Low fat dietary information for people with Severe Insulin Resistance

You will need to follow a low fat and calorie (energy) diet. In addition you should increase the amount of calories you use from physical activity. Due to your Severe Insulin Resistance (SIR) you will need to follow a similar diet to a very overweight person even though you may not appear overweight.

Although the dietary information may sound strict, if followed it will reduce your health risks significantly. It should also help you reduce the number of medications you take/ may have to take in the future.

Non-alcoholic fatty liver disease

Over time excess dietary calories and fat can lead to storage of fat in the liver. This can result in inflammation and scarring of the liver. This can make your insulin resistance worse.

Diabetes

Diabetes is common in people with severe insulin resistance. It is likely to develop sooner if there are higher levels of fat being stored in the liver, muscles and other vital organs.

If you already have diabetes then without strict lifestyle modification your control will worsen and the risk of developing diabetic complications increases.

Cardiovascular (heart) problems

The risks of heart attacks and strokes are increased by high levels of fat in the blood stream. By reducing the amount of fat in your diet you can reduce the risks.

Pancreatitis

Pancreatitis is the inflammation of the pancreas. This can be extremely painful and if acute can result in hospitalisation. Triglycerides are a way that our bodies store fat. If you have SIR/lipodystrophy and reduced fat storage this can lead to higher levels of triglycerides in the blood stream. High circulating triglycerides can lead to pancreatitis. To prevent pancreatitis you should follow a low fat diet. If triglycerides are found to be extremely high you will be advised to follow a minimal fat diet until levels reduce.

Many people will measure weight and height to work out Body mass index (BMI). On a BMI chart you may see you are within the healthy range or even on the lower end of a healthy weight. Unfortunately there is not a healthy range for people who have Lipodystrophy/SIR so BMI is not an ideal measure. This is because people with lipodystrophy/SIR may only store fat internally or in areas of the body that are linked with higher health risks such as around the middle. Therefore the leaner you are all over, and the less fat that is stored anywhere the lower your risk of complications.

Generally you should be aiming for less than 20- 30% energy from fat. This fat should be spread throughout the day and you should avoid eating it in one meal. Just one large fatty meal can lead to serious consequences such as pancreatitis.

An example of someone eating a 1500Kcal diet and aiming for less than 20-30% fat would be equal to 33-50grams of fat per day. No meal or snack should contain more than 10-15g fat. Some people need to be more restrictive.

• Try micro-waving, steaming, poaching, boiling or grilling instead of roasting and frying. If you do fry, use a non-stick pan with a spray oil or no oil.
• Take the skin off poultry and remove visible fat from meat before you start cooking.
• Use low-fat products where available, such as skimmed milk and low-fat spreads rather than margarine or butter. Do not be tempted to put on more because it’s lower in fat. Don’t assume that plant based milk alternatives will be lower in fat – make sure you check the labels
• Avoid all cheese with the exception of extra low fat cream cheese and cottage cheese. Eat lean protein cheeses are also low fat.
• Avoid fatty foods such as crisps, nuts, pastry, cakes, biscuits, cream, tinned meats, chips, roast potatoes, Yorkshire puddings, dumplings and gravy made with meat juices. Try baked crisps or ‘light’ versions and choose smaller packets (25g). When having potatoes try boiling, mashed or jacket rather than roast or chipped.
• Try using fat free yoghurt. Those with higher protein in may be more filling.
• Be aware when you look at recipes – can you try adding less fat?

Also known as Orlistat. This is a medication that can help you lose weight by reducing the amount of fat you absorb from your diet. Xenical can be very useful to aid weight loss alongside a low fat diet. Xenical can cause side effects of wind and loose bowels if a low fat diet is not followed when taking. For more information and a more in depth information sheet please ask your dietitian or doctor.

Note that a lower strength version of Xenical can be brought over the counter at pharmacies. This is called Alli.

We do not advocate any herbal remedies and if you want to take one of them please speak to your GP or a member of the SIR team first.

Reducing the amount of saturated fat you eat will help lower your cholesterol. For example lard, butter, fat on meat and skin on poultry, many processed meats such as burgers, sausages, salamis. You do not need to restrict foods high in cholesterol such as eggs and prawns as these have little effect on blood cholesterol levels.

Foods that are high in soluble fibre can help to lower cholesterol levels. Sources of soluble fibre are whole porridge oats, fruit and vegetables, soya, legumes e.g. red kidney beans, butter beans, lentils. Including these as part of your diet on a daily basis can help to lower cholesterol levels.

Other foods, also known as “functional foods” can help to lower cholesterol levels. These are products that have been specially formulated to have a cholesterol lowering effect and contain Phytosterols, which research has shown to lower cholesterol. Some examples are Benecol/Proactiv yoghurts, yoghurt drinks, margarine. These do not help everyone but if you have raised cholesterol and have already made the other dietary changes you may wish to try them for a short period (3-6 months) to see if effective.

Meat alternatives – chick peas, tofu, quorn and soya. These can be a great alternative to meat and can substitute meat in many dishes. Make sure you check the labels as not all will be low in fat or a healthier option.

