# What is the best macronutrient diet for blood sugar control in diabetes **URL:** \ **Category:** Factual Questions\ **Created:** [August 27, 2012, 1:02am UTC](https://boards.straightdope.com/t/what-is-the-best-macronutrient-diet-for-blood-sugar-control-in-diabetes/632774 "2012-08-27T01:02:55Z")\ **Posts on this page:** 12\ **Page:** 2
**Author:** ![bardos](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bardos/32/1069_2.png) [@bardos](https://boards.straightdope.com/u/bardos)\ **Post date:** [August 27, 2012, 8:42pm UTC](https://boards.straightdope.com/t/what-is-the-best-macronutrient-diet-for-blood-sugar-control-in-diabetes/632774/21 "2012-08-27T20:42:53Z")
More data: I have just completed a 3 week walking tour along the Camino de Santiago, Spain. Google this if you have never heard of this pilgrimage. I was walking about 15 - 20km per day. My blood sugar hit totally normal levels all through the trip. This to say that exercise is also key, as mentioned before by another poster. The ultimate goal of a Type II should be to have reasonable BG levels without meds. With change of diet (and this oft times will require desire and willpower) and an adequate exercise program, this should be possible for many who suffer from high glucose levels in the blood. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [August 27, 2012, 8:54pm UTC](https://boards.straightdope.com/t/what-is-the-best-macronutrient-diet-for-blood-sugar-control-in-diabetes/632774/22 "2012-08-27T20:54:16Z")
> [@bardos](#): > > … Eating cereals, whether whole grain or “white” is, in the end, the exact same thing as eating pure sugar. Maybe worse. … > > … Eating more fat (there are good fats and bad fats) and less carbs will drastically lower blood sugar … Okay this is GQ not IMHO so these statements must both be corrected. As stated above, with citations, eating whole grains i.e. grains high in cereal fiber _not_ “the exact same thing as eating pure sugar” let alone worse. It is a factual answer that high fiber, especially insoluble fiber such as that of whole grain cereals, helps increase insulin sensitivity. Refined carbs and sugar does not. Also “cite please” for a claim that “eating more fat … will drastically lower blood sugar.” In general “more fat” in the sense of the way most Americans eat fat is felt to do [quite the opposite](http://www.springerlink.com/content/7734t22852m6w515/). > [@](#): > > Most, although not all, studies suggest that higher levels of total fat in the diet result in greater whole-body insulin resistance. … clinical trials demonstrate that high levels of dietary fat can impair insulin sensitivity independent of body weight changes. In addition, it appears that different types of fat have different effects on insulin action. Saturated and certain monounsaturated fats have been implicated in causing insulin resistance, whereas polyunsaturated and omega-3 fatty acids largely do not appear to have adverse effects on insulin action. Also see [here](http://onlinelibrary.wiley.com/doi/10.1002/dmrr.1229/full) both for the bit below and a very comprehensive recent state of the art review that addresses the op. > [@](#): > > Consensus exists that a very high intake of total fat (\>37% of daily energy intake) reduces insulin sensitivity irrespective of individual fatty acid concentrations. Involved mechanisms include decreased binding of insulin to its receptors, impaired glucose transport, reduced proportion of glycogen synthase and accumulation of stored triglycerides in skeletal muscle 3–7. If, however, total fat intake does not exceed more than about a third of total energy intake, then fatty acid composition does seem to be significant, with distinct types of fatty acids having differing effects on glucose metabolism. … > [@al27052 discussing very low carb for diabetes](#): > > Well, generally, people will do it when their chronic symptoms have gotten too bad, and start to increase carbs when their symptoms abate somewhat, or when they start having new problems that are being caused by the low-carb diet. IME, anyway. > > As far as the Inuit go, living in their traditional extremely cold environments, they are generally very healthy on their traditional diets. I would not recommend much fruit consumption to someone who has to deal with -30 F regularly. Fruit tends to lower body temperature. If someone is dealing with their diabetes by implementing a nutrition plan “when their chronic symptoms have gotten too bad” then they have started taking down the fire extinguisher after the house is pretty much fully burnt down. The goal is to prevent the damage by controlling blood sugar levels, not going on a diet after you have diabetic complications, or only intervening when you have to pee constantly. And actually the [least thermogenic per calorie macronutrient is fat](http://www.nutritionandmetabolism.com/content/1/1/5). Protein is the highest. Most vegetables and fruits are somewhere in between. The macronutrient balance of the traditional Inuit diet may surprise you, btw. It’s about 37% of energy consumed from fat, about the same as the standard American diet and less than the typical Danish