Type 2 Diabetes Diet Guidelines: Foods to Eat, Foods to Avoid

Type 2 diabetes diet definition and facts

Salmon is a diabetes superfood.

Type 2 diabetes involves problems getting enough glucose into the cells. When the sugar can't get where it is supposed to be, it leads to elevated blood sugar levels in the bloodstream, which can lead to complications such as kidney, nerve, and eye damage, and cardiovascular disease.
Foods to eat for a type 2 diabetic diet meal plan include complex carbohydrates such as brown rice, whole wheat, quinoa, oatmeal, fruits, vegetables, beans, and lentils. Foods to avoid include simple carbohydrates, which are processed, such as sugar, pasta, white bread, flour, and cookies, pastries.
Foods with a low glycemic load (index) only cause a modest rise in blood sugar and are better choices for people with diabetes. Good glycemic control can help in preventing long-term complications of type 2 diabetes.
Fats don't have much of a direct effect on blood sugar but they can be useful in slowing the absorption of carbohydrates.
Protein provides steady energy with little effect on blood sugar. It keeps blood sugar stable, and can help with sugar cravings and feeling full after eating. Protein-packed foods to eat include beans, legumes, eggs, seafood, dairy, peas, tofu, and lean meats and poultry.
Five diabetes "superfoods" to eat include chia seeds, wild salmon, white balsamic vinegar, cinnamon, and lentils.
Healthy diabetes meal plans include plenty of vegetables, and limited processed sugars and red meat.
Diet recommendations for people with type 2 diabetes include a vegetarian or vegan diet, the American Diabetes Association diet (which also emphasizes exercise), the Paleo Diet, and the Mediterranean diet.
Guidelines on what to eat for people with type 2 diabetes include eating low glycemic load carbohydrates, primarily from vegetables, and consuming fats and proteins mostly from plant sources.
What to not to eat if you have type 2 diabetes: sodas (regular and diet), refined sugars, processed carbohydrates, trans fats, high-fat animal products, high-fat dairy products, high fructose corn syrup, artificial sweeteners, and any highly processed foods.

Oral Medications for Type 2 Diabetes

Currently, there are nine drug classes of oral diabetes medications approved for the treatment of type 2 diabetes.

Sulfonylureas, for example, glimepiride (Amaryl) and glipizide (Glucotrol, Glucotrol XL)
Meglitinides, for example, nateglinide (Starlix) and repaglinide (Prandin)
Thiazolidinediones, for example, pioglitazone (Actos)
DPP-4 inhibitors, for example, sitagliptin (Januvia) and linagliptin (Tradjenta)

Read the side effects of type 2 diabetes medications »

What is type 2 diabetes?

Type 2 diabetes occurs over time, and involves problems getting enough sugar (glucose) into the cells of the body. (The cells use the sugar for fuel/energy.)

Sugar (glucose) is the preferred fuel for muscle and brain cells, but it requires insulin to transport it into cells for use.
When insulin levels are low, and the sugar can't get into the cells where it is supposed to be, it leads to elevated blood sugar levels.
Over time, the cells develop resistance to insulin (insulin resistance), which then requires the pancreas to make more and more insulin to move sugar into the cells; however, more sugar is still left in the blood.
The pancreas eventually "wears out," and can no longer secrete enough insulin to move the sugar into the cells for energy.

Which types of foods are recommended for a type 2 diabetes diet?

A diabetes meal plan can follow a number of different patterns and have a variable ratio of fats, proteins, and carbohydrates.

The carbohydrates consumed should be low glycemic load and come primarily from vegetables.
The fat and proteins consumed should primarily come from plant sources.

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Diabetes is defined best as…
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What is the glycemic index? Which type of carbohydrates should be included?

Glycemic index and load

Carbohydrates (carbs) are the primary food that raises blood sugar. Glycemic index and glycemic load are scientific terms used to measure the impact of a carbohydrate on blood sugar.

