Diabetes Self-Management Blog

Right about now, folks in Massachusetts would welcome a trip to a sunny, warm Mediterranean country. We’ve had so much gloomy, wet, raw weather this spring that a little sunshine — heck, even a day of sunshine — would do much to lift our spirits. Speaking of the Mediterranean, May is Mediterranean Month! And what better way to get ready for warmer weather (and help your diabetes at the same time) than to embrace the Mediterranean way of eating.

Back in 2008, I wrote about the Mediterranean “diet,” as it’s usually called. If you’re not familiar with this way of eating, here are some basics:

It’s heart-healthy. It’s not really fair to call the Mediterranean diet a “diet.” The word “diet” often implies something strict or stringent, or something that you follow for a short while, then “go off.” Really, this plan is a way of eating that primarily focuses on promoting heart health. And the research is there to back it up: The Mediterranean diet has been shown to lower LDL (“bad”) cholesterol and the risk of overall and cardiac-related deaths, while also reducing the risk of and deaths from certain types of cancer. This way of eating may even lower the risk for Parkinson and Alzheimer diseases, too.

It’s based on good-for-you foods. No big surprise here, but the basis of this eating plan is a lot of fruits and vegetables, beans, whole grains, nuts, seeds, olive oil, and herbs. In other words, it’s very much a plant-based way of eating. Fish and other seafood are the main protein sources, but poultry, eggs, cheese, and yogurt are also OK. Red meat and sweets are not completely off-limits, but they should be eaten less often and in smaller amounts.

It’s pretty low in sodium. At least, the intent is that you stay away from the salt shaker, along with highly processed foods. Cooking with tasty herbs and spices is encouraged. And if you need a snack, skip the chips and grab a handful of nuts and yogurt instead.

Wine is OK! Studies have shown that alcohol (in moderation) may lower the risk of heart disease. Moderation is the key word here, and it’s mostly red wine that’s encouraged. This means no more than two glasses (10 ounces total) of wine per day for men, and no more than one glass (5 ounces total) of wine per day for women. Obviously, if you don’t drink or shouldn’t drink alcohol for whatever reason, it’s not intended for you to start. But enjoying a glass of wine has been shown to have both physiological and psychological benefits!

It can help you shed the pounds…and keep them off. In a two-year study published in The New England Journal of Medicine in 2008, subjects following the Mediterranean diet lost more weight than those following a low-fat diet (but not as much weight as those on a low-carb diet). And researchers studying 206 participants living in Spain over 10 years found that a high intake of fruits and vegetables was linked with a reduced chance of long-term weight gain and obesity. This way of eating isn’t a “fad” diet geared towards weight loss, so if your goal is to lose weight, you still need to watch portions and calories.

What About Diabetes?
If you’re thinking, “This all sounds great but I have diabetes. Can I really eat this way and manage my diabetes at the same time?” The answer is: Yes!

A study published in the Annals of Internal Medicine in 2009 looked at 215 overweight people with Type 2 diabetes not on medicine. They were told to follow either a low-fat diet (no more than 30% of calories from fat) or a Mediterranean diet, which consisted of 50% of calories from carbohydrate and no less than 30% of calories from fat.

After four years, only 44% of the folks on the Mediterranean diet needed to start diabetes medicine compared to 70% of the people on the low-fat diet. Blood glucose control was better in the Mediterranean diet group, along with certain markers for heart disease. Interestingly, both groups lost about the same amount of weight.

Getting Started
It’s easier than you may think to “go Mediterranean.” Here are some tips to get you started:

  • Cook with olive oil and drizzle some on your salads. Use a good quality extra-virgin olive oil. While you’re at it, toss a few olives into your salad.
  • Set a goal to eat at least one fruit and/or vegetable at each of your meals.
  • Eat carbohydrates, but go for the healthier ones, such as brown rice, quinoa, barley, bulgur, whole-grain pasta.
  • Be keen on beans. Chickpeas, lentils, black beans, cannellini beans…add them to salads, soups, and grain and pasta meals. Canned are fine — just rinse them before eating.
  • Flavor your foods with fresh or dried herbs, garlic, lemon, and pepper instead of salt.
  • Nibble on a small handful of unsalted nuts. Nuts are a good choice if you’re hungry between meals. They’ve got staying power and are very low in carbohydrate.
  • Try to include fish in your menu at least twice each week.
  • With your doctor’s OK, savor a glass of red wine with your meal. Wine contains antioxidants that may help your heart.
  • Learn more about the Mediterranean diet on Oldway’s Web site.

