Healthy Eating for Diabetes

Healthy Eating for Diabetes

Why Is Healthy Eating Important in Diabetes?

Nutritional therapy is the treatment of a disease through changes in the intake of nutrients or whole-food1. It is an important part of quality diabetes management, as supported by strong evidence and highlighted by the American Diabetes Association (ADA).2 Nutritional therapy has been shown to be effective in achieving hemoglobin A1c reductions and maintaining glycemic control.3 Furthermore, it is cost-effective and is covered by Medicare benefit.4 As such, nutritional therapy is recommended for all individuals with diabetes and prediabetes as part of working towards glycemia control, weight management, and cardiovascular risks improvement.2


What Are Recommended Macronutrients?

There is currently no known ideal composition of macronutrients (ie, carbohydrates, proteins, fat) for people with or at risk for diabetes.5 Therefore, how much patients eat from each food group should be individualized based on their metabolic goals and preferences.

When selecting the type of foods to consume, the ADA Consensus Report provides several recommendations.2 Since consistent, sufficient intake of dietary fiber is associated with lower mortality in people with diabetes,6,7 at least 14 g of fiber per 1000 kcal is recommended (per the 2015-2020 Dietary Guidelines by the U.S. Department of Health and Services).8 Vegetables, beans, peas, lentils, fruits, and whole grains are good sources of fiber. Consumption of carbohydrates rich in dietary fiber, vitamins, and minerals and low in added sugars, sodium, and fat is recommended. Furthermore, consumption of synthetic trans-fat should be avoided.

The Consensus Report also provides some guidelines in the prevention and management of diabetes-related complications such as cardiovascular disease (CVD) and diabetic kidney disease (DKD). To reduce the risk of CVDs and to lower total cholesterol and low-density lipoprotein cholesterol, saturated fats should be replaced with unsaturated fats.9 People with diabetes, along with the general population, are recommended to consume less than 2,300 mg/day of sodium and to eat a serving of fish twice a week. People with DKD do not need to reduce their protein consumption to below the recommended level (0.8 g/kg body weight/day). Doing so does not meaningfully improve glycemic, cardiovascular, or kidney measures, and may increase the risk of malnutrition.10–12


What Are Recommended Healthy Eating Patterns?

There are numerous eating patterns that are acceptable for diabetes management, including the Mediterranean-style, low-fat, or low-carbohydrate ketogenic diet.2 It is unclear whether a specific eating pattern is superior given limited available evidence. However, several commonalities among these eating patterns can be noted, including focusing on non-starchy vegetables, selecting whole foods over processed foods, and reducing added sugars and refined grains.

Mediterranean Diet – This eating pattern is characterized by plant-based foods, fish and other seafood, olive oil as the main source of fat, low to moderate amounts dairy products, typically fewer than 4 eggs/week, low amounts of red meat, low to moderate amounts of wine, and rare amounts of concentrated sugars. Benefits of the Mediterranean-style eating pattern may include reduction of risk in the development of diabetes, A1c reduction, triglycerides reduction, and reduction of risk of major cardiovascular events.

Low-Fat Diet – This eating pattern is characterized by vegetables, fruits, starches, lean protein sources (including beans), and low-fat dairy products. The Consensus Report defines it as achieving a total fat intake of ≤30% of the total calories and a saturated fat intake of ≤10%. Benefits of the low-fat eating pattern may include reduced risk of diabetes and weight loss.

Low-Carbohydrate Ketogenic Diet  This eating pattern is characterized by vegetables low in carbohydrates (salad greens, broccoli, cauliflower, cucumber), fat from animal foods, oils, butter, and avocado, and protein from meat, seafood, cheese, nuts, and seed. Starchy and sugary foods such as pasta, rice, potatoes, breads, and sweets are avoided. The Consensus Report defines it as carbohydrates contributing to 26-45% of total calories intake. Benefits of the low-carbohydrate eating pattern may include A1c reduction, weight loss, lowered blood pressure, and increased high-density lipoprotein cholesterol and lowered triglycerides.


What About Sweeteners and Alcohol Consumption?

As sugar-sweetened beverages are linked to significantly greater risks of type 2 diabetes mellitus (T2DM) among other conditions such as weight gain and heart disease,13,14 sugar-sweetened beverages should be replaced with water as much as possible. One study showed that the replacement reduced the risk of T2DM by 7-8%.15

Sugar substitutes (eg, aspartame, stevia) may result in lower caloric and carbohydrate intake and could potentially have beneficial effects on glycemic, weight, and cardiometabolic control.16,17 However, the data is insufficient to conclusively support these benefits, and people should be advised against compensating with extra calories from other sources.

Alcohol consumption should be moderate (≤2 drinks per day for men and ≤1 drink for women, with one drink defined as a 12-oz beer, 5-oz wine, or 1.5 oz distilled spirit, each with about 15 g of alcohol). Moderate alcohol consumption may be associated with decreased incidences of diabetes;18–20 however, the evidence does not suggest that healthcare providers should advise non-alcohol users to start consuming alcohol. Furthermore, patients should be advised of the risk of delayed hypoglycemia due to alcohol consumption, especially those who use insulin or insulin secretagogues, and on the importance of frequent glucose monitoring after drinking.21 Additionally, they should be educated on the recognition and management of delayed hypoglycemia.2


How Can I Develop a Dietary Plan if I have Diabetes or Prediabetes?

