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

Can Supplements Help You Live Longer?

Posted June 11, 2019 by Dr. Steve Chaney

Are Supplements The Fountain Of Youth?

Author: Dr. Stephen Chaney

 

It is buyer beware in the supplement industry. I have discussed the dark side of the supplement industry in the first half of my book “Slaying The Supplement Myths.”

I called that section of my book “The Lies of the Charlatans.”  In it, I detailed many of the false claims that some manufacturers make for their supplements. There are claims that their supplements will…

  • Cure what ails you (Just fill in the disease of your choice. Some company will try to tell you they have the cure).
  • Make the pounds melt away.
  • Make you smarter.
  • Make you stronger.
  • Improve your sex life.

Can supplements help you live longer?

The list seems endless…Except for one! I don’t know of any supplement company claiming their supplements make you live longer. Nobody is claiming their supplements are the “Fountain of Youth.”

However, many of you have been asking me about headlines claiming that a recent study showed that supplements don’t extend lives. Could it be that the study generating the recent headlines was designed to disprove a claim nobody was making?

In this issue of “Health Tips From The Professor” I will analyze the study and answer two questions:

  • Is it true?
  • Is it important?

How Was The Study Done?

Every few years the National Center for Health Statistics (a division of the CDC) conducts a massive survey of factors