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Comments
  1. Ahmen to this blog and comments on meterranean diet. Get your metformin, daily hearty exercise and watch eating aka mediterannean diet. For this person this style of eating has been very helpful and excellent.

    Posted by jim snell |
  2. Thanks for spreading the word on the healthy Mediterranean diet. A study published in 2010 compared traditional Mediterranean with a low-carb Mediterranean diet. The latter came out ahead. I blogged about it here:

    http://advancedmediterraneandiet.com/blog/2010/07/09/low-carb-mediterranean-diet-improves-glucose-control-and-heart-disease-risk-factors-in-overweight-diabetics/

    -Steve

    Posted by Steve Parker, M.D. |
  3. Is there a book for this? Thank you!

    Posted by J'Marinde Shephard |
  4. With regard to DM II, how does this

    “Eat carbohydrates, but go for the healthier ones, such as brown rice, quinoa, barley, bulgur, whole-grain pasta.”

    square with Drs. Bernstein and Schwarzbein, emphasis on low carb diet…and mitigating the insulin response to carbs…whether high GI or not? More protein…fewer grains/carbos and limited fruit intake with more fat in the diet, works much better for me in controlling levels of insulin required, and therefore serum glucose levels.

    I would further suggest that medications that increase the excretion of the pancreas like glyburide, cause the insulin response of increasing trigs and ldl cholesterol…while eventually burning out the already impaired pancreas…

    By keeping the need for more insulin at a minimum through dietary control, you may not need additional meds like the glybs* and might be able to get by on a mono therapy of metformin.

    mi dos pesos…

    ~mak

    Posted by kozmick |
  5. I wish you would distinguish between Type1 & Type2 diabetes in your articles! Most people who don’t understand the difference keep quoting info from your articles that doesn’t apply to Type1, like: Only 44% of people on Mediterranean diet needed to take medicine…… Thanks.

    Posted by susan hopkins |
  6. Hi susan,

    Actually, I did specify that the study was done with people with Type 2 diabetes (see the paragraph above the one that discusses the 44% of people). But thanks for the suggestion, and I will try harder in the future to be more specific.

    Posted by acampbell |
  7. Hi kozmick,

    It’s possible to take a lower-carbohydrate approach to the Mediterranean diet. Eating less carbohydrate may help some people with Type 2 diabetes delay the need to start on medicine or add a second or third medicine. But I’m not in favor of cutting out healthful carbohydrate altogether or even to the point where the diet then becomes nutritionally unbalanced. Low-carbohydrate eating isn’t for everybody. Some people really struggle with being able to follow a mostly protein-based eating plan.

    Posted by acampbell |
  8. Hi J’Marinde,

    There are a lot of books about the Mediterranean diet. One that you might try is called The Mediterranean Diet by Marissa Cloutier and Eve Adamson, and another is The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer by Dr. Steve Parker (a regular on this site!).

    Posted by acampbell |
  9. Type 1/Type 2; Mediterranean diet has benefits in the alzheimer arena where it is believed healthy eating as proposed along with dark red wine are also beneficial besides the type 2 help on diabetes.

    It is unfortunate the argument over type 1 and type 2. With a insulin system shut down it does not interfere with taking drugs. - insulin.

    With a partly working endocrine system for type 2 it adds a whole new level of fun and having to work with that without driving ones BG system rail to rail. That does not make type 1 easier but does remove one factor as being shut down.

    The whole investigation and understanding as to what is working and not working is unclear in type 2 till proper eval of the hormones and their degredation.

    Posted by jim snell |

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