Diabetes mellitus, or diabetes, is a disease affecting blood glucose (sugar) levels. An organ called the pancreas creates the hormone insulin, which helps keep blood sugar levels in a healthy range.
With diabetes, the pancreas either doesn’t make enough insulin, or the body doesn’t respond to it well. Without proper insulin function, blood sugar levels rise and can lead to health problems if left untreated.
Diabetes is becoming more prevalent worldwide. As of 2015, 30.3 million people in the United States, or about 9.4 percent of the population, had diabetes. Unfortunately, more than 1 in 4 people with diabetes don’t know they have it. Having undiagnosed diabetes increases the risk of complications from lack of prompt treatment.
Many people also have prediabetes, a condition where blood sugars are slightly elevated but not high enough to be considered diabetes. Having prediabetes is a significant risk factor for eventually developing type 2 diabetes. The U.S. Centers for Disease Control (CDC) estimates that up to 30% of people with prediabetes will develop type 2 diabetes within five years of their prediabetes diagnosis.
One of the ways to help promote good blood sugar control is through healthy lifestyle habits. Along with other aspects of a diabetes self-management plan, a healthy diet can help improve blood sugars and reduce the risk of complications. Vegetables are a very important aspect of a healthy eating plan for people with diabetes.
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Best vegetables for type 2 diabetes
Carbohydrates have the most significant impact on blood sugar levels compared to the other macronutrients (protein and fat). Carbs are present in plant-based foods such as grains, fruits, vegetables, legumes, nuts, seeds, and dairy products like milk & yogurt. Carbohydrates consist of starches, sugars, and fiber.
Starches and sugars raise blood sugar when they’re digested because they are broken down into glucose or blood sugar. Fiber doesn’t raise blood sugar because it’s not absorbable by the body. Vegetables are carbohydrates but are mainly composed of water and fiber. This is one reason they don’t raise blood sugar significantly.
Vegetables that are high in starch, such as potatoes, tend to raise blood sugar levels more significantly than non-starchy vegetables like dark leafy green vegetables, which have a minimal effect on blood sugar.
Choosing high-fiber, low-starch vegetables is a good strategy to promote healthy blood sugar levels. However, all foods can fit into a healthy eating plan for diabetes, even starchy vegetables like potatoes. The key is to aim for balance and not have overly-large portions of carbohydrates at each meal.
Some of the best vegetables for diabetes include:
- Green leafy vegetables & salad greens: Spinach, kale, romaine lettuce, and mixed greens are all examples of leafy green vegetables, which are very low in carbohydrates. One cup of spinach contains one gram of carbohydrate in the form of fiber, so it has a negligible impact on blood sugar levels.
Green leafy vegetables are also a source of iron, vitamin C, and other minerals important for health. They can be enjoyed in salads, added to omelets, or even blended in smoothies.
The darker and richer the green color, the more phytochemicals are present. Phytochemicals are nutrients that give fruits and vegetables their pigment and are associated with positive health outcomes such as reduced cancer risk. Choosing spinach over romaine lettuce is one example of a way to get more phytochemicals. - Brussels sprouts: One cup of Brussels sprouts contains 8 grams of carbohydrates, but almost 3.5 of those grams come from fiber. This makes the net carbohydrate total or the amount that has an impact on blood sugar levels around 4.5 grams. Eating fiber-rich foods such as Brussels sprouts can help promote healthy blood sugar levels as well as improve heart health.
- Broccoli: Made up of about 90% water, one cup of raw broccoli contains 6 grams of total carbs, around 2.5 of those grams coming from fiber. Broccoli is also relatively high in protein for a vegetable, containing around 2.5 grams per cup. Protein can help boost the feeling of satiety after meals, which may help with blood sugar control as well as weight management.
- Cauliflower: One cup of cauliflower contains 5 grams of carbohydrates with 2 grams of fiber. It’s also rich in vitamin C and vitamin K. Cauliflower is great in stir-fries and can also be used to make cauliflower “rice” and as a substitute for mashed potatoes due to its unique texture.
- Bell peppers: With more vitamin C than oranges, bell peppers are another flavorful vegetable that can be enjoyed in stir-fries, in salads, or in egg dishes such as omelets and quiche. 3.5 ounces of bell pepper contains 6 grams of carbs, around 2 of those grams from fiber.
- Carrots are a root vegetable that is often misclassified as a starchy vegetable, when in fact, they are considered non-starchy. One-half cup of carrots contains 6 grams of carbohydrates with 2 grams of fiber. Carrots are naturally higher in sugar than some vegetables, with 3 grams per half-cup serving, making them great to roast, caramelizing the sugars, and giving them a great taste.