Foods with low glycemic load (index) raise blood sugar modestly and thus are better choices for people with diabetes.
The main factors that determine a food's (or meal's) glycemic load are the amount of fiber, fat, and protein it contains.
The difference between glycemic index and glycemic load is that glycemic index is a standardized measurement and glycemic load accounts for a real-life portion size. For example, the glycemic index of a bowl of peas is 68 (per 100 grams) but its glycemic load is just 16 (lower the better). If you just referred to the glycemic index, you'd think peas were a bad choice, but in reality, you wouldn't eat 100 grams of peas. With a normal portion size, peas have a healthy glycemic load as well as being an excellent source of protein.

Carbohydrates can be classified as either

complex carbohydrates, or
simple sugars.

1. Complex carbohydrates (low glycemic load foods, or foods that are a part of a type 2 diabetes low-carb diet plan) are in their whole food form and include additional nutrients such as:

Fiber
Vitamins
Smaller amounts of proteins and fats

These additional nutrients slow down the absorption of the glucose and keep blood sugar levels more stable.

Examples of complex carbohydrates, or low glycemic load (index) foods include:

Brown rice
Whole wheat
Quinoa
Steel-cut oatmeal
Vegetables
Fruits
Beans
Lentils

Grains and starchy vegetables

Whole grains, such as brown rice, quinoa, and oatmeal are good sources of fiber and nutrients; and have a low glycemic load making them good food choices. Processed food labels make it very confusing to understand whole grains. For example, "whole wheat bread" is made in many different ways, and some are not that different from white bread in its blood sugar impact (glycemic load). The same is true for whole grain pasta, it's still pasta. Whole grains have less of an impact on blood sugar because of the lower glycemic load. Choose whole grains that are still in their grain form like brown rice and quinoa, or look at the fiber content on the nutrition label. For example, a "good" whole grain high-fiber bread will have 3+ grams of fiber per slice.

Starchy vegetables that are good sources of nutrients like vitamin C, and that are higher in carbohydrates than green vegetables, but lower in carbs than refined grains. They can be eaten in moderation. Starchy vegetables include:

Potatoes
Squash
Corn
Other root vegetables

The above starchy vegetables are best eaten in smaller portions (1 cup) as part of a combination meal that includes protein and plant-based fat.

Non-starchy vegetables

Non-starchy vegetables, such as green vegetables, can be eaten in abundance. These foods have limited impact on blood sugar, and also have many health benefits, so eat up! Almost everyone can eat more vegetables – we need at least five servings a day.

Fresh vegetables are a great option, and usually the tastiest option. Studies show that frozen veggies have just as many vitamins and nutrients because they are often frozen within hours of harvesting. Just check to make sure there aren't added fats or sweeteners in the sauces that are on some frozen veggies. If you don't like vegetables on their own, try preparing them with fresh or dried herbs, olive oil, or a vinaigrette dressing. Aiming to consume a rainbow of colors through your vegetables is a good way to get all of your nutrients.

2. Simple carbohydrates (high glycemic load foods, or foods that are not part of a type 2 diabetes diet plan because they raise blood sugar levels) are processed foods, and don't contain other nutrients to slow down sugar absorption and thus these foods can raise blood sugar dangerously fast. Many simple carbohydrates that are off-limits are easily recognized as "white foods."

Simple carbohydrates or high glycemic index foods that should not be included in your diet, for example::

Sugar
White pasta
White bread
Flour
Cookies
Pastries
White potatoes
Breakfast cereals
Pastries and sweets
Fruit juice
Pineapples
Soft drinks
Watermelon

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Which type of fats are recommended?

Fats have little direct effect on blood sugar; but, as part of a meal, they are useful in slowing down the absorption of carbohydrates. Fats also have effects on health that are not related to blood sugar. For example:

Animal meat fats increase the risk of cardiovascular disease. However, dairy, and specifically fermented dairy such as yogurt, appears to decrease this risk.
Plant-based fats such as olive oil, nuts, seeds, and avocado are associated with lower cardiovascular disease risk.
Fat also contributes to feelings of satiety and can play a role in managing overeating and carbohydrate cravings. A portion of healthy fats (like avocado on whole grain toast) is much more satisfying and healthy than jam on white toast.

