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The Mediterranean Diet and Diabetes

By Vanessa Vargas, RDN

The Mediterranean diet has been named the best overall diet for the last 4 years and is most often recognized for its favorable cardiovascular health benefits. However, this eating style can also help improve and prevent Type 2 diabetes.

Diabetes is a major health concern for many adults. According to the CDC approximately 10.5% of the US population has diabetes. Unfortunately with age this number increases to 26.8% for those 65 or older. Over a third of US adults have prediabetes. (1)

Type 2 diabetes is a chronic, metabolic disease that occurs when our blood glucose, also called blood sugar levels, are too high. Diabetes can develop when our body doesn't produce enough of the hormone insulin or does not use its own insulin efficiently. Insulin is a hormone produced by the pancreas that allows our cells to absorb sugar. If compromised the sugar starts to build up in our blood stream causing much harm if left untreated. 

Unfortunately, as obesity rates have risen in the US and worldwide so has the prevalence of diabetes. The SAD or Standard American Diet is a driving force in these statistics as it is low in fruits and vegetables, whole grains, healthy fats, and lean protein sources while containing too many ultra-processed foods, refined grains, added sugars, salt, and unhealthy fats. The good news is that we can choose to live differently and can adopt healthy eating habits such as the Mediterranean diet while still enjoying delicious foods. It is important to recognize that the Mediterranean diet is not a diet, but instead a lifestyle that embraces plant-based foods, the joy of eating and regular activity.

There have been multiple well controlled clinical studies that demonstrate the many positive effects of a Mediterranean diet for diabetes, including improvements with glucose metabolism, lower HgAIC levels (a test that measures your average blood sugar), and improved insulin sensitivity when compared with a low fat diet.

Here are reasons as to why the Mediterranean diet has been shown to be protective against diabetes. (2, 3)

High Quality Carbohydrates Source

Oftentimes those with diabetes are encouraged to moderate, limit, and maybe even count carbohydrates as an effort to control blood sugars. While this certainly is an important factor in diabetes management, the quality of the carbohydrates makes a big difference in blood sugar control. The Mediterranean diet is not considered a low carbohydrate diet as it is rich in many carbohydrate sources including whole grains, fruits, and beans, yet this eating style yields better blood sugar control. Why? The carbohydrate sources in a Mediterranean diet are considered complex carbohydrates, meaning they are slow to digest and much less likely to spike blood sugars especially when paired with lots of non-starchy vegetables, lean proteins, and healthy fats. The focus on whole plant-based foods and the reduction of ultra-processed foods is a major contributing factor as to why this diet trumps many other diets including low fat, high protein, and low carbohydrate in the long run.

High Intake of Healthy Fats

The Mediterranean diet derives approximately 30-40% of its calories from fat, which is similar to the Standard American Diet, however the fat quality is very different. Olive oil is the primary fat source used in cooking with the Mediterranean diet while the SAD diet is excessive in the unhealthy fats - saturated and trans fat. Olive oil, nuts, seeds, and avocados are rich in both monounsaturated and polyunsaturated fats which have anti-inflammatory properties and are known to help prevent chronic diseases. Making the switch to these healthy fats and oils helps improve insulin sensitivity. Insulin resistance is often observed in the progression of diabetes, so efforts to improve insulin sensitivity can help prevent and improve Type 2 diabetes. The other bonus about eating more olive oils, olives, nuts, seeds, and avocados is that they pair well with vegetables, salads, and beans by making meals delicious, helping us to eat more plants.

Nuts are emphasized on the Mediterranean diet and encouraged daily. While many are well aware that nuts are high in calories, there has been strong evidence that moderate intake of nuts has not been associated with weight gain despite their higher energy density. Both the American Heart Association and the US Food and Drug Administration recommend consuming 1.5 ounces of nuts every-day. There is strong evidence that frequent nut intake can help reduce cardiovascular risk for those with diabetes. (4) 

Antioxidant Rich

High intake of fruits and vegetables, olive oil, and plant-based foods are rich in antioxidants. Antioxidants reduce oxidative stress and help our pancreas make and use insulin more effectively resulting in better prevention and treatment of diabetes. Fruits and vegetables also contain polyphenols which act in a similar manner as antioxidants as they help reduce free radical damage in the cells and also decrease insulin resistance. (5)

Fiber Packed

Plant based fibers found in whole grains, fruits, vegetables, nuts and seeds are slow to digest, take longer to work their way through the digestive tract, and are more satiating meaning that they fill you up faster and longer - basically built in portion control. Ultra-processed foods start to break down in your mouth and do not really contribute to the same level of fullness… just think of the melt in your mouth characteristic of potato chips and buttery crackers.  These foods fail at keeping you full and satisfied for hours leading us to eat more, graze and feel hunger soon after meals, often a recipe for weight gain. Plant based foods often contain more water, so they take up more volume and push on the stretch receptors of our stomach helping us to feel full.

Plant fibers are also rich in gut healthy prebiotics and provide fuel for our trillions of microbes living in our intestines helping to build and diversify our gut bacteria. Much of the soluble fiber sources found in beans, oats, flax seeds, fruits, and vegetables is fermented by gut bacteria and converted into SCFA (short chain fatty acids) which are known to support a diverse gut microbiome, combat inflammation, and regulate appetite. (6)

Weight Loss

A Mediterranean diet can help with weight loss. It has been shown that even a modest 5% weight loss can have a BIG impact on the progression of diabetes and prediabetes. Healthy weight loss can help one to achieve better blood sugar control with less diabetes medications including insulin and for some manage their diabetes with diet and exercise alone.

