I ran across a thought-provoking article published a few months ago at DiabetesHealth online. It’s a non-scientific exploration of the potential causes of “diabesity,” the combination of obesity and type 2 diabetes.
You’ll get a kick out of this especially if you’re over 40.
Click here to read “50 Reasons Why Diabesity Wasn’t Prevalent 50 Years Ago.”
Steve Parker, M.D.
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Filed under Causes of Diabetes, DM Prevalence
![MPj04329340000[1]](https://diabeticmediterraneandiet.com/wp-content/uploads/2009/05/mpj043293400001.jpg?w=223&h=300 "MPj04329340000[1]")
Several of the websites below include comments from people who have tried the recipes, as well as nutritional analysis.
http://www.allrecipes.com Enter search term “Mediterranean”
http://www.arabicnews.com See Food and Recipes under “Resources”
http://www.cliffordawright.com
http://www.gourmed.gr For English, click on the British flag in the upper right corner
http://www.mediterrasian.com
http://www.recipezaar.com Not a sure thing. Try searching “Mediterranean”
http://www.videojug.com Check the Mediterranean subsection under “Food & Drink”
Happy hunting!
Steve Parker, M.D.
Minimally refined grain
Methodology
Over 42,000 mostly middle-aged men in the Health Professionals Follow-up Study, without diabetes at baseline, were followed over six years to see if diet composition was related to onset of type 2 diabetes. Food intake was determined by a questionnaire. 95% of participants were white.
Results
523 cases of type 2 diabetes developed. Men with the highest glycemic index eating pattern were 37% more likely to develop diabetes compared to the lowest glycemic index.
Cereal (grain) fiber was inversely related to risk of diabetes. That is, the higher the intake of grain fiber, the lower the risk of developing diabetes.
The combination of high glycemic load and low cereal fiber yielded the highest rate of diabetes.
Total dietary fiber was not associated with reduced risk of diabetes.
Fiber from fruits and vegetables was not associated with diabetes one way or the other.
As other studies found, total carbohydrate intake was not related to risk of diabetes.
Take-Home Points
These findings may or may not apply to women and non-white ethnic groups.
Grains in a minimally refined form reduced the incidence of diabetes in this population.
Diets with a high glycemic load increase the risk of diabetes, at least in men.
Elsewhere, I’ve reviewed studies indicating that, in women, both high glycemic load and high glycemic index eating increase the risk of type 2 diabetes. Click here for details.
We must wonder if established cases of diabetes would respond positively to diets with low glycemic load and grains in a minimally refined form. Or is it too late?
Steve Parker, M.D.
Reference: Salmeron, Jorge, et al. Dietary fiber, glycemic load, and risk of NIDDM in Men. Diabetes Care, 20 (1997): 545-550
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Filed under Carbohydrate, Causes of Diabetes, Fiber, Glycemic Index and Load
Better living through chemistry
Class
Dopamine receptor agonist.
How Does It Work?
How it lowers glucose levels is not entirely clear, but it may reset or alter glucose metabolism in tissues outside the brain. Bromocriptine is an ergot derivative that increases dopamine activity in the brain. Cycloset improves after-meal glucoses without an increase in blood insulin levels. This is appealing since high insulin levels are implicated as a contributor to some chronic diseases.
Usage
It’s for adults with type 2 diabetes and can be used alone or with certain other diabetes drugs. “Other drugs” used in clinical trials were mostly metformin and sulfonylureas, with less experience using it with thiazolidinediones. We know little about using it with insulin. Bromocriptine is not for type 1 diabetics or diabetic ketoacidosis. It lowers hemoglobin A1c by 0.6 to 0.9% (absolute decrease).
Dose
Start with 0.8 mg every morning and increase by an additional tablet (0.8 mg) weekly up to 4.8 mg or the maximal tolerated dose (1.6 to 4.8 mg). Take all of it in the morning.
Side Effects
In clinical studies, the most common cause for discontinuation of the drug was nausea. It can cause drowsiness, fainting, blood pressure drops with standing (causing lightheadedness, fainting, weakness, or sweating), fatigue, vomiting, and headaches. Hypoglycemia is not much of a problem, if any, when bromocriptine is used as the sole diabetic medication. In other words, bromocriptine by itself may slightly increase the risk of hypoglycemia.
Bromocriptine has been in use for many years to treat other conditions, so we may not see any of the unforeseen consequences that have led to so many drugs being pulled from the market a couple years after FDA approval.
Don’t Use It If You . . .
-take neuroleptic drugs, are a nursing mother, have syncopal migraines (that make you faint), have hypersensitivity to ergot-related drugs, or have a severe psychotic disorder.
If you gotta have type 2 diabetes, this is a great time in history to have it. Twenty five years ago, we had maybe three classes of medications to fight it. By my count, we’re up to 11 classes now. Always good to have options!
