The dietary recommendations for diabetes focus on creating a healthful eating plan. The healthful eating plan recommended to Americans is the MyPlate plan, which promotes a large portion of fruits and vegetables, with moderate grains, dairy, and protein. The Planetary Health Diet also supports the addition of nuts, seeds, and legumes. These additional recommendations help increase the amount of unsaturated fats and fiber in the diet. Saturated fats can lead to dyslipidemia, and should be less than 10% of calories per day. Saturated fats primarily come from animal sources and tropical oils. Unsaturated fats come from fatty fish, nuts, seeds, olives, avocados, and plant oils. Fiber helps to slow digestion and maintain a stable blood sugar level. Fiber is found in beans, legumes, whole grains, fruits, and vegetables.

Chronic inflammation accompanies diabetes. As adipose tissue can secrete inflammatory hormones, an appropriate energy balance should be maintained. Additional strategies to fight inflammation include consuming foods high in omega 3s such as fatty fish, chia seeds, and walnuts. Antioxidants rich foods such as fruits and vegetables, as well as foods rich in polyphenols such as olive oil, tea, and dark chocolate, can reduce inflammation.

The Planetary Health Diet provides additional recommendations to improve both personal health and the health of the planet by recommending nuts and seeds and legumes, eating cultural foods, and reducing animal protein consumption when appropriate.

Clinical recommendations for Diabetes Management:

1. Increase Nutrient Density
2. Limit added sugars and refined carbs
3. Increase fiber
4. Reduce saturated fats
5. Limit Transfats
6. Increase Omega-3 Fatty Acids

Increase Nutrient Density:

• The goal of nutrition recommendations for diabetes management is to promote a healthful eating pattern that emphasizes a variety of nutrient-dense foods (1).
• A general healthful diet for Americans is the MyPlate plan which has half of a plate coming from fruits and vegetables, a quarter grains, a quarter protein, and a serving of dairy or a dairy alternative (2).

Planetary Health Considerations:

Biodiversity is the natural variety that occurs within an ecosystem; it includes everything from bacteria in the soil, to bugs, flowers, trees, and animals. This diversity helps to create a balance within the ecosystem, for example, bugs may pollinate flowers, then be eaten by a bird, and the clover along the ground protects the soil from being washed away during heavy rain and provides a source of food for small animals. The droppings from the animals get broken down into nutrients for the soil, the soil grows the brush the animal lives in, and so on. Maintaining biodiversity helps the ecosystem stay balanced.

An increasing loss in biodiversity has been seen with increased land conversion for food production. Much of the land is used to grow crops to feed livestock. The land is cleared and replaced with a crop; almost all of the previous variety of that land no longer has a place. A system called monoculture farming, where only one crop is grown, has been the primary producer of wheat, corn, and soy. Advanced technologies and machinery have been developed and used to make this process highly efficient. The efficiency comes at the expense of the soil.

Limit added sugars and refined carbs:

• Foods high in added sugars and refined grains:
• Sodas, sports drinks, fruit juice, sweetened coffee drinks
• White bread, pasta, or crackers
• Candy and sweets
• Sugary cereals
• Foods low in added sugars and complex carbs
• Unsweetened tea, water, black coffee
• Whole grains with 100% whole wheat labels
• Nuts, seeds, beans, and lentils
• Fruits and vegetables

Notes:

• Evidence does not suggest a low or no carbohydrate diet as the standard treatment.
• On low-carb diets, practitioners should consider medications, pregnancy, dieting history, and assess the client's likelihood of continuing treatment when restricting carbohydrates.
• Recommended carbohydrates should be nutrient-dense carbs containing fiber, paired with fats and protein.

Planetary Health Considerations:

Added sugars and refined carbohydrates are most commonly found in ultra-processed foods. Ultra-processed foods typically lack nutrient density, contribute to additional waste, and have a significant environmental impact from production. However, to promote a just and equitable food system, the benefit of convenience food items must be acknowledged. Convenience food, even when ultra-processed, can improve the accessibility of food for a variety of populations. For individuals that face food access barriers, prioritize advocacy for food justice.

Increase fiber

• Increasing fiber intake reduces spikes in blood sugar (3).
• Fiber consumption supports satiety.
• Fiber is fermented in the gut and contributes to a diverse gut microbiome, which is linked to improved health.

Insoluble Fiber: supports digestive regularity

Soluble Fiber: shown to lower blood cholesterol, blood sugar regulation

Fiber recommendations:

• RDA: 38 g/day for men, 25 g/day for women

High Fiber Foods:

• Whole grains
• Beans and lentils
• Apples
• Berries
• Leafy greens

Notes: Consider gradually increasing to avoid negative GI effects.

Planetary Health Diet Considerations:

Increased consumption of high-fiber foods promotes climate resistance by supporting biodiversity, polycropping, and the production of foods that provide nitrogen to the soil, such as beans. Additionally, the prioritization of high-fiber foods increases the percentage of total energy consumption of whole foods that are derived from plants and reduces the percentage of total energy consumption from animal products that typically have an increased environmental impact (4).  