Anti-inflammatory Effects

There is evidence that suggests those with Type 2 diabetes have more of the inflammatory protein cytokine which can lead to insulin resistance, a major contributing factor to the development of diabetes. The Mediterranean diet is rich in many well-known anti-inflammatory foods such as olive oil, walnuts, avocados, fruits, and vegetables. (7)

Less Emphasis on Animals

The Mediterranean diet relies heavily on plant-based foods, however fish and seafood are encouraged multiple times per week and lean meats such as chicken and turkey are acceptable. Fish, in particular, is rich in omega 3 fatty acids and very low in saturated fat. Limiting red meat such as beef and pork plus high fat dairy products helps reduce our overall saturated fat intake leading to improved cardiovascular health, an important risk factor for those with diabetes.

Less Sugar

It is safe to say that most of us know we should watch our sugar intake and especially for those with diabetes as it has an immediate effect on blood glucose control. The Mediterranean diet greatly limits added sugars which are found in sugar sweetened beverages such as soda and lemonade, cookies, candy, ice cream, and other sweet treats. These dessert type foods can spike blood sugars soon after consumption. Did you know that a 12 oz soda contains ~44 grams of added sugar? The American Heart Association recommends a cap of 25 grams of added sugar for women and 36 grams for men. Consuming fewer foods with less added sugar on the Mediterranean diet limits added sugar and this helps greatly with diabetes control.  It is not necessary or encouraged to avoid natural sugars found in fruit and dairy but may need to be consumed in moderation to maintain healthy blood sugars.

We hope that this sheds some light of the many benefits of the Mediterranean diet. If you have diabetes or prediabetes, adapting a Mediterranean lifestyle can greatly impact your health and progression of this chronic disease. While medical management is important, adaptation to a healthy diet and regular exercise can have significant improvements. That’s why Mediterranean diet meal delivery can be the perfect solution or helping you adapt a Mediterranean lifestyle.

At ModifyHealth, we now offer Mediterranean diet meal delivery, to make this time tested, scientifically supported diet easy to implement into your life. In addition to our home-delivered meals, our dietitian team is ready and available to support you on your journey to health by making the Mediterranean diet and lifestyle much easier to incorporate into your life.

 

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Vanessa Vargas is a registered dietitian living in Bend, Oregon. She has many years of experience working as an outpatient dietitian specializing in weight management, bariatric surgery, diabetes, and cardiovascular disease. After discovering the low FODMAP diet to help manage her own IBS in 2016 she has expanded her practice to GI nutrition with a focus on irritable bowel syndrome, small intestinal bacteria overgrowth, inflammatory bowel diseases, and celiac disease. Vanessa is a Monash trained FODMAP dietitian and has been contributor of FODMAP related articles and grocery lists. Vanessa is available for in person nutrition counseling at Summit Health in Bend, OR and also offers a virtual nutrition practice with a focus on the low FODMAP diet.  During her free time you will find her exploring the beautiful landscape of Central Oregon on her mountain bike, running, swimming, skiing, and hiking the nearby mountains. 

 

References: 

  1.  Quick-facts.html
  2. Esposito K, Maiorino MI, Bellastella G, Panagiotakos DB, Giugliano D. Mediterranean diet for type 2 diabetes: cardiometabolic benefits. Endocrine. 2017 Apr;56(1):27-32. doi: 10.1007/s12020-016-1018-2. Epub 2016 Jul 9. PMID: 27395419.
  3. Protective mechanisms of the Mediterranean diet in obesity and type 2 diabetes HelmutSchröder Lipids and Cardiovascular Epidemiology Unit, Institut Municipal d'Investigació Mèdica, IMIM, Barcelona 08003, Spain Received 21 February 2006, Revised 16 May 2006, Accepted 25 May 2006, Available online 11 September 2006.
  4. Lovejoy JC. The impact of nuts on diabetes and diabetes risk. Curr Diab Rep. 2005 Oct;5(5):379-84. doi: 10.1007/s11892-005-0097-x. PMID: 16188174.
  5. Guasch-Ferré M, Merino J, Sun Q, Fitó M, Salas-Salvadó J. Dietary Polyphenols, Mediterranean Diet, Prediabetes, and Type 2 Diabetes: A Narrative Review of the Evidence. Oxid Med Cell Longev. 2017;2017:6723931. doi: 10.1155/2017/6723931. Epub 2017 Aug 13. PMID: 28883903; PMCID: PMC5572601.
  6. Kassem Makki, Edward C. Deehan, Jens Walter, Fredrik Bäckhed,

The Impact of Dietary Fiber on Gut Microbiota in Host Health and Disease,

Cell Host & Microbe,Volume 23, Issue 6,2018,Pages 705-715, ISSN 1931-3128,

  1. Giugliano D, Esposito K. Mediterranean diet and metabolic diseases. Curr Opin Lipidol. 2008 Feb;19(1):63-8. doi: 10.1097/MOL.0b013e3282f2fa4d. PMID: 18196989.