Category Archives: Mediterranean Diet

Another Study Finds the Mediterranean Diet Preserves Brain Function During Aging

Well, maybe that’s a bit of an overstatement. Preserved brain function and the Mediterranean diet were  positively associated in a study involving Americans in Utah. This fits with prior observations that the Mediterranean diet prevents dementia.

In the study at hand, the DASH diet (Dietary Approaches to Stop Hypertension) also protected the brain:

Higher levels of compliance with both the DASH and Mediterranean dietary patterns were associated with consistently higher levels of cognitive function in elderly men and women over an 11-y period. Whole grains and nuts and legumes were positively associated with higher cognitive functions and may be core neuroprotective foods common to various healthy plant-centered diets around the globe.

See the American Journal of Clinical Nutrition for details.

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Filed under Dementia, Health Benefits, Mediterranean Diet

Live Longer With The Mediterranean Diet Even If You Already Have Cardiovascular Disease

Conquer Diabetes and Prediabetes, Steve Parker MD

Olive oil and vinegar: prominent components of the Mediterranean diet

We’ve known for years that the Mediterranean diet helps prolong life and prevent cancer, heart attacks, type 2 diabetes, dementia, and strokes in folks who start out healthy.

What about patients with existing cardiovascular disease? I’m talking about history of heart attacks, strokes, angina, and coronary artery disease.

Yep. The Mediterranean diet helps them live longer, too.

Details of the study are at the American Journal of Clinical Nutrition. The research was done at Harvard.

Steve Parker, M.D.

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Filed under coronary heart disease, Health Benefits, Heart Disease, Longevity, Mediterranean Diet, Stroke

Mediterranean Diet Once Again Linked to Lower Risk of Type 2 Diabetes

Conquer Diabetes and Prediabetes, Steve Parker MD

Olive oil and vinegar

And eating low glycemic load helps, too, according to an article at MedPageToday. The 22,000 Greek study participants were followed for 11 years. From the article:

The findings suggest that eliminating or strictly limiting high glycemic load foods such as those high in refined sugars and grains and following the largely plant-based Mediterranean diet, which emphasizes vegetables, fruits, nuts and legumes, can have a significant impact on diabetes risk, La Vecchia said.

“The impact of the diets was synergistic,” he told MedPage Today. “The message is that eating a largely Mediterranean diet that is also low in glycemic load is particularly favorable for preventing diabetes.”

Spanish researchers found the same thing a few years ago.

The Mediterranean diet is also healthy for those who already have type 2 diabetes.

The Low-Carb Mediterranean Diet may be the ideal way of eating for diabetics.

Steve Parker, M.D.

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Filed under Glycemic Index and Load, Health Benefits, Mediterranean Diet, Prevention of T2 Diabetes

Canadian Study Finds Abdominal Obesity Health Markers Much Improved With Mediterranean Diet and High-Intensity Interval Training

…according to the Heart and Stroke Foundation. Some quotes:

The study found an average reduction in waist circumference of eight centimeters, a reduction in systolic blood pressure of 6 mm Hg and an aerobic fitness improvement of 15 per cent over the first nine months of the study.

Improvements in waist circumference, blood pressure and fitness can lead to numerous other health benefits including a reduced risk of developing high blood pressure, as well as improving osteoarthritis symptoms, quality of life, physical functioning, and cognition.

The high-intensity interval training was done two or three times a week over 20-30 minutes each session. Click for an example of HIIT on a stationary bike. More basic info on HIIT.

The classic Mediterranean diet has too many carbohydrates for many diabetics, although it’s better for them than the Standard American Diet. That’s why I devised the Low-Carb Mediterranean Diet.

Steve Parker, M.D.

Steve Parker MD, low-carb diet, diabetic diet

Olives, olive oil, and vinegar: classic Mediterranean foods

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Filed under Exercise, Health Benefits, Mediterranean Diet, Overweight and Obesity

Yet Another Study Links Long Life Span to the Mediterranean Diet

…by Johns Hopkins researchers.

Six thousand Americans were followed over eight years, with attention to heart disease and death. Significantly lower death rates were seen in nonsmokers, and those maintaining a healthy weight, exercising regularly, and eating the Mediterranean diet. The more adherence to those healthy factors, the lower the risk of death

h/t Lyle J. Dennis, M.D.

