THE LATEST NUTRITION RECOMMENDATIONS FOR PEOPLE WITH DIABETES

If you’re unsure about what to eat, you are certainly not alone. There’s a lot of confusing and conflicting nutrition information available, particularly for people with diabetes.

A good place to look for the latest evidence-based recommendations is the American Diabetes Association (ADA) Standards of Care in Diabetes. Published every year, based on the latest scientific evidence, the standards provide clinical practice recommendations for all aspects of diabetes management, including nutrition.

According to the 2024 ADA recommendations, several eating patterns, including Mediterranean, DASH (Dietary Approaches to Stopping Hypertension), low-fat, carbohydrate-restricted, vegetarian, and vegan diets, have shown benefits for diabetes management. Until there is stronger evidence for specific eating patterns, their recommendation is to focus on the common elements mentioned in these dietary patterns. This means a diet which includes non-starchy vegetables, whole fruits, legumes, minimally processed wholegrains, nuts, seeds and low-fat dairy products, and minimising consumption of red meat, added sugars including sugar-sweetened beverages, refined grains and ultra-processed foods.

The Standards of Care 2024 also state that there is no specific recommended percentage of energy (Calories / kilojoules) from carbohydrate, protein, and fat for people with diabetes. Instead, they recommend that macronutrient distribution is based on individualised assessment of a person’s eating patterns, food preferences and health goals.

Carbohydrates are an important macronutrient for people with diabetes, as they have the most direct effect on blood glucose levels. However, cutting out carbs isn’t necessarily the solution for managing blood glucose levels. While the ADA say there is some evidence to support the benefits of lower carbohydrate diets, particularly for type 2 diabetes, they conclude that there is insufficient evidence to support an optimal amount of carbohydrate for people with diabetes. Questions also remain about the optimal level of carbohydrate restriction and the long-term effects of low-carb meal patterns on cardiovascular disease risk.

The ADA recommend that, regardless of carbohydrate quantity, the focus should be on high-quality, nutrient-dense carbohydrate sources that are high in fibre and minimally processed. This includes vegetables, fruits, legumes, whole grains and dairy products like milk and yoghurt. The consumption of sugar-sweetened beverages and processed foods with high amounts of refined grains, added starches and sugars that can displace healthier, more nutrient-dense food choices, should be minimised.

Depending on how you manage your diabetes, learning to match your carb intake with your diabetes medications, and/or spreading your carb intake over the day can be an important part of managing blood glucose levels. For those who use insulin, learning how different carbohydrate foods impact blood glucose levels (along with the effect of fat and protein) is important for optimising insulin dosing at meals.

The ADA standards also outline the goals of nutrition therapy for all individuals with diabetes, which include:

• Promoting and supporting healthy eating patterns, emphasising a variety of nutrient-dense foods and appropriate portion sizes to improve overall health, achieve and maintain body weight goals, attain individualised blood glucose, blood pressure and blood fat goals and delay and prevent diabetes-related complications.
• Addressing individual nutrition needs based on personal and cultural preferences, health literacy and numeracy, access to healthy foods and barriers to change.
• Maintaining the pleasure of eating by providing nonjudgemental messages about food choices while limiting food choices only when indicated by scientific evidence.
• Providing an individual with diabetes the practical tools for developing healthy eating patterns rather than focusing on individual macronutrients, micronutrients or single foods

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