European dietary guideline emphasizes whole grains, fruits and vegetables for diabetes
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Key takeaways:
- Updated EASD recommendations advise people with diabetes to eat more whole grains, fruits, vegetables, legumes and nuts.
- People with diabetes should minimize eating meat and refined grains.
Dietary patterns focused on eating more whole grains, vegetables, fruits, legumes, nuts and seeds are best for the management of diabetes, according to an updated guideline published in Diabetologia.
The Diabetes and Nutrition Study Group of the European Association for the Study of Diabetes published evidence-based dietary recommendations for people with diabetes. The group found that multiple dietary patterns, including the Mediterranean diet, the Nordic diet and the vegetarian diet, could all provide benefits for people living with diabetes.
“I liked that we found a wide range of weight-loss programs, and dietary patterns were appropriate, providing patients with choice,” Andrew Reynolds, PhD, MPH, MSc, senior research fellow in the department of medicine at the University of Otago Medical School in New Zealand, told Healio. “This was really good to see, and something I wasn’t expecting; there is no one way of eating all people must follow. Having that flexibility and freedom in what is promoted enables all those cultural, social and personal preferences we have, meaning that adherence in the long term should be possible, as normally, the more extreme or different the diet, the harder it is to follow.”
The Diabetes and Nutrition Study Group’s recommendations were an update to recommendations published in 2004. The authors wrote that the paper was composed to provide evidence-based recommendations and guidance on macronutrients, food, dietary patterns, and broader lifestyle context for type 2 diabetes prevention and management.
“The guidelines were developed for health professionals to inform discussion with their patients,” Reynolds said. “They form a starting point for nutrition therapy, which all people with diabetes need and deserve. We see this as particularly important, as the vast majority of health professionals are not trained to provide nutrition support.”
High-fiber, low-sugar diets emphasized
For type 2 diabetes prevention, the authors recommend people with overweight or obesity lose at least 5% of their body weight to reduce their risk. A combination of a health dietary pattern, regular physical activity, avoiding excess weight and not smoking are also recommended for diabetes prevention.
The group emphasized that a variety of diet types and macronutrient compositions can induce and maintain weight loss, as long as they follow dietary recommendations. Low-energy formula products can be used either temporarily for weight-loss induction as a total diet replacement or by replacing one to two meals per day. Remission of type 2 diabetes can be achieved through sustained weight loss, and a low-energy total diet replacement program for 12 to 20 weeks, with carefully adjusted glucose-lowering and antihypertensive medication, could provide a 10% to 15% weight loss to induce type 2 diabetes remission. Extreme high-carbohydrate diets and very low ketogenic diets are not recommended for weight loss.
For carbohydrate intake, the group emphasized foods that are naturally high in dietary fiber, especially minimally processed whole grains, vegetables, legumes, seeds, nuts and whole fruits. Sugar intake should be below 10% of a person’s total energy intake, and non-nutritive sweeteners may be used as a replacement for sugar.
The recommendations state dietary fats should come from plant-based foods that are high in both monounsaturated and polyunsaturated fats. Saturated fats should make up less than 10% of a person’s total energy and trans fats should comprise less than 1% of total energy.
Protein intake for a person with diabetes and normal weight should comprise 10% to 20% of total energy intake. Higher intakes are recommended for a people aged 65 years and older. For people with type 2 diabetes and overweight or obesity with an estimated glomerular filtration rate of more than 60 mL/min/1.73 m2, protein intake may be increased to 23% to 32% short term in the context of a weight-loss diet. Protein intake should be 10% to 15% for people with moderate diabetic nephropathy.
Whole grains, fruits and vegetables recommended
The study group recommended several key foods to base meals and snacks around for people with diabetes, including minimally processed whole grains, whole vegetables and fruits, legumes, nuts and seeds. Any dietary patterns emphasizing those foods, including the Mediterranean diet, Nordic diet and vegetarian diet, are recommended for people with diabetes. The study group also listed foods and drinks to avoid, including meat, sugar-sweetened beverages, sweets and refined grains.
Reynolds noted that while recommendations provided by the group are broad, more research is needed to know how to promote long-term behavioral change in people with diabetes. Additionally, Reynolds said future recommendations should explore what governments can do to help promote a healthy diet.
“Changing the food environment such as through removing taxes on some foods or having clear guidelines on what foods are available in public institutions should be useful, as would tackling some of the commercial determinants of health, such as placing restrictions on food advertising or the marketing of foods that contribute to poor health outcomes,” Reynolds said.
For more information:
Andrew Reynolds, PhD, MPH, MSc, can be reached at andrew.reynolds@otago.ac.nz.
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