Barbie Cervoni MS, RD, CDCES, CDN, is a registered dietitian and certified diabetes care and education specialist.
Do-Eun Lee, MD, has been practicing medicine for more than 20 years, and specializes in diabetes, thyroid issues and general endocrinology. She currently has a private practice in Lafayette, CA. 
One of the most important concepts in diabetes prevention and management is understanding the elements of healthy eating. Healthy eating has been linked with longevity, increased energy, as well as healthier body weight and reduced risk of cardiovascular disease and diabetes.
When it comes to diabetes, researchers suggest that "Nutrition therapy and regular physical activity are the cornerstones for managing A1C, blood pressure, and cholesterol, and treatment for each has its own set of nutrition guidelines."
Maintaining a healthy weight and losing a modest amount of weight if you are overweight or obese can reduce the risk of developing type 2 diabetes and in some instances put type 2 diabetes in remission if you already have it.
The problem is that many people continue to be very confused as to what they should and should not eat. Should they eat low-carb, keto, low-fat, low-sugar, low-sodium? The answer isn't straightforward because everyone's needs are different.
However, research has consistently demonstrated that adopting a Mediterranean style of eating is advantageous for health and may help to prevent or control type 2 diabetes. Find out what the research says, what the diet entails, and how to implement this type of eating style into your daily regimen.
The Mediterranean diet has been associated with a plethora of positive health outcomes, including improving the gut microbiome, protecting against late-life depression, improving cognitive function in diabetes, and better cardiovascular health outcomes, including reductions in rates of coronary heart disease, ischemic stroke, and total cardiovascular disease.
Researchers believe that the Mediterranean type of eating style inherently targets parameters that are important in controlling diabetes—lowering blood glucose or hemoglobin A1C, blood pressure, and cholesterol. The eating style provides easy guidelines such as eat more fruits and vegetables and limit intake of high fat meat, such as red meat.
Foods found in the Mediterranean diet are naturally low in sodium and saturated fat, and rich in polyunsaturated and monounsaturated fat and fiber. Most people agree that the diet is not only nutritious, but also delicious and sustainable.
In a meta-analysis of 17 studies, the Mediterranean-type diet was found to improve fasting glucose and A1C levels for those with type 2 diabetes. In several other studies, the Mediterranean diet lowered fasting glucose levels in those with diabetes more than did low-fat diets.
When it comes to diabetes prevention, numerous studies have shown that adopting a Mediterranean-style diet has been associated with a decreased risk of diabetes as well as a decreased risk of developing diabetes in those with cardiovascular disease.
In a systematic review that examined the effect of the Mediterranean diet on weight loss and cardiovascular risk factor levels in overweight or obese individuals trying to lose weight for 12 months or more, researchers found that a Mediterranean diet resulted in greater weight loss than compared to the low-fat diet at 12 months or more, but produced similar weight loss as other comparator diets, such as low-carb and American Diabetes Association Diet. 
Most experts refer to the Mediterranean diet as an eating style because the diet varies depending on the culture. For example, people from Greece as compared to people from Italy, don't eat entirely the same.
In addition, over time, different variations of the diet have evolved. For example, there is a lower carbohydrate sub-type and a pescatarian (fish) variation, amongst others.
The good news is that you can adopt this style of eating to match your own lifestyle, making it an attractive type of eating plan that can be followed long-term. Regardless of the variation, the key concepts are the same.
Aim to eat a variety of fruits and vegetables of all colors. Fruits and vegetables should be the base of every meal. They provide volume for little calories and offer a host of health benefits including vitamins, minerals, fiber, antioxidants, phytochemicals, and more. They are also considered anti-inflammatory foods.
Each color of fruits and vegetables provides its own benefits. Therefore, eating a variety of colors not only makes a diet more fun but also provides different types of beneficial nutrients.
For example, orange, yellow, and red fruits and vegetables are rich in carotenoids, which have been shown to combat free radicals and promote eye health. β-carotene, lutein, zeaxanthin, and lycopene and amongst the most common carotenoids. They are found in foods such as carrots, sweet potatoes, kale, collard greens, butternut squash, pumpkin, peppers, spinach, turnip greens, and tomatoes.
