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Culinary Medicine: What to Eat if You Have Prediabetes by Sara Bowling, MD

Prediabetes is one of the most common conditions I see, affecting one in three Americans, 90% of whom don't know they have the condition. Prediabetes is usually diagnosed by a blood test called hemoglobin A1C, which measures the percentage of hemoglobin proteins in your blood that are coated with sugar. This value reflects an average of your blood sugar levels over the previous three months, and when this value is 5.7–6.4%, it indicates prediabetes. This means that the sugar levels in your blood are elevated and beginning to cause damage to blood vessels, increasing the risk of heart disease and stroke. However, the levels are not yet high enough to be considered type 2 diabetes. A diagnosis of prediabetes represents a fork in the road. If you do nothing to change how you eat or move your body, you will be likely to progress and develop Type II Diabetes in the next 5–10 years. However, with small, sustained changes to your routines, you have the power to reverse this disease and prevent type 2 diabetes.  

Source: American Diabetes Association via Centers for Disease Control

The culprit is sugar: in the obvious form of juices, sugar-sweetened drinks and desserts, and in white bread, white rice, white pasta — or any food with a high glycemic index. The glycemic index of a food is a measure of how much a specific food raises your blood sugar compared to a reference food. Carbohydrates include high glycemic index foods (>70), moderate glycemic index foods (56-69), and low glycemic index foods (<55).  

High glycemic foods (like candy, potatoes, white bread or bagels) create large spikes in your blood sugar levels, which trigger insulin release.

Produced by the pancreas, the insulin hormone acts like a key and "unlocks" muscle, liver and fat cells in our body to take sugar out of the bloodstream to be used for energy by the cells at a later time. If your blood sugars and insulin repeatedly spike, two things happen: #1: the cells stop responding and "unlocking" when they see insulin — thus leaving more sugar in the bloodstream; #2: your pancreas works on overdrive, producing more and more insulin, which is still not enough to remove all the excess sugar from your bloodstream. This is when diabetes develops. With low glycemic foods (e.g., most vegetables and whole grains like quinoa and pearled barley), your blood sugars rise and fall slowly, and this helps prevent diabetes, lower cholesterol and control weight and food cravings. In addition to the amount of sugar in the food, how fast the food is digested and the specific combination of proteins, fiber and carbohydrates you consume affect your blood sugar.  

There is no food you must eliminate entirely, but focusing on incorporating more lean proteins, vegetables and whole grains into your diet allows you to reverse the path toward diabetes.

What to eat if you have prediabetes  

Proteins: Stick to lean and plant-based proteins, as these are lower in saturated fats, which reduces the risk of heart disease. Lean proteins include chicken, turkey, eggs, salmon, cod, tuna, shrimp, clams, lean cuts of pork (loin chop, tenderloin) and lean cuts of beef (flank, tenderloin). Great plant-based protein sources include tofu, tempeh, edamame, nuts/nut butters, beans and lentils. Keep in mind that while beans and lentils are high in carbohydrates, they still have a low glycemic load, given their protein and fiber content. Research shows reduced insulin resistance and improved blood sugar management in patients who regularly consume lentils and legumes. In one study, adding one cup of legumes daily (beans, chickpeas or lentils) lowered HbA1C, blood pressure and estimated cardiovascular risk.

Vegetables: Most vegetables have a low glycemic index, and I recommend they make up 50% of your plate at every meal. Green salads, roasted root vegetables and adding kale or spinach to a morning smoothie are accessible and easy ways to achieve this goal. Buying frozen chopped veggies ready for roasting or prewashed spinach can help make it even more attainable. Other non-starchy vegetables include asparagus, broccoli, cabbage, Brussels sprouts, celery, cucumber, carrots, mushrooms, snow peas and peppers. Avoid starchy vegetables, such as yellow corn, green peas, plantains, squash and white potatoes, which all carry a substantial glycemic load. I encourage people to substitute cauliflower or broccoli for corn and sweet potatoes for white potatoes. These easy substitutions carry half the glycemic load of the starchier options. 

