Hawaiian cuisine has two distinct food cultures – traditional/pre-contact Hawaiian diet (fish, poi – cooked and pounded taro root, sweet potato/uala, breadfruit/ulu, leafy greens, small amounts of pork/kalua pig, fruits like banana coconut papaya breadfruit, herbs, minimal added oil; very low refined sugar; whole foods; balanced macros) and modern Hawaii cuisine (heavy influences from Asia especially Japanese – rice, soy sauce, spam, teriyaki; Portuguese – pao doce sweet bread; Filipino; mainland American; emphasis on rice, processed meats – Spam, sweet sauces, large portions; “plate lunch” of 2 scoops rice + scoop macaroni salad + meat is very carbohydrate heavy 60-80+ g carb just from sides). Diabetes statistics – Native Hawaiians have 2-3x diabetes prevalence vs general U.S.; about 20% adult prevalence; significant cardiovascular complications. Multiple contributing factors – dietary changes since Western contact (traditional whole-food diet replaced by Western processed foods, white rice, sugary drinks); food insecurity; socioeconomic disparities; cultural disruption from colonization; genetic factors; obesity; healthcare access. Disproportionate diabetes complications – kidney failure, amputation, blindness, cardiovascular mortality. Traditional/best choices – poke (raw fish salad – typically tuna, salmon, or octopus; very diabetes-friendly without sweet sauces; choose shoyu/sea salt seasoning); poi (cooked pounded taro – moderate carb but traditional whole-food); lomi salmon (raw fish with tomato, onion – very diabetes-friendly); kalua pork (whole roasted pork); laulau (fish or pork wrapped in taro leaves and steamed); steamed fish; long rice and chicken; haupia in moderation (coconut pudding); luau leaves (cooked taro greens); ahi seared with vegetables. Watch portions – traditional plate lunch (2 scoops white rice + scoop macaroni salad = 80-100+ g carb); white rice in large portions; macaroni salad (mayonnaise + pasta); Spam (high sodium); kalua pork with rice (limit rice); manapua (Chinese buns – high carb); malasadas (Portuguese donuts); shave ice (sweet syrups); haupia; pao doce (Portuguese sweet bread); kulolo (taro coconut sweet); musubi (Spam rice ball – high sodium, white rice). Pre-Contact Hawaiian Diet research – shown metabolic improvements when traditional diet emphasized; weight loss, improved blood sugar. Pacific Diabetes Alliance promotes return to traditional foods.
Traditional vs Modern Hawaiian Food
| Traditional (Pre-Contact) | Modern Hawaii |
|---|---|
| Fresh fish | Plate lunch with white rice |
| Poi (taro) | Spam musubi |
| Sweet potato (uala) | Manapua (Chinese buns) |
| Breadfruit (ulu) | Malasadas (Portuguese donuts) |
| Leafy greens (luau leaves) | Macaroni salad |
| Kalua pork (whole) | Teriyaki preparations |
| Whole foods | Processed foods |
| Minimal sugar | Sweet sauces, shave ice |
Best Diabetes-Friendly Hawaiian Choices
- Poke without sweet sauces (shoyu/sea salt only).
- Lomi salmon (raw fish with tomato, onion).
- Laulau (fish or pork in taro leaves, steamed).
- Kalua pork (small portion, no rice).
- Steamed Hawaiian fish.
- Luau leaves (cooked taro greens).
- Long rice with chicken (small portion).
- Hawaiian salad with poke.
- Grilled mahi mahi or ono.
- Squid luau (with luau leaves).
- Small portions of traditional starches (poi, sweet potato, ulu).
- Fresh tropical fruit (small portions of pineapple, papaya).
- Coconut water (unsweetened).
Foods to Limit
- Traditional plate lunch (2 scoops rice + mac salad + meat).
- White rice in large portions.
- Macaroni salad (mayonnaise + pasta).
- Spam and processed meats.
- Spam musubi.
- Sweet teriyaki sauces.
- Manapua (Chinese buns).
- Malasadas (Portuguese donuts).
- Shave ice (sweetened syrups).
