Adherence to a popular diet plan is not required to manage diabetes, but you may like the direction it offers. A professional who is an RDN and CDCES can help you follow one of these approaches safely.
The Defining Features of a Diabetes Diet
There isn’t necessarily a single diet that is best for diabetes. The ADA declined to recommend any one particular eating pattern over others in a consensus report from a panel of experts, noting that “all eating patterns include a range of more-healthy versus less-healthy options.” Rather than naming a single, one-size-fits-all diet, the organization identifies three key factors shared by the most healthful approaches:
Eat plenty of nonstarchy vegetables.
Minimize your consumption of added sugars and refined grains.
Choose whole foods and ingredients over highly processed foods.
These recommendations can be applied to a wide variety of diets, including vegan, paleo, low-carb, and Mediterranean eating patterns.
Diabetes Eating Patterns
Mediterranean Diet Palinski-Wade favors the Mediterranean diet: “It’s been researched for decades and has been shown to be beneficial at reducing the risk of heart disease,” she says. That’s important because people with diabetes are up to 4 times more likely to die from heart disease compared with adults without diabetes.
On the Mediterranean diet, you’ll focus on whole foods in the form of fruits and vegetables, whole grains, olive oil, legumes, nuts, and poultry and fish, while limiting red meat.
DASH Diet “The DASH diet has been found to be beneficial at reducing blood pressure levels, a key risk factor for heart disease and kidney disease. Because both of these disease risks are elevated with diabetes, this style of eating may promote a reduction in the risk of comorbid conditions associated with diabetes,” Palinski-Wade explains.
Similar to the Mediterranean diet, the DASH diet promotes fruits and vegetables, whole grains, fish and poultry, beans, nuts, and fat-free or low-fat dairy. You’ll also cap sodium to 2,300 mg per day (1,500 mg if advised by a doctor).
Vegetarian or Vegan These two plant-based eating patterns are associated with many positive health outcomes in people both with and without diabetes. One meta-analysis found that people with diabetes on a vegetarian diet enjoyed both weight loss and improved glycemic control, in addition to improved cardiovascular risks.
Low-Carb As noted in greater detail above, low-carb diets have great potential for people with type 2 diabetes; carbohydrate restriction may be the best eating pattern for lowering blood glucose levels.
Low-Fat There’s not much hype for low-fat diets these days, but fat restriction remains synonymous with dieting for many. The ADA has concluded that lowering fat intake does not in and of itself consistently improve blood sugar levels, except to the extent that it also results in weight loss. Structured very-low-fat diets, such as the Ornish diet, may be more beneficial.
Diet Plans to Discuss With Your Healthcare Team
While it’s best to talk to your doctor before you start any diet plan, it’s especially important to talk to them if you’re interested in the following:
Ketogenic Diet You’ll eat very few carbs on this very-low-carbohydrate plan (20 to 50 g a day) to achieve a state of ketosis, where your body burns fat for fuel instead of carbs. “There is some research that suggests ketogenic diets may help to reduce insulin resistance and improve blood glucose levels,” says Palinski-Wade.
A keto diet may have benefits above and beyond more moderate forms of carbohydrate restriction. The evidence suggests that “the greater the carbohydrate restriction, the greater glucose lowering.” But there are potential downsides. A 2022 study found that keto dieters with diabetes or prediabetes lost weight and improved their blood sugar levels, but that the diet “had potential untoward risks” in comparison to a Mediterranean diet, particularly an increase in LDL (“bad”) cholesterol. Study participants also found the ketogenic diet more difficult to stick to. It’s a controversial diet, so make sure to weigh the pros and cons with your physician.
Intermittent Fasting (IF) IF requires you to limit the time period in which you eat to a certain number of hours per day or to eat a very low number of calories on certain days. Some research (small studies and animal trials) has shown benefits from IF to fasting glucose and weight. That said, skipping meals may hinder blood sugar control or cause low blood sugar (hypoglycemia), especially if you’re on insulin or a sulfonylurea, so talk to your doctor about the risks and benefits before you attempt it.
Paleo Diet The premise of the paleo diet is to eat like our hunter-gatherer ancestors, focusing on fruits, vegetables, nuts, lean meat, and certain fats. (It eliminates grains, legumes, and most dairy.) A 2020 review found that the paleo diet led to many improvements in glucose metabolism, including lower A1C and less insulin resistance, but it did not outperform other diabetes diets.
Diet Plans to Avoid
Any diet that is gimmicky, not backed by research, is too restrictive, or makes too-good-to-be-true promises (like losing x amount of weight in a certain amount of time) is one to skip.