What's the Best Diabetes Food Plan? Choosing Between Low-Carb, Vegan, Paleo and Mediterranean-Style Diets

If you’re at risk for type 2 diabetes, what you eat can make a big difference to your health. But experts don’t all agree on the best diabetes food plan. Before you decide, learn the benefits of low-carb, vegan, “caveman” and Mediterranean-style eating… If you’re overweight or obese, your doctor has probably warned you that excess pounds can make you a target for type 2 diabetes. Losing weight can reduce that risk significantly. Shedding just 7%-10% of your weight can help reduce your diabetes risk by 60%, according to the Harvard School of Public Health. And if you already have type 2 diabetes, dropping 10-15 pounds can help lower your blood sugar levels and blood pressure and improve your cholesterol, says the American Diabetes Association (ADA). But with thousands of weight-loss programs to choose from, what’s the best diet for managing diabetes? It’s tough to say, because even experts don’t agree on a perfect diabetes food plan, says Judith Wylie-Rosett, R.D., Ed.D., professor and division head for health promotion and nutrition research at Albert Einstein College of Medicine in New York City. “There’s no one official diabetes diet to lose weight and manage blood glucose levels,” adds Sheri Colberg-Ochs, Ph.D., a diabetes management expert and professor of exercise science at Old Dominion University in Norfolk, Va. “Different diets work for different women,” she says. Some experts recommend a Mediterranean-style diet with moderate amounts of healthy carbs. Others swear by a low-carb diet (with as few as 30 grams of carbs daily). Still, others suggest you eat a moderate-carb vegan diet, or a “caveman” diet with meat and vegetables but no grains. Even the nation’s biggest diabetes advocacy group, the ADA, has changed its perspective on the healthiest way to eat. Historically, the organization backed a moderate-carb Mediterranean-style diet centered on whole grains, lean protein and healthy fats, and eschewed low-carb diets. That was because “women with type 2 diabetes already have a higher risk for heart disease, and many low-carb diets are high in saturated fats and have been linked with cardiovascular disease,” Wylie says. But in 2008, after several large studies found that low-carb diets were as good as moderate-carb diets for managing diabetes, the ADA endorsed low-carb eating for weight loss. Whether your aim is to lose weight, or prevent or manage diabetes, choose a diet you can stick with, whether it’s a moderate-carb, low-carb, vegan or cavemen diet, advises Hope Warshaw, R.D., C.D.E., a nationally recognized diabetes educator and author of Guide to Healthy Restaurant Eating (ADA). Also, ask your doctor how many carbs you need to control blood sugar levels, Warshaw says. So which kind of diet works best for people with diabetes? Read on for the latest research on each one. Diabetes Food Plan #1: Moderate-Carb, Mediterranean-Style Diet Women with type 2 diabetes who ate healthy carbs as part of a Mediterranean-style diet lost more weight, saw more improvements in cholesterol and reduced their blood pressure and risk of heart disease more than women following a low-fat diet, according to a 2009 study conducted in Naples, Italy. “The Mediterranean diet also gives you built-in protection against diseases that come with diabetes, such as obesity, high blood pressure, high blood sugar and high cholesterol,” says Michael Nussbaum, M.D., a bariatric physician and medical director of the Obesity Treatment Center outside Philadelphia. “The diet also helps you reduce or get off your diabetes medications,” says Timothy Harlan, M.D., a chef and associate chief of general internal medicine at Tulane University School of Medicine in New Orleans. “In the [Naples] study, 56% of people following the Mediterranean diet were able to stop taking insulin, compared to just 30% of people following the low-fat diet,” says Harlan, who’s also the editor of DrGourmet.com, a diet, health and lifestyle website. Mediterranean-style diets focus on fresh vegetables and fruits, moderate amounts of fish, lean poultry and nuts, healthy fats such as olive oil, and whole grains. Whole grains help protect against diabetes, whereas diets rich in refined carbohydrates lead to increased risk, according to the Harvard School of Public Health. “If you have type 2 diabetes, you need a steady source of healthy carbs (found in whole grains, fruits, beans and vegetables) to keep your blood sugar levels stable,” says Lisa Moskovitz, R.D., a New York-based registered dietitian who specializes in diabetes. “That’s about 45-60 grams of carbs per meal, or 135-180 grams daily [adding up to 540-720 calories], based on a 2,000-calorie diet,” she adds. “It’s not healthy to skimp on healthy carbs, because they provide fiber, vitamins and disease-fighting antioxidants and phytochemicals not available in other foods,” says Connie Guttersen, Ph.D., R.D., creator of The New Sonoma Diet and author of The New Sonoma Cookbook: Simple Recipes for a Healthy, More Delicious Way to Live, which features a Mediterranean-style eating plan. This diabetes food plan may also be easier to stick with over the long term. “Unlike other diets, the Mediterranean diet doesn’t exclude food groups or force you to give up foods you love,” says Jessica Bartfield, M.D., an internist who specializes in weight loss at Loyola University Health System outside Chicago. “Women with diabetes may lose weight faster on a low-carb diet than on a moderate-carb one, but they tend to regain lost weight on a low-carb diet because they just can’t live without bread, pasta and other healthy carbs,” she says. Diabetes Food Plan #2: Low-Carb Diet Despite the advantages of a Mediterranean-style diet, more physicians and scientists believe diabetes control needs a more drastic carb-cutting approach. “Type 2 diabetes is fundamentally a disease of carbohydrate intolerance,” says diabetes researcher Richard Feinman, Ph.D., professor of biochemistry at the SUNY Downstate Medical Center in Brooklyn. “Eating 180 grams of carbs a day is like eating poison if you have the disease – your body just can’t tolerate it,” he says. “The more carbs you