Here’s a rundown of foods to avoid, what to eat instead, what to enjoy in moderation and, importantly, how to successfully make these changes to your diet and lifestyle.
Prediabetes Diet
If your doctor says your bloodwork reveals prediabetes, you’re bound to have questions about what’s best to eat. Tara Seymour, an advanced practice clinical dietitian and diabetes educator at Johns Hopkins, provides guidance on how a healthy diet and lifestyle can control — and even help reverse — prediabetes.
Diet for Prediabetes — What foods should I eat?
People with prediabetes have fasting blood sugar levels that are elevated, but not to the point that they meet the criteria of type 2 diabetes.
The key to warding off progression of prediabetes is a balanced approach to diet, says Seymour.
“People with prediabetes do not have to eliminate entire food groups,” she explains. “All foods can fit in the meal plan, and patients should steer clear of fad diets and other strategies that promise quick fixes, since their claims are not supported. We encourage making gradual behavior changes. Small changes can lead to big results.”
With that in mind, she regards the Mediterranean diet as the gold standard for people with prediabetes, with its emphasis on whole grains, lean protein and healthy fats.
She also refers patients to diabetes meal planning recommendations from the Centers for Disease Control and Prevention and a version of the MyPlate guidelines issued by the U.S. Department of Agriculture and adapted by the American Diabetes Association (ADA).
“Though these resources are not specifically for prediabetes, they can serve as a guide to incorporating healthy choices, especially when you’re eating away from home,” Seymour says.
The ADA’s version of the recommendations suggests these proportions for meals:
- 50% of the plate filled with nonstarchy vegetables, such as leafy greens
- 25% with healthy carbohydrates, such as whole grains like brown rice, farro or quinoa
- 25% with lean protein, such as chicken, turkey, fish or tofu, not fried
Water or another zero-calorie beverage is preferred.
Seymour also recommends:
- Avoiding excessive intake of added sugars by limiting sugary beverages, cakes, cookies, candy and snacks
- Limiting portion sizes of refined carbohydrate foods such as white bread, white rice and white pasta
- Incorporating fiber to reach a goal of 25 to 30 grams per day by eating a variety of fruits, vegetables and whole grains
- Limiting saturated and trans fats by choosing lean protein and low-fat dairy
Foods to Avoid If You Have Prediabetes
“Grapefruit and pomegranate juice can interact with some medications, since they are processed by the same liver enzyme that metabolizes medication. That enzyme is cytochrome P450, which accounts for about 75% of the total drug metabolism performed by the body.”
In addition, Seymour advises care with some nutritional supplements. Ginseng, gingko and garlic are OK in moderation, but high doses of these, as you get in over-the-counter supplements, can cause low blood sugar. “When it comes to supplements,” she says, “it is always important to know your risks and follow the proper dietary protocol by consulting your doctor or dietitian.”
“What should I eat for breakfast if I have prediabetes?”
“Opt for balanced meals that incorporate lean protein, low fat dairy and plenty of fiber,” Seymour advises. “Try cereals with at least five grams of fiber per serving, whole fruits, vegetables and whole grains.
“If you’re tempted to skip breakfast, try a low carbohydrate meal replacement bar or shake to start your day off right.”
“What fruits should I avoid with prediabetes?”
Seymour stresses that all types of fruit are OK and unlikely to be a problem for people who have prediabetes (with the exception of pomegranate juice and grapefruit for people taking certain medications).
“Fruit is a carbohydrate that provides both sugar and fiber,” she says. “You will get more fiber eating whole, fresh fruit than you will by drinking fruit juice.”
“All foods can fit,” she adds. “The key is to watch your portion sizes and read labels of prepared items. Fruit juice and canned fruit may have more sugar.”
A professional can help customize a prediabetic meal plan
Because everyone is different and many people with prediabetes have other health issues, Seymour says it is important to tailor prediabetes food plans to the individual. For instance, patients with high cholesterol may do better with a lower-fat approach, while those with high A1C may benefit from a meal plan that’s lower in carbohydrates.
