We are what we eat

What we eat is what we are and a cornerstone in the prevention and management of type 2 diabetes, hypertension and cardiovascular disease (CVD) [1]. Thus, there are diets aplenty with vegetarian and vegan diets, low-carbohydrate diets or alternate-day, intermittent, time-restricted, and periodic fasting; claiming to reduce metabolic dysfunction-associated steatotic liver disease (MASLD) [2], CVD risk and dementia [3]. Reading ‘Correlation of the Mediterranean-DASH Diet vs. Ultra-Processed Diet with Health Outcomes in Type 2 Diabetes and Hypertension: New Insights from a 12-Month Interventional Study’ [4] was a welcome distraction from learning about the latest benefits of SGLT2i or GLP-1, GLP-1/GIP agonists for type 2 diabetes mellitus (T2DM) [5] and indeed the latest drugs for hypertension like the aldosterone synthase inhibitors [6]. As such, this study shows remarkable, perhaps unbelievable benefits of a ‘healthier’ Mediterranean, Dietary Approaches to Stop Hypertension (DASH) diet in patients with type 2 diabetes and hypertension from Sao Paulo, Brazil. This was despite recruitment and follow up being undertaken during the COVID-19 pandemic with 3 monthly visits over 15 months. At face value this diet seems to be the magic bullet for type 2 diabetes and hypertension, with the intervention group losing ~10 kg and reporting postmeal fullness in 86.4% with daily satiety in 75% – were they really excluded if they were on a GLP-1 agonist? Alternatively, the control group gained ~5 kg during the first 12 months and ~8 kg by 15 months with an increase in ~8 cm in waist circumference, indicating the harm we did by consuming ultra-processed diets, especially during the COVID-19 pandemic. More surprisingly, there was a reduction of ~20 mmHg in systolic and diastolic blood pressures and an inexplicable reduction in heart rate by 20 beats/min. Who needs medication? As expected, a higher protein intake was associated with lower TC/LDL, but counter to the published literature – higher carbohydrate intake correlated with a lower BMI and a higher fat intake correlated with a lower total cholesterol [7,8]. Also plasma and urinary sodium levels improved significantly but were not associated with sodium intake. Furthermore there were increases in the intake of multiple vitamins (A, D, K, C, B12), sodium, potassium, magnesium, calcium, iron and zinc, presumably as a result of dietary advice, even though generally, there is no evidence that vitamin and mineral supplementation reduces CVD risk [1]. In summary, Minari et al. present compelling data on the short-term benefits of the Mediterranean-DASH Diet. All said, this was a small study of less than 100 patients enrolled via convenience sampling who were not treated with insulin, SGLT2i and GLP1 agonists or exercising >150 min/week; questioning the generalizability of these findings. Large, longer, randomized placebo controlled studies are required to confirm these benefits, especially as a major issue with any diet is adherence. ACKNOWLEDGEMENTS Conflicts of interest There are no conflicts of interest.