Healthnotes Newswire (October 22, 2009)�A new diagnosis of diabetes is often enough to convince people that it�s time to start eating a healthy diet. But while we�ve all heard plenty about a wide range of healthy and weight-reducing diets, how can a person tell which is the best for managing diabetes? A new study sheds light on the answer: researchers found that a low-carbohydrate version of the Mediterranean diet led to better blood sugar control in people recently diagnosed with diabetes than a low-fat diet.

Healthy fats make a better diet

The study, published in the Annals of Internal Medicine, included 215 overweight adults who had recently been diagnosed with type 2 diabetes. They were randomly assigned to either a Mediterranean-style diet group or a low-fat-diet group. The two diets were designed to provide the same number of calories but differed in their fat and carbohydrate composition:

� In the Mediterranean-diet group, calories from carbohydrates were restricted to no more than 50% of total calories and 30% or more of total calories were from fat. It was also rich in vegetables and whole grains, and included olive oil, poultry, and fish.

� In the low-fat-diet group, calories from carbohydrates were unrestricted, while calories from fats were limited to 30% or fewer and calories from saturated fats were limited to 10% or fewer of total calories in the low-fat diet, which was low in sugar and meat and emphasized whole grains.

� People in both groups also received guidance in increasing physical activity to about 30 minutes per day, six days per week.

After four years, health measures improved in both groups�fasting blood sugar and a marker of long-term blood sugar control (hemoglobin A1c levels)�but these improvements were more pronounced in the Mediterranean-style diet group, and fewer people in that group needed blood sugar-lowering medications at the end of the study (44% compared with 70% the low-fat diet group).

In addition, the Mediterranean-style diet was associated with greater reductions in triglyceride levels and greater increases in levels of beneficial HDL cholesterol.

Drug-free diabetes management

These results add to the growing body of evidence that a low-carbohydrate diet improves insulin sensitivity and blood sugar control more than a low-fat diet. The poly- and mono-unsaturated fats that comprise about one third of the calories in the Mediterranean diet have also been found to be beneficial in diabetes management.

�In comparing a low-carbohydrate, Mediterranean-style diet with a low-fat diet in people with newly diagnosed type 2 diabetes, we found that the Mediterranean diet was associated with better long-term blood sugar control,� said study co-author Dr. Dario Giugliano at the Seconda Universita di Napoli in Naples, Italy. He added, �We also monitored the medication needs of the study participants, all of whom were not using medications at the beginning of the study. We observed a delay in the need for anti-hyperglycemic drug therapy in people eating the Mediterranean-style diet, which derives a significant proportion of calories from fat, primarily from olive oil and fish.�

So, the combined effect of moderate carbohydrate restriction and inclusion of healthy fats from olive oil and fish could be just what is needed for restoring healthy blood sugar control without need for medications.

Healthy eating for diabetics

In addition to paying attention to proportions of calories from fats and carbohydrates, here are some guidelines to help people with a new diabetes diagnosis take control of their blood sugar:

� Make fruit and vegetable consumption a top priority at every meal.

� Don�t skimp on the beans, lentils, nuts, and seeds: let these replace some of the animal foods that you currently eat like meat, cheese, and butter.

� Use olive oil for cooking, dressings, and other places where you would add fat to your food.

� Have a helping of cold-water fish, like salmon or tuna, once or twice per week.

� Avoid sugar and sweet food additives like high-fructose corn syrup, and get your carbohydrate calories from whole grains such as oats, barley, brown rice, and quinoa, instead of refined grain products such as breads and crackers made from white flour.

(Ann Intern Med 2009;151:306�14)