Working with a doctor or dietitian can be helpful. “People diagnosed with prediabetes can ask their primary care practitioner for a referral to a local registered dietitian,” Seymour says. “That way, they can get individual counseling to achieve their health goals.”
Prediabetes and sugar — How much is too much?
Blood sugar levels are important indications of prediabetes, and it’s no secret that most Americans eat more sugar than they should. Sugar can hide in less obvious places, including processed foods such as breakfast cereals, frozen meals, snacks, sauces and dressings.
Though some sugar is necessary for your body to function, too much can worsen prediabetes. Seymour explains: “Carbohydrates are an important source of energy since glucose [blood sugar] is the preferred molecule to fuel the brain. However, excessive intake of refined carbohydrates from added sugar can cause adverse health effects.
Recommendations for Limiting Sugar
“The World Health Organization advises limiting added sugars to less than 10% of your total energy intake. For added health benefits, you would limit sugar calories to 5% or less of your total.
“For example, for someone on a 2,000-calorie daily diet, if they are following the 10% guideline, they would limit sugar calories to about 50 grams, which is about 12 teaspoons. For the 5%, they would stick to 25 grams, or about six teaspoons.
“The American Heart Association is a little more stringent, and for people at risk for heart disease, including those with prediabetes, it recommends less than six teaspoons of sugar a day for women (about 25 grams) and less than nine teaspoons (about 36 grams) a day for men.”
That’s not a lot. Seymour points out that one can of soda contains about 32 grams of sugar, which is about eight teaspoons.
“We urge our patients to watch what they drink,” Seymour says, noting that sweetened beverages such as sodas, sports drinks, juices and gourmet coffee shop creations account for some of the biggest concentrated sources of added sugar. “Just one of these beverages can take up your entire recommended allotment of sugar for the day ― or even several days.”
The 5-20 Rule
Another way to assess whether a product is overly high in sugar is to read the nutrition label. “The general rule for sugar content is choose products with a sugar content of 5% or less of the daily requirement and avoid items in which the amount of sugar is 20% or more of the daily requirement,” Seymour says.
How to Reverse Prediabetes — Lifestyle
Seymour says switching to well-balanced meals high in healthy, fiber-rich foods, along with incorporating more physical activity, can help people with prediabetes take charge of their health.
“It has been well cited in research studies such as the National Institutes of Health’s Diabetes Prevention Program Outcome Study that incorporating healthy eating habits, weight reduction and increased physical activity can lower your risk of developing type 2 diabetes.
“Additionally, lifestyle changes resulting in modest weight loss have shown to delay the onset of type 2 diabetes by 34% for four years compared to placebo, which was an outcome of the Johns Hopkins’ diabetes prevention program.”
Stay active
Physical activity can help prevent diabetes while boosting heart health. Seymour recommends that people with prediabetes try to get at least 150 minutes per week of moderate to vigorous exercise or aim for 10,000 daily steps. Be sure to check with your doctor before starting exercise or leveling up your current physical activity.
Lose some weight
To steer away from type 2 diabetes, Seymour says men and women should try to achieve and maintain a body mass index of 25 or lower. Waist circumference should be under 35 inches for women and under 40 inches for men.
Even small amounts of weight loss can have a benefit. “The ADA states that moderate rate reduction of 5% to 10% of your body weight can significantly lower your A1C level,” says Seymour. “So, for instance, for a person weighing 200 pounds, a weight loss of 10 to 20 pounds could make a difference.”
Get enough sleep
The relationship among sleep, diabetes and weight gain is important to understand. “Sleep deprivation has been shown to increase people’s cravings for sugary foods,” Seymour says. “People with prediabetes should make sure they’re getting seven to eight hours of sleep a night.”
