The Mediterranean Diet and Diabetes

The Mediterranean diet, as the majority food of the Mediterranean areas, is the product of the good work of the people and the privileged climate of the region, which guarantees food of great variety and quality. However, with globalization came different culinary trends from around the world, some of them based on a less nutritious and balanced type of diet.

Even knowing the virtues and benefits of the food of our land, we adopt less healthy eating habits. We begin to consume food that reaches our supermarkets from the other side of the planet, in some cases belittling our own. Fast Food was established all over the world, and little by little, we were leaving aside our tradition of cooking patiently and with local products.

The consequences of these changes in habits were felt in general health. Obesity and cases of type 2 diabetes reached peaks never seen before in recent decades. But the worst consequence is that the transmission of knowledge, recipes, and customs that root us in the territory was broken (in part), depriving future generations of enjoying privileged gastronomy and food.

What Is The Mediterranean Diet?

Following the Mediterranean diet could mean that people are more successful in maintaining weight and avoiding chronic diseases. It is low in red meat, sugars, and saturated fats, but high in fresh fruits and vegetables, nuts, and other healthy foods. Along with a healthy lifestyle, this diet offers a host of health benefits: weight loss, cardiovascular and brain health, cancer and diabetes prevention, and improved glucose regulation.

People eat differently in Greece, Italy, France, and Spain, so there is no single Mediterranean diet, but many principles are shared, a consumer-friendly Mediterranean diet pyramid that offers guidelines on how to fill a plate was developed. What is this diet based on? Simple cuisine, rich in vegetables, with most meals composed of fruits and vegetables, whole grains, beans and seeds, nuts, and which it is essential to cook with olive oil. Refined sugar and flour are rarely used. Saturated fats are only consumed from time to time. The diet encourages meals with friends or family, paying attention while eating, and exercising for a healthy lifestyle.

What Characterizes The Mediterranean Diet and How Should You Follow It?

• The oil, which is virgin olive: Olive oil is the king of oils, both for its flavor and for its nutritional qualities. Use it for both seasoning and cooking, but be careful with the quantities. Remember that it is fat, and although it is healthy it has a high caloric value.
• Foods of vegetable origin in abundance: Vegetables, vegetables, fruits, legumes, nuts, and even mushrooms. These foods should not be missing from your table at any meal.
• If they are seasonal, much better: Our temperate and varied climate guarantees a great diversity of foods throughout the year. Consume seasonal vegetables and fruits to enjoy your best version.
• Flours and cereals: They should not be missing from your daily diet. They are a fundamental piece to balance your diet, since they are the main source of carbohydrates, and these must account for about 55% of the daily caloric intake for the diet to be balanced. For people with diabetes, it is advisable to consume cereals and whole-grain flours, since their absorption is slower, they cause lower spikes in blood glucose and provide greater amounts of fiber.
• Dairy and cheeses: They are an excellent source of protein, vitamins, and minerals. In addition, microorganisms in yogurt and other dairy ferments improve the balance of intestinal flora.
• Little red meat, fewer sausages: Meat is part of the Mediterranean diet but in moderation. Once a week would suffice as it contains a lot of saturated fats. Unlike in other cultures… The hamburger is not considered breakfast!
• More fish than meat: Fish is, nutritionally, much more suitable than meat. Ideally, eat fish at least twice a week, and alternate between white fish and oily fish.
• Eggs yes or eggs no?: Eggs are a very complete food, they contain almost everything that the body needs (protein, lipids, and vitamins), so their consumption is more than justified. Of course, it is not recommended to moderate your consumption of them, since their abuse could increase cholesterol levels.
• For dessert, fruit: They say that men only eat those fruits that are easy to peel. If you are a man, make an effort or eat the apple with skin! If you have diabetes, it’s best to eat ripe fruits.
• To drink, water is the best: Although the Mediterranean basin is a land of good wine, no drink is as healthy as water. If you get used to drinking water with your meals, your body will thank you.

Diabetes: An Increasingly Widespread Disease

More and more people in the world are facing, in the course of life, a diagnosis of diabetes mellitus. this disease represents an important public health problem, and its management is a challenge for doctors and patients.

