What’s the Right Nutrition Approach for People Living with Type 2 Diabetes?

You might have been told that the only way to live well with type 2 diabetes is by cutting out all carbohydrates (no more bread or pasta), by going vegan, by eating less fruit (or more fruit), the list goes on. All that advice can be confusing and it’s often unhelpful, especially when you are new to diabetes.

The reality is that there's no such thing as a “diabetic diet” and we all respond differently to different diets. So what’s important is that you find what works for you, your body, your mental health, and wellbeing.

How to Find the Diet That’s Right for You

It would be easier if there was ONE way to eat for optimal health and blood sugar management, but the American Diabetes Association now recommends that your diet should be individualized to your body, your lifestyle, and your personal diabetes management goals.¹

To find the diet that’s right for you, it’s highly recommended that you work with a nutrition specialist, such as a Registered Dietitian. If your doctor's office specializes in diabetes, they might even have an RD on staff.

Registered Dietitian (RDN) and Certified Diabetes Care & Education Specialist (CDCES) Ariel Warren, recommends that you start by establishing your diabetes goals. For most people living with type 2 diabetes, those goals will include reducing insulin resistance, meaning how efficient your body is at using the insulin it produces, and thereby reducing insulin or other medication needs while maintaining optimal blood sugars.²

Once your goal is set, you need a solid plan for how to know if a diet is working for you. If you work with an RD, this will be their primary role. Registered Dietician Ben Tzeel, living with type 1 diabetes himself, recommends that you start with understanding your current diet by tracking your food and your blood sugars. Once you have your diet baseline down, you can make small changes and keep track of how this impacts your blood sugar.³

Spotlight on 3 Different Nutrition Approaches

Most diet recommendations focus on carbohydrates (carbs) in one way or another. The reason for this is that carbs get converted into glucose the fastest. That means that you’ll generally see a larger blood sugar impact when you eat carbs (like a slice of bread) than when you eat protein (such as chicken) or fat (such as avocado).⁴

However, the carb, protein, and fat composition of your meals can also change the blood sugar impact which is why it’s important to understand how some of the most common diets generally impact blood sugars.  

1. The Moderate to Low Carb Diet

A moderate to low carb diet aims at reducing your overall carb intake. Some Registered Dieticians might adjust the total carb amount somewhat but it’s still a grey area as there’s no medical definition of what "low-carbohydrate" actually means.⁵

Net carbs are the total amount of carbs minus fiber (and half of any sugar alcohols if present). The reason we focus on net carbs is that dietary fibers won’t impact blood sugars and sugar alcohol only impacts blood sugar partially. 

According to Ben Tzeel, the benefits of a moderate to low carb diet are that some people living with type 2 diabetes see an improvement in blood sugar fluctuations and an improvement in overall blood sugar control.³

He adds that this type of diet can be a great way to ease into a lower-carb lifestyle. Because carbs aren’t completely eliminated, many find this diet fairly easy to stick to.

However, switching directly from a high carb diet to a moderate to low carb diet might be challenging for some people. Instead, it may be beneficial to ease into it by slowly reducing overall carb intake.

Ariel Warren recommends that you should still continue to think about your meal composition, regardless of what diet you’re following. If you add large amounts of fat to one meal, especially highly-processed and engineered fats, this can increase insulin resistance which can lead to prolonged high blood sugars. She recommends that you build your meals by starting with your protein, then adding a source of fiber, then a healthy fat.⁶

2. Keto (Very Low-Carb High-Fat)

If you follow the keto diet, most of your calories will come from fat and the goal is to reduce your overall carb intake significantly. Many who follow the keto diet eat as little as 40 grams of carbs a day or 20 grams net carbs.⁷

Since the carb intake is very low, many see a reduction in blood sugar fluctuations after meals. Some people also report weight loss, as fats generally make you feel full faster, reducing the risk of overeating.