Reference: VeroScience Announces FDA Approval of Cyclocet for Treatment of Type 2 Diabetes, in Medical News Today, May 7, 2009.
Date last modified: December 2, 2010
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Filed under Drugs for Diabetes
Mucho protein, amigo
This scientific study caught my eye because it utilized a high-monounsaturated fat diet for weight loss. The Mediterranean diet is rich in monounsaturated fats, mostly from olive oil.
Researchers in Australia ran a study to determine the effect of high- versus lower-protein wieght loss diets on fat and lean tissue, glucose levels, and blood lipids. For perspective, remember that a typical American diet has about 15% of calories from protein, 30% from fat, and 55% from carbohydrates.
Methodology
This was their high-protein diet: 28% protein, 42% CHO, 28% fat (8% saturated fatty acids, 12% monounsaturated fatty acids, 5% polyunsaturated fatty acids).
The low-protein diet: 16% protein, 55% CHO, 26% fat (8% saturated fatty acids, 11% monounsaturated fatty acids, 5% polyunsaturated fatty acids).
They studied 54 obese men (19) and women (35) with type 2 diabetes during 8 weeks of energy restriction (1,600 kcal) and 4 weeks of energy balance. Body composition was determined by dual-energy X-ray absorptiometry at weeks 0 and 12.
Results
Average weight loss for both groups was 5 kg. However, women on the HP diet lost significantly more total (5.3 vs 2.8 kg) and abdominal (1.3 vs 0.7 kg) fat compared with the women on the LP diet, whereas, in men, there was no difference in fat loss between diets (3.9 vs 5.1 kg). Total lean mass decreased in all subjects independently of diet composition. LDL cholesterol reduction was significantly greater on the HP diet (5.7%) than on the LP diet (2.7%). Blood glucose levels were reduced 5 or 10% by both diet interventions. Trigylcerides dropped 20% in both groups. Insulin concentrations were reduced in both groups. Subjects lose 2.1% lean mass overall, with no difference between the groups.
Conclusions of the Study Authors
Both dietary patterns resulted in improvements in the cardiovascular disease (CVD) risk profile as a consequence of weight loss. However, the greater reductions in total and abdominal fat mass in women and greater LDL cholesterol reduction observed in both sexes on the HP diet suggest that it is a valid diet choice for reducing CVD risk in type 2 diabetes.
Take-Home Points
This was a relatively small study, so results may not be widely applicable.
Substituting proteins for carbs doesn’t seem to be detrimental to people with type 2 diabetes needing to lose weight, and may be advantageous: greater total and abdominal fat loss in women, greater reductions in LDL cholesterol for both sexes. At least in the short run.
Nephrologists will be concerned that the higher-protein diet, if sustained long-term, could lead to kidney damage.
Current dogma is that the lower-carb (high-protein) dieters should have had lower blood glucose, triglycerides, and HgbA1c levels: not seen here.
Calorie-restricted diets tend to lower glucose levels and improve lipids, despite diet composition.
Reference: Parker, Barbara et al. Effect of a High-Protein, High–Monounsaturated Fat Weight Loss Diet on Glycemic Control and Lipid Levels in Type 2 Diabetes. Diabetes Care, 25 (2002): 425-430. From CSIRO Health Sciences and Nutrition, Adelaide, Australia.
Filed under Carbohydrate, Protein, Weight Loss
Oldways and the Mediterranean Foods Alliance announce that May is Mediterranean Month. It’s a way to promote healthy Mediterranean-style eating.
I can’t think of any other organization that’s done more than Oldways to spread the gospel about the Mediterranean diet.
In this context, “diet” refers to a habitual way of eating rather than a weight-loss program.
But who is Mediterranean Foods Alliance? From their website, MFA “is a group of devoted partners (health professionals, scientists, food companies, retailers, culinary experts, and media) working together to help people eat better with the Mediterranean Diet.”
Mediterranean Month features include:
* Mediterranean diet recipe contest (with prizes!)
* 7-day Mediterranean diet meal plan
* budget-friendly recipes
* Mediterranean Month Calendar Tips for incorporating the Mediterranean diet into your life
Click on the links in the first paragraph for details.
Steve Parker, M.D.
Filed under Mediterranean Diet
Medical News Today on May 6, 2009, published a comprehensive review of the health benefits of the Mediterranean diet. Click here to read. It’s definitely worth your time if you’re not already sold on the Mediterranean diet.
My only point of disagreement is regarding whether the Mediterranean diet lowers your risk of obesity. MNT says “yes.” The studies I’ve read are inconclusive.
Steve Parker, M.D.
