There are more than 422 million cases of type 2 diabetes mellitus (DM2) globally, and the prevalence is rising quickly in middle- and low-income nations.2 DM2 occurs when the pancreas cannot create enough insulin to regulate glucose levels in the bloodstream. This often coincides with chronic inflammation of both insulin-producing and glucose-absorbing cells. As this is occurring, the body gains increasing resistance to insulin, meaning it needs more and more to accomplish the same job.3
Although it is widely known that both hereditary and environmental factors have a role in the onset and progression of DM2, the recent increase appears to be mostly attributable to the significant lifestyle changes and unhealthy lifestyle seen in contemporary society. Fortunately, lifestyle factors, such as diet and exercising habits, can be significantly changed. These factors are now being addressed as a way to both prevent and treat DM2.4
Trendy diets seem to have always existed; new ways of eating that will result in rapid weight loss and increased health are always emerging. Several dietary patterns have been proven beneficial both for the prevention and management of DM2 and weight loss for people with diabetes: low-carbohydrate, low-fat, calorie-restricted, and the Mediterranean Diet.4,5
The Mediterranean Diet
Plant based foods such as olive oil, whole grains, vegetables, legumes, fruits, nuts, seeds, herbs, and spices that grow in the countries surrounding the Mediterranean Sea.6 These foods “provide plant chemicals (phytochemicals), antioxidants, and fiber that prevent cellular stresses, inhibit inflammatory signals caused by the immune system, promote healthy gut microbiota, and slow down digestion to prevent surges in blood glucose.”7 The main draw of the diet being that one can reduce chronic inflammation associated with refined sugars, making it ideal for the people with diabetes.
The popularization of this style of eating began over 50 years ago as researchers started investigating the health of impoverished towns in southern Italy compared to those of the elite wealth of New York City. Most notably, American scientist Ancel Keys, PhD, was perplexed as to why the towns along the coast of the Mediterranean were in near perfect health, boasting a marked drop in cardiovascular disease when compared to its American counterparts. Of the evidence taken, the small-town inhabitants showed lower scores in blood glucose, bad cholesterol, and blood pressure levels, which were later correlated to be key signs of heart disease. Not long after the discovery, Keys, alongside his wife Margaret, wrote and published Eat Well and Stay Well, which preached a reduced consumption of animal fats and cholesterol in conjunction with a lifestyle based off what they had observed in these smaller Mediterranean towns.8,9
Decades later, continued research has presented evidence of the physiological effects animal fats and foods high in cholesterol can cause in the body, most notably, the chronic inflammation of various cells, which can alter the way we metabolize certain molecules. Inflammation commonly occurs in everyone’s bodies. It’s a natural process that helps protect us from viruses and pathogens. It is when the body experiences chronic inflammation due to certain stimuli that cells in the body can become stressed or agitated, resulting in adverse effects. This chronic inflammation is often a result of overnutrition, obesity, and lower physical activity, and can trigger a cascade of chemical pathways in the body, ultimately creating a cluster of diagnoses known as metabolic syndrome.10
One of the more prominent symptoms of metabolic syndrome is insulin resistance, which if left unchecked can result in DM2.11 There are steps one can take to gradually adopt a Mediterranean diet lifestyle.12,13
Foods found within the Mediterranean diet encourage less inflammation and better health.
Using these foods can help create meals that focus on nutrient-rich produce and whole grains over foods that induce excessive inflammation such as simple carbohydrates, dairy products, and various meats.15 Suggestions for changes in diet include:
- Replacing pancakes or high-sugar cereals with oatmeal
- Trying salads packed with vegetables and a vinaigrette rather than processed cold cut sandwiches
- Substituting fish such as salmon for red meat
The Benefits of a Mediterranean Diet for People With Limb Loss
For someone with a unilateral amputation, it becomes important to maintain a healthy contralateral limb due to the increased forces and weight it can experience throughout the day. If an abrasion or ulceration is sustained, it must be offloaded in some way to allow the body to heal. Luckily, a low inflammation diet is rich in nutrients that have shown potential to aid in a speedier recovery. The leafy vegetables flood the body with iron; they are key to transporting oxygen to the tissues that need it for proper healing.7 The proteins and Omega-3 fatty acids provided by various fish fuel platelet formation for proper blood clotting, and they create the building blocks for collagen, which is necessary in wound closure by the body.7 Many studies have found keeping this style of diet in conjunction with appropriate medical treatment resulted in abbreviated healing time for individuals with diabetes.2,9,16,17
In addition to wound healing, the nutrients provided encourage healthy weight maintenance, lower cholesterol, and a reduction of atherosclerotic plaques, which encourage a healthy heart. According to Altomare, et al., “If you have diabetes, you’re twice as likely to have heart disease or a stroke than someone who doesn’t have diabetes—and at a younger age. The longer you have diabetes, the more likely you are to have heart disease.”8 It takes a larger amount of energy to ambulate with a prosthesis, thereby putting a large stress on your heart. If a person maintains a healthy weight, he or she has a better center of mass and reduced stress or strain on the ligaments, allowing for more efficient ambulation. Replacing fats like butter with olive oil increases the amount of HDL (good fats), which encourage a healthy cardiovascular system, reducing chance of heart attack and stroke.15
Alternatively, in recent studies, there has been a strong link to overall gut microbiota health and the development of insulin resistance and DM2. Typical western diets’ tendency to leave the body in a pro-inflammatory state leave the gut in a state of oxidative stress. This chronic inflammation of the gut creates an inhospitable environment for many helpful bacteria. An anti-inflammatory diet contains foods rich in fiber and phytochemicals that support a greater diversity of gut microbiota. This prolonged decrease in pro-inflammatory state may prevent the increase in endotoxins, which are believed to cause the inflammation associated with metabolic issues such as DM2.12 As a result, many individuals with limb loss and diabetes present with similar gut bacteria, which if altered could aid in the body’s ability to use insulin appropriately.