The mere presence of diabetes, regardless of other pathologies often associated with it (such as hypertension, and obesity …) confers a doubled risk, compared to healthy controls, of encountering cardiovascular complications, such as heart attack, cerebral stroke, and peripheral arterial disease.

The adoption of a correct lifestyle remains a milestone to prevent complications and improve the quality of life of patients with diabetes; the reduction of body weight, in particular, is associated with a significant reduction in glycated hemoglobin values and cardiovascular risk. Obesity is in fact one of the main causes of diabetes mellitus, as well as one of the elements that, together with hypertension, dyslipidemia, and diabetes itself contribute to establishing the increasingly widespread condition that takes the name of metabolic syndrome.

In association with physical activity, diet, therefore, plays a fundamental role in patients with diabetes.

Diabetes and the Mediterranean diet

The Mediterranean diet is characterized by low calorie intake, reduced cholesterol and saturated fats and a high share of fiber and vegetable proteins. Diabetic people with a good adherence to a dietary style in line with that of the Mediterranean diet are able to achieve a reduction in body weight, better overall glycemic control – which is reflected in lower glycated hemoglobin values – a lower glycemic index – ie the glycemic peak that occurs following the intake of a food – and a lower level of subclinical inflammation. The best control of the disease (expressed in terms of arterial hypertension, LDL cholesterol, HDL cholesterol, triglycerides, glycated hemoglobin) is reflected in a 21% reduction in cardiovascular risk, according to a recent 2018 paper.

The benefits of the Mediterranean diet also affect those who do not have a diagnosis of diabetes, people who may be hypertensive or overweight, and even those who do not have any risk factors. In all these categories the Mediterranean diet prevents obesity and increased abdominal circumference and reduces cardiovascular risk and mortality related to it.

What are the mechanisms by which the Mediterranean diet protects against the risk of diabetes and its complications?

First of all, the Mediterranean diet, rich in fiber linked to the intake of fruits, vegetables and whole grains, prevents weight gain through mechanisms such as the sense of satiety, low caloric intake, the containment of the post-prandial glycemic peak, with a consequent reduction in insulin secretion and lipogenesis (production of fat from carbohydrates).

The key concept, however, is that of “insulin resistance”. What is it? The decreased action that insulin exerts on cellular receptors, and therefore on tissues, due to a “resistance” of the receptors themselves, and the consequent need for an increase in insulin secretion to obtain the normal effects produced by it.

Insulin resistance is the main mechanism underlying the onset of type 2 diabetes, and body fat induces insulin resistance. In a vicious circle, insulin resistance is the cause of dyslipidemia, hyperglycemia, endothelial dysfunction, and increased risk of developing atherosclerosis, while adipose tissue produces inflammatory substances that further increase insulin resistance.

The reduction of body fat resulting from the intake of a low-calorie diet is therefore fundamental in breaking this vicious circle. But it is not the only mechanism: the Mediterranean diet is rich in polyphenols, and antioxidant substances contained in various foods, including fruits, vegetables, red wine, olive oil, legumes, and dried fruits. Polyphenols are the most important source of antioxidants and anti-inflammatory substances that we can take with food, and contribute significantly to reducing insulin resistance. According to clinical studies, they work by slowing down the digestion of carbohydrates and the absorption of glucose, stimulating insulin secretion, activating insulin receptors and improving insulin sensitivity. The results are a long-term reduction in glycated hemoglobin and fasting blood glucose levels.

Important is also the contribution of phytosterols, compounds structurally similar to cholesterol but without atherogenic abilities, by vegetable fibers, dried fruit, olive oil: phytosterols are absorbed in the intestine by the same cholesterol receptors, thus reducing the uptake of cholesterol by the liver and stimulating it to produce additional receptors for the uptake of LDL. The fermentation of fiber in the intestine also raises the levels of short-chain fatty acids, which produce an inhibition of cholesterol synthesis. The result is a reduction in total cholesterolemia and LDL cholesterol. Added to this is the fact that the Mediterranean diet is rich in polyunsaturated fatty acids (fish, olive oil) and low in saturated fats: being the latter precursors of LDL cholesterol, following a diet of this type helps to keep LDL cholesterol levels constantly low.

