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Due to the fact that they have the most profound effect on blood glucose levels, carbohydrates (e.g., starches and sugars) have been the primary nutrient focus of diabetes prevention and management for millennia. Over the past 100 years, medical nutrition therapy for the management of diabetes has swung from severe carbohydrate restriction prior to the identification and commercial availability of insulins in the 1920’s, to liberalisation in the 1950s using carbohydrate exchanges as a tool for moderating intakes, to the recommendation of higher (≥45% of energy) carbohydrate diets in the 1970’s, and to the most recent recommendation of no set amount/percent of carbohydrate – instead taking into account personal and cultural preferences.

Indeed, the American Diabetes Association’s 2024 Standards of Care in Diabetes recommends a variety of eating patterns for the prevention and management of diabetes, including Mediterranean-style, vegetarian, vegan, low-fat, low-calorie and very low-calorie, low-carbohydrate, and Dietary Approaches to Stop Hypertension (DASH). It recommends that people follow individualized meal plans that keep nutrient quality, total calories, and metabolic goals (e.g., blood glucose, cholesterol, triglycerides, etc…) in mind, as data do not support a specific macronutrient pattern. Furthermore, they recommend food-based dietary patterns that emphasize key nutrition principles like the regular consumption of non-starchy vegetables, whole fruits, legumes, whole grains, nuts/seeds, and lower-fat dairy products and minimize consumption of processed meats, sugar-sweetened beverages and refined grains/starches.

While they may not be as well known as they should be, these guidelines have existed in various forms for several decades now. Perhaps due to the very social nature of foods, meals and eating in general, food fashion and even tribalism often tries to convince people that there’s only one eating pattern for preventing and managing diabetes. This is a great shame, because one size most definitely does not fit all.

Low and very low carbohydrate diets are currently very fashionable (again) in many parts of the world, including Australia, the United Kingdom and United States of America (USA). Many proponents/tribalists suggest that most health professionals still predominantly recommend low fat diets – even though they went out of fashion at least 20 years ago.

Luckily, a new survey of Registered Dietitians (RDs), and other primary care health professionals who provide nutrition counselling, provides insight into what dietary patterns are currently being recommended to patients with type 2 diabetes. RDs affiliated with an academic health system or in primary care practices in midwestern USA were invited to complete an on-line survey asking them to select the eating pattern(s) that they commonly recommend or avoid for patients with type 2 diabetes and why. Survey respondents recommended a broad range of eating patterns including:

  • low-carbohydrate (77.8% of participants)
  • Mediterranean-style (52.8%)
  • energy-modified/energy-restricted (36.1%)
  • low fat (23.6%)
  • DASH (20.8%)
  • vegetarian (16.7%)
  • vegan (11.1%).

On the other hand, survey respondents most commonly recommended avoiding very low-carbohydrate/ketogenic (51.0%) and very low-energy (49.0%) eating patterns, with most concerned about the eating patterns being too restrictive (93.0%) and difficult to sustain over time (82.5%).

There’s no need to follow the latest food fashion. A variety of eating patterns can be enjoyed by people with diabetes and those at risk. Discuss the options with your Accredited/Registered Dietitian and find the one that’s best for you for long-term health and wellbeing.

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Dr Alan Barclay, PhD, is a consultant dietitian and chef with a particular interest in carbohydrates and diabetes. He is author of Reversing Diabetes (Murdoch Books), and co-author of 40 scientific publications, The Good Carbs Cookbook (Murdoch Books), Managing Type 2 Diabetes (Hachette Australia) and The Ultimate Guide to Sugars and Sweeteners (The Experiment Publishing).

Contact: Follow him on Twitter, LinkedIn or check out his website.