Should pre diabetics avoid carbs?

Prediabetes is a condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. An estimated 88 million American adults have prediabetes, and up to 70% of them will eventually develop type 2 diabetes. One of the best ways to prevent or delay the progression from prediabetes to diabetes is through lifestyle changes like diet and exercise. This leads many prediabetics to wonder if they should avoid dietary carbohydrates to help manage their blood sugar levels. In this comprehensive guide, we’ll examine the evidence on carbohydrate restriction for prediabetes, discuss the pros and cons of low-carb diets, provide carbohydrate recommendations for prediabetics, and offer meal tips to control carbs and blood sugar.

Should prediabetics avoid carbs completely?

The short answer is no, most experts do not recommend completely avoiding all carbs for prediabetics. Carbohydrates are the main source of energy for the body and brain, and restricting them too severely can lead to nutritional deficiencies, low energy, and unsustainability. However, moderating carbohydrate intake and making smart choices about carb quality is important.

Here’s a quick rundown of why prediabetics don’t need to fully eliminate carbs:

– Carbs provide vital nutrients: Carbs supply fiber, vitamins, minerals, and phytonutrients. A very low-carb diet lacks whole grains, fruits, starchy vegetables, legumes, and dairy products that provide essential nutrition.

– Extremism isn’t sustainable: Restricting any one food group too severely is hard to maintain over the long run. Moderation and balance is key for lifestyle changes.

– It can cause side effects: Very low carb intake often causes symptoms like fatigue, nausea, constipation, cramps, and bad breath. Nutritional ketosis should only be attempted with medical supervision.

– Glucose is the main energy source: The brain and muscles preferentially use glucose for fuel. Very low carbs require the body to shift into using ketones and fatty acids for energy.

– Carbs don’t need to be feared: Carbs are not inherently “bad.” The type, amount, and timing are what matters most for managing blood sugar.

So in summary, prediabetics don’t need to cut out all carbs. But they should be mindful of carb quality, quantity, and timing to help control blood sugar spikes.

What are the benefits of reducing carbs for prediabetes?

Although completely avoiding carbs is not necessary, reducing overall carb intake does have potential benefits for prediabetics, including:

– Lowering blood sugar: Eating fewer carbs means less glucose entering the bloodstream, which directly helps control blood sugar levels.

– Reducing insulin spikes: Requiring less insulin release can preserve and improve insulin sensitivity over time.

– Promoting weight loss: Ketogenic and low-carb diets are effective for weight loss, which helps improve insulin resistance.

– Reducing triglycerides: Lower carb intake is linked to decreased triglyceride levels. High triglycerides are a risk factor for diabetes and heart disease.

– Improving HDL: Carb restriction helps raise beneficial HDL cholesterol, which is often low in prediabetes.

– Decreasing blood pressure: Due to reductions in insulin and sodium, lower carb diets can reduce blood pressure.

– Increasing insulin sensitivity: Lower insulin demand improves cellular sensitivity to insulin over time, which helps reverse prediabetes.

– Preventing progression: Carb moderation can help prevent prediabetes from worsening into full-blown type 2 diabetes.

The level of carb restriction needed to achieve these benefits varies by individual. Work with a registered dietitian or diabetes educator to determine the suitable carb range for your body and lifestyle.

What are the downsides of very low carb diets?

Although carb reduction from the standard American diet is beneficial, taking carb restriction to the extreme comes with potential downsides:

– Nutrient deficiencies: Very low carb diets eliminate foods that provide beneficial vitamins, minerals, antioxidants and phytonutrients. Key deficiencies can include B vitamins, iron, magnesium, selenium, and fiber.

– Lack of energy: Drastically reducing carbs can lead to fatigue, weakness, and poor exercise performance as glucose is the muscles’ preferred fuel source. Low energy makes it hard to stay active.

– Loss of muscle mass: Lower insulin levels and inadequate protein on ketogenic diets can cause the breakdown of lean muscle over time. This reduces metabolic rate.

– Constipation: Without adequate fiber from whole carb sources, very low carb diets frequently lead to constipation and other GI issues.

