Written by Amy Brownstein, MS, RD
Yes, people with type 2 diabetes can eat fruit. Fruit is a healthy, nutrient-dense food option full of water, fiber, antioxidants, vitamins, and minerals. Furthermore, fruit is a fat-free food. Despite these health benefits, most Americans do not meet the recommended 2 cups of fruit daily. Moreover, many people with type 2 diabetes are wary of eating fruit due to its high sugar content. But this sentiment is not warranted: research shows that fruit can be part of a healthy diet for people with type 2 diabetes. Moreover, a higher fruit intake is even associated with a reduced risk of developing type 2 diabetes.
Here we debunk myths related to fruit consumption and type 2 diabetes and discuss how you can incorporate fruit into your diet.
Fruit has a positive effect on blood sugar
Research shows fruit positively affects blood sugar levels and insulin resistance —the root cause of type 2 diabetes.
One study found that participants with the highest fruit intake (about 372 grams per day or the equivalent of 1 ¾ cups) had higher markers of insulin sensitivity (how responsive the body is to insulin) and lower markers of insulin resistance than those who consumed the least amount of fruit (about 62 grams per day or the equivalent of ¼ cup). At the 5-year follow-up, participants with moderate fruit intake (230 grams per day or 1 ¼ cups) had a 35% lower chance of having diabetes than those with the lowest fruit intake (62 grams per day) [1].
Limiting fruit intake may be counterintuitive for blood sugar levels in people with type 2 diabetes. One randomized controlled trial (the gold standard for research) found no difference in HbA1c, body weight, or waist circumference between people who restricted fruit to 2 servings per day and those who ate 2 or more servings of fruit daily. What’s more, fruit is associated with additional benefits for blood sugar [2].
How does fruit benefit blood sugar levels in people with type 2 diabetes?
Fruit may benefit blood sugar levels through its effect on glucose metabolism (the process by which the body breaks down the carbohydrates we eat into their simplest form, sugar). But exactly how fruit influences glucose metabolism is not yet fully understood.
People with type 2 diabetes who consume higher amounts of fruit may be more insulin sensitive than those who consume lower amounts of fruit [1]. This difference may be attributed to the nutritional composition of fruit. Fruit is low in calories and glycemic load (how quickly a food raises blood sugar levels based on the quantity consumed) and contains beneficial nutrients, such as fiber, water, and phytochemicals (compounds in plants that may benefit health).
Phytochemicals help stabilize blood sugar levels
Fruit contains polyphenols (a type of phytochemical) that help reduce oxidative stress in the body. Oxidative stress occurs when there is an imbalance between unstable molecules (free radicals) and the beneficial molecules (antioxidants) that help remove them. Polyphenols act as antioxidants, which may help improve insulin sensitivity and lower the risk of type 2 diabetes [3].
Polyphenols reduce inflammation and cellular damage and support glucose metabolism. IIn type 2 diabetes, the body is less responsive to insulin. Glucose is not as quickly taken up by muscle and organ cells. So, glucose stays in the bloodstream longer, leading to the pancreas releasing more insulin. Polyphenols contribute to insulin sensitivity by supporting pancreatic beta-cells (the cells in the pancreas responsible for producing insulin), improving the removal of glucose from the bloodstream, and reducing the release of glucose from the liver, all of which helps to stabilize blood sugar levels [1,4].
How Can You Lower the Glycemic Response of Carbohydrates?
We frequently see people concerned about the sugar content of fruit. Fruit contains fructose, a form of sugar found naturally in fruit, honey, and table sugar. Fructose has gotten a bad reputation from its presence in many ultra-processed foods, often in the form of high-fructose corn syrup. But fructose found in fruit is not inherently bad. Fruit also contains other nutrients — such as fiber and antioxidants — that influence fructose’s absorption and health benefits.
How does fructose affect blood sugar?
Consuming fructose in small amounts (approximately 10 grams per meal or the equivalent of the amount of fructose found in a medium size apple) may benefit glucose regulation by the liver. Eating small quantities of fructose — like what’s in fruit — influences how the liver metabolizes glucose, resulting in the liver producing less glucose and instead increasing the formation of glycogen (the stored form of glucose). This lowers glucose in the bloodstream and may help improve HbA1c levels [5].
The source of fructose matters
The food source of fructose matters. While fructose from fruit benefits blood sugar, fructose from other food sources — such as sugar-sweetened beverages or processed foods — can have an unfavorable effect. This may be partially explained by the difference in nutrient composition of fruit and ultra-processed foods.