diet used as the comparative reference in [this classic of Paleo nutrition article](http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/Meeting2/CommentAttachments/Hahn-178DOC.pdf). Of course the balance of fat was different: relatively high in MUFA, PUFA, and in particular n-3 fatty acids. Of course it also is 70 to 75% higher in protein than the [standard American diet](http://en.wikipedia.org/wiki/Western_pattern_diet) (26 to 15%), and has about 3/4s of the carb content (37 to 50%). Amazingly caribou and seal, especially when also eating the organs and the marrow, provides a different fat and protein profile than does bacon or a factory farmed steak. And the traditional Inuits, like other hunter-gatherers, had a baseline of activity that only a few Westerners have. Yes, agreed, exercise is key and a lack of fitness is a horrible risk factor. As to actually answering the op - I am not aware of enough head to head comparisons of those nutrition plans to be able to provide a GQ answer. Honestly I do not think they exist. Moreover the devil’s in the details: as pointed out one person’s vegan diet coud be awful for insulin sensitivity and glucose control and another’s pretty ideal; one person’s “Paleo” is has few vegetables and fruits and lots of beef and bacon and another’s is full of fruits, vegetables, nuts, tubers, game meats and fish. Heck even “Mediterranean” means many different things. _IMHO_, if attention is paid to the details any of those nutrition plans can be pretty ideal. The one chosen has to be one that fits the needs and desires of the person. I suspect that a well designed vegan plan and a well designed very low carb high protein moderate fat plan can each do just fine as can any of the others. It likely varies drastically because the compliance with the different plans varies drastically depending on who’s doing the eating. I’d suggest working with a qualified nutritionist. ---
**Author:** ![western12](https://avatars.discourse-cdn.com/v4/letter/w/b19c9b/32.png) [@western12](https://boards.straightdope.com/u/western12)\ **Post date:** [August 27, 2012, 9:55pm UTC](https://boards.straightdope.com/t/what-is-the-best-macronutrient-diet-for-blood-sugar-control-in-diabetes/632774/23 "2012-08-27T21:55:43Z")
> [@Wesley\_Clark](#): > > If a person has type II diabetes which diet is best for bringing blood sugar under control? Or does it vary drastically person to person or does it really not matter much between them? > Very low carb diet (20g a day of carbs) > low carb diets (carbs restricted to 20% of calories) > plant based diet high in fruits and vegetables (very high in carbs, very low fat) > paleo diet > mediterranean diet The low carb diabetes diet is a fallacy. Type II diabetes can be cured in most cases with the right diet, including a high complex carbohydrate diet. This information is not typically shared being that you are now a lifelong customer for insulin… The bodies #1 nutrient need is for complex carbohydrates. For your body to heal and do what it needs to do you have to give it the right fuel…Complex starches, fruits and vegetables supply all the protein your body needs including the essentials… ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [August 28, 2012, 12:19am UTC](https://boards.straightdope.com/t/what-is-the-best-macronutrient-diet-for-blood-sugar-control-in-diabetes/632774/24 "2012-08-28T00:19:16Z")
> [@bardos](#): > > More data: > > I have just completed a 3 week walking tour along the Camino de Santiago, Spain. Google this if you have never heard of this pilgrimage. I was walking about 15 - 20km per day. My blood sugar hit totally normal levels all through the trip. > > This to say that exercise is also key, as mentioned before by another poster. > > The ultimate goal of a Type II should be to have reasonable BG levels without meds. With change of diet (and this oft times will require desire and willpower) and an adequate exercise program, this should be possible for many who suffer from high glucose levels in the blood. I assume that was the same walk described in the movie [the way](http://www.imdb.com/title/tt1441912/)? Sounds like it, I didn’t really care for the movie but it sounded like a nice thing to try before you die. How did you walk that much w/o your feet hurting like hell and being full of blisters? ---
**Author:** ![bardos](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bardos/32/1069_2.png) [@bardos](https://boards.straightdope.com/u/bardos)\ **Post date:** [August 28, 2012, 5:03am UTC](https://boards.straightdope.com/t/what-is-the-best-macronutrient-diet-for-blood-sugar-control-in-diabetes/632774/25 "2012-08-28T05:03:34Z")
> [@western12](#): > > The low carb diabetes diet is a fallacy. Type II diabetes can be cured in most cases with the right diet, including a high complex carbohydrate diet. This information is not typically shared being that you are now a lifelong customer for insulin… > > The bodies #1 nutrient need is for complex carbohydrates. For your body to heal and do what it needs to do you have to give it the right fuel…Complex starches, fruits and vegetables supply all the protein your body needs including the essentials… This is extremely dangerous advice for any diabetic to follow. Filled with misinformation. ---
