Ask an expert: Eating to beat prediabetes

Q: “I just found out I have prediabetes. All the dietary info I find online seems so complicated. Can you give me some simple guidelines for how to eat to get back to normal?”

Answered by Daniel Norfleet, M.D., internal medicine, Providence Medical Group-Gateway Internal Medicine

Sure! The truth is that most of the changes that help control prediabetes are pretty simple and straightforward. What makes them seem complicated and overwhelming is trying to focus on all of them at once.

To keep it simple, I usually recommend trying just one or two small changes first. Work on these until they fit comfortably into your life. Once you’ve got them down, add a couple more, and then a couple more, working your way down the list gradually.

This isn’t downplaying the importance of the changes you need to make. Prediabetes is a sign that your body is already having trouble using insulin – that’s the hormone that moves blood sugar (glucose) into your cells, where it can be used for fuel, instead of letting it float around in your blood, where it can do a lot of damage. Without making changes, you risk developing full-blown Type 2 diabetes; up to 70 percent of people with prediabetes eventually do.

To turn things around, you do need to make some changes – you just don’t need to make them all at once. Focusing on one or two changes at a time allows you to adjust to new habits until, one day, they no longer look like changes at all – they’re just your normal life.

Changing how – and how much – you eat

One of the easiest ways to start making healthy changes, before you even look at what you eat, is to look at how much you eat. Carrying extra pounds, especially in your belly, makes blood sugar harder to control. Three simple portion-control tricks can help you trim a lot of extra calories and bring down the high blood sugars that go along with them:

  • Switch to smaller plates and bowls for your meals – most people who do this don’t even notice that they’re now eating less.
  • Drink a full glass of water before every meal and snack to curb your appetite.
  • Slow down your eating and eat more mindfully so your brain has time to tell your body that you’re getting full. 

Changing what you eat

At its simplest, a diet aimed at turning around prediabetes should echo the advice of food scientist Michael Pollan: "Eat food. Not too much. Mostly plants." That doesn’t mean you’re stuck with rabbit food. I recommend following a Mediterranean-style diet, which includes healthy fats and proteins and has been proven to lower blood sugar even better than low-fat diets.

The Mediterranean diet isn’t a fad that somebody invented – it’s a way of life in a part of the world where we’ve noticed that people tend to have less diabetes and heart disease, fewer strokes, better blood pressure and less obesity. People who eat this way don’t think of themselves as being "on a diet" – it’s just the way they eat. They enjoy real food – not food that comes out of boxes, cans and drive-thru windows, but food that is grown and raised on farms, cooked at home and doesn’t go through a lot of changes between the farm and the plate.

Here is a short list of the most effective changes you can adopt from this way of eating:

Drinks: For lower blood sugar and weight, make sure your beverage of choice comes from the tap rather than from a bottle or can.

  • Avoid: sweet drinks like sodas, bottled teas, energy and sports drinks, sweetened coffee drinks and juices
  • Reduce: alcohol – for the best blood sugar and calorie control, limit it to one drink a day
  • Focus on: water (try a squeeze of lime for flavor), unsweetened tea and coffee

Sweets: Candy, cookies and other sweet treats are high in refined sugars and flours, which raise blood sugar and increase the kind of belly fat that can lead to Type 2 diabetes – even if your weight is normal.

  • Avoid or reduce: candy, cookies, donuts, cake and muffins
  • Focus on: treating yourself to more fresh berries

Protein: As a rule, keep it lean and keep it real.

  • Eat less: fatty meat and processed meat like salami, sausage, hot dogs and deli meat
  • Focus on: fish and shellfish, chicken, leaner meats, eggs, and vegetarian proteins such as quinoa, lentils, edamame, beans and legumes
  • Snack on: unsweetened yogurt (add fresh fruit for sweetness), nuts (raw, not roasted) and seeds

Carbohydrates: Fresh, high-fiber and unrefined are the keys when selecting grains, vegetables and fruits that will help stabilize, not spike, your blood sugar.

  • Avoid or reduce: pasta, bread, white flour, white rice
  • Keep an eye on: whole grains – even the good guys, like brown rice and oat groats, can be a problem if your blood sugar is being stubborn
  • Load up on: vegetables, especially dark leafy greens like broccoli, kale, cabbage and salad greens; go easier on starchy vegetables like potatoes and carrots
  • Snack on: fresh, high-fiber fruit (whole, not juice), especially berries, apples and pears; go easy on higher-sugar fruits like bananas and grapes

Fats: Emphasize natural, plant-based fats over harmful, manmade fats and high amounts of animal fats.

  • Eat less: fried food, margarine, shortening, packaged crackers and other foods that contain partially hydrogenated oils – also known as trans fats
  • Focus on: olive oil as your main fat for cooking and salad dressings
  • Snack on: avocados, nuts and olives (in small quantities – they’re still high in calories)

A few final tips:

  • This is a lot to process, so remember to take it one step at a time.
  • If you’re not sure where to start, keep a food diary for a week. Write down everything you eat and drink, and then review it with your doctor. Seeing your habits in writing can point out powerful opportunities for improvement.
  • To boost your success, partner with a registered dietitian, who can coach you and help you find ways to make changes that fit your style and preferences. 
  • Learn more about prediabetes and the Mediterranean diet in this excellent read: An Evidence-based Guide to Successful Waist Loss, and Preventing or Reversing Insulin Resistance and Type 2 Diabetes.
  • Don’t forget exercise! You didn’t ask about it, but getting regular activity is probably the most important thing you can do to bring your blood sugar into balance. Work your way up to 30 minutes of walking or some other activity that you enjoy every day. Start by talking to your doctor about what is safe for you.

It can be disheartening to learn that you have prediabetes, but on the bright side, you discovered a problem that could have done a lot of damage if you hadn’t found it. Now you have the opportunity to do something about it. If you can lower your blood sugar now, without medication, before it progresses to diabetes, that’s definitely the way to go.


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