eat, the more insulin you need to [metabolize them], which becomes a vicious cycle that ensures you’ll always have diabetes.” People with diabetes who went on low-carb diets were better able to control blood glucose levels, lose weight and avoid cardiovascular disease than those who followed moderate-carb diets, according to a 2008 study led by Feinman. Another study, conducted in 2009 at Duke University, found that diabetics who followed low-carb diets under medical supervision lost more weight and had lower levels of A1C, a measure of long-term blood sugar levels, than people following a reduced-calorie diet that included some slow-burning carbs. Richard K. Bernstein, M.D., uses his own experience to promote the benefits of this diabetes food plan. Widely regarded as the father of low-carb diets, he says he suffered from uncontrolled type 1 diabetes, heart disease and kidney disease until he put himself on a plan that allows just 30 grams of carbs per day. “When I cut the carbs, I became healthy,” he says. Today, Bernstein treats patients with a low-carb eating plan. They have no trouble sticking with the diet because it tastes good, they lose weight without feeling hungry and can reduce or even eliminate their diabetes medications, he says. Critics claim low-carb diets increase the risk of heart disease because they contain more fat and saturated fat, in foods such as red meat, than moderate-carb diets. But you can eat lean meats and dairy if you want to lower your intake of saturated fat, and use your limited carb allowance for fruits and vegetables, Feinman notes. Red meat is rich in iron, which can reduce the effectiveness of insulin or damage cells that produce the hormone, according to a 2007 review of studies by the Harvard School of Public Health. Eating a 3-ounce serving of red meat every day increases the risk of type 2 diabetes by 20%, while smaller amounts of processed red meat, such as a few strips of bacon or hot dog, increases the risk of diabetes risk by 51%, according to a 2011 Harvard study. Substituting nuts, low-fat dairy, poultry, fish or whole grains for red meat lowers diabetes risk by up to 35%, the study found. Here’s another reason to limit red meat: “Eating a high-fat meal is rapidly followed by an increase in blood endotoxins, which are bacterial fragments that can provoke inflammation,” says Alison Harte, Ph.D., senior research fellow and lead author of a 2012 study on high-fat diets conducted at the University of Warwick in the United Kingdom. Inflammation provoked by immune cells can lead to insulin resistance and type 2 diabetes, according to a 2007 study conducted at the University of California, San Francisco. “Patients with type 2 diabetes show this response more than twice that of controls,” Harte says. But even that long-held truth is being questioned. “There’s some misunderstanding about saturated fats,” notes Frank Nuttall, M.D., Ph.D., chief of the Endocrinology, Metabolism & Nutrition Section at the Minneapolis VA Health Care System and professor of medicine at the University of Minnesota, in the ADA’s Diabetes Forecast magazine. “We really don’t have good evidence that saturated fat causes coronary heart disease. It can raise cholesterol levels, but whether that’s sufficient to raise the risk for coronary heart disease is not conclusive,” he says. Nuttall’s theory has been proven in research by Kerry Stewart, Ed.D, professor of medicine at Johns Hopkins School of Medicine in Baltimore and lead author on a 2012 study that compared higher-fat, low-carb diets with higher-carb, low-fat diets. In the study, people on a low-carb diet with 40% calories from fat lost more weight and belly fat than people on diet with 30% fat calories, Stewart says. (Fat in the belly is more metabolically active and more likely to increase diabetes risk.) “Cardiovascular improvement was directly linked to how much belly fat people lost, regardless of which diet they were on,” he says. Diabetes Food Plan #3: Low-Fat, Moderate-Carb Vegan Diet If eating meat is a turn-off, consider a vegan diet. It’s based on fruits, vegetables and grains that have a low glycemic index rating, which means they’re absorbed more slowly, says Ulka Agarwal, M.D., chief medical officer of the Physicians Committee for Responsible Medicine (PCRM), a non-profit organization that promotes healthful vegetarian eating. In 2006, PCRM co-authored a study with George Washington University School of Medicine that compared how people with type 2 diabetes fared on a low-fat vegan diet versus a Mediterranean-style diabetes food program. The vegan group lost more weight and saw more improvements in cholesterol than the Mediterranean group, and 43% were able to reduce their insulin requirements, compared to 26% on the Mediterranean diet. Diabetes Food Plan #4: Caveman (Paleo) Diet These plans are based on the assumption that a healthful human diet evolved to favor plants and meat, before the introduction of grains and processed carbs. “The caveman diet revolves around fruits, vegetables and lean meats – hold the grains, dairy and processed foods,” says Lynda Frassetto, M.D., an internist and nephrologist at the University of California, San Francisco and coauthor of a 2009 study comparing how people with type 2 diabetes did on a caveman plan versus the Mediterranean-style diet. “Women with type 2 diabetes who ate like cavemen saw dramatic reductions in blood pressure, cholesterol, triglycerides and blood sugar and were able to reduce their insulin needs, while those on the Mediterranean diet saw very little improvements,” she adds. “The only downside to the diet is that it eliminates all processed foods, so you have to do a lot of shopping, prep work and cooking,” Frassetto says. Confused about how to track the number of carbs in your meals? Read Carb-Counting Tips for Diabetics. For more on eating with type 2 diabetes, visit our Type 2 Diabetes Health Center and Diabetes Healthy Eating Guide. Myth vs. Fact: How Much Do You Know About Diabetes? In the United States alone, 23.6 million people have diabetes. And 5.6 million of them don’t even know it. Unfortunately, misinformation about diabetes is rampant – and mixing up the facts about this disease can have dire consequences.