu because I’m a bit of a fussy eater, but there are some good ideas there.

I personally found the easiest way to facilitate a diet like the one you want is to cook from scratch - there aren’t that many things you can buy off the shelf that fulfil every need, particularly when it comes to sugar and fat (and salt), and reading packets will be the only way to determine which things are ok, and which aren’t. It can be a real eye opener when you start reading them, but also when you realise that low fat things can be just as unhealthy as regular when you take hidden sugar into account. Cooking doesn’t have to be fancy, and probably better if you don’t try to be too fancy, because the more you add to food other than herbs or spices, the more calories/carbs/fat you’re adding: an example of a really basic meal would be grilled chicken breast (or two), *small* amount of boiled or mash potato if you can’t not have any at all, veg of some description. A small jacket potato with tinned tuna and a salad on the side. Tinned tuna and white meat are all good, easy sources of lean protein, as are meat alternatives like quorn, and you can substitute things like beef mince or meatballs for chicken or Turkey versions. Most supermarkets do chicken and turkey mince that you can use to make things like bolognese now. It won’t be exactly the same as using beef, but it turned out that we much prefer Turkey meatballs as a household. We also use meat alternatives on a regular basis. Eggs are a really good source of protein, and I make Not-chicken egg ‘fried’ rice once a week on average. I use a tiny amount of olive oil, garlic quorn pieces, wholegrain rice, frozen peas and sweetcorn, two eggs, and reduced salt soy sauce to feed two of us. It is relatively carb heavy, but the whole portion is less than 500 calories, with 23g of protein and 11g of fat, which is less than a quarter of my daily maximum, and I always plan when I’m going to cook it so I can factor the carbs into my eating for the day. It also only takes about 20 minutes from start to finish.

Don’t fry food, don’t add extra fat, just grill, oven cook, poach or boil (or microwave), and use only a very small amount of something like olive oil if fat is absolutely required for cooking purposes (like to fry off some garlic). Avoid processed carbs like bread/cakes/pastries, and reduce how much potato and pasta etc. you eat. Switch from white varieties to wholegrain/wholemeal, including rice. I like to use the microwave pouches of wholegrain rice mixed with other grains: one pouch serves 2 people, but it is about a third of my daily carbs: the only way to successfully know how much you’re eating, will be to weigh your food and track what you eat to begin with. From experience, a 100g portion of oven chips in reality, is nowhere close to what my brain thinks 100g of oven chips looks like. This was true of every single food I ate, and if you’re trying to track how much carbs or fat or whatever, you need to have accurate information about the portion sizes you’re eating. The good thing, though, is that there are free apps out there that have databases of food included along with the composition: you tell it how much of something you ate, it will work out the fat, protein and carbs against target values it gives you based on whether you want lose, maintain or gain weight.

Switch to skimmed milk, and if like me you’re a dairy fiend, look at low fat cheese alternatives (leerdammer, Edam, weight watchers), buy slices rather than a block, and look at quark or skyr based yogurts. They’re usually very high in protein, but low in fat and sugar, and often almost zero carbs. I often have one for breakfast. These kinds of things are often more expensive, but are better for you and easier to track as you’ll know how much each is for fat and protein etc. You can still have some of what you want/fancy, but you just need to think about it a little bit to make sure you’re keeping your diet on track and not suffering with your gallbladder as a consequence of too much fat.

I realise all this sounds like effort and faff, but it quickly became second nature, and it is living ‘normally’. Other than weighing my food where necessary to work out my macros (and that’s a choice I make because my primary reason to diet originally was obesity, which means I automatically have a slightly squiff relationship with food in relation to my emotions), it’s no different to what anyone does each day. I’m no longer trying to lose any weight as I’m down to a bmi of 24, but I stick to the same principles as a result of the various health problems I have including my cholesterol, insulin resistance and liver issues.

Daggerton profile image
Daggerton in reply to Charlie_G

Thank you so much for taking time to write such a comprehensive reply. My gall bladder problems arrived out of the blue, no previous history, and it was a surprise to find myself being rushed to hospital overnight. Even more of a surprise to be chucked out a few days later being told I’m likely to need an operation soon and to eat low fat, without any documentation advice or guidance to help with what that meant. Its all a bit bewildering at the moment. I know I could do with shedding around a stone so will set that as a starting target and see how things develop. T

I hesitate too give diet advice because there are so many individual (and even genetic) differences that what works for one may not work for another. In addition I know nothing about the gallbladder problem you face.

However, I was diagnosed with atherosclerosis (heart disease) and even though I'd never had a heart attack I had bypass surgery. I'm fortunate in having a GP who is passionate about establishing the root cause of heart disease, he went over the annual company medicals and discovered a rising trend of insulin resistance, which put me borderline pre-diabetic. He believes this, along with elevated cortisol levels due many years of jet lag from long haul flights, is the primary cause of my heart disease.

