Beyond pharmaceuticals: Integrating Chinese culinary medicine with modern nutritional science for holistic diabetes management

The prevalence of diabetes mellitus in China has increased from <1% in 1980 to 13.7% in 2023, parallel to the adoption of a Western-style diet. Chinese medicine (CM) approaches diabetes differently through food therapy, which is more holistic than the reductionist focusing on the bioactive compounds found in modern nutritional science. Herein, we review the CM and modern nutritional approaches to diabetes of five regional Chinese cuisines: Sichuan, Cantonese, Shandong, Hunan, and Jiangsu. A literature review of PubMed, Web of Science, China National Knowledge Infrastructure, and other medicine-specific databases was conducted, including papers from 2014 to 2024 and foundational CM literature. The inclusion criteria were systematic reviews, clinical trials, population studies, and mechanistic studies of Chinese dietary patterns and diabetes outcomes. In several studies, CM food therapy demonstrated clinical outcomes comparable to those of Western dietary interventions, with the added advantage of fewer reported adverse effects. CM food therapy operates through five main mechanisms: glucose transport enhancement, glycogen metabolism improvement, glucagon-like peptide 1 secretion promotion, pancreatic islet protection, and intestinal flora modulation. Regional Chinese cuisine contains many bioactive compounds with established anti-diabetic effects. Sichuan capsaicin enhances insulin sensitivity by activating the AMP-activated protein kinase pathway. The fermented components of Hunan cuisine support gut microbiota; fresh food preparations of Cantonese cuisine are rich in antioxidants; and traditional dietary patterns are more protective against diabetes than Westernized dietary patterns. A combined approach of CM and Western medicine offers the best potential for managing diabetes, as the cuisine from each area has distinct therapeutic value. Blending age-old food therapy with contemporary nutrition provides a rational basis for clinical integration.