Mediterranean Diet and Diabetes: Prevention and Treatment

Diabetes mellitus, or diabetes, is a disease affecting the regulation of blood glucose (sugar) levels.

An organ called the pancreas creates the hormone insulin, which helps keep blood sugar levels in a healthy range.

With diabetes, the pancreas either doesn’t make enough insulin, or the body doesn’t respond to it well. Without proper insulin function, blood sugar levels rise and can lead to health problems if left untreated.

Diabetes is becoming more prevalent worldwide. As of 2015, 30.3 million people in the United States, or about 9.4 percent of the population, had diabetes. Unfortunately, more than 1 in 4 people with diabetes don’t know they have it. Having undiagnosed diabetes increases the risk of complications from lack of prompt treatment.

Many people also have prediabetes, a condition where blood sugars are slightly elevated but not high enough to be considered diabetes. Having prediabetes is a significant risk factor for eventually developing type 2 diabetes.

The U.S. Centers for Disease Control (CDC) estimates that up to 30% of people with prediabetes will develop type 2 diabetes within five years of their prediabetes diagnosis.

Chronic high blood sugars increase the risk of diabetes complications, so keeping blood sugar levels controlled is the main priority for managing diabetes. One of the ways to help promote good blood sugar control is through healthy lifestyle habits.

Along with other aspects of diabetes self-management, a healthy diet can help improve blood sugars and reduce the risk of other chronic diseases like heart disease and hypertension, which people with diabetes are more likely to have. 

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What is a Mediterranean diet?

A Mediterranean diet is a style of eating that focuses on plant-based foods. It’s based on foods that people eat in Greece and Italy, but isn’t limited to those countries.

A Mediterranean style diet isn’t as much of a diet as it is a lifestyle. Unlike many fad diets, there aren’t foods that are considered not allowed, nor are there any point system, measuring, etc. Thus, it tends to be easier to adopt long-term, so it is more effective at providing health benefits.

A typical Mediterranean diet emphasizes plant-based foods as the backbone of the diet. Fruits, vegetables, whole grains, legumes, nuts, and seeds are abundant in this style of eating, as are healthy fat such as olive oil and avocados.

Meat, dairy, processed foods, and refined sugar are avoided, and the emphasis is put on whole foods. While sugary drinks are avoided, moderate amounts of alcohol such as red wine are included, but of course, this is entirely optional.

The different types of foods in a Mediterranean-style diet include:

  • Vegetables: Tomatoes, broccoli, kale, spinach, onions, cauliflower, carrots, Brussels sprouts, cucumbers, etc.

  • Fruits: Apples, bananas, oranges, pears, strawberries, grapes, dates, figs, melons, peaches, etc.

  • Nuts and seeds: Almonds, walnuts, macadamia nuts, hazelnuts, cashews, sunflower seeds, pumpkin seeds, etc.

  • Legumes: Beans, peas, lentils, pulses, peanuts, chickpeas, etc.

  • Tubers: Potatoes, sweet potatoes, turnips, yams, etc.

  • Whole grains: Whole oats, brown rice, rye, barley, corn, buckwheat, whole wheat, whole-grain bread, and pasta.

  • Fish and seafood: Salmon, sardines, trout, tuna, mackerel, shrimp, oysters, clams, crab, mussels, etc.

  • Poultry: Chicken, duck, turkey, etc.

  • Eggs: Chicken, quail, and duck eggs.

  • Dairy: Cheese, yogurt, Greek yogurt, etc.

  • Herbs and spices: Garlic, basil, mint, rosemary, sage, nutmeg, cinnamon, pepper, etc.

  • Healthy Fats: Extra virgin olive oil, olives, avocados, and avocado oil.

Foods not eaten on a Mediterranean diet include:

  • Added sugar: Soda, candies, ice cream, table sugar, and many others

The American Heart Association recommends that women consume no more than 6 teaspoons of added sugar per day (24 grams) and men consume no more than 9 teaspoons of added sugar per day (36 grams).

  • Refined grains: White bread, pasta made with refined wheat, etc.

  • Refined oils: Soybean oil, canola oil, cottonseed oil, and others.

  • Processed meat: Processed sausages, deli meats, hot dogs, etc.

  • Highly processed foods: Packaged foods with a long list of ingredients.

In addition to eating more whole, plant-based foods, the Mediterranean diet is also coupled with increased physical activity.

Many of the Mediterranean “food pyramids” show physical exercise at the base, meaning it’s the most important and should be the priority. Getting at least 30 minutes of moderate to vigorous activity each day is recommended.

Can a Mediterranean diet benefit those with diabetes?

Reduction in diabetes risk. 

A Mediterranean diet is associated with a reduced risk of developing type 2 diabetes. Some studies have found as much as an 83% reduction in diabetes risk when a Mediterranean diet was followed. It’s also estimated that as many as one in three people will have diabetes in 2050, so prevention is especially important for those at higher risk.

Risk factors for developing type 2 diabetes (the most common type) include:

  • Weight: people who are considered overweight or obese according to their body mass index (BMI).

  • Age: people 45 and older are at increased risk.

  • Family history of diabetes

  • Race/ethnicity: diabetes tends to affect certain races more than others. At-risk races include African American, Alaska Native, Native American, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander.

  • High blood pressure: if your blood pressure is higher than 120/80, you may be at increased risk.

  • Altered lipid levels: low levels of HDL “good” cholesterol and high levels of LDL “bad” cholesterol are risk factors, as well as high triglycerides (blood fat).

