The Mediterranean Diet For Heart Health

Written by Dr. Steve Chaney on . Posted in Mediterranean diet

Can You Cut Your Heart Disease Risk In Half?

Author: Dr. Stephen Chaney

 

what ifShould you use the Mediterranean diet for heart health?

What if…

  • You could reduce your risk of heart disease by almost 50%…and…
  • It didn’t cost you an extra penny?
  • You didn’t need to lose weight (although you would probably get even better results if you did)?
  • You didn’t need to buy a gym membership and start a workout program (although you would probably get even better results if you did)?
  • There were absolutely no side effects?
  • There were considerable side benefits like reduced risk of type 2 diabetes, high blood pressure, inflammation, and cognitive decline as you aged?

Would you be interested? I’m willing to bet if this were a TV ad, you would be on the edge of your seat. If it were a new “magic” supplement, you might be reaching for your credit card before the ad was over. If it was the latest “miracle” workout machine, you might order it right away.

However, I am not talking about a magic pill or a miracle workout machine. I’m talking about a way of eating called the Mediterranean diet. Recent headlines have claimed that the Mediterranean diet can cut heart disease risk almost in half. This would lead you to believe you could use the Mediterranean diet for heart health.  Let’s look at the evidence behind that claim.

 

How Was The Study Designed?

omega-3 lowers heart disease riskThe study behind the headlines (C-M. Kastorini et al. Atherosclerosis, 246: 87-93, 2016) enrolled 2583 adults, ages 18-89, from the region around Athens, Greece in a 10-year study beginning in 2001-2002.

At the beginning of the study and at the 5 and 10-year mark, participants completed in-depth surveys about their medical records, lifestyle, and dietary habits. These surveys were conducted by trained personnel (cardiologists, general practitioners, dietitians, and nurses). Participants with active cardiovascular disease in the first survey were excluded from the study.

The study evaluated 4 things:

  • Cardiovascular disease risk factors including obesity, high cholesterol, high triglycerides, high blood pressure, diabetes, and inflammation.
  • Adherence to the Mediterranean diet (see below).
  • Heart disease incidence based on heart attacks, stroke, angina, ischemia, cardiac arrhythmias and deaths due to heart disease.
  • Confounding variables such as age, sex, family history of heart disease, smoking, and lack of physical activity. All comparisons were corrected for these confounding variables so that they did not influence the results.

Adherence to the Mediterranean diet was based on a diet analysis scoring system called MedDietScore. The Mediterranean diet is one which emphasizes fresh fruits and vegetables, whole grains, beans, nuts, fish, olive oil, and moderate consumption of red wine.  You can see this might lead you to believe in the Mediterranean diet for heart health.

The MedDietScore gives positive points based on how often these foods are consumed. It gives negative points based on how often meats, meat products, poultry, and full-fat dairy products are consumed. For alcohol, modest consumption is considered a positive, with either no or excess alcohol consumption rating a score of 0. The composite score ranges from 0 to 55, with higher values indicating greater adherence to the Mediterranean diet.

As an aside, you might think that everyone in Greece consumes a Mediterranean diet. Unfortunately, our unhealthy Western diet and our fast foods restaurants are making inroads in the birthplace of the Mediterranean diet.

 

The Mediterranean Diet for Heart Health?

Mediterranean diet for heart healthEven after correcting for confounding variables, the study results were impressive.

  • Each 10% increase in adherence to the Mediterranean diet was associated with a 15% decreased risk of developing heart disease during the 10-year study period.
  • When they compared participants in the upper third for adherence to the Mediterranean diet to those in the lower third, their risk of developing heart disease was decreased by 47%. That’s huge.

However, the results were even more impressive when they looked at the effects of the Mediterranean diet on other risk factors for heart disease.

  • For individuals with low adherence to the Mediterranean diet, each of those risk factors (obesity, high cholesterol, high triglycerides, high blood pressure, diabetes, and inflammation) independently increased the risk of developing heart disease. These results are identical to almost every other published study looking at those risk factors.
  • However, for individuals with high adherence to the Mediterranean diet, those same risk factors had only small, non-significant effects on the risk of developing heart disease. If this finding is verified by future studies, it would suggest that adherence to a Mediterranean diet has the potential to override risk factors like obesity, diabetes, high blood pressure and elevated cholesterol.

Of course, I would not recommend that you ignore obesity and other cardiovascular risk factors and just focus on following a Mediterranean diet. I’m pretty sure you will get even better results if you get your weight, blood sugar, cholesterol, and blood pressure under control in addition to following a Mediterranean diet. Who knows, you might even reduce your risk of heart disease by 75% or more.  So, should we believe in the Mediterranean diet for heart health?

