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Mediterranean Diet for Diabetes

The following article by health and medicine writer Nicholas Bakalar is reprinted from the New York Times, January 13, 2014

More good news on the Mediterranean diet. Sticking to a Mediterranean-style diet may help reduce the risk for Type 2 diabetes, even when people don’t lose weight or increase exercise levels.

The Mediterranean diet is rich in olive oil, nuts, fish, beans, fruits and vegetables, with few dairy products and moderate alcohol consumption.

The study, published in Annals of Internal Medicine, randomly assigned 3,541 men and women, ages 55 to 80 and free of diabetes, to one of three diets: a Mediterranean diet supplemented with either two ounces of extra-virgin olive oil, one supplemented with an ounce of mixed nuts a day, and a control group advised to eat a low-fat diet. They followed the participants for an average of about four years, with no intervention to increase physical activity or limit calories.

Compared with the control group, and after adjusting for health and socioeconomic factors, the risk for diabetes was 40 percent lower with the Mediterranean diet supplemented with olive oil and 18 percent lower with the diet supplemented with nuts.

“The strength of our study is that it has a large number of participants with a long followup and a randomized design,” said an author, Dr. Ramón Estruch, an associate professor of medicine at the University of Barcelona. “The diet works by itself without considering physical activity or changes in weight, which were insignificant between groups.”

The study in Annals of Internal Medicine referenced in the article above can be found here.

Mediterranean Diet Reduces Diabetes, Inflammation

 The following article by Mark L. Fuerst is reprinted from Psychiatric Times, March 31, 2014.

Two new studies show the heart-healthy benefits of eating a Mediterranean diet.

One study linked the diet to a lower risk of diabetes mellitus (DM), especially among those at high risk for cardiovascular disease…

In the first pooled analysis of studies evaluating the possible role of the Mediterranean diet in DM development, adherence to this diet was associated with a 21% reduced risk of DM compared with the control dietary groups. The likelihood of developing DM was almost 27% less in those at high risk for cardiovascular disease than in controls.

“Adherence to the Mediterranean diet may prevent the development of diabetes irrespective of age, sex, race, or culture,” said lead investigator Demosthenes Panagiotakos, PhD, professor at Harokopio University, Athens, Greece. “This diet has a beneficial effect, even in high risk groups, and speaks to the fact that it is never too late to start eating a healthy diet…”

The Mediterranean diet frequently emphasizes fresh fruits and vegetables, whole grains, beans, nuts, fi sh, olive oil, and even a glass of red wine.

Dr. Panagiotakos said he believes the Mediterranean diet lowers the risk of DM by helping guard against obesity. Earlier research has shown that following the traditional Mediterranean diet also is linked to weight loss, a reduced risk of heart disease and related death, and lower blood pressure and blood cholesterol levels…

[In a second study], Italian researchers conducted an analysis of the eating habits of nearly 15,000 healthy Italian men and women aged 35 years or older…

The investigators observed that consumption of the Mediterranean diet was directly related to lower levels of platelets and white blood cells, which, in turn, correlated to lower levels of inflammation [which has been associated with a greater risk of myocardial infarction (heart attack) and stroke].

For more detailed information on these studies, please see the following: Mediterranean diet and diabetes mellitus:

Why Olive Oil Is So Good for the Heart

The following article by Alice. G Walton is reprinted from Forbes, May 20, 2014.

New research in Proceedings of the National Academy of Sciences looks at the effect of the Mediterranean diet on heart health—and the verdict is favorable. But even more than that, the study lays out exactly why olive oil and greens are together so beneficial for the heart.

Until now, researchers hadn’t quite been able to explain why a diet as high in fat as the Mediterranean diet is linked to cardiovascular health. Researchers have wondered what exactly it is about the fats that helps the heart, and now they’ve arrived a pretty convincing mechanism to explain it.

The trick is to create a “fusion” of the healthy fats in, say, olive oil and the nitrites and nitrates in greens like spinach, celery, and carrots, which make up a large part of the Mediterranean diet. This fats–greens pairing, according to the researchers, creates a compound—nitro fatty acid—that has the effect of relaxing blood vessels and bringing down blood pressure, which are key components of heart health.

To test the theory, the team fed mice—with high blood pressure—the omega-6 fatty acids found in olive oil. They also added to their diets sodium nitrite, in order to mimic the pairing of olive oil and veggies. Indeed, not only was the level of nitro fatty acids higher in these mice, but their blood pressure was lower at the end of the 5-day intervention. And when the researchers used a strain of mice that were resistant to the effects of the nitro fatty acids, their blood pressure did not change.

