An issue that troubles many of our patients is what foods they can eat “because of diabetes” or “with diabetes”. We will start by firstly rephrasing this question to foods to eat “for diabetes”. The difference is subtle, but important because it uses food as a tool in order to ‘work with’ the diabetes, rather than as a tool to ‘fight against’ it.
A recent meta-analysis by Esposito K et al1 in the British Medical Journal concludes that the mediterraneran diet compared to controlled diets (eg: low carbs/fat etc) is associated with lower cardiovascular risk factors and better glucose control in diabetes.
So, what to eat?
We generally know that high-fibre foods are crucial in a healthy diet, and this is especially so of certain foods, as they help lead to higher satiety and also reduce insulin levels (higher insulin levels are seen in insulin resistance and type 2 diabetes and may contribute to heart disease). One such food, which features a lot in the mediterranean diet is:
Wholegrains: wholegrain bread, cereal and pasta are higher in fibre and provide a slow release of energy with a slower effect on glucose level fluctuations. At the same time as they reduce glucose level in the blood they also reduce insulin levels. Barley, buckwheat, bulgur wheat and rye are popular options in the Mediterranean countries. If you like rice, opt for the wholegrain variety, or combine it with one of the above (also quinoa and rice make a good, lower-carb dish). Choose to base your meals on these types of complex carbohydrates for slower energy release and greater satiety. If you are counting carbs (more relevant for type 1 diabetes) make sure you measure out your portions.
Nuts and Seeds: Harvard researchers have discovered that women who regularly eat nuts (about a handful five times a week) are 20% less likely to develop type 2 diabetes than those who don’t eat them that often.
Nuts are also cardio-protective and this could be due to their high potassium content (care to be taken in diabetes with severe kidney failure), which helps lower blood pressure by balancing sodium levels. Nuts also help lower cholesterol (possibly due to their abundance in omega-3 fatty acids) and may also help protect against cancer. Additionally, they may boost energy, alleviate constipation, fight anaemia and aid in weight loss (it has been found that the mono-unsaturated fats in nuts may stave off hunger for up to 2.5 hours). Of course, nuts and seeds are very calorific, so eat mindfully. Recent studies recommend 60g of nuts for improved cardiovascular benefit (omega-3 fatty acids). Choose walnuts, pecans, brazil nuts and almonds over peanuts and cashews and prefer the raw variety rather than the roasted and salted one. Seeds are becoming increasingly popular and there’s an array to choose from: chia, linseed/flaxseeds and pumpkins are good choices. Again, mind the portions as they are high in calories.
Olives and olive oil: It is often said that the lower cardiovascular incidents in Southern Mediterranean countries is due to the frequent consumption of olives and their oil. Three to four olives or one teaspoon (tsp) to one tablespoon (tbsp) of olive oil makes a serving and over time this can help against cholesterol, breast cancer, inflammation, low immunity and weight gain. Olives are dense in anti-oxidants and omega 3, which help raise the good cholesterol (HDL) and lower the bad cholesterol (LDL). Two tbsp of olive oil daily for a week can lead to lower LDL and higher anti-oxidants in the blood. Olive oil also contains phytochemicals (hydroxytyrosol, oleuropein and lignans) and vitamin E, which have anti-cancer properties.
Furthermore, they can ease inflammation (arthritis or general body aches) and aid in weight loss by reducing stomach contractions and helping us feel full for longer.
Onions: this very common food is at its most nutritious form when eaten raw and minced finely, as that’s when it releases its phytochemical power. Onions help stabilize blood sugar due to their sulphur compounds and flavonoids. Also, they are rich in chromium, which is increasingly becoming more studied into for its potential positive effect on insulin sensitivity. A 100g serving of onions provides around 40 calories, 10g carbohydrate and 1.7g fibre. More than diabetes, it can also help in wound care due to its strong anti-bacterial properties.
Garlic – may help reduce blood glucose levels and also protect against atherosclerosis (plaque formation in the arteries).
Beans and lentils– rich in complex carbohydrates (unlike simple carbohydrates like sugar), lean protein and soluble fibre, these form a big part of the Mediterranean diet.
Oats– consumed in high amounts (3g or more every day) can also help reduce cholesterol. They are high in soluble fibre, which slows down their digestion and helps us feel full for longer. In order to help release their energy more slowly, add chopped fruit such as berries or apple, a few chopped nuts or seeds such as linseed and chia.
Fish- source of protein, omega-3 and vitamin D. Two portions of fish a week are recommended, especially oily fish.
Peas- high in fibre and protein and low in glycaemic index.
Vitamins C and E (antioxidant properties) such as found in pears, apples and oranges, tart cherries, berries, apricots and peaches. The abundance of fruit in the Mediterranean makes it easier for people to snack on this colourful food rather than go for cakes and biscuits.
Figs- a big part of the Mediterranean summer table, figs come in different varieties and are a healing food due to their high fibre content. In addition, they may also help reduce the risk of certain cancers (e.g. colon, breast and prostate- again due to the same reason), as well as support bone health (rich in calcium) and ease constipation. An 80g serving of figs provides 8g of carbohydrates, 34 calories and forms one serving of your five-a-day. Of course, like with anything else, enjoy in moderation as they are also high in natural sugars.
Avocado– rich in mono-unsaturated fatty acids (cardioprotective), fibre (helps reduce blood sugar spikes), lower in carbohydrates (17g per 100) and dense in vitamins such as C, E, K and B-6, avocado is a nutritional powerhouse! This can be enjoyed in many different ways but mind its ample calories too (250-300 per fruit).
Chicken breast– high in protein and low in fat, it’s a versatile food that can be enjoyed in many healthy ways to reach satiety and keep blood sugars stable.
Mushrooms, broccoli and other non-starchy vegetables– low in sugar and fat, dense in vitamins and fibre, they make an essential part of the mediterranean diet, either in their raw or cooked form (according to the vegetable).
(Greek) salad: typically features olives, lettuce, tomatoes, cucumber, parsley, coriander, mint, cabbage, or a different combination of these, drizzled with olive oil and lemon or vinegar. Topped with dried oregano, bazil or mint.
Lemon and vinegar– used to dress salads or to enhance the taste of fish, meat and pulses, they can be used to reduce salt while preserving flavour. Lemon is rich in anti-oxidants and low in calories, whilst vinegar can help in weight loss and lower cholesterol and blood sugar levels. Use mindfully if you suffer from stomach problems (both are acidic).
Natural yoghurt– this is an ever-present food on the Mediterranean dinner and lunch table. It is generally offered with most main meals, such as meat, pulses, rice, bulgur wheat, salads, and is known for its richness in probiotic bacteria (good for gut health). It also contains calcium, vitamins B6 and B12, riboflavin, magnesium and potassium. It can also be enjoyed as a healthy dessert with a drizzle of pure honey, cinnamon and chopped walnuts (see relevant blog). It can be found in low-fat varieties too.
1Esposito K, Maiorino MI, Bellastella G, et al. A A journey into a Mediterranean diet and type 2 diabetes: a systematic review with meta-analyses. BMJ Open 2015;5:e008222. doi: 10.1136/bmjopen-2015-008222