It's hard to know the right thing to do.
As scientists explore the intricacies of type 2 diabetes, those who are diagnosed with the disease or its precursor are faced with new challenges about what they should eat.
Different diet advocates offer opposing advice, compounding what for many has been a series of poor lifestyle choices - years of eating too many rich foods and not getting enough exercise. People who are obese are seven times more likely to develop diabetes than people of normal or heavy weight, according to the Centers for Disease Control and Prevention.
But there is hope, and the solution is almost simplistic.
"Energy balance and weight management," said Elizabeth Mayer-Davis, a professor of nutrition and diabetes researcher at UNC Gillings School of Global Public Health. "I know it's boring, but it's true."
She said people who are overweight should try to lose weight - even a few pounds helps. And exercise is crucial, she said. It not only speeds weight loss, but it also helps improve insulin sensitivity so blood glucose levels don't spike.
Mayer-Davis said she worked on a large national study several years ago that showed a 58 percent reduction in diabetes risk among adults who participated in a diet and exercise program.
"That's unbelievably powerful," she said.
The Atkins diet, which touts eating fats and proteins over carbohydrates, has helped many lose weight and improve their blood glucose levels. Dr. Eric Westman, director of Duke's Lifestyle Medical Clinic and co-author of the latest Atkins' diet book, said it may be that lots of fats and proteins become a problem only when combined with lots of carbohydrates.
"People don't just eat a hamburger; they eat it in a bun," he said.
What everyone agrees on is the need for more research, combined with an acknowledgment that the tried-and-true approach of diet and exercise is the best medicine.
"The truth of the matter is, it's hard to know what the right thing to do is," said Dr. John Buse, director of the UNC Diabetes Care Center and former president for medicine and science at the American Diabetes Association.
Buse said that the new science into the role of fats and proteins in causing diabetes is exciting and important to better understand a deadly disease, but that most of the findings are still in animal models. For clinicians who help people manage their diabetes, radical changes in diet recommendations and interventions are not yet warranted.
"Caution is essential," Buse said, noting that health messages too often become distorted into absolutes of all or nothing.
His advice: a wide variety of healthy foods, all in moderation.