Fruits: Most people are concerned about the sugar content of fruits. While fruits contain natural sugars, they also have a lot of fiber, so they are digested very differently from highly refined sugars. Most fruits are low-glycemic foods. In fact, they can help stabilize blood sugars and are a great option as a snack for those with prediabetes. The exceptions include bananas, mangos and any canned fruits. I encourage people to substitute pears, apples, or frozen berries for bananas. If you buy or pick fruit at its peak season (when it's cheaper), you can freeze it and use it later in smoothies or on your morning oatmeal.

Grains: Whole grains (couscous, bulgur wheat, pearled barley, quinoa, farro, old-fashioned oatmeal and wild rice) are packed with fiber, protein and nutrients. They lower cholesterol and reduce your risk of heart attack and stroke. They also increase satiety — keeping you feeling full for longer and reducing cravings for high-sugar snacks between meals. The exceptions include basmati and white rice, which both carry high glycemic loads. Of note: it DOES matter what you are eating with these grains. For example, traditional Mexican diets were based mainly on vegetables and legumes with a portion of rice, tortilla or corn. The fiber content of the vegetables and legumes helped to slow the digestion and sugar spike of the high glycemic carbohydrates in corn tortillas or white rice. Mexican fast food today, made up mostly of tortillas, rice and beef, and with few vegetables, is a totally different story.  

Breads: Breads like 100% white bread, English muffins and, especially, bagels have a very high glycemic load. Wheat bread is very similar to white bread. If you enjoy bread, pumpernickel or rye bread is a great option, with its higher fiber content. Thanks to its fermentation process, sourdough bread slows the release of sugar into the bloodstream and is also a delicious option! Whole-grain breads are also good choices, but beware of the "9-grain" or "12-grain" gimmick. You want 100% whole grain bread; most bread marketed as "12 grain" or "multigrain" is made of processed wheat flour rather than the whole grain (bran, germ and endosperm). The whole grain is what is rich in fiber, B vitamins, antioxidants and healthy fats. 

SnacksI always recommend nuts (unsalted almonds or peanuts) as a snack rather than pretzels or crackers (which are often also packed with salt and will spike your sugar and drop you an hour later, leaving you craving more). Other great snack options include veggies and hummus, celery or apple with peanut butter, a piece of fruit, edamame or a small cup of soup. And of course, despite all this discussion about food, another crucial part of diabetes prevention is moving your body daily!

If you are wondering if you are at risk for prediabetes and should be tested by your doctor, you can take this test. It's recommended that any person > age 35 with a BMI > 25 should have annual testing for prediabetes.

If you have prediabetes, ask your healthcare provider about the National Diabetes Prevention Program lifestyle change program. These programs provide coaching, support groups and a structured plan to reverse this disease and are offered nationwide.

In summary:

  • Get tested for prediabetes if you are at risk; know where you stand

  • Prediabetes is reversible with tiny, sustained changes

  • Think lean, plant-based protein and legumes, legumes, legumes

  • Think of non-starchy vegetables as taking up 50% of your plate at every meal; you can even do this at breakfast by adding spinach or broccoli to your smoothie

  • Think 100% whole grains, explore the bulk food section of your local store

  • Think ahead to keep high-fiber snacks with you like nuts, nut butters or an apple

  • Take a short walk after eating a meal to help stabilize your blood sugar 

If you're looking for a healthy, simple weeknight meal that's ready in under 30 minutes, I invite you to try our family favorite: Honey Miso Sheet Pan Salmon with Broccoli.


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Sara Bowling, MD

Sara Bowling is a family medicine physician, medical acupuncturist, yoga teacher, athlete, amateur chef and mom of two little boys. She works at AC Wellness, providing care for Apple employees and their families. Previously, she was in private practice, incorporating acupuncture and culinary medicine into her day-to-day care. She graduated from Stanford University, completed medical school at the University of Michigan in Ann Arbor and family medicine training at the University of Washington.

Dr. Bowling believes in the power of diagnostic tools and medicines. She also believes strongly in the power of food, physical activity, and community in creating long-lasting health and wellness. She loves to cook and share her recipes with the hope of inspiring her patients, friends and family to find foods that lift the senses, nourish, delight and provide a basis for a long and healthy life. 

When not working, she spends most of her time with her husband and young boys, usually outside (rain or shine) — and often on bikes! She also loves mountain biking, gravel biking, running, skiing, traveling and, of course, cooking!  

Contact Information:

Instagram: @drbowlingskitchen 

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