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The Prediabetes Nutritionist

Can You Reverse Prediabetes with the Mediterranean Diet?

You can reverse prediabetes with any healthy diet that fits your lifestyle. But if you’re considering the Mediterranean diet, go for it!

Why?

Because it is scientifically proven to lower not only your blood sugars but also your blood pressure and risk of heart disease. And best of all? It is sustainable!

In a nutshell, you can reverse prediabetes with the Mediterranean diet by eating whole grains, fruits, vegetables, legumes, nuts, seeds, fatty fish, and poultry with limited amounts of red meat and processed foods such as sugar-sweetened beverages. You should also exercise regularly, get adequate sleep, and socialise with your friends and family.

Eating the foods contained in a Mediterranean diet is a great start, but there are several nuances you must be aware of to ensure you reverse prediabetes and keep your blood sugars in the healthy range.   

Before we address them, let’s cover some basics.

What is prediabetes?

Prediabetes is when your blood sugar is higher than normal but not high enough to be classified as diabetes (ADA, 2022). People with prediabetes typically have abnormal fasting blood sugar or higher than normal blood sugars two hours after a meal (impaired glucose tolerance) or elevated glycated haemoglobin (HbA1c)– average blood sugar over the past two to three months.

In the United Kingdom, prediabetes is diagnosed when:

  • Fasting plasma glucose is 6.1-6.9 mmol/L or 110-125 mg/dL and/or
  • Two-hour post-meal glucose is 7.8-11.0 mmol/L or 140-199 mg/dL and/or
  •  HbA1c of 42-48 mmol/L is 6.0-6.4%.

In the United States, prediabetes is diagnosed using more stringent fasting plasma glucose and HbA1c cut-offs (ADA, 2022). It is diagnosed when:

  • Fasting plasma glucose is 5.0-6.9mmol/L (100-125mg/dL) and/or
  • HbA1c is 39-47 mmol/mol (5.7-6.4%)

A prediabetes diagnosis doesn’t necessarily mean you will develop type 2 diabetes, but it significantly increases your risk of type 2 diabetes and heart disease (ADA, 2022). Prediabetes is usually associated with overweight and obesity, abnormal lipids (high triglycerides, high low-density lipoprotein (LDL or bad) cholesterol, and low high-density lipoprotein (HDL or good) cholesterol) and high blood pressure (ADA, 2022). Prediabetes rarely causes symptoms, so you should screen for it if you meet the criteria described here

What is the Mediterranean Diet and Lifestyle?

The Mediterranean diet describes the traditional eating pattern of Crete, Greece and southern Italy in the early 1960s (Guasch-Ferre and Willett, 2021). Although modernisation has altered the eating pattern in these regions, the traditional diet contains a daily abundance of vegetables, a variety of minimally processed grains, bread, and beans as the source of starchy carbohydrates, and nuts, seeds and olive oil as the source of fat.

Protein comes from local cheese and yoghurt, moderate fish, poultry and eggs and small quantities of red meat. Desserts typically consist of fresh fruits, with sweets containing added sugar or honey consumed in small amounts a few times a week. Red wine is consumed moderately with meals.

Notably, regular exercise and social activities are vital to the Mediterranean lifestyle. While individual components of the Mediterranean diet, such as nuts and olive oil, have well-documented health benefits, recent evidence shows that the overall diet and lifestyle provide most of its main health benefits – low disease rates and longevity (Guasch-Ferre and Willett, 2021).

Evidence for the Mediterranean Diet in Blood Sugar Control

A team of researchers conducted a meta-analysis to investigate the impact of the Mediterranean diet on the risk of developing type 2 diabetes. The researchers evaluated ten studies (nine prospective and one clinical trial), including 136 846 participants from different European and non-European countries.

Regardless of the country, greater adherence to the Mediterranean diet significantly reduced the risk of type 2 diabetes, especially among participants with a history of gestational diabetes or at high risk of heart disease and diabetes (Koloverou et al., 2014).

The PREDIMED study, a large-scale, multicentre randomised controlled trial, compared the Mediterranean diet with a low-fat diet to heart disease in people at high risk.

A sub-group analysis of 3541 patients showed that the Mediterranean diet enriched with extra-virgin olive oil or nuts prevented diabetes, reducing diabetes risk by 52% in older participants with a high risk of heart disease (Salas-Salavado et al., 2014).

Notably, the risk reduction was not because of weight loss, calorie restriction or exercise, but because of the foods contained in the diet.

In a 2018 study, researchers systematically reviewed published studies to compare the effectiveness of different diets on blood sugar control in people with type 2 diabetes. They reviewed 56 trials, including a total of 4937 participants and compared nine diets: low-fat, vegetarian, Mediterranean, high-protein, moderate carbohydrate, low-carbohydrate, control, low glycaemic index or low glycaemic load and palaeolithic.

The low-carbohydrate diet was ranked the best for reducing HbA1c, followed by the Mediterranean and Palaeolithic diets. However, the Mediterranean diet was rated the best for lowering fasting blood sugar and improving blood sugar control in type 2 diabetes (Schwingshackl et al., 2018).

