Nutritional Pearls: Food Plus Medication Equals
Tom is a 50-year-old man with diabetes. In an effort to better control his cholesterol levels, he has begun to consider following a Mediterranean-style diet. At his most recent check-up, however, he asks if there is any point in changing his diet, when he already takes several medications to improve his health.
How would you advise your patient?
(Answer and discussion on next page)
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Answer: The combination of medication and improvements in diet is synergistic.
As health care practitioners, you know that caring for people with diabetes is much more than simply helping them manage their blood sugars. Among other things, those with diabetes are at higher risk of poor cholesterol scores, which can lead to greater risk of heart attack and stroke.
We know that olive oil is an excellent source of the monounsaturated fats that are so important in maintaining good cholesterol scores, but obviously olive oil is not the only source of these healthy fats. There is research to suggest that sesame oil and rice bran oil also have positive effects on cholesterol scores as well as HbA1c scores.
A team in India recruited 300 adults averaging 50 years of age who had been recently diagnosed with type 2 diabetes. None were using oral diabetes medication or had evidence of heart or liver damage. An additional 100 adults without diabetes (average age 32 years) were also recruited to participate.
The 300 patients with diabetes were randomly assigned to 1 of 3 groups: Group 1 received a daily cooking oil stipend of 35-40 milliliters (about 7-8 teaspoons) of an oil blend of 20% unrefined sesame oil and 80% refined rice bran oil and were instructed to use no other oils for cooking. Group 2 received a daily oral dose of glyburide. Group 3 received both the cooking oil stipend and the daily dose of glyburide.
The 100 control participants received the daily stipend of the oil blend and were also instructed to use only that oil blend for cooking. (Note that none of the participants receiving the cooking oil were required to use all of their daily stipend.)
The study lasted for a total of 8 weeks. At the start and conclusion of the study, participants' blood glucose, HbA1c, and cholesterol scores were recorded, with an additional assessment of their glucose scores midway through the study.
The oil blend had no clinically significant effect on those who did not have diabetes. For those with diabetes, however, it's a very different story: those using the oil blend saw improved glucose scores, lower levels of total cholesterol and LDL cholesterol, higher levels of HDL cholesterol, and lower HbA1c scores.
Those taking only the oral diabetic medication had similar improvements in their HbA1c and better glucose scores. Their cholesterol scores, however, changed hardly at all, except their triglycerides and LDL cholesterol, which increased slightly.
Those who took both the oral medication and used the oil blend, however, found that using both meant that their glucose scores and HbA1c scores improved significantly—more than either those taking the medication alone or those only using the oil. Further, they reaped about the same benefits to their cholesterol scores as did those using the oil blend alone.
What’s the “Take-Home”?
I often see that the combination of medication and improvements in diet is synergistic, with the 2 treatments yielding greater results together than they do individually.
A few cautions, however, before you suggest these oils to your patients: unrefined sesame oil and rice bran oil can be hard to find and they have strong flavors—even a little may overpower a recipe's other flavors. Second, bear in mind that the participants were not instructed to use all of their allotment of oil each day. Seven to 8 teaspoons of almost any oil will contain about 450 calories, which your patients may not need.
Finally, recall that a Mediterranean-style diet, which emphasizes olive oil and other monounsaturated fats for cooking, is a fantastic diet for patients with diabetes, and doesn't require specialized ingredients like unrefined sesame oil and rice bran oil.
Devarajan S, Chatterjee B, Urata H, et al. A blend of sesame and rice bran oils lowers hyperglycemia and improves the lipids. AJM 2016;129(7):731–739.