For those looking to start the New Year off on the right track with a health kick that’s easy and can help you live longer, it’s time to bring out the olive oil and wine!
Recent major clinical trials have confirmed years of research showing that heart disease can not only be prevented by following a Mediterranean diet, but this eating pattern is proven to reduce heart attacks, strokes and death in both heart patients and healthy people.
Scientists first noticed the benefits of the diet in the 1950s when it was observed that Mediterranean people from countries like Spain, Italy, Southern France and Turkey experienced far fewer deaths from heart disease and lower death rates compared with most other populations, including the United States. Speculative studies pointed to diet and lifestyle as the primary reason, specifically reduced intake of saturated fat.
Yet, while the diet is low in saturated fat, it is far from a low-fat diet. “The diet is more like an ocean-side vacation on the Riviera than a health intervention,” Dr. David H. Newman, MD an Emergency Medicine expert and author of TheNNT explained to AlterNet. “It includes protective effects of olive oil, moderate intakes of red wine, and a heavy reliance on fruit and vegetables and paucity of dairy and red meat. It is low in saturated and omega-6 fats but high in omega-3 antioxidants.”
Almost two decades of research has shown that heart patients who ate this diet saw life-changing benefits. A study last month, which followed 10,000 women in their 50s and 60s over 15 years, found that those who had a better diet quality at mid-life – mirrored on a Mediterranean diet – experienced greater health and wellbeing 15 years later and were 40 percent more likely to live past the age of 70 without chronic illness.
Another major clinical study published in the New England Journal of Medicine in 2013, which followed more than 7000 people without cardiovascular disease for five years, revealed that the Mediterranean diet also extended to preventing first-time heart problems in healthy people and reduced heart attacks and deaths by up to 30 percent.
The study found that those who ate a common Mediterranean diet suffered fewer heart problems than those who ate a low-fat diet similar to the American Heart Association (AHA) recommended diet. Think about how effective the diet would have fared if its competitor had been the average American diet that is much higher in fats and carbohydrates than the AHA recommended diet.
Such observations raise the question of what role cholesterol plays in heart disease given the recent trend of the AHA and cardiology experts advocating for the increase in use of cholesterol-reducing drugs as a way to prevent heart problems.
Typically in the United States, if your cholesterol levels are high, specifically your low-density lipoprotein (LDL) levels which are considered to be the “bad cholesterol“ responsible for blockages (as opposed to the “good” HDL cholesterol) practitioners are more than eager to put you on drugs known as statins to lower cholesterol levels. But here’s some food for thought — three quarters of people who visit the ER experiencing their first heart attack have normal cholesterol levels, Newman says.
“For people who have high cholesterol, the thing to remember is that it’s not as nearly as dangerous as we are led to believe,” he said. “I work in ER and when I see people come in experiencing a heart attack for the very first time, there is good data to tell me as well as my own personal experience that three-quarters of those people with first ever heart attacks do not have high cholesterol.”
In fact, half a century ago researchers first suggested that cholesterol may be a weak risk factor for determining heart disease which led to a line of drugs that “despite lowering cholesterol didn’t help people live longer or avoid heart attacks,” wrote Newman in the Huffington Post.
That’s not to minimalize the use and importance of statins for some people. The benefits of taking the drugs unquestionably trump the harms for some. The data shows that higher cholesterol levels are associated with higher mortality at age 40 rather than in older populations where high cholesterol wasn’t associated with more deaths. Studies have also shown that statins can reduce heart attacks and strokes for heart patients by 25 percent. On the other hand, there is data to suggest that even for heart patients, 80 people have to take the drug for one life to be saved. Moreover, the percentage it reduces heart attacks is still less than the 30 percent reduction from the Mediterranean diet. Newman explains:
“What we’re looking at is an absolutely optimized best case scenario of the effect of these drugs. There is good data to suggest that statins save lives for heart patients but the number of lives they save, if you are a known heart patient ie. had a heart attack and are taking the drug for five years – it’s about a 1 in 83 chance that taking that drug will save your life.”
Those who take statins are also at risk of developing unwanted side effects from taking the drug such as liver problems, muscle damage and diabetes. For those who benefit from taking a statin, one in every 50 will get diabetes. Contrast with the Mediterranean diet where there are no known harmful side effects.
