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Eating fresh whole fruit can lower the risk of type 2 diabetes despite its high sugar content, doctors say. Photo: Getty Images

How eating whole fresh fruit can lower the risk of type 2 diabetes and its complications – have two servings a day – and even help reverse the disease

  • Many people avoid consuming fruit because of its high sugar content, but they may be missing out on essential nutrients
  • Studies show that eating fruit daily may reduce risk of type 2 diabetes and lower the risk of complications and mortality in those with the disease

Fruit is known as “nature’s confectionery”, which might be why diabetics and anyone trying to limit their sugar intake tend to shun it.

When low-carbohydrate diets such as the keto diet started gaining popularity more than two decades ago, the overall message about fruit was that it was high in carbohydrates and therefore “bad”. Many people mistakenly believed that consuming fruit caused blood glucose (sugar) levels to spike and that excess glucose in the body would immediately be converted into fat.

But fruit is an essential component of a healthy diet, says Dr Soham Patel, an endocrinologist and lifestyle medicine doctor who practises in Florida in the United States. Patel is an advocate for a plant-based diet and the founder of the Centre for Preventive Endocrinology and Nutrition.

“Fruit is low in fat and high in vitamins, minerals, antioxidants, water and fibre, plus, it’s an excellent source of energy as it contains carbohydrates. Everyone should consume a couple of servings of whole fruit every day,” he says.

Endocrinologist Dr Soham Patel says fresh whole fruit is an essential part of a healthy diet.

Rather than increase your risk of type 2 diabetes, eating whole fruit may actually lower it. A recent Australian study revealed that people who consumed about two servings of fruit per day as part of a healthy diet had a 36 per cent lower risk of developing the disease over the following five years than those who consumed less than half a serving per day.

The researchers found a link between fruit consumption and insulin sensitivity markers: people who ate more fruit had to produce less insulin to lower their blood glucose levels. These findings were published in June 2021 in The Journal of Clinical Endocrinology & Metabolism.

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Another study, published in January in the Korean Journal of Family Medicine found that eating 200 grams (7oz) of fruit per day appeared to prevent type 2 diabetes. (A medium apple weighs about 70 to 100g; a banana, about 110g; a cup of blueberries about 190g.)

In addition, eating up to 133g of fresh fruit daily was shown to reduce the risk of complications and mortality in people with type 2 diabetes. Fruit juices, on the other hand, especially those sweetened with sugar, may increase the risk of type 2 diabetes.

According to the International Diabetes Federation, diabetes is a growing problem worldwide. In 2019, about 463 million adults aged 20 to 79 years old were living with diabetes, and by 2045, this figure is predicted to reach 700 million. Approximately 374 million people are at increased risk of developing type 2 diabetes – the most common form of the disease. (In type 1 diabetes, the pancreas produces little or no insulin.)

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“The pancreas produces insulin, a hormone that helps the body process glucose in the blood and store it as readily available energy in our liver and muscle cells,” Patel explains. “When these same cells are packed with fat, the glucose has nowhere to go but to continue circulating through the bloodstream.” That is because excess fat stops the insulin receptor from working. Type 2 diabetes occurs when blood glucose levels are consistently elevated and outside the normal range.

“Our liver and muscle cells are not designed to store fat; they are designed to store glucose. So, when there’s a build-up of fat in these cells, the insulin cannot do its job of processing and storing glucose. The pancreas will produce extra insulin to compensate initially, but this can only go on for so long.

“At the same time, the liver cells are unable to use insulin effectively, so that’s a double whammy for blood glucose levels.”

Like type 1 diabetes, type 2 diabetes is associated with a number of complications including heart and blood vessel disease, nerve damage, kidney disease and eye damage.
Patel says that the way to reverse this condition or minimise our risk of developing it is to consume a low-fat diet, made up mostly of whole plant foods such as starchy and non-starchy vegetables, beans and lentils, whole grains and fresh fruit.
Sydney-based dietitian and diabetes educator Kate Marsh recommends low GI fruits such as apples, pears, oranges, berries and stone fruits.

“Whole fresh fruit is a healthy choice for everyone, including people with, and at risk of, type 2 diabetes,” says Kate Marsh, a dietitian and diabetes educator in Sydney, Australia. “Fruit is great if you’re looking for a sweet snack or dessert. Most fruits have a low or moderate glycaemic index (GI), which means they don’t raise blood glucose levels quickly.”

While all fruits are fine to include in a healthy diet, Marsh adds that lower GI fruits, including temperate fruits such as apples and pears, citrus fruits like oranges and grapefruit, stone fruits like peaches, plums, nectarines and apricots, and berries, tend to cause a more gradual rise in blood glucose levels compared to other fruits.

If you’re diabetic and have an A1C level of 10 or more, Patel suggests consuming low-GI fruits at first. Then, as your insulin resistance improves, you can include higher-GI varieties into your diet, such as tropical fruits like pineapple and papaya.

An HbA1C blood test will reveal your average blood glucose levels over three months.

You can find your A1C level with a blood test (also known as an HbA1C test) that measures your average blood glucose levels over the past three months. A normal A1C level is below 5.7 per cent, a level of 5.7 to 6.4 indicates pre-diabetes, and a level of 6.5 or higher indicates diabetes.

How you consume fruit is important. Patel says that fresh is best and to limit your intake of juices and dried fruit. Juices lack fibre and can raise blood sugar levels quickly, while dried fruit, although high in fibre, lacks water, so you’ll need to eat a large quantity to feel satiated – and may take in too many calories.

The best time to eat fruit is first thing in the morning, Patel says. It hydrates your body upon waking and keeps you energised until lunchtime. Eat it on its own and avoid combining it with high-fat foods like cheese, as this may substantially raise your blood glucose level.

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If you prefer to eat fruit later in the day, Patel suggests having it as a snack a couple of hours before dinner.

“That’s about how long it takes for fruit to pass through your gut. If you have it after your meal it’ll take longer to digest and this will create more fermentation in your gut, which is not healthy. Having fruit before dinner fills you up, too, so you eat less later on.”

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