It’s Time to Rethink the Diet Advice We Give for Type 2 Diabetes
Within the world of nutritional advice, there’s finally growing recognition that our dietary guidelines need a serious update—especially when it comes to managing type 2 diabetes.
Type 2 diabetes now makes up about 95% of all diabetes cases. It’s not an autoimmune disease like type 1 diabetes. It’s a condition rooted in carbohydrate intolerance and poor glucose metabolism, made worse by decades of dietary guidance that pushed refined carbs and demonized fat. And despite all we know about its causes, the nutrition advice many people with T2DM still receive feels decades behind the science.
Early on, type 2 diabetes was rare. It mostly affected affluent, sedentary people who had easy access to sugar and white flour. Pioneers like Dr. Elliott Joslin (yes, the namesake of the famous Joslin Diabetes Center) didn’t treat it with high-carb diets. They did the opposite—restricting carbohydrates led to dramatic improvements in blood sugar control and fewer complications like nerve damage, kidney disease, and heart issues (Taubes, 2024).
But somewhere along the line, we started prioritizing covering carbs with insulin instead of reducing the carbs themselves. That shift created a new normal where ultra-processed, high-glycemic foods were seen as acceptable—as long as you had the right dose of medication to match.
At the same time, mainstream cardiovascular nutrition advice stayed locked into the “low-fat, low-cholesterol” model, even as meta-analyses called the diet-heart hypothesis into question. In diabetes care, we acknowledge carbohydrate intolerance is the issue, yet we hesitate to restrict the very foods driving the disease. We downplay restriction, elevate food pleasure, and often send mixed messages that leave patients confused and discouraged (American Diabetes Association, 2024).
But here’s the truth: a compassionate approach doesn’t mean being permissive about the foods most responsible for metabolic dysfunction. Especially when we’re talking about refined carbs that are both addictive and harmful when consumed over the long haul. We need more clarity, not less.
Better results come from better meals—those centered around satisfying portions of healthy fats, quality proteins, and non-starchy, fiber-rich vegetables. These meals support blood sugar stability without relying on insulin spikes to mop up dietary damage.
In fact, multiple studies have shown that lower-carb, higher-fat diets—especially Mediterranean-style versions that moderate saturated fat—consistently outperform the old-school low-fat playbook. They improve key markers like A1C, fasting glucose, and triglycerides. Yes, LDL cholesterol may rise in some people, but particle size and density tell a more complete story than total cholesterol alone (Volek et al., 2021; Soto-Mota et al., 2024).
Even leaders at the Joslin Diabetes Center have started advocating for these approaches. As Volek and colleagues argue, decades of high-carb guidance have paralleled rising rates of obesity and diabetes—not declines. It’s time to stop ignoring that correlation.
Critics sometimes question whether people can stick to a lower-carb lifestyle. But maybe the real issue isn’t adherence—it’s confusion. If you’re told your body can’t handle carbs but also told not to worry too much about carbs, it’s no wonder results fall flat. Clear guidance matters.
We have the science. We have the clinical evidence. What we need now is a shift in public messaging to match what many practitioners already know: nutrition that respects metabolic individuality—and doesn’t rely on outdated or misinterpreted data—can change lives.
References
American Diabetes Association. (2024). Classification and diagnosis of diabetes: Standards of Care in Diabetes—2024. Diabetes Care, 47(Supplement_1), S19–S31. https://doi.org/10.2337/dc24-S002
Raymond, J. L., & Morrow, K. (2012). Krause and Mahan’s Food & the Nutrition Care Process (15th ed.). Elsevier Health Sciences.
Soto-Mota, A., Flores-Jurado, Y., Norwitz, N. G., Pereira, M. A., Danaei, G., & Ludwig, D. S. (2024). Increased low-density lipoprotein cholesterol on a low-carbohydrate diet in adults with normal but not high body weight: A meta-analysis. The American Journal of Clinical Nutrition, 119(3), 740–747. https://doi.org/10.1016/j.ajcnut.2023.11.010
Taubes, G. (2024). Rethinking Diabetes: What Science Reveals About Reversing Type 2 Diabetes and Preventing Insulin Resistance. Alfred A. Knopf.
Volek, J. S., Phinney, S. D., Krauss, R. M., Johnson, R. J., Saslow, L. R., Gower, B., Yancy, W. S., Jr., King, J. C., Hecht, F. M., Teicholz, N., Bistrian, B. R., & Hamdy, O. (2021). Alternative dietary patterns for Americans: Low-carbohydrate diets. Nutrients, 13(10), 3299. https://doi.org/10.3390/nu13103299