And yet despite the data, the American Heart Association remains reluctant to recommend this diet.
“Before advising people to follow a Mediterranean diet, we need more studies to find out whether the diet itself or other lifestyle factors account for the lower deaths from heart disease,” its website states.
So why is the AHA endorsing statins but not the Mediterranean diet as a heart disease preventative for healthy people? Particularly in light of the AHA recently expanding the recommendations of statins for those without known heart disease. Already, 25 percent of adults over the age of 45 who are taking the pills do not have heart disease.
According to AHA Nutrition Committee Member, Linda Vanhorn, not all studies are made equally. Vanhorn told AlterNet that data suggesting the majority of people who show up in the ER with a heart attack do not have high cholesterol is the exception and not the rule.
“Those people aren’t the norm. Their cholesterol levels are uncharacteristically low or high and it’s not necessarily representative of what a typical patient’s profile looks like,” she said. “This is also not a good indicator of patient’s normal risk. High cholesterol is considered a high risk factor in determining a patient’s risk of heart disease according to the AHA recommendations.”
“To focus on high cholesterol as the big issue to avoid your first heart attack is misleading,” he said. “High cholesterol is a risk factor, but it arguably the weakest risk factor. Diabetes, smoking and high blood pressure are much more important than high cholesterol. It is the weakest of all of the weak factors.”
But, Big Phama has a history of gamesmanship and tendency to manipulate clinical trials out of primary concern for maximizing profits on current drug investments. In fact, 7 out of 15 of the cardiologists on the Committee who wrote the 2013 guidelines advocating for the use of statins and endorsing the drug companies have financial ties to them.
But it seems other countries around the world are starting to catch on, insisting that the Mediterranean diet be placed at the forefront of health policy. Last month, eleven senior doctors in the United Kingdom presented a letter to Prime Minister David Cameron concluding that the Mediterranean diet can prevent many chronic illnesses including dementia.
“We are not going to overcome the increasing burden of chronic diseases by prescribing more pills,” Dr. Aseem Malhotra, a cardiology registrar at Croydon University Hospital said. “The medical profession has itself been guilty of placing too much emphasis on drugs, the benefits of which are often grossly exaggerated and fuelled by a powerful pharmaceutical industry, who naturally wish to expand the use of their drugs for financial gain. The evidence base for the Mediterranean diet in preventing all of the chronic diseases that are plaguing the Western world is overwhelming.”
Newman agrees: “If you go to the AHA recent guidelines on heart disease prevention, in one of the most remarkable abnegations of responsibility, they have spent their entire guidelines looking at surrogate markers like cholesterol reduction and sodium reduction. There is not a quotation of a study that looks at clinical outcomes. They are looking at the things they think are important but have completely ignored the patient. This will be a huge problem in 40-50 years if doctors are only taught to focus on disease rather than treating patients,” he said.
The best advice? Unless you’re considered high risk, in other words, you’ve had a heart attack before, you have high blood pressure or are a smoker, it might be time to look beyond the statins and start the Mediterranean diet.
“Don’t take statins if you are healthy person. If you have egregiously high cholesterol levels it is worth focusing on your cholesterol, but for everyone else stop focusing on cholesterol and start with this delicious diet. It’s fish, it’s wine, it’s not a diet designed to punish or reduce the things you like.”
If during the diet you become a higher risk person because you develop high blood pressure, are a smoker or have a family history or diabetes, than you might want to add a statin to your Mediterranean diet, Newman says. But in the meantime, a lifestyle change is always going to be the most powerful change you can make.
The AHA’s Vanhorn takes a more precautionary approach.
“There is not a cookie-cutter diet that fits all. It requires certain adjustments based on individual needs. Rarely does a patient have one risk factor,” she said. “The Mediterranean diet can be successful, it just requires a lot of cooperation with a physician and a dietician and a progress report that allows the physicians to make further decisions evaluating the success and improvement of that patient.”
For those interested in following a Mediterranean diet, here’s the gist of it as laid out in Emergency Physicians Monthly:
– Eat more fruits (3 servings a day)
– Eat more vegetables (2 a day including a salad)
– Use olive oils abundantly
– Eat less red meat and more white meat
– Indulge in plenty of fish
– Snack on legumes like nuts and beans
– Eat red sauces
– Enjoy a glass of wine with diner if you choose
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