Though the research was done in mice, the mechanism likely applies to people, too. Earlier research has pointed to the benefits of olive oil and nuts on cardiovascular health in humans.

“The findings of our study,” said study author Philip Eaton, “help to explain why previous research has shown that a Mediterranean diet supplemented with extra-virgin olive oil or nuts can reduce the incidence of cardiovascular problems like stroke, heart failure and heart attacks.” Avocados may work too, the team told the BBC, since they also contain healthy unsaturated fats.

Mayo Clinic Recommends Mediterranean Diet as “Heart-Healthy Eating Plan”

The following is excerpted from an article published by the Mayo Clinic News Network on November 17, 2014.

If you’re looking for a heart-healthy eating plan, the Mediterranean diet might be right for you. The Mediterranean diet incorporates the basics of healthy eating—plus a splash of flavorful olive oil and perhaps even a glass of red wine—among other components characterizing the traditional cooking style of countries bordering the Mediterranean Sea.

Most healthy diets include fruits, vegetables, fish, and whole grains, and limit unhealthy fats. While these parts of a healthy diet remain tried and true, subtle variations or differences in proportions of certain foods may make a difference in your risk of heart disease.

Benefits of the Mediterranean diet

Research has shown that the traditional Mediterranean diet reduces the risk of heart disease. In fact, an analysis of more than 1.5 million healthy adults demonstrated that following a Mediterranean diet was associated with a reduced risk of death from heart disease and cancer, as well as a reduced incidence of Parkinson’s and Alzheimer’s diseases.

The Dietary Guidelines for Americans recommends the Mediterranean diet as an eating plan that can help promote health and prevent disease. And the Mediterranean diet is one your whole family can follow for good health.

Key components of the Mediterranean diet

The Mediterranean diet emphasizes:

  • Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes, and nuts.
  • Replacing butter with healthy fats, such as olive oil.
  • Using herbs and spices instead of salt to flavor foods.
  • Limiting red meat to no more than a few times a month
  • Eating fi sh and poultry at least twice a week.
  • Drinking red wine in moderation (optional).

The diet also recognizes the importance of being physically active and enjoying meals with family and friends.

Compound in Olive Oil Shows Promise in Fight Against Cancer

The following is excerpted from an article by Chris Weller, published February 20, 2015, on MedicalDaily.com, based on the results of a recent study conducted by Rutgers University and Hunter College scientists.

Oleocanthal, the primary phenolic compound found in extra virgin olive oil, has been shown to eradicate cancer cells in less than an hour, giving scientists hope that targeted drug options in the future may be possible.

A team of researchers from Rutgers University and Hunter College published their recent study in the journal Molecular & Cellular Oncology. The findings add even more firepower to the argument in favor of olive oil, which has been shown in prior studies to shield our bodies against air pollution, improve our immune systems, protect aging bones, and perhaps even prevent the slide into Alzheimer’s disease….

The study isn’t without its limits. Cell cultures provide a reliable model for understanding how an external substance affects a new biological environment, but cells aren’t as complex as rats, which aren’t as complex as humans. It will still be years before oleocanthal makes its way into a clinical setting, by which time other technologies may have already crowded it out.

As a proof of concept, however, the findings suggest a robust set of possibilities for the compound. Oleocanthal is just one of the many phenols — a type of antioxidant — that appears in extra-virgin olive oil. It’s no accident the stuff appears in so many of the world’s healthiest diets. In addition to the heart-healthy antioxidants, olive oil provides a rich source of healthy fats that may preserve brain health and improve memory.

“We think oleocanthal could explain reduced [cancer] incidence in Mediterranean diets where consumption is high,” Foster told Medical Daily in an email. “And it is also possible that purified (higher-dose) could possibly be used therapeutically.”

Ultimately, the co-authors want to learn more about why oleocanthal targets and shrinks cancer cells specifically. “We also need to understand why it is that cancerous cells are more sensitive to oleocanthal than non-cancerous cells,” Foster said in the release. Even if consuming more olive oil won’t necessarily protect you from cancer today, budding research may help bring [some of its compounds] into the hospital in the future.

Source: LeGendre O, Breslin PAS, Foster DA. Oleocanthal rapidly and selectively induces cancer cell death via lysosomal membrane permeabilization (LMP). Molecular & Cellular Oncology. January 23, 2015. http://www.tandfonline.com/doi/abs/10.1080/23723556.2015.1006077

Mediterranean Diet Plus Olive Oil or Nuts May Boost Thinking and Memory

The following is excerpted from an article published on the website of the U.S. National Library of Medicine, May 11, 2015.