- Green beans contain 7 grams of carbohydrates per cup, 3.5 grams coming from fiber. Green beans are an excellent source of vitamin C. They’re a great side dish vegetable and can also be used in casseroles and soups.
Glycemic index
Another way vegetables are classified in terms of their impact on blood sugar levels is their glycemic index. The glycemic index (GI) is a value used to measure how much a food raises blood sugar and is based on a number from 0-100.
Foods are usually described as low (GI of 55 or less), medium (56-69), or high (GI of 70+) glycemic index based on the number. The lower the glycemic index, the more slowly it raises blood sugar levels. Using this scale, pure glucose would have a glycemic index of 100.
The glycemic index has been recommended as a useful tool in determining a healthy eating pattern for those with diabetes. By focusing on foods that don’t raise blood sugar levels as significantly, people with diabetes may find that their blood sugar levels are more stable when focusing on low GI foods.
Another term associated with the glycemic index is the glycemic load. The glycemic load takes into consideration how much of the food is eaten, as well as its carbohydrate content.
The formula to determine glycemic load is [GI value × carbohydrate per serving]/100). Foods with a glycemic load less than 10 are considered to have a low glycemic load, and those with a glycemic load greater than 10 are considered to have a high glycemic load. For instance, the GI of popcorn is 72 (high), but the carbohydrates in a serving size of 1.5 cups is 11 grams, making the glycemic load 8 ([72 x 11]/100)=7.92 rounded up to 8.
Some vegetables considered to be low-glycemic-index include asparagus, artichoke, avocado, broccoli, cabbage, cauliflower, celery, cucumber, eggplant, greens, lettuce, mushrooms, peppers, tomatoes, okra, onions, spinach, summer squash, zucchini, and turnips.
Vegan and vegetarian diets for diabetes
Eating a diet rich in vegetables is associated with positive health outcomes. A vegetarian diet is one that doesn’t consume meat but usually eats dairy products and eggs. A vegan diet is more strict, with all animal products being avoided, including eggs and dairy products.
There are some variations of a vegetarian diet. For example, a pescatarian is a vegetarian that avoids all meat but eats seafood. A flexitarian is a term for someone who primarily follows a vegetarian diet but occasionally eats meat.
Studies have found that people who follow a vegetarian diet may be at a reduced risk of developing diabetes. Plant-based diets such as a vegan diet have also shown benefits in those with type 2 diabetes. These diets tend to be lower in saturated fat, high-glycemic foods, and higher in plant-based protein.
People following plant-based diets may take in fewer calories than a standard Western diet, leading to weight loss. Weight loss in people considered overweight can help improve insulin sensitivity, helping lower high blood sugars.
Vegan diets can be lower in some important nutrients due to the lack of reliance on animal products. The specific nutrients that can be deficient in a vegan diet are iron, vitamin B12, and calcium.
- Iron: Important for building red blood cells, this nutrient is found in its most absorbable form in meats, especially red meat. Vegetarian sources of iron include soybeans; beans, peas & lentils; nuts & seeds; leafy green vegetables; tomato paste; potatoes; mushrooms, and palm hearts.
- Vitamin B12 is also important for preventing anemia, which is a lower-than-normal red blood cell count. Vitamin B12 is primarily found in meats, eggs, and dairy products, making it difficult to get adequate amounts in a strictly vegan diet. Vegetarians usually consume dairy products and eggs, which can help prevent a B12 deficiency. Vitamin B12 isn’t naturally found in many foods, making it more difficult to obtain on a vegan diet.
Many vegan foods are fortified with vitamin B12, such as vegan burger patties and other products such as cereals and nutritional yeast. If adequate amounts of vitamin B12 can’t be consumed in the diet, a vitamin B12 supplement is recommended.
- Calcium is primarily obtained through dairy products in a typical Western diet. Most vegetarians consume dairy, making a calcium deficiency unlikely. Vegans can obtain calcium from plant-based foods such as nuts and seeds, broccoli, soybeans, beans & lentils, seaweed, and fortified dairy alternatives (almond milk, soy milk, etc.)
Healthful diabetes meals
There are countless options for healthy meals for people with diabetes.
Plate Method
A general recommendation is to base meals off the Plate Method, which helps control carbohydrate portions while promoting a balanced meal.
Using the Plate Method, half of the plate would consist of non-starchy vegetables, ¼ of the plate would be protein, and ¼ would contain starch, such as rice, pasta, or a starchy vegetable like potatoes.
Healthy meal combinations using the Plate Method are limitless; simply choose a protein, starch, and a non-starchy vegetable. Mixed meals can also follow the Plate Method; for example, lasagna with a salad contains starch (noodles), protein (meat in the sauce), and non-starchy vegetables in the side salad.