Ultra-processed foods that contain fructose tend to be more energy-dense (higher in calories and fat), which can contribute to insulin resistance [6]. Conversely, fruit is naturally low-calorie and contains beneficial nutrients like fiber, phytochemicals, and water. Fruit’s high water content dilutes the sugar. This dilution helps reduce the impact of fruit on blood sugar levels compared to concentrated fructose sources like sugar-sweetened beverages and processed foods. Additionally, the presence of fiber and phytochemicals in fruit influences how fructose is processed and absorbed, leading to a slower and more controlled release of sugar into the bloodstream.
The bottom line: just because fructose may benefit blood sugar does not mean you should eat any food containing fructose. Instead, focus on fruit and limit ultra-processed foods.
Fiber influences the effect of fruit on blood sugar
Fiber is the nondigestible part of carbohydrates. It is abundant in fruit, particularly bananas, apple and pear skins, and berries. Soluble fiber — a type of fiber — draws water into the gut to form a gel that slows digestion. This regulates blood sugar spikes and differentiates the absorption of sugar in fruit from sugar in more processed foods, such as candy, desserts, and sugar-sweetened beverages.
Fiber plays an important role in reducing insulin resistance. One meta-analysis of randomized controlled trials found that diets rich in soluble fiber — such as a whole food, plant-based diet full of fruit — reduce HbA1c levels by almost 5% compared to diets low in fiber [7]. And reduced HbA1c levels are a sign of reversing type 2 diabetes, as the body has improved its responsiveness to insulin.
Can you drink fruit juice with type 2 diabetes?
Eating whole fruit is preferred to fruit juice. 100% fruit juice retains many of the vitamins, minerals, and phytochemicals found in fruit, but its digestive process and effect on blood sugar differ from whole fruit.
Fruit juice consumption is positively associated with type 2 diabetes [8]. According to one meta-analysis, drinking more than one serving of fruit juice per day is associated with a 7% increased risk of type 2 diabetes [9].
Many factors influence the relationship between fruit juice and type 2 diabetes. Fruit juice contains little to no fiber, which affects the glycemic load. This contributes to higher blood sugar levels despite smaller portions. Fiber helps regulate blood sugar by slowing the absorption of carbohydrates in the bloodstream. Additionally, fluids (like fruit juice) move through the stomach to the intestines more rapidly than solids, leading to more significant and faster changes in blood sugar and insulin levels [8].
Tips for incorporating more fruit into your diet
Adding more fruit into your diet may feel scary if you’re not used to eating fruit with type 2 diabetes. Follow these tips to start increasing your fruit intake.
- Choose whole fruits: Opt for whole fruits rather than juices or processed fruit products. Whole fruits contain more fiber, which helps slow down the absorption of sugars and provides various other health benefits.
- Pair fruits with protein or healthy fats: Blood sugar spikes after eating fruit can indicate insulin resistance. If you notice this occurring after you eat fruit, try pairing the fruit with protein or a healthy fat. Combining fruits with protein or healthy fats can further regulate blood sugar levels and enhance satiety. For example, have a small serving of nuts or plain yogurt with your fruit.
- Spread fruit intake throughout the day: Avoid consuming large amounts of fruit in a single sitting. Instead, distribute your fruit intake throughout the day to prevent rapid spikes in blood sugar.
- Monitor blood sugar levels: Data is knowledge. Keep track of your blood sugar levels after eating different fruits. This can help you identify which fruits are better tolerated and guide your choices accordingly.
- Avoid sugary fruit products: Be cautious with canned fruits in heavy syrup, fruit snacks, and other sugary fruit products, as they can contain added sugars that may negatively affect blood sugar levels.
- Choose fruits with edible skins: Fruits with edible skins, such as apples and berries, provide additional fiber, promoting better blood sugar control.
- Monitor dried fruits: Dried fruits have a concentrated sugar content and can cause a more significant rise in blood sugar levels. If you eat dried fruits, do so in small portions and opt for varieties without added sugars.
Eating fruit with type 2 diabetes is fine and encouraged. The quantity of sugar in whole fruit, phytochemicals, water content, and fiber influence glucose metabolism to benefit blood sugar levels. Try increasing your fruit intake using the above tips. And if you notice your blood sugar levels are higher, know that this is normal and will subside over time as your body becomes more insulin sensitive. You are not alone in this journey to reverse type 2 diabetes—reach out to our team with questions or for more support.
References
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8475213/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3599615/
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4718092/
[4] https://www.sciencedirect.com/science/article/pii/S0002916522029148?via%3Dihub
[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6247175/
[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3379616/
[7] https://academic.oup.com/nutritionreviews/article/71/12/790/1833415?login=false
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