Diabetes

Nutritional Pearls: How Diet Affects Diabetes

Colleen is a 42-year-old female who has been diagnosed with type 2 diabetes. She knows that diet can help control her blood sugar levels, but is unsure what adjustments to make to her daily food intake. She is interested in weaning off medication, if possible.

How would you advise her?        

What is the correct answer?
(Answer and discussion on next page)

 

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Answer: Avoid medication longer with the Mediterranean diet.

Five years ago, I was really pleased to report on a study that confirmed my personal suspicions: Individuals with type 2 diabetes following a healthy, Mediterranean-style diet do better than those on a traditional low-fat American Heart Association style plan.1

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The Original Research

In the study,2 215 participants with type 2 diabetes and hemoglobin A1c levels <11% were assigned to either a low fat diet (similar to the one recommended by the American Heart Association) or a Mediterranean-style diet. Note: Both diets included reduced caloric intake of 1500 calories for women and 1800 calories for men.

The low fat diet targeted no more than 30% of calories from total fat and less than 10% of calories from saturated fat. The Mediterranean-style diet targeted no more than 50% of calories from carbohydrates and at least 30% of calories from fats, with the main source of added fats being olive oil.

Over the course of the 4-year study, 56% of participants following the Mediterranean-style diet avoided medication to control their blood sugars. By contrast, 70% of participants on the low fat diet had to start medication. 

The Follow-Up

The original authors of that study invited the original 215 patients to participate in a 4-year follow-up study to continue their research.3 Monthly meetings were held over 6 months with the authors of the study and blood tests, physical measurements (weight, waist-to-hip ratio), diet, and exercise records were collected as in the first study.

The primary goal was to measure how long the participants avoided being put on medication. Researchers also observed that some of the participants actually improved their diabetes to the point that their blood sugars were considered pre-diabetic (partial remission) or absolutely normal (full remission).

After a total study period of a little over 6 years, all of those on the low fat diet who had not achieved full or partial remission (about 5%) needed to be on medication. Individuals on the Mediterranean diet avoided medications for as long as 8 years, while 15% of participants achieved full or partial remission.

What’s the “Take Home”?

There is no guarantee that a Mediterranean diet will cure type 2 diabetes, but a 15% chance is a lot more than 5%—and your patient will start eating better food! Also noteworthy, while both the low fat and the Mediterranean diets were designed to induce weight loss, individuals on the Mediterranean diet lost an average of 2 kilograms (about 4.5 pounds) more than participants on a low fat diet.

If you have overweight patients who have recently been diagnosed with type 2 diabetes, refer them to a dietitian to discuss a Mediterranean diet.

References:

  1. Harlan T. The Mediterrnean diet is a diabetic diet. Dr. Gourment. September 14, 2009. www.drgourmet.com/column/dr/2009/091409.shtml. Accessed October 7, 2014.
  2. Esposito K, Maiorino MI, Ciotola M, et al. Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: a randomized trial. Ann Intern Med. 2009;151(5):306-314.
  3. Esposito K, Maiorino MI, Petrizzo M, et al. The effects of a Mediterranean diet on the need for diabetes drugs and remission of newly diagnosed type 2 diabetes: follow-up of a randomized trial. Diabetes Care. 2014;37(7):1824-1830.