2024 Diabetes Diet Guidelines: Three Key Points for Staple Foods

For individuals with high blood sugar levels or those already diagnosed with diabetes, understanding "how to properly eat staple foods" has always been a crucial aspect of dietary blood sugar control.

To provide better dietary guidance for individuals with high blood sugar and diabetic patients, the National Health Commission of China released the latest version of the "Nutritional and Exercise Guidelines for Hyperglycemia" in July 2024.

2024 "Nutritional and Exercise Guidelines for Hyperglycemia"

In these guidelines, the section on "how to eat staple foods" can be summarized into three key points: "Not Low-Carb", "Low Glycemic", and "Coarse and Fine Mix"! This article will break down and explain these three concepts in detail.

1. "Not Low-Carb" Diet

The term "low-carb" refers to a low-carbohydrate diet (LCDs), typically defined as reducing the proportion of carbohydrate energy intake to ≤40%, while increasing the intake of fats and proteins. A more extreme version, where carbohydrate intake is reduced to ≤20%, is called an "extremely low-carb diet (VLCDs)". The ketogenic diet is a common example of this.

It is widely known that carbohydrates in food are digested and converted into blood glucose. As a result, many people believe that a low-carb diet is beneficial for controlling blood sugar. However, the 2024 "Nutritional and Exercise Guidelines for Hyperglycemia" clearly state that the proportion of carbohydrates in the diet should be 45%-60%.

This means that the latest dietary guidance issued by the National Health Commission does not support a low-carb strategy for people with high blood sugar or diabetes!

So, how should we correctly interpret this recommendation? Does that mean a low-carb diet is completely off-limits?

In fact, while low-carb diets have been shown to have clear effects in controlling blood sugar and aiding weight loss, mainstream medical opinion does not recommend this approach for the long term.

For example, the "Chinese Overweight/Obesity Medical Nutrition Therapy Guidelines (2021)" mention that a low-carb diet can be useful for short- and medium-term weight loss and can help improve blood sugar control in overweight/obese individuals with type 2 diabetes. However, the long-term safety and efficacy of such a diet are not yet clear.

Likewise, the "Chinese Diabetes Medical Nutrition Therapy Guidelines (2022 Edition)" also state that limiting carbohydrates may help control blood sugar in type 2 diabetes patients within one year, but long-term benefits have not been observed.

Additionally, the "Chinese Cardiovascular Disease Primary Prevention Guidelines" highlight that research in cardiovascular disease prevention suggests that both high carbohydrate intake (>70%) and low carbohydrate intake (<40%) may increase the risk of death!

Therefore, it becomes clear why the National Health Commission's latest dietary guidelines recommend maintaining carbohydrate intake at 45%-60% of total energy, emphasizing that long-term low-carb diets are not recommended.

While some overweight/obese individuals may benefit from a short-term low-carb diet under medical supervision, long-term adherence to such a strategy is not advised.

2. Low Glycemic Diet

If low-carb diets are not suitable for the long term, is there a diet strategy that can be sustained over the long term while still effectively controlling blood sugar?

Indeed, there is: the "Low Glycemic Index Diet"!

Different foods have different structures, which causes their carbohydrates to be digested and absorbed at different rates, affecting blood sugar levels differently. This is where the concept of Glycemic Index (GI) comes into play.

The Glycemic Index (GI) of a food is a measure of how quickly it raises blood sugar compared to pure glucose. For example, glucose has a GI of 100. Foods that raise blood sugar faster than glucose have a GI >100, while foods that raise blood sugar more slowly have a GI <100.

In the "Principles of Health Management for High-Risk Diabetic Populations and Food Glycemic Index", foods with a GI >70 are classified as high-GI foods, those with a GI between 55-70 are medium-GI foods, and foods with a GI <55 are low-GI foods.

Another related concept is Glycemic Load (GL), which is the product of the GI and the total amount of available carbohydrates in a given food portion. GL helps assess how much a particular serving of food will affect blood sugar.

For example, watermelon has a high GI, but because it contains a low amount of carbohydrates, its GL may not be high if consumed in small portions.

According to the "Chinese Diabetes Medical Nutrition Therapy Guidelines (2022 Edition)", adhering to a low-GI/low-GL diet over the long term helps in blood sugar control and may even reduce the risk of diabetic complications.

The 2024 "Nutritional and Exercise Guidelines for Hyperglycemia" specifically recommend selecting low-GI staple foods and managing their GL to help control blood sugar.

For those interested in these two indicators, an "Index of Food Glycemic Index" is available online, which lists the GI values of hundreds of foods.

If you're not keen on searching for the GI values of each food and calculating their GL, the 2024 guidelines offer a simple solution: focus on "Coarse and Fine Mix" when preparing meals.

3. "Coarse and Fine Mix"

The term "Coarse and Fine Mix" refers to incorporating whole grains and multigrain into meals. These "coarse" grains are generally low-GI/low-GL foods due to their high fiber content, which slows the digestion and absorption of carbohydrates, helping to avoid sharp increases in blood sugar.

If at least half of the staple foods in each meal come from whole grains and multigrains, the blood sugar rise after meals will be smoother compared to eating refined grains alone.

Conclusion: Balancing Staple Food Intake for Optimal Blood Sugar Control

In addition to the three principles of "Not Low-Carb", "Low Glycemic", and "Coarse and Fine Mix", it is essential to remember that the total intake of staple foods must support the "overall blood sugar reduction goal".

This goal specifically refers to obese/overweight individuals with type 2 diabetes, who should reduce their total caloric intake to support weight loss, which is crucial for blood sugar control.

According to the "Chinese Expert Consensus on Type 2 Diabetes Remission", weight loss is the key to diabetes remission for overweight/obese individuals with type 2 diabetes. The greater the weight loss, the higher the likelihood of remission, potentially even without the need for diabetes medications.

Therefore, obese/overweight individuals with type 2 diabetes must remember: In addition to following the three principles for staple food intake, the total amount of staple foods should be adjusted to support weight loss. This involves reducing daily caloric intake by at least 500 kcal, which translates to cutting about 250 kcal from staple foods.

By effectively reducing weight while adhering to the "Not Low-Carb", "Low Glycemic", and "Coarse and Fine Mix" principles, individuals with high blood sugar and diabetes can maximize the improvement in their blood sugar levels.