The Mediterranean Diet and Diabetes

You may have been hearing a lot about the Mediterranean diet lately, and for good reason. In 2024, this eating approach was named the number one “Best Diet Overall” by U.S. News & World Report for the seventh consecutive year.

Widely studied by researchers and healthcare professionals for over 80 years — and particularly since the 1990s — this diet has demonstrated significant benefits for heart disease, metabolic syndrome, type 2 diabetes, obesity, and certain cancers.

This article will explore the Mediterranean diet — what it is, the foods to eat, and the benefits it offers. But is this diet good for people who have diabetes? Keep reading to find out.

What is the Mediterranean diet?

The Mediterranean diet is not exactly a diet. Rather, it’s a way of eating based on the foods and cultures of more than 20 countries bordering the Mediterranean Sea. These countries include Greece, Italy, Spain, Portugal, Turkey, Morocco, and Croatia. 

In 1993, the Harvard School of Public Health, Oldways Preservation and Exchange Trust, and the European Office of the World Health Organization introduced the Mediterranean Diet Pyramid. The pyramid highlighted commonly eaten foods in Crete, other regions in Greece, and southern Italy during the mid-20^th century.

At the same time, researchers realized that people in these countries had low rates of chronic disease and a longer life expectancy. The conclusion was that their diet, consisting mainly of fruits, vegetables, legumes, whole grains, nuts, fish, and olive oil was contributing to these health benefits.

However, there is no “one” Mediterranean diet. The style of eating varies from country to country due to differences in culture, religion, economy, and agricultural production. 

What are the benefits of the Mediterranean diet?

There are many health benefits attributed to a Mediterranean way of eating supported by numerous studies. Some of the primary benefits include:

Improved heart health

This diet is associated with a lower risk of heart disease, stroke, and other heart-related conditions. This improvement in heart health is likely linked to the emphasis on eating healthy fats, fruits, vegetables, and whole grains. 

Improved blood sugars

The Mediterranean diet has been shown to improve blood sugars, A1c, and insulin sensitivity in people with diabetes. The focus on eating whole, unprocessed foods, fiber-rich fruits, vegetables, whole grains, and healthy fats helps to stabilize blood sugar levels and can even help reduce the risk of type 2 diabetes. 

Weight management

This diet can help with losing and managing weight, again, due to its focus on nutrient-dense foods, moderate portions, and healthy fats. 

Studies suggest that people following this type of eating pattern are more likely to achieve and maintain a healthy weight compared to people following other types of diets. One possible reason: It’s easier to stick with this way of eating for long periods of time, unlike some other diets that are rigid and restrictive. 

Anti-inflammatory effects 

Chronic inflammation is linked to a variety of health conditions, such as heart disease, diabetes, metabolic syndrome, and autoimmune disorders. The Mediterranean diet has been shown to protect against these diseases thanks to the foods that make up this way of eating; these foods are rich in antioxidants, omega-3 fatty acids, vitamins, and trace minerals.

Cancer prevention

Studies suggest that the Mediterranean diet may help lower the risk of some types of cancer, including breast, colorectal, and prostate cancer. Foods included in this diet contain antioxidants and anti-inflammatory nutrients that protect against cancer. 

Brain health

The Mediterranean diet, as well as another diet called the MIND diet, may help protect against brain damage caused by Alzheimer’s disease. Foods included in both diets, especially green leafy vegetables, berries, beans, nuts, and fish may slow cognitive decline and lower the risk of Alzheimer’s. 

Longevity 

Eating a Mediterranean diet is associated with a longer lifespan and lower risk of early death from all causes. A study published in a 2014 issue of the journal BMJ found that greater adherence to the Mediterranean diet was associated with longer telomeres. Telomeres, found at the end of chromosomes, are a biomarker of aging: The longer the telomeres, the longer the life expectancy. 

What types of foods can you eat on this diet?

The Mediterranean diet emphasizes a wide variety of whole, unprocessed foods, which are mostly plant-based. Smaller amounts of poultry, fish and other seafood, meat, eggs, and dairy foods are also included.

Fruits, vegetables, legumes, nuts, seeds, whole grains, seafood, olive oil, herbs, spices, and even red wine, coffee, and tea comprise this way of eating. 

Because plant-based foods and healthy fats make up the bulk of the Mediterranean diet, there is little room for the saturated and trans fats, added sugars, and sodium that are characteristic of a typical American-style diet. 

Unlike many other popular diets, the Mediterranean diet is more than just eating certain foods. 

Lifestyle plays a key role, as well. Adopting a Mediterranean lifestyle, such as incorporating sufficient physical activity, rest, mindfulness, social habits, and adequate sleep, also contributes to the health benefits that this way of eating offers. 

Interacting with other people and having a sense of community have been shown to be particularly important for people as they get older, as social isolation can increase the risk of heart attack, stroke, and dying. 

How can this way of eating help you manage diabetes?

