Nutrition is a top concern among diabetes patients. The most common question asked after receiving a diabetes diagnosis is, “What can I eat?” This is for a good reason since there’s strong evidence to support nutrition therapy and counseling as an essential aspect of diabetes management and its effectiveness in terms of health outcomes and cost.

While nutritional therapy and counseling can help patients manage their weight, maintain glycemic targets, and improve blood pressure and other cardiovascular risk factors, the American Diabetic Association (ADA) stresses there’s no one-size-fits-all approach to diabetic patients. Instead, dietary recommendations should be patient-specific based on comorbidities, health status, cultural background, and other factors. 

The ADA says a variety of dietary patterns are acceptable for managing type 2 diabetes, with an overall emphasis on consuming non-starchy vegetables, minimizing added sugars and refined grains, selecting whole foods over processed, and reducing overall carbohydrate intake. While various dietary patterns are recognized as acceptable, it’s especially worthwhile to look at the safety of some of the latest health trends that patients are likely to ask about.

Intermittent Fasting (IF)

This diet can be defined in multiple ways. However, the definition here includes fasting each day for 16 hours and eating during the remaining eight, or eating normally for five days of the week and restricting caloric intake during the other two. Overall, IF involves alternating between periods of fasting and eating and places more emphasis on when you eat than what you eat. Many studies of diabetic patients show that IF benefits weight loss through the effect on blood sugar levels. However, the need for medication varies across studies.

Bret Scher, MD, a board-certified cardiologist and medical director at Diet Doctor, believes IF can sometimes benefit patients with type-2 diabetes. “When you’re not taking in any calories, your body is in a completely different metabolic state. You’re starting to burn your fat for fuel, and you start to undo that insulin resistance because now your body’s not having this excess glucose coming in. And so it can manage its blood sugar much more efficiently, and insulin levels can then drop.” 

This eating pattern can also address the root cause of diabetes rather than simply providing patients with medications to reduce their blood sugar levels. “The optimal treatment for diabetes is not just lowering the blood sugar level but also reversing that insulin resistance,” Dr. Scher adds.

Of course, there are some risks. These are primarily among patients on diabetes medications that lower blood sugar. “People who have type 2 diabetes and are not yet on medication, or they’re only on metformin, are not at increased risk of lower blood sugar, so they don’t have to be quite as concerned,” Dr. Scher explains. IF also is not advised for people with a history of eating disorders, those who are very thin or malnourished, and those who are pregnant or breastfeeding. Patients should consult with their physician or another medical professional to determine if the diet is right for them and if any risks are involved. 

Low-Carbohydrate and Ketogenic Diets

Research supports that low-carbohydrate and very low-carbohydrate, also known as ketogenic diets, reduce the need for medications and A1C levels. Additionally, studies have shown these eating patterns lower blood pressure and triglycerides, among other health benefits. Why? When a patient is on a ketogenic diet, they are taking in calories mostly from protein and fat, so the body turns from burning glucose for fuel to burning fat stores and ketones for fuel, according to Dr. Scher. This lowers glucose levels, improves insulin sensitivity, and eventually lowers insulin levels.

“We’re having trials that are showing an actual reversal of the type 2 diabetes diagnosis where people are getting off their medications and normalizing their blood sugar and reversing diabetes, which is not something that the medications do and is not something that the standard diabetes diet has ever been shown to do,” Scher says.

Low-carbohydrate diets, defined as consuming less than 100 grams of net carbohydrates per day, may achieve similar results. However, the most substantial evidence is related to the ketogenic diet, which involves a lower carbohydrate intake. The amount of carbohydrates people can consume while still staying in ketosis will vary from person to person. Still, almost everyone will be in ketosis when consuming less than 20 grams of net carbohydrates daily.

Similar risks apply to these diets as with IF, such as when patients are malnourished, have a history of eating disorders, or are taking diabetic medications that lower their blood sugar levels. “Otherwise, ketogenic and low-carbohydrate diets are definitely safe for patients with type 2 diabetes,” Scher says.

Like with IF, it’s important that diabetes patients only adopt low-carb and ketogenic diet plans after consulting with a knowledgeable medical professional to assess and minimize risk and ensure the diet is followed healthily.

Suppose these diets do not fall under your expertise as a healthcare practitioner. In that case, you can help patients access quality medical nutrition therapy by connecting them with a registered dietitian or nutritionist who has comprehensive knowledge of diabetes care, as recommended by the ADA.