New Diabetes Nutrition Recommendations: Macronutrients and More

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Last week I touched upon some of the updated nutrition recommendations that were recently released by the American Diabetes Association. I appreciate all of the comments, and I can understand why guidelines can seem vague and, yes, occasionally frustrating.

It’s interesting to learn about different viewpoints regarding eating with diabetes, and doing so further affirms, at least for me, that guidelines are just that — they serve as a basis or a guide from which to draw upon. But by no means are they a mandate or an ultimatum that tells people exactly what to eat. So, back to some of the highlights of these recommendations.


Protein. Guess what? For people with diabetes who don’t have kidney disease, there’s no “ideal” amount of protein that helps to improve glycemic control or helps lower the risk for heart disease. Now, several studies have shown that higher protein intakes (28% to 40% of calories) have favorable effects on blood glucose and A1C levels. But different studies have shown otherwise. And some studies have shown improved LDL cholesterol and triglyceride levels with a higher protein intake. But again, other studies did not show improvement.

When there isn’t consistent evidence, it’s hard to recommend a specific amount. The good news is that people who have kidney disease don’t need to follow a very-low-protein diet. Too little protein can lead to malnourishment and doesn’t seem to affect the rate of progression of kidney disease.

Fat. You might be surprised to hear that no ideal amount of fat exists for people with diabetes. However, the Institute of Medicine suggests a fat intake of between 20% and 35% of calories for the general population. What’s more important is the type of fat that you consume. Monounsaturated fat, such as olive and canola oil, seems to have some benefit on glycemic control and can also improve risk factors for heart disease. The recommendation is to replace 5% of saturated fat intake with monounsaturated fat. Continue to limit your intake of saturated and trans fat.

Omega-3 fatty acids. If you’re popping fish oil supplements, keep in mind that there’s no evidence showing that doing so will protect you from heart disease. However, the guidelines reinforce the importance of getting your “fish oils” (omega-3 fatty acids) from food sources, aiming for at least two fish meals per week to help lower the risk of heart disease.

Micronutrients and herbal supplements
Micronutrients include vitamins and minerals, and these recommendations find no benefit in taking supplements if there’s no underlying deficiency. What about supplements for improving glycemic control? There’s a lot of buzz around taking supplements like chromium, vitamin D, magnesium, and cinnamon to improve blood glucose levels. But the studies are inconsistent in terms of their findings.

I know a lot of people have commented on how helpful taking cinnamon is, for example. People respond very differently to supplements and, in my opinion, there certainly can be a place for them. But remember that supplements can sometimes be harmful and may interact with medicines that you take, so be careful about taking them and always let your health-care provider know what you’re taking.

The Dietary Guidelines for Americans recommend that people who are 51 years of age or older and those who are African-American or who have high blood pressure, diabetes, or chronic kidney disease limit their sodium intake to 1500 milligrams (mg) per day. Restricting sodium to this level is difficult, and it can be unpalatable and expensive as well. Also, for the most part, evidence doesn’t support lowering sodium to this amount. Therefore, the guidelines recommend capping sodium intake at 2300 mg per day, which is the recommendation for the general public.

These guidelines are packed with much more information, a lot of which is a reiteration of the previous nutrition guidelines.

It can be confusing to figure out what to eat and in what amounts, but remember that help is available: Ask your doctor to refer you to a dietitian or look into diabetes and/or nutrition programs in your community. Health plans generally cover some of these services. You can even take online classes through the University of California, San Francisco, if you’re unable to find these services in your area (visit And of course, this website is packed with helpful information, too!

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