Five Best Diets for Diabetes
The U.S. News & World Report recently released its 2023 list of the best diets for people with diabetes. See which diets made the list, and the benefits and drawbacks of each.
In descending order, the top five rankings of the best diets for people with diabetes were for the DASH, Mediterranean, Flexitarian, Ornish, and MIND diets.
While all of these diets—better described as meal patterns—favor whole foods as well as minimize added sugars and refined carbohydrates, their approaches vary. All five diets, however, have been shown to help improve blood sugar levels while providing adequate nutrition.
The DASH Diet
DASH— which stands for Dietary Approaches to Stop Hypertension—emphasizes fruits, vegetables, whole grains, lean proteins, and low-fat dairy, while discouraging red meat, added salt, sugar, or saturated fat. Eating the DASH way results in a nutrient-dense meal plan high in potassium, calcium, magnesium, fiber, and protein; the American Diabetes Association has published a consensus report on the effectiveness of the DASH meal plan for people with diabetes
Benefits of the DASH Diet
In addition to promoting blood pressure control, "this eating pattern has been shown to improve insulin resistance, hyperlipidemia, and and obesity,” said Kari Garner, a registered dietitian & certified diabetes care and education specialist (CDCES) and owner of Springtime Nutrition, in South Carolina, who pointed to a 2022 study that linked the DASH diet to lower mortality risk among individuals with diabetes.
"The DASH diet encourages the intake of nutrient- and fiber-rich foods, which can promote weight loss and decrease blood pressure, total cholesterol, and low-density lipoprotein (LDL) cholesterol. The DASH diet also has cardiovascular benefits similar to the Mediterranean diet,” Garner added.
Drawbacks of the DASH Diet
One challenge of DASH is that more than 50% of the calories in it come from carbohydrates, which may be too high for some people with diabetes; DASH carbohydrates may range between 180 - 270 g per day depending on the calorie level.
There’s also the challenge of keeping sodium to below 2,300 mg per day—less than 1 teaspoon of table salt. "DASH may be hard to sustain due to perceived lack of flavor in foods,” Garner admitted, adding that limited culinary skills, affordability of fresh ingredients or lack of an organized support system as other possible impediments to success on DASH.
Editor’s Note: At diaTribe, we recommend that people limit their intake of carbohydrates to no more than 100-150 grams per day, with no more than 30 carbs per meal. This can help you stay on track and achieve your blood sugar target. You can learn more about diaTribe’s nutrition principles here.
The Mediterranean eating pattern focuses on consuming an abundance of vegetables, fruits, legumes, beans, nuts, and seeds; whole grains, extra virgin olive oil as the main source of fat; moderate amounts of fish rich in omega-3 fatty acids such as salmon or tuna, and cheese & yogurt with low to no red meat intake. Sweets should be consumed sparingly if at all.
Benefits of the Mediterranean Diet
Studies have shown that the Mediterranean diet can improve insulin sensitivity, help regulate blood sugar and reduce A1C, and reduce the risk of type 2, and the Mediterranean diet has been endorsed by notable health organizations, including the American Heart Association and the American Diabetes Association.
What’s more, the Mediterranean diet offers flexibility. "The Mediterranean meal pattern is based on a general pattern of eating that can be adapted to different cultural traditions and food preferences,” said Daisy Seremba, CDCES, a Marrieta, Georgia-based registered dietitian. ”There are no exclusions of specific foods or food groups, making it easy to follow long term and maintain the health benefits it offers.
Drawbacks of the Mediterranean Diet
The Mediterranean diet offers many benefits and is an excellent option for most people, but cost may be a concern. "Some consumers report the cost of such things as olive oil, fish, nuts, and seeds may be prohibitive for their budgets," Seremba said. She recommends shopping for frozen fish or canned varieties, which confer many of the same benefits, as a way to save on the cost of purchasing items such as fresh seafood.
Those on the Mediterranean diet may also need to be mindful of carbohydrate content. "Because the Mediterranean diet promotes the intake of fruits, vegetables, and whole grains, people with diabetes may need additional guidance from a registered dietitian or diabetes care and education specialist to ensure they are following their meal plan and limiting their carb intake as needed," Seremba said.
The Flexitarian Diet
The flexitarian eating pattern is a mix between vegan and vegetarian with the flexibility to consume animal products in limited amounts. It includes three stages: The first stage limits meat to 2 days per week with no more than 28 ounces of meat per week. The second stage consists of consuming more plant-based foods, with eggs and dairy allowed, 3-4 times per week with less than 18 oz of meat weekly. The third stage limits meat to no more than 9 ounces per week. The majority of foods eaten are plants, nuts, seeds, whole grains, legumes, fruits, and vegetables.
The majority of foods consumed with the flexitarian diet are nuts, seeds, whole grains, legumes, fruits, and vegetables, with occasional intake of lean, organic, grass-fed or pasture-raised meat, poultry, eggs, dairy, and fish.
Benefits of the Flexitarian Diet
"The flexitarian eating pattern encourages consumption of more plants as the base of the diet with less emphasis on consuming meat, which is more environmentally friendly and healthier in terms of saturated fat content. In addition, a flexitarian diet is higher in fiber, fruits, and vegetables than the typical or standard American diet," said Sue-Ellen Anderson-Haynes, national spokesperson for the Academy of Nutrition and Dietetics.
