Ask the Dietitian: Should You Eat Low Fat for Diabetes?

Dear Jillian,

I’m confused about diet recommendations. Should I be eating a low fat diet for my diabetes?

— Bezzy Type 2 Diabetes Member

It can be confusing to choose what and how to eat when you have diabetes. Health and wellness experts often give out conflicting advice on diet, especially when it comes to fats.

Certain fats, such as saturated fats, are widely believed to be unhealthy, no matter the source. This has led many people to avoid some nutritious foods that contain saturated fat, such as full-fat dairy products.

But the relationship between fat intake and health isn’t black and white, and some people with diabetes may thrive on a high fat diet.

In this article, I’ll explain the recent history of dietary fat — and why most people with diabetes don’t have to avoid high fat whole foods.

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Why does fat get such a bad rap?

It’s advisable to limit or avoid certain high fat foods, such as fried foods, because we know they’re harmful to health. But most high fat whole foods are not harmful. While this may be surprising to hear, eating foods that contain saturated fat will not lead to negative health outcomes, even for those with diabetes.

Unfortunately, most people oversimplify fats, categorizing saturated fats as “bad” and unsaturated fats as “good.” Not only is this incorrect, but it can also lead to poor food choices in people living with type 2 diabetes.

In the 1960s, health organizations such as the American Heart Association started recommending a low fat diet and warning against foods high in saturated fats, such as whole milk and butter, after some research linked high fat diets to an increased risk of heart disease.

As a result, Americans started increasing their intake of high carbohydrate foods such as cereal and bread. They also began replacing fat sources with low fat and nonfat alternatives, such as replacing butter with margarine. Unfortunately, this didn’t do much for public health, and rates of obesity and type 2 diabetes continued to rise.

Today, people are still confused about dietary fats and generally believe that low fat diets are healthiest and that their fat intake should be as low as possible.

This couldn’t be further from the truth. High fat diets such as the Mediterranean diet and moderate low carb diets have been associated with a variety of health benefits, including a reduced risk of heart disease and type 2 diabetes.

What fats should be avoided with diabetes?

So, what types of fat should you limit or avoid if you have diabetes?

Studies show that a diet high in fried foods and fast food can negatively affect blood sugar regulation. A 2019 study that included 843 people with type 2 diabetes found that people who consumed fast food at least once per week were nearly twice as likely to have poor blood sugar regulation.

Frequent fried food consumption has been linked with insulin resistance, weight gain, inflammatory diseases, heart disease, and more.

Processed meats, another high fat food, are also high in harmful compounds called advanced-glycation end products and have been linked with poor blood sugar regulation, insulin resistance, and an increased risk of heart disease.

What fats should be included with diabetes?

It’s well known that unprocessed, whole-food sources of fat, including saturated fat, may help improve blood sugar management in people with type 2 diabetes. For example, studies show that adding high fat ingredients to high carb dishes, such as adding pesto or cheddar cheese to pasta, can significantly reduce postmeal blood sugar levels.

Higher fat diets such as very low carb, high fat diets, paleo diets, and Mediterranean-type diets have been shown to improve blood sugar regulation and other aspects of health in people living with type 2 diabetes.

Still, some people thrive on lower fat, plant-based diets and find that they can better manage their blood sugar when they follow those diets. This includes people who are sensitive to dietary fats and cholesterol, known as cholesterol hyper-responders.

The only way to know whether you’re a cholesterol hyper-responder is to experiment. If eating a lower carb, higher fat diet sends your low-density lipoprotein (LDL) cholesterol number through the roof, you might be one.

Additionally, some people living with diabetes can significantly reduce or even stop taking their diabetes medication after switching to a high fat, low carb diet.

Since responses to food can vary widely among people living with diabetes, your best approach is to experiment and see what works for you.

Takeaway

A person who consumes a high fat diet consisting mostly of ultra-processed foods, fast food, and processed meats is likely to have poorer overall health and blood sugar regulation than a person who follows a higher fat diet that includes nutritious foods such as pasture-raised beef and poultry, fatty fish, nuts and seeds, full-fat yogurt, avocados, coconut, and olive oil.

In most cases, even if you live with diabetes, there’s no need to go out of your way to avoid or significantly limit high fat foods. In fact, adding healthy fats to your diet could help improve your blood sugar regulation, your heart health, and more.

Here are a few tips for being fat-savvy with blood sugar in mind:

• Add a source of fat to most meals and snacks. Pairing carbs and protein sources with fats can help improve the fullness factor and the taste of meals and snacks. Try pairing fruit with nut butter or full-fat, plain yogurt and drizzling vegetables with olive oil. 
• Choose foods based on their nutritional value and taste, not their fat content. Full-fat dairy products are nutritious and filling, and there’s no reason to choose reduced fat or nonfat products, which are much less satisfying and less flavorful — not to mention higher in carbs.
• Be wary of low fat products. Products that are advertised as low fat or nonfat usually contain other ingredients to make up for the missing fat. For example, low fat peanut butter and salad dressings often contain added sugars to improve their taste. And high carb fillers are often added to products to make up for the missing texture, or mouthfeel, that fat provides.

If you have questions about your fat intake and how to eat for optimal blood sugar management, consider making an appointment with a registered dietitian, who can help you break down the complex world of nutrition and develop an eating plan that works for your specific needs.