According to latest study by Trouwborst et al., Cell Metabolism 2023, it is now established that instead of prescribing a uniform low carb diet for all Type 2 diabetes patients, it is preferable to categories them into two categories viz.,Muscle Insulin Resistant (MIR) or Liver Insulin Resistant (LIR). The MIR patients be provided with low-fat,high-protein, high-fiber(LFHP) diet whereas LIR patients be provided with a high-monounsaturated fatty acid (HMUFA) diet.
Low-Fat, High-Protein, High-Fiber Diet
This combination is well supported for both weight management and blood-sugar control — protein and fiber help reduce glucose spikes, whereas low consumption of saturated fat helps to improve insulin sensitivity. Recent studies on type 2 diabetes prevention indicate that high-fiber intake slows glucose absorption and improves postprandial glucose position,while protein improves lean muscle and glucose metabolism.
Core principles
• Protein: 1.2–1.7 g/kg body weight/day, from lean sources.
• Fiber: aim for 30–35 g/day prioritizing soluble fiber for glycemic benefit.
• Fat: to be kept low, especially saturated fat — favor lean meat, skinless poultry, fish, legumes, low-fat dairy over fried/fatty options
• Carbs: not eliminated, but shifted toward whole, unrefined, fiber-rich sources rather than refined foods. Good food choices include millet-friendly options.
Lean protein: skinless chicken breast, fish curry, egg whites, soy chunks/tofu.
Protein + fiber combos: dals and legumes (moong, masoor, chana, rajma, black beans) — high in both protein and fiber with minimal fat
Fiber-rich grains: whole millets (jowar, bajra, ragi, foxtail), oats, brown rice, whole wheat — align well with the millet-based nutrition approach.
Vegetables and fruits: leafy greens, cruciferous vegetables (not for people with kidney ailments), whole fruits with skin (not juiced) — high volume, high fiber, low calorie.
Nuts/seeds in moderation: chia, flaxseed, small portions of almonds/walnuts for healthy fat without overloading saturated fat.
For Muscle Insulin Resistance, it should be protein and fiber diet whereas for Liver Insulin Resistance it should be healthy fats and less carbs along with early dinner.
The MIR diet would be the DFF prescribed diet of 40:30:20 whereas the LIR, the diet would consist of High Fiber, adequate protein and shift from carbohydrates to monounsaturated fats like Olive oil, almonds, pistachio, walnuts,peanuts, sesame seeds, Avocado, peanut butter. This helps improving the insulin resistance by reducing the Liver fat. This works well with low-glycemic-index, whole-food approach compatible millet-based diet.
The most evidence-backed approach for T2D combines all three : High fiber (soluble fiber especially), adequate protein,and a shift of remaining fat calories toward MUFA (monounsaturated fatty acids)/PUFA (Poly Unsaturated Fatty acids) away from saturated fat.
This study came out with the observation that this approach is a precision nutrition for insulin resistance rather than treating it as one-size-fits all. The Muscle Insulin Resistance (MIR) patients can be identified by their hepatic look like central obesity and fatty liver whereas the Liver Insulin Resistance (LIR) patients generally are lean on the outside and fat on the inside.
It is suggested to carry out OGTT of the patient at the very outset to identify whether the patient is Type 2 Diabetic on account of Muscle Insulin Resistance (MIR) or Liver Insulin Resistant (LIR). The level of visceral fat and subcutaneous fat measured through BMI, Fasting Insulin and Fasting and Post Prandial Glucose indicate T2D is on account of Muscle Insulin Resistance whereas High Fasting insulin, fasting and post prandial glucose will indicate the Organ related insulin resistance like Liver Insulin Resistance. The lifestyle change of each of these types of patients need to be different particularly with regard to the diet.
More detailed study is required in this area to find out its applicability to a large number of patients suffering from T2D.