We've been studying a Mediterranean diet in combination with an exercise plan to see how much we could improve the health of people with type 2 diabetes.

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Studies based on Mediterranean diet, combined with exercise, have proved groundbreaking in managing type 2 diabetes. Image: Flickr / Moyan Brenn

More than 350 million people worldwide suffer from type 2 diabetes. The condition is already rampant in several Western countries and numbers are now rising fast in emerging economies, such as India and China. But the right kind of dietary changes could dramatically reduce the impact of the illness on both patients and economies.

Alongside the impact of the disease and its associated complications on the lives of patients and their families, diabetes’ cost to health-care systems is huge. In Australia, for example, the total economic impact of type 2 diabetes is estimated at A$10.3 billion, while in the United States it is likely to exceed US$174 billion.

There are many ways to beat diabetes or reduce its impact; the key is making changes to your diet and lifestyle that you then follow for life. Indeed, lifestyle modification – eating a healthy diet and exercising regularly – is the cornerstone of any effective diabetes-management plan.

More than sugar

For decades now, the general recommendation has been for everyone to cultivate a high-unrefined-carbohydrate, low-fat diet. More recently, reducing sugar intake, even though it is one of the most popular carbohydrates, has been receiving a lot of attention. But a healthy eating plan for diabetes is not just about cutting out sugar. And scientific opinion is now turning in favour of lower carbohydrate diets – for everyone.

While excessive sugar will no doubt increase blood sugar levels, especially if you’re having sweetened drinks, any source of carbohydrate will have the same effect. This includes anything that contains flour, rice or pasta, as well as fruit and potato.

Burger and chips

Eating foods like this will only increase the risks of diabetes and its associated complications. Josephine Stenudd/Flickr, CC BY

Carbohydrate foods with a low glycaemic index (GI), such as oats and legumes, on the other hand, will dampen down the blood sugar response. That’s why careful carbohydrate selection is now recommended for everyone, especially people who have type 2 diabetes.

New data from high-quality nutrition research now strongly suggests that restricting carbohydrates even further, while moderately increasing protein and unsaturated fat intake, may have further benefits for controlling type 2 diabetes and reducing the risk of complications.

What we did and found

Based on these ideas, our research teams have been studying the effects of a “Mediterranean” diet – which has low carbohydrate, high protein and includes a lot of vegetables, nuts, lean meats and healthy fats – in combination with an exercise plan. We wanted to see how much we could improve the health of people with type 2 diabetes.

We assigned 115 adults with type 2 diabetes to one of two weight-loss programs. One group followed a very low-carbohydrate and high-protein diet for 24 weeks. The other had a higher carbohydrate, but still low GI, diet.

Early results have been ground-breaking; our diet is better at improving diabetes control compared to traditional weight-loss diets. But its most striking benefit is that it reduces the amount of medication someone with diabetes has to take by half. This reduction was three times greater than for people who followed the lifestyle program that incorporates a traditional high-carbohydrate diet plan.

Our very low-carbohydrate diet also improved blood cholesterol profile by increasing the levels of good (HDL) cholesterol and decreasing triglyceride (blood fat) levels to a greater extent than the traditional high-carbohydrate, low-fat diet. Both diets achieved similar reductions in bad (LDL) cholesterol levels – often a concern with some low-carbohydrate diets.

There’s more

Variation of blood glucose levels through the day is emerging as a strong independent risk factor for diabetes complications. In our study, the very low-carbohydrate diet was also more effective in reducing the number and levels of blood glucose variations over a 24-hour period.

In 2008-09, of the estimated A$1,507 million spent on the health care of diabetes in Australia, A$490 million was spent on diabetes-related medications. Our findings suggest that, by implementing a lifestyle program incorporating a healthy low-carbohydrate, high-protein, high-unsaturated-fat diet at a national level, the country could save up to A$250 million annually through reductions in diabetes-related medication alone.

This does not even account for any additional cost savings that could be generated from the marked improvements in diabetes control and patients’ well-being. It is these costs – related to the complications of diabetes and patients’ ability to contribute to the economy – that account for most of the economic impact of type 2 diabetes.

Our research shows evidence from the latest nutrition science can guide dietary approaches to tackling one of the most serious global health challenges of this century.

The Conversation

Chris Proud is Theme Leader, Nutrition and Metabolism at South Australian Health & Medical Research Institute.
Grant Brinkworth is Senior Research Scientist in Human Nutrition at CSIRO.
Manny Noakes is Professor of Nutrition & Research Director for the Food and Nutrition Flagship at CSIRO.

This article was originally published on The Conversation.
Read the original article.

12 comments

  1. Still banging on about low fat – lean meat and unsaturated fat tho.?? Keep up with programme guys – fat (the healthy fats- not grain or seed based PUFA’s but natural saturated fats) is not the enemy but another friend in fighting the obesity/diabetes war.

  2. Finally!
    Now you just have to convince all those other ‘head in the sand’ dietetic, diabetic institutions and foundations to see the light. Wouldn’t it be great if Australia became one of the first nations to buck the worldwide diabesity trend?

  3. Excellent article and EVERYBODY should read it. Carbs are surely the problem in modern diets. However I think you have played down the dangers of that most highly energy dense carb – sugar, for people who currently don’t have Type 2 diabetes and don’t want to get it.

