The Top 9 Diabetes Nutrition Myths

From everydayhealth.com

If you have type 1 or type 2 diabetes, you’ve probably heard a lot of conflicting advice about the best way to eat. And it certainly doesn’t help when your family, acquaintances, and even social media bombard you with their own tips and warnings.

The doctors, nutritionists, and educators who treat diabetes have heard it all — and they can help you debunk the top diabetes nutrition myths and parse fact from fiction.

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1. Sugar-Free Foods Don’t Spike Blood Sugar

If you’re trying to avoid sugar, it may make sense to reach for sugar-free versions of certain foods instead. Foods labelled “sugar-free” contain a maximum of 0.5 grams (g) of sugar per serving. But a sugar-free food doesn’t necessarily lack carbohydrates.

“Sugar-free foods may not have added sugars, but they may still have other forms of carbohydrates that may increase blood sugar,” says Deena Adimoolam, MD, a New York City–based spokesperson for the Endocrine Society.

And while sugar-free artificial sweeteners probably won’t spike your blood sugar, their long-term health impact on people with diabetes remains an area of ongoing research.

2. A Gluten-Free Diet Is Healthier

Gluten is a protein present in certain grains, such as wheat. People with type 1 diabetes are at a higher risk for celiac disease, an autoimmune condition in which eating gluten can lead to intestinal damage. For people with celiac disease, following a gluten-free diet is critical.

But going gluten-free isn’t necessarily a healthier option for everyone else. Gluten-free doesn’t mean carbohydrate-free, since gluten-free products often contain ingredients like corn or rice instead of wheat or other sources of gluten. They may even have more sugar than the original, gluten-containing versions.

“Many gluten-free foods have carbohydrates and can still raise blood sugar,” says Dr. Adimoolam.

3. You Need a Special Diet

There isn’t a single one-size-fits-all diet for diabetes management. In fact, there are many eating plans that can work.

“While diet plays an important role in diabetes management, there isn’t one eating pattern for diabetes management,” says Toby Smithson, RDN, CDCES, a certified diabetes care and education specialist in South Carolina and the senior manager of nutrition and wellness at the American Diabetes Association. “There are several eating pattern options to fit with people’s individual needs.”

While plenty of evidence suggests that eating patterns like the Mediterranean diet or the Dietary Approaches to Stop Hypertension (DASH) diet are good for people with diabetes, you don’t need to follow a trend or adhere to a strict eating structure as long as you’re consistently prioritizing healthy foods like non-starchy vegetables and lean protein sources. Meal plans should also consider carbohydrates and how they affect blood sugar.

Your diet should fit your lifestyle, not the other way around. “The eating plan should consider cultural backgrounds, personal preferences, other health conditions they may have, and elements like costs of food, living situations, and access to healthy foods,” says Smithson. 

4. Fruit Is Bad for You

Smithson says it’s a common myth that people with diabetes shouldn’t eat fruit because it has too much sugar. In truth, fruit is a source of quality carbohydrates that’s also rich in vitamins and other nutrients, she says.

“Fruit is an important part of our diet for essential vitamins and antioxidants,” says Adimoolam. One meta-analysis even suggests that eating fruit could have a positive impact on fasting blood sugar.

With that said, fruit does have carbohydrates, so limiting your fruit intake could help keep your blood sugar under control.

Smithson advises choosing fruits that are higher in fibre, like raspberries, blackberries, pears, or kiwi. Adimoolam says people with diabetes can incorporate fruit into their diet and soften blood sugar spikes by pairing it with a healthy fat or protein source. 

5. You Have to Cut Carbs

“It’s true that foods high in carbohydrates have the biggest impact on blood glucose (blood sugar) compared with foods high in protein and fat,” says Smithson. “[But] carbs offer an important fuel source for your body and brain. Also, many quality carbs [serve as] a source of fiber, which is helpful with gut health and blunts rises in blood glucose post-meal.”