Reminder: Conquer Diabetes and Prediabetes is now available on Kindle and other ebook formats. That’s where you’ll find the full Low-Carb Mediterranean Diet.

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Filed under Health Benefits, Longevity, Mediterranean Diet

Experts Debate Composition of the Mediterranean Diet

…but they have some good ideas as to the healthy components, according to a report in MedPageToday. A sample:

Through a subtractive statistical technique, the EPIC investigators calculated that the biggest chunk of the health advantage—24%—came from moderate alcohol consumption (predominantly wine).

The other relative contributions were:

  • 17% from low consumption of meat and meat products
  • 16% from high vegetable consumption
  • 11% from high fruit and nut consumption
  • 11% from high monounsaturated-to-saturated lipid ratio (largely due to olive oil consumption)
  • 10% from high legume consumption

Here’s my definition of the Mediterranean diet.

Steve Parker, M.D.

Reference:
Sofi F, et al “Ideal consumption for each food group composing Mediterranean diet score for preventing total and cardiovascular mortality” EuroPRevent 2013; Abstract P106.

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Filed under Alcohol, Fruits, legumes, Mediterranean Diet, nuts, olive oil, Vegetables

Should Diabetics Avoid or Seek Fruit?

Advanced Mediterranean Diet, paleo diet, paleobetic diet

Grapes probably destined for wine

Newly diagnosed type 2 diabetics have no need to avoid fruit …according to an article in Nutrition Journal.  Fruit is a prominent component of the Mediterranean and paleo diets.  It can be good for us, containing phytonutrients, fiber, etc.  But fruit has the potential to increase blood sugars, too, which may be harmful over the long run.  So whadda you do?

Researchers took newly diagnosed type 2 diabetics and split them into two groups. One group was told to eat at least two pieces of fruit daily, the other was told to eat no more than two pieces.

The researchers conclusions:

A recommendation to reduce fruit intake as part of standard medical nutrition therapy in overweight patients with newly diagnosed type 2 diabetes resulted in eating less fruit. It had however no effect on HbA1c, weight loss or waist circumference. We recommend that the intake of fruit should not be restricted in patients with type 2 diabetes.

Read the full research report.

PS: I haven’t read the full report yet.

Steve Parker, M.D.

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Filed under Fruits, Mediterranean Diet, Paleo diet

E-mail Interview With a Low-Carb Friendly Dietitian

Conquer Diabetes and Prediabetes, Steve Parker MD

Brain food that won’t spike blood sugars

I received an email from a registered dietitian (FS) in May, 2013. She had some reasonable questions for me and I thought you might be interested in my answers. Here’s her email first:

So funny that you happened to comment on my blog post today because I’d already planned to email you. I’m writing an article on low-carbohydrate diets for Diabetes Self Management magazine and was hoping to ask you a few questions about your experience treating your patients with the Diabetic Mediterranean and Ketogenic diets. We could do it via e-mail if you like. What I’d really like to know is how many of your patients were/are successful in sticking to the diet long term and what type of feedback you’ve received from them, along with any other information you feel is pertinent. Also, what carb range to you recommend for your diabetic patients?

My response:

Dear F,

First, let me explain a little about my medical practice. I’m a full-time hospitalist, meaning I treat adult patients only in the hospital setting. Nearly all of my patients come in through the emergency department. I treat a great variety of problems, like pneumonia, heart failure, cellulitis, pancreatitis, urinary tract infections, headaches, strokes, GI tract bleeding, cholecystitis, altered mental status, out of control diabetes, etc. My training is in Internal Medicine.

By the way, I work in Scottsdale, Arizona, which is a fairly sophisticated and affluent community. My two hospitals employ some dietitians who receptive to very-low-carb eating.

As it turns out, 30% of my hospitalized patients happen to have diabetes, at least 95% of which is type 2. This is typical for non-pediatric hospitalists. Nearly all of these diabetics have an established diagnosis of diabetes and a relationship with an outpatient doctor who is treating it. I usually ask them, “Are you on any special diet, or do you pretty much eat whatever you want?” Half of them say “nothing special; I eat what I want”! Three out of 10 respond that they “avoid sweets and desserts” or something similar. One or two of every 10 report they make a strong effort to reduce carb consumption below the usual American level (250-300 g/day). No more than five of every 100 has ever heard of Dr. Richard Bernstein’s Diabetes Solution. (I consider Dr. B the founder and leader of the modern carbohydrate-restricted diabetes diet movement.) No more than one of every 100 follows Dr. Bernstein’s or a similar very-low-carb or ketogenic diet.

