Replacing Carbohydrates With Nuts Improves Glycemic Control in Type 2 Diabetes

Replacing nuts for carbohydrates may improve glycemic control and reduce cardiovascular risk factors in patients with type 2 diabetes.

In patients with type 2 diabetes, a diet that replaces carbohydrates with nuts improves glycemic control and lipid risk factors, according to results published in Diabetologia.

The study included participants with type 2 diabetes who were taking oral glucose-lowering agents and with hemoglobin A1c levels between 47.5 and 63.9 mmol/mol (n=117). Participants were randomly assigned to 1 of 3 diets for 3 months: “full-dose nut diet’”(n=40), a diet where 2.0 megajoule (MJ; 477 kcal) per 8.4 MJ (2000 kcal) energy was provided as mixed nuts (75 g/day); “full-dose muffin diet” (n=39), a diet where 1.97 MJ (471 kcal) per 8.4 MJ (2000 kcal) energy was provided as 3 whole wheat muffins (188 g/day); or “half-dose nut diet” (n=38), a diet where 1.98 MJ (474 kcal) per 8.4 MJ (2000 kcal) energy was provided as half portions of both the nuts and muffins.

The full-dose nut diet also reduced hemoglobin A1c compared with the full-dose muffin diet by −2.0 mmol/mol (95% CI, −3.8 to −0.3 mmol/mol; P =.026) and −0.19% (95% CI, −0.35% to −0.02%), respectively.

Additionally, the full-dose nut diet resulted in reduced cholesterol (−0.25 mmol/L; P =.022), low-density lipoprotein cholesterol (−0.23 mmol/L; P =.019), non-high-density lipoprotein cholesterol (−0.26 mmol/L; P =.020), apolipoprotein B (−0.06 g/L, P =.013), and low-density lipoprotein-c<255Å (−0.42 mmol/L; P <.001).

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Investigators concluded, “the exchange of carbohydrate intake in the form of a whole wheat muffin for monounsaturated fats in nuts improved glycaemic control in diabetes and was negatively associated with lipid risk factors for [cardiovascular disease]. These data support the benefit of including nuts in the diet of individuals with diabetes despite previous concerns over their high fat and energy density.”


Jenkins DJA, Kendall CWC, Lamarche B, et al. Nuts as a replacement for carbohydrates in the diabetic diet: a reanalysis of a randomised controlled trial [published online May 23, 2018]. Diabetologia. doi:10.1007/s00125-018-4628-9