You might be wondering if a Mediterranean eating pattern can be helpful for someone who has diabetes. The short answer: Yes. 

The emphasis on eating whole, nutrient-rich, less-processed foods means that the Mediterranean eating pattern can help with managing diabetes. Here’s how:

Weight management

Not everyone who has diabetes needs to lose weight. But weight loss — even small amounts of weight loss — can help improve insulin sensitivity and lower blood sugars, too, especially in people with type 2 diabetes.

Fiber-rich foods

The United States Department of Agriculture (USDA) estimates that 95 percent of American adults and children do not consume the daily recommended amounts of fiber. One reason? Many of the foods in a typical American diet are overly processed and stripped of fiber, along with other important nutrients. 

The Mediterranean eating pattern, however, emphasizes fiber-rich foods that can help slow the absorption of glucose from carb digestion into the bloodstream, preventing or limiting glucose spikes after meals. 

Healthy fats

The types of fats that are part of the Mediterranean eating pattern, including monounsaturated fat found in olive oil, and omega-3 fatty acids found in fatty fish, are thought to improve insulin sensitivity and reduce inflammation. 

Lean protein foods

This diet promotes lean protein from poultry, fish, and legumes which, like fiber, help keep blood sugars more stable and promote satiety (feelings of fullness). 

Antioxidants

Antioxidant-rich foods, such as fruits, vegetables, herbs, and spices, help to reduce oxidative stress and inflammation, which are associated with diabetes complications. 

Fewer processed foods

Refined grain foods, sugary snacks, sweetened drinks, fast foods, and other highly processed foods are not a part of the Mediterranean eating pattern. These foods are linked with a higher risk of developing type 2 diabetes. For people who have diabetes, processed foods may make it more challenging to manage blood sugars and can increase insulin resistance.

Heart health

Research shows that the Mediterranean eating pattern can improve heart health and lower the risk of heart disease, heart attack, and stroke. Heart disease is one of the major complications of diabetes, and a leading cause of death in people with diabetes.

Prediabetes and the Mediterranean diet

Prediabetes is a condition characterized by blood sugar levels that are higher than normal but not yet high enough to be classified as type 2 diabetes. 

Research has shown that the Mediterranean diet can improve insulin sensitivity and reduce fasting blood glucose levels in those with prediabetes. 

The diet’s high fiber content helps slow the absorption of sugar into the bloodstream, preventing spikes in blood glucose levels. Additionally, the anti-inflammatory properties of the foods included in this diet can reduce chronic inflammation, a key factor in the development of insulin resistance and type 2 diabetes.

A randomized controlled trial published in The New England Journal of Medicine found that participants following a Mediterranean diet supplemented with extra-virgin olive oil or nuts had a significantly lower risk of developing type 2 diabetes compared to those on a low-fat diet. 

What are the best foods to eat on a Mediterranean diet?

Fortunately, with this type of eating pattern, there is no shortage of variety or foods to eat! However, some foods are better than others in terms of managing blood sugars. Here are some of the best “diabetes-friendly” foods to include in your eating plan:

• Non-starchy vegetables: E.g., spinach, kale, lettuce, broccoli, cauliflower, Brussels sprouts, artichokes, eggplant, celery, mushrooms, green beans, cucumbers, tomatoes, peppers, zucchini, leeks, onions.
• Fruits: E.g., berries, apples, oranges, clementines, melons, nectarines, peaches, pears, cherries, pomegranates, tangerines.
• Whole grains: E.g., whole-wheat bread, farro, quinoa, brown rice, barley, bulgur, oats, corn.
• Legumes: E.g., chickpeas, lentils, black beans, kidney beans, fava beans, cannellini beans, peas.
• Nuts and seeds: E.g., almonds, cashews, hazelnuts, pine nuts, pistachios, walnuts, sesame seeds, sunflower seeds, pumpkin seeds, chia seeds, hemp seeds, peanut butter, almond butter.
• Fatty fish: E.g., salmon, mackerel, sardines, trout, tuna, herring.
• Lean protein: E.g., skinless chicken and turkey, eggs, mussels, clams, oysters, shrimp, lean beef, pork. Red meat is generally limited to a few times per month.
• Dairy foods: E.g., low-fat plain Greek yogurt, ricotta, feta, Manchego, halloumi, Parmigiano-Reggiano, pecorino cheese.
• Fats: E.g., olive oil, olives, avocados, nuts, seeds.
• Herbs and spices: E.g., anise, basil, bay leaf, chiles, cloves, cumin, fennel, garlic, mint, oregano, parsley, pepper, rosemary, sage, tarragon, thyme, za’atar.
• Beverages: E.g., water, sparkling water, coffee and tea (without added sugar or cream), skim or 1 percent fat milk.
• Wine: Red wine is often consumed — in moderation. “Moderation” means up to one 5-ounce glass of wine per day for women and up to two five-ounce glasses of wine per day for men.

