Prediabetes is a high-risk state for developing type 2 diabetes. But not to worry if you have symptoms of prediabetes, you can take control of your prediabetes by changing your diet.
In this article, we will discuss what prediabetes is and how diet relates to prediabetes. We will then get into what exactly a prediabetes diet plan includes. We will cover several different types of prediabetic diets and talk about how they work.
What is prediabetes?
Prediabetes is a high-risk state for developing type 2 diabetes. In fact, the presence of prediabetes increases the risk of developing type 2 diabetes by 3-fold to 10-fold. Someone with prediabetes has glycemic values that are higher than a healthy person, but lower than the numbers that would indicate diabetes is present.
A person with prediabetes has impaired fasting blood sugar, impaired blood glucose tolerance, and/or an HbA1c ranging from 5.7 percent to 6.4 percent.
Five to ten percent of people per year with prediabetes will progress to diabetes. Five to ten percent of people per year with prediabetes will convert back to a normal blood sugar level.
The identification and treatment of prediabetes are crucial in preventing and delaying the progression to type 2 diabetes. Prediabetes is actually a complex metabolic disorder with many contributing factors. Prediabetes extends beyond simply impaired glucose control.
Prediabetes doesn’t happen overnight. It develops slowly for many years, often not producing symptoms until very late in the game. Insulin resistance and dysfunction of the beta cells in the pancreas are both abnormalities that start before glucose changes are detectable.
Insulin resistance, impaired action of a protein called incretin, and hypersecretion of insulin are central to diabetes development.
The small blood vessels affect the delivery of insulin and glucose to skeletal muscle. This then affects insulin sensitivity. This is how blood vessel dysfunction helps to promote the progression from prediabetes to diabetes mellitus.
The major risk factors for prediabetes include:
- Fasting insulin
- LDL cholesterol
- Body mass index
- Male sex
- Uric acid
The prevalence of prediabetes is increasing around the world. Experts have projected that by 2020, more than 470 million people will have prediabetes. This is a reflection of the rapidly changing access to high-calorie foods.
It is also in part due to decreasing levels of physical activity occurring worldwide. These factors contribute to obesity and other metabolic consequences. This is especially true in developing countries. Women who are diagnosed with prediabetes are at higher risk of developing gestational diabetes during pregnancy.
Prediabetes can have consequences throughout the body, even before progressing to diabetes. These include:
- Kidney disease
- Coronary artery disease
- Peripheral vascular disease
- Periodontal disease
- Cognitive dysfunction
- High blood pressure
- Obstructive sleep apnea
- Low testosterone levels
- Fatty liver disease
How does diet relate to prediabetes?
Lifestyle interventions, including diet and exercise, are first-line treatments for the prevention of prediabetes. Not only can diet benefit insulin resistance and type 2 diabetes risk, but it can also improve the function of blood vessels in those with prediabetes.
Experts say that weight loss is the cornerstone of treatment in prediabetes, and we know that diet is an effective treatment for weight loss. Besides, research has shown that lifestyle interventions reduce all-cause mortality, and who wouldn’t want to live a longer, healthier life?
Research shows that restoring normal blood glucose levels during prediabetes and early diabetes can lead to the reversal of diabetes. Diet influences prediabetes through several different mechanisms. For example, a healthy diet promotes the uptake of glucose into tissues, therefore improving insulin sensitivity.
There is evidence that there is a 40 to 70 percent relative risk reduction in patients with prediabetes who modify their diet and lifestyle.
What does a prediabetic diet include?
Low GI foods/carbs
One study compared the effects of two different diet types on HbA1c and other health-related outcomes. This study was conducted in overweight and obese adults with type 2 diabetes or prediabetes with an HbA1c higher than 6 percent.
One diet type included medium carbohydrates, low saturated fats, low trans fats, and was calorie-restricted and involved counting carbohydrates. This diet was consistent with guidelines from the American Diabetes Association.
The other diet was very low in carbohydrates, high in fat, and not calorie-restricted. The goal of this diet was to induce nutritional ketosis (like the ketogenic diet). After three months, the average HbA1c was unchanged from baseline in the medium carbohydrate group.
However, in the low carbohydrate group, it went down by 0.6 percent. 44 percent of the low carbohydrate group discontinued one or more of their diabetes medications, compared to just 11 percent of the medium carbohydrate group.
The low carb group lost 5.5 kilograms on average, compared to just 2.6 kilograms in the medium carb group. These results suggest that a very low carbohydrate diet may improve glycemic control in prediabetes while allowing decreases in medications.
A review of the current literature indicates that in addition to helping you lose weight, a low carbohydrate diet may optimize improvements in another type 2 diabetes risk factors. These include insulin resistance and hyperglycemia.
A study found that low glycemic index diets were effective at reducing HbA1c, fasting glucose, body mass index, total cholesterol, and LDL cholesterol in those with prediabetes.
International experts on carbohydrate research held a scientific summit to discuss controversies surrounding the glycemic index, glycemic load, and glycemic response. There was a consensus that diets low in glycemic index and glycemic load helped in diabetes prevention and management, coronary heart disease, and obesity.
Foods that are high on the glycemic index raise your blood sugar faster. These are foods you’ll want to avoid if you want to follow a diet for prediabetes and include:
- White bread
- White potatoes (and other white starchy vegetables)
- White rice
A review of the current literature shows that a diet that is lower in calories may optimize type 2 diabetes risk factors. These include insulin resistance, hyperglycemia, and even weight loss.