  • Pregnancy history: women with a history of gestational diabetes (GDM) or gave birth to a baby 9 pounds or heavier are at increased risk.

  • Physical activity: people who aren’t regularly active or who have a sedentary lifestyle are at increased risk.

  • Smoking status: Smokers are 30-40% more likely to develop type 2 diabetes than nonsmokers.

  • Health history: those with a history of heart attack or stroke have a higher likelihood of developing type 2 diabetes.

  • PCOS: Polycystic Ovarian Syndrome in women is a risk factor, as it usually is associated with insulin resistance.

  • Acanthosis nigricans: dark, velvety patches of skin are a sign of insulin resistance and are a risk factor for developing diabetes. These patches of skin usually occur around the neck or armpits.

Lower risk of developing heart disease

People with diabetes are two to four times more likely to die from cardiovascular disease than those without diabetes. People with diabetes are also more likely to have high blood pressure, which is another risk factor for heart disease.

The Mediterranean diet is associated with a 30% reduced risk of heart disease, stroke, and death compared to people following a low-fat diet.

The low-fat diet used to be recommended for heart health, but recommendations have changed as more research has been done. Low-fat diets often replace some of the fat with carbohydrates, which is potentially more detrimental to health. Fat-free foods can be higher in sugar and carbohydrate-based thickeners to try to improve the taste and texture with the loss of fat content.

The Mediterranean diet isn’t a low fat diet but is instead rich in plant-based fats. These fats are heart-healthy monounsaturated and polyunsaturated fats, which describe their chemical chain. On the other hand, saturated fats have been associated with an increased risk of heart disease, though this topic has recently been highly debated.

Foods high in saturated fat typically come from animal products such as meat and dairy. The Mediterranean diet doesn’t include meat and instead focuses on seafood or poultry for protein, which is why it tends to be lower in saturated fat than the traditional Western diet.

Improved blood sugar control

For people with diabetes, a Mediterranean diet can promote healthier blood sugar levels. Part of the reason is that added sugar consumption is much lower on a Mediterranean diet. Added sugar is linked with an increased risk of diabetes.

It’s thought to have this impact by increasing fat in the liver, which can cause insulin resistance and inflammation. Fructose may be especially harmful, which is why high-fructose corn syrup (a commonly used sweetener due to its low cost and ease of use) isn’t recommended. Instead, eating naturally sweet foods such as fruit is a much healthier option.

Foods on the Mediterranean diet are also rich in fiber. Whole fruit and vegetables, whole grains, legumes, nuts, and seeds are all staples in the Mediterranean diet and are also excellent fiber sources. Fiber helps to delay the release of carbohydrates into the bloodstream, making it helpful in preventing blood sugar spikes and crashes. Fiber is also beneficial for heart health by promoting healthy cholesterol levels. 

People with diabetes are more likely to have dyslipidemia, which means “bad” cholesterol is high, and “good” cholesterol is low. The Mediterranean diet is a good remedy for dyslipidemia because it’s rich in plant-based foods and lower in saturated fat, and higher in fiber, which may improve cholesterol.

More omega-3 fatty acids

Omega-3 fatty acids are found in some plant-based fats as well as fatty fish such as salmon. The Mediterranean diet focuses on eating more fish, like salmon, instead of red meat. It also includes more nuts and seeds than the traditional Western diet, which are good plant sources of these beneficial fatty acids.

Omega-3 fats have heart health benefits such as reducing blood fat, increasing good cholesterol, among many others. They are especially abundant in salmon, walnuts, flaxseeds, and chia seeds.

Less sodium

Processed foods such as hot dogs, deli meats, and frozen entrees are loaded with sodium, increasing blood pressure. Many people with diabetes also struggle with high blood pressure, which increases the risk of heart disease and stroke.

The Mediterranean diet avoids processed foods, which helps reduce overall sodium consumption. It also uses herbs and spices to flavor foods instead of salt or other sodium-based flavorings like monosodium glutamate (MSG). The average American eats 3,400 milligrams of sodium, while the recommended amount of sodium per day is less than 2,300 milligrams or less. 

The Mediterranean diet is often recommended for people with high blood pressure and heart disease because it’s lower in sodium. A version of the Mediterranean diet is called the DASH diet, which stands for Dietary Approaches to Stop Hypertension. 


Diet and nutrition play a large role in blood glucose levels for people with prediabetes and diabetes. The Mediterranean diet is a popular diet that has long been known for its numerous health benefits, including reduced diabetes and heart disease risk.

The Mediterranean diet is more of a lifestyle, not a restrictive diet with foods “not allowed.” It emphasizes regular physical activity and focuses on fruits, vegetables, whole grains, legumes, nuts, seeds, and healthy fats like avocados and olive oil.

Red and processed meats usually aren’t the protein of choice, but instead, fish and other seafood are utilized more often in addition to poultry. The Mediterranean diet is higher in omega-3 fatty acids from foods like salmon, walnuts, and other seeds. Omega-3 fatty acids can help reduce inflammation and may be protective against heart disease.

The Mediterranean diet is very different from the typical Western diet, which tends to be high in processed foods and added sugars.

Added sugars have been found to play a role in developing diabetes and even heart disease, so avoiding them is beneficial for overall health and diabetes prevention. The Mediterranean diet for diabetics is also lower in sodium, so it is beneficial for people with high blood pressure or at risk of heart disease.

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  5. Omega-3 Fatty Acids and Heart Health, Ashish Chaddha, Kim A. Eagle, 2015;132:e350–e352

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