Filed under Health Benefits, Mediterranean Diet
High dietary fiber intake helps prevent constipation, diverticular disease, hemorrhoids, irritable bowel syndrome, and perhaps colon polyps.
Soluble fiber helps control blood sugar levels in people with diabetes, and it reduces LDL cholesterol levels, thereby reducing risks of coronary heart disease.
An article in the journal Nutrition suggests how fiber may have beneficial effects in atherosclerosis (the cause of heart attacks and strokes), type 2 diabetes, and some cancers. These conditions are felt to be related to underlying systemic inflammation.
Systemic inflammation can be judged by blood levels of inflammatory markers such as interleukin-6, tumor necrosis factor-alpha-receptor-2, and high-sensitivity C-reactive protein.
Researchers looked at 1,958 postmenopausal women in the Women’s Health Initiative Observational Study, comparing inflammatory marker levels with dietary fiber intake. They found that high fiber intake was associated with significantly lower levels of inflammatory markers interleukin-6 and tumor necrosis factor-alpha-receptor-2. This association was true individually for total fiber, insoluble fiber, and soluble fiber. The researchers found no association with C reactive protein.
Bottom line?
High intake of dietary fiber seems to reduce chronic inflammation, which may, in part, explain the observed clinical benefits of fiber.
Average adult fiber intake in the U.S. is 12 to 15 grams daily. Expert nutrition panels and the American Heart Association recommend 25 to 30 grams daily from whole grains, fruits, and vegetables.
Nutritionist Monica Reinagel at NutritionData.com has reviewed soluble vs insoluble fiber and good sources of soluble fiber: oranges, apples, carrots, oats and oat bran, psyllium husk, nuts, legumes, and flaxseed. Click the link for good sources of insoluble fiber.
Rest assured that the Mediterranean diet is naturally high in fiber.
Reference: Ma, Yensheng, et al. Association between dietary fiber and markers of systemic inflammation in the Women’s Health Initiative Observational Study. Nutrition, 24 (2008): 941-949.
Filed under Fiber
A study published yesterday supports the idea that even in older adults, over 65, type 2 diabetes can be prevented in most cases by healthy lifestyle choices.
Researchers examined the participants in the Cardiovascular Health Study – 4,883 men and women over 65 at baseline – over the course of 10 years. Median age at enrollment was 73. Participants were followed clinically for 10 years. New cases of diabetes over 10 years: 337. Researchers suspected, based on previous studies in younger folks, that a reduced incidence of diabetes onset would be related to:
We’ll call these “lifestyle factors.” Participants were analyzed to see how well they fit this profile and whether or not they developed diabetes.
Results
The more each of these lifestyle factors characterized a person, the lower the risk of developing diabetes.
High physical activity and healthy diet by themselves reduced risk of diabetes by half.
Study authors estimate that healthy lifestyle choices could prevent eight or nine out of 10 cases of diabetes in older adults.
Take-Home Point
The researchers rightfully point out that their results are associations, not proof that these lifestyle factors prevent diabetes. Given the totality of the evidence from this and other studies, I would adopt many of the low-risk lifestyle choices if I wanted to avoid diabetes.
Reference: Mozaffarian, D., et al. Lifestyle risk factors and new-onset diabetes mellitus in older adults. Archives of Internal Medicine, 169, (2009): 798-807.
Update April 30, 2009:
Research in younger populations has associated the following factors with prevention of type 2 diabetes:
Some cases of diabetes are related to genetic factors beyond our control. Having parents or close relatives with diabetes suggests that you may be genetically predisposed. Genetics is not necessarily destiny, however.
-Steve
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Filed under Causes of Diabetes
People with diabetes are prone to develop atherosclerosis, which is often called “hardening of the arteries.” The hardening isn’t so bad; the problem is that the arteries develop obstructive plaques that impair the flow of life-sustaining blood to living tissues.
Actually, almost everybody will develop atherosclerosis eventually. But it’s better to get it when you’re 120 instead of 50 years old. Atherosclerosis causes most heart attacks, half of all strokes, and poor blood flow to the legs.
Diabetes accelerates the process of atherosclerosis, especially if the diabetes is poorly controlled.
The American Journal of Medicine in January this year published a supplement (volume122, number 1A) entitled “Management of Atherosclerosis: A Practical Guide in 2008.” William Insull, Jr., M.D., wrote a chapter on development and natural history of atherosclerosis. I summarized it at the Heart Health Blog at NutritionData.com today.
Did you know that atherosclerosis starts in childhood? Find the details at NutritionData.
The good news is that we can modify risk factors for atherosclerosis, such as diabetes, smoking, physical inactivity, and poor diet, thereby preventing the heart attack or stroke in a 57-year-old.
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Filed under Diabetes Complications
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Bible Verse of the Day
Diabetic Mediterranean Diet 