Type 2 Diabetes
Characterised by insulin resistance and elevated blood glucose. The strongest-evidence dietary patterns are Mediterranean, DASH, low-GI / low-GL, and well-formulated low-carb — all individualised to medications and comorbidities.
Patterns the ADA Endorses
The American Diabetes Association's 2024 Standards of Care state that "there is no single ideal dietary distribution of calories among carbohydrates, fats, and proteins for people with diabetes." Choose a pattern your patient can sustain.
Limit
Hypertension
Persistent BP >130/80 mmHg. The best-studied dietary pattern is DASH (Dietary Approaches to Stop Hypertension); the second is Mediterranean. Both lower systolic BP by 8–14 mmHg in trials — comparable to a single medication.
DASH Pattern in One Glance
Beetroot & Nitrate Foods
Dietary nitrates from beetroot, spinach, arugula, and other leafy greens convert to nitric oxide and modestly lower BP (≈ 4–5 mmHg systolic in meta-analyses). Effect is acute and dose-dependent.
Hidden Sodium Sources
Irritable Bowel Syndrome (IBS)
A symptom-based diagnosis — pain + altered bowel habits without structural disease. The best-evidenced dietary intervention is a structured low-FODMAP protocol, done in 3 phases under RD supervision.
The 3 Phases of Low-FODMAP
Do NOT stay on elimination long-term
Permanent low-FODMAP starves the gut microbiome — bifidobacteria drop. Phase 1 is diagnostic, not therapeutic. Work with an IBS-trained RD.
Generally Well-Tolerated
Common Triggers (High-FODMAP)
Polycystic Ovary Syndrome (PCOS)
Diagnosis varies — Rotterdam (most common), NIH and AE-PCOS Society criteria require ≥2 of: irregular cycles, hyperandrogenism, polycystic ovaries on ultrasound. ~70% of cases involve insulin resistance, which is the dietary lever.
Anti-Inflammatory + Low-GI Pattern
Strongest evidence: Mediterranean-style + emphasis on lower-glycaemic-index carbs. Modest weight loss (5–10%) when applicable can restore ovulation in many. Endocrine Society guidelines recommend it as first-line.
Inositol — Evidence & Caveats
Myo-inositol (often combined with D-chiro-inositol in a 40:1 ratio) has accumulating evidence for improving insulin sensitivity and ovulation rates in PCOS. The Endocrine Society 2023 guideline accepts it as an option. Discuss dose with your endocrinologist or gynaecologist — it interacts with other medications and isn't well-regulated as a supplement.
Limit
Heart Disease & Cardiovascular Risk
Includes coronary artery disease, post-MI recovery, heart failure, and elevated LDL/triglycerides. AHA's strongest endorsement is the Mediterranean pattern (PREDIMED trial showed 30% reduction in major events).
Mediterranean as Foundation
Specific LDL-Lowering Foods
"Portfolio Diet" foods — each contributes ~5% LDL reduction; combined they rival a low-dose statin in trials.