3 Outside-the-Box Dietary Strategies to Recommend to Patients with Type 2 Diabetes


Nutrition is a top concern among diabetes patients. In fact, “What can I eat?” is the most common question diabetes patients ask after receiving their diagnosis, according to the American Diabetes Association (ADA).

Nutritional counseling for type 2 diabetes

This is for good reason, since there’s strong evidence to support nutrition therapy and counseling as an important aspect of diabetes management. Not to mention, it’s effective in terms of both health outcomes and cost.

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Nutritional therapy and counseling can help patients manage their weight, maintain glycemic targets, and improve blood pressure and other cardiovascular risk factors, but ADA stresses there’s no one-size-fits-all approach when it comes to diabetes patients. Instead, dietary recommendations should be patient specific based on comorbidities, health status, cultural background and other factors. 

ADA says a variety of dietary patterns are acceptable for the management of 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

Intermittent fasting (IF) can be defined in a few different ways—primarily fasting each day for a period of 16 hours and eating during the remaining eight (the definition used here), 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 of an emphasis on when you eat than what you eat.

Many studies among diabetes patients show that IF is beneficial for weight loss, though the effect on blood sugar levels and need for medication varies across studies.

How IF Works

Bret Scher, MD, a board-certified cardiologist and medical director at Diet Doctor, believes IF is sometimes beneficial for patients with type-2 diabetes.

“When you’re not taking in any calories, your body is in a completely different metabolic state,” Dr. Scher tells Florence Health. “You’re starting to burn your own 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.”

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

What are the risks?

Of course, there are some risks, 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 undernourished, and those who are pregnant or breastfeeding. But to be on the safe side, providers should closely monitor any patient they recommend it to.

Low-Carb Diet & Ketogenic diets

There’s research to support that low-carbohydrate and very low-carbohydrate (ketogenic) diets reduce the need for medications and reduce A1C levels. Additionally, studies have shown these eating patterns lower blood pressure and triglycerides, among other health benefits. 

How Keto Works

Why? When a patient is on a ketogenic diet in particular, he or she is 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.

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More general, low-carbohydrate diets (consuming less than 100 grams of net carbohydrates per day) may achieve similar results, but the strongest evidence right now is related to the ketogenic diet, which involves a lower carbohydrate intake, Dr. Scher clarifies. The exact amount of carbohydrates people can consume while still staying in ketosis will vary from person to person, but pretty much everyone will be in ketosis when consuming less than 20 grams of net carbohydrates each day.

What are the Risks?

Similar risks apply for these diets as with IF, such as when patients are malnourished, have a history of eating disorders, or are taking diabetes 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 in order to assess and minimize risk, and ensure the diet is followed in a healthy way.

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


Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report, Diabetes Care.

The Effect of Short Periods of Caloric Restriction on Weight Loss and Glycemic Control in Type 2 Diabetes, Diabetes Care.

Intermittent fasting in Type 2 diabetes mellitus and the risk of hypoglycaemia: a randomized controlled trial, Diabetic Medicine.

The effects of intermittent compared to continuous energy restriction on glycaemic control in type 2 diabetes; a pragmatic pilot trial, Diabetes Research and Clinical Practice.

Not so fast: Pros and cons of the newest diet trend, Harvard Health Publishing.

Effects of low-carbohydrate- compared with low-fat-diet interventions on metabolic control in people with type 2 diabetes: a systematic review including GRADE assessments, The American Journal of Clinical Nutrition.


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