    I didn’t know why or how bad sugar was until I read (and verified from other sources)“Sweet Poison” by David Gillespie. Here’s a summary of the important points. I hope you’ll print it, even though many (esp sugar sellers) don’t wholly agree with it. But there must be some validity to it given that before sugar became entrenched in our diet, Type 2 diabetes was so rare as to be considered a curiosity, and didn’t even have a name. But it was so prevalent by the 1950s it definitely needed a name because over three million cases were identified in sugar rich nations.

    First some facts about sugar and fructose:
    • Table sugar (chemical name sucrose) is 50% glucose and 50% fructose. Think of sugar as a molecule of glucose and a molecule of fructose bonded weakly together. Water or saliva easily breaks that bond. We say sugar is sweet, but it’s really the fructose we are tasting. The glucose part isn’t particularly sweet at all.
    • Glucose is essential for life – it creates energy when metabolized by our cells. Glucose is a good ‘sugar’. It is not particularly sweet. Our digestive system is perfectly tuned to turn most of what we eat into glucose, and to tell us when we’ve had enough.
    • Fructose, however, is not essential, and is relatively unfamiliar to our cells since we evolved with only very tiny amounts in our diet. It was available in quantity only in honey (hard to get) and in fully ripe fruit (seasonal if you lived in the tropics and were fast enough to get it before other animals did). It was also available in what vegetables existed back then, again in small amounts and always with cellulose (dietary fibre) associated with it.
    • Because fructose is unfamiliar to our cell chemistry, we don’t have many ways of dealing with it. It doesn’t get metabolized into energy because our cells don’t have the appropriate enzyme to do it. Instead fructose gets converted into fatty acids by our catch-all liver, which excretes the fatty acids into our bloodstream. Fatty acids then circulate in our bloodstream for a while either smearing the walls of our veins and arteries with a greasy film, or eventually getting converted into body fat. Either way, fructose from sugar ends up as fat somewhere.
    • So for most of human history our bodies rarely saw fructose. Even when sugarcane started being processed into sucrose after 1650, sugar was more expensive than opium. All that changed in the 1874 when tax on sugar was abolished and the average person could afford it. The world was suddenly flooded with sugar. The sweet taste of sugar was as craved-for then as heroin is today by drug addicts. People just couldn’t get enough of it because it sweetened so many bitter flavours like tea, coffee and chocolate, and made flour palatable. Cakes as we know them were invented about that time, as was jam, marmalade, preserved fruits etc. People also started losing teeth prematurely about that time and the practice of modern dentistry began. The first recorded myocardial infarction (Hollywood-style, fatal heart attack) was in 1897. Up until this time type 2 diabetes was so rare as to be considered a curiosity, and didn’t even have a name. But it was so prevalent by the 20th century it needed a name because over three million cases were identified in sugar rich nations.
    Question: So why are people fatter all of a sudden, when they weren’t so fat 50 years ago?
    Answer: because sugar (50% fructose) has found its way into almost every processed food in the supermarket and we can’t easily tell we are eating it. Look at any label – sugars are always present and 50 % of that is fructose. Sugary things are high in calories, yet we keep on eating them. Why?
    • We have chemical messengers in our metabolic system that tell us to stop eating when we are full. They are activated by the concentrations of hormones like insulin, leptin and GLP1 in the blood, and are constantly monitored by the hypothalamus in our brains. You can think of the hypothalamus as a very accurate calorie counter. It counts the calories we eat, and at a certain concentration triggers the “I’m full” feeling, and we know to stop eating.
    • BUT (and this is the what makes our BUTTS so big), fructose does not get counted. Fructose does not stimulate insulin release, nor does it have much effect on other “I’m full” hormones. As a result the brain doesn’t measure the calories resulting from fructose. It is therefore quite easy to eat (or drink) staggering quantities of fructose and not feel full. We all know this intuitively because we can eat a large hamburger and feel full, then immediately down a large Coke, or eat a sugar-rich dessert with almost no extra full feeling.
    • Fructose molecules are like “ninja calories”. They sneak in; they never trigger the “feel full” alarm, and they take up residence in our bodies as fat, accumulating with every new intake of sugar. This fat only disappears if we deliberately go hungry for long periods. Exercise won’t do it because exercise makes us so hungry we actually eat more or drink more afterwards – often a high sugar drink like fruit juice or Gatorade, or reward ourselves with a Mars Bar or sticky bun. Exercise is good for many, many reasons, but slimming down isn’t one of them.
    • Even worse, besides making us look fat and feel sluggish, excess fat (over time) cascades to a series of fatal diseases like type 2 diabetes, myocardial infarction, stroke, and some cancers*of the digestive tract.
    *Re cancers: Multiple studies show this is very likely true, but so far the mechanisms aren’t fully understood, so not everyone is willing to agree. But the chemistry that shows sugar (the fructose part) makes us fat, is compelling to all but the most commercially biased minds.
    Fructose is a nasty substance. Don’t drink it or eat it if you can help it. Only cellulose (ie dietary fibre) counters it, which is why one or two pieces of whole fruit per day is perfectly fine to eat, as are vegetables; but juices devoid of fibre, and fizzy drinks are not fine – ever.

    Read the labels on your processed foods. Tomatoes have almost no fructose, yet Heinz tomato sauce is 28% sugar (14% fructose). No wonder they sell a lot.

    1. Fructose is actually turned into glycogen by the liver not fatty acid

  4. Reblogged this on By the Mighty Mumford and commented:
    IT JUST RAKES A READJUSTMENT IN ONE’S THINKING…AND BUDGET…!

  5. I know…!

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