Reduce saturated fats

• Decreasing saturated fat intake reduces CVD risk diabetes and cardiovascular disease are often co-morbidities
• Increased intake of saturated fats contributes to a pro-inflammatory state
• Research suggests that increased saturated fat intake can lead to insulin resistance (5).
• Total dietary fat reduction is not recommended as a treatment for diabetes.
• Maintain adequate fat intake through consumption of unsaturated fats

Foods High in Saturated Fats:

• Whole fat dairy
• Fatty meats
• Coconut oil, palm oil
• Deep fried foods
• Shortening
• Non-dairy creamers

Foods Low in Saturated Fats:

• Vegetables
• Fruit
• Beans and lentils
• Grains
• Avocado and olive oils
• Nuts and seeds

Foods high in unsaturated fats:

• Olive and avocado oil
• Avocados
• Nuts and seeds
• Olives
• Fatty fish

Notes: Total dietary fat intake should remain around 20-30% of caloric intake,as saturated fat decreases, unsaturated fat should increase. Carbohydrates should not replace saturated fats in diets. Low-fat diets are not effective at reducing CVD risk (6).

Planetary Health Diet Considerations:

Foods that are naturally higher in saturated fats typically have an increased environmental impact. Animal proteins require increased resource use, like water and land, for production. Palm and Coconut oils are often produced in unsustainable ways that contribute to deforestation, monocropping, and utilize large amounts of land. Additionally, the production of palm oil may rely on the exploitation of laborers.

As with all foods, the sustainable production of food is nuanced and personal ethics should be considered as well as advocating for a more just and equitable food system.

Limit Trans-Fats

Increase Omega-3 Fatty Acids

• Omega 3’s are essential fatty acids, we cannot produce these and must consume them from food sources.
• Omega 3’s has a greater impact when in proper ratio to Omega 6’s.
• To boost the impact of omega 3’s reduce the intake of omega 6’s
• ALA is an essential fatty acid, it cannot be synthesized and produced by the body

Foods High In Omega-3s:

• Mackerel
• Salmon
• Anchovies
• Flax Seeds
• Chia seeds
• Algae

Foods High in ALA:

• Chia seeds
• Flax seeds
• Walnuts

Foods High In Omega-6s:

• Corn Oil
• Soybean Oil

Notes:

• Corn and soybean oil are very common in the food system, they make the base of many packaged salad dressings, sauces, non-dairy creamers, and are often the oils used to fry foods.
• ALA is the source of omega 3’s found in plants and has a very low conversion rate (7).
• Vegan sources of DHA and EPA can be found in algae supplements.

Planetary Health Diet Considerations:

Fishing can have negative environmental impacts from ocean pollution to overfishing and negatively impacting the biodiversity of sea life. It is important to be aware of the nuance surrounding fishing and the types of fishing that contribute to a more just and equitable food system. Despite the fishing industry has a considerable environmental impact, fish and seafood are important to many cultural cuisines and accessible seafood like packaged tuna can be a quality protein and omega-3 source for those on a limited budget.

References:

1. Gray A, Threlkeld RJ. Nutritional Recommendations for Individuals with Diabetes. [Updated 2019 Oct 13]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279012/
2. https://www.myplate.gov/eat-healthy/what-is-myplate
3. Soliman GA. Dietary Fiber, Atherosclerosis, and Cardiovascular Disease. Nutrients. 2019 May 23;11(5):1155. doi: 10.3390/nu11051155. PMID: 31126110; PMCID: PMC6566984.
4. Rust, N. A., Ridding, L., Ward, C., Clark, B., Kehoe, L., Dora, M., Whittingham, M. J., McGowan, P., Chaudhary, A., Reynolds, C. J., Trivedy, C., & West, N. (2020). How to transition to reduced-meat diets that benefit people and the planet. The Science of the total environment, 718, 137208. https://doi.org/10.1016/j.scitotenv.2020.137208
5. Sears B, Perry M. The role of fatty acids in insulin resistance. Lipids Health Dis. 2015 Sep 29;14:121. doi: 10.1186/s12944-015-0123-1. PMID: 26415887; PMCID: PMC4587882.
6. Sacks FM, Lichtenstein AH, Wu JHY, Appel LJ, Creager MA, Kris-Etherton PM, Miller M, Rimm EB, Rudel LL, Robinson JG, Stone NJ, Van Horn LV; American Heart Association. Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association. Circulation. 2017 Jul 18;136(3):e1-e23. doi: 10.1161/CIR.0000000000000510. Epub 2017 Jun 15. Erratum in: Circulation. 2017 Sep 5;136(10 ):e195. PMID: 28620111.
7. Sacks FM, Lichtenstein AH, Wu JHY, Appel LJ, Creager MA, Kris-Etherton PM, Miller M, Rimm EB, Rudel LL, Robinson JG, Stone NJ, Van Horn LV; American Heart Association. Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association. Circulation. 2017 Jul 18;136(3):e1-e23. doi: 10.1161/CIR.0000000000000510. Epub 2017 Jun 15. Erratum in: Circulation. 2017 Sep 5;136(10 ):e195. PMID: 28620111.

‍