Which types of protein are recommended?

Protein provides slow steady energy with relatively little effect on blood sugar. Protein, especially plant-based protein, should always be part of a meal or snack. Protein not only keeps blood sugar stable, but it also helps with sugar cravings and feeling full after eating (satiety). Protein can come from both animal or plant sources; however, animal sources are also often sources of unhealthy saturated fats.

Good protein choices include:

Beans
Legumes
Eggs
Fish and seafood
Organic dairy products
Peas
Tofu and soy foods
Lean meats such as chicken and turkey

Pay attention to the balance of macronutrients (fat, protein, and carbohydrates) in a meal to support stable blood sugar levels. Specifically, fat, protein, and fiber all slow down the absorption of carbohydrates and thus allow time for a slower, lower insulin release and a steady transport of glucose out of the blood and into the target tissues – this is a good thing.

What types of diet or meal plans are recommended for people with type 2 diabetes?

Several dietary patterns have been studied, and have shown to have beneficial effects on type 2 diabetes. Because multiple patterns work, people can choose the eating pattern that works best for them. However, there are commonalities among all healthy diabetes diets. All healthy diabetes meal plans include:

a lot of vegetables, and
limit processed sugars and red meat.

People with type 2 diabetes must be extra aware of the carbohydrate content of their meals so their blood sugar levels don't rise, or if they are using injectable insulin, so they can dose insulin appropriately.

What are vegetarian or vegan diets?

A vegetarian or vegan diet can be a good choice for people with diabetes. Vegetarian and vegan diets are typically high in carbohydrates – about 13% higher than a diet with that includes both plant and animal products (omnivorous) – which we generally think is bad for diabetes. However, a vegetarian or vegan diet is typically fiber-rich and lower in calories and saturated fat, so the inflammatory risks associated with high meat consumption are avoided. Research studies that have tested vegetarian and vegan diets for people with diabetes; have found them to be beneficial at reducing blood sugar.

A good quality vegetarian or vegan diet:

Is high in vegetables and fruits
Includes quality proteins such as beans, nuts, and seeds
Includes plant-based fats such as olive oil and avocado
Prioritizes whole grains such as brown rice and quinoa rather than refined carbohydrates (sweets and processed, packaged white foods)

What is the ADA diabetes diet?

The American Diabetes Association (ADA) advocates for a healthy diet with an emphasis on balancing energy intake with exercise. Historically, they have advocated for the majority of calories coming from complex carbohydrates from whole grains such as whole-grain bread and other whole-grain cereal products and a decreased intake of total fat with most of it coming from unsaturated fat.

Recently, this has shifted to acknowledge that there is no one ideal macronutrient ratio, and that dietary plans should be individualized. ADA guidelines advocate:

Low glycemic load
Avoid sugar-sweetened beverages including soda
The importance of fat quality as well as quantity

However, many people find these guidelines difficult to implement in real-life, and the dietary patterns described below can be easier and more common sense ways for people to manage their eating plan.

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What is a Paleo Diet?

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Paleolithic diets include a moderate amount of protein, and have gained a lot of attention recently. The theory behind this dietary pattern is that our genetic background has not evolved to meet our modern lifestyle of calorically dense convenience foods and limited activity, and that returning to a hunter-gatherer way of eating will work better with human physiology. This has been studied in a few small trials, and it does seem beneficial for people with type 2 diabetes.

The Paleolithic diet is based on:

Lean meat
Fish, fruit
Leafy and cruciferous vegetables
Root vegetables
Eggs
Nuts

The Paleolithic diet excludes:

Dairy products
Grains of all kinds
Beans
Refined fats
Sugar
Candy
Soft drinks
Beer
Any extra addition of salt

The Paleo Diet doesn't specify macronutrient balance or caloric intake goals.