Adding more olive oil or nuts to a Mediterranean diet—one rich in fruits, vegetables, fi sh, and whole grains and low in red meat—may help keep your mind sharper as you age, a new study suggests.

The Spanish researchers found that seniors following such diets had greater improvements in thinking and memory than people who were simply advised to eat a lower-fat diet.

“You can delay the onset of age-related mental decline with a healthy diet rich in foods with a high antioxidant power, such as virgin olive oil and nuts,” said lead researcher Dr. Emilio Ros, director of the lipid clinic at the Hospital Clinic in Barcelona.

“Because the average age of participants was 67 when the trial began, one can say that it is never too late to change your diet to maintain or even improve brain function,” he said.

The report was published online May 11 in the journal JAMA Internal Medicine.

Dr. Sam Gandy, director of the Center for Cognitive Health at Mount Sinai Hospital in New York City, said, “The general heart-healthy and brain-healthy effects of eating less beef and more chicken, fi sh, fruits and vegetables [have] been validated to the point that I now recommend this general Mediterranean diet to all my patients.”

…. Participants were randomly assigned to add a liter (about 33 ounces) of extra virgin olive oil per week to their Mediterranean diet, or to supplement their Mediterranean diet with 30 grams (roughly 1 ounce) per day of a mixture of walnuts, hazelnuts and almonds. Others followed a low-fat diet…. The participants followed the diets for four years, on average, according to the study.

In both groups following a Mediterranean diet, the researchers saw improvements in tests of memory and thinking compared to the group on the low-fat diet, the study showed.

Samantha Heller, a senior clinical nutritionist at New York University Medical Center in New York City, explained that “healthy fats from foods like nuts and olive oil play crucial roles in brain function and health.”

Every one of the nerve cells in the human brain is surrounded by an ultra-thin layer of fat and protein called the myelin sheath, she explained. The myelin sheath protects the nerve structure and helps nerve cell interaction. The brain gets its fats to make and maintain the myelin sheath from the foods people eat. The healthier the foods and fats, the healthier the brain, Heller said.

SOURCES: Emilio Ros, M.D., Ph.D., director, lipid clinic, Hospital Clinic, Barcelona, Spain; Sam Gandy, M.D., Ph.D., director, Center for Cognitive Health, Mount Sinai Hospital, New York City; Samantha Heller, M.S., R.D., senior clinical nutritionist, New York University Medical Center, New York City; Valls-Pedret C, Sala-Vila A, Ros E, et al. Mediterranean diet and agerelated cognitive decline. JAMA Intern Med. 2015;doi:10.1001/jamainternmed.2015.1668. [Epub ahead of print]

Mediterranean Diet May Reduce Breast Cancer Risk

 The following is excerpted from an article by Sara G. Miller that appeared in LiveScience on September 14, 2015.

The Mediterranean diet may be able to add “reduces risk of breast cancer” to its long list of health benefits, according to a new study from Spain.

In the study, researchers found that women who were asked to follow a Mediterranean diet that was high in extra-virgin olive oil were 68 percent less likely to develop breast cancer than those who were advised only to reduce the amount of fat in their diets.

In the study, 4,152 post-menopausal women who had never had breast cancer were asked to follow one of three diets: One was a Mediterranean diet rich in extra-virgin olive oil (extra-virgin olive oil accounted for 15 percent of their daily calories), the second was a Mediterranean diet rich in nuts, and the third was a control diet, in which the women were advised to reduce the amount of fat they ate.

After about five years, 35 women in the study had developed breast cancer. Women in the extra-virgin olive oil group were the least likely to develop breast cancer. The researchers also observed a slight decrease in risk for the women in the nut group, but this was not statistically significant (meaning it could have been due to chance), according to the study published today (Sept. 14) in JAMA Internal Medicine.

The Mediterranean diet contains many components that have been suggested to have antitumor effects, Dr. Miguel Martinez-Gonzalez, a professor of preventive medicine at the University of Navarra in Spain and coauthor of the study, told Live Science in an email.

Extra-virgin olive oil in particular is rich in compounds called polyphenols, which have been shown in lab studies to have anti-cancer effects, he said. Indeed, the study found that the greater the percentage of calories that came from extra-virgin olive oil in the women’s diets, the lower their risk of developing breast cancer, Martinez- Gonzalez told Live Science. “For every additional 5 percent of calories from extra-virgin olive oil, the risk was reduced [by] 28 percent,” he said.