– Bad breath: Ketone-rich breath is a common side effect due to metabolic changes.

– Adverse effects: Further carb restriction can lead to headaches, irritability, cramps, nausea, kidney problems, dehydration, dizziness and more.

– Social impact: Restrictive diets can isolate people from social gatherings involving food and drink. Strict rules create stress.

– Short term outlook: Very low carb diets are difficult to adhere to over the long haul for most people, leading to yo-yo dieting.

– Not for everyone: People vary in their level of carbohydrate tolerance. Some do require a lower carb intake than others to maintain normal blood sugar levels. Very low carb or ketogenic diets should only be attempted with medical supervision.

Are some carbs better than others for prediabetes?

Yes, carb quality matters. Not all carbs are created equal when it comes to impact on blood sugar levels.

Here is an overview of carb types ranked best to worst for prediabetes:

Fibrous whole grains: Oats, quinoa, whole grain bread, etc. Fibrous carbs are digested slowly, preventing blood sugar spikes. They provide important nutrients and fiber.

Starchy vegetables: Carrots, sweet potatoes, winter squash, peas, etc. They have a modest glycemic impact and provide key vitamins and minerals.

Colorful fruits: Berries, citrus, stone fruits, apples, etc. Their fiber and antioxidants help mitigate their natural sugars. Focus on lower glycemic options.

Legumes: Lentils, beans, peas. Their fiber balances out their starch and protein. Limit serving sizes to control blood sugar effects.

Low fat dairy: Milk, yogurt, cheese. Opt for full fat dairy if you struggle with weight management or insulin resistance.

Refined grains: White breads, pastries, cookies, etc. Lack of fiber and nutrients causes rapid blood sugar spikes.

Fruit juices: Lack of fiber makes the liquid sugars rapidly absorb. Significant insulin response.

Sugary drinks: Sodas, sweet teas, sports drinks, etc. Large amounts of quickly absorbed sugar without any redeeming nutrition.

By focusing carb intake on whole food options like vegetables, fruits, legumes, minimally processed grains and low fat dairy, prediabetics can obtain health benefits while keeping blood sugar relatively stable.

How many grams of carbs should a prediabetic aim for?

There is no one-size-fits-all carbohydrate recommendation for prediabetes. Experts agree total carb intake should be individualized based on a variety of factors like:

– Body size and activity level
– Gender, age and family history
– Degree of insulin resistance
– Medications that influence insulin
– Food preferences and habits
– Ability to monitor blood glucose response

However, most nutrition experts suggest between 130-225 grams of total carbs per day is a good starting range for many prediabetics. The American Diabetes Association recommends aiming for 45-60 grams of carbs per meal. Very physically active prediabetics can often tolerate slightly higher carb intakes, while more insulin resistant individuals may prefer lower carb targets.

Here are some reasonable carb range guidelines to consider:

– Sedentary: 130-150 g/day
– Moderately Active: 150-180 g/day
– Very Active: 180-210 g/day

– Sedentary: 150-180 g/day
– Moderately Active: 180-210 g/day
– Very Active: 210-250 g/day

These recommendations should be further personalized based on individualized meal timing, medication use, blood sugar monitoring and preference. Portion control and food choices are also key for balancing carb intake. A registered dietitian nutritionist can provide individual guidance on optimal carb intake for your needs and goals.

What are the best low carb foods for prediabetics?

Focusing on delicious whole foods that are naturally low in carbs and calories makes carbohydrate restriction more enjoyable and sustainable. Here are some great options:

Non-Starchy Vegetables: Lettuce, spinach, kale, tomatoes, cucumbers, zucchini, peppers, broccoli, onions, green beans, mushrooms, cauliflower, etc. Load up on these low carb veggies.

Protein Foods: Chicken, turkey, seafood, lean beef, pork, eggs, plain Greek yogurt, cottage cheese, milk, cheese. Choose lean proteins and moderate dairy portions.

Healthy Fats: Olive oil, coconut oil, avocados, nuts, seeds, nut butters. Incorporate for satiety, but still be mindful of excess calories.