When making carbohydrate choices, consider whole grain options and maximize your fibre intake. “Quality carbs are those in vegetables, beans, lentils, fruit, milk, yogurt, and whole grains,” says Smithson. “They break down slowly and have key nutrients like fibre, protein, vitamins, and minerals.”

Adimoolam says people with diabetes also need to understand how certain carbohydrates impact their blood sugar. “Learn how to balance simple and complex carbohydrates to avoid blood sugar spikes,” she adds.

6. Sugar Is the Most Important Ingredient to Consider

Sugar is a major carbohydrate source, but it’s not the only one.

“Sugar is a carbohydrate component,” says Smithson. “It’s more accurate to say people with diabetes need to manage their intake of total grams of carbohydrates.” So when you’re perusing nutrition labels at the grocery store, look at total carbohydrates (or net carbs) as well as sugar content.

All diabetes experts, of course, recommend minimizing your intake of sugar, especially added sugar, which is highly refined and lacks the nutritional value of natural sugars found in fruits or dairy products. But if you’re paying attention to your blood sugar levels, you may notice that a carb-heavy food like white pasta or white bread spikes your blood sugar just as quickly as a sugary one.

“I recommend that my patients with diabetes learn where sugars are in their diet, how these various sugars impact their blood sugar, and how to pair sugar with other foods to stabilize blood sugar better,” says Adimoolam.

7. Brown Sugar and Honey Don’t Raise Blood Sugar

It may be tempting to see brown sugar or honey as alternatives to white sugar. But they will still raise your blood sugar quickly.

“Brown sugar will still spike your blood sugar,” says Adimoolam. “A teaspoon of brown sugar has a similar carbohydrate amount to white sugar.”

Be equally cautious with supposedly healthier sugars such as maple syrup, coconut sugar, and agave syrup. These alternatives may seem more natural or healthy than refined white sugar, but that doesn’t necessarily mean they’re any better for blood sugar management.

There may be secondary benefits to eating natural sugars. Honey, for example, provides antioxidants and may help decrease inflammation in the body. But each tablespoon contains 17 g of carbohydrates.

8. Intermittent Fasting Is Always Great for People With Diabetes

Intermittent fasting alternates restricted windows for food consumption with periods of fasting, with lots of timing variations to consider. This method may benefit people with diabetes by supporting weight loss and blood sugar management efforts, but it’s not foolproof.

“Intermittent fasting may help some people with diabetes with blood sugar control, but it isn't for everyone,” says Adimoolam. “If [one’s] average carb intake throughout the day doesn’t change with intermittent fasting, then it may not help with glucose control.”

People with diabetes who want to try intermittent fasting should work with their doctors or a registered dietitian-nutritionist and monitor their blood sugar carefully. They may need to adjust their intermittent fasting plans based on their blood sugar levels. People with type 1 diabetes should be particularly cautious when fasting because of the risk of low blood sugar.

9. ‘Diabetes-Friendly’ Foods Are Healthier

Sometimes foods are marketed as “diabetes-friendly.” While it may be tempting to assume these options are preferable to other choices not labelled as such, the U.S. Food and Drug Administration doesn’t regulate this label. That means that foods with these labels may not have evidence to support their claims.

“[Foods labelled ‘diabetes friendly’] may not always be healthy and may still have carbohydrates,” says Adimoolam. “Many of these items are processed with many additives.”

Instead of relying on these labels, it’s better to look closely at a food’s nutrition facts and ingredients list.

