New dietary recommendations for people with diabetes

28 April 2023

Ulf Risérus, a professor of clinical nutrition and metabolism, has been researching diet and diabetes for almost 25 years.

Diet and diabetes researcher Ulf Risérus has been involved in the development of updated European guidelines for the dietary management of diabetes. Several new findings have emerged since the last guidelines were published more than a decade ago, including the fact that energy-reduced diets may contribute to the remission of type 2 diabetes in some cases.

What is the most important thing you have found?
Some of our key findings are that there are a range of foods and healthy dietary patterns that are suitable for diabetics and should be recommended by healthcare professionals for the management of diabetes. Most dietary advice that is appropriate for the general population is generally suitable for people with diabetes.

There is now scientific evidence that energy-reduced diets, referred to as “powder diets”, can help to reverse diabetes in some cases of new-onset type 2 diabetes. Research shows that for about one in three people with type 2 diabetes who lose a significant amount of weight and then keep it off, their blood sugar levels return to normal. This effect can last for at least two years, but has only been shown in people who have had diabetes for up to six years.

What kind of diet is recommended?
The new European dietary recommendations emphasise a dietary intake of minimally processed plant-based foods, such as whole grains, vegetables, whole fruits, nuts, seeds, lentils and beans, and non-hydrogenated non-tropical vegetable oils, while minimising the consumption of red and processed meats, salt, sugar, sugar-sweetened drinks and refined grains.

Healthy dietary patterns, such as the Mediterranean diet, the healthy Nordic diet and a vegetarian diet, can be part of the treatment. The new recommendations generally focus more on food quality and nutritional content, rather than on the total amount of fat, protein or carbohydrates one should eat.

These dietary recommendations are consistent with the scientific evidence from SBU (Swedish Agency for Health Technology Assessment and Assessment of Social Services) that served as the basis for the National Board of Health and Welfare’s new clinical practice guidelines on diet in diabetes. Why is diet so important in diabetes?
A high-energy and unhealthy diet is the single most important cause of the development of type 2 diabetes, so it is logical that dietary treatment with weight reduction is the first choice for the treatment of new-onset type 2 diabetes. A high-energy diet is the main contributor to overweight, abdominal obesity and fatty liver disease, which in turn greatly increases the risk of developing diabetes, especially in people with a family history.

But we now also know that it is not just calories that matter. The composition and type of food in the diet affects several important risk factors for diabetes, such as high blood lipids, fatty liver, high blood pressure and blood sugar regulation. Avoiding a high-energy diet and following a healthy eating pattern can prevent a large number of cases of both diabetes and cardiovascular disease in the population, which is increasingly supported by recent research.

How did you come to be part of this expert group? 
I have been a researcher in the field of nutrition and diabetes for almost 25 years. About 10 years ago, I was elected to the European research group of experts from 13 countries for the development of scientific and evidence-based guidelines for the treatment of diabetes in Europe.

I have chaired the international group that led the work on different fats, and have also participated in all the evidence-based work on dietary management including protein, fat, carbohydrates, weight reduction, dietary patterns and diabetes prevention. I was also an expert in the SBU expert group for the report “Diets for diabetes” (Mat vid diabetes), which was published last year.

Guidelines for dietary management of diabetes

  • The European Diabetes and Nutrition Study Group (DNSG), a European research group of experts from 13 countries, has developed scientific and evidence-based guidelines for the management of diabetes in Europe.
  • The group is part of the larger European scientific organisation European Association for the Study of Diabetes (EASD).
  • The scientific support for the previous diabetes dietary recommendations has been strengthened and expanded to include advice on healthy dietary patterns, environmental aspects such as sustainability, processed foods and patient support, as well as remission of new-onset type 2 diabetes.