Benefits of a Low Inflammation Diet in Diabetic, Dysvascular Amputees

Article originally published in Edge Advantage.

Trendy diets seem to have always existed. A new way of eating that will result in rapid weight loss and increased health. In the last few years, the idea of an anti-inflammation has made a resurgence, carving out its own niche as the “New Mediterranean Diet”.  No, this style of eating doesn’t encourage the pizzas and smoked meats of Italy, but rather plant-based foods, such as Olive oil, whole grains, vegetables, legumes, fruits, nuts, seeds, herbs and spices that grew in the countries surrounding the Mediterranean Sea. (10) 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“. (8) The main draw of the diet being that one can reduce chronic inflammation associated with refined sugars, making it ideal for the diabetic population.

The popularization of this style of eating first began over 50 years ago as researchers started investigating the health of impoverished towns in southern Italy when compared to those of the elite wealth of New York City. Most Notably, Ancel Keys, an American scientist was perplexed as to why these 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, Ancel, 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 (1). 

Decades later, continued research has presented evidence of the physiological effects these types of nutrients 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 that want to do us harm. 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, often a result of overnutrition, obesity and lower physical activity (4), can trigger a cascade of chemical pathways in the body ultimately creating a cluster of diagnoses known as metabolic syndrome. 

 One of the more prominent symptoms of metabolic syndrome is Insulin resistance, which if left unchecked can result in type 2 diabetes. (14)  Diabetes Mellitus type 2 (DM2), occurs when the pancreas cannot create enough insulin to regulate glucose levels in the bloodstream. This often coincides with chronic inflammation in 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. By introducing a low-inflammation diet focusing meals around nutrient-rich produce and smaller portions of lean proteins the overall stress on these cells can be greatly reduced, and in some circumstances, the effects can be reversed. (13)

As a unilateral amputee, it becomes important to maintain a healthy contralateral limb due to the increased forces and weight it may experience throughout the day. If an abrasion or ulceration is sustained, it must be offloaded in some way in order to allow the body to heal. Luckily, a low inflammation diet is rich in nutrients that have shown the potential to aid in a speedier recovery. The leafy vegetables flood the body with iron, the key to transporting oxygen to the tissues that need it for proper healing (8). While the proteins and Omega-fatty acids provided by various fish fuel platelet formation for proper blood clotting as well as create the building blocks for collagen, which is necessary in wound closure by the body (8).  Many studies have found keeping this style of diet in conjunction with the appropriate medical treatments that individuals with diabetes underwent abbreviated healing times when compared to those who did not. (16) 

In addition to wound healing, the nutrients provided, encourage healthy maintenance of weight, lower cholesterol, and a reduction of atherosclerotic plaques which encourage a healthy heart. “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”. (5) It takes a larger amount of energy to ambulate with a prosthesis putting a large stress on your heart. In encouraging a healthy weight, the body is able to more efficiently ambulate by creating a better center of mass and reducing stress or strain on the ligaments of the body.  Replacing fats like butter with olive oil increases the amount of HDL (good fats), which encourages a healthy cardiovascular system, reducing the chance of heart attack and stroke. (12)  

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 leaves 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, which support a greater diversity of gut microbiota. This prolonged decrease in the pro-inflammatory state may prevent the increase in the endotoxins, which are believed to cause the inflammation associated with metabolic Issues such as DM2. (6) As a result, many diabetic amputees present with similar gut bacteria presentations, which if altered could aid in the body’s ability to use insulin appropriately.  

There are steps one can take to gradually adopt a Mediterranean diet lifestyle. Below are a group of foods found within the Mediterranean diet that encourage less inflammation and better health.  

Herbs/Spices 

• Ginger 

• Parsley 

• Oregano 

• Basil 

• Mint 

• Paprika 

• Cumin 

Veggies/Beans 

• Spinach 

• Garlic 

• Red Onion 

• Cabbage 

• Broccoli 

• Kale 

• Chick Peas 

Meats (in Moderation) 

• Salmon 

• Chicken 

Fruits 

• Avocado 

• Cherry Tomatoes 

• Lemon 

• Blackberries 

Oil and Dairy 

• Olive Oil 

• Low/No fat dairy products 

(3)(6)

Foods to Avoid/Limit 

• White bread, pastas 

• Candy 

• Full-fat Dairy (whole milks) 

• Alcohol 

• Fried Foods 

• High-sugar sodas/juices 

• Bacon, Hot dogs (processed meat) 

Mediterranean Diet Pyramid (11)

Using lists like this can help you create meals focusing on nutrient-rich produce and whole grains over excessive inflammation-inducing simple carbs, dairy products and various meats. (12) 

• Replace pancakes or high-sugar cereals with oatmeal.