Other vegetables that should be eaten in ample amounts for this type of eating style include artichokes, arugula, beets, broccoli, Brussels sprouts, cabbage, carrots, celery, celeriac, chicory, collard cucumber, dandelion greens, eggplant, fennel, kale, leeks, lettuce, mushrooms, mustard greens, okra, onions (red, sweet, white), peas, parsnips, potatoes, purslane, radishes, rutabaga, scallions, shallots, spinach, turnips, zucchini.
All fruits are permitted. Some of the most popular being: Avocados, apples, apricots, cherries, clementines, dates, figs, grapefruit, grapes, lemons, melons, nectarines, olives, oranges, peaches, pears, pomegranates, pumpkin, strawberries, tangerines, tomatoes.
Keep in mind that if you have diabetes, the type of fruit and the quantity can have an impact on your blood sugar. A typical serving of fruit is about 1 small piece (the size of a tennis ball), 1 cup of berries, 1/2 cup melon, or two tablespoons of unsweetened dried fruit. One serving of fruit contains roughly 15 grams of carbohydrates.
Pairing fruit with a handful of nuts, 1 ounce of cheese or, 1 tablespoon of nut butter can slow how quickly blood sugar rises. To see how you respond to fruit, you can always test your blood sugar before eating and then two hours after and make adjustments based on your blood glucose reading.
Use olive oil and other heart healthy fats when cooking. One of the core elements of a Mediterranean type of eating style is the use of heart-healthy fats, like olive oil. Olive oil is rich in monounsaturated fat.
The American Heart Association says that monounsaturated fats can help to reduce bad cholesterol in your blood which increases the risk of heart disease and stroke. People who have diabetes are at increased risk of heart disease and therefore using monounsaturated may contribute to lowering their risk of heart disease.
Using olive oil, for example, in replacement of butter can improve heart health by lowering cholesterol. Olive oil, especially extra virgin olive oil, is naturally rich in polyphenols—a plant compound that has been associated with anti-inflammatory effects as well as antioxidative properties.
Other types of heart-healthy fats included in the Mediterranean-style diet are canola oil, avocado, unsalted nuts and seeds (walnuts, almonds, flaxseed, pumpkin seed, chia seed), nut butters, and olives.
Fat is not only important for heart health, but it is satiating and can aid in feelings of fullness. Additionally, fat-soluble vitamins and certain antioxidants found in fruits and vegetables are absorbed when eaten with fat.
As for servings of fat per day, this will depend on your total calorie needs and the percentage of calories eaten from fat daily. There are no set guidelines for this type of eating plan, but a serving of fat for one person for one meal is about 1 tablespoon of olive oil, 1/3 avocado, 1 small handful of nuts or seeds.
Again, the amount of fat you need per day will vary. If you want specific portions, consider meeting a registered dietitian or certified diabetes care and education specialist to provide you with an individualized meal plan to meet your specific needs.
Consume whole grains, legumes (beans), nuts, and seeds daily. Whole grains and legumes (beans) provide long-lasting energy in the form of carbohydrates, satiating fiber, and tons of B vitamins and other nutrients. It is recommended that one-half of your grain consumption be whole grains.
Nuts and seeds provide heart-healthy fat, fiber, vitamins, and minerals as well as protein. According to the American Academy of Nutrition and Dietetics, adults should consume 25-38 grams of fiber daily to meet their needs.
Fiber has many benefits including, improving bowel function, keeping energy levels stable, improving satiety, and lowering cholesterol. People with diabetes benefit from eating higher fiber foods because these types of foods are metabolized slower and increase blood sugars at a slower rate.
Whole grains and legumes also provide a large amount of carbohydrates, therefore people with diabetes will need to be mindful of portions. A typical serving per meal is about 1 fist full, 1 cup, or 1/4 of the plate which equates to about 45 grams of carbohydrates.
The American Diabetes Association suggests keeping your carbohydrates—grains, legumes, starchy vegetables, to about one-quarter of your plate. For those people who would like to eat a lower carbohydrate diet or those that need to reduce their blood sugars, they can alter the amount as needed.
Whole grain sources include: Amaranth, barley, buckwheat, bulgur, corn, einkorn, farro, fonio, freekah, Kamut Khorasan grain, kañiwa, millet, oats, quinoa, rice, rye, sorghum, spelt, teff, triticale, wheat, wild rice. For foods that contain whole grains, the first ingredient should say whole or contain the whole grain stamp.
Legumes can be dried or canned, but keep in mind that canned legumes will have sodium to added for preservation. To reduce roughly 40-50% of the sodium, rinse them with cool water.