Avoid excessive alcohol and all tobacco
“These are modifiable lifestyle factors that can significantly lower your risk of several chronic diseases, including type 2 diabetes, heart disease, vascular problems and metabolic syndrome,” Seymour explains.
Stay on top of your numbers
Seymour says people with prediabetes should be vigilant about their laboratory test results. “Know your ABCs,” she advises. “That’s A1C, blood pressure and cholesterol. And if you’re at risk or have prediabetes, make sure you follow up with your A1C level with a blood test at least yearly.”
Reversing Prediabetes — Is it possible?
Yes! “If you’ve been diagnosed with prediabetes, progressing to diabetes is not a given,” Seymour emphasizes.
In addition to taking medications, she says there are other ways to take control.
“Adopting a well-balanced diet, staying active, controlling your weight can put you in control, enabling you to arrest or even reverse the process,” she says.
“I like this quote from the CDC: ‘Life doesn’t always give you the time to change the outcome. Prediabetes does.’”
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What To Eat If You’ve Been Diagnosed With Prediabetes
Being diagnosed with prediabetes means you’re on your way to developing Type 2 diabetes, a disease that greatly increases your risk of heart attack and other serious health issues.
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But there’s good news: Type 2 diabetes isn’t inevitable after you’ve been diagnosed with prediabetes. Dietitian Julia Zumpano, RD, LD, says making healthy dietary changes can delay or even prevent the onset of Type 2 diabetes.
“The goal is to reduce your carbohydrate intake by choosing more complex carbs and exercising to burn them off,” she says.
Here’s a rundown of foods to avoid, what to eat instead, what to enjoy in moderation and, importantly, how to successfully make these changes to your diet and lifestyle.
Diet tips to help manage prediabetes
You’ve probably heard the term “blood sugar,” but what does it actually mean?
Your blood sugar is the amount of sugar currently circulating in your bloodstream. When you have prediabetes, your blood sugar is higher than it should be, but not yet high enough to be Type 2 diabetes.
Following these guidelines can help you lower your blood sugar levels, which can ultimately reverse your prediabetes.
Cut out added sugars
Rethinking your diet to reduce the risk of diabetes doesn’t mean giving up the foods you love. But it does mean eating less of them.
The first rule is to cut down on simple carbohydrates like sugar. “Sugar is a quick-release carb, which means that when you eat it, your body quickly releases glucose, or sugar, into your bloodstream,” Zumpano explains. “This causes a spike in your blood sugar level.”
Foods that have added sugar include:
- Candy.
- Desserts and sweets.
- Baked goods.
- Agave.
- Honey.
- Jams and jellies.
- Syrups.
Eliminate sweetened beverages
Cutting out sugary drinks is one of the simplest (and, for some people, the easiest) ways to lower your blood sugar. “They have no fat or protein to prevent the carbs from rocketing your blood sugar,” Zumpano continues.
That does just mean saying see ya to soda. Eliminate or scale way back on:
- Alcohol.
- Energy drinks.
- Fruit juices.
- Lemonade.
- Punch.
- Sweet tea.
- Sweetened coffee drinks.
- Soda.
Water is your best beverage bet, and you can even infuse it with fruits and herbs to jazz it up a little. Other good substitutes include unsweetened tea (hot or iced), coffee and sparkling water, so long as they don’t include added sugar.
Swap simple carbs for smart substitutes
Your next move is to cross off empty-calorie “white foods,” including:
- Chips.
- Crackers.
- Pretzels.
- White rice.
- White bread.
- White pasta.
“Instead, begin choosing whole-grain breads and pastas, brown rice and wild rice, Zumpano says. Start experimenting with other grains and starches, like:
- Whole wheat or bean-based pasta.
- Brown or wild rice.
- Beans and lentils.
- Barley.
- Bulgur.
- Buckwheat.
- Farro
- Quinoa.
- Sweet potatoes or yams.
- Redskin potatoes.
