More than 37 million Americans have diabetes, and more than 90 percent of those people have type 2 diabetes. About 1.7 million or one in twelve Texas adults are diagnosed with diabetes, another 425,000 are undiagnosed and more than a million are estimated to have pre-diabetes and are at high risk for developing the disease within 10 years, according to the Texas Diabetes Council.

While there are many factors that contribute to the development of diabetes, diet plays a big role. However, there is a common misconception that a diet high in sugar, even natural sugars, can lead to developing type 2 diabetes. But consuming excessive amounts of sugar isn’t directly correlated with the disease. According to a new study published in the journal Nature Medicine, consuming too many processed wheat and rice products and too much red and processed meats, while also not eating enough whole grains, is fueling the growth of new cases of type 2 diabetes worldwide. To put it simply, it has less to do with sugary sweets and more to do with carbs and saturated fats.

We spoke with Kelly King, a registered dietitian and certified diabetes care and education specialist on the medical staff at Texas Health Plano, to understand more about these food items and why they can have such a big impact on the development of diabetes.

How Food Impacts Your Diabetes Risk

When you eat, your food is broken down into a sugar called glucose. Glucose gives your body the energy it needs to work, but in order for your body to use glucose, it needs help from insulin, which is naturally created by your pancreas. Insulin essentially unlocks the door to let glucose into the cells so your body can use it for energy. But when you have diabetes, your body does not make enough insulin or cannot use it efficiently, which causes the glucose to stay in your blood, setting the stage for prediabetes and eventually type 2 diabetes if preventative measures are not taken.

Carbohydrates are often talked about when it comes to diabetes because they are broken down into glucose during digestion. Consistently high carbohydrate intake can lead to chronically elevated blood sugar levels, requiring the pancreas to produce more insulin until it eventually can’t keep up anymore, as we mentioned earlier.

However, not all carbs are created equal. This study highlights that processed wheat and rice products are playing major roles in the development of diabetes, but what about them makes them different from any other carb? For starters, processed wheat and rice products are foods that have been made from refined grains, which have had the bran (fiber-rich outer layer) and germ (nutrient-rich core) removed, resulting in a finer texture and longer shelf life but also removing most of the fiber and many other nutrients. These products have a higher glycemic index, which means they are rapidly digested and cause substantial fluctuations in blood sugar levels. In contrast, whole grains have a lower glycemic index, so they take longer to digest — resulting in a more gradual rise in blood sugar levels.

“Typically, the concern is that the refined or simple carbohydrates have less fiber and sometimes more added sugar and saturated fat. When the carbohydrate is lower in fiber (especially if it also has added sugar) it does not take long to break down into sugar. Therefore, increasing the blood glucose (sugar) rather quickly,” King explains. “Whole grains (plain oatmeal, whole grain bread, quinoa, brown rice) have more fiber which makes it a complex carbohydrate. High fiber slows down the breakdown of the food into sugar. Therefore, the increase in blood glucose (sugar) is usually slower or more gradual.”

Additionally, whole grains are a good source of fiber, which helps regulate blood sugar levels and makes you feel fuller for longer, reducing the urge for snacking between meals.

But what exactly is a processed wheat and rice product? Examples include:

• White flour
• White bread
• Regular white pasta
• Degermed cornmeal
• White rice
• Enriched wheat flour

This also includes any products made with these items, such as cookies, cakes, breakfast cereals, crackers, and snack foods.

Too much red meat and processed meats is a second major contributor to the development of diabetes, according to this study. Processed meats refer to meats that have undergone various techniques to enhance flavor, improve preservation, or extend shelf life.  Some examples include:

• Bacon
• Deli meat
• Sausages
• Ham
• Pepperoni
• Salami
• Hot dogs

A diet high in red meat and processed meats can increase the likelihood of developing diabetes due to several reasons. According to the National Institutes of Health (NIH), nitrates and preservatives in processed meats can damage cells in the pancreas that are involved in insulin production, leading to insulin resistance and diabetes.

Additionally, red meat contains a high amount of "heme" iron, which can contribute to oxidative stress and inflammation, both of which are risk factors for diabetes. Red meat is also a substantial source of saturated fat and cholesterol, which can cause inflammation and insulin resistance.