Although some people see great improvements in blood sugar fluctuations after meals, the downside of eating a high-fat diet is that it can make you more insulin resistant overall which can lead to increased blood sugar levels.⁸

Ariel Warren notes that the rigid nature of the keto diet can make it difficult to adhere to in the long run and that there are limited studies showing the efficacy and safety of going keto long-term.⁶ 

3. Vegetarian (Moderate to High Carb)

Most people choose to follow a vegetarian or vegan diet due to environmental or animal rights concerns, but many also follow this nutrition approach to better manage their type 2 diabetes.⁹

If you choose to eat a vegetarian diet, your food intake is mostly made up of fruits, vegetables, dried beans and peas, grains, seeds, and nuts. Some people also eat eggs and dairy.¹⁰ 

Since the vegetarian diet is predominantly plant-based, many people end up eating little fat, which according to some studies can improve insulin sensitivity and thereby reduced medication needs.¹¹

However, if your type 2 diabetes is not managed with insulin a high carb diet can be challenging from a blood sugar management perspective.

Registered Dietitian Ben Tzeel mentions that the high amount of carbs could lead to more blood sugar fluctuations for some. But a diet high in plants and thereby in fiber, is recommended for most. Many will notice weight loss when sticking to a vegetarian diet. Going veggie can be a great way to get essential vitamins and minerals if you stick to a wholefood vegetarian diet.¹

You don’t have to follow a specific diet to achieve good  blood sugar management and live a healthy life with diabetes. You might find that your body and mind does well when you implement certain aspects of different diets or when you employ a mindset of eating everything in moderation. It’s important to check your blood sugar regularly to understand the impact of different food and diets on your blood sugar level.

What’s important is that you experiment and find what’s right for you and your diabetes monster. 

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All of the information in this article is based on the following sources 

1. Evert, A.B., Dennison, M. Gardner, C.D., Garvey, W.T. Lau, K.H.K., MacLeod, J., Mitri, J., Pereira, R.F., Rawlings, R., Robinson, S., Saslow, L., Uelmen, S., Urbanski, P.B., Yancy, W.S., 2019. Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Continuing Evolution of Nutritional Therapy for Diabetes. [online] Available at: https://care.diabetesjournals.org/content/42/5/731. 

2. Diabetes Strong, 2019. Insulin Resistance: Symptoms, Causes, and Treatment Options. [webpage] Available at: https://diabetesstrong.com/insulin-resistance/  [Accessed 20/01/21].

3. Tzeel, B., 2020. A discussion about food tracking. [conversation] (Personal communication, 2 November 2020).

4. Healthline, 2017. 12 Simple Tips to Prevent Blood Sugar Spikes.  [webpage] Available at: https://www.healthline.com/nutrition/blood-sugar-spikes  [Accessed 20/01/21].

5. Everyday Health, 2018.The Ultimate Guide to Following a Low-Carb Diet: What to Eat and Avoid, a Sample Menu, Health Benefits and Risks, and More. [webpage] Available at: https://www.everydayhealth.com/diet-nutrition/diet/low-carb-diet-beginners-guide-food-list-meal-plan-tips/  [Accessed 20/01/21].

6. Warren, A., 2020. A discussion about diabetes meal plans. [conversation] (Personal communication, 30 October 2020).

7. Diabetes Strong, 2019. The Ketogenic Diet and Diabetes: The Definitive Guide. [webpage] Available at: https://diabetesstrong.com/ketogenic-diet-and-diabetes/ [Accessed 20/01/21].

8. Frankenberg, A.D., Marina, A., Song, X., Callahan, H.S., Kratz, M., Utzschneider, K.M., 2015. A high-fat, high-saturated fat diet decreases insulin sensitivity without changing intra-abdominal fat in weight-stable overweight and obese adults. European Journal of Nutrition. [online] Available at: https://pubmed.ncbi.nlm.nih.gov/26615402/.  

9. Diabetes Strong, 2019. Vegan Diet and Diabetes: Everything You Need to Know. [webpage] Available at: https://diabetesstrong.com/vegan-diet-diabetes/ [Accessed 20/01/21].

10. Medline Plus, 2015. Vegetarian Diet. [webpage] Available at: https://medlineplus.gov/vegetariandiet.html  [Accessed 20/01/21].

11. McMacken, M., Shah, S., 2017. A plant-based diet for the prevention and treatment of type 2 diabetes. Journal of Geriatric Cardiology. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466941/.