If you try a Mediterranean diet to reduce your diabetes risk, you may have more success by also cutting calories, getting more exercise, and seeking professional weight loss support.
In a new study, scientists examined data on almost 5,000 middle-aged and older adults who were overweight or had obesity, and also had metabolic syndrome — a cluster of conditions like high blood pressure, elevated cholesterol, and excess fat around the waist that can all increase the risk of type 2 diabetes.
Researchers first asked all participants to follow a Mediterranean diet. Then they randomly assigned half of them to also cut calories, get more moderate-intensity exercise, and receive nutrition and behavior support to aid weight loss. The other half of the participants didn’t receive any of these extra interventions.
After six years of follow-up, people on the Mediterranean diet who also cut calories, got more exercise, and received professional support were 31 percent less likely to develop type 2 diabetes than the participants who just tried the diet on its own, according to findings published in the Annals of Internal Medicine.
Reduced Calories in a Mediterranean Diet
“A low-calorie version of the Mediterranean diet may offer even greater protection than the traditional version,” says the lead study author, Miguel Ruiz-Canela, PhD, a professor and the chair of the department of preventive medicine and public health at the University of Navarra in Spain.
Cutting calories often involves eating more fiber-rich foods and whole grains, which can help people feel more full, lose weight, and shed excess fat around their midsections, Dr. Ruiz-Canela says.
All the study participants were advised to follow a Mediterranean-style diet by eating more fruits, vegetables, whole grains, legumes, nuts, and extra-virgin olive oil and limiting meat, sugar-sweetened beverages, and foods with added sugars or heavy cream.
Half the participants were also asked to reduce their daily food intake by about 600 calories a day. Researchers advised the low-calorie group to get 35 to 40 percent of their calories from olive oil and other healthy fats, 40 to 45 percent of their calories from carbohydrates, and approximately 20 percent of their calories from protein.
The Low-Cal Group Got Extra Dietitian Contact
Over the first year of the study, participants who cut calories got three sessions a month with a dietitian: one in a group, one individual, and one by phone. Over the next five years, they continued with monthly group sessions, individual sessions every three months, and two phone calls every three months.
By contrast, people in the control group who didn’t have to cut calories had just one individual visit, one phone call, and one group session with the dietitian every six months.
“The behavioral support from dietitians was a key element of the intervention,” Ruiz-Canela says.
Exercise With a Mediterranean Diet
Researchers also asked the group who were cutting calories to steadily increase their physical activity. The goal was to complete:
- Moderate-intensity exercise like a brisk walk for 45 minutes a day, six days a week
- Strength training at least twice a week
- Exercises to improve flexibility and balance at least three times weekly
Because the study had people combine so many approaches at once, it’s hard to say from this research how much the workouts on their own would help, without the calorie reduction and regular support from a dietitian.
Extra Exercise and Structured Support Made a Difference
In the calorie-cutting group that got extra exercise and extra support, a total of 280 people, or 9.5 percent, developed type 2 diabetes by the end of the study. That compares with 349 participants, or 12 percent, in the group that simply followed a traditional Mediterranean diet.
“People do better when they have structured support,” says Melanie Jay, MD, a professor at the New York University Grossman School of Medicine in New York City and the director of the obesity research program at NYU.
“Having guidance and accountability makes it easier to stay motivated and stick with new eating habits,” says Dr. Jay, who wasn’t involved in the new study. “On the other hand, it’s much harder to sustain changes alone, especially since our food environments often push us toward less healthy choices. You really have to go out of your way to find healthier options.”
How to Try a Mediterranean Diet
“When you have professional support, structured programs, and ongoing motivation, it is a lot easier to make changes and stick with them,” says Erin Palinski-Wade, CDCES, RD, a registered diabetes nutritionist in New Jersey who wasn’t involved in the new study.
“But it is certainly possible to make these changes on your own and achieve significant health improvements,” Palinski-Wade says.
The key to success is tracking and planning, Palinski-Wade says. If you track what you eat, you can better understand the impact of your food choices and what changes might be best for you. Planning ahead can help you stock up on foods you want to eat, so you have healthy options when you’re hungry.
“My favorite tip is to spend 2 minutes at night thinking about your day and identifying one small change you want to improve upon for the day ahead,” Palinski-Wade says. “It can be as simple as drinking an extra glass of water or adding an extra handful of veggies to your plate. All these small changes really add up to big results.”
How a Registered Dietitian Can Help
It can also help to seek support from a registered dietitian, says Maya Vadiveloo, PhD, RD, an associate professor of nutrition at the University of Rhode Island in Kingston and the chair of the lifestyle nutrition committee for the American Heart Association.
“I do think it is feasible for people to adopt fairly significant changes to their lifestyle to consume a diet that is more closely aligned with the Mediterranean diet and increase physical activity,” says Dr. Vadiveloo, who wasn’t involved in the new study.
“However, I also acknowledge that behavior change is difficult and many people struggle not only with knowing what to eat, but understanding how to prepare it in a way that is flavorful and appealing to the whole family, affordable, and not too time consuming.”
For many people, eating because of stress or other reasons that go beyond just hunger can make a new diet even more challenging to stick to, Vadiveloo says. It can also be hard to make dietary changes when the foods that are easiest to access and afford are unhealthy and high in salt, fats, and added sugars, Vadiveloo adds.
“While some people are successful navigating those influences on their own, for others, it can be helpful to have a registered dietitian come up with a tailored plan to help navigate some of those behavioral challenges,” Vadiveloo says.
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