Advanced Mediterranean Diet

Eating nuts improves blood sugar control and cholesterol levels in type 2 diabetics, according to a recent research report in Diabetes Care.

Canadian researchers randomized 117 type 2 diabetics to eat their usual types of food, but also to be sure to eat either

•  mixed nuts (about 2 ounces a day)
•  muffins (I figure one a day)
• or  half portions of each. 

They did this daily for three months.  Compared to the muffin group, the full nut group ate quite a bit more monounsaturated fatty acids.  (I don’t have full study details because I have access only to the article abstract.)

Results

Hemoglobin A1c, a reliable measure of blood sugar control, fell by 0.21% in the mixed nut group.  That’s a move in the right direction.  LDL cholesterol, the “bad cholesterol” linked to heart and vascular disease, also dropped significantly. 

So What?

The investigators suggest that replacement of certain carbohydrates with 2 ounces of daily mixed nuts is good for people with type 2 diabetes.

I must mention that nuts are  a mandatory component of the Ketogenic Mediterranean Diet  and the Low-Carb Mediterranean Diet, and a recommended option on the Advanced Mediterranean Diet. 

Steve Parker, M.D.

References:  Jenkins, David J.A., et al.  Nuts as a replacement for carbohydrates in the diabetic diet.  Diabetes Care, June 29, 2011.  doi: 10.2337/dc11-0338

PS: The lead author of this study is the same David Jenkins of glycemic index fame.

White flour is better suited to glue for kindergarten art projects than to nutrition.

    —Drs. Westman, Phinney, and Volek in The New Atkins for a New You

Great source of marine omega-3 fatty acids

Circulation recently published the American Heart Association Scientific Statement: Triglycerides and Cardiovascular Disease.  I’ve not read the full document, but here are a few tidbits I’ll share:

• Triglycerides (TGs) are not direclty atherogenic; they are a biomarker for cardiovascular risk
• Optimal fasting TGs are under 100 mg/dl (1.1 mmol/l)
• Normal nonfasting TGs are under 200 mg/dl (2.3 mmol/l)
• If levels are high, treatment focuses on intensive therapeutic lifestyle change
• To reduce high TGs, diet modifications include reduction of “simple carbohydrates” like added sugars and fructose by replacing with unsaturated fats, implementing a Mediterranean-style diet, reduction of saturated fat and trans fat consumption, increased marine omega-3 fatty acid intake
• To reduce high TGs in the setting of overweight and obesity, aim for loss of 5 or 10% of body weight
• To reduce high TGs, do aerobic exercise at least twice weekly

From my quick scan, I didn’t see much effort to push drugs on people with triglycerides under 500 mg/dl (5.6 mmol/l).

Thanks to Circulation for making this available to the public at no charge.

Steve Parker, M.D.

Olives and olive oil are iconic components of the the Mediterranean diet.  Nutrition Diva Monica Reinagel has a wonderful post about olives and olive oil.  What are the best olives to eat?  How are olives processed?  Are olives more heathful than olive oil?  Click through for the answers.

Steve Parker, M.D.

I just finished reading The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable, by Stephen Phinney, M.D., Ph.D., and Jeff Volek, Ph.D. published this year.  I give it four stars per Amazon.com’s rating system (I like it).

♦    ♦    ♦

The authors medicalize overweight and obesity by naming the cause of most cases to be “carbohydrate intolerance,” along the lines of lactose intolerance and gluten intolerance.  Given the myriad illnesses and shortened lifespan associated with obesity, medicalizing it is reasonable.  Ask Gary Taubes why we get fat, and he’ll say it’s excessive consumption of carbohydrates, especially sugars and refined flours.  Ask Phinney and Volek, and they’ll say “carbohdyrate intolerance.”  For them, the “treatment” is avoidance of carbs.  I also referred to carbohydrate intolerance in my 2011 book, Conquer Diabetes and Prediabetes.

If a patient asks me why he’s fat, I guess I’d prefer to say “you have carbohydrate intolerance,” rather than “you eat too many carbs.”  It’s less confrontational and doesn’t blame the patient.

So how many of us in the U.S. have carbohydrate intolerance?  The authors estimate a hundred million or more - about a third of the total poplulation, or more, who could directly benefit from carbohydrate restriction.  I agree.

Before reading this book, I was convinced that carbohydrates are indeed major contributors to overweight and obesity, especially concentrated sugars and refined grains.  The authors cite much of the pertinent scientific/medical literature. 

Gary Taubes made the same case in his brilliant book, Good Calories, Bad Calories.  Dr. Robert Atkins argued the same in Dr. Atkins New Diet Revolution.  The problem is that many healthcare providers such as physicians and dietitians are biased against thosesources.  Physicians resist a non-physician such as Taubes giving them advice about the practice of medicine.  And most physicians over 45 still labor under the misconception that dietary cholesterol and total and saturated fat are major-league killers, so they’ve already dismissed Dr. Atkins and don’t have time to get caught up to date on the recent research.