However, the researchers do not know if the lower risk may have been lowered due to the extra-virgin olive oil on its own, or if it was the effect of oil working in combination with the rest of the diet, he said.

….Previous studies have also shown a reduced risk of breast cancer in women who eat a Mediterranean diet, Martinez-Gonzalez said.

A strength of the new study is that unlike those previous studies, in which women were asked to report what foods they ate, women in the new study were randomized to a specific diet, which eliminates certain factors that can influence the results, Dr. Mitchell Katz, a deputy editor of JAMA and the author of an editorial about the study, told Live Science.

The study did have limitations, including the small number of cases of breast cancer, and that all of the participants were white, post-menopausal women who were at risk of heart disease, Katz wrote in his editorial.

….Still, he encouraged women to try out the diet: “Although no diet is perfect, a Mediterranean diet [rich in] olive oil is likely good for your health,” Katz said.

Martinez-Gonzalez agreed. Women should be encouraged to eat more extra-virgin olive oil, salads with fresh vegetables and have fruit for dessert, he said.

Even Fried Food Has Nutritional Value When Cooked in Olive Oil

 The following is excerpted from an article by Yvette Brazier that appeared in Medical News Today on January 25, 2016.

Frying in extra virgin olive oil is healthier than other cooking methods, according to research published in Food Chemistry.

Numerous studies have extolled the virtues of the Mediterranean diet. There is evidence that it leads to a lower risk of heart disease, stroke and other cardiovascular problems, improves gut health, slows the process of brain aging, and reduces the risk of various chronic, degenerative conditions. The Spanish Mediterranean diet features a high volume of vegetables and extra virgin olive oil (EVOO), both of which are good sources of phenols, the antioxidant effect of which is believed to contribute to the reduction of health risks.

Concentrations of antioxidants can be either increased or decreased, depending on how the food is processed.

Researchers from the University of Granada in Spain wanted to compare cooking methods to find out which one would give the best antioxidant capacity, and maximize the amount of phenolic compounds provided by vegetables used in the Mediterranean diet, including potato, pumpkin, tomato and eggplant.

Phenols transfer from olive oil to vegetables during frying

Under controlled conditions, the team cooked 120 g of potato, pumpkin, tomato and eggplant without seeds or skin. They compared three methods: frying, boiling, and cooking with a mixture of EVOO and water. The ratio of vegetable to water followed traditional Spanish cooking methods.

They also used high performance liquid chromatography (HPLC) to measure the levels of phenolic compound in each vegetable.

Frying in EVOO was found to increase fat content and reduce moisture; other methods did not have this effect. Cooking in oil increased the levels of phenolic compounds, but cooking in water did not. This is thought to be due to phenols being transferred from the EVOO to the vegetables, adding to the vegetables some beneficial compounds not normally found there.

Results showed that frying in EVOO is the most effective way to increase the antioxidant capacity and levels of phenolic compounds in raw potato, pumpkin, tomato, and eggplant. In other words, the cooking process improves the quality of the raw foods.

All three methods led to a higher level of antioxidant capacity in all the vegetables. The final levels of phenols, moisture, fat, dry matter, and antioxidant activity of each vegetable varied according to the composition of the original vegetable and the cooking method.

Any raw vegetable that started with a high level of phenols had its phenolic content boosted further by the use of EVOO in cooking, suggesting that frying and sautéing should be used not only to conserve the goodness, but also to enhance it.

Reference: Ramírez-Anaya JP, Samaniego-Sánchez C, Castañeda-Saucedo MC, Villalón-Mir M, de la Serrana HL. Phenols and the antioxidant capacity of Mediterranean vegetables prepared with extra virgin olive oil using different domestic cooking techniques. Food Chem. 2015;188:430-8.

After-Meal Blood Glucose Spikes? Try Using Extra Virgin Olive Oil

 The following is reprinted from an article on the American Diabetes Association website, summarizing a study published in the April 2016 issue of Diabetes Care.

What is the problem and what is known about it so far? The glycemic index, or GI, measures how much a carbohydrate-containing food raises blood glucose levels. A food with a high GI raises blood glucose more than a food with a medium or low GI. Researchers have discovered that certain types of fat affect blood glucose differently when you eat a high-GI meal.

Why did the researchers do this particular study? The researchers wanted to determine how the type of fat (or the lack of fat) eaten affects glucose levels after both a high-GI and low-GI meal.

