Diets and Diabetes – Let’s Compare!

  • Healthy Food - Fish Fruits Nuts Vegetables

“The word diet comes from the old French word diete and the medieval Latin word dieta meaning a daily food allowance.” Diets are, “a set course of eating and drinking in which the kind and amount of food should be planned to achieve weight loss and better health.”

According to Dr. Roxanne Sukol, a preventative medicine specialist at The Wellness Institute at Cleveland Clinic, “The spread of conflicting information and even misinformation may be playing a role in America’s obesity epidemic.” Referring to recent data collected by the CDC, “50% of Americans have either diabetes or pre-diabetes by age 65.” Most people are still confused about what healthy eating is and it’s not because they are not trying, but because it can be very confusing. Many Americans make choices based on “taste and pricing” with “healthfulness” in third place. Labels can be conflicting and confusing stating “this food is healthy” even when it may not be. Americans recently received a failing grade in nutrition literacy from the findings presented by The International Food Information Council Foundation. According to Dr. Fatima Stanford, MD, MPH, MPA, from Mass. General Hospital in Boston, “There is no one strategy that is universally effective in helping people achieve a healthy weight and lower their risk of chronic diseases.” We do know that yo–yo dieting that is severely restrictive can lead to bingeing and may lead to insulin resistance, pre-diabetes, diabetes, hypertension, and elevated cholesterol and eventual heart disease. How you eat should always remain safe and realistic.

My patients with diabetes are always asking “what is the diabetes diet or which diet should I follow for my diabetes?” I’m not recommending any of the reviewed diet plans below, but I will give you some general comparisons. Since I am a practicing RN/CDE, I still believe in, teach and recommend the ADA guidelines for a food plan when you have diabetes. Yes, it should be individualized but it should include eating lean proteins, non- starchy vegetables, whole grains like barley, amaranth, and bulgur, whole starch foods such as sweet potatoes, brown rice and beans, fruits, legumes which are all counted as carbohydrates, as well as good fats like olive oil and avocados. No or limited processed or refined foods and no sugary drinks should be a part of your diet. Portion size is extremely critical and timing of meals does matter. Do not skip meals and make it up later in the day. Eat a daily small bedtime snack such as a serving of a carbohydrate and a protein (2 whole grain crackers and a tablespoon of natural peanut butter) 30 minutes prior to bed. This is a well-balanced, recommended food plan. Incorporate daily exercise, do not smoke and practice stress management.

With that said, I will review some of the more popular diet plans being used today. Remember, there are literally hundreds of thousands of diet plans with endless variations and tweaks. I am not recommending or suggesting these diet plans are poor or good choices for you. I am simply offering some of the basic components of each popular plan. Always consult with your endocrinologist, primary care physician, nurse practitioner or registered dietitian prior to changing your eating plan especially when you have diabetes. Here we go!

Vegetarian Diet

Vegetarian DietsA vegetarian diet usually eliminates meat, fish, and poultry but includes eggs and dairy products. This diet is said to help you lose weight and lower your risk of chronic disease (heart disease, diabetes, and hypertension) but as with any plan, choices and portions are important. Some vegetarians eat highly processed foods that are high in sodium, fat calories and additives and may include chips, sweets and pastries. The vegetarian diet should be focused on a plant based diet. Also, many vegetarians consume large amounts of starches including breads, pasta and rice dishes which could send blood sugars soaring and add unwanted weight. Focusing on a plant based diet may make you miss out on nutrients if you are not including protein sources. This plan may work well for some people but it depends on choices and quantities as with all diet plans. Some individuals follow a “semi-vegetarian diet” also called a flexitarian diet. It is mostly plant based but allows for a minimum of added meat, dairy, eggs, fish and poultry. There are many variations of a vegetarian diet. If you choose becoming a vegetarian for health or environmental reasons, consult with a professional to make sure you are including all the important nutrients. Notice how it works on your blood sugar control.

