Mediterranean Diet: Heart Health – Not Just Yet

Mediterranean Diet Good For Your Heart?

Healthy Mediterranean Diet

This week most news outlets are touting the recent article in The New England Journal of Medicine about the Mediterranean Diet, and how it cut cardiovascular disease. But here is the rest of that story:

There was no significant reduction in heart attacks, there was no reduction in death from heart disease, but there was a small reduction in death from stroke. When you combine the strokes into a category of cardiovascular disease you have the difference the article noted.  To be clear, the study did not say a reduction in stroke, or a reduction in disability from stroke but just death from stroke.

There is a call for studies of diets to see how it affects heart disease, or cancer, or other diseases. But here is one that really didn’t show anything, and yet some are saying- hey, we need more.

What was not properly accounted for in the study was smoking, people who were taking statins, people who were taking blood pressure medicine,  and there was more obesity in the control group. There was no weight loss in the Mediterranean diet group.

Even the New York Times didn’t get this, their article said, “About 30 percent of heart attacks, strokes and deaths from heart disease can be prevented in people at high risk if they switch to a Mediterranean diet rich in olive oil, nuts, beans, fish, fruits and vegetables, and even drink wine with meals, a large and rigorous new study has found.”

In another part of the NYT article they said, ” Disease experts said the study was a triumph because it showed that a diet was powerful in reducing heart disease risk, and it did so using the most rigorous methods. ” 

The study did not show that the diet was “powerful” in reducing heart disease risk, and the most rigorous method used was statistical jockeying to add stroke deaths to heart issues to put it all under one statistical umbrella.

Plus, one group were required to drink a liter of olive oil a week (thats a lot of oil).

What was also missing from the study was any laboratory data, nothing showing a change in blood lipid chemistry (which may not matter). There was nothing in the data that showed changes in plaque formation. There was nothing in the data that showed inflammatory markers were lower.

Bottom line: you have a study that makes a lot of reaches, conclusions, and promises, but the facts are simply not there to support it. It also shows that the era of science journalism is gone.

Eating Healthier is better than not – in fact: Just Cook! :

Olive oil- buy local (US olive oils).

There are plenty of ways a person can eat healthy. And once someone begins to pay attention, and eat healthier they tend to think that their diet is the best of any. Diets become a religion for some people- proselytizing with the evangelical fervor of a Revival preacher.

What the report in the New England Medical Journal showed was this: eating healthier is a bit better than not.

A lot to love in this diet – what I like most, is it gets people into the kitchen, and cooking. There is nothing wrong with a diet that is rich in fruits, vegetables, whole grains, fish (and shellfish) with less emphasis on cattle raised on corn (grass fed is ok), and decreased portions, is probably best. Oh- and don’t forget the red wine.

 One of the New York Times columnists got it partially right. Mark Bittman, whose contributions to the food section of the NY Times are known for advocating cooking, healthy foods, and less red meat.  His column pointed out the flaws, as Bittman called physicians who were critical of the article. Bittman’s colum about this can be found by clicking here.  Bittman does credit Ornish with a diet showing a reversal of heart disease – which, sadly is simply not true (our review of Dr. Ornish here). Essentially, Ornish’s cardiac imaging was flawed – and his studies have not been reproduced.

What is the Mediterranean Diet – a Diet Plan

Breakfast: Greek yogurt. Fruit, fresh and whole. Granola made from fresh nuts, whole grains, and sweetened with blueberries. Fresh, whole wheat toast, or sourdough pancakes. Cucumbers with onions dipped in balsamic vinegar with some olive oil.  Tea or coffee

Mid-Morning snack: fresh fruits, nuts, or – dried fruits (that you have made).

Lunch: Fresh fish grilled or fried in olive oil. A hearty lentil soup. Fresh fish with pita bread.

Mid-afternoon snack: 1 banana or 1 apple, or some fresh fruit. A handful of nuts

Dinner: Chicken – baked or roasted, in a warm hummus salad. Fresh pita bread. Green beans blanched, then dressed with olive oil and mustard. Or pasta with a true Marinara sauce. One the island of Sardinia, I ordered pasta with Marinara sauce – besides tomatoes, in the sauce were fresh mussels, lobster, mackerel, and tuna — and it hit me – this is what marinara means- from the sea.

2 glasses of red wine.

Dessert: Poached pear with yogurt, or baked apple with nuts, fresh fruit salad

 Mediterranean Diet: What it consists of 

Vegetables and Fruits: the base of the Mediterranean pyramid. The bulk of food in this comes from these ingredients. Fruits form the basis of most deserts. This means fruits or vegetables with every meal- and for every snack, up to ten servings a day. These are not processed juices, these are something you can identify out of the garden. If you have dried fruits, that is acceptable, and prefer that you do them.

Grains: Whole grains, not processed wheats: quinoa, wheat berry, and sesame seeds. Perhaps my favorite of this is hummus, a great snack, all vegetable, that provides all the essential amino acids. It was this snack that allowed migration across the world.

Dairy: Greek yogurt, cottage cheese, are all used in this diet.

Fats: Primary source is olive oil in this diet, also grape seed oil

Pasta: A basis of high-carbohydrate, high fuel for people from the Mediterranean to China.

 

 

 

REFERENCE:
Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. Estruch R,et. al. N Engl J Med. 2013 Feb 25.PMID: 23432189

 

The NYT article can be found here.

Dr. Terry Simpson About Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate and graduate degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. He found he liked people more than petri dishes, and went to medical school. Dr. Simpson, a weight loss surgeon is an advocate of culinary medicine. The first surgeon to become certified in Culinary Medicine, he believes teaching people to improve their health through their food and in their kitchen. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcolm Baldrige award for healthcare in 2011 for the NUKA system of care in Alaska and in 2013 Dr Simpson won the National Indian Health Board Area Impact Award. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit www.terrysimpson.com.

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