In reality, when people in a study followed the Paleolithic diet, it turned out the diet was lower in total energy, energy density, carbohydrates, dietary glycemic load, fiber, saturated fatty acids, and calcium; but higher in unsaturated fatty acids (good fats), dietary cholesterol, and several vitamins and minerals. Research also demonstrates that people with diabetes are less hungry, have more stable blood sugar, and feel better with lower carbohydrate diets.

What is the Mediterranean diet?

The Mediterranean diet is high in vegetables. This refers to the true Mediterranean pattern traditionally followed in the south of Italy and Greece, not "Americanized Italian," which is heavy in pasta and bread. The Mediterranean pattern includes:

Lots of fresh vegetables
Some fruit
Plant-fats such as olive oil
Avocados and nuts
Fish such as sardines
Some wine
Occasional meat and dairy

This pattern of eating is very nutrient-dense, meaning you get many vitamins, minerals, and other healthful nutrients for every calorie consumed. A very large recent study demonstrated that two versions of the Mediterranean diet improved diabetes control including better blood sugar and more weight loss. The two versions of the Mediterranean diet that were studied emphasized either more nuts or more olive oil. Since both were beneficial, a common-sense approach to adopting the Mediterranean diet would include both of these. For example, sprinkle chopped almonds on green beans or drizzle zucchini with olive oil, oregano, and hemp seeds.

Five diabetes superfoods

Superfoods are foods that benefit your health beyond providing calories or fats, protein, or carbohydrates. Superfoods may be particularly rich in types of vitamins or other nutrients that are uniquely beneficial for people with type 2 diabetes.

1. Chia seeds

Chia is a type of seed that provides fiber, protein, and omega-3 fatty acids. Chia is a superfood because it brings down the glycemic load of any meal, increases hunger satisfaction (satiety), and stabilizes bloods sugar. Adding chia to your breakfast will help keep you full longer. They primary type of fiber in chia is soluble fiber. Soluble fibers turn to a gel when mixed with water. This makes chia seeds excellent to use in baking and cooking when a thickener is needed. Chia mixed with almond milk, cocoa, and a low-glycemic index sweetener like agave or stevia makes an excellent healthy pudding!

2. Wild salmon

Salmon is a type 2 diabetes superfood because salmon is a great source of anti-inflammatory omega-3 fatty acids. There are differences in the fatty acids in wild vs. farmed salmon. This is because of what the fish eat. Wild salmon eat smaller fish and live in colder waters, which causes them to develop a higher ratio of anti-inflammatory omega-3s to saturated fats in their meat. Farmed fish are up to 10 times higher in persistent organic pollutants, antibiotics, and other contaminants. These harmful chemicals are pro-inflammatory and have been associated with increased risk of cancer and heart disease.

3. White balsamic vinegar

The superfood vinegar is best consumed as vinaigrette dressing on your salad, but it has beneficial effects no matter how you enjoy it. Vinegar slows gastric emptying, which has several beneficial effects for people with type 2 diabetes. This slows the glucose release into the bloodstream, allowing for a small, steady insulin response instead of a large insulin surge. Vinegar also increases satiety, so if you enjoy salad with vinaigrette as your first course, you are less likely to overeat during the main course.

4. Cinnamon

Cinnamon lowers the blood glucose level in people with type 2 diabetes, and it has been well researched and found to be beneficial at doses of about 1 teaspoon/day.

Cinnamon lowers both fasting and postprandial (after meals) blood sugar levels.
It is easy to add to any dietary pattern.
Cinnamon can be sprinkled on oatmeal.
It also is tasty added to coffee!

Its high polyphenol content also has added benefit in preventing health complications.

5. Lentils

Lentils are a superfood because they contain important vitamins, have great protein, and have lots of fiber. Lentils are rich in:

iron,
other minerals, and
B vitamins such as folate.

