Low Carb Mediterranean Diet Still King

I’ve always been a huge fan of low-carb, high protein diets. If you’ve been reading my blog over the years, you’ll see how many articles I have posted on low-carb diets.

This diet improves your cholesterol profile as well as your glucose tolerance.

In this trial, the authors compared the effects of a Mediterranean diet versus a typical low-fat diet for diabetes management.

Researchers randomly assigned 215 patients to follow either a low carbohydrate, Mediterranean-style diet or a low-fat diet for four years.

After four years, 44% of patients in the Mediterranean-style diet group required antihyperglycemic drug therapy compared to 70% in the low-fat diet group.

Patients in the Mediterranean diet group also experienced greater weight loss and an improvement in some coronary risk factors.


Background: Low-carbohydrate and low-fat calorie-restricteddiets are recommended for weight loss in overweight and obesepeople with type 2 diabetes.

Objective: To compare the effects of a low-carbohydrate Mediterranean-styleor a low-fat diet on the need for antihyperglycemic drug therapyin patients with newly diagnosed type 2 diabetes.

Design: Single-center, randomized trial. Randomization wascomputer-generated and unstratified. Allocation was concealedin sealed study folders held in a central, secure location untilparticipants gave informed consent. Participants and investigatorswere aware of treatment assignment, and assessors of the primaryoutcome were blinded.

Setting: Teaching hospital in Naples, Italy.

Patients: 215 overweight people with newly diagnosed type 2diabetes who were never treated with antihyperglycemic drugsand had hemoglobin A1c (HbA1c) levels less than 11%.

Intervention: Mediterranean-style diet (<50% of daily caloriesfrom carbohydrates) (n = 108) or a low-fat diet (<30%of daily calories from fat) (n = 107).

Measurements: Start of antihyperglycemic drug therapy, definedby protocol as indicated for follow-up HbA1c level greater than7% (primary outcome), and changes in weight, glycemic control,and coronary risk factors (secondary outcomes).

Results: After 4 years, 44% of patients in the Mediterranean-stylediet group and 70% in the low-fat diet group required treatment(absolute difference, –26.0 percentage points [95% CI,–31.1 to –20.1 percentage points]; hazard ratio,0.63 [CI, 0.51 to 0.86]; hazard ratio adjusted for weight change,0.70 [CI, 0.59 to 0.90]; P < 0.001). Participants assignedto the Mediterranean-style diet lost more weight and experiencedgreater improvements in some glycemic control and coronary riskmeasures than did those assigned to the low-fat diet.

Limitations: Investigators responsible for initiating drugtherapy were not blinded to treatment assignment. Dietary intakewas self-reported.

Conclusion: Compared with a low-fat diet, a low-carbohydrate,Mediterranean-style diet led to more favorable changes in glycemiccontrol and coronary risk factors and delayed the need for antihyperglycemicdrug therapy in overweight patients with newly diagnosed type2 diabetes.