Berries: Raspberries, strawberries, blueberries and blackberries provide fiber, vitamins, and sweetness with minimal carbs.

Cruciferous Veggies: Cauliflower, broccoli, Brussels sprouts and cabbage can be creatively turned into low carb “rice” or pizza crust.

Herbs/Spices: Garlic, basil, oregano, cinnamon, cumin, pepper. Add big flavor without carbs or calories.

Beverages: Unsweetened coffee and tea, water, sparkling water, unsweetened almond milk. Stay hydrated with low/no carb options.

What foods and meals should prediabetics restrict or avoid?

While no foods have to be totally avoided, here are some smart guidelines for limiting carbs from high glycemic sources:

– Limit breads, crackers, pretzels and baked goods made with refined flours to 1-2 servings max per day.

– Restrict sugary breakfast cereals, pancakes, muffins and pastries to an occasional treat. Opt for a veggie omelet or Greek yogurt instead.

– Cut back on starchy sides like rice, pasta and potatoes. Try cauliflower rice or zoodles for lower carb substitutes.

– Limit fruits like grapes, bananas, mango, pineapple and watermelon due to their higher sugar content. Stick with lower glycemic options like berries.

– Skip sugary beverages like sodas, fruit juices and sports drinks. Stick with water, unsweetened tea and coffee.

– Avoid candy, cookies, cakes, pies, ice cream and other sweets. Reserve for a special occasion treat a few times per month max.

– Be mindful of high carb sauces and condiments like barbecue sauce, teriyaki sauce, ketchup and sweet salad dressings.

– Limit alcohol intake, as it impacts blood sugar and impairs judgement around food choices.

– Choose lower carb options when dining out. Order a veggie fajita instead of rice and beans, for example.

Sample Lower Carb Day for a Prediabetic

Here is a sample lower carb day that comes in around 150-180 grams of total carbohydrate. This provides moderate carb restriction while still including fruit, dairy and whole grains in balance.

Breakfast: Veggie omelet with cheese, avocado and salsa, plus Greek yogurt with berries (30-45g carbs)

Lunch: Chopped salad with chicken or salmon, balsamic dressing, plus an apple (45-60g carbs)

Snack: Hummus with raw veggies and whole grain crackers (15-30g carbs)

Dinner: Sheet pan chicken fajitas over cauliflower rice with cheese, salsa and guacamole (30-45g carbs)

Dessert: Frozen yogurt with blackberries (15-30g carbs)

This provides nutritional variety while keeping carb counts in a moderate, balanced range for better blood sugar management. Adjust the meal details and carb totals to match your own preferences and carb tolerance.

Tips to Manage Carbs with Prediabetes

Here are some additional practical tips for keeping carb intake at a moderate, controlled level:

– Monitor your blood sugar to determine your optimal carb tolerance. Shoot for fasting under 100mg/dL and post-meal under 140mg/dL.

– Read nutrition labels and become aware of carb contents. Look for foods lowest in total and added sugars.

– Stick to food shopping lists and avoid impulse purchases that could derail your carb goals.

– Measure starchy foods like grains and potatoes to stay within recommended servings.

– Fill half your plate with non-starchy veggies to crowd out excess carbs.

– Avoid mindless carb-heavy snacking by staying busy and drinking water.

– If you go over on carbs at one meal, rebalance at the next meal. Don’t give up.

– Increase fiber to slow carb absorption. Supplement if needed.

– Stay active with regular exercise to increase carb flexibility.

– Seek support through apps, coaches and diabetes education programs.


In summary, prediabetics do not necessarily need to avoid all carbohydrates. However, managing overall carb intake and making smart food choices is crucial for controlling blood sugar, losing weight and potentially preventing progression to type 2 diabetes. Focus on whole, fiber-rich sources like non-starchy vegetables, fruits, legumes and minimally processed grains. Limit sweets, refined grains and sugary beverages. Monitor your responses, and work with a registered dietitian to determine the optimal carbohydrate intake for your health and goals. With the right dietary pattern and smart carb choices, you can still enjoy a varied, balanced diet with prediabetes.

Leave a Comment