The Takeaway

• Foods labelled "sugar-free," "gluten-free," or "diabetes-friendly" can still cause blood sugar spikes because they often contain high amounts of other carbohydrates.
• Carbs aren’t all off-limits: whole grains, legumes, vegetables, and fruit provide essential nutrients and fiber that can improve your long-term diabetes health.
• Refined sugar alternatives like honey, brown sugar, and agave syrup are still forms of sugar that contain similar carbohydrate counts to white sugar, thereby impacting blood glucose levels in a similar way.
• There’s no single diabetes diet, and while trends like intermittent fasting or Mediterranean eating can help provide structure or inspiration, your meal plans should be customized based on your culture, preferences, budget, and health goals.
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Eating after 5pm can disrupt blood sugar control

From diabetes.co.uk/news 

• Late-evening meals can hinder blood sugar regulation
• Eating after 5 PM may increase the risk of diabetes complications
• Meal timing is as important as meal content

Managing diabetes is a complex task that involves more than just monitoring carbohydrate intake or choosing healthier foods.

It also involves paying attention to when you eat.

Recent research by Universitat Oberta de Catalunya and Columbia University highlights the impact of meal timing on blood sugar regulation, revealing that consuming a significant portion of daily calories after 5pm (17:00) can hinder glucose metabolism and increase the risk of developing or worsening diabetes.

Meal timing

The study sheds light on how the body’s natural circadian rhythm which governs processes like insulin secretion and sensitivity can influence blood sugar levels.

Insulin production naturally declines in the evening and the body’s cells become less sensitive to it which makes it harder to process glucose from late meals.

This poses a unique challenge for people with diabetes as they already face difficulties in maintaining stable blood sugar levels.

Late eating linked to elevated blood sugar

Researchers studied 26 individuals aged 50 to 75 who were overweight or living with prediabetes or type 2 diabetes.

The participants were divided into two groups: early eaters and late eaters.

Despite consuming the same foods and calories, those who ate after 5pm displayed poorer glucose tolerance measured by elevated blood sugar levels following meals.

Findings suggest that eating later in the day can disrupt the body’s ability to manage glucose effectively, potentially contributing to long-term complications of diabetes.

Late eating is often associated with calorie-dense, processed foods which can exacerbate issues like weight gain and increased fat storage.

Additionally, late eaters tend to burn calories more slowly while hormonal changes caused by eating later can increase hunger and reduce the body’s ability to break down fat.

These factors not only complicate blood sugar management but also increase the likelihood of obesity.

Intermittent fasting could be beneficial

Intermittent fasting which typically involves eating within a specific time window (e.g., 11am to 5pm) has gained attention for its potential to improve blood sugar control.

By encouraging earlier eating, intermittent fasting aligns meal timing with the body’s natural glucose metabolism giving the pancreas and insulin-sensitive tissues a break from constant activity.

Considering the timing of your meals could be a simple but effective way to improve your blood sugar control.  To reduce the risks associated with late eating:

• Aim to consume most of your daily calories earlier in the day, ideally before 5pm
• Plan meals to be balanced and nutrient-dense, focusing on whole foods like vegetables, lean proteins, and whole grains
• Avoid calorie-dense, processed snacks late at night, which can further strain glucose regulation

Dr. Diana Díaz Rizzolo, a co-author of the study, explains, “Until now, nutrition advice has focused primarily on what and how much we eat. This study highlights the growing importance of when we eat in supporting cardiometabolic health.”

For people managing diabetes, adopting an earlier eating schedule could offer a valuable tool for enhancing glucose control and reducing the risk of complications.

While the focus often remains on dietary choices, meal timing is emerging as a critical factor in effective diabetes management.

https://www.diabetes.co.uk/news/2024/nov/eating-after-5pm-can-disrupt-blood-sugar-control.html

How a 5:2 intermittent fasting diet can help people with type 2 diabetes

From medicalnewstoday.com

• A study from China suggest that a 5:2 intermittent fasting diet with meal replacement may be helpful for people with type 2 diabetes.
• Researchers reported that participants on the eating plan had better glycemic control and weight loss at 16 weeks compared to those on diabetes medications.
• Experts say the 5:2 diet is an option for people with type 2 diabetes, but it may not be suitable for everyone.