Koloverou and colleagues (2014) have even suggested that “the Mediterranean diet could, if appropriately adjusted to reflect local food availability and individual’s needs, constitute a beneficial nutritional choice for the primary prevention of diabetes.”

How to Reverse Prediabetes with the Mediterranean Diet Lifestyle

To reverse prediabetes with the Mediterranean diet, you must first determine the number of calories you need daily for your overall health and nutrition goals. Once you determine that, organise your diet, ensuring it contains:

  • A variety of vegetables from all the subgroups – dark green, red and orange, yellow, blue and purple, legumes (beans, peas and lentils) and starchy carbohydrates such as potatoes, yams and plantains
  • Grains, at least half of which should be whole, unrefined grains such as brown rice, quinoa, millet and buckwheat
  • Fruits, especially whole fruits. Consume fruit juices in small quantities, sparingly
  • Reduced-fat dairy, especially fermented yoghurt (kefir), cheese and/or fortified plant-based alternatives
  • A variety of protein foods, prioritising fatty fish and other seafood, lean meats and poultry, eggs, legumes (beans, peas and lentils)
  • Whole fats, including avocado, nuts, seeds,
  • Unsaturated oils such as olive and avocado oils

Minimise your intake of saturated and trans fats (typically found in fatty cuts of meats and processed foods), added sugars and sodium. As a rule of thumb, added sugars and saturated fat should each provide no more than 10% of your calories. Work towards eating less than 2300mg of sodium (approximately one teaspoon of salt) daily.

To prevent blood sugar spikes after meals, consider reducing your portions and eating smaller meals spaced evenly throughout the day. This personalised portion planner can help you determine the number of portions of each food group you need for weight loss and blood sugar reduction.

Lastly, when serving your meals, always ensure you pair starchy carbohydrates with high-quality protein foods, a source of fat and plenty of vegetables. This recipe is a perfect example of a balanced plate.

A Mediterranean lifestyle is incomplete without exercise, relaxation, and socialising. Besides increasing muscle mass and improving heart health, exercise helps to regulate blood sugar. It does this by increasing your insulin sensitivity and reducing stress. Aim for at least 150 minutes per week or about 30 minutes daily on most days of the week, and make time to relax and socialise with your family and friends.

You now know that a prediabetes diagnosis does not mean you will get type 2 diabetes. But doing nothing about it and continuing your current eating and lifestyle habits almost guarantees you will.

The Mediterranean diet is one of the most sustainable eating patterns available to not only nourish you but lower your blood sugars and, you guessed it, reverse prediabetes!

So, friend, imagine getting your blood test results and finding out your blood sugars are in the normal range.

Instead of shuddering when you see your doctor, you can look forward to your appointment because you know you’ll both be delighted! And that’s all because you’ve done the work to lower your blood sugars. And more importantly, you’ve cultivated new habits!

You’re not only eating well, but you’re finally exercising regularly, getting more sleep and socialising with your friends. You’re also bursting with energy and feeling more confident than ever in your skin.

Sound impossible? It’s not.

Just do the work, commit to making the necessary changes to your current lifestyle and keep going until you reach your goal.

You know what and how to eat – all you need to do is follow and stick with it.

Your new healthy life awaits.

REFERENCES

  1. American Diabetes Association (ADA, 2022). Classification and diagnosis of diabetes: standards of medical care in diabetes. Diabetes Care, 45(Supplement 1): S17-S38.
  2. Guasch-Ferre, M., & Willett, W.C. (2021). The Mediterranean diet and health: a comprehensive overview. Journal of Internal Medicine, doi.org/10.1111/joim.13333.
  3. Koloverou, E., Esposito, K., Giugliano, D., & Panagiotakos (2014). The effect of Mediterranean diet on the development of type 2 diabetes mellitus: A meta-analysis of 10 prospective studies and 136,846 participants. Metabolism, 63(7); P903-911.
  4. Salas-Salvado, J., Bullo, M., Estruch, R., Covas, M-I., Ibarrola-Jurado, N., Corella, D., Aros, F., Gomez-Gracia, E., Ruiz-Gutierrez, V., Romaguera, D., Lapetra, J., Lamuela-Raventos, R.M., Serra-Majem, L., Pinto, X., Basora, J., Munoz, M.A., Sorli, J.V., & Martinez-Gonzalez, M.A. (2014) Prevention of diabetes with Mediterranean diets – a subgroup analysis of a randomised trial. Annals of Internal Medicine, 160(1): 1-10.
  5. Schwingshackl, L., Chaimani, A., Hoffmann, G., Schwedhelm, C., & Boeing, H. (2018). A network meta-analysis on the comparative efficacy of different dietary approaches on glycaemic control in patients with type 2 diabetes mellitus. European Journal of Epidemiology, 33: 157-170.
  6. Martin-Pelaez-S., Fito, M., & Castaner, O. (2020) Mediterranean diet effects on type 2 diabetes prevention, disease progression, and related mechanisms. A review. Nutrients, 12(8): 2236
  7. Esposito, K., Maiorino, M.I., Bellastella, G., Chiodini, P., Panagiotakos, D., & Giugliano, D. (2015) A journey into a Mediterranean diet and type 2 diabetes: a systematic review with meta-analyses. BMJ Open, 5(8): e008222.

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