- Consuming at least 14 grams of dietary fiber per 1,000 calories per day
- Making half of grain choices whole grains
- Consuming low-glycemic foods that are rich in fiber and other nutrients (The glycemic index is a measure of how a food affects blood glucose levels following meals. Foods with a low glycemic index raise blood glucose levels less or more slowly than foods with a high glycemic index.)
For managing diabetes, the ADA offers the following recommendations regarding the various macronutrients:
Carbohydrate. Consumption of carbohydrate-containing foods such as fruits, vegetables, whole grains, legumes, and low-fat milk is encouraged. Consuming less than 130 grams of carbohydrate per day is not recommended for diabetes management. Counting the total amount of carbohydrate consumed is recommended for blood glucose control; choosing foods with a low glycemic index may provide additional benefit in controlling blood glucose. Eating a variety of fiber-containing foods is recommended.
Protein. There’s no reason for people who have diabetes and normal kidney function to consume other than the usual protein intake of most Americans, which is 15% to 20% of total daily calories. High-protein diets are not recommended for weight loss because their long-term effects are unknown.
Fat. Saturated fat should be limited to less than 7% of total calories, and intake of trans fat should be minimized. Two or more servings of fish per week are recommended to provide omega-3 fatty acids.
Cholesterol. Dietary cholesterol should be limited to less than 200 milligrams per day.
The goals of the Joslin Diabetes Center guideline for overweight and obese adults with Type 2 diabetes or prediabetes are basically the same as the ADA’s goals: improve cardiovascular health, control blood glucose levels, and reduce body fat. However, unlike the ADA, they do recommend a particular distribution of macronutrients. Specifics of the Joslin guideline are as follows:
Carbohydrate. About 40% of calories should come from carbohydrate. Like the ADA, however, Joslin recommends consuming no less than 130 grams of carbohydrate per day, which means that people with very low calorie intakes may end up getting slightly more than 40% of their calories from carbohydrate.
The Joslin guideline states that when choosing carbohydrate-containing foods, preference should given to foods with a low glycemic index. Recommended carbohydrate foods include fresh vegetables, fruits, beans, and whole or minimally refined grains. At least 20–35 grams of fiber should be consumed daily.
Protein. About 20% to 30% of calories should come from protein, unless a person has any signs of kidney disease, such as the presence of protein in his urine. (People with diabetes are generally advised to have a microalbuminuria test once a year to check for this.) Recommended protein sources are fish, skinless chicken or turkey, nonfat or low-fat dairy products, legumes (dried beans and peas), tofu, tempeh (a soy product), and seitan (wheat gluten).
Fat. About 30% to 35% of calories should come from fat, primarily monounsaturated and polyunsaturated fats. Saturated fat should be limited to less than 10% of calories or less than 7% in people with LDL cholesterol over 100 mg/dl. Recommended fat sources include olive oil, canola oil, nuts, seeds, and fatty fish such as salmon.
Cholesterol. Dietary cholesterol should be limited to less than 300 milligrams a day or less than 200 milligrams in people with LDL cholesterol over 100 mg/dl.