Better Alternatives

While the study does not note that you should completely cut these items out of your diet, eating them sparingly can go a long way in helping prevent diabetes. One easy swap for refined carbs is to switch over to whole grains, which the study notes eating too few of is another defining factor.

Opt for whole grains when you can and read labels for serving sizes and total carbohydrates. At least half your grain intake should be whole, and you should have about two to three servings per day.
When choosing whole grains, consider these foods, which take longer to digest and help keep your cravings at bay:

• corn
• oats
• buckwheat
• quinoa

“Some of these simple carbohydrates are foods that people have enjoyed for a long time,” King says. “We encourage people to make gradual changes over to whole grains and practice moderation. It’s also important to pair your carbohydrates with a protein (preferably lean) and fat (preferably unsaturated) to help with controlling blood glucose (sugar).”

When it comes to protein, try to plan at least two servings of a good fatty fish each week, such as salmon, tuna or mackerel. In contrast to the saturated fat, trans fat and cholesterol found in red meat and processed meats, the omega-3 fatty acids in fatty fish can help support heart health and brain protection.

Also, aim to fit three servings of lean meat into your meal plan every week. Lean meat is meat with a relatively low fat content. The following are examples of lean meat:

• Skinless chicken and turkey
• Red meat, such as pork chops, with the fat trimmed off
• Round steaks and roasts
• Top loin
• Top sirloin
• Chuck shoulder
• Arm roasts
• Ground round and ground sirloin

You may notice that red meat is still part of this list. The United States Department of Agriculture (USDA) regulates whether cuts of beef can be labeled as "lean" or "extra lean" based on their fat and cholesterol content. A lean cut of beef is defined as a 3.5-ounce serving (about 100 grams) that contains less than 10 grams of total fat, 4.5 grams or less of saturated fat, and less than 95 mg of cholesterol. An extra-lean cut of beef is defined as a 3.5-ounce serving (about 100 grams) that contains less than 5 grams of total fat, 2 grams or less of saturated fat, and less than 95 mg of cholesterol.

While these serving sizes may not seem substantial, loading up half of your plate with hearty, fiber-rich veggies, in addition to those slow-digesting whole grains, will work to keep you feeling full and satisfied.

Other Factors to Keep in Mind

While this study shows that these food items are playing a big role in the development of diabetes worldwide, King notes it’s only one factor.

“Risk factors include being overweight or obese, a family history of diabetes, history of high blood pressure, history of prediabetes or gestational diabetes, history of polycystic ovarian syndrome (PCOS) and being 45 years of age or older are a few factors,” she says. “Additionally, low physical activity, low ‘good’ cholesterol and/or high ‘bad’ cholesterol levels, and your race/ethnicity (Black, Hispanic / Latino, American Indian, Asian American, or Pacific Islander) all play major roles in the development of type 2 diabetes. It’s multifaceted.”

Some of these factors are out of your control, such as family history or ethnicity, however, many are within your control. King says taking a proactive role in your health can go a long way in preventing diabetes or catching it early.

“Texas Health offers a free diabetes risk assessment that you can take and then discuss the results with your doctor. If you don’t have a primary care doctor, the assessment can guide you to a provider near you,” King explains. “Once you have a primary care physician established, go see them at least once a year for a checkup and a physical exam. They can screen you for diabetes, or if you’ve been diagnosed, they can help you manage symptoms and your blood sugar levels.”

King adds that Texas Health offers diabetes education and support groups through outpatient centers and community-based settings located throughout the Dallas-Fort Worth area.

As with anything, it takes time and patience, and eventually, you’ll feel more and more comfortable discerning what’s appropriate for your personal health.

In simple terms, refined carbs and highly processed or sugary foods often equate to elevated blood sugars. Stick to a balanced diet, focusing on:

• plenty of non-starchy vegetables
• high-fiber foods, such as fruits and whole grains
• lean animal and plant proteins
• healthy fats, as in nuts, seeds and avocados

Additionally, King suggests visiting the American Diabetes Association website and their Diabetes Food Hub for helpful articles, guidance and recipes. The Diabetes Food Hub can even help you plan meals and create grocery lists.