What Does This Mean For You?

If this were the only published study showing that adherence to the Mediterranean diet reduces heart disease risk I would consider it speculative. However, it is only one of several recent studies that have come to a similar conclusion. At this point in time, the evidence is strong that following a Mediterranean-type diet will reduce your heart disease risk.  The Mediterranean diet for heart health seems to be true.

That brings me back to my opening statement. Following a Mediterranean diet:

  • Won’t cost you a penny. You are just spending your food budget on healthier foods.
  • May reduce your risk of heart disease by up to 47% even if you don’t lose weight, but I recommend that you do lose weight.
  • May be as effective as exercise at reducing your heart disease risk. That statement comes from a talk given by one of the authors when he was describing the study.
  • Has no side effects. You could probably achieve a 47% reduction in heart disease using a cardiologist-approved cocktail of 3-5 drugs, but those drugs would come with significant side effects and a considerable cost for someone.
  • Will likely come with side benefits like reduced risk of type 2 diabetes, high blood pressure, inflammation, and cognitive decline.

My question to you is: Now that you know that a simple dietary change could have all those benefits and no downside, are you willing to give it a try? If so, your heart may just thank you for it.

However, I don’t mean to imply that the Mediterranean diet is the only way to reduce your heart disease risk. If your blood pressure is elevated, you might want to try the DASH diet . If you want to reduce heart disease risk and also minimize cognitive decline as you age, you might want to consider the MIND diet .

Those three diets are actually quite similar. They all emphasize fruits, vegetables, whole grains, nuts, seeds, fish, and moderate amounts of healthy fats. They all minimize refined flour, pastries, sweets, red & processed meats. You won’t find a Twinkie or a Big Mac in any of them.

The Mediterranean diet for heart health?  Sure!

The Bottom Line

 

  • A recent study suggests that adherence to a Mediterranean type diet could reduce the risk of developing heart disease by up to 47%.
  • The beneficial effect of the Mediterranean diet was so strong that it overcame other cardiovascular risk factors such as obesity, high cholesterol, high triglycerides, high blood pressure, diabetes, and inflammation.
  • This study is likely to be accurate because it is fully consistent with several other studies looking at the effect of the Mediterranean diet on heart disease risk.
  • To put it into perspective, this simple dietary change.
    • Won’t cost you a penny. You just redirect your food budget.
    • Has zero side effects. You could probably achieve a similar 47% reduction in heart disease risk with a cardiologist-approved cocktail of 3-5 drugs, but that would come with multiple side effects.
    • Has side benefits such as reduced risk of type 2 diabetes, high blood pressure, inflammation, and cognitive decline
  • However, the Mediterranean diet is not the only game in town. Other studies suggest that the DASH diet and MIND diet are also effective at reducing heart disease risk.
  • Those three diet patterns (Mediterranean, DASH & MIND) are actually quite similar. They all emphasize fruits, vegetables, whole grains, nuts, seeds, fish, and moderate amounts of healthy fats. They all minimize refined flour, pastries, sweets, red & processed meats. You won’t find a Twinkie or a Big Mac in any of them.
  • Finally, I am not suggesting that you go on the one of these diets and just throw away your heart medicines without talking to your doctor. However, I would recommend that you talk with your doctor about implementing what the National Institutes of Health calls Therapeutic Lifestyle Change. All three dietary patterns are fully consistent with the NIH-recommended Therapeutic Lifestyle Change. The NIH recommends that Therapeutic Lifestyle Change be tried before considering cholesterol lowering drugs or be used along with cholesterol lowering drugs so that drug dosage can be minimized.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Comments (2)

  • Louise Levesque

    |

    Thank you for your article on the Mediterranean Diet. I suffer from high blood pressure and high cholesterol, so I am a prime candidate for heart disease. These three diets will help me avoid heart disease. Is there anything I can change in my diet to avoid strokes?

    Reply

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Latest Article

What Is The Best Diet For You?

Posted May 23, 2017 by Dr. Steve Chaney

Sorting Through The Dueling Diets

Author: Dr. Stephen Chaney

battle over best dietDiets are a lot like politics in today’s world. Everyone is absolutely convinced their diet is the best and absolutely convinced the other diets are terrible.

Remember the nursery rhyme: “Jack Sprat could eat no fat. His wife could eat no lean…”? Today’s diets remind me of that. They run the gamut from no fat to no carbohydrates. Surely, both extremes couldn’t be healthy. Or could they?