Vegan Diet

Vegan DietsAccording to Dr. Sonya Angelone, RD, from the Academy of Nutrition and Dietetics, “veganism can cause weight loss simply because it is a form of food restriction. Restricting anything can promote weight loss in the short term but will it last, depends.” The vegan diet is also plant based and includes foods such as grains, beans, nuts, seeds, fruits, vegetables and nut butters. Many people follow a vegan diet based on health, environmental and ethical values where no animal products are eaten. It takes a vegetarian diet a step further in that it eliminates eggs, cheese, honey and dairy. Again, this diet can include chips, bagged and processed snacks, and high amounts of fruit, non-dairy ice cream or vegan cheese and may be high in sugar, carbohydrates and calories. Desserts such as pumpkin/gingerbread scones, banana and nut muffins or cherry/peanut butter cobblers are readily available and considered vegan. Eating vegan may cause “nutritional deficiencies” including low calcium, iron, vitamin B12, zinc and Omega 3s. Vegans may become hungrier since they often lack enough high quality protein and fat that keeps them satiated. This could lead to over–eating carbohydrates and snacks again. Vegans can and should add quinoa, lentils, beans, amaranth, chia, flax and hemp seeds, peas, tofu and soybeans to keep hunger low, have adequate protein and avoid cravings.

Paleo Diet

Paleo DietsThis diet plan is based on “our hunter and gatherer ancestors.” It relies on whole food and what it looks like in nature. The basics include fish, eggs, meat, vegetables, fruits, nuts, seeds, spices, herbs and healthy oils. It avoids processed and refined foods, sugar, grains, most dairy, artificial sweeteners, margarine and vegetable oils. Some high fat dairy is accepted including butter and high-fat cheese. The basic Paleo model is “if it looks like it was made in a factory, don’t eat it.” The Paleo plan encourages organic fruits and vegetables and pasture raised or grass feed meat. There are several variations in the Paleo diet which allows some “indulgences” such as red wine and dark chocolate. This diet remains controversial among healthcare professionals and mainstream nutrition organizations. There are studies that suggest health benefits including blood sugar reduction and weight loss, but check with your health care provider before you start any new eating program.

Low Carbohydrate Diets

Low Carbohydrate DietsMany patients with diabetes choose to follow “low carb plans” although they are still not recommended by mainstream diabetes organizations. This does not mean carbohydrates should be eaten in large quantities but complete elimination is not recommended. Low carb diets consist of severely limiting carbohydrates found in grains, milk, yogurt, starchy vegetables and fruits and focuses on foods high in protein and fat. Some branded low carb diets include the South Beach diet and the Atkins diet. The Atkins diet premise is that “by limiting carbohydrates, the body will have to burn fat instead of sugar for energy.” This in turn causes weight loss; yet the weight loss is often loss of water. Our bodies use carbohydrates as “its main source of fuel” especially for the brain and muscles. Certain carbs that are plant based like grains, legumes and starchy vegetables are loaded with fiber and when eaten in portion size, raise blood sugar slowly. Milk and fruit get into your system quicker and simple refined carbs such as white bread, white rice, cakes, pastries and chips or bars are absorbed the fastest with a quick rise in blood sugar. Low carb diets are limited to just 60-130 grams of carbohydrate a day. The Dietary Guidelines for Americans recommends between 225-325 grams of carbohydrate a day. Certainly, this is too high for people with diabetes but 130-160 grams could be considered a reasonable amount if broken up evenly throughout the day depending on the individual person. The studies on low carb diets offer mixed results. Reducing carbs may cause a reduction in overall calories which generally translates into weight loss, reduced metabolic syndrome, improved blood sugars, and a decrease in insulin resistance, hypertension, lower LDL levels and heart disease. According to The American Heart Association, The American College of Cardiology and The Obesity Society, “there is still not enough evidence to say whether most low carb diets provide heart healthy benefits.” Low carb diets may induce headaches, hypoglycemia, nausea, weakness, moodiness and fatigue. Decide with your practitioner if this could work for you.


Dash DietsThe DASH diet has had very good results in most studies. It stands for “Dietary Approaches to Stop Hypertension” and focuses on the need to reduce blood pressure. It reduces sodium levels to 1500-2300 mg per day, advises choosing nutrient-rich, dense foods and limiting food portions. The DASH diet encourages eating beans, whole grains, fruits and lentils in small portions and eating lean, high quality protein, including nuts, seeds, and fatty fish. It includes green, leafy vegetables, all non-starchy vegetables, and healthy fats like olives and avocados. The diet is based on foods rich in nutrients such as potassium, calcium and magnesium to help regulate blood pressure. It can also benefit those with diabetes since it lowers the risk of heart disease.

Mediterranean Diet

Mediterranean DietsThe Mediterranean diet was considered the “best overall diet for health.” It is very attractive for those with diabetes. This diet includes fatty fish, lots of vegetables, extra virgin or virgin olive oil, whole grains, some fruit, and nuts, with a small amount of red wine. The Mediterranean diet teaches to avoid or limit unhealthy saturated fats such as red meat or trans-fats. The diet encourages eating while socializing as well as eating around family and friends. The Mediterranean diet has been shown to lower LDL values and cut the risk of heart disease.