• Try salads packed with vegetables and a vinaigrette over processed cold-cut sandwiches. 

• Try eliminating red meats for fish such as salmon.

How to Build a Healthy Mediterranean Plate

In the end, the Mediterranean diet is more than just a style of eating, but a lifestyle. Starting a new diet can seem like an overwhelming feat for anyone, but it’s important to understand that change takes time. Post amputation one must learn a slew of new skills in order to adapt to the changes in his / her life, but learning a new lifestyle is similar to learning any new skill. Amputees are taught to ambulate with their new prosthesis and similarly can be educated on foods that can positively impact the state of their body. It’s 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” (11).

There are a number of diets that encourage a healthy lifestyle. Many of which have positives and negatives within them. For the diabetic population which makes up a lot of amputees, the introduction of anti-inflammatory foods is proven to be beneficial on varying levels. Ultimately, it’s up to the individual to decide on adherence to any diet, but with proper education and support and a healthier lifestyle can be achieved.  

References

1. Altomare, Roberta, et al. “The Mediterranean Diet: A History of Health.” Iranian Journal of Public Health, Tehran University of Medical Sciences, 1 May 2013, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684452/.  

2. Chelsea Gloeckner, M.S. “Anti-Inflammatory Mediterranean Diet Plan.” EatingWell, https://www.eatingwell.com/article/2061785/anti-inflammatory-mediterranean-diet-plan/.  

3. D;, Esposito K;Giugliano. “The Metabolic Syndrome and Inflammation: Association or Causation?” Nutrition, Metabolism, and Cardiovascular Diseases : NMCD, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/15673055/#:~:text=Chronic%20inflammation%20may%20represent%20a,genetically%20or%20metabolically%20predisposed%20individuals.  

4. “Diabetes and Your Heart.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 7 May 2021, https://www.cdc.gov/diabetes/library/features/diabetes-and-heart.html#:~:text=If%20you%20have%20diabetes%2C%20you,are%20to%20have%20heart%20disease.  

5. Felice, Francesca, et al. “The Importance of Mediterranean Diet and Hydration Habitus in Patients with Lower Limb Ulcers: A Pilot Study.” Journal of Vascular Nursing, Mosby, 15 July 2021, https://www.sciencedirect.com/science/article/abs/pii/S1062030321000625#!  

6. Hernáez Á;Lassale C;Castro-Barquero S;Ros E;Tresserra-Rimbau A;Castañer O;Pintó X;Vázquez-Ruiz Z;Sorlí JV;Salas-Salvadó J;Lapetra J;Gómez-Gracia E;Alonso-Gómez ÁM;Fiol M;Serra-Majem L;Sacanella E;Razquin C;Corella D;Guasch-Ferré M;Cofán M;Estruch R; “Mediterranean Diet Maintained Platelet Count within a Healthy Range and Decreased Thrombocytopenia-Related Mortality Risk: A Randomized Controlled Trial.” Nutrients, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/33567733/.  

7. “Mediterranean Diet for Heart Health.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 23 July 2021, https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801.  

8. Roberts, Christian K, et al. “Metabolic Syndrome and Insulin Resistance: Underlying Causes and Modification by Exercise Training.” Comprehensive Physiology, U.S. National Library of Medicine, Jan. 2013, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129661/.  

9. “Take Your Diet to the Mediterranean.” Johns Hopkins Medicine, 8 Aug. 2021, https://www.hopkinsmedicine.org/health/wellness-and-prevention/take-your-diet-to-the-mediterranean.  

10. Tsalamandris, Sotirios, et al. “The Role of Inflammation in Diabetes: Current Concepts and Future Perspectives.” European Cardiology, Radcliffe Cardiology, Apr. 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6523054/.  

11. Tsigalou, Christina, et al. “Mediterranean Diet as a Tool to Combat Inflammation and Chronic Diseases. an Overview.” Biomedicines, MDPI, 8 July 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400632/#:~:text=The%20Mediterranean%20diet%20(MD)%20as,autophagy%20and%20Th%20cells%20imbalance.  