The Good Diet For Diabetes: Some General Principles

• The ideal diet for the prevention and treatment of people with diabetes involves a diet rich in fiber (from vegetables, fruits, and unrefined cereals) and low in animal fats.
• The sources of carbohydrates to be preferred are whole grains, fruits, legumes and vegetables; in general, it is preferable to avoid carbohydrates with a high glycemic index (the use of carbohydrates with a low glycemic index allows to improve blood sugar control and also reduces the risk of hypoglycemia). There is currently no evidence to suggest the use of low-carbohydrate diets (“low carb” diets, < 130 g/day) in people with diabetes who should take them in such quantities as to guarantee 45-60% of total daily calories.
• Although the use of sucrose (the common cooking sugar) and other simple sugars should not be demonized, it is important to avoid their habitual consumption, also with a view to weight control.
• Acaloric sweeteners are safe when consumed in moderate amounts.
• In the presence of normal kidney function, protein should provide 10-20% of the calories introduced daily with the diet. High-protein diets (> 20%) in people with diabetes should be avoided due to a possible increase in cardiovascular risk and damage to kidney function in the long term.
• Dietary intake of saturated fats and trans fats should be limited to the maximum; in general, dietary fats should provide 20-35% of the total daily energy, cholesterol intake should not exceed 300 mg per day.
• Including fish in the diet (preferably blue) twice a week provides a good supply of polyunsaturated fatty acids, useful and not harmful.
• A moderate introduction of alcohol, up to 10 grams per day in women and 20 grams per day in men is acceptable, except in obese subjects or with high triglyceride values. Alcohol intake is absolutely not recommended for pregnant women and for subjects with a history of pancreatitis. Individuals treated with insulin may take alcohol, but only in the context of a meal.
• The consumption of foods rich in antioxidants, microelements and vitamins, all contained in fruits and vegetables, should be encouraged. There is no scientific evidence of the usefulness of giving people with diabetes vitamin supplements (except of course in deficiency states) and even the use of “dietary” foods for diabetics is not supported by scientific evidence.

To Sums Everything Up 

When we talk about “Diabetes” we may refer to one in particular, but with this word, we encompass many types. The most common is type 2 diabetes with which the body does not produce or use insulin well. (This is a hormone that helps glucose enter cells to give them energy.) Without insulin blood glucose levels are too high, so over time, it can cause problems for the heart, eyes, kidneys, nerves, gums, and teeth.

If your blood tests reveal sugar levels above 100, it obviously doesn’t mean you have diabetes, but it’s a sign that your metabolism is out of control. In this situation we will have to pay attention to the diet, the main solution to control the levels of our body.

Professionals unanimously recommend opting for the Mediterranean diet since there are many studies that prove that this type of diet is the one that best regulates blood glucose levels and manages to reverse diabetes and obesity.

Even so, it should be noted that in the original Mediterranean diet there are no sugars from processed products. The World Health Organization (WHO) advises against exceeding 25 g of sugar daily, but most of the population takes much more.

A figure that we currently exceed because we are not aware of the amount of sugar hidden in processed foods from which we already get 80% of what we need. Not only sweet, but also salty: pastries, sauces, pre-cooked dishes. For example, a can of carbonated soft drink contains up to 40gr of sugar.

Ultra-processed foods have different types of names: dextrose, fructose, glucose, maltose, sucrose, agave… Between five and seven grams of these ingredients are already equivalent to one sachet of those used for coffee.

Following a Mediterranean diet, without alterations, we will get our body used to having correct levels and thus function more efficiently and effectively. For example, carbohydrates stimulate the work of the pancreas and generate insulin.

Among other benefits of this diet so ours we find the balance of dishes, by combining carbohydrates with proteins and vegetables (rice, legumes, fished vegetables …); the accompaniment of a salad that carries antioxidants and avoids glucose peaks or the presence of more fish than meat.