A 5:2 intermittent fasting diet with meal replacements may be helpful for people with type 2 diabetes.

A studyTrusted Source published today in the journal JAMA Network Open reports that following such an eating plan can improve glycaemic control as well as short-term weight loss.

“In this randomized clinical trial of 405 adults, the 5:2 meal replacement approach achieved better glycaemic control at 16 weeks compared with metformin and empagliflozin,” the study authors write.

“5:2 meal replacement may serve as an initial lifestyle intervention for patients wit h type 2 diabetes, providing an alternative to the use of metformin and empagliflozin medications,” they added.

Details on the study on fasting diet and type 2 diabetes

The study involved 405 adults in China who had obesity, or were overweight. The participants had been diagnosed with type 2 diabetes within the previous year.

The participants were randomly allocated to either receive metformin, empagliflozin or a 5:2 meal replacement eating plan for a 16-week period. All of the participants were also given guidance on exercise, diet and diabetes education every four weeks.

Those in the 5:2 meal replacement group had two non-consecutive days each week in which they used meal replacements. Meal replacements are pre-packaged food or beverages that may be used to give energy in place of a usual meal.

On the meal replacement days, the participants had one meal replacement instead of eating three regular meals. This amounted to an intake of 500 calories for women and 600 calories for men.

On the other five days, the participants in the 5:2 group were encouraged to monitor their calorie intake but eat whatever they wanted for breakfast and lunch. At dinner they then had a meal replacement.

The researchers reported that those in the 5:2 meal replacement group showed the greatest reduction in average HbA1C blood glucose levels over three months. Those in this group also had greater weight loss than the other two groups with a significant reduction in both waist and hip circumference.

The health benefits of intermittent fasting

Dr. Marilyn Tan, an endocrinologist at Stanford University in California who was not involved in the study, says intermittent fasting may be beneficial for some people with type 2 diabetes.

“There has been significant interest in intermittent fasting or time restricted eating for type 2 diabetes, and many studies have shown a benefit. The metabolic benefits may be due to both the specific timing of the eating and also reduced caloric intake. Many patients also find intermittent fasting to be more sustainable than other popular diets because the focus is more on timing rather than diet content,” she told Medical News Today.

“Extreme diets that are very restrictive in content can be difficult to follow long term and can lead to nutritional deficiencies, so the fact that the intermittent fasting diets focus less on dietary content often makes them more sustainable,” Tan added. “There’s no one size fits all diet for diabetes and it’s critical that whatever diet one chooses is sustainable long term. Many people can follow a more restrictive diet in the short term, but if they go off the diet, glycemic control and weight often revert to the prior state.”

More than 38 millionTrusted Source people in the United States have diabetes and of those 90% to 95% Trusted Sourcehave type 2 diabetes.

Risk factors for type 2 diabetes include being 45 or older, having a family history of diabetes, being overweight, and being physically inactive.

Type 2 diabetes can be managed with exercise and healthy eating. Insulin and diabetes medications may also be used to manage blood glucose levels.

Dana Hunnes, PhD, a senior dietitian supervisor at RR-UCLA Medical Center in Los Angeles who was not involved in the study, says diet is an important factor for a person living with type 2 diabetes.

“Diet and eating/meal patterns do matter quite a lot for someone with type 2 diabetes. What we eat can increase inflammation and make us more insulin resistant, have higher blood sugars, or it can lower inflammation, improve our insulin sensitivity, and make us require less insulin or less medication to help control glucose levels. So, what we eat, when we eat it, how we eat it, can make a difference,” she told Medical News Today.

Nutrition and type 2 diabetes

The American Diabetes Association recommends those with diabetes use the “diabetes plate” as a framework for building meals.

This involves beginning with a 9-inch plate and filling half with non-starchy vegetables. Another quarter of the plate should be made up with lean protein and the final quarter should be made up of quality carbs that can include whole grains, fruits, starchy vegetables, or low fat dairy.

