What is the Right Diet with Diabetes Mellitus?

In the following article, we want to provide a bit of clarity regarding the much-loved and much-discussed topic of "healthy eating with diabetes".

Low fat or low carb?

First of all, it is important to know that there is no one right "diet"!

According to current scientific knowledge, there are various ways to design a healthy diet. Here, the focus should not only be on the distribution of macronutrients, but also on their quality. Consuming too much or too little fat or carbohydrates is not the only consideration. Much more important are questions such as how much animal or plant based protein is eaten, whether saturated or unsaturated fatty acids or how rich in fiber the food selection is and how quickly the carbohydrate-containing foods cause blood sugar to rise. (1,9)

According to leading professional societies (ADA/EASD/EASD), those who want to lose weight can do so in a number of ways:

• Low-fat: Eating a healthy diet with less fat.
• Low- Carb: Eating a healthy diet with reduced carbohydrate content.
• Or moderately reduce both. (1)

Protein is the only nutrient that should not be reduced because it is needed as an important building material for all cells in the body and especially the muscles. Otherwise, instead of losing that pesky belly fat, you end up losing even more beloved muscle.

Studies suggest that for some people with type 2 diabetes, a low-carb diet lowers HbA1c, triglycerides, blood pressure and the amount of diabetes medication more significantly than a low-fat diet. (1)

However, since a low-carb diet often cannot be maintained as well in the long term, it is most important that the healthy diet should be attainable for the individual and fit into their lifestyle, making it easier to maintain long term. A vegetarian, vegan or Mediterranean diet is also possible, but according to current findings, no dietary form is superior in diabetes. (1)

After the theory, now for the practical tips:

If you are more the type for suggestions and recommendations suitable for everyday use, you should read on now. Maybe some of it fits for you.

Drinks

• Drink mainly water (still or sparkling), tea, black coffee.
• Limit Diet/sugar free drinks .
• Avoid sugary drinks like regular soda pop, energy drinks, and juice. And if it absolutely must be juice, dilute it with water in the ratio 1:5. (2)

Vegetables and Fruit

• Non-starchy vegetables, you can eat as much as you want.
• Try to make ½ of your plate veggies at each meal! This satiates well and helps you get many of the necessary vitamins and minerals. (4)
• If you like, choose 1-2 portions of fruit per day. Berries are best! (2)

Grains, Cereals and Starchy Vegetables

• Choose whole grains over refined grains (whole grain bread, brown rice, steel cut oats over white bread, white rice, quick cook oats). (3)
• In general, aim to make smaller carb-portions (¼ of your plate at each meal). (4) The more physical activity you engage in, the larger your carb-portion can be. One hour of endurance sport consumes an additional 50 g of carbohydrates. (2)
• Potatoes and corn also contain a lot of starch, which causes blood sugar to rise quickly. So keep an eye on the portion size.

Protein-Rich Foods

• Choose plant based protein sources like legumes, nuts, seeds, tofu and other soy products. (3)
• Using 1-2 oz of nuts/seeds or nut/seed butters (almonds, walnuts, pumpkin seeds, chia seeds, etc.) daily can be a wonderful way to spice up your meal or as a snack. (2,3)
• Enjoy legumes several times a week. They contain carbohydrates as well as proteins, but these are the good carbs. They raise the sugar slowly. (3)
• Because of the high content of the healthy omega-3-fatty acids, it is recommended to eat 1-2x / week fatty fish such as salmon and herring. (5,6)
• Choose full-fat and fermented dairy products over non-fat. (2,3) In the case of cheese, the fatter the tastier, but keep an eye on the quantity.
• Choose eggs and, if you are not vegetarian, lean poultry (chicken, turkey) more often and red meat less often. (3)
• Limit, or even better, avoid processed meats like salami, bacon and sausage. (2,3)

Fats

• Choose olive, canola and flaxseed oil and butter. (2,3)
• Also avocados,olives, nuts, seeds are good sources of healthy unsaturated fatty acids.(2)
• Avoid trans fats (partially hydrogenated oils), which are used in processed foods, fried foods, pastries, sweets,snacks, and fast food. They increase the risk of
• elevated triglyceride and cholesterol levels and coronary heart disease.(2,6) To avoid as much trans fat as possible, you should read the ingredients list on food
• labels. Look for words like hydrogenated oil or partially hydrogenated oil. (7)

Sugar, Sweets and Sweeteners

• Limit to 6 teaspoons/25g added sugar per day. This also applies to natural sweeteners like honey, agave and maple syrup. (8)
• Choose small portions of the alternative sweeteners stevia, monk fruit, xylitol and erythritol if needed for sweetness. (3)
• And for all the chocolate fans among you, 85% chocolate is high in calories but only slightly increases blood glucose.

Sources:

(1) DDG: Stellungnahme des Ausschuss Ernährung der DDG zum Consensus Report: Nutrition Therapy for Adults with Diabetes or Prediabetes [Evert AB et al. Diabetes Care 2019;42:731-54 [Internet]. 2019 Sep [cited 2022 Jun 23]
Available from: https://www.deutsche-diabetes-gesellschaft.de/fileadmin/alte_seite/Redakteur/Gremien/Ausschuss_Ern%C3%A4hrung_DDG_Stellungnahme_zu_den_ADA_Ern%C3%A4hrungsempfehlungen.pdf

(2) VDBD: Diabetes und Ernährung [Internet]. 2017 Oct [cited 2022 Jun 23]
Available from: https://www.vdbd.de/fileadmin/portal/redaktion/Publikationen/171018_vdbd_ernahrung_download_end.pdf

(3) Nussbaumer H. Ernährungsempfehlungen bei Typ-2-Diabetes: Für Diabetesberatung und -schulung. 1th ed. 2018.

(4) ADA: Eat good to feel good.[Internet]. [cited 2022 Jun 23]
Available from: https://www.diabetes.org/healthy-living/recipes-nutrition/eating-well

(5) ADA: Protein.[Internet]. [cited 2022 Jun 23]
Available from: https://www.diabetes.org/healthy-living/recipes-nutrition/eating-well/protein

(6) DDG: trans-Fettsäuren und ihr Einfluss auf die Gesundheit.[Internet] 2016 May [cited 2022 Jun 23]
Available from: https://www.dge.de/wissenschaft/weitere-publikationen/fachinformationen/trans-fettsaeuren/#:~:text=Eine%20hohe%20Zufuhr%20von%20trans,Cholesterolkonzentration%20im%20Blut

(7) ADA: Fats.[Internet]. [cited 2022 Jun 23]
Available from: https://www.diabetes.org/healthy-living/recipes-nutrition/eating-well/fats

(8) WHO: WHO calls on countries to reduce sugars intake among adults and children [Internet]. 2015 Mar [cited 2022 Jun 23]
Available from: https://www.who.int/news/item/04-03-2015-who-calls-on-countries-to-reduce-sugars-intake-among-adults-and-children

(9) Davies M, et al. Management of hyperglycaemia in type 2 diabetes. A consensus report by the American Diabetes Association (ADA) and the European
Association for the Study of Diabetes (EASD), Diabetologia. 2018 61:2461–2498, p.19