Some examples of balanced meals for people with diabetes include:
- A bowl of plain oatmeal with ¼ cup of blueberries and 1 ounce of slivered almonds.
- Steak with mashed potatoes and green beans.
- Chicken breast with rice pilaf and a Normandy vegetable blend.
- A lean beef patty on a whole wheat bun with a slice of cheddar cheese and a side of baby carrots.
Mediterranean diet
Another healthy eating pattern for people with diabetes is the Mediterranean diet, which emphasizes plant-based foods as the backbone of the diet.
Fruits, vegetables, whole grains, legumes, nuts, and seeds are abundant in this style of eating, as are healthy plant-based fats such as olive oil and avocados. Meat, dairy, processed foods, and refined sugar are avoided, and the emphasis is put on whole foods. While sugary drinks are avoided, moderate amounts of alcohol such as red wine are included, but of course, this is entirely optional.
The different types of foods in a Mediterranean-style diet include:
- Vegetables: Tomatoes, broccoli, kale, spinach, onions, cauliflower, carrots, Brussels sprouts, cucumbers, etc.
- Fruits: Apples, bananas, oranges, pears, strawberries, grapes, dates, figs, melons, peaches, etc.
- Nuts and seeds: Almonds, walnuts, macadamia nuts, hazelnuts, cashews, sunflower seeds, pumpkin seeds, etc.
- Legumes: Beans, peas, lentils, pulses, peanuts, chickpeas, etc.
- Tubers: Potatoes, sweet potatoes, turnips, yams, etc.
- Whole grains: Whole oats, brown rice, rye, barley, corn, buckwheat, whole wheat, whole-grain bread, and pasta.
- Fish and seafood: Salmon, sardines, trout, tuna, mackerel, shrimp, oysters, clams, crab, mussels, etc.
- Poultry: Chicken, duck, turkey, etc.
- Eggs: Chicken, quail, and duck eggs.
- Dairy: Cheese, yogurt, Greek yogurt, etc.
- Herbs and spices: Garlic, basil, mint, rosemary, sage, nutmeg, cinnamon, pepper, etc.
- Healthy Fats: Extra virgin olive oil, olives, avocados, and avocado oil.
Foods not eaten on a Mediterranean diet include:
- Added sugar, such as the kind in flavored yogurts, cold cereals, sugary drinks, and many other sweets. The American Heart Association recommends that women consume no more than 6 teaspoons of added sugar per day (24 grams), and men consume no more than 9 teaspoons of added sugar per day (36 grams).
- Refined grains: White bread, pasta made with refined wheat, etc.
- Refined oils: Soybean oil, canola oil, cottonseed oil, and others.
- Processed meat: Processed sausages, deli meats, hot dogs, etc.
- Highly processed foods: Packaged foods with a long list of ingredients.
In addition to eating more whole, plant-based foods, the Mediterranean diet is also coupled with increased physical activity. Many of the Mediterranean “food pyramids” show physical exercise at the base, meaning it’s the most important and should be the priority. Getting at least 30 minutes of moderate to vigorous activity each day is recommended.
Ketogenic diet
The ketogenic, or “keto” diet has gained popularity in recent years. It is a very low carbohydrate diet, usually limiting carbohydrates to under 50 grams per day. It’s also a very high-fat diet, with 70-80% of calories coming from fat.
The keto diet is especially popular among people with diabetes due to its low carbohydrate content, improving blood sugar levels. Some of the drawbacks of the keto diet are that it’s very strict and often unsustainable long-term.
Studies have found that ketogenic diets can help promote healthy blood sugars, but more long-term studies need to be done to determine their impact on health outcomes. One such concern is the keto diet’s effect on cholesterol levels due to the high-fat content and potentially lower fiber intake.
Conclusion
Healthy eating habits can help improve the outcomes in people with type 2 diabetes. Vegetables are a nutrient-rich food that should be incorporated into a healthy diet for diabetes.
Vegetables are a type of carbohydrate, which is the nutrient that has the biggest impact on blood sugar. However, vegetables are mostly made of water and fiber, making their impact on blood sugar negligible. Some vegetables higher in starch do raise blood sugar levels more significantly, such as potatoes.
Including vegetables along with a sustainable healthy eating pattern is an excellent way to promote health and manage diabetes. Whether someone with diabetes chooses to follow a regular, vegetarian, vegan, or ketogenic diet should be sustainable, enjoyable, and well-planned to prevent nutritional deficiencies. It’s also recommended to follow-up with a healthcare provider when someone with diabetes decides to make significant changes to their eating habits.
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