**Author:** ![tracer](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/tracer/32/20578_2.png) [@tracer](https://boards.straightdope.com/u/tracer)\ **Post date:** [August 28, 2012, 5:06am UTC](https://boards.straightdope.com/t/what-is-the-best-macronutrient-diet-for-blood-sugar-control-in-diabetes/632774/26 "2012-08-28T05:06:32Z")
> [@DSeid](#): > > As stated above, with citations, eating whole grains i.e. grains high in cereal fiber _not_ “the exact same thing as eating pure sugar” let alone worse. It is a factual answer that high fiber, especially insoluble fiber such as that of whole grain cereals, helps increase insulin sensitivity. Refined carbs and sugar does not. Even when eating pure starch (e.g. white flour with no fiber in it at all), there are two slight differences between doing that and eating pure sugar: 1. Starch is broken down by the saliva into maltose and maltotriose, which in turn are further broken down into monosaccharides in the duodenum by an enzyme called maltase. Table sugar (sucrose), on the other hand, is broken down into monosaccharides in the gut by an entirely different enzyme called sucrase. Neither substance is absorbed into the blood stream unless and until it is broken down into monosaccharides. 2. Starch/maltose/maltotriose is broken down into pure glucose. Table sugar (sucrose) is broken down into a 50-50 mixture of glucose and fructose. ---
**Author:** ![tracer](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/tracer/32/20578_2.png) [@tracer](https://boards.straightdope.com/u/tracer)\ **Post date:** [August 28, 2012, 5:09am UTC](https://boards.straightdope.com/t/what-is-the-best-macronutrient-diet-for-blood-sugar-control-in-diabetes/632774/27 "2012-08-28T05:09:12Z")
> [@bardos](#): > > This is extremely dangerous advice for any diabetic to follow. Filled with misinformation. Especially the part about being a “lifelong customer for insulin.” **Type 1** diabetics are routinely prescribed insulin. **Type 2** diabetics are usually started off on Metformin, then progressively stronger insulin-sensitivity/blood-sugar-management drugs. Only recently have doctors started prescribing insulin to patients with Type 2 diabetes, and then never as the first line of defense. EDIT: Oh, and **western12**? You do realize that “complex carbohydrates” includes any and all polysaccharides, including starch, right? So plain white bleached flour counts as a complex carbohydrate. ---
**Author:** ![bardos](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bardos/32/1069_2.png) [@bardos](https://boards.straightdope.com/u/bardos)\ **Post date:** [August 28, 2012, 5:15am UTC](https://boards.straightdope.com/t/what-is-the-best-macronutrient-diet-for-blood-sugar-control-in-diabetes/632774/28 "2012-08-28T05:15:06Z")
> [@Wesley\_Clark](#): > > I assume that was the same walk described in the movie [the way](http://www.imdb.com/title/tt1441912/)? Sounds like it, I didn’t really care for the movie but it sounded like a nice thing to try before you die. > > How did you walk that much w/o your feet hurting like hell and being full of blisters? Yes, the same walk. Personally I loved the film. I only walked from León to Santiago de Compostela, a mere 300 KM. For me, my feet were not the problem, it was my knees. Many people do in fact get painful blisters. Each evening in the Albergues (the Refuges for Pilgrims)you would see many people (the camino is made up of many folks who I would term the walking wounded) treating their blisters; a first aid kit composed of needles, band-aids and iodine were de rigeur for many of the unfortunate walkers… vaseline is/was recommended to be applied to the feet daily to avoid these blisters. Also, it is/was recommended to not purchase new shoes for this venture as breaking in new shoes usually will cause blisters. I for one did not have any blisters, although I did purchase new (oversized) trekking boots along the way. My friend at “base camp” in Madrid told me it was because my feet were already “cured” by life (in the sense of cured meat, not as in healed). The big joke the travellers often shared was that the Camino de Santiago was sponsored by the makers of Ibuprofen, as many folks were obliged to take these anti-inflammatory pills to be able to continue their walk and that without the Camino, big pharma would go out of business. Such was the prolific use of anti-inflammatory pills along the Way. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [August 30, 2012, 1:21am UTC](https://boards.straightdope.com/t/what-is-the-best-macronutrient-diet-for-blood-sugar-control-in-diabetes/632774/29 "2012-08-30T01:21:34Z")