Once these patients leave the hospital, I cannot follow them in a clinic setting. I wish I could. I see many of them in the hospital only once, which is not much time to develop a trusting relationship. Perhaps surprisingly, I don’t often do a “hard sell” for a low-carb diet, even though that’s what I’d follow if I had diabetes of either type. People have to be ready to make a change in hard-wired eating behavior, like an alcoholic is ready to quit drinking only when he’s hit “rock bottom.” For someone with diabetes, that rock bottom point is typically at the time of initial diagnosis or when a major complication hits (such as neuropathy, kidney impairment, or retinopathy). They’re more receptive to change then. All of my hospitalized diabetics get a business card referring them to my Low-Carb Mediterranean Diet website (Diabetic Mediterranean Diet).

Since I have no outpatient clinic, I have no way of knowing how many of them adopt a low-carb way of eating. I do get unsolicited emails from diabetics who have adopted the Low-Carb Mediterranean Diet or Ketogenic Mediterranean Diet, and they report satisfying results with weight management and glucose control. Problem is, as mentioned, I don’t know the denominator. Not once in two years has anyone ever contacted me to report they were harmed by the diets or that they didn’t help at all with glucose control.

I’m convinced you can get good nutrition eating low-carb and very-low-carb. By “low-carb,” I mean under 130 g/day, and “very-low-carb” is under 50 or so. An added benefit for diabetics is that they may be able to avoid the cost and toxicity of some diabetes drugs. We have no long-term toxicity data on most of our diabetes drugs. (Insulin and metform are safe long-term.)

Whether a diabetic goes with Dr. Bernstein’s, my Low-Carb Mediterranean Diet, or Dr. Atkins’ Diabetes Revolution, I think they’re going to be better off over the long run compared to eating a typical “diabetic” diet that has 200+ grams of net carbs. Of course, I have no hard proof. We may never have it. Of those who choose LCMD, I have no data on how many of them actually follow it long-term. Hey, I finally answered one of your questions!

If one of my diabetics prefers to eat Bernstein or Atkins-style over my program, I have no problem with that at all. (The Atkins program recommends some nutritional supplements that I’m not convinced are necessary or even minimally helpful.)

How many diabetics stick with a carb-restricted diet (e.g., under 130 g/day) long-term, more than 2-3 months? My guesstimate is only two or three out of ten. The problem is that we live in a highly carb-centric culture: temptation abounds, we form firm dietary habits in childhood, carbs are cheap, and, frankly, many taste very good.

Incidentally, I don’t have diabetes but I strive to keep my digestible (or net) carbs in the range of 60 to 80 grams/day. The carb restriction helps me control my weight, and I’m seeing some preliminary evidence that it may help with prevention of dementia and mild cognitive impairment.

The long-term carbohydrate intake range I recommend for diabetics is 60-80 g of net or digestible carb daily. Twenty or 30 g/day (a la Bernstein or my Ketogenic Mediterranean Diet) can help overweight diabetics lose the excess fat a little quicker and easier. But 30 d/day over the long run is extremely difficult for all but the most highly motivated. If I had type 1 diabetes, I’d give 30 g/day a serious try, like Dr. Bernstein. Competitive endurance athletes may need more than 100 g/day. Some mild type 2′s may be able to adequately handle over 80 g/day depending on degree of residual pancreas beta cell function. It bothers me to see a type 2 diabetic taking 4-5 diabetes drugs just so they can control diabetes while eating a high-carb diet (e.g., over 200 g/day). Again, we don’t know the long-term effects of most of these drugs.

I’m sorry for being so long-winded! I hope this helps. Email me soon if you have more questions and I’ll respond w/in 24h. Or call me at xxx-xxx-xxxx. Please keep up the good work. In turn, I’ll keep doing my little part to turn around this carb-centric culture. At least until the science dictates otherwise.

