More and more people in the US are being diagnosed with type 2 diabetes and impaired glucose tolerance, which is also called pre-diabetes. They are usually told to change their diets but are not referred to a Registered Dietitian or Diabetes Educator and are given very little specific advice. Many are left on their own to sort through the sea of conflicting information found on the internet. So what is the best diet to follow if you want to improve your management of existing diabetes or prevent your impaired glucose tolerance from developing into diabetes? The answer is that you have more than one option. But whatever plan you follow, the most important thing is that you lose weight, if you are over-weight, and that you decrease your calorie intake. This isn’t a temporary plan but rather a lifestyle change, so it’s important that you make changes that you know you can stick to. A low carbohydrate diet is probably the most popular one that people attempt when they first hear that they have diabetes. While following a low carbohydrate diet, usually defined as less than 100 grams of carbohydrate per day, you will initially lose weight improve blood glucose control and improve your blood lipids. The problem most people face with this way of eating is that it can be very restricting and hard to stick to over the long term. While weight loss may be significant in the beginning, after 12 months of following this plan weight loss and improved blood tests are very similar to those seen in people who follow a Mediterranean diet. The Mediterranean diet is rich in olive oil, beans, nuts, oatmeal and other unrefined cereals, whole grains, fruit, and vegetables, low in meat and meat products, and with moderate contents of dairy products (mostly cheese and yogurt), fish, and red wine. People following this diet appear to have the greatest improvement in lipids including higher HDL (good cholesterol) and lower LDL (bad cholesterol) and .5% decrease in HbA1c, which is a marker of glucose control. This is a similar change seen with medication alone. Another plan that leads to desirable improvements is a low Glycemic Index plan. This means including only those carbohydrates that increase blood sugar the least after eating them. These include 100% stone-ground whole wheat, pumpernickel bread, oatmeal (rolled or steel-cut), oat bran, muesli, pasta, sweet potato, corn, yam, lima/butter beans, peas, legumes, lentils, most fruits, non-starchy vegetables. These foods would all be included in the Mediterranean diet. In addition, vegetarian and vegan diets also result in weight loss, improved blood lipids and improved glucose control. So the bottom line is: regardless of what plan you follow a low carbohydrate, low glycemic index, Mediterranean, vegan, vegetarian or a combination of any of the above, you must cut calories and lose weight in order to improve blood glucose control.
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