Physicians Perspective.....Mediterranean Diet

Mediterranean Diet Might Delay Need for Drugs in Diabetes
The benefits of a “therapeutic" lifestyle as an integral part of diabetes management is evident in a new study by Dr Katherine Esposito and colleagues, published in the September 1, 2009 issue of the Annals of Internal Medicine. Moreover, the importance of compliance with nutritional advice is not just in forestalling the need for medicines and decreasing cost but in improving important CV risk factors attributable to future heart attacks, stroke and kidney failure.

The study evaluated a low-carbohydrate, Mediterranean diet rather than a low-fat diet, in newly diagnosed diabetic patients. After four years, with continued nutritional advice, only 44% of newly diagnosed diabetic patients on a Mediterranean diet vs 70% of those on a low-fat diet required drug therapy as well as diet to control their diabetes.

Currently the American Diabetes Association (ADA) recommends a low-carbohydrate or a low-fat diet for overweight people with type 2 diabetes, however, few studies have directly compared these diets in diabetes.

The patients were sedentary, had a mean age of 52 years (range 30 to 75 years), a body-mass index greater than 25 kg/m2 (mean 29.6 kg/m2), and a hemoglobin A1c level of less than 11%. Most (77%) had an HbA1c level greater than 7%. The primary study outcome was timed) to introduction of antihyperglycemic therapy--predetermined to start when HbA1c levels were more than 7% at two measurements three months apart.

Secondary outcomes included weight change, glycemic control, and attaining ADA coronary-risk-factor goals (HbA1c <7%;>30% of calories were from fat, largely olive oil).

2. A low-fat diet based on AHA guidelines, which included lots of whole grains and restricted sweets, fats, and high-fat snacks, where <30%>7% at baseline, only 22 patients still had an elevated HbA1c level after three months, and all patients had lower levels after six months on either diet.

Patients in both diet groups lost weight and had declines in plasma glucose and HbA1c levels, but the reductions were nearly 40% greater in the Mediterranean-diet group. The dramatic benefits of the Mediterranean diet included the delayed need for BP drug therapy independent of weight change. More participants in the Mediterranean diet met all three ADA goals and had consistently greater increases in HDL-cholesterol levels and decreases in triglycerides.

Problems of HDL/triglyceride metabolism are in fact more important in predicting risk than cholesterol levels for those with cardiometabolic disease and diabetes.

A simple and inexpensive method to delay the need for drug therapy for diabetes and lessen major CV risk factors of hypertension and abnormal lipids offers very impressive hope for our patients. The importance of this 4 year study mandates the importance of the Mediterranean diet, and most importantly nutritional counseling and the clear call to provide individuals with a better system for long-term counseling and/or coaching.
SR
1. 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. Ann Intern Med 2009; 151:306-314.