Sincerely,

-Steve

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Filed under Carbohydrate, ketogenic diet, Mediterranean Diet, Prediabetes

Periodic Tests, Treatments, and Goals for PWDs (Persons With Diabetes)

If you don't like your physician, find a new one

If you don’t like your physician, find a new one

So, you’ve got diabetes. You’re trying to deal with it or you wouldn’t be here. You’ve got a heck of a lot of medical information to master.

Unless you have a good diabetes specialist physician on your team, you may not be getting optimal care. Below are some guidelines you may find helpful. The goal is to prevent diabetes complications. Many primary care physicians will not be up-to-date on the guidelines. Don’t hesitate to discuss them with your doctor. Nobody cares as much about your health as you do.

Annual Tests

The American Diabetes Association (ADA) recommends the following items be done yearly (except as noted) in non-pregnant adults with diabetes. (Incidentally, I don’t necessarily agree with all ADA guidelines.) The complete ADA guidelines are available on the Internet.

  • Lipid profile (every two years if results are fine and stable)
  • Comprehensive foot exam
  • Screening test for distal symmetric polyneuropathy: pinprick, vibration, monofilament pressure sense
  • Serum creatinine and estimate of glomerular filtration rate (MDRD equation)
  • Test for albumin in the urine, such as measurement of albumin-to-creatinine ratio in a random spot urine specimen
  • Comprehensive eye exam by an ophthalmologist or optometrist (if exam is normal, every two or three years is acceptable)
  • Hemoglobin A1c at least twice a year, but every three months if therapy has changed or glucose control is not at goal
  • Flu shots

Other Vaccinations, Weight Loss, Diabetic Diet, Prediabetes, Alcohol, Exercise, Etc.

Additionally, the 2013 ADA guidelines recommend:

  • Pneumococcal vaccination. “A one time re-vaccination is recommended for individuals >64 years of age previously immunized when they were <65 years of age if the vaccine was administered >5 years ago.” Also repeat the vaccination after five years for patients with nephrotic syndrome, chronic kidney disease, other immunocompromised states (poor ability to fight infection), or transplantation.
  • Hepatitis B vaccination to unvaccinated adults who are 19 through 59 years of age.
  • Weight loss for all overweight diabetics. “For weight loss, either low-carbohydrate, low-fat calorie-restricted, or Mediterranean diets may be effective in the short-term (up to two years).” For those on low-carb diets, monitor lipids, kidney function, and protein consumption, and adjust diabetic drugs as needed. The optimal macronutrient composition of weight loss diets has not been established. (Macronutrients are carbohydrates, proteins, and fats.)
  • “The mix of carbohydrate, protein, and fat may be adjusted to meet the metabolic goals and individual preferences of the person with diabetes.” “It must be clearly recognized that regardless of the macronutrient mix, total caloric intake must be appropriate to weight management goal.”
  • “A variety of dietary meal patterns are likely effective in managing diabetes including Mediterranean-style, plant-based (vegan or vegetarian), low-fat and lower-carbohydrate eating patterns.”
  • “Monitoring carbohydrate, whether by carbohydrate counting, choices, or experience-based estimation, remains a key strategy in achieving glycemic control.”
  • Limit alcohol to one (women) or two (men) drinks a day.
  • Limit saturated fat to less than seven percent of calories.
  • During the initial diabetic exam, screen for peripheral arterial disease (poor circulation). Strongly consider calculation of the ankle-brachial index for those over 50 years of age; consider it for younger patients if they have risk factors for poor circulation.
  • Those at risk for diabetes, including prediabetics, should aim for moderate weight loss (about seven percent of body weight) if overweight. Either low-carbohydrate, low-fat calorie-restricted, or Mediterranean diets may be effective in the short-term (up to 2 years). Also important is exercise: at least 150 minutes per week of moderate-intensity aerobic activity. “Individuals at risk for type 2 diabetes should be encouraged to achieve the U.S. Department of Agriculture (USDA) recommendation for dietary fiber (14 g fiber/1,000 kcal) and foods containing whole grains (one-half of grain intake).” Limit intake of sugar-sweetened beverages.
  • “Adults with diabetes should be advised to perform at least 150 min/week of moderate-intensity aerobic physical activity (50–70% of maximum heart rate), spread over at least 3 days/week with no more than two consecutive days without exercise. In the absence of contraindications, adults with type 2 diabetes should be encouraged to perform resistance training at least twice per week.”
  • Screening for coronary artery disease before an exercise program is depends on the physician judgment on a case-by-case basis. Routine screening is not recommended.
Steve Parker MD, low-carb diet, diabetic diet