Some diets eliminate whole food groups. That couldn’t be a good thing. Or, could it?

So, what is the best diet for you?

In today’s article, I will give you the pros and cons of these dueling diets. Before I do that, however, let me give you some principles to put things into perspective.

General Principles For Evaluating Diets

How do you sort out the claims and counterclaims associated with the various diets? More importantly, how do you know which of the claims are true and which are misleading? Here are some general principles to help you separate the wheat from the chaff.  What’s the right diet for you?

We are omnivores. We can adapt to a wide variety of diets and do reasonably well. That means most people will do well on any of these diets short term.

wings proteinAnything is better than the standard American diet (SAD). It is high in sugar and refined carbohydrates. It is also high in saturated and trans fats. That is why proponents of every diet can claim that you will feel better and be healthier when you switch to their diet.

Processed and convenience foods are part of the problem. Most diets recommend “clean eating” (elimination of processed and convenience foods). Any diet that eliminates processed and convenience foods is likely to help you lose weight and get healthier. Caution: As soon as a diet becomes popular, food manufacturers rush in to provide pre-packaged, convenience foods to support that diet. Avoid the temptation to use those foods. Big Food Inc. does not have your best interests in mind. They are not your friends.

Most diets lead to a fairly rapid initial weight loss. This is because they restrict food choices and eliminate processed foods. When you eliminate familiar foods from someone’s diet, they instinctively eat less without even thinking about it. This rapid initial weight loss is part of the allure of almost every diet program. However, over time most people start adding back some of their favorite foods or find new foods they like, and the weight comes back.

Weight loss leads to improved blood parameters irrespective of diet composition. That is why every diet, no matter how bizarre, can claim it lowers your blood pressure, improves your blood sugar, lowers your cholesterol, and lowers your triglycerides.

Long term weight loss is virtually identical on every diet. Numerous clinical studies have compared long term weight loss on low fat diets, low carbohydrate diets, and virtually everything in between. Initial weight loss is more rapid on the low-carbohydrate diets. However, at the end of one or two years there is not a dime’s worth of difference in weight loss between any of the diets. The exception is the Vegan diet. Long term Vegans typically weigh less than their meat-eating counterparts, probably because the foods in the Vegan diet have low caloric density (fewer calories per serving).

Healthy carbs and healthy fats are more important than low carb or low fat diets. Ignore the claims and counter claims about low fat and low carb diets. Focus instead on diets that provide moderate amounts of whole grains instead of refined grains & sugar. Also focus on diets that provide moderate amounts of monounsaturated and polyunsaturated fats, especially the omega-3 polyunsaturated fats, instead of saturated and trans fats.

Focus on well balanced meals rather than individual foods. For example, moderate amounts of healthy carbohydrates will have relatively little effect on blood sugar and triglyceride levels as part of a plant-based meal that provides plenty of fiber and protein. However, those same carbohydrate-rich foods by themselves may cause a spike in both blood sugar and triglycerides.

best diet for youPlant-based diets rule. The Ornish diet (a very restrictive form of the Vegan diet) is the only diet that has been shown to reverse atherosclerosis in some people. The Vegan diet and the Mediterranean diet, which is largely plant-based, have been shown to be healthy long term. On the other hand, we simply don’t know whether low carbohydrate diets are healthy long term. Those clinical studies have not been done.

Saturated and trans fats are not your friends. They increase inflammation, which can have many serious long-term health consequences. In addition, the foods that are rich in saturated fats are often acid-forming foods, which can upset your acid-base balance.

We have 5 food groups for a reason. Each food group provides valuable nutrients (vitamins a & minerals) and phytonutrients. You may be able to replace the missing nutrients with supplementation, but you are unlikely to replace the phytonutrients with supplements – even those supplements that claim to be made from whole foods. You should be concerned about the long-term health consequences of any diet that eliminates whole food groups.

Low fat diets aren’t necessarily healthy. Whole food, low-fat diets like the Vegan diet are extremely healthy. However, as soon as health experts started recommending low-fat diets, Big Food Inc. stepped in to offer convenient low fat options. They simply replaced the fat with refined carbohydrates, sugar, and a witch’s brew of chemicals (Remember the part about Big Food Inc. not being your friend?). As a result, the low-fat diet consumed by most Americans is anything but healthy.

The supposed advantages of low carbohydrate diets are misleading. Low carbohydrate diets look very good when you compare them to the Big Food Inc version of the low-fat diet. However, when you compare them to something like the Vegan diet the advantages disappear.