Anderson-Haynes believes the Flexitarian diet may be a good option for those with diabetes. "Plant-based diets, such as the Flexitarian diet, are plentiful in fiber, antioxidants, magnesium, and other nutrients that are well documented in research to assist with the prevention and management of chronic illness such as heart disease, cancer, and diabetes," says Anderson-Haynes.
"A recent JAMA study reports that those who followed plant-based dietary patterns had a lower risk of developing type 2 diabetes. In terms of managing diabetes, plant-based diets have shown promising results to slow down complications related to diabetes. Conversely, research from the Diabetes Care journal of the American Diabetes Association reports that diets high in animal protein increase diabetes risk," adds Anderson-Haynes.
Drawbacks of the Flexitarian Diet
The flexitarian diet imposes no limits on the amount of eggs or dairy consumed. "There is no true limit on eggs and dairy as there is with meat, so people following this diet may not know how much of these foods to limit or to consume," Anderson-Haynes said.
The Ornish Diet
The Ornish eating plan was developed by Dr. Dean Ornish, a clinical professor of medicine at the University of California, San Francisco. This diet eliminates meat, fish, poultry, refined carbohydrates, added sugars, alcohol, and high-fat foods, as well as limits the amounts of nuts, seeds, and vegetable oils that can be consumed.
The diet, which ranks foods from the healthiest to the least healthy, is predominantly plant-based; the only animal products allowed include egg whites and non-fat dairy products, and fat should not make up more than 10% of calories, meaning high-fat foods such as nuts and seeds can only be consumed in small amounts.
Benefits of the Ornish Diet
“This is a whole-foods plant-based diet that is very low in saturated fat and refined carbohydrates. There is no calorie restriction, which is an advantage for people with diabetes, who may already feel limited with the number of diet choices they can have,” Justine Chan, CDCES and owner of Your Diabetes Dietitian in Toronto, Ontario, said. Additionally, the complete Ornish program—including the lifestyle component—is the only program shown to reverse heart disease without drugs or surgery in randomized controlled trials.
Drawbacks of the Ornish Diet
With fat intake limited to just 10% of calories, the Ornish diet can be hard to follow. "Added fats offer flavor and texture to your favorite foods, making them more enjoyable,” Chan said, adding that the diet could also be low in fat-soluble vitamins like vitamins A, D, E, and K, which need dietary fat to be absorbed by the body.
The MIND Diet
Developed by Martha Clare Morris, a nutritional epidemiologist at Rush University Medical Center, the MIND eating pattern, which stands for Mediterranean-DASH Intervention for Neurodegenerative Delay, is a combination of the Mediterranean and DASH eating patterns, and it has shown benefits for brain health. The MIND diet encourages people to consume vegetables, nuts, olive oil, whole grains, berries, fish, beans, poultry, and wine in moderate amounts.
"Several studies suggest that good fats, like omegas in olive oil and phytochemicals in berries, might be responsible for the neuroprotective effects," said Sandra J. Arévalo Valencia, CDCES and director of community health & wellness at Montefiore Nyack Hospital in New York.
Benefits of the MIND Diet
“MIND doesn’t restrict any food groups, allowing for well-balanced meal plans that can be followed long term without causing any dietary insufficiencies. In addition to reducing the risk of mental illness, it can help control weight, improve glycemia, improve cholesterol levels, and reduce hypertension,” Valencia said. Several studies also suggest that MIND can slow the progression of Alzheimer's disease, although the specific nutritional components responsible for these possible benefits or their mechanism of action haven’t been well studied.
MIND is a combination of the Mediterranean and DASH eating patterns, both of which have been recommended by the American Diabetes Association, something that bodes well for the MIND diet, as Valencia points out with a caveat.
"Both eating patterns are recognized to positively impact the management of diabetes and its comorbidities, such as hypertension, cardiovascular disease, high blood cholesterol, and obesity.
“Because MIND is a combination of Mediterranean and DASH eating patterns, it is my opinion that MIND is also beneficial for people with diabetes,” said Valencia. “However, I haven't come across any studies that evaluate the effect of MIND for diabetes specifically."
"When talking about MIND with my patients with diabetes, I recommend they exercise caution with the amount of fruit and nuts they consume. Excessive fruit intake could increase glycemia (blood sugar). In addition, the high fat content of nuts could cause weight gain. The fact that you are eating good fats doesn't take away from the reality that all fats are high in calories."
Drawbacks of the MIND Diet
As with the Mediterranean eating pattern, Aravelo believes MIND can be expensive, as ingredients such as fresh berries, olive oil, avocados, salmon, and other recommended foods tend to be costly.
One more thing that Valencia notes: "MIND could create the false expectation that you will never be diagnosed with Alzheimer's or other mental conditions,” she said. “It's important to understand that MIND helps to reduce the risk but doesn’t completely prevent or cure mental illness.”
One Thing to Remember: No One Size Fits All
No eating plan or pattern for diabetes is magical. However, with careful consideration and an understanding of your personal goals, preferences, and capacity to adjust, one of these meal patterns may be right for you.
If you’re looking for assistance with meal planning, a registered dietitian and CDCES can help. Find one who can work with you.