Tan notes that while those in the 5:2 meal replacement group experienced weight loss and glycemic control benefits, meal replacements may not be be a long-term solution.

“Meal replacements usually provide fairly accurate calorie counts and can help restrict carbs and calories. However, they don’t necessarily help patients with a long term solution to real life situations. It’s much easier to follow a specific diet when one is in isolation. However, once you throw social and work situations, travel/vacation, special events, etc, into the mix, patients still need tools to navigate these solutions. For most people, it’s neither financially sustainable nor satisfying to stay exclusively on meal replacements long term,” she said.

Grant Brinkworth is a professor and director of research at Diabetes Australia. He told Medical News Today that people living with type 2 diabetes should consult with their doctor about the best method for them to attain sustainable weight loss and diabetes management.

“There is no one approach to losing weight that suits every person with type 2 diabetes. It is established that type 2 remission can be achieved through significant weight loss, although remission is not possible for everyone. What method a person uses to achieve sustainable weight loss is a personal decision and it is recommended that this decision is made in consultation with a healthcare professional,” said Brinkworth, who was not involved in the study.

https://www.medicalnewstoday.com/articles/how-a-52-intermittent-fasting-diet-can-help-people-with-type-2-diabetes 

Are Religious Fasts Safe for People With Diabetes?

From health.clevelandclinic.org

Planning ahead, checking in with your care team and being vigilant about blood sugar monitoring can help ensure a safe fast 

When you have diabetes, you know you have to keep a careful eye on what you eat and how it impacts your blood sugar. But if you’re part of a faith community that observes religious fasting holidays, you may be left wondering: Can you safely take part, or do you have to sit them out?

“Many people with diabetes are able to fast safely and enjoy the full spiritual, physical and mental health benefits of religious fasts, provided they’re medically cleared and take some necessary precautions,” says endocrinologist Hasan Husni, MD.

Dr. Husni offers wellness tips for fasting holidays and explains why it’s so important to know your blood sugar numbers — plus, how new technology can help.

Is it safe to fast when you have diabetes?

Before you participate in a religious fast, you should talk with your diabetes management team to make sure it’s safe for you to do so.

“During this consultation, your care team can advise you on any medication adjustments, how to monitor your blood sugar levels while you’re fasting, and in which circumstances you may need to break your fast,” Dr. Husni says.

Fasting not only alters the timing of meals, but it can also affect many other elements of your everyday life, including:

• Dietary habits.
• Circadian rhythms.
• Physical activity.
• Sleeping patterns.

“Lifestyle factors like diet, excess weight, smoking and lack of physical activity can all have a negative impact on your blood sugar and insulin levels, which can make diabetes more difficult to manage,” Dr. Husni says.

“A fasting holiday can provide an opportunity to focus on adopting healthy habits that reduce or eliminate these diabetes risk factors, while also reducing cholesterol levels and improving cardiovascular health.”

Plan ahead for fasting holidays by using these five strategies.

1. Be vigilant about monitoring your blood sugar

When you’re fasting, it’s especially important to monitor your blood sugar.

“While you have diabetes and you participate in a fast, you’re at greater risk for the dangers of very high or low blood sugar levels, as well as for dehydration,” Dr. Husni shares.

Another serious complication is diabetes-related ketoacidosis, a life-threatening condition that occurs when your body doesn’t have enough insulin to use sugar for energy. Instead, it breaks down fat, releasing ketones that build up and cause your blood to turn acidic.

To reduce these risks, it’s important to regularly monitor your blood sugar throughout your fast.

“If you want to minimize the need for finger pricking, ask your healthcare provider about continuous glucose monitoring,” Dr. Husni suggests. “This is a small, temporary and wearable device that measures glucose levels 24 hours a day. You typically replace it every 10 to 14 days, or as needed.”