Avoid sugar-sweetened and diet beverages. This should go without saying. Choose water instead. Add carbonation and/or a little lemon or lime juice for flavoring if necessary. Fortunately, most of the major diets exclude sugar-sweetened and diet beverages.

 

The Pros and Cons Of The Major Diets

It is not possible to cover each diet in depth in a single article, so this is meant to be a very brief overview of the major diets.

Low Fat Diets

The Dean Ornish Diet. This is a variation of the Vegan Diet that eliminates all oils, even vegetable oil.

Pros:

  • Whole food, plant-based diet.
  • All the advantages of the Vegan diet, plus it is the only diet shown to reverse atherosclerosis.

Cons:

  • Very restrictive.
  • Long-term adherence is low.

 

vegetablesThe Vegan Diet. This is a whole food, plant based diet. It uses plant proteins instead of meat and plant substitutes for dairy and eggs.

Pros:

  • Whole food, plant-based diet.
  • Associated with lower blood pressure, blood sugar, cholesterol, triglycerides, and inflammation.
  • Clinical studies show that the onset of major diseases like heart disease, cancer, and diabetes are delayed by at least 5-10 years. People on this diet live healthier, longer.

Cons:

  • Long-term adherence is relatively low, but some people stick with this diet for a lifetime.

 

Healthy Fat, Healthy Carb Diets

The Mediterranean Diet. This diet emphasizes fresh fruits & vegetables, whole grains, fish, nuts, seeds, legumes and olive oil. It includes cheese, poultry and eggs in moderation.

whole food dietPros:

Cons:

  • Not designed specifically for weight loss. You will need to watch portion sizes and track calories if you want to lose weight on this diet.

 

The DASH Diet. This diet was specifically designed to help reduce the risk of hypertension and stroke. It is similar to the Mediterranean diet except that it restricts sodium and includes a wider range of lean meats and low-fat dairy products. It does not specifically include olive oil.

Pros:

  • Whole food diet.
  • Clinically proven to lower blood pressure  as effectively as some blood pressure medications.
  • Relatively easy to follow. Includes foods familiar to Americans.

Cons:

  • Not designed specifically for weight loss. You will need to watch portion sizes and track calories if you want to lose weight on this diet.

 

Low Carb Diets

meat protein dietThe Paleo Diet. The Paleo diet is supposedly based on the diet of our paleolithic hunter-gatherer ancestors. The diet is high in protein & fat, and low in carbohydrates. The diet eliminates grains, sugars, refined oils, dairy, legumes, and starchy fruits & vegetables. Most of the protein comes from meats, but the animals must be grass-fed. This reduces, but does not eliminate, saturated fat and gives a modest increase in omega-3 polyunsaturated fat. Thus, the meats included in this diet are healthier than the meats in other low carbohydrate diets. However, it does not turn red meats into health foods.

Anthropologists tell us that the premise of the Paleo diet is faulty. The diet of our paleolithic ancestors was highly dependent on the foods available in their environment. Some were hunters and gatherers. Others lived in areas where fruits & vegetables were prevalent and game was scarcer. Still others lived in areas where starchy root vegetables were an important part of their diet. Furthermore, the enzymes required for digestion of starches are inducible. We can easily adapt to the introduction of grains into our diet.

Pros:

  • Whole food diet.
  • The Paleo diet is associated with several short-term benefits including weight loss, improved blood sugar control and reduced cholesterol, triglycerides & blood pressure.

Cons:

The Atkins Diet. The Atkins diet is the granddaddy of the low-fat diets. It is a very low carbohydrate diet that restricts sugars, grains, high carbohydrate fruits and vegetables. The allure of the diet is that it includes as much fatty meats and saturated fats as you want.

Pros:

  • The Atkins diet is associated with several short-term benefits including weight loss, improved blood sugar control and reduced cholesterol, triglycerides & blood pressure.

Cons:

  • There are no studies evaluating the long-term benefits and risks of the Atkins diet.
  • Weight loss at the end of one or two years is no better than for the low-fat diets.
  • The high intake of saturated fat has the potential to increase the risk of heart disease and cancer.
  • It is a very restrictive diet. Long-term adherence to this diet is poor.

The Ketogenic Diet. The Ketogenic diet is even more restrictive than the Atkins diet. I have covered the pros and cons of the Ketogenic diet in a recent post, so I will refer you to that article, Is the Ketogenic Diet Safe for details. In short, the Ketogenic diet has some short-term benefits and some potential long-term risks. Ketone supplements mimic some, but not all, of the short-term benefits of the Ketogenic diet. Their long-term health risks are unknown.

