What are the dietary restrictions for diabetic patients?

Dietary Restrictions for Diabetic Patients

People with diabetes should limit saturated fat to <7% of total calories, minimize trans fats, restrict dietary cholesterol to <200 mg/day, and keep sodium intake below 2,300 mg/day, while emphasizing whole grains, vegetables, fruits, legumes, and lean proteins over processed foods and sugar-sweetened beverages. 1

Fat Restrictions

The most critical dietary restriction for cardiovascular risk reduction involves limiting specific types of fats:

• Saturated fat must be restricted to less than 7% of total daily calories 1
• Trans fats should be minimized or completely avoided 1
• Dietary cholesterol should be limited to 200 mg/day 1
• Replace saturated fats with unsaturated fats rather than refined carbohydrates when reducing intake 1

These restrictions are paramount because saturated and trans fatty acids are the principal dietary determinants of LDL cholesterol, and cardiovascular disease risk in diabetes equals that of non-diabetic individuals with pre-existing CVD. 1

Consume two or more servings of fish weekly (excluding commercially fried fish) to obtain omega-3 polyunsaturated fatty acids. 1

Sodium Restriction

Limit sodium consumption to less than 2,300 mg/day. 1

• Further restriction to 1,500 mg/day is not generally recommended, even for those with hypertension 1
• The most effective way to achieve sodium goals is by limiting processed foods 1
• Consider palatability, availability, affordability, and nutritional adequacy when implementing sodium restrictions 1

Sugar and Sweetener Restrictions

Minimize consumption of sugar-sweetened beverages and foods with added sugars to avoid displacing nutrient-dense food choices. 1

• Water is recommended over both nutritive and nonnutritive sweetened beverages 1
• Nonnutritive sweeteners (acesulfame potassium, aspartame, neotame, saccharin, sucralose) are safe and can be used instead of sugar-sweetened products if consumed in moderation and for the short term 1
• While sucrose-containing foods may be substituted for isocaloric amounts of other carbohydrates with similar blood glucose effects, consumption should be minimized 1

Alcohol Restrictions

If adults with diabetes choose to drink alcohol, limit intake to one drink per day or less for women and two drinks per day or less for men. 1

• Alcohol must be consumed with food to reduce risk of nocturnal hypoglycemia, especially when using insulin or insulin secretagogues 1
• Advise complete abstention for those with history of alcohol abuse, during pregnancy, or with liver disease, pancreatitis, advanced neuropathy, or severe hypertriglyceridemia 1

Foods to Minimize or Avoid

Restrict consumption of red and processed meats, refined grains, and ultraprocessed foods. 1, 2

• Minimize sugar-sweetened beverages and sweets 1
• Avoid commercially fried fish filets 1
• Limit foods high in saturated fat, particularly animal products 3

Protein Considerations

Maintain usual protein intake of 15-20% of total energy (0.8 g/kg body weight/day) for those with normal renal function. 1

• Do not restrict protein below 0.8 g/kg/day, even in diabetic kidney disease, as this does not improve outcomes and may increase malnutrition risk 1
• High-protein diets (>20% of calories) are not recommended for weight loss due to unknown long-term effects 1
• Avoid using high-protein foods (milk, nuts) to treat hypoglycemia, as protein increases insulin response without raising plasma glucose 1

Supplements to Avoid

Do not use vitamin, mineral, herbal, or spice supplements for glycemic management, as there is insufficient evidence of benefit. 1

• Specifically avoid chromium, magnesium, vitamin D, cinnamon, and aloe vera for diabetes management 1
• Counsel against β-carotene supplementation due to evidence of harm (increased lung cancer and cardiovascular mortality risk) 1
• Omega-3 fatty acid supplements do not improve glycemic control and are not recommended for cardiovascular event prevention in most patients 1

Critical Pitfall to Avoid

The most common error is using high-protein carbohydrate sources (such as milk or peanut butter) to treat or prevent hypoglycemia. In type 2 diabetes, protein increases insulin response without raising plasma glucose, which can worsen hypoglycemia rather than correct it. 1