Dietary Substitutions for Refined Carbohydrate That Show Promise for Reducing Risk of Type 2 Diabetes in Men and Women1–3

Both genetics and lifestyle contribute to type 2 diabetes (T2D), a condition of elevated circulating glucose induced by a collection of metabolic defects including peripheral insulin resistance, elevated hepatic glucose output, and impaired pancreatic insulin secretion. Because the prevalence of T2D and its modifiable risk factors (overweight/obesity, dyslipidemia, hypertension, and physical inactivity) have been increasing in recent decades, there has been growing interest in lifestyle interventions that target T2D management and prevention. Although it is increasingly recognized that lifestyle interventions aimed at encouraging physical activity and reducing body weight can improve insulin sensitivity, nutritional contributions to T2D risk reduction are less clear. Evidence from prospective cohort and randomized controlled trials suggests that diets rich in refined dietary carbohydrate [particularly those with a high glycemic index (GI)] may elevate T2D risk; however, the appropriate combination of macronutrients to optimize metabolic health has not been fully described. To date, the collective evidence suggests that diets rich in low-GI carbohydrates, cereal fiber, resistant starch, fat from vegetable sources (unsaturated fat), and lean sources of protein should be emphasized, whereas refined sugars and grains (high-GI carbohydrates) are to be avoided in order to lower risk of T2D and its related risk factors and comorbidities.