Here's the good news, I completely turned around my insulin resistance with diet and exercise, and am now well back in the safe zone.

I basically used a Mediterranean Diet with a moderate low carb bias, but the big difference was I employed "intermittent fasting". Alongside exercise this really drives down your insulin and blood sugar levels. I don't eat between 9.00pm at night through to 1pm the following day. And I mean absolutely nothing apart from water and black coffee.

It certainly worked for me. Maybe it could work for you?

Good luck!

Daggerton profile image
Daggerton in reply to Chappychap

Thank you for your help

Side suggestion.... ask if you can have an appointment with a dietician. It is just this kind of problem they exist for. This said NHD Dietetic referrals can be quite hard to come by but maybe worth a try.

I'll give it a go. Thanks!

Is it low fat or low saturated fat you are aiming for? Big difference. Also watch out for fasting while increasing activity. I’ve never needed to fast but I know some think it works. I refer to Dr Greger’s work for advice quite often and I know some here think he is a crank. I use what I want from it and what I think might work. Good luck 👍

Daggerton profile image
Daggerton in reply to COYW

Thanks for the advice

PS watch out for advice that contains words like ‘totally changed’, ‘completely clear of’ and ‘amazing cure’ 😂

Are u able to exercise like walking or up a flight of stairs? To control diabetes you need to know the exact amount of carb in your meal and your ability to lower blood glucose. That means you need to know how much carb is in your meal which include complex carb and not just avoiding sugar. If you can walk a little after meal it will help to reduce blood glucose level. Finally you need a glucometer to monitor two hours after a meal and when you just woke up.

Daggerton profile image
Daggerton in reply to redshock11

I’m relatively fit and healthy. Regularly walk 5 to 6 miles with my wife. Ive been monitoring food intake and blood readings for many years. The issue I have is that the dietary advice given by heart specialist and diabetic nurse frequently conflicted Each other. Now I have new input from gall bladder people which prohibits so much of what I was previously instructed to eat. I seems that specialists fo each illness operate and give advice in its own silo, and getting across the board advice which isn’t contradictory is very difficult. Simple items like bananas and prawns - recommended foods in one list, banned in the other. Bread- eat plenty of it, only eat whole grain, don’t touch it! Which is the path to chose? 😕

redshock11 profile image
redshock11 in reply to Daggerton

Gallbladder problems means you can't eat too much fat each meal? That means you need to limit all visible fat and avoid high fat food? Being diabetes type 2 means you need to limit your carb intake to a level your body can manage with your activity level. U definitely cannot eat as much bread as you can.

Lots of good advice already. I had a massive HA around 14 months ago and whilst in the CCU was diagnosed Type 2.

My one bit of advice is to join the Diabetes UK forum (as well as this BHF forum).

I reduced my carb intake by around 75% by, for example, eating pasta, rice and potatoes half as often and halving the portion size. For breakfast I’ve gone from two to one slice of lower carb bread (Brennan’s “Be Good” range). No porridge or cereals. Whatever your GP or DN tell you get a meter and measure your blood glucose regularly. Lots and lots of help with this in the DUK forum.

Daggerton profile image
Daggerton in reply to HenryB

Thanks for the advice

COYW profile image
COYW in reply to HenryB

Good advice but why no porridge? 🥲

HenryB profile image
HenryB in reply to COYW

Oats/porridge are 60% carbohydrate. I avoid pretty well anything with oats in it.

HenryB profile image
HenryB in reply to COYW

Most of my life I didn’t like porridge but over the last few years got to actually like it. Once I started my food diary and regular finger pricking I saw the big spike after having porridge for breakfast.

COYW profile image
COYW in reply to HenryB

From BHF website.......Porridge is our top choice for a heart healthy breakfast – when it is made with low-fat milk or water and unsweetened. All porridge oats are wholegrains and they all contain a soluble fibre called beta-glucan, which can help lower your cholesterol level if you have 3g or more of it daily, as part of a healthy diet. (A 40g serving of porridge oats contains 1.6g of beta-glucan.) As well as this, you’ll be getting the fibre from the whole grains, plus there is no added sugar or salt.

Make sure you don’t add extra sugar or salt to your porridge as this will undo all your good work – instead, try adding a banana or some fruit for extra sweetness. For every 80g that you add it will be one of your 5-a-day at the same time.

A serving of porridge made with 40g of oats and semi-skimmed milk contains:

Energy 1016kJ / 241kcal, 12% of your Reference Intake (RI)

Fat 6.2g, 9% of your RI

Saturates 2.5g, 13% of your RI

Sugars 8.2g, 9% of your RI

Salt 0.2g, 3% of your RI

A 40g serving of oats (not made up) contains:

Energy 645kJ / 152kcal, 7.6% of your RI

Fat 3.2g, 5% of your RI

Saturates 0.5g, 2.6% of your RI

Sugars 0.1g, 0.1% of your RI

Salt <0.01g, <1% of your RI

HenryB profile image
HenryB in reply to COYW

I thought we were talking about T2 diabetes🤔

In any event this list of ingredients shows “sugars” but not “carbohydrates”.