Who was studied? A total of 13 patients with type 1 diabetes (8 women and 5 men) were recruited from the diabetes care unit of the University of Naples Federico II hospital in Naples, Italy.

How was the study done? Study participants consumed three high-GI meals in one week and then switched to three low-GI meals for an additional week. The meals had similar total carbohydrate content but were different in the amount and type of fat eaten. Meals were broken down as follows: 1) low in fat, 2) high in saturated fat (butter), and 3) high in monounsaturated fat (extra virgin olive oil). Participants’ blood glucose levels were measured continuously throughout the study weeks.

What did the researchers find? When patients ate a low-GI meal, the quality and the amount of fat did not significantly affect blood glucose levels after the meal. But when patients ate a high-GI meal, there was a rise in glucose levels soon after eating the meals with butter or low in fat. However, after the meal with extra virgin olive oil, there was no steep rise in blood glucose levels.

What were the limitations of the study? The meals were eaten at home, so the patients were not being directly monitored on what they were eating. This lack of oversight may have affected the reliability of the results. What are the implications of the study? This study shows for the fi rst time that the type of fat eaten significantly affects blood glucose levels after a high-GI meal in patients with type 1 diabetes. Avoiding foods rich in butter and using extra virgin olive oil could help improve your postprandial (after-a-meal) blood glucose levels.

Reference: Bozzetto L, Alderisio A, Giorgini M, et al. Extra-virgin olive oil reduces glycemic response to a high–glycemic index meal in patients with type 1 diabetes: a randomized controlled trial. Diabetes Care. 2016;39(4):518–524.

Mediterranean diet may help stop breast cancer coming back, study says

The following is excerpted from an article by Sarah Bosley that appeared in the Guardian on June 5, 2016.

Eating a Mediterranean diet, rich in fruit, vegetables, fish and olive oil, may help prevent breast cancer returning, according to a study presented at a major international cancer conference.

Lifestyle—whether people are physically active or not—and being overweight are known risk factors for breast cancer, but there is increasing interest in whether particular eating habits play a part in its occurrence and recurrence.

The study presented at the American Society of Clinical Oncology (ASCO) meeting in Chicago is a trial in Italy that compared the outcomes for 307 women who had been treated for early breast cancer. One group of 199 women were asked to eat a Mediterranean diet, involving four portions of vegetables, three pieces of fruit and one serving of grains a day, together with four or more servings of fi sh each week, some red and processed meat and plenty of olive oil. They were allowed up to one alcoholic drink a day.

The other group of 108 women were asked to eat their normal diet, but given advice on healthy food by a dietician.

The cancer researchers at Piacenza hospital, Italy, found that after three years, 11 women from the group eating a normal diet suffered a return of their breast cancer, while none of those eating a Mediterranean diet did.

Experts say the study is small and has limitations, but raises issues of great interest. “The whole topic of lifestyle interventions for breast cancer survivors is a very important one. There is substantial research going on into what we should be recommending,” said Dr. Erica Mayer, an ASCO expert in breast cancer, assistant professor at Harvard Medical School and director of clinical research at the Dana-Farber Cancer Institute in the US.

But the results of studies to date have been conflicting. “It is not clear whether there is a specific diet or foods to eat or not to eat to prevent recurrence,” she said. Physical activity, on the other hand, is very beneficial, helping to prevent cancer both occurring and recurring.

The signals so far from research into women’s eating habits and breast cancer “probably reflect weight loss rather than diet,” she said. On this particular study there were issues with the methodology. “They don’t say if this is randomized. People were asked to participate in one diet or the other. There is no information about the activity level or change in weight, which for most of the lifestyle research one needs to be aware of,” she said.

Lady Delyth Morgan, the chief executive of Breast Cancer Now, said: “This study adds to increasingly interesting discussions about how lifestyle factors might influence breast cancer recurrence.

“We need to see results from longer-term studies before we can give specific diet advice to breast cancer patients. In the meantime we do know that a varied, balanced diet for general health and well-being, as well as being physically active, can be beneficial to breast cancer patients.”

Reference: Biasini C, Di Nunzio C, Cordani MR, et al. Effect of Mediterranean diet on the prevalence of breast cancer relapse: preliminary results of the “SETA PROJECT.” Ann Oncol. 2015;26(suppl 6):vi4; doi: 10.1093/annonc/mdv336.05. Presented at 17th National Congress of Medical Oncology, October 23–25, 2015, Rome, Italy. http://annonc.oxfordjournals.org/content/26/suppl_6/vi4.2