While there is no one diet that is recommended by the American Diabetes Association, the best diet is a healthy diet low in starchy carbohydrates. We also know that one of the best diets overall is the Mediterranean diet. For Diabetes, we can recommend a modified Mediterranean diet low in carbs and higher in healthy fats. For high blood pressure a Mediterranean diet low in salt.
Diet and lifestyle interventions are effective in preventing and treating all of these conditions.
Cardiovascular and metabolic dysfunctions share similar causes, including inflammation, insulin resistance, and stress. The use of food as medicine to treat the common underlying causes of cardiovascular and metabolic dysfunctions like diabetes.
Traditional Mediterranean Diet
The traditional Mediterranean diet first attracted interest when it became apparent that people living on the Greek island of Crete had a greatly reduced risk of Cardiovascular. Since then, it has become perhaps the most well-known, well-studied diet for Cardiovascular, metabolic syndrome, and Type 2 diabetes. The Mediterranean tend to eat whole, unprocessed foods such as fruits, vegetables, whole grains, nuts, legumes, dairy, extra virgin olive oil, spices, modest amounts of poultry, fish and red meat, and red wine.
It is the combination of all these foods, rather than the consumption of one of these foods in isolation, that is responsible for the cardiovascular and metabolic benefits of this way of eating. A review of 50 studies on the Mediterranean diet reported that this way of eating favorably changes parameters of metabolic syndrome such as waist circumference, high-density lipoprotein cholesterol, triglycerides, systolic and diastolic blood pressure, and glucose.
The key is to select whole, fresh, unprocessed foods rather than to buy pre-packaged foods that have been manufactured to be convenient. This is truly one of the most important takeaways of the Mediterranean diet.
Low Glycemic Impact:
Not all foods have the same impact on blood sugar and insulin. Ideally, blood sugar should remain relatively constant, without huge spikes that cause insulin to surge in order to shuttle sugar into tissues that need it, like muscles and the liver. A rollercoaster of glucose and insulin levels throughout the day is not healthy in the long term, especially for those with cardiovascular, metabolic, or diabetic concerns.
High blood sugar levels sustained over time can damage the blood vessels, blood cells, and other parts of the body that are sensitive to high sugar like the eyes and kidneys. Therefore, regulating sugar levels by eating foods that do not spike blood sugar is preferred. There are two ways to assess the impact of food on blood sugar.
The goal of the Cardiometabolic Food Plan is to eat low-GI foods (foods scoring 55 or lower on the GI) so that only small fluctuations in blood glucose and insulin beans, lentils, chickpeas), nuts (e.g., almonds, walnuts), seeds (e.g., pumpkin, flax, sesame), most intact grains (e.g., oat, barley, spelt), and most vegetables and fruits (e.g., peaches, berries).
Foods containing refined sugars, artificial sweeteners, and refined grains are considered to be high-Glycemic index foods because they lead to sharp increases in blood sugar levels. Examples include cakes, cookies, pies, white bread, and other processed foods.
It is important to recognize that the Glycemic Index refers to the increase in blood sugar for a defined portion of all foods. It does not necessarily take into account the portion of these foods eaten in a typical setting. For example, watermelon is considered to be high-Glycemic index, but the average person eats relatively little at a time; therefore, the actual glycemic impact of watermelon may not be all that significant.
Since we all eat a combination of foods with differing Glycemic Index levels, we also use the concept of Glycemic Load to capture a more comprehensive picture of the glycemic impact of the diet as a whole. Glycemic Load takes into account appropriate portions of food and is thus a more realistic measure of glycemic effect.
High in Fiber:
Fiber is found in plant-based foods like whole grains, nuts, legumes, vegetables, and fruits. It is a form of carbohydrate that the body is unable to digest, giving the sensation of fullness without many calories.
There are two types of dietary fiber—insoluble and soluble—and they have somewhat different benefits. Insoluble fiber can be found in the bran (outer coat) of vegetables and whole grains. This type of fiber acts like a bulky “inner broom,” sweeping out debris from the intestine and creating more motility and movement.
Soluble fiber attracts water and swells, creating a gel-like mass. The soluble fiber in foods like oat bran, barley, nuts, seeds, beans, lentils, peas, and some fruits and vegetables act to slow digestion. (Psyllium, the main ingredient of common fiber supplements, is a soluble fiber.)
In addition to slowing the release of glucose from food into the blood (thus warding off the spikes in blood sugar levels that need to be prevented in cardiometabolic diseases), soluble fiber also traps toxins and other undesirables (including cholesterol and other dietary fats) in the gut, helping to carry them to excretion, while also providing “food” for healthy bacteria in the digestive tract. With greater fiber in the diet, a cholesterol-lowering effect may be experienced.
Balanced Quality Fats:
Dietary fats have had a bad reputation when it comes to heart disease. In the past decades, the popularity of fat-free foods grew exponentially. Much of the research on the health benefits of dietary fats has found that what replaces dietary fat matters a great deal. For example, when saturated fat is replaced with refined carbohydrates, cardiovascular outcomes are not good. Instead, replacing saturated fats with unsaturated (liquid fats) can lead to an overall improvement in cardiovascular health.
Despite all the confusion about dietary fats, the message for someone with cardiometabolic issues is simple: emphasize high-quality oils and fats in the diet and minimize those that are associated with the disease.
Eating too much-saturated fat (e.g., animal fat, lard) and omega-6 fat (e.g., corn oil, soybean oil) can have “inflammatory” effects. These effects can be offset by adding “anti-inflammatory” fats to the diet. The anti-inflammatory fats typically have a higher concentration of omega-3 fats to omega-6 fats and include foods like fish, leafy greens, nuts, certain oils, and seeds
Protein
Protein stabilizes blood sugar and should be included in every meal. In fact, unless there are medical restrictions on dietary protein intake, protein should provide about one-third of the daily calories. Yet in the average Western person’s diet, the protein comprises only about one-fifth of the total calories. Choose oily fish high in anti-inflammatory fats and low in methylmercury, such as anchovies, herring, mackerel, salmon, sardines, and trout. Another option is free-range eggs which have about one-quarter of anti-inflammatory fats found in a serving of fatty fish. Therapeutic Foods in this category are fish and soy-containing proteins, which provide anti-inflammatory fats for heart health.
Patients who have diabetes can benefit from a nutritional consult and an annual visit to personalize their diet and nutritional needs. Seeking help from a certified diabetes educator can also help create healthy habits and keep on track with nutrition, exercise and treatment plans.