- Haupia in large portions.
- Pao doce (sweet bread).
- Kulolo (taro coconut sweet).
- Loco moco with large rice portion.
- Hawaiian sweet bread.
Traditional Hawaiian Starches
- Poi (taro) – per ½ cup = 23 g carb, 3 g fiber.
- Sweet potato (uala) – moderate carb, lower GI than white potato.
- Breadfruit (ulu) – starchy fruit, moderate carb.
- All whole foods with fiber – better than refined carbs.
- Pre-Contact Hawaiian Diet research shows benefits.
- Limit portion to ½ cup or smaller.
- Pair with abundant vegetables and protein.
- Choose over white rice when possible.
Poke Strategy for Diabetes
- Choose plain shoyu (soy sauce) or sea salt seasoning.
- Avoid sweet teriyaki, sweet chili, mango sauces.
- Add seaweed, sesame seeds, scallions for flavor.
- Cucumber, edamame for extra vegetables.
- Skip rice base; use mixed greens.
- Small avocado for healthy fats.
- Spicy mayo – limit (mayo + sugar).
- Spam musubi (limit Spam version).
- Many poke bowl chains offer customization.
Native Hawaiian Diabetes Disparity
- 2-3x diabetes prevalence vs general U.S.
- About 20% adult Native Hawaiian prevalence.
- Higher complication rates (kidney, amputation, cardiac).
- Younger onset.
- Health disparities linked to colonization, food sovereignty.
- Return to traditional foods promising approach.
- Pre-Contact Hawaiian Diet research shows metabolic improvements.
- Cultural and community-based approaches.
- Papa Ola Lokahi resources for Native Hawaiian health.
- Pacific Diabetes Alliance work.
The Bottom Line
Hawaiian cuisine has two distinct food cultures – traditional/pre-contact Hawaiian diet (fish, poi, sweet potato, breadfruit, leafy greens, small amounts of pork, fruits, herbs, minimal added oil; very low refined sugar; whole foods) and modern Hawaii cuisine (heavy influences from Asia – especially Japanese – rice, Spam, teriyaki; Portuguese; mainland American; emphasis on rice, processed meats, sweet sauces, large portions). The “plate lunch” – typical modern Hawaiian meal of 2 scoops rice + scoop macaroni salad + meat – very carbohydrate heavy (60-80+ g carb just from sides). Diabetes statistics – Native Hawaiians have 2-3x diabetes prevalence vs general U.S.; about 20% adult prevalence; significant cardiovascular complications. Multiple contributing factors – dietary changes since Western contact; food insecurity; socioeconomic disparities; cultural disruption from colonization; genetic factors; obesity; healthcare access. Disproportionate diabetes complications – kidney failure, amputation, blindness, cardiovascular mortality. Traditional/best choices – poke (raw fish salad – typically tuna, salmon, or octopus; very diabetes-friendly without sweet sauces); poi (cooked pounded taro – moderate carb but traditional whole-food); lomi salmon (raw fish with tomato, onion); kalua pork; laulau (fish or pork wrapped in taro leaves and steamed); steamed fish; luau leaves (cooked taro greens); ahi seared with vegetables. Watch portions of traditional plate lunch (2 scoops white rice + scoop macaroni salad = 80-100+ g carb), white rice in large portions, macaroni salad, Spam, Spam musubi, manapua, malasadas, shave ice, haupia, pao doce, kulolo, sweet teriyaki sauces. Pre-Contact Hawaiian Diet research – shown metabolic improvements when traditional diet emphasized; weight loss, improved blood sugar. For Native Hawaiian adults with diabetes – 2-3x higher prevalence than general population; culturally-tailored care matters; combining traditional foods with modern diabetes management; community support systems; Papa Ola Lokahi resources. For adults with type 2 diabetes – traditional Hawaiian diet very diabetes-friendly; modern Hawaii plate lunch requires significant carb portion reduction; poke without sweet sauces is excellent diabetes-friendly meal; whole-food traditional starches (poi, sweet potato, ulu) in moderate portions better than white rice. See our broader diabetes diet guide for context.
