Managing Diabetes at the Dinner Table: A Yale Nutrition Expert Weighs In

Eating healthfully during the holiday season is tricky—pumpkin pies, hot chocolates, and turkey roasts make the dinner table even more enticing than usual. For people who have diabetes, holiday indulgences can lead to blood sugar spikes and raise the risks of complications, such as high blood pressure and heart disease. And with so much conflicting nutrition advice online, figuring out what actually works can feel overwhelming.

Our bodies rely on the three macronutrients—fats, carbohydrates, and proteins—says Nate Wood, MD, assistant professor of internal medicine and director of culinary medicine at Yale School of Medicine. “Your body extracts macronutrients from whatever you eat, ‘junk’ or healthy, and uses them to keep you functioning," he says.

But simply functioning isn’t the same as functioning well. Achieving an ideal, healthy diet that supports the body’s metabolism, optimizes our immune function, and reduces diabetes risk requires more than macronutrients alone. That’s where micronutrients—vitamins and minerals—come in. “We’re physically made of what we eat,” Dr. Wood says. “But what matters is where those macronutrients come from. Do they come packaged with micronutrients? Because the micronutrients are what keep us functioning well.”

According to the World Health Organization, even tiny deficits in micronutrients can contribute to serious health issues. For diabetes management especially, food quality matters just like food quantity, and a healthy plate balances both macronutrients and micronutrients. But finding this balance raises practical questions that many people with diabetes struggle to answer.

More than 38 million Americans live with diabetes, and that number is projected to continue to rise. While exact causes vary, one thing is clear: when blood sugar levels spike too high, the body struggles to regulate them.

Achieving a stable blood sugar level is attainable, and it often starts with what’s on your plate.

A diabetes-friendly diet focuses on foods that digest slowly and help keep blood sugar steady. Here’s why: Excess fat stored around organs such as the pancreas can increase inflammation and impair the function of insulin—the hormone that regulates blood sugar levels. “By maintaining a healthy weight or losing some weight, patients can reduce that inflammation and improve blood sugar control,” Dr. Wood says.

To that end, Dr. Wood recommends three key strategies:

Choose whole grains over refined grains. Instead of white flour, white pasta, white bread, and white rice, opt for whole-wheat flour, brown rice, quinoa, barley, millet, and bulgur. “There’s so much fiber in the whole grain version, plus healthy fats, and those two things really slow the absorption of the starch into the bloodstream,” Dr. Wood says.

Reduce added sugars. Fruit is fine—in fact, up to two servings daily are generally recommended, because fiber slows sugar absorption. But added sugars like syrups, high-fructose corn syrup, and sucrose (table sugar) can cause quick blood sugar spikes.

Consider the order in which you eat your food. “If you start with protein, vegetables, and healthy fats, then move on to carbs, your blood sugar won’t spike as much,” Dr. Wood says.

Search “diabetes diet” online and you’ll see everything from keto testimonials to carnivore diet transformations to intermittent fasting hacks. No wonder people with diabetes feel confused.

“It’s so confusing. I really empathize, because you get a lot of conflicting information,” Dr. Wood says. The confusion stems from a logical but flawed leap. People with diabetes have high blood sugar, so they make what seems to be a natural assumption: sugar is the enemy, and they try to avoid all carbs. “Then they fall into restrictive diets,” Dr. Wood adds. Such restrictive diets often backfire, he says, because they eliminate foods that support a healthy weight and immune function long-term.

He recalls one patient who, based solely on social media research, adopted a carnivore diet and began consuming large amounts of butter. “His cholesterol values were some of the highest I’ve ever seen,” he says. “He believed beans and fruit were the enemy.”

Nutrition doesn’t have to be complicated. “The best diet for diabetes is actually the best diet for dementia, fatty liver disease, overweight and obesity, heart attacks, and strokes,” Dr. Wood says. “The best diet is the same for everyone—it’s a plant-forward diet.”

A plant-forward diet means eating as many whole and minimally processed plants as possible. Your plate should contain fruits, vegetables, whole grains, nuts, seeds, and legumes. “The more of those that you can eat, the better,” Dr. Wood says. “Although animal-based products can still be part of a healthy diet, the biggest nutritional benefits come from plants.”

Examples of plant-forward diets include the DASH diet, Mediterranean diet, traditional heritage diets, whole food plant-based diets, the Harvard diet, and the Ornish diet. No matter what diet you choose, Dr. Wood advises avoiding restrictive diets that focus on eliminating entire food groups.

Many people with diabetes worry about navigating holiday meals. Dr. Wood’s primary advice is to load up during dinner to leave less room for dessert. Other practical tips include:

• Eat plenty of lean proteins, like turkey
• Fill half your plate with vegetables such as greens, Brussels sprouts, sweet potatoes, and squash
• Stick to water or seltzer instead of sugary drinks or alcohol
• Be mindful with dessert—try small slivers of multiple desserts rather than whole slices
• Try festive, lower-sugar snacks such as nuts in the shell, which slows down eating and are extra fun to consume

“Healthy eating for diabetes doesn’t require extreme restriction or following the latest social media trend,” Dr. Wood says. “I remind my patients—where you get your nutrients matters just as much as what they are.”