Nuts and seeds are best when unsalted. Epidemiologic studies have associated nut consumption with a reduced incidence of coronary heart disease and gallstones in both genders and diabetes in women.
Reduce intake of red meat and high-fat dairy (butter, cream, full-fat yogurt and cheese). Red meat, such as ground beef, steak, processed meats like sausage, and bacon, and high-fat dairy contain saturated fat. A diet high in saturated fat has been linked to heart disease, diabetes, and obesity.
Saturated fats are solid at room temperature and, if eaten in excess, can increase cholesterol and increase the risk of atherosclerosis by clogging the arteries. Foods that are rich in trans fat such as baked goods, sweets, and hydrogenated and partially hydrogenated oils should be limited as well, as they can have the same effect as saturated fats.
Incorporate lean protein such as fish, chicken, white meat turkey, lean pork, etc. Lean protein provides the body with important amino acids that are responsible for maintaining and building lean body tissue, keeping the immune system healthy, as well as building blocks of DNA, hair, skin, and nails. These types of proteins are also lower in saturated fat.
Fish is rich in omega-3 fatty acids which have positive effects on health, including acting as antioxidants and boosting brain function. Research has shown that eating a diet rich in omega-3 fatty acids can reduce your risk of heart disease and stroke.
The American Heart Association recommends eating 2 servings of fish (particularly fatty fish) per week. A serving is roughly 3.5- 4 ounces cooked, or about 3/4 cup of flaked fish. Fatty fish like salmon, mackerel, herring, lake trout, sardines, and albacore tuna are high in omega-3 fatty acids.
Eat dairy, eggs, and cheese less often. This eating style limits the intake of dairy, eggs, and cheese. This is likely because these types of foods contain larger amounts of saturated fat. These foods aren't off-limit but are limited. The total amount of servings will depend on your needs.
One serving of dairy is considered to be about 1 cup of milk, 6 ounces of plain yogurt, and 1 ounce of cheese. Eggs are also allowed. Some experts suggest limiting the number of egg yolks to about three to four per week and allow unlimited egg whites, but this is also individualized based on individual needs.
Limit white flours, sugar, and processed foods. This doesn't mean you can never eat pasta or ice cream ever again, but you should limit foods such as deli meat, white breads, regular pasta, chips, and cookies and cakes. Instead, you'll swap these types of foods for whole grains, nuts, seeds, fresh fruit, and vegetables.
For example, if you are used to eating regular pasta with sauce and meatballs for dinner, you may swap your white pasta with a whole wheat variety or a bean-based pasta, or another whole grain variety such as brown rice or quinoa.
Instead of ground beef for your meatballs, you can try lean ground turkey or chicken meatballs and add a serving of spinach or a side salad or roasted vegetables to your dish. While you may be accustomed to topping your pasta with a large amount of ricotta cheese, consider sprinkling a small amount of Parmesan, instead.
Load up on fresh and dried herbs. Herbs provide flavor, vitamins, minerals, and antioxidants without lots of sodium, fat, and calories. Marinate protein sources in herbs and spices, toss them into salad dressings or chop them up and add them to salads, grain dishes, stews, soups, etc. The options are endless.
Some common herb choices include but are not limited to basil, bay leaves, black pepper, cinnamon, cloves, coriander, crushed red pepper, cumin, curry powder, dill, garlic powder, ginger, oregano, paprika, rosemary, saffron, sage, thyme, turmeric, or blends like Italian seasoning.
Drink in alcohol moderation, especially red wine. The Mediterranean style of eating allows for drinking alcohol in moderation with an emphasis on red wine, 1 glass per day for women, and 1-2 glasses per day for men. A glass is considered to be about 4 ounces or 1/2 cup. Keep in mind that the emphasis is on moderate consumption and not excessive.
Red wine contains resveratrol, a phenolic compound that possesses antioxidative properties. Some studies have shown a correlation between red wine consumption and a reduction of cardiovascular disease and all-cause mortality.
Some people are advised not to drink alcohol. For example, people with high blood pressure, uncontrolled diabetes, high cholesterol, those who are pregnant or nursing, or those people taking certain medications are advised not to drink alcohol. It's always important to confirm with your healthcare provider first.
For those people with diabetes who take insulin or oral glucose-lowering medication, drinking alcohol may cause blood sugars to drop and result in hypoglycemia, therefore, speaking with your healthcare provider is always important.