Phinney and Volek have wisely targeted this work towards healthcare providers such as physicians, so it’s somewhat technical and clinical.  Both have Ph.D.s and Phinney is also an M.D.  The authors are respected researchers who thoroughly review the science behind low-carb eating.  They explain how high blood pressure, metabolic syndrome, type 2 diabetes, and other conditions are related to carb consumption.

I rate the book four stars instead of five only because it’s a little pricey at $29 (US).

Smart nutrition- and fitness-minded folks will also benefit from a reading.  For a more consumer-oriented book, I recommend the authors’ The New Atkins for a New You or Taubes’ Why We Get Fat.

Steve Parker, M.D.

To get the full health benefits of regular physical activity, you need to put some effort into it.  A leisurely hour-long stroll in the mall while window-shopping doesn’t pass muster, although that’s better than nothing.

One rough way to gauge whether you are working hard enough during aerobic exercise is to monitor your heart rate, also known as pulse.  Subtract your age from 220.  The result is your theoretical maximum heart rate in beats per minute.  Your heart rate goal, or target, during sustained aerobic exercise is a pulse that is 60 to 80 percent of your theoretical maximum pulse.  For example: maximum heart rate for a 40-year-old is 180 (220 - 40 = 180), so the target heart rate zone during exercise is between 108 and 144 (60 to 80 percent of 180).  Exceeding the upper end of the target zone is usually too uncomfortable to be sustainable.  Exercise heart rates below the target zone suggest you’re not working hard enough to reap the full long-term benefits of aerobic exercise.

Here’s how to determine your pulse.  After five or 10 minutes of exercise, stop moving and place the tips of your first two fingers lightly over the pulse spot inside your wrist just below the base of your thumb.  Count the pulsations for 15 seconds and multiply the number by four.  The result is your pulse or heart rate.  It will take some practice to find those pulsations coming from your radial artery.  If you can’t find it, ask a nurse or doctor for help.

Like all rules-of-thumb, this target heart rate zone isn’t always an accurate gauge of cardiovascular workout intensity.  For instance, it is of very little use in people taking drugs called beta blockers, which keep a lid on heart rate.

As you become more fit, you’ll notice that you have to work harder to get your heart rate up to a certain level.  This is a sure sign that your heart and muscles are responding to your challenge.  You may also want to monitor your resting heart rate taken in the morning before you get out of bed. Unfit, sedentary people have resting pulses of 60 to 90.  Athletes are more often in the 40s or low 50s.  Their hearts have become more efficient and just don’t need to beat as often to get the job done.

As you become more fit, you’ll also notice that you have more energy overall and it’s easier to move about and handle physical workloads. You’ll feel more relaxed and have a sense of accomplishment. Expect these benefits eight to 12 weeks after starting a regular exercise program.

Steve Parker, M.D.

A Mediterranean-style diet is one of four factors helping to greatly reduce the risk of sudden cardiac death in women, as reported by Reuters on June 5, 2011.  The other factors reducing risk were maintainence of a healthy weight, regular exercise, and not smoking.

The study involved women only, so we don’t know if the research, reported in the Journal of the American Medical Association, applies to men.

This study confirms many earlier ones linking the Mediterranean diet with longevity and reduced rates of heart disease.

Steve Parker, M.D.

In 2009, Current Diabetes Reports published “The usefulness of a Mediterranean-based diet in individuals with type 2 diabetes,” by Catherine M. Champagne, Ph.D., R.D., L.D.N.  Unfortunately, the full article isn’t available to you at no cost.  But I read it.  Her article is a review of available scientific evidence related to the Mediterranean diet as applied to a diabetic population.  Dr. Champagne wrote:

This diet is a viable treatment option; advisors should stress not only adherence to a fairly traditional Mediterranean eating plan but also a lifestyle that includes sufficient physical activity.

I’ve been publishing my series on exercise here in dribs and drabs for the last several months.

Dr. Champagne was very favorably impressed with the DIRECT trial of Shai et al, which I covered extensively elsewhere.  DIRECT compared three diets over 24 months: Atkins, Mediterranean/calorie-restricted, and low-fat/calorie-restricted.  Mind you, it was a weight loss study, but a fair number of diabetics participated.  Mediterranean-style eating showed the most beneficial effects for diabetics. 

I think the Mediterranean diet could be even healthier for people with diabetes if it had fewer carbohydrates.  That’s why I composed the Low-Carb Mediterranean Diet.

Dr. Champagne also mentions evidence that a modified Mediterranean diet may help counteract the build-up of fat in the liver, seen in up to 70% of type 2 diabetics.  I wrote recently about how a very-low-carb diet beat the low-fat diet so often recommended for this condition (hepatic steatosis or non-alcoholic fatty liver disease).

If you want full online access to Champagne’s 6-page article, you can purchase it for $34 (USD) at SpringerLink.  I cite many of the same scientific sources and provide a whole lot more in my 216-page Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet, at Amazon.com for $16.95 or $9.99 (the Kindle edition) or in multiple ebook formats from Smashwords.

Steve Parker, M.D.

Reference: Champagne, Catherine (2009). The usefulness of a Mediterranean-based diet in individuals with type 2 diabetes. Current Diabetes Reports DOI: 10.1007/s11892-009-0060-3