Ideally, a dietary plan should be developed with a registered dietitian nutritionist (RDN) at the time of diagnosis in the context of diabetes self-management education.2 The plan should be coordinated as part of an overall diabetes management strategy that includes medication and exercise. The dietary plan should also be regularly reassessed and updated according to the changing health status of the patient. Consult with your physician for a referral to an RDN for a personalized dietary plan.


1. Medicine I of. The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population.; 1999. doi:10.17226/9741
2. Evert AB, Dennison M, Gardner CD, et al. Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Diabetes Care. 2019;42(5):731-754. doi:10.2337/dci19-0014
3. Franz MJ, MacLeod J, Evert A, et al. Academy of Nutrition and Dietetics Nutrition Practice Guideline for Type 1 and Type 2 Diabetes in Adults: Systematic Review of Evidence for Medical Nutrition Therapy Effectiveness and Recommendations for Integration into the Nutrition Care Process. J Acad Nutr Diet. 2017;117(10):1659-1679. doi:10.1016/j.jand.2017.03.022
4. Briggs Early K, Stanley K. Position of the Academy of Nutrition and Dietetics: The Role of Medical Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and Treatment of Prediabetes and Type 2 Diabetes. J Acad Nutr Diet. 2018;118(2):343-353. doi:10.1016/j.jand.2017.11.021
5. Wheeler ML, Dunbar SA, Jaacks LM, et al. Macronutrients, food groups, and eating patterns in the management of diabetes: a systematic review of the literature, 2010. Diabetes Care. 2012;35(2):434-445. doi:10.2337/dc11-2216
6. He M, van Dam RM, Rimm E, Hu FB, Qi L. Whole-grain, cereal fiber, bran, and germ intake and the risks of all-cause and cardiovascular disease-specific mortality among women with type 2 diabetes mellitus. Circulation. 2010;121(20):2162-2168. doi:10.1161/CIRCULATIONAHA.109.907360
7. Burger KNJ, Beulens JWJ, van der Schouw YT, et al. Dietary fiber, carbohydrate quality and quantity, and mortality risk of individuals with diabetes mellitus. PLoS One. 2012;7(8):e43127. doi:10.1371/journal.pone.0043127
8. 2015-2020 Dietary Guidelines | Accessed November 8, 2022.
9. Sacks FM, Lichtenstein AH, Wu JHY, et al. Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association. Circulation. 2017;136(3):e1-e23. doi:10.1161/CIR.0000000000000510
10. Pan Y, Guo LL, Jin HM. Low-protein diet for diabetic nephropathy: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2008;88(3):660-666. doi:10.1093/ajcn/88.3.660
11. Dussol B, Iovanna C, Raccah D, et al. A randomized trial of low-protein diet in type 1 and in type 2 diabetes mellitus patients with incipient and overt nephropathy. J Ren Nutr. 2005;15(4):398-406. doi:10.1053/j.jrn.2005.07.003
12. Robertson L, Waugh N, Robertson A. Protein restriction for diabetic renal disease. Cochrane Database Syst Rev. 2007;(4):CD002181. doi:10.1002/14651858.CD002181.pub2
13. Malik VS. Sugar sweetened beverages and cardiometabolic health. Curr Opin Cardiol. 2017;32(5):572-579. doi:10.1097/HCO.0000000000000439
14. Malik VS, Hu FB. Fructose and Cardiometabolic Health: What the Evidence From Sugar-Sweetened Beverages Tells Us. J Am Coll Cardiol. 2015;66(14):1615-1624. doi:10.1016/j.jacc.2015.08.025
15. Pan A, Malik VS, Schulze MB, Manson JE, Willett WC, Hu FB. Plain-water intake and risk of type 2 diabetes in young and middle-aged women. Am J Clin Nutr. 2012;95(6):1454-1460. doi:10.3945/ajcn.111.032698
16. Gardner C, Wylie-Rosett J, Gidding SS, et al. Nonnutritive sweeteners: current use and health perspectives: a scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care. 2012;35(8):1798-1808. doi:10.2337/dc12-9002
17. Nichol AD, Holle MJ, An R. Glycemic impact of non-nutritive sweeteners: a systematic review and meta-analysis of randomized controlled trials. Eur J Clin Nutr. 2018;72(6):796-804. doi:10.1038/s41430-018-0170-6
18. Howard AA, Arnsten JH, Gourevitch MN. Effect of alcohol consumption on diabetes mellitus: a systematic review. Ann Intern Med. 2004;140(3):211-219. doi:10.7326/0003-4819-140-6-200403160-00011
19. Baliunas DO, Taylor BJ, Irving H, et al. Alcohol as a risk factor for type 2 diabetes: A systematic review and meta-analysis. Diabetes Care. 2009;32(11):2123-2132. doi:10.2337/dc09-0227
20. Knott C, Bell S, Britton A. Alcohol Consumption and the Risk of Type 2 Diabetes: A Systematic Review and Dose-Response Meta-analysis of More Than 1.9 Million Individuals From 38 Observational Studies. Diabetes Care. 2015;38(9):1804-1812. doi:10.2337/dc15-0710
21. Tetzschner R, Nørgaard K, Ranjan A. Effects of alcohol on plasma glucose and prevention of alcohol-induced hypoglycemia in type 1 diabetes-A systematic review with GRADE. Diabetes Metab Res Rev. 2018;34(3). doi:10.1002/dmrr.2965



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