Foods to limit on the Mediterranean diet

The foods listed above are the mainstays of a Mediterranean eating plan. While no foods are entirely forbidden altogether, there are certain foods that should be limited to reap the health benefits that this eating plan offers: 

• Refined grain foods: E.g., white rice, white bread, white pasta.
• Added sugars and sweets: E.g., desserts, candies, cookies, pastries, sweetened yogurt, sweetened cereals, sweetened instant oatmeal.
• Highly processed foods: E.g., frozen meals, chicken nuggets, packaged soups, potato chips, fast foods.
• Processed meats: E.g., cold cuts, hot dogs, sausages, bacon.
• Saturated fats: E.g., butter, margarine, full-fat dairy foods, fatty cuts of meat.
• High-sodium foods: E..g, canned soups and vegetables, salty snacks, fast foods, frozen meals.
• Sweetened beverages: E.g., soda, fruit juices, energy drinks, sweetened tea, sweetened coffee drinks, sweetened milk drinks.

What are the drawbacks of the Mediterranean diet?

While the Mediterranean diet has a lot going for it, this way of eating may not be best suited for everyone. Some general concerns may be:

• Dealing with weight gain from eating too many nuts, seeds, or olive oil, or eating “Americanized” versions of foods, such as fried cheese or heavy pasta dishes.
• Developing lower iron levels from not eating as much or eating smaller portions of animal foods.
• Not getting enough calcium from not eating as many dairy foods as you used to.
• The potential negative health effects of drinking wine, especially if you are pregnant or planning a pregnancy, or have alcohol dependence or other health conditions.
• The cost of foods on this eating plan.

Note that these concerns can easily be addressed by working with your healthcare team, including a registered dietitian nutritionist (RD/RDN) to ensure that you can reach and stay at a weight goal, as well as obtain essential nutrients for good health. And while wine is a part of the Mediterranean lifestyle, there is no mandate that you drink wine if you choose not to.

While some foods on a Mediterranean diet may seem cost-prohibitive (think pomegranates, fancy olive oil, nuts), there are plenty of foods that can fit into your food budget, including peanut butter, legumes, canned fish, and seasonal fruits and vegetables.

Is the Mediterranean diet right for me?

You might be wondering if a Mediterranean eating pattern is right for you if you have diabetes. After all, there are no set rules that you must follow, nor are there foods that you need to stay away from completely. And because this eating pattern includes foods that contain carbs, how will that impact your blood sugars?

Here are some tips for making the Mediterranean eating pattern work for you:

Monitor your carbs

Watch portions and count carb grams to help you manage your blood sugars. A dietitian can give you guidance on how many grams of carbs to aim for at meals and snacks, as well as suggest portion sizes for you.

Balance carbs with protein and fat

Don’t ditch the whole grains and fruits at your meals and snacks. Instead, include a protein source and a healthy fat to help keep your blood sugars stable and keep you feeling full.

Emphasize vegetables

There are so many vegetables that are low in carbs and calories, and because of their fiber content, they’ll help to fill you up. 

Pay attention to portions

You might decide to measure out portions, but if that’s not up your alley, use smaller plates and bowls. Fill half of your plate with vegetables.

Stay hydrated 

Drink plenty of water during the day. Flavor plain or sparkling water with slices of lime, lemon, or cucumber, or try using herbs such as mint or basil. 

Monitor your blood sugars

You won’t know how any eating plan impacts your blood sugar unless you check, either with a meter or with a continuous glucose monitor (CGM). Doing so helps you learn how certain foods and meals affect your glucose levels. Work with your healthcare team to adjust your carb goals and diabetes medication, as needed. 

Be active

Remember, diet is not the only aspect of the Mediterranean eating plan. Staying active is also a big part of this way of life and it’s important for managing diabetes.

Seek support

Joining a support group and/or working with a dietitian or other member of your healthcare team can help you navigate any diabetes challenges you are facing. 

A medley of benefits

A Mediterranean-style diet is an evidence-based eating plan that offers numerous health benefits. This way of eating can work for most people, including people who have diabetes.

Its overall approach focuses primarily on plant-based foods, with smaller amounts of meat, poultry, and fish. No food groups are eliminated on this eating plan, although there are foods to limit and eat less often. In addition, a Mediterranean eating pattern encourages regular physical activity, quality sleep, and spending time with family and friends as part of a healthy lifestyle.

People with diabetes can benefit from a Mediterranean eating pattern in terms of improved blood sugars and A1c, reduced insulin resistance, weight loss, and a lower risk of heart disease, a leading complication of diabetes. Check with your healthcare provider or dietitian to find out if this eating approach is right for you. 

Explore some alternative healthful eating approaches in How to Eat a Flexitarian Diet for Diabetes Management and What Is the Best Diet for Type 2 Diabetes? Did you find this article helpful? Click Yes or No below to let us know!