One study showed that people with diabetes lost 2 kilograms more on a low-calorie diet than those on a low-fat, high carbohydrate diet.
When managing your portion control, the best method is to consume approximately 50 to 55 percent of carbohydrates daily. Individual calorie and carbohydrate needs will vary from person to person. It’s best to speak to a registered dietitian about the portion sizes and eating plan that is best for you.
There are several beneficial effects of high fiber diets. These include lower postprandial glucose, improved insulin response, improved cholesterol levels, and reduced insulin resistance.
One study showed that individuals with prediabetes on a high fiber diet lost an average of six kilograms more than those on a control diet.
Another study looked at 160 people with prediabetes between the ages of 20 and 60 years. They were put into a six-month lifestyle modification program or a control group. Those on the lifestyle modification program consumed 21.9% fiber in their diets, compared to 3.1% in the control group. There were clinically significant improvements in fasting glucose and insulin resistance in the lifestyle modification group.
Yet another study found that fiber has benefits for those with prediabetes. This study had 30 patients with prediabetes who were randomized to either a high fiber diet or a placebo group. The study was conducted for 28 days. The group that was eating a high fiber diet showed a significant decrease in body mass index and HbA1c values.
Fiber-rich foods help to avoid the crash that comes from eating foods high in sugar. Fiber-rich foods should be encouraged in the diet, and include the following:
- Legumes (lentils, chickpeas, etc.)
- Whole grain (quinoa, barley, etc.)
- Fruits and vegetables that have edible skin (apples, plums, cucumbers, tomatoes, etc.)
Cut out sugary drinks
As we know, several factors increase the risk of prediabetes. One of these is sugary drink intake. A study looked at the association between prediabetes and which foods were available to patients at home.
The study included 8929 adults who participated in the National Health and Nutrition Examination Survey between 2007 and 2010. The results showed that those participants who had more access to sugary drinks tended to have prediabetes.
Sugary drinks should be avoided and include the following:
- Fruit juice
- Energy drinks
- Gourmet coffee drinks
Reduce alcohol intake
Studies have found that heavy alcohol intake is associated with an increased risk of diabetes.
One study on rats looked at alcohol’s relationship to prediabetes. The rats with prediabetes showed that alcohol-induced expression of stress markers in the pancreas. These results indicate that chronic alcohol consumption increased the risk of diabetes in rats with prediabetes.
So how many drinks are too many? Research has shown that consuming more than four drinks per week increases the risk of insulin resistance and prediabetes.
But this number may differ depending on your sex and the type of alcohol you consume. One study showed that men who consumed a lot of beer showed a higher risk of prediabetes. In women, there was actually a lower risk of prediabetes with high wine intake. But high consumption of spirits increased the risk of prediabetes.
It turns out that high alcohol consumption in general increases the risk of abnormal glucose regulation in men. In women, the associations are more complex. There seems to be a decreased risk with low or medium alcohol intake and a high risk of high alcohol intake.
Alcoholic beverages are dehydrating and can spike your blood sugar, especially mixed cocktails. Reduce your risk by minimizing alcohol intake as much as possible, keeping in mind that one portion of alcohol is:
- One bottle of beer
- One glass of wine
- One shot of spirits (gin, vodka, whiskey)
Replacing refined carbohydrates in the diet with protein can help impact appetite. It may also affect glucose and fat metabolism in individuals at risk of prediabetes. A study had overweight or obese men and women with prediabetes consume one of two diets.
One was a high protein breakfast meal; the other option was a refined carbohydrate breakfast meal. This went on every day for two weeks. Average glucose and insulin were significantly lower after the protein breakfast compared to the refined carbohydrate breakfast.
Researchers concluded that having a higher protein, lean pork containing breakfast may favorably affect appetite. It also helps to lower postprandial glucose level, insulin, and cholesterol values.
Lean meats include the following:
- Chicken without the skin
- Egg whites
- Flank steak/tenderloin/roast with fat trimmed/ground round
- Turkey without the skin
- Greek yogurt
Although sufficient water intake is an important part of a general healthy lifestyle, it’s especially important for those with prediabetes. Water is a great replacement for sugary soda, energy drinks, and juices. You’ll want to drink enough water to prevent dehydration.
The amount of water you should consume will depend on your body size, activity level, climate, and weather. You can keep an eye on the volume when you urinate to know whether you’re consuming enough water. The color of your urine should be a pale yellow, as this indicates sufficient hydration.
Natural ways to prevent prediabetes
- Portion control– Controlling portion size can be difficult, but awareness of portion size is vital for prediabetes. Ensure you are loading your plate with the right amount of each food group. Sites such as MyPlate can help with this.
- Reduce sugar intake– Swap sweets for fruit- It is easy to make your 3 pm chocolate bar a habit, but this daily treat adds up. Try swapping sugary treats for fruit, such as berries. To bulk it up, you can add plain greek yogurt, which is a good source of protein.
- Limit alcohol/ smoking– Both alcohol consumption and smoking can increase your risk of diabetes. In fact, smokers are 30–40% more likely to develop type 2 diabetes than nonsmokers.
- Exercise– Research shows that physical activity can promote weight loss, reduce body fat, and improves insulin sensitivity.
As you can see, a diagnosis of prediabetes should not be taken lightly. However, it’s not a death sentence, either. It is not only manageable but can even be reversible.
By making lifestyle changes and implementing healthy eating habits, you can reduce your risk of developing diabetes. If you have received a prediabetes diagnosis and want help reversing prediabetes, speak to your health care provider and ask them which dietary changes are right for you.