 

What Is The Best Diet For You?

what diet is right for youWe are all different, so there is no perfect diet for everyone. Want to know how to find a diet that works for you?  Here are some things to think about.

  • If you are like most Americans, almost any of these diets is better than your current diet.
  • The good thing about all the diets reviewed in this article is:
    • They replace refined carbohydrates & sugars with healthier alternatives (The best of the diets also replace saturated & trans fats with healthier alternatives).
    • They emphasize whole foods rather than processed and convenience foods.
    • They eliminate sugar-sweetened and diet beverages.
    • They emphasize fresh vegetables and most include fresh fruit.
  • If you are looking for rapid initial weight loss:
    • The very restrictive diets at either extreme (very low fat or very low carb) are best because they eliminate familiar foods from the diet.
    • The very low carb diets are slightly more effective than low fat diets initially because of water loss, but weight loss on most low carb and low fat diets is identical after 1-2 years.
    • Because both the Mediterranean and DASH diets involve many familiar foods, you will need to pay more attention to portion sizes and total calories on these diets if your primary goal is to lose weight.
  • If you are looking for long term weight control, the Vegan diet is best, probably because most foods in the Vegan diet have low caloric density. Multiple studies have shown that Vegans weigh less than their meat-eating counterparts.
  • If you are looking for long term health benefits:
    • The Vegan and Mediterranean diets are clearly your best choices. They are backed by multiple clinical studies showing they reduce the risk of heart disease, cancer, diabetes, dementia and other diseases.
    • The DASH diet is probably equally healthy. However, because it was designed to control blood pressure, most clinical studies have focused only on how well it reduces blood pressure.
    • There is no evidence that the low carb diets have any long-term health benefits, and there is reason to suspect they may have some long-term health risks.
  • I have serious concerns about long-term health risks for any diet that:
    • Eliminates whole food groups.
    • Is high in saturated and trans fats.
  • The effectiveness of any diet is dependent on how well you stick with it:
    • The long-term adherence to any of the very restrictive diets (either low carb or low fat) is low, although some people do stick with the Vegan diet for a lifetime.
    • Adherence is best with the Mediterranean and DASH diets, probably because many of the foods are familiar and readily available.

 

The Bottom Line

 

In this article I have reviewed the major low fat diets (the Dean Ornish diet and the Vegan diet), the major healthy carb, healthy fat diets (the Mediterranean diet and the DASH diet), and the major low carb diets (the Paleo diet, the Atkins diet, and the Ketogenic diet). In summary:

 

  • If you are like most Americans, almost any of these diets is better than your current diet.
  • The good thing about all these diets is:
    • They replace refined carbohydrates & sugars with healthier alternatives (The best of the diets also replace saturated & trans fats with healthier alternatives).
    • They emphasize whole foods rather than processed and convenience foods.
    • They eliminate sugar-sweetened and diet beverages.
    • They emphasize fresh vegetables and most include fresh fruit.
  • If you are looking for rapid initial weight loss:
    • The very restrictive diets at either extreme (very low fat or very low carb) are best because they eliminate familiar foods from the diet.
    • The very low carb diets are slightly more effective than low fat diets initially because of water loss, but weight loss on most low carb and low fat diets is identical after 1-2 years.
    • Because both the Mediterranean and DASH diets involve many familiar foods, you will need to pay more attention to portion sizes and total calories on these diets if your primary goal is to lose weight.
  • If you are looking for long term weight control, the Vegan diet is best, probably because most foods in the Vegan diet have low caloric density. Multiple studies have shown that Vegans weigh less than their meat-eating counterparts.
  • If you are looking for long term health benefits:
    • The Vegan and Mediterranean diets are clearly your best choices. They are backed by multiple clinical studies showing they reduce the risk of heart disease, cancer, diabetes, dementia and other diseases.
    • The DASH diet is probably equally healthy. However, because it was designed to control blood pressure, most clinical studies have focused only on how well it reduces blood pressure.
    • There is no evidence that the low carb diets have any long-term health benefits, and there is reason to suspect they may have some long-term health risks.
  • I have serious concerns about long-term health risks for any diet that:
    • Eliminates whole food groups.
    • Is high in saturated and trans fats.
  • The effectiveness of any diet is dependent on how well you stick with it:
    • The long-term adherence to any of the very restrictive diets (either low carb or low fat) is low, although some people do stick with the Vegan diet for a lifetime.
    • Adherence is best with the Mediterranean and DASH diets, probably because many of the foods are familiar and readily available.
  • For more details, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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