Prediabetes is incredibly common—an estimated 88 million U.S adults met the criteria for the condition in 2018. If you’ve been diagnosed with prediabetes, the nutrition choices you make now are more important than ever, as it could mean the difference between getting your blood sugars stabilized within a healthful range and developing type 2 diabetes.
Here’s what you need to know about the role nutrition plays in prediabetes, as well as expert-backed guidance on which foods to eat with this condition.
What Is Prediabetes?
Prediabetes is a condition in which the body isn’t able to metabolize carbohydrates normally, causing blood sugar levels to become high—but not high enough to meet the criteria for a diagnosis of diabetes.
Blood sugar, or blood glucose, is the amount of glucose in your blood. The pancreas plays a key role in maintaining healthy blood sugar levels in your body through its production of insulin, glucagon and other hormones. Insulin acts like a key that allows glucose in your blood to enter your cells. Your cells use that glucose for energy.
Many people with prediabetes (or type 2 diabetes) either don’t have enough insulin or are insulin resistant, meaning their cells don’t respond normally to insulin and glucose can’t enter the cells as easily. When glucose can’t enter the cells, it builds up in the blood, leading to high blood sugar. The pancreas produces more insulin to compensate, but eventually isn’t able to make enough, causing blood sugar to rise.
Health Complications of Prediabetes
Though most people with prediabetes have no symptoms, it’s a serious health condition that puts you at higher risk for developing type 2 diabetes, heart disease and stroke.
Despite its name, “prediabetes is not a pre-problem,” notes Virginia-based Jill Weisenberger, a registered dietitian nutritionist and creator of the The Prediabetes Meal Planning Crash Course. “It’s actually a sign that you’ve had a metabolic problem for some time, but only recently has your pancreas been unable to keep up with your blood sugar needs,” she explains.
When prediabetes progresses to type 2 diabetes, the risk of serious health problems increases even more. These complications can include kidney disease, blindness and nerve damage, along with peripheral arterial disease and stroke.
How Does Diet Impact Prediabetes?
If you have prediabetes, the foods you eat play a significant role in whether you will develop type 2 diabetes. While you cannot control certain risk factors for prediabetes like genetics, ethnicity and age, “nutrition is one of the modifiable risk factors for the development of diabetes,” notes Amanda Lane, a registered dietitian, diabetes education specialist and founder of Healthful Lane Nutrition in Minnesota.
“For people with prediabetes, the goal is to keep blood sugars on target and prevent progression to type 2 diabetes,” adds Wisconsin-based Laura Isaacson, a registered dietitian and manager of cardiometabolic care at Vida Health.
The amount and types of foods you eat determine how much and how quickly glucose enters your bloodstream. For instance, eating a high-fiber, nutrient-rich diet may help with blood sugar control and weight management, which may also reduce your risk of developing type 2 diabetes.
“If you have prediabetes, the good news is that it’s reversible,” says Isaacson. “Both nutrition and physical activity are key to preventing prediabetes and diabetes. In fact, the Diabetes Prevention Program showed that calorie reduction and physical activity of at least 150 minutes per week resulted in weight loss of 5% to 7% of body weight and reduced the risk of developing type 2 diabetes by 58%,” she adds.
Foods to Eat With Prediabetes
You may be worried that a prediabetes diagnosis means you’ll have to give up your favorite foods and eat a limited diet. But according to the American Diabetes Association, a healthy eating plan for people with diabetes or prediabetes is generally the same as healthy eating for anyone.
Though there is no one perfect diet for people with prediabetes, certain eating patterns are associated with a lower risk of type 2 diabetes. These healthy dietary patterns for prediabetes include:
The Mediterranean Diet
The Dietary Approaches to Stop Hypertension (DASH) Diet
A Vegetarian diet
Plant-based and plant-forward eating patterns that contain some animal products but emphasize plant-based ingredients
Diets that emphasize whole grains, legumes, nuts, fruits and vegetables and limit refined and processed foods are associated with a lower risk of type 2 diabetes, according to the American Diabetes Association.
Fill your plate with these delicious, health-promoting foods to help keep your blood sugar on target:
Replacing refined grains in your diet with whole grains may help lower your blood sugar, improve insulin sensitivity, help you lose weight and lower your risk of developing type 2 diabetes. Whole grains naturally contain more fiber than refined grains, which can help slow down your body’s digestion of carbohydrates into glucose.
Oats and barley are especially smart choices, notes Weisenberger. “Oats and barley are unique to other grains because these are the only foods with appreciable amounts of a fiber called beta-glucan, which improves insulin action, lowers blood sugar and, as a bonus, sweeps cholesterol from the digestive tract,” she explains.
