The clearest insight into how India eats has come recently naturopathy The publication is based on the ICMR-INDIAB study, which is the largest and most comprehensive diabetes study conducted in the country. Covering every state, union territory and island, and using detailed food-frequency questionnaires, the study allowed us to find out what Indians actually eat and link dietary patterns to diabetes, prediabetes, obesity, cholesterol levels and other metabolic outcomes.
A shocking discovery emerged in all areas. Regardless of geography – North, South, East, West, Central India, or North-East – the Indian diet is extremely high in carbohydrates. The main ingredients may vary: rice in the south, east and north-east; Wheat in the north and west. But the underlying pattern is consistent. In simple words, India is a carb-heavy nation.
Our analysis showed that even minor dietary adjustments can have meaningful health benefits. Replacing just 5-10% of high-glycemic carbohydrates with protein significantly improves metabolic outcomes. Currently, the average Indian diet provides about 60-65% of calories from carbohydrates and barely 10% from proteins. Shifting protein intake by 15-20% and reducing carbohydrates by about 50-55% can help prevent diabetes, slow the progression from prediabetes to diabetes, and, in some cases, may even support reversal or regression.
The main challenge lies in implementing these recommendations in everyday practice. One of the most effective is the plate method.
In most Indian households, meals are planned around carbohydrates – chapatti in the North and West, or rice with it. Sambar, Rasam, Or curd in the south. We recommend reconsidering this structure. Ideally, half the plate should be vegetables, one-fourth protein and the remaining quarter carbohydrates. This approach is especially important for vegetarians, who need to consciously include plant-based protein sources at every meal.
Another practical strategy involves the use of diabetes-specific nutrition options. Today, there are special formulations designed for people with diabetes that contain slow-release carbohydrates, adequate plant-based proteins, and healthy monounsaturated fats. These are designed to reduce glucose spikes while providing balanced nutrition.
For individuals aiming to lose weight or achieve better glucose control, replacing one meal a day with such a structured nutritional supplement can be highly effective. These options provide a fixed calorie count and an optimal balance of macronutrients. Our study shows that changing even one meal has noticeable benefits, while changing more than one meal makes the effect even stronger.
By combining culturally familiar foods with a practical framework such as the Plate Method – and integrating diabetes-specific nutrition where appropriate – health care professionals can design meal plans that honor tradition while improving glycemic control.
An effective way to help people understand the impact of daily food choices on blood sugar is to show them what actually happens when they eat. This is especially important in India, where the diet is high in refined carbohydrates. At first, it was difficult to demonstrate. Today, continuous glucose monitoring (CGM) systems have changed this.
With the CGM patch, individuals can eat different foods and observe their glucose responses instantly. The impact is no longer theoretical. One can try a typical Indian breakfast one day and a different meal the next, quickly knowing which foods cause problematic spikes. This real-time feedback naturally encourages people to modify their choices.
As part of diabetes education, we explain concepts like glucose spikes, glycemic index, and glycemic load. However, nothing is as powerful as personal experience. There is no one-size-fits-all diet: individuals react differently to the same foods due to factors such as genetics, metabolic structure, and lifestyle. CGM empowers people to learn from their own data, allowing them to continue eating the foods they enjoy and understand how different eating patterns affect their glucose levels.
Diabetes is a complex and heterogeneous condition. Even within type 2 diabetes, there are several subtypes, including severe insulin-deficient diabetes, insulin-resistant diabetes, mixed forms, and younger age-related diabetes. Each individual may respond very differently to nutritional and metabolic interventions.
For some individuals, calorie restriction is central. For others, redistribution of carbohydrates, proteins and fats is more important. In some cases, correcting micronutrient deficiencies may be a major driver of improvement. Standard of living also plays an important role. Nutritional needs during pregnancy are completely different from those of a frail older adult or a growing child with type 1 diabetes, for whom calorie restriction would be inappropriate.
Real success comes from recognizing these differences and designing strategies accordingly. While the basic principles remain constant – excessive consumption of high-glycemic foods like sugar, white rice and refined flour is harmful – the way these principles are implemented should vary. Protein and healthy fats need a big place in the Indian diet, but here too quality matters. Saturated and trans fats remain harmful, while monounsaturated fats are favorable for metabolism and do not disrupt glucose or lipid balance.
Future advances in nutrition science must be culturally and economically viable. Recommending foods that are unfamiliar or inaccessible – like avocados or expensive imported fruits – is unrealistic for most people in India. Instead, we should identify local, familiar, and affordable alternatives that achieve the same nutritional goals.
The coming decade should therefore focus on individualized, context-specific approaches to diabetes nutrition – approaches that respect immutable metabolic principles while making them accessible, practical, and effective for each individual.
There are many areas of diabetes research that have not yet been explored. In terms of nutrition and remission, an important distinction is to understand how to achieve and maintain diabetes reversal. We know from numerous studies that calorie restriction and targeted nutrient changes can induce weight loss and even remission. The challenge lies in sustainability. Many individuals gain weight again within three to four months, leading to a relapse of diabetes.
An immediate research priority is to identify strategies that enable long-term remission. Even more neglected is the remission of prediabetes. In theory, prediabetes should be easy to reverse, yet relatively little research attention has been paid to it. Emerging studies suggest that remission can occur even without weight loss, possibly through redistribution of fat from harmful visceral depots to safe subcutaneous stores. These findings raise important questions that remain unanswered.
As the prevalence of diabetes continues to increase globally, research must focus not only on treatment, but also on preventing progression, reversing the disease, and maintaining treatment. Mechanisms vary between individuals, particularly between lean and obese populations, necessitating an individualized approach.
Tools such as structured nutrition, diabetes-specific supplements, meal replacement, intermittent fasting, and time-restricted eating can all play a role. However, an extreme dietary approach is unlikely to be sustainable. Stable, personalized, and realistic strategies offer the greatest promise.
Beyond intervention, awareness remains a major challenge. In the US, about 50% of people with diabetes were unaware of their condition two decades ago; Today this figure has fallen to around 25-30%. However, about 50% of people with diabetes in India remain undiagnosed. The situation is even more worrying for prediabetes, which can only be detected through screening.
The ICMR-INDIAB study revealed serious regional differences. States like Kerala and Tamil Nadu have robust screening systems, including door-to-door visits, community camps and regular blood sugar testing at primary health centres. As a result, out of every two people who know they have diabetes, only one remains undiagnosed, with levels approaching those seen in developed countries.
In contrast, many other states, especially in rural areas, tell a very different story. For every person aware of their diagnosis, three or four others may also be unknowingly living with diabetes. These disparities make it clear that India cannot be seen as a monolithic whole.
Ultimately, the main challenge is that diabetes is largely symptomless in its early stages. Without active testing and awareness, people may not realize they have the disease – until complications arise. Therefore, testing is an indispensable first step on the path from prevention to remission.
This article is written by Dr. V. Mohan, Chairman and Head of Diabetology at Dr. Mohan’s Diabetes Specialist Center and Chairman of the IDF Center of Excellence in Diabetes Care.