Olive, olive oil, and vinegar: classic Mediterranean foods

Obviously, some of my dietary recommendations conflict with ADA guidelines. The experts assembled by the ADA to compose guidelines were well-intentioned, intelligent, and hard-working. The guidelines are supported by 528 scientific journal references. I greatly appreciate the expert panel’s work. We’ve simply reached some different conclusions. By the same token, I’m sure the expert panel didn’t have unanimous agreement on all the final recommendations. I invite you to review the dietary guidelines yourself, discuss with your personal physician, then decide where you stand.

General Blood Glucose Treatment Goals

The ADA in 2013 suggests these therapeutic goals for non-pregnant adults:

  • Fasting blood glucoses: 70 to 130 mg/dl (3.9 to 7.2 mmol/l)
  • Peak glucoses one to two hours after start of meals: under 180 mg/dl (10 mmol/l)
  • Hemoglobin A1C: under 7%
  • Blood pressure: under 140/80 mmHg
  • LDL cholesterol: under 100 mg/dl (2.6 mmol/l). (In established cardiovascular disease: <70 mg/dl or 1.8 mmol/l may be a better goal.)
  • HDL cholesterol: over 40 mg/dl (1.0 mmol/l) for men and over 50 mg/dl (1.3 mmol/l) for women
  • Triglycerides: under 150 mg/dl (1.7 mmol/l)

The American Association of Clinical Endocrinologists (AACE) in 2011 proposed somewhat “tighter” blood sugar goals for non-pregnant adults:

  • Fasting blood glucoses: under 110 mg/dl (6.11 mmol/l)
  • Peak glucoses 2 hours after start of meals: under 140 mg/dl (7.78 mmol/l)
  • Hemoglobin A1C: 6.5% or less

The ADA reminds clinicians, and I’m sure the AACE guys agree, that diabetes control goals should be individualized, based on age and life expectancy of the patient, duration of diabetes, other diseases that are present, individual patient preferences, and whether the patient is able to easily recognize and deal with hypoglycemia. I agree completely.

Steve Parker, M.D.

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Filed under Diabetes Complications, Exercise, Fat in Diet, Fiber, Mediterranean Diet, Overweight and Obesity, Prediabetes, Prevention of T2 Diabetes

Dr. Sigurdsson’s Thoughts on the Best Diet for Diabetes

"Vegan? Vegetarian? Mediterranean? Low-Carb? ADA? Low GI?  SAD?

“Vegan? Vegetarian? Mediterranean? Low-Carb? ADA? Low GI? SAD?

Remember that recent report on the best diet for diabetes from American Journal of Clinical Nutrition?  I didn’t think so.  Here’s Dr. Axel Sugurdsson’s summary:

Ajala and coworkers conclude that their review provides evidence that modifying the amount of macronutrients can improve glycemic control, weight and lipids in type 2 diabetes. In their analysis, low carbohydrate diets appeared to provide superior weight loss, better control of blood glucose, and better lipid profile, compared with low fat diets. The authors also conclude that vegan and vegetarian diet may improve glucose control and promote weight loss in type 2 diabetes.

Here’s the verbatim conclusion of the researchers from the article abstract:

Low-carbohydrate, low-GI, Mediterranean, and high-protein diets are effective in improving various markers of cardiovascular risk in people with diabetes and should be considered in the overall strategy of diabetes management.

No mention of vegan and vegetarian diets per se.

And now Dr. Sigurdsson’s concluding opinion:

What is the best diet for diabetes?  Although, there is probably not a simple answer,  the question reflects one of the main challenges of modern medicine. It is likely that our dietary recommendations will have to be tailored to the needs of the individual. A one-size-fits-all approach is unrealistic. Although not providing any definitive answers, the study by Ajala and coworkers is an important contribution to our understanding of this highly important issue.

Read the rest.

I’ve reviewed some of the literature supporting vegetarian diets for diabetes.  I’ve seen some evidence that the paleo diet may be beneficial.  Regular readers here know that I currently favor a carbohydrate-restricted Mediterranean-style diet for control of diabetes.

Steve Parker, M.D.

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Filed under Carbohydrate, Mediterranean Diet, Vegetarian Diet