HenryB profile image
HenryB in reply to HenryB

There’s around 65g of carbohydrates in 100g of oats!! The biggest single myth regarding diabetes is that you need to cut just sugar. This is why NHS support is so poor. It’s carbs: potatoes, rice, pasta, flour etc

COYW profile image
COYW in reply to HenryB

Nutrition without prejudice and without siloed approaches to disease is in my humble opinion the best way forward but I’m willing to accept disagreements 😀

forum.diabetes.org.uk/boards/

You will develop lots of ways to reduce fat whilst waiting to have your gall bladder removed. We've both had gallstones and husband had to be on no fat diet when his gallbladder was infected. Some of the things we did include using Laughing Cow extra light instead of butter on toast etc; use fat free yoghurt as a base for sauces, salad dressings, mixed with sugar free jelly as a dessert, very low fat sausages, I think they were Heck's, use Frylight spray instead of oil when frying, make burgers etc using 2% fat turkey mince, soya milk instead of cow's milk. You can make scones etc using fat free yoghurt, Google 2 ingredient dough.

Daggerton profile image
Daggerton in reply to Ecki

Thanks for your input.

daisypainters profile image
daisypainters in reply to Ecki

Also on BBC good foods as pizza dough - my children’s favourite and no rising time.

Hi Tony I am always wary of giving advice but I do think just sharing things that might work can sometimes be of benefit I was on the borderline of type 2 a year or so ago and apparently my blood results late last year suggested I had brought it into the normal range ( I am not sure I believe these blood tests sometimes personally but I have not had any symptoms anyway ) - I need to lose weight but as I am tall I get away with it with my clothes fitting as usual I think I would look to most deceptive in this regard.

All I can say is that when they told me I was getting closer to borderline and would perhaps have a stroke if I didn't lose the weight I accepted to attend the groups for type 2 diabetics etc that was in 2019 - I removed all the obvious sugars out of my diet which was not much

( only ginger biscuits which I used to have with my cups of tea ) - not often cake but I did begin to look at all the ingredients in products and used the traffic light system on packages - I now don't buy anything with a Red on - and I stick to this its helpful at a glance ( this would be my one tip )

I think I manage never to fry anything and I believe many have suggested a Mediterranean diet - this is good along with making your own cooked meals rather than buying the ready made and certainly no takeaways - no cakes or biscuits - ( although I do eat crackers etc ) - I eat porridge with fruit every morning and instead of any spread on bread - toast or crackers I use avocados - these are a super food and are good for you they have the good HDL not the bad fats - so tips that for me have helped me are Traffic lights - cook from scratch and swap heavy fats in cheese for cottage cheese and avocados.

I am not completely out of the woods myself because I have nightly heartburn or acid not sure which but discomfort - had all the tests and looks like a very sensitive stomach - I have to take one Gaviscon tablet each night - I can't tolerate the PPIs - I am not sure if this will need an op for something like a sphincter or if its just down to weight because with lock down I have put some weight back on and its become a little worse

I have no longer had the other pain which appeared to be close to the pancreas on my left lower rib etc this has all passed now but I clearly have some issues that are unresolved in my digestion. In 2019 ultra sound and endoscopy had been fine - I have not had the CT scan as I am a bit worried about the iodine in that - but it looks like its not gone away - I only notice the issue when I lay down at night so its as if its postural however I have heard you can have 'silent ' symptoms . ( sometimes I think I might be celiac - because I do love bread and eat too much of that - which of course is sugar in the end ! ( there is no happy life is there without some carbs somewhere !?)

I have not had a blood test for the type 2 but even before it was a low number even for the borderline - still I do think that the extremely obvious sugars if you cut them out completely you will notice a big difference I hope so and wish you well Tony

Gwen

Oh I forgot to add - and exercise too - you sound so lucky that you do walk a lot - I do like to walk but I am limited with arthritis now in my hips and possibly knees and back ( but again its not so obvious )- before lockdown what I think helped my early borderline type two and weight in general ...I was swimming regularly and it helped my joints too. - if you are getting out walking this must be helping your type two - I noticed you mentioned prawns which are also super foods but of course they are rich in fats so like avocados need to be a little bit moderate perhaps more so than with the avocados - I find bananas good too I have these on porridge - perhaps its the action of the oats which helps counter the fat here - I wont preach about amounts Tony because I know that I am not good at being moderate with prawns or avocados but this is better than going mad with the ginger nuts !

I hope you find the right diet for you and that all goes well with your health journey

Consider following the Fast 800 method. Great for reversing type 2 and you could consider occasional fasting styles explained in the book. Certain foods can improve the health of a gallbladder too!

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