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It's no secret that eating a Mediterranean-style diet—more fresh vegetables, fruit, and fish, less red meat, and fewer processed foods high in sugar and carbohydrates—tends to result in better cardiovascular health for people in general (DOC News, January 2005, page 16).1,2 Now a new Australian study suggests it benefits heart health in the high-risk diabetes population too.3
The researchers gauged eating patterns among >40,000 Australian men and women, ages 40–69 years, over 10 years. Questionnaire responses show that people who ate the most Mediterranean-diet foods had a 30% decreased risk for cardiovascular mortality compared with those who ate the least amount.3 Findings also reveal that, in a subsample of individuals with diabetes, those who ate a predominantly Mediterranean-style diet had a reduced risk for ischemic heart disease.3
"Those people in our study with diabetes who most frequently consumed traditional Mediterranean foods had a 79% lower risk of dying from ischemic heart disease compared to those who were in the lowest category," notes lead researcher Linton Harriss, a PhD student in the Department of Epidemiology and Preventive Medicine at Monash University in Melbourne, Australia.
MEDITERRANEAN DIET CHARACTERISTICS
Compared with traditional Western eating patterns, the Mediterranean pattern comprises higher intake of vegetables, fruits, legumes, nuts, grains, unrefined cereals, breads, olive oil, and garlic; moderately high intake of fish; and moderate intake of wine consumed primarily with meals, Harriss says.
This pattern also consists of low-to-moderate intake of low-fat dairy products such as cheese and yogurt and lower intake of lean meats and poultry, compared with Western eating patterns. In Mediterranean-style diets, healthier fats come mostly from polyunsaturated oils such as sesame or soy and from nuts and seeds, while olive oil is the primary source of the monounsaturated fats.
A Mediterranean dietary model consists of a wide variety of high-fiber, low-saturated-fats foods—important in managing risk factors associated with heart disease and diabetes, Harriss notes.
Harriss and colleagues note a significantly lower ischemic threat among study participants with diabetes who, over a 10-year period, ate greater amounts of garlic, cucumbers, olive oil, salad greens, capsicum, cooked dried legumes, legume soups, feta and ricotta cheeses, olives, steamed fish, and boiled chicken; and infrequently consumed biscuits, cake, cream, sour cream, ice cream, chocolate, sausages, jams, and honey.3
In comparison, research studies on diets that do not correspond to Mediterranean-style eating have demonstrated very different results. They show that women who consume large amounts of soft drinks, refined grains, potatoes, french fries, and processed meats and who eat lower amounts of cruciferous and yellow vegetables, wine, and coffee are at increased risk for type 2 diabetes.4,5
CHOOSE WISELY, SEEK VARIETY
Transforming a Western-style diet into one with Mediterranean aspects requires improving the quality and portions of the carbohydrates one consumes, notes American Dietetic Association (ADietA) spokesperson Lisa Dorfman, MS, RD.
Clinicians can help by advising patients to choose only whole-grain breads, pasta, and rice and to eat more fish rich in omega 3 fatty acids—such as salmon, mackerel, and tuna—as well as fresh vegetables and fruits. Patients also should limit their intake of steak.
Dorfman suggests the use of olive oil in lieu of, not in addition to, other fats such as butter and margarine. The combination of smaller amounts of meat or poultry with larger amounts of vegetables, beans, and whole-grain pastas, rice, and bread is typical of a Mediterranean eating pattern, notes ADietA spokesperson Bonnie Taub-Dix, RD.
Such food combinations, she adds, play an especially important role in controlling diabetes. Absorption of a bread or fruit carbohydrate is mitigated when combined with foods that contain protein, such as cheese or chicken, according to Taub-Dix. Beans are beneficial, says Taub-Dix, because they combine carbohydrate and protein in one nutrient source.
Mediterranean-style combinations might include:
Compared with Western-style pasta dishes, those with a Mediterranean flair often contain greater amounts of vegetables flavored with a small portion of hard cheese, such as grated Romano, and a minimal portion of meat, poultry, or fish over a moderate serving of pasta.
"Mediterranean dishes include a bouquet of colors," Taub-Dix
says. And eating foods in a variety of colors ensures a variety of nutrients
for people who have diabetes, are at cardiovascular risk, are watching their
weight, or are simply trying to stay healthy. 
Footnotes
The American Diabetes Association offers advice for meal planning and recipe resources for people with diabetes at www.diabetes.org/nutrition-and-recipes/nutrition/healthyfoodchoices.jsp.
American Dietetic Association nutrition fact sheets on beans, pasta meals, whole grains, and other foods are available at www.eatright.org/cps/rde/xchg/ada/hs.xsl/nutrition_350_ENU_HTML.htm.
A Mediterranean diet pyramid can be viewed at www.oldwayspt.org/med_pyramid.html.
References
2. Tortosa A, Bes-Rastrollo M, Sanchez-Villegas A, et al.: Mediterranean diet inversely associated with the incidence of metabolic syndrome: The Sun Prospective Cohort. Diabetes Care. Published online at http://care.diabetesjournals.org/cgi/reprint/dc07-1231v1 August 21, 2007, DOI: 10.2337/dc07-1231. Accessed October 15, 2007.
3. Harriss L, English D, Powles J, et al.: Dietary patterns and
cardiovascular mortality in the Melbourne Collaborative Cohort Study.
Am J Clin Nutr 86:221–229, 2007.
4. Schulze M, Hoffmann K, Manson J, et al.: Dietary pattern,
inflammation, and incidence of type 2 diabetes in women. Am J Clin
Nutr 82:675–684, 2005.
5. Halton T, Willett W, Liu S, et al.: Potato and french fry
consumption and risk of type 2 diabetes in women. Am J Clin
Nutr 83:284–290, 2006.
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