“Focus on whole-ingredients foods that have at least three grams of fiber per serving,” Zumpano suggests, “and limit your carb intake to about 1 cup (or two slices of bread) per meal.”
Incorporate healthy proteins
“Protein slows the rate that carbohydrates enter your bloodstream, which keeps blood sugar levels steadier,” Zumpano explains. Eating protein at every meal can help you feel full and reduce the urge to snack.
Healthy proteins include:
- Dried beans and peas.
- Eggs.
- Fish.
- Greek yogurt.
- Lean meats.
- Nuts and seeds.
- Part-skim cheese and cottage cheese.
- Tofu.
If you have cardiovascular disease, limit red meat and stick with skinless poultry and fish.
Get your fill of veggies
“Load up on vegetables, particularly non-starchy ones,” Zumpano says. “The fiber in veggies and legumes will help you feel full and satisfied.”
Because fiber slows down digestion and absorption, you’re less likely to get hungry between meals and reach for a sugary snack.
- Asparagus.
- Beets.
- Brussels sprouts.
- Broccoli.
- Carrots.
- Cauliflower.
- Celery.
- Cucumber.
- Eggplant.
- Leafy greens.
- Mushrooms.
- Onions.
- Peppers.
- Radishes.
- Sprouts.
- Squash.
The American Diabetes Association shares an even more complete list of veggies that are good for keeping your blood sugar low.
And if you’re eating canned vegetables, be sure to drain them and rinse them with water, which will reduce the amount of sodium you consume when you eat them.
Enjoy fruit in moderation
Fruit is a natural source of sugar that you can enjoy in moderation. “Limit portion size to one cup or less at a time,” Zumpano says. And choose lower-sugar fruits, like berries and kiwi, most often.
To slow the rate of glucose entering your bloodstream, pair fruit with a protein source, like a handful of nuts or seeds, 2 tablespoons of nut butter, plain yogurt, cottage cheese, a boiled egg or a string cheese.
Don’t overdo it on alcohol
Alcoholic beverages are a form of carbohydrate and should be consumed in moderation — in general, and especially if you’ve been diagnosed with prediabetes.
“If you’re going to drink, choose spirits with a no-calorie mixer, or an option like light beer, seltzer or dry wine,” Zumpano says. They contain the fewest carbs.
Consider your meal times
When you eat is nearly as important as what you eat. “Don’t skip meals, or you’ll get hungry and tend to overeat later,” Zumpano advises.
Eating late at night is associated with elevated sugar levels in people with prediabetes, so she also recommends making lunch your largest meal and not eating in the three hours before bed. If you do need a snack, keep it small and healthy, like a few carrot sticks or a string cheese.
What’s the best diet for prediabetes?
If you need help understanding exactly what you should and shouldn’t eat, take a close look at a Mediterranean-style diet. This type of eating plan is especially likely to help get your blood sugar levels back on track.
That said, there’s no single prescribed diet that will reverse prediabetes, so you can try to adopt overall healthier eating habits or experiment with specific diets. In addition to the Mediterranean diet, you may want to consider intermittent fasting or the ketogenic (keto) diet.
“The most critical thing is being able to stick to whichever diet you pick, so it’s important to find something that works for your lifestyle, your tastes and your preferences,” Zumpano says.
Why your diet matters for prediabetes
Making changes to lifelong eating habits can be difficult, but it may help to think about all the good you’re doing for your body in the long run.
A 2017 study found that when it comes to warding off Type 2 diabetes, lifestyle changes like exercising more and adopting a healthy diet may actually work better than standard treatments like medications.
“Early intervention in prediabetes is the key to successful reversal,” Zumpano says, “and a healthy diet plays a huge role in that process.”
To learn more about managing your prediabetes, listen to the Health Essentials Podcast episode, “Preventing and Reversing Prediabetes with Dr. Shirisha Avadhanula.” New episodes of the Health Essentials Podcast publish every Wednesday.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
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