The Effect of the Macrobiotic Ma-Pi 2 Diet vs. the Recommended Diet in the Management of Type 2 Diabetes

The Randomized Controlled MADIAB Trial

Andreea Soare; Yeganeh M Khazrai; Rossella Del Toro; Elena Roncella; Lucia Fontana; Sara Fallucca; Silvia Angeletti; Valeria Formisano; Francesca Capata; Vladimir Ruiz; Carmen Porrata; Edlira Skrami; Rosaria Gesuita; Silvia Manfrini; Francesco Fallucca; Mario Pianesi; Paolo Pozzilli


Nutr Metab. 2014;11(39) 

In This Article


Type 2 diabetes is currently one of the most challenging problems facing national healthcare systems worldwide.[1] Nutritional therapy (as part of life-style intervention), with or without additional drug treatment, represents an effective option for managing this disease.[2] Formulating a universal diet for type 2 diabetes patients can be difficult, since cultural preferences and economic conditions influence patient acceptance of, and adherence to, recommended diets.[3]

In general, consumption of healthy, plant-based diets which are low in saturated fat and refined carbohydrates but high in whole grains, vegetables, legumes and fruits, coupled with appropriate exercise regimens, is recommended for patients with type 2 diabetes.[4–7] Additionally, reduction in the intake of carbohydrates with a high glycemic index has been shown to result in significant improvements in glucose tolerance and body weight when compared with conventional low-fat diets with similar energy content.[8] The International Diabetes Federation (IDF) and the American Diabetes Association (ADA) have issued diet recommendations for patients with type 2 diabetes,[9,10] however, alternative approaches need to be investigated because of the frequent low adherence of the currently recommended diets in the management of type 2 diabetes.[11]

Macrobiotic diets, originally derived from an ancient Eastern philosophy of life, and updated for Western culture by the Japanese philosopher Georges Ohsawa,[12] contain a large proportion of whole grains. The Ma-Pi 2 diet, conceived by Mario Pianesi, is a kind of macrobiotic diet; it is high in dietary fiber, which is in line with dietary recommendations by the Academy of Nutrition and Dietetics.[13] High-fiber diet may induced several health benefits such as prevention or reduction of bowel disorders and decreased risk of the development of coronary heart disease and type 2 diabetes.[14,15] The Ma-Pi 2 diet is also rich in complex carbohydrates, whole grains, vegetables and legumes, fermented products, sea salt and green tea, without fat or protein from animal sources (including milk and dairy products) and no added sugars. These features are designed to achieve optimal glucose control, lower insulin requirement, prolong the time of glucose absorption, increase insulin sensitivity, reduce total cholesterol and triglyceride levels in plasma, improve body weight control and lower systemic blood pressure.[16–19] Additionally, the Ma-Pi 2 diet appears to have antioxidant properties and prebiotic or probiotic effects.[20] This may alter the composition of gut microbiota, which in turn may affect the glycemic control.[21,22]

In previous uncontrolled intervention studies of 3-weeks' duration, patients with type 2 diabetes following the Ma-Pi 2 diet have exhibited reduced HbA1c, cholesterol, triglycerides, and blood pressure.[23,24] We report here on the first randomized comparative trial which compares the Ma-Pi 2 diet with the dietary guidelines for type 2 diabetes recommended by professional societies in Italy.[25]