I’ve circled back to trying to see if there is anything out there authoritative enough to offer as a GQ response to the op, rather than an IMHO response. [This Sept. 2011 review](http://www.sciencedirect.com/science/article/pii/S0939475311000895) may be the best there is. > [@](#): > > …The conclusion is that there is no universal dietary strategy to prevent diabetes or delay its onset. Together with the maintenance of ideal body weight, the promotion of the so-called prudent diet (characterized by a higher intake of food groups that are generally recommended for health promotion, particularly plant-based foods, and a lower intake of red meat, meat products, sweets, high-fat dairy and refined grains) or a Mediterranean dietary pattern rich in olive oil, fruits and vegetables, including whole grains, pulses and nuts, low-fat dairy, and moderate alcohol consumption (mainly red wine) appears as the best strategy to decrease diabetes risk, especially if dietary recommendations take into account individual preferences, thus enabling long-time adherence. [This one](http://care.diabetesjournals.org/content/34/Supplement_2/S210.full) is also good. > [@](#): > > Thus, in type 2 diabetes prevention, it is important to pay attention not only to one single factor such as obesity but also to several factors simultaneously. This method was unequivocally demonstrated by the Finnish Diabetes Prevention Study (DPS), where none of the high-risk individuals with impaired glucose tolerance (IGT) developed diabetes during the initial trial period if they reached four or five out of five predefined lifestyle targets (1). These targets were as follows: weight loss \>5%, intake of fat \<30% energy, intake of saturated fats \<10% energy, increase of dietary fiber to ≥15 g/1,000 kcal, and increase of physical activity to at least 4 h/week. Such targets are relatively modest and therefore possible to reach by many people. Moreover, to practice such a lifestyle is feasible for the long term, even for an entire lifetime. … Lifestyle intervention in these clinical trials had a strong focus on increased physical activity (2.5–4 h/week) and dietary modification (increased whole grains, fiber, vegetables, and fruit; reduced total and saturated fat, sugar, and refined grains). Weight reduction among overweight participants was also an important goal and predictor of decreased diabetes risk (5); however, beneficial changes in type 2 diabetes incidence were also achieved independently of weight reduction (6,7). … ---
**Author:** ![Michael63129](https://avatars.discourse-cdn.com/v4/letter/m/3da27b/32.png) [@Michael63129](https://boards.straightdope.com/u/Michael63129)\ **Post date:** [August 30, 2012, 2:56am UTC](https://boards.straightdope.com/t/what-is-the-best-macronutrient-diet-for-blood-sugar-control-in-diabetes/632774/30 "2012-08-30T02:56:31Z")
I thought that [this graph](http://3.bp.blogspot.com/-FSPyeovhQos/T994MDnyNaI/AAAAAAAAAJY/CbRT3EjSkIU/s1600/Calorie_trend_publish.png) would provide insight into the diabetes epidemic; note which food groups have increased in caloric contribution in recent decades: added fats and sugars and grains, with all of the others relatively constant (although that doesn’t necessarially mean anything; the type of meat is also important as [this study](http://www.webmd.com/heart-disease/news/20100517/processed-meat-linked-to-heart-disease-risks) shows (which claims that read meat isn’t actually bad unless it is processed), and processed (again, that word) fruits and vegetables are generally less nutritious, although [this article](http://www.chow.com/food-news/54376/are-frozen-vegetables-as-nutritious-as-fresh/) claims that they are equivalent unless you eat them the day they are picked). ---
**Author:** ![Athena](https://avatars.discourse-cdn.com/v4/letter/a/35a633/32.png) [@Athena](https://boards.straightdope.com/u/Athena)\ **Post date:** [August 30, 2012, 1:40pm UTC](https://boards.straightdope.com/t/what-is-the-best-macronutrient-diet-for-blood-sugar-control-in-diabetes/632774/31 "2012-08-30T13:40:35Z")
Just wanted to say low-GI versus high-GI, I see no difference in blood sugar spikes. My body is my lab; Type 1 here, so I’m very interested in whatever carbs I can eat without having to worry. The answer I’ve found so far is “none”. High-GI, low-GI, they all cause havoc. That said, veggies - even carrots - though they contain carbs, do very little to blood sugar. I’m pretty sure that’s a matter of how many carbs they contain. As someone upthread said, you have to eat a LOT of carrots to get a significant amount of carbs. Not so with processed sugar. I never worry about eating non-starchy vegetables, because I simply can’t eat enough of them to make a difference blood-sugar-wise. ---
**Author:** ![western12](https://avatars.discourse-cdn.com/v4/letter/w/b19c9b/32.png) [@western12](https://boards.straightdope.com/u/western12)\ **Post date:** [August 30, 2012, 9:07pm UTC](https://boards.straightdope.com/t/what-is-the-best-macronutrient-diet-for-blood-sugar-control-in-diabetes/632774/32 "2012-08-30T21:07:47Z")
> [@bardos](#): > > This is extremely dangerous advice for any diabetic to follow. Filled with misinformation. Misinformation? Unfortunately the blind leading the blind wins again. I’m sorry you feel that way. It is not misinformation I assure you…We believe what we are told to believe. So sad for long term Type II diabetics! [Previous page](https://boards.straightdope.com/t/what-is-the-best-macronutrient-diet-for-blood-sugar-control-in-diabetes/632774.md?page=1)