Saturday, November 29, 2014

The Nutrition Debate #266: “Food Therapy for Metabolic Syndrome”


The banner on my smart phone was, “Food Therapy for Metabolic Syndrome,” but when I read it on my laptop, the title of this Diabetes in Control piece had morphed into “The Impact of Mediterranean Diets on Metabolic Syndrome.” Okay, I don’t shill for the Mediterranean Diet, or any other, but I do support the idea of “food therapy,” and I am very interested in how diet can affect all aspects of Metabolic Syndrome, a dysfunctional metabolic state that is present and unrecognized in increasing numbers in the population. I have written about it numerous times starting with The Nutrition Debate #9.

The piece begins, “Metabolic Syndrome is characterized by risk factors that increase an individual’s chances for cardiovascular disease. These risk factors include obesity, hypertension, high cholesterol and uncontrolled blood glucose. In addition to cardiovascular disease, those with Metabolic Syndrome are at increased risk for type 2 diabetes.” One problem: The digest piece incorrectly shortens to 4 risk factors and mischaracterizes the definition of Metabolic Syndrome; the full text paper correctly describes its components as 5 risk factors and specifically includes high triglycerides and low HDL cholesterol, not “high cholesterol.” By definition, you have Metabolic Syndrome if you present with at least 3 of these risk factors.

What I liked about this digest piece was the clear message the study design sends. The low fat diet, that is the one our government and all our medical societies want us to eat, is the control diet; it is the one that the two different Mediterranean diets are being compared to. And guess what? Both Mediterranean diets fare better than the control. Another nail in the coffin of the low fat diet, folks! Even a diet of “fruits, nuts and seeds,” and that is high in MUFAs, monounsaturated fat (from olive oil and nuts), and low in saturated fat, is better than a low fat diet.

The two Mediterranean diets being compared to the low fat diet were supplemented with olive oil and nuts respectively, provided free by the Spanish producers. Each randomly selected sample of several thousand people consisted of “older participants at high risk of cardiovascular disease,” and each diet group regularly “completed a 14-item questionnaire to assess adherence to the intervention” – eating the free liter per week of olive oil or the 30 grams per day of free walnuts, hazelnuts and almonds, and other “fruits, nuts and seeds.”

“Participants were not advised on calorie restriction, and physical activity was not promoted for any intervention group.” The folks were just “community-dwelling men and women between 55 and 80” years of age with “no previously documented cardiovascular disease and… who had either type 2 diabetes or at least 3 cardiovascular risk factors,” according to the study design published in the Canadian Medical Association Journal. Hmmm, that’s interesting. The patriotic (chauvinistic?) ulterior motive of the Spanish government, the Spanish “medical researchers” (from all over the Iberian peninsula) and the Spanish olive oil and nut producers is clear, but the Canadian Medical Association? I guess they just want to help the Spanish interests promote the Mediterranean diet too.

Okay, let’s take a closer look at the RESULTS: “Over 4.8 years of follow-up, Metabolic Syndrome developed in 960 (50%) of the 1919 participants who did not have the condition at baseline. The risk of developing Metabolic Syndrome did not differ [emphases both added] between participants assigned to the control diet and those assigned to either of the Mediterranean diets.” As stated in the DISCUSSION, “...the recognized protective effect of the Mediterranean diet was not enough to prevent [again, emphasis added] Metabolic Syndrome in our study population.” Hmmm. Then what’s the upside?

However, “Reversion [emphasis added] occurred in 958 (28.2%) of the 3392 participants who had Metabolic Syndrome at baseline. Compared to the control group, participants on either Mediterranean diet were more likely to undergo reversion (control v. olive oil: HR [hazard ratio] 1.35; control v. nuts: HR 1.28).” Reversion is good, right? Well, maybe. It’s a “statistics” thing. Read closely this DISCUSSION in the full text, and you decide.

“(A) Mediterranean diet supplemented with extra-virgin olive oil was associated with a smaller increase in the prevalence of Metabolic Syndrome compared with advice on following a low-fat diet. Thus, the smaller increase in prevalence was likely due to reversion. Because there were no between-group differences in weight loss or energy expenditure, the change is likely attributable to the difference in dietary patterns” [all emphases added].

“We found the Mediterranean diet supplemented with extra virgin olive oil to have the most beneficial effect on central obesity and hyperglycemia.” And, “an isocaloric Mediterranean diet rich in extra-virgin olive oil prevented accumulation of central body fat compared with a low-fat diet, without affecting body weight.” Thus, “Participants assigned to the Mediterranean diets were significantly more likely to no longer meet the criterion of central obesity compared with those in the control group.” In other words, it conferred a benefit: Ergo, give up low-fat; eat more MUFAs and lose belly fat.
Of course, if they had eaten a LCHF diet (including more saturated fat), they would similarly have reduced their truncal obesity, and dramatically raised their HDL cholesterol (#67) and lowered their serum triglycerides (#68) too, both additional risk factors for Metabolic Syndrome. And they’d surely have lost weight and had lower blood glucose. In other words, LCHF confers a benefit with all 5 risk factors!

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