Ideally you would get you omega 3 intake from food but if you cannot do this you could try an omega 3 supplement. If you would like to take a supplement please discuss with your dietitian as they will contribute to your fat intake.

The energy we eat and drink is measured in calories (kcal). Fat contains more calories per gram (~9kcal) than either carbohydrate or protein (~4kcal).

If you have excess fat, this will be stored as triglycerides damaging your liver and other vital organs. You need to ensure you eat the right amount of calories to prevent this from happening.

Everyone will have a different calorie requirement as build, age and sex all determine our requirements. The dietitian will work out your requirement.

Your calorie requirements per day __________

Your suggested grams of fat per day___________

• Eat regularly - skipping meals is a false economy. When you eat three meals a day you are less likely to feel hungry and less tempted to eat unsuitable snacks between meals.
• Plan ahead – have healthy snacks ready in the fridge and place them at the front so you see them first. Try to avoid filling cupboards with unhealthy snack options to avoid temptation
• Eat slowly and give the food your full attention – do not eat in front of the TV.
• Sit down to eat and focus on what you are doing – food should be enjoyed, not rushed.
• Do not feel guilty after eating. It will make you feel worse and set you back on reaching your goals
• Stop eating when you’re full
• Avoid eating multiple courses
• Shop on a full stomach only and take a shopping list with you that you stick too.
• Remember the calories you take from drinks. Try to always have low fat or sugar free drinks. Alcohol is high in calories so either avoid or cut down what you are having. Make drinks last by making a long drink such as a spritzer and always use low calorie mixers.
• Treat yourself with no food related treats!

A low fat diet doesn’t mean you can’t eat out, it just means you need to be more aware of what you order. If you were allergic to peanuts you would make sure you didn’t order a dish containing nuts. It’s the same for Lipodystrophy/SIR but with fat!

Italian foods

If having a pizza aim to have a thin crust with vegetable toppings. You could ask for less cheese or just tomato. Many pizza restaurants will offer a lighter option.

If choosing a salad, ask for the dressing on the side or to exchange it for a balsamic vinegar dressing or squeeze of lemon. Ask for no croutons.

If choosing a pasta dish, chose a tomato based sauce e.g. Arrabiata. Avoid adding cheese. Dishes made with creamy/cheesy sauces such as lasagne or carbonara should be avoided.

Chinese foods

Choose won-ton or hot soups rather than deep fried dishes like spring rolls and prawn toast. Choose steamed or stir fried rather than deep fried dishes. Good examples include stir fried vegetable or chicken in black bean sauce.

Avoid sweet and sour dishes (as the meat is deep fried), fried chicken, beef and duck. Aim for boiled rice or noodles, rather than fried.

Café / pub food

Rather than a beef burger, try grilled chicken in a bun with a little tomato or BBQ sauce rather than mayonnaise.

Try vegetable based soups with wholemeal breads or rolls, baked potato with vegetarian chilli, baked beans or cottage cheese. Do not add butter or cheese.

Ask for sandwiches to be made without butter or mayonnaise. Choose wholemeal options.

Indian foods

Avoid creamy curries such as those made with coconut milk, e.g. Korma, masala. Try tomato based curries such as tandoori, bhuna and vegetable dishes (avoiding those that are made with ghee). Avoid deep fried sides such as samosas and bhajis and choose boiled rather than fried rice. Lastly, choose baked breads like chapatti and plain naan rather than peshwari and paratha.

A recipe booklet is available to support this diet sheet. Ask your dietitian for this.

The following websites all contain lots of different recipes – they include nutritional information so ensure you choose those which are low fat.

• British Heart Foundation (opens in a new tab)
• Heart UK (opens in a new tab)
• Diabetes UK (opens in a new tab)

The dietitian will provide you with a food diary. By completing a food diary you and the dietitian can assess your food intake and help you to make some changes. If you prefer you can always try using one of the below diaries online/as an app.

• My Fitness Pal (opens in a new tab)
• My Net Diary (opens in a new tab)
• Fat Secret (opens in a new tab)

You will be referred to a dietitian at the hospital. They will help you to understand why you need to make changes and how to go about it. The aim is to personalise your diet to you.

Dietitian contact number. 01223 216655

Email Catherine Flanagan

Email Lisa Gaff

Sometimes people will find they need on-going support. There are a number of NHS support programmes and the dietitian involved in the SIRs clinic is available to offer you support. However, some people find attending support /diet clubs the most motivating ways to lose weight. If you would like to attend one of these groups it will be useful for you to explain your condition to the group leader. Please ask the dietitian to contact the group if you need someone to explain for you.

• Weight watchers
• Slimming world
• Rosemary Conley

Local NHS weight loss programmes can also be found via your GP surgery

A lipodystrophy forum run by and set up by people with the condition can be found at the Lipodystrophy website (opens in a new tab)

Carbs & Cals & protein & Fat – A visual guide Carbohydrate, Fat and Calorie counting.

NHS website (opens in a new tab) - scan your favourite foods to find healthier alternatives.