2. Recognise warning signs

In addition to monitoring your blood sugar, check in with yourself throughout your fast — and be sure you know the warning signs of high or low blood sugar so that you know if you’re experiencing a medical emergency that will require you to break your fast.

Some of the most common signs of low blood sugar (hypoglycaemia) are:

• Shakiness or trembling.
• Weakness.
• Sweating and/or chills.
• Feeling extremely hungry.
• Sped-up heart rate.
• Dizziness or light-headedness.
• Confusion or trouble concentrating.
• Anxiety or irritability.
• Colour draining from your skin.
• Tingling or numbness in your lips, tongue or cheeks.

Symptoms of high blood sugar (hyperglycaemia) include:

• Blurred vision.
• Frequent urination.
• Headache.
• Increased thirst and/or hunger.

“If you start to experience any of these symptoms, test your blood sugar immediately,” Dr. Husni advises. “In general, you’ll need to break your fast if your blood glucose is lower than 70 mg/dl (3.9 mmol/l) or higher than 300 mg/dl (16.7 mmol/l).”

Some people, he notes, may need to break their fast at different blood glucose levels depending on their age and overall health, so it’s important to discuss this ahead of time with your diabetes management team.

3. Break your fast carefully

It’s always best to break your fast with a healthy meal that will help hydrate you and restore your strength. And it’s important not to gobble it down.

“It can be challenging to resist the temptation to have a very large meal at iftar. Additionally, people often break their fasts by eating quickly, which can lead to overeating,” Dr. Husni says. “It takes 15 to 30 minutes for the satiety signal to reach the brain.” This can make it difficult to tell when you're full.

Plus, he adds that some people actually gain weight during long-term fasting holidays like Ramadan, as a result of factors like being less active, eating carb-heavy foods at iftar and snacking throughout non-fasting hours.

If you have diabetes and are observing Ramadan, consider working with a nutritionist who’s experienced in diabetes education.

“They’ll determine your daily calorie needs for weight loss or weight maintenance, whichever the case may be,” Dr. Husni says, “and they can help you create a sustainable meal plan or strategy that ensures that you’re getting the correct balance of macronutrients, including proteins, fats and carbohydrates, at suhoor and iftar.”

Generally, he recommends consuming around 40% to 50% of your daily calorie intake at iftar; around 30% to 40% at suhoor; and the remainder as a snack at night.

4. Stay hydrated during non-fasting hours

Dehydration is a major risk during fasting holidays, especially if you’re doing a dry fast that doesn’t allow you to drink water.

“It’s important to drink adequate amounts of water during non-fasting hours and to limit your intake of caffeine-based or sugary drinks,” Dr. Husni stresses. “This is especially true in areas with hot climates or long daylight hours, where the risk of dehydration and diabetes-related ketoacidosis is greater.”

5. Get some exercise

In general, physical activity brings all kinds of benefits, including helping regulate blood sugar, weight management and supporting cardiovascular health. But when you have diabetes, it’s best to talk to your healthcare provider ahead of time about exercising during a religious fast.

“Exercise should only be undertaken carefully, particularly if you take insulin,” he says, “because it can put you at a higher risk of having low blood sugar when you exercise.”

It’s best to stick to low- to- moderate-intensity physical activity rather than going all-out with a hardcore sweat session.

“During Ramadan, for example, we generally recommend walking as a safe way to exercise, preferably after iftar,” he adds.

Diabetes doesn’t necessarily require you to skip your fast

While some people with diabetes seek a religious exemption from fasting, many can safely participate. It should always be a shared decision between you, your physician and your religious leader.

From a medical perspective, Dr. Husni emphasizes checking in with your diabetes care team ahead of time to be sure you’re approaching fasting in the healthiest way possible.

“Religious fasting holidays, especially longer-term ones like Ramadan, can be a wonderful time to embrace healthy habits that you can build on once the fasting period is finished for long-term health benefits,” he says.

https://health.clevelandclinic.org/fasting-and-diabetes