Good sources of whole grains include:
Fruits and Vegetables
Fruits and vegetables are a source of fiber while being high in volume and generally low in calories, which may lessen feelings of hunger and help you maintain a healthy weight. Research suggests the fiber and polyphenols in fruits and vegetables may also delay the digestion and absorption of carbohydrates from foods, potentially preventing spikes in blood sugar, lowering oxidative stress and decreasing inflammation.
Non-starchy vegetables like salad greens, broccoli and other vegetables are low in sugar and offer significant fiber and other nutrients that help prevent blood sugar spikes. One review found that consuming up to 300 grams of vegetables per day was associated with a 9% decreased risk of type 2 diabetes.
Berries like strawberries, blueberries and cranberries may help improve insulin sensitivity and reduce your risk of developing type 2 diabetes. In one long-term study of 2,332 healthy men between the ages of 42 and 60, those with the highest berry intake had a 35% reduced risk of developing type 2 diabetes compared to those with lower intake.
While berries may be particularly good for lowering your risk of developing diabetes, eating more fruit in general can also help. One review found that eating 200 to 300 grams of fruit daily was associated with a 10% decreased risk of type 2 diabetes.
Be sure to stick to whole fruits and vegetables—fruit juices may have the opposite effect and actually increase your risk for type 2 diabetes due to their lack of fiber coupled with high sugar content.
Protein is important for blood sugar management. Including protein in your meals and snacks helps slow how quickly your blood sugar rises. It also can help you feel fuller longer.
However, the source of protein matters. Red and processed meats are associated with an increased risk of type 2 diabetes. So, emphasize the following sources of quality protein:
Beans and legumes
Plant-based protein foods, like tofu and tempeh
Nuts and seeds
Fish and shellfish
Nuts and Seeds
Nuts aren’t just a good source of protein, fiber and healthy fats—they may help you control your blood sugar.
One review of studies looked at the effect eating nuts and seeds had on glucose metabolism in adults with prediabetes. It found that eating 57 grams of pistachios or about 60 grams of almonds daily for four months improved blood sugar and insulin resistance.
Almonds are particularly high in fiber, providing 3.5 grams for every 1 ounce serving. “Recent research looked at the link between eating almonds and markers of prediabetes,” explains Toby Smithson, registered dietitian for DiabetesEveryDay.com and author of Diabetes Meal Planning and Nutrition for Dummies. “Those who ate two 1-ounce servings of unroasted almonds every day had better outcomes related to their prediabetes,” she says.
Foods to Limit With Prediabetes
While it’s important to fill your plate with a wide range of healthy foods that help you manage your blood sugar, there are some foods you should limit as much as possible when you have prediabetes.
Sugar sweetened beverages, in particular, are associated with a significant increased risk of developing type 2 diabetes, according to Weisenberger. Some examples include:
Lemonade and other fruit drinks
Sports and energy drinks
Sweetened coffee beverages
While studies highlight the association between sugar sweetened beverages and diabetes, any foods with excess added sugars or refined carbohydrates can cause blood sugar spikes. These include fruit juice, white bread, low-fiber cereals, sweet baked goods, desserts and candy.
Weisenberger advises her patients to limit desserts and added sugars to very small amounts. “If you focus on what’s good to eat, there’s little room in the belly for foods that can cause harm. A small amount of most any food is okay in the background of a wholesome diet,” she adds.
When to See a Doctor
While diabetes can cause symptoms like frequent urination, excessive thirst, unintended weight loss and fatigue, prediabetes usually doesn’t cause any symptoms. But that doesn’t mean you should wait to be screened—early detection is key to making lifestyle changes that can prevent your prediabetes from developing into type 2 diabetes.
The American Diabetes Association now recommends all adults begin screening for prediabetes and diabetes at age 35, regardless of other risk factors.
People living with a lot of extra weight or obesity who have one or more additional risk factors should begin screening earlier. According to the Centers for Disease Control and Prevention and the American Diabetes Association, risk factors for prediabetes include:
Living with a lot of extra weight or obesity
Being 45 years or older
Having a parent, brother or sister with type 2 diabetes
Being physically active less than three times a week
Having high blood pressure
Ever having gestational diabetes during pregnancy or giving birth to a baby weighing more than nine pounds
Having polycystic ovary syndrome (PCOS)
Being of African American, Latino, Native American, Asian American or Pacific Islander descent
“Anyone who is concerned that they may have prediabetes or diabetes should see their doctor to be tested. If you are unsure if you are at risk for developing prediabetes or diabetes, you can take the CDC Prediabetes Risk Test and talk with your primary care provider about your risk factors,” advises Isaacson.