12. Wright, Josephine A, et al. “The Role of Iron in the Skin and Cutaneous Wound Healing.” Frontiers in Pharmacology, Frontiers Media S.A., 10 July 2014, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4091310/#B12.  

13. Altomare, Roberta, et al. “The Mediterranean Diet: A History of Health.” Iranian Journal of Public Health, Tehran University of Medical Sciences, 1 May 2013, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684452/.  

14. Baum, Isadora. “Here's What a Healthy Plate Looks like on the Mediterranean Diet.” Well+Good, 28 June 2021, https://www.wellandgood.com/mediterranean-diet-macros-portions/amp/.  

15. Chelsea Gloeckner, M.S. “Anti-Inflammatory Mediterranean Diet Plan.” EatingWell, https://www.eatingwell.com/article/2061785/anti-inflammatory-mediterranean-diet-plan/.  

16. D;, Esposito K;Giugliano. “The Metabolic Syndrome and Inflammation: Association or Causation?” Nutrition, Metabolism, and Cardiovascular Diseases : NMCD, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/15673055/#:~:text=Chronic%20inflammation%20may%20represent%20a,genetically%20or%20metabolically%20predisposed%20individuals.  

17. “Diabetes and Your Heart.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 7 May 2021, https://www.cdc.gov/diabetes/library/features/diabetes-and-heart.html#:~:text=If%20you%20have%20diabetes%2C%20you,are%20to%20have%20heart%20disease.  

18. “Diet Review: Anti-Inflammatory Diet.” The Nutrition Source, 22 Oct. 2021, https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/anti-inflammatory-diet/.  

19. Felice, Francesca, et al. “The Importance of Mediterranean Diet and Hydration Habitus in Patients with Lower Limb Ulcers: A Pilot Study.” Journal of Vascular Nursing, Mosby, 15 July 2021, https://www.sciencedirect.com/science/article/abs/pii/S1062030321000625#!  

20. Hernáez Á;Lassale C;Castro-Barquero S;Ros E;Tresserra-Rimbau A;Castañer O;Pintó X;Vázquez-Ruiz Z;Sorlí JV;Salas-Salvadó J;Lapetra J;Gómez-Gracia E;Alonso-Gómez ÁM;Fiol M;Serra-Majem L;Sacanella E;Razquin C;Corella D;Guasch-Ferré M;Cofán M;Estruch R; “Mediterranean Diet Maintained Platelet Count within a Healthy Range and Decreased Thrombocytopenia-Related Mortality Risk: A Randomized Controlled Trial.” Nutrients, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/33567733/.  

21. Kaputk. “Anti-Inflammatory Diet: What to Eat (and Avoid).” Cleveland Clinic, Cleveland Clinic, 5 July 2022, https://health.clevelandclinic.org/anti-inflammatory-diet/.  

22. “Mediterranean Diet for Heart Health.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 23 July 2021, https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801.  

23. “Oldways Mediterranean Diet Pyramid.” Oldways, https://oldwayspt.org/resources/oldways-mediterranean-diet-pyramid.  

24. Roberts, Christian K, et al. “Metabolic Syndrome and Insulin Resistance: Underlying Causes and Modification by Exercise Training.” Comprehensive Physiology, U.S. National Library of Medicine, Jan. 2013, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129661/.  

25. “Take Your Diet to the Mediterranean.” Johns Hopkins Medicine, 8 Aug. 2021, https://www.hopkinsmedicine.org/health/wellness-and-prevention/take-your-diet-to-the-mediterranean.  

26. Tsalamandris, Sotirios, et al. “The Role of Inflammation in Diabetes: Current Concepts and Future Perspectives.” European Cardiology, Radcliffe Cardiology, Apr. 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6523054/.  

27. Tsigalou, Christina, et al. “Mediterranean Diet as a Tool to Combat Inflammation and Chronic Diseases. an Overview.” Biomedicines, MDPI, 8 July 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400632/#:~:text=The%20Mediterranean%20diet%20(MD)%20as,autophagy%20and%20Th%20cells%20imbalance.  

28. Wright, Josephine A, et al. “The Role of Iron in the Skin and Cutaneous Wound Healing.” Frontiers in Pharmacology, Frontiers Media S.A., 10 July 2014, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4091310/#B12.