Raw Food Diet

Raw Food DietsThe followers of the raw food diet claim “cooking food destroys or alters the enzymes, diminishes the vitamins and minerals and decreases the food quality”. Scientific research has not confirmed this. Foods included on a raw diet are dried fruits, sprouted beans and shoots, grains and legumes, raw fresh fruits and veggies ,nut milks, raw nut butters, raw nuts and seeds, green food powder and fermented foods including Kimchi, sauerkraut , and Kefir. The only heating process allowed is with a dehydrator which blows hot air through the food but does not actually cook it. The claim is “it could lead to weight loss and prevent chronic diseases”.

Summertime is coming and with bathing suit weather, most people are interested in losing weight. Losing weight and keeping it off is one of the most difficult things we strive for. Try to remember that general health, feeling well and controlling chronic disease is much more important than “how you look in a bathing suit”. Work with a health care professional to find the right balance of foods for you to maintain blood sugars and prevent diabetes complications including heart disease, prevent hypoglycemia, promote energy and reduce your risk of future problems related to nutrition. Remember, it is also a great time to stay physically active.

Diabetes affects everyone in one way or another. New information is constantly being offered to keep you healthy and your diabetes better controlled. Stay aware and ask questions!

Have a question or comment? Then post below, no registration required. I would love to hear from you!

NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.

About the Author: Roberta Kleinman

Roberta Kleinman, RN, M. Ed., CDE, is a registered nurse and certified diabetes educator. She grew up in Long Island, NY. Her nursing training was done at the University of Vermont where she received a B.S. R.N. Robbie obtained her Master of Education degree, with a specialty in exercise physiology, from Georgia State University in Atlanta, Georgia. She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past. She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups. More about Nurse Robbie


  1. Mr Thrifty June 7, 2017 at 1:31 pm - Reply

    Low carb diet section is full of mis-information like:

    >”Low carb diets are limited to just 60-130 grams of carbohydrate a day.”

    Most serious T2D’s that want normal BG are doing ketogenic low carb diets of 20 carbs or less. I was T2D Dx with FBG of 315 and A1c of 11.3. Doing keto (no added fats) and time restricted eating (2 meals per day) my morning fasting came down to yet the weight loss is often loss of water.

    Really? I lost 60 lbs of water?

    • Nurse Robbie June 8, 2017 at 2:51 pm - Reply

      Hi John,

      Thanks for your comment regarding our recent ADW diabetes newsletter concerning diet plans and diabetes. Actually low carb diets are “60-130grams per day.” You are talking about the “ketogenic diet” which is completely different. By reducing carbs to 20 grams per day, you are using fat for energy instead of carbs; our brain thrives and relies on carbs for energy. By reducing carbs to this level, you may be more at risk for hypoglycemia or low blood sugar. When you are ill and on a ketogenic diet, you may set yourself up for DKA or diabetic ketoacidosis, which is a serious complication. Again, I was discussing the pros and cons of different diets but not making a specific diet recommendation. I am going by the ADA standards of nutritional counseling; they do not recommend this plan. As far as the ketogenic diet, there are still no large studies showing the long term affects or if it is beneficial. To most nutritional organizations and experts it is not considered “nutritionally sound.” 75% of the diet comes from fat, 20% from protein and 5% from carbs – 20 grams or less per day. Are you eating mono, poly unsaturated fats or saturated fats? By eating too many saturated fats, you may lower your A1C but still increase your risk of heart disease and LDLs. Most people are not able to maintain this dietary restriction long term; when carbs are reintroduced weight goes up and “weight cycling “ begins; it is dangerous with diabetes. The ketogenic diet is not successful for most people even those with diabetes. You should be monitoring your blood sugars more frequently as well as using urine ketone strips to monitor dietary ketones. Hopefully, you are working closely and having a strong discussion with your endocrinologist. If you have any kidney disease, you should avoid the ketogenic diet. The most recommended diet for those with diabetes and heart issues is generally the “Mediterranean diet”. I hope this further discussion about the ketogenic diet has helped you. As always, each person reacts differently to each plan; if this plan works for you and your physician, then keep up the good work but be aware of the limitations.

      Best of luck,
      Nurse Robbie-

  2. Kathleen Phillips June 7, 2017 at 12:06 pm - Reply

    Roberta, you right such helpful articles! It is nice to have a reference guide for the major diets out there. Keep up the good work!

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