July 21, 2013
Last week’s preventive health note began with my ole school (SHS 1962) remembrance of the 3-D moves we enjoyed at the old Austin Theater (now a performing arts center). Let me suggest that one really does not have to position their 3-D glasses properly to recognize the commonality of strokes and diabetes in rural North Carolina. Mention was made that numerous hypoglycemic events (low blood sugar) in diabetics over time often results in dementia.
It is the cerebrovascular accident (stroke) that is rampant in Sampson County. In fact, for years physicians and epidemiologists have pondered numerous etiologic theories for the southern USA region as Three-S Belts: High Rates of Strokes, Stones and Sarcoidosis.
A prospective, population-based, cohort of individuals was enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study 2003-2007. Their population included 17,478 individuals whose mean age was 64.4 ± 9.1 yrs and range 45-98 years. There were 5368 black (31%), 7548 males (43%), 2913 (17%) with known diabetes and 9832 (56%) resided within the Stroke Belt. Food Frequency Questionnaires evaluated incident cognitive impairment (ICI), the forerunner for Alzheimer’s, at baseline and annually for 4.0 ± 1.5 yrs using Six-item Screeners which computed adherence to Mediterranean Diets.
Results indicated that 1248 (7%) out of 17,478 developed impairment and there were no differences between races (p=0.2928). There was, however, a strong interaction with diabetes (p=0.0134). A high adherence to the Mediterranean Diet was associated risk for ICI in nondiabetic participants (p=0.0066) but not in diabetic subjects (p=0.1063). Simply put: Diabetics Do Worst!
The Mediterranean Diet is NOT a DIET!!! It is a Way of Life within this global region. Eating and dietary patterns in Greece, Spain, Italy, Turkey and surrounding countries use olives (oil, fruit) as source of monounsaturated fats, fruits/berries, vegetables, nuts/seeds, beans, yoghurt/cheese, fish and wine (typically the red varieties at meals). These dietary habits are known to reduce heart diseases, diabetes and some cancers, and may increase longevity. We in Clinton and Sampson should incorporate some of these Mediterranean patterns to help us “turn the corner” on strokes, diabetes, and dementia.
Ref. Tsivgoulis G, Judd S, Letter AJ et al.: Adherence to a Mediterranean diet and risk of incident cognitive impairment. Neurology 2013; 80:1684-1692.