Type 2 diabetes and the Mediterranean diet

The number of people with type 2 diabetes is increasing, with the rise in numbers heavily linked to lifestyle and dietary intake. Specific factors such as physical inactivity, and a diet low in fibre and high in fat, sugar and salt have been found to play an important role in the development and management of type 2 diabetes.

What is the Mediterranean diet?

Although the Mediterranean diet uses the word 'diet', it is different to other forms of diets that focus on specific food groups or restrict certain foods. The Mediterranean diet factors in lifestyle and behavioural patterns which, for a condition such as type 2 diabetes, is vitally important. The Mediterranean diet is a way of eating that incorporates nutrition, culture, seasonal and local produce, socialisation, and lifestyle.

Benefits of the Mediterranean diet for type 2 diabetes 

There are many benefits of the Mediterranean diet for individuals with type 2 diabetes:

1. Improve weight-loss and reduce obesity

The lifestyle pattern associated with the Mediterranean diet takes into consideration nutritional intake but also promotes being physically active. Both nutritional intake and physical activity play a role in reducing obesity levels and in the prevention and management of type 2 diabetes. It has been shown that for those with type 2 diabetes, a 5% reduction in weight can significantly improve blood sugar levels and reduce the risk of secondary complications associated with type 2 diabetes.

2. Anti-inflammatory and antioxidant-rich

Antioxidants are molecules that help to fight off harmful compounds called free radicals. A high number of free radicals in the body can increase the risk of illness and disease including type 2 diabetes. The Mediterranean diet is rich in anti-inflammatory and antioxidant foods through a high consumption of fruit and vegetables as well as healthy fats from olive oil, nuts, and fish.

Fruit and vegetable intake is heavily associated with a reduction in the risk of cardiovascular disease, which is a secondary complication of type 2 diabetes. This is partly thought to be due to the cardioprotective effects of antioxidants.

Good sources of foods containing high levels of antioxidants include:

• blueberries
• strawberries
• raspberries
• tomatoes
• broccoli
• kale
• red cabbage
• beans

3. Promotes good gut health

Type 2 diabetes is a metabolic disease characterised by the inability to regulate blood glucose levels. Recent research has focused on the impact our gut health and gut microbiome, which controls our gut health, has on disease and associated risks. The gut microbiome directly affects the breakdown of carbohydrate and fat molecules. This can play a major role in the ability to control blood sugar levels which for those with type 2 diabetes is essential.

Those with type 2 diabetes have been found to have reduced diversity and a less stable gut microbiome. A good gut microbiome can be positively influenced by consuming a variety of foods, especially a diverse range of fruits and vegetables. The saying 'eat the rainbow' is an appropriate method of encouraging a variety of fruit and vegetable intake. The more colours you eat, the larger the variety of vitamins and minerals within your diet. The Mediterranean diet promotes a way of eating that encourages the consumption of foods containing healthy fats, fruits and vegetables and high-fibre-containing carbohydrates.

4. High in dietary fibre and complex carbohydrates

The Mediterranean diet encourages the intake of wholegrains and complex carbohydrates which are high in dietary fibre. Complex carbohydrates are carbohydrates which, due to their high fibre content, are broken down slowly by the body. This results in a slower and more stable increase in blood sugar levels, minimising blood sugar highs and lows.

The high dietary fibre of the Mediterranean diet also plays a role in weight management as the dietary fibre keeps us feeling fuller for longer. The feeling of fullness can help with control over energy intake and reduce the likelihood of overconsumption. In addition, dietary fibre helps to promote good gut health by creating a variety of gut bacteria - and good gut health helps to manage blood sugar levels.

Good sources of high-fibre complex carbohydrates:

• wholegrain pasta
• brown rice
• oats
• grains and pulses (quinoa, chickpeas, kidney beans, lentils)
• potatoes and sweet potatoes

The Mediterranean diet and lifestyle approach is appropriate for individuals with type 2 diabetes and has many benefits. It encourages a lifestyle that does not restrict certain food groups and does not promote the typical 'diet' pattern of avoiding certain foods, in particular carbohydrates. It emphasises the importance of fruits and vegetables, wholegrains, and healthy fats while consuming a moderate to low amount of dairy, meat, and alcohol.

The benefits of the Mediterranean diet for those with type 2 diabetes discussed above are interlinked. For example, high intakes of fruit, vegetables and wholegrains promote good gut health which can improve blood glucose control which, in turn, reduces the risk of secondary complications.

Type 2 diabetes can be a life-inhibiting condition but changes to diet and lifestyle can help to prevent and manage the condition. As a registered associate nutritionist who specialises in type 2 diabetes, I don't recommend specific diets or restricted eating plans. My approach focuses on lifestyle and behavioural factors which create a balance between health and enjoyment. If you would like more information or help relating to type 2 diabetes and nutritional intake, please don't hesitate to contact me.

References

1. D'Innocenzo, S., Biagi, C. and Lanari, M. 2019. 'Obesity and the Mediterranean Diet: A Review of the Evidence of the Role and Sustainability of the Mediterranean Diet'. Nutrients. 11(6), pp. 1306.

2. Martín-Peláez, S., Fito M., and Castaner, O. 2020 'Mediterranean Diet Effects on Type 2 Diabetes Prevention, Disease Progression, and Related Mechanisms. A Review'. Nutrients. 12(8), pp.2236.