Eating with loved ones, including friends and family is important. Sharing meals is pleasant and makes food more enjoyable. Engaging with people during mealtime can also slow the pace of eating, which improves digestion and may stimulate feelings of fullness sooner, which can result in consuming less food and improving weight.
Being physically active is an important part of any healthy lifestyle. The Physical Activity Guidelines for Americans provides a comprehensive set of recommendations on the amounts and types of physical activity needed each day and says that physical activity is one of the most important things people can do for their health.
Many people are attracted to this type of eating style because they are not required to count calories, carbohydrates, fat, etc. For people with diabetes who are required to practice daily self management tasks, such as taking medication, and testing blood sugar, this may help to lessen the burden of the disease.
As a bonus, the food is delicious and the concept is simple. A great way to begin is to change one meal at a time.
For example, if your regular breakfast includes a large bagel with cream cheese and coffee with heavy cream and 2 sugars, swap your bagel for a whole grain English muffin with avocado and tomato and coffee with 1 tablespoon of half and half and instead of 2 sugars, drop down to one.
After a week, consider dropping down to 1/2 of sugar and then after another week to none at all. You'd be surprised at how your taste buds change.
This style of eating includes eating ample amounts of fruits and vegetables which might seem costly, however, there are ways to save. Frozen fruits and vegetables are around all season and can be a cost-effective way to include fruits and vegetables in your diet.
Frozen fruits and vegetables are frozen at peak freshness, which means they may have more vitamins and minerals than those fruits and vegetables that are picked before they ripen so that they can sustain the effects of traveling to their destination. In addition, you can opt to purchase locally and seasonally to save on money.
Lastly, items such as dried beans and whole grains are typically inexpensive. Normally when you reduce the quantity of meat in the diet, you save money, too.
Below you will find a sample day of eating a Mediterranean style diet. The portions and amount of food will vary based on individual needs. This is just a sample of how to incorporate fruits, vegetables, legumes, whole grains, healthy fats, and lean protein.
Breakfast: 1/2 cup whole grain oatmeal, with 3/4 cup blueberries, 1 tablespoon of ground flaxseed, cinnamon, and a small handful of chopped almonds
1 whole grain English muffin with 1 tablespoon of nut butter and 1 cup of strawberries
For a lower carbohydrate version, you may try: 1 whole egg plus 2 whites scrambled (made with 1 teaspoon olive oil) with spinach (or another vegetable variety) with 1/3 avocado and chopped herbs such as chives and 1 serving of fruit
Lunch: Large salad (2 cups of mixed greens, kale, or another lettuce of choice), 1/2 cup beans (or 4 ounces of broiled fish, grilled chicken or 1 can of tuna), cucumber, tomato, carrots, broccoli, pepper, with 1 tablespoon olive oil and vinegar
Grilled Mediterranean vegetable salad

1 cup of a cooked whole grain such as quinoa, with 1 cup of arugula salad, 6 olives chopped, tomatoes, peppers, and 1 tablespoon vinaigrette dressing
For a lower carbohydrate version: A small portion of grilled or roasted pork or chicken with grilled vegetables (eggplant, onion, zucchini, squash, etc), and one small sweet potato or 1/2 cup roasted butternut squash with sage
Snack: Two tablespoons hummus or guacamole with cut up crudite or your choice. or 1 slice of whole grain bread
Dinner: Roasted vegetables made with olive oil served on top of grilled salmon, shrimp, or white fish with 1/2 cup whole grain such as farro with cumin and tahini
Barley vegetable soup with lentils
Dessert: Fresh berries or another fruit of choice
A Mediterranean style of eating has proven to have a ton of health benefits. If you are looking to eat a diet that has no food restrictions and that focuses on wholesome foods, such as fruits, vegetables, whole grains, lean proteins, and healthy fats, like nuts, seeds and fatty fish then this type of eating plan may be the right one for you.
You can alter the diet to fit your needs, too. For those people with diabetes, who are looking to eat a lower carbohydrate version of this diet, this is also possible. It is important to discuss any new diet with your healthcare provider before getting started and if you want this type of eating plan to be individualized to meet your specific needs, consider consulting with a registered dietitian.
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By Barbie Cervoni MS, RD, CDCES, CDN
Barbie Cervoni MS, RD, CDCES, CDN, is a registered dietitian and certified diabetes care and education specialist.

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