In January 2004 the American Diabetes Association (ADA) released its dietary recommendations for patients with type 2 diabetes.1 While they are reasonable, they are far from optimal. They state, “In subjects with type 2 diabetes, it appears that ingestion of very large amounts of fiber are necessary to confer metabolic benefits on glycemic control, hyperinsulinemia, and plasma lipids.” But they go on to say “It is not clear whether palatability and the gastrointestinal side effects of fiber would be acceptable to most people.” A little more intestinal gas and bloating is a lot better than having a heart attack, going blind or ending up on dialysis.
It has been clearly shown that consuming more dietary fiber from foods (50 g/day) and particularly soluble fiber (25 g/day) improves blood sugar control, lowers the need for insulin and reduces “bad” blood lipids in type 2 diabetic patients even if no weight is lost.2 Those with type 2 diabetes should consume as much fiber from foods as possible to reduce the risk of cardiovascular diseases and diabetic complications.
The new ADA recommendations overlook the importance of limiting sugar to lose weight. They state, “When dieting to lose weight, fat is probably the most important nutrient to restrict.” True, but if weight loss is a goal, reducing calorie density by limiting fat is fine but it’s best if refined grains and sugars are limited, too. The ADA states, “…intake of sucrose and sucrose-containing foods does not need to be restricted.” In fact, dietary fructose (sucrose is half fructose) has adverse effects on blood lipids and all refined sugars are very calorie dense. The more sugar, refined grains, fats and oils people eat, the higher the calorie density and the lower the fiber content of their diet. Overweight type 2 diabetes patients should eat a diet high in whole grains, fruits and vegetables with at least 50 g of fiber per day and reduce nonessential dietary fat and refined carbohydrates as much as possible.
1. Diabetes Care 2004;27:S36-S46
2. N Engl J Med 2000;342(19):1440-1
By James Kenney, PhD, RD, LD, FACN.
Stephanie Ronco has been editing for Food and Health Communications since 2011. She graduated from Colorado College magna cum laude with distinction in Comparative Literature. She was elected a member of Phi Beta Kappa in 2008.