It should be definitively clear that our clinical focus is helping patients prevent or treat cardiometabolic disease including diabetes, metabolic syndrome, and subsequently atherosclerotic cardiovascular disease. So when we see patients in clinic, we focus on lifestyle changes like diet, exercise, sleep, and other miscellaneous components of non-pharmacologic treatment because these are most imperative and work the best for diabetes prevention, treatment, and likely longevity. Hopefully you have previously reviewed our basic dietary recommendations, so in this article I will endorse a popular dietary pattern which is very similar to what we have always recommended and whose studies have driven the basis of many of our recommendations. For a more detailed, yet simple, direction on eating to beat diabetes, sign up for our newsletter and get our upcoming free e-book, “5 Steps to Beat High Blood Sugar (and get Leaner!) Plan.
I’m sure if you are reading this, you have possibly heard about the benefits of a Mediterranean diet based upon veggies, legumes, fish/lean meats, olive oil, and nuts. Well recently a study came out (PREDIMED trial) which made big news regarding how a Mediterranean-style diet tested versus a low-fat diet decreases risk of cardiovascular events (heart attacks & strokes) in adults who are at high risk of heart disease (including 50% being diabetics). A Mediterranean-style diet has previously shown decreased occurrence of heart attacks and strokes in a population cohort and subsequent heart attacks in people who already had known heart disease but this new study was an interventional trial for primary prevention and was not even a weight loss trial. Basically all they did was prescribe either a low-fat dietary plan (bread/potatoes/pasta/rice, veggies, fruit, lean fish while discouraging oils/nuts, fatty fish and other fatty foods) or a Mediterranean diet (veggies, legumes, fruit, fatty fish, other lean meats, and some optional wine while discouraging sodas, baked sweets, and processed fats/meats) plus extra fat from either olive oil or nuts with no calorie goals and an average follow-up of about 5 years. The bottom line was 30% risk reduction of heart attack and stroke for the groups assigned to either the nut-based or olive-oil-based Mediterranean diet compared to a low fat diet.
This may not come as much of a surprise since Mediterranean diets have previously shown to decrease the incidence of metabolic syndrome while a meta-analysis has concluded that it is effective in treating all the individual components of metabolic syndrome (obesity, glucose dysmetabolism, dyslipidemia & hypertension). In fact, the same study which we are focusing on, also previously showed effective prevention of diabetes in those high-risk patients without any calorie restriction.
We feel that the Mediterranean diet style is very beneficial for our diabetics, but we do like to dig even deeper with our recommendations. For those with trouble metabolizing glucose (diabetes, pre-diabetes, or metabolic syndrome), we emphasize consuming “carbohydrates” primarily from veggies, along with legumes, fruit (especially berries), and less so from grains (though sources such as whole oats have benefits). While a generalized Mediterranean-like dietary pattern has been shown to reduce mortality (death) compared to a generalized “low-carb” diet, we prescribe a sort of “low-carb Mediterranean” diet which has been studied with great success in helping subjects lose weight while dramatically improving the components of metabolic syndrome.
In the end, the bottom line is that there is good evidence for health benefits from a Mediterranean-type diet and our general recommendations to diabetics as noted above and in our diet section along with our recipes will not only help with blood sugar optimization and lipids but hopefully also help you live long while living lean. Very importantly, don’t forget to have fun with improving your diet and enjoy the journey!
 N Engl J Med. 2002;346(6):393-403
 N Engl J Med 2013. DOI: 10.1056/NEJMoa1200303
 Am J Clin Nutr doi:10.3945/ajcn.111.012799
 Circulation 1999;99:779-85
 Diabetes Care 2007; 30(11)2957-2958)
 J Am Coll Cardiol 2011;57:1299-313)
 Diabetes Care 2011;34:14-19
 Am J Clin Nutr 2010;92:967-74
 Nutrition Journal 2008;7:30
 Nutrition Journal 2011;10:112