Eating Patterns and Type 1 Diabetes: Mediterranean Diet

In my previous post, I mentioned the term “eating patterns,” which might not be all that familiar to you. Eating patterns refer to combinations of foods or food groups that help with managing diabetes. Eating patterns aren’t “diets” in the sense that they’re not something you’re meant to “go on” for a short period of time and then revert back to your usual eating plan.

One of the eating patterns that the American Diabetes Association recognizes as being healthful and appropriate for people with diabetes is the Mediterranean-style eating plan. You’ve likely heard or read about this plan; it’s been mentioned frequently in the media, too, regarding a number of health benefits that it provides. In addition, this eating plan earned the title of “best diet” for 2019 by U.S. News & World Report.

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A brief history

Unlike some of the popular diets that are touted these days, the Mediterranean-style eating plan wasn’t invented or created. Rather, this way of eating evolved over thousands of years and centers around foods that are native to countries along the Mediterranean Sea, including Greece, Italy, France, Spain and Morocco. The vast history of each of these countries has helped to shape the types of foods and dishes that are promoted by this particular eating pattern. And because there are so many countries that contribute to this way of eating, there isn’t a single Mediterranean diet that truly reflects the different cultures, economics and religious practices that make up this eating pattern.

Health benefits

You might be wondering what all the hype is about the Mediterranean-style eating plan. Perhaps somewhat surprisingly, there’s about 50 years of research to back up all of that hype. Ancel Keys, a professor from the University of Minnesota, was the first researcher to show that men from Crete had lower rates of heart disease compared to men from other countries, and he attributed this to their diet based on fish, whole grains, beans, fruits and vegetables. The Lyon Diet Heart Trial in 1998 showed that people following a Mediterranean-style eating plan for three years had a 56% lower risk of death and a 50% to 70% lower risk of heart attack. And the PREDIMED study (a randomized clinical trial) from 2013 reaffirmed earlier research: following a Mediterranean eating plan lowered the risk of heart disease by 30% compared to a control diet. (The PREDIMED study is the largest dietary intervention trial that has looked at the effects of this eating pattern on the prevention of heart disease).

Heart disease is a major concern when it comes to diabetes: people with this condition are two to four times more likely than those without diabetes to develop heart disease, and heart disease is the most common cause of death among people with diabetes. But the Mediterranean eating pattern just keeps on giving! Other health benefits include:

· A lower risk of cognitive decline and Alzheimer’s disease

· A lower risk of stroke in women

· A lower risk of developing type 2 diabetes

· A way to manage diabetes

· Weight loss

· Relief from symptoms of rheumatoid arthritis

· A lower risk of breast and colorectal cancer

· Reduced depression

· A longer life

What do you eat on a Mediterranean-style eating plan?

If this eating pattern has you intrigued, great! The next step is to figure out what to eat if you want to go Mediterranean. Luckily, this plan doesn’t involve purchasing pre-made meals or expensive supplements. In fact, it’s almost the opposite: a variety and abundance of fresh, whole foods are emphasized. Let’s take a closer look at the staples of this eating plan:

Staples of the Mediterranean eating plan

Vegetables: Just about anything goes when it comes to veggies, as long as they’re not doused in salt, butter or cheese. If you like kale, go for it. If not, there are plenty of other veggies to choose from, including broccoli, spinach, cauliflower, onions, cucumbers and tomatoes.

Fruit: Berries, figs, melons, peaches, apples, oranges, pears, grapes, pomegranate seeds. Yes, they contain carbohydrate, but a) the point is to eat whole fruit versus drinking juice and b) managing portions is still important.

Legumes: Chickpeas (aka garbanzo beans), lentils, black beans, kidney beans and others from this family are strongly encouraged. They’re high in fiber and they contain protein, which can help keep blood sugars within your target range. Plus, they’re perfect for any food budget.

Nuts and seeds: Almonds, walnuts, hazelnuts, cashews, sesame seeds and sunflower seeds are just a few examples of the myriad nuts and seeds to enjoy.

Whole grain: Again with the carbs? Yes — the emphasis here is on “whole” versus “refined.” Brown rice, whole-grain pasta and bread, quinoa, farro, millet, oats, barley, buckwheat and corn are all healthful grains with a low glycemic index.

Fish and poultry: Fish and seafood, such as oysters, clams, crab, lobster, and shrimp, and poultry such as chicken, turkey and duck are highly encouraged.

Eggs: Chicken eggs are what you’re probably used to eating, but duck eggs and quail eggs work, too.

Dairy foods: Plain Greek yogurt and small amounts of cheese are acceptable.

Fats: Olives and olive oil and nut oils, such as walnut oil, avocado and avocado oils are the main types of fat for this plan

Beverages: Water, unsweetened coffee and tea, and small to moderate amounts of red wine are encouraged (although, of course, wine is optional).

Seasonings: When it comes to salt, less is best. Instead, choose from a variety of herbs and spices such as oregano, rosemary, mint, basil, sage, garlic and black pepper.

There are, not surprisingly, some foods to go easy on. Red meat, such as beef, pork, lamb and veal, is OK, but it takes a backseat to healthier protein foods, such as seafood and beans. Desserts and sweets are limited and are reserved for treats or special occasions. Fruit juices and sweetened soda, tea, coffee and sports drinks are also discouraged (and frankly, they don’t do your blood sugar any favors unless your blood sugar is low!).

Putting Mediterranean meals together

It’s one thing to read a list of foods “allowed;” it’s totally another thing to figure out what your meals might consist of. Here are some examples to get you started:

Breakfast: steel-cut oatmeal with fresh berries or whole-grain toast with an egg

Lunch: vegetable-bean soup with a whole-grain roll and a slice of cheese

Dinner: salmon cooked with olive oil, steamed broccoli, a salad with fresh greens, and a small sweet potato

Snacks: hummus with raw vegetables or a handful of almonds and small piece of fruit

The Mediterranean eating pattern: type 1 pointers

Changing up your eating plan may have an impact on your blood sugars — but in this case, hopefully it’s for the better! Here are some tips to help you get started:

· Let your healthcare provider or diabetes educator know if you are thinking of trying the Mediterranean-style eating pattern.

· If you haven’t done so already, have a discussion with your diabetes care team about carbs and consider setting some meal and snack carb goals. For example, you might aim for 45 to 60 grams of carb per meal, and 15 to 20 grams of carb per snack (if you do snack). Everyone’s carb goals are different, and yours may be lower or higher.

· If you use an insulin-to-carb ratio, be extra vigilant about how Mediterranean-style eating can impact your glucose levels. Because the emphasis is on whole, lower glycemic foods, you may see some lower blood sugars, and you might even see more “lows,” so checking with your meter or paying closer attention to alerts on your CGM is highly recommended. It’s also not a bad idea to track your carb intake for a while until you settle into the eating plan. You may even find that you need less insulin at mealtimes.

· Watch portions. Eating too much of anything will likely result in higher glucose readings and even some weight gain, so continue to keep an eye on portion sizes.

· If you’re used to lower-carb eating, no worries! You can shift away from or downplay the fruit and whole grains, and focus more on fish, poultry, vegetables and healthy fats.

Interested in more information about the Mediterranean-style eating pattern? Check out Diabetes Self-Management’s free A Guide to the Mediterranean Diet for tasty tips and recipes.

Want to learn more about eating well with diabetes? Read “Improving Your Recipes: One Step at a Time,” “Top Tips for Healthier Eating” and “Cooking With Herbs and Spices.”