Lentils have a great balance of protein and complex carbohydrate (high in fiber), and are very versatile to cook with.

The green and brown ones stay firm when cooked and are delicious in a salad.
The orange ones get soft when cooked, making them well suited in Indian soups, curries, and dal.

Which foods should be avoided in a type 2 diabetes meal plan?

People with type 2 diabetes should avoid many of the same unhealthy foods everyone should limit. Dietary restrictions include:

Sodas: both sugar sweetened regular soda and diet soda raise blood sugar
Refined sugars (donuts, pastries, cakes, cookies, scones, sweets, candy)
Processed carbs (white bread, pasta, chips, saltines)
Trans fats (anything with the word hydrogenated on the label) such as butter "spreads," some mayonnaise "spreads" some salad dressings, packaged sauces, bakery goods
High-fat animal products (red meat, fatty cuts of pork, bacon, sausage)
High-fat dairy products (whole milk, cream, cheese, ice cream)
High fructose corn syrup (in soda, candy, packaged convenience food)
Artificial sweeteners (in processed foods labeled "diet")
Highly processed foods – novelty sweets, candies, chips, kettle corn, cookies)

The best way to avoid these foods is to shop around the edges of the grocery store and minimize the number of processed, packaged foods in the middle. Sticking with "real" food in its whole, minimally processed form is the best way to eat well for diabetes. People with type 2 diabetes who eat a healthy diet pattern like the ones discussed here reduce the risk of complications that stem from high blood sugar, like cardiovascular disease and obesity.

Can I drink alcohol if I have type 2 diabetes?

For most people with type 2 diabetes, the general guideline for moderate alcohol consumption applies. Research shows that one drink per day for women and two a day for men reduces cardiovascular risk and doesn't have a negative impact on diabetes. However, alcohol can lower blood sugar, and people with type 2 diabetes who are prone to hypoglycemia (such as those using insulin) should be aware of delayed hypoglycemia.

Ways to prevent hypoglycemia include:

Eat food with alcoholic drinks to help minimize the risk.
Mixed drinks and cocktails often are made with sweeteners or juices, and contain a large amount of carbohydrates so they will increase blood sugar levels.
Wear a diabetes alert bracelet so that people know to offer food if you demonstrate hypoglycemic symptoms.

It also is important to know that hypoglycemia symptoms often mimic those of intoxication.

How can I make healthier choices when eating out?

It can be challenging to eat out, both because of the unknowns about what exactly a meal will contain in terms of carbs and calories, but also because eating out with friends or family can often lead to unintentional pressure to eat foods you would be better off without, such as dessert!

When eating out don't feel shy asking questions about what a dish contains or how it is prepared.
Look at menus online before you go.
Talk to your friends and family beforehand about your reasons for eating healthy. Tell them it's important to your long-term health that you stay on your healthy eating plan and ask them not to encourage you to eat things that aren't good for you. Friends and family are often just trying to demonstrate their love by wanting you to enjoy a dessert, however mistaken that is. Help them understand they can best help you by not making it more difficult to stay on track and by supporting you in your efforts to take good care of yourself.
Share a single dessert with the whole table and limit yourself to two bites.
Choose ethnic restaurants such as Thai, sushi, or Indian that have lots of vegetables and fewer refined carbohydrates like pasta and bread. Limit your portion of rice to 1 cup.

What are the complications of type 2 diabetes?

Type 2 diabetes can lead to a number of complications such as kidney, nerve, and eye damage, as well as heart disease. It also means cells are not receiving the glucose they need for healthy functioning. A calculation called a HOMA Score (Homeostatic Model Assessment) can tell doctors the relative proportion of these factors for an individual with type 2 diabetes. Good glycemic control (that is, keeping sugar/carbohydrate intake low so blood sugar isn't high) can prevent long-term complications of type 2 diabetes. A diet for people with type 2 diabetes also is referred to as a diabetic diet for type 2 diabetes and medical nutrition therapy (MNT) for people with diabetes.

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