In the end, the Mediterranean diet is more than just a style of eating, it is a lifestyle. Starting a new diet can seem like an overwhelming feat for anyone, but it’s important to understand that change takes time. Following an amputation, patients must learn a slew of new skills to adapt to the changes in their lives, but learning a new lifestyle is similar to learning any new skill. People with amputations are taught to ambulate with their new prostheses and similarly can be educated on foods that can positively impact the state of their bodies. It is always good to start with the foundation and slowly move upward. In dieting, one strategy is to add one healthy item to replace an unhealthy item, “stick with it for three weeks, then make two more changes.”14 There are a number of diets that encourage a healthy lifestyle. Many of which have positives and negatives within them. For people with limb loss who have diabetes, the introduction of anti-inflammatory foods is proven to be beneficial on varying levels. Ultimately, it is up to individuals to decide on adherence to any diet, but with proper education and support a healthier lifestyle can be achieved.
Derek Inserra, CPO, is the US clinical specialist with Adapttech.
- Anti-Inflammatory Diet: What To Eat (and Avoid) – Cleveland Clinic. Accessed July 21, 2022. https://health.clevelandclinic.org/anti-inflammatory-diet/
- Mcmacken M, Shah S. A plant-based diet for the prevention and treatment of type 2 diabetes. Journal of Geriatric Cardiology. 2017;14:342-354. doi:10.11909/j.issn.1671-5411.2017.05.009
- Kharroubi AT, Darwish HM. Diabetes mellitus: The epidemic of the century. World Journal of Diabetes. 2015;6(6):850. doi:10.4239/WJD.V6.I6.850
- Georgoulis M, Kontogianni MD, Yiannakouris N. Mediterranean Diet and Diabetes: Prevention and Treatment. Nutrients. 2014;6(4):1406. doi:10.3390/NU6041406
- Sleiman D, Al-Badri MR, Azar ST. Effect of Mediterranean Diet in Diabetes Control and Cardiovascular Risk Modification: A Systematic Review. Frontiers in Public Health. 2015;3:69. doi:10.3389/FPUBH.2015.00069/BIBTEX
- Sripongpun P, Churuangsuk C, Bunchorntavakul C. Current Evidence Concerning Effects of Ketogenic Diet and Intermittent Fasting in Patients with Nonalcoholic Fatty Liver. http://www.xiahepublishing.com/. 2022;0(000):0-0. doi:10.14218/JCTH.2021.00494
- Hernáez Á, Lassale C, Castro-Barquero S, et al. Mediterranean Diet Maintained Platelet Count within a Healthy Range and Decreased Thrombocytopenia-Related Mortality Risk: A Randomized Controlled Trial. Nutrients. 2021;13(2):1-13. doi:10.3390/NU13020559
- Altomare R, Cacciabaudo F, Damiano G, et al. The Mediterranean Diet: A History of Health. Vol 42.; 2013. Accessed July 21, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684452/pdf/ijph-42-449.pdf
- Milenkovic T, Bozhinovska N, Macut D, et al. Mediterranean Diet and Type 2 Diabetes Mellitus: A Perpetual Inspiration for the Scientific World. A Review. Published online 2021. doi:10.3390/nu13041307
- Esposito K, Giugliano D. The metabolic syndrome and inflammation: association or causation? Nutrition, Metabolism and Cardiovascular Diseases. 2004;14(5):228-232. doi:10.1016/S0939-4753(04)80048-6
- Tsalamandris S, Antonopoulos AS, Oikonomou E, et al. The Role of Inflammation in Diabetes: Current Concepts and Future Perspectives. European Cardiology Review. 2019;14(1):50. doi:10.15420/ECR.2018.33.1
- Diet Review: Anti-Inflammatory Diet | The Nutrition Source | Harvard T.H. Chan School of Public Health. Accessed July 21, 2022. https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/anti-inflammatory-diet/
- Anti-Inflammatory Mediterranean Diet Plan | EatingWell. Accessed July 21, 2022. https://www.eatingwell.com/article/2061785/anti-inflammatory-mediterranean-diet-plan/
- Oldways Mediterranean Diet Pyramid | Oldways Mediterranean Diet Pyramid. Accessed July 21, 2022. https://oldwayspt.org/resources/oldways-mediterranean-diet-pyramid
- Roberts CK, Hevener AL, Barnard RJ. Metabolic Syndrome and Insulin Resistance: Underlying Causes and Modification by Exercise Training. Compr Physiol. 2013;3(1):1. doi:10.1002/CPHY.C110062
- Wright JA, Richards T, Srai SKS. The role of iron in the skin and cutaneous wound healing. Frontiers in Pharmacology. 2014;5. doi:10.3389/FPHAR.2014.00156
- Mekary RA, Dundar C, Rosas-Blum ED, Azar ST, Sleiman D, Al-Badri MR. Effect of Mediterranean diet in diabetes control and cardiovascular risk modification: a systematic review. Public Health. 2015;3:69. doi:10.3389/fpubh.2015.00069
- Mediterranean diet macros to follow when filling your plate | Well+Good. Accessed July 21, 2022. https://www.wellandgood.com/mediterranean-diet-macros-portions/amp/
- Take Your Diet to the Mediterranean | Johns Hopkins Medicine. Accessed July 21, 2022. https://www.hopkinsmedicine.org/health/wellness-and-prevention/take-your-diet-to-the-mediterranean