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Over the years there have been a number of different strategies for diabetic diets. For a long time diabetics were taught to use exchange lists. That method worked well but was cumbersome for a lot of folks. More recently the training has focused on counting carbohydrates at each meal or snack. For diabetics who take insulin being careful with regulating when and what they eat is key and counting carbs works well for them.
The majority of diabetics, however, have Type 2 diabetes and don't take insulin. For these folks I have long felt that simply following a healthy diet is the best choice.
In one of the lectures that I give medical students on nutrition I cite multiple studies showing that diet can have as powerful an effect on controlling cholesterol as medications. We know that a Mediterranean style diet can help folks lose weight, prevent high blood pressure and avoid diabetes. But, can it also treat diabetes? A study published in the Annals of Internal Medicine says yes (Ann Intern Med. 2009;151:306-314). A resounding yes!
Researchers in Naples, Italy randomized 215 Type 2 diabetics to either a low fat diet similar to the one recommended by the American Diabetic Association or a Mediterranean style diet providing about 50% of calories from carbohydrates and 30% from fat. These were patients who had Hemoglobin A1c levels less than 11% (this is a measure of diabetic control with good control being under 7%).
The Mediterranean diet is rich in vegetables and whole grains, low in red meat, and higher in poultry and fish. Calories were restricted to 1500 per day for women and 1800 per day for men. The diet had 30% or more calories from fat, with the main source of added fat as olive oil. The low-fat diet was based on American Heart Association guidelines, being rich in whole grains with a restriction of additional fats, sweets, and high-fat snacks. Calories were the same as for the Mediterranean diet, with the target of less than 30% of calories from fat.
The study looked at the number of participants who needed to be put on medication for their diabetes. The researchers set the goal of having a Hemoglobin A1c over 7% for more than 3 months as the criteria for starting medication. The results are pretty amazing. Those following the Mediterranean style diet avoided medication 56% of the time while 70% of those following the low fat American Heart Association style diet ended up taking meds. Those on the Mediterranean style diet also lost more weight and had a greater improvement in their cholesterol and blood pressures.
For the last ten years or so I have not directly addressed a "diabetic diet" as part of the Dr. Gourmet website. This is because I have felt that the research showed that following a Mediterranean diet would work best for diabetics. Up to now there's not been proof of just how powerful this can be, but now, thankfully, we finally have proof.
Timothy S. Harlan, MD, FACP, CCMS
First posted: September 14, 2009