One of the clearest insights into how India eats comes from the recent Nature Medicine publication based on the ICMR–INDIAB study, 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 map what Indians actually consume and link dietary patterns to diabetes, prediabetes, obesity, cholesterol levels, and other metabolic outcomes.
A striking finding emerged across regions. Regardless of geography—north, south, east, west, central India, or the northeast—Indian diets are overwhelmingly high in carbohydrates. The staple may vary: Rice in the south, east, and northeast; wheat in the north and west. But the underlying pattern is consistent. India is, quite simply, a carb-heavy nation.
Our analysis showed that even modest dietary adjustments can lead to 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 protein. Shifting protein intake to 15–20% and reducing carbohydrates to around 50–55% can help prevent diabetes, slow the progression from prediabetes to diabetes, and, in some cases, even support reversal or regression.
The key challenge lies in translating these recommendations into everyday practice. One of the most effective is the plate method.
In most Indian households, meals are planned around carbohydrates—chapatis in the north and west, or rice paired with sambar, rasam, or curd in the south. We advise rethinking this structure. Ideally, half the plate should consist of vegetables, one quarter of protein, and the remaining quarter of carbohydrates. This approach is especially important for vegetarians, who need to consciously include plant-based protein sources in every meal.
Another practical strategy involves the use of diabetes-specific nutritional options. Today, there are specialised formulations designed for people with diabetes that contain slow-release carbohydrates, adequate plant-based protein, and healthy monounsaturated fats. These are designed to minimise glucose spikes while providing balanced nutrition.
For individuals aiming to lose weight or achieve better glucose control, replacing even one meal a day with such a structured nutritional supplement can be highly effective. These options offer fixed calorie counts and an optimal balance of macronutrients. Our studies show that even a single meal replacement produces noticeable benefits, while replacing more than one meal strengthens the effect further.
By combining culturally familiar foods with practical frameworks like the plate method—and integrating diabetes-specific nutrition where appropriate—health care professionals can design meal plans that respect 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 diets are high in refined carbohydrates. Earlier, this was difficult to demonstrate. Today, continuous glucose monitoring (CGM) systems have changed that.
With a CGM patch, individuals can eat different foods and immediately observe their glucose responses. The impact is no longer theoretical. Someone may try a typical Indian breakfast one day and a different meal the next, quickly identifying which foods cause problematic spikes. This real-time feedback naturally encourages people to modify their choices.
As part of diabetes education, we explain concepts such as glucose spikes, glycemic index, and glycemic load. However, nothing is as powerful as personal experience. There is no one-size-fits-all diet: individuals respond differently to the same foods due to factors such as genetics, metabolic makeup, and lifestyle. CGM empowers people to learn from their own data, allowing them to continue eating foods they enjoy while understanding how different eating patterns affect their glucose levels.
Diabetes is a complex and heterogeneous condition. Even within type 2 diabetes, there are multiple subtypes, including severe insulin-deficient diabetes, insulin-resistant diabetes, mixed forms, and milder age-related presentations. Each may respond very differently to nutritional and metabolic interventions.
For some individuals, calorie restriction is central. For others, redistributing carbohydrates, proteins, and fats is more important. In certain cases, correcting micronutrient deficiencies may be the key driver of improvement. Life stage also plays a crucial role. Nutritional needs during pregnancy are entirely different from those of a frail older adult or a growing child with type 1 diabetes, for whom calorie restriction would be inappropriate.
The real breakthrough comes from recognising these differences and tailoring strategies accordingly. While core principles remain constant—excess intake of high-glycemic foods such as sugar, white rice, and refined flour is harmful—the way these principles are applied must vary. Proteins and healthy fats need a larger place in the Indian diet, but here too, quality matters. Saturated and trans fats remain harmful, whereas monounsaturated fats are metabolically favorable and do not disrupt glucose or lipid balance.
Future advances in nutritional science must be culturally and economically viable. Recommending foods that are unfamiliar or unaffordable—such as avocados or expensive imported fruits—is unrealistic for much of India. Instead, we must identify local, familiar, and affordable options that achieve the same nutritional goals.
The coming decade should therefore focus on personalized, context-specific approaches to diabetes nutrition—approaches that respect unchanging metabolic principles while making them accessible, practical, and effective for each individual.
Several areas of diabetes research remain underexplored. Within the context of nutrition and remission, one critical gap is understanding how to achieve and sustain diabetes reversal. We know from multiple studies that calorie restriction and targeted nutrient changes can induce weight loss and even remission. The challenge lies in sustainability. Many individuals regain weight within three to four months, leading to a return of diabetes.
An urgent research priority is identifying strategies that enable long-term remission. Even more neglected is the remission of prediabetes. In theory, prediabetes should be easier to reverse, yet it has received relatively little research attention. Emerging studies suggest that remission may occur even without weight loss, possibly through redistribution of fat from harmful visceral depots to safer subcutaneous stores. These findings raise important questions that remain unanswered.
As diabetes prevalence rises globally, research must focus not just on treatment, but on halting progression, reversing disease, and sustaining remission. Mechanisms differ between individuals particularly between lean and obese populations making personalized approaches essential.
Tools such as structured nutrition, diabetes-specific supplements, meal replacements, intermittent fasting, and time-restricted eating may all play a role. However, extreme dietary approaches are unlikely to be sustainable. Steady, personalised, and realistic strategies offer the greatest promise.
Beyond intervention, awareness remains a major challenge. In the US, nearly 50% of people with diabetes were unaware of their condition two decades ago; today that figure has fallen to around 25–30%. In India, however, approximately 50% of people with diabetes remain undiagnosed. The situation is even more concerning for prediabetes, which can only be detected through screening.
The ICMR–INDIAB study revealed stark regional differences. States such as Kerala and Tamil Nadu have robust screening systems, including door-to-door visits, community camps, and routine blood sugar testing at primary health centres. As a result, for every two people who know they have diabetes, only one remains undiagnosed, levels approaching those seen in developed countries.
In contrast, many other states, particularly in rural regions, tell a very different story. For every individual aware of their diagnosis, three or even four others may be living with diabetes unknowingly. These disparities make it clear that India cannot be viewed as a monolithic whole.
Ultimately, the core challenge is that diabetes is largely asymptomatic in its early stages. Without proactive testing and awareness, people simply do not know they have it—until complications appear. Detection, therefore, remains the indispensable first step on the path from prevention to remission.
This article is authored by Dr V Mohan, chairman & chief of diabetology, Dr Mohan’s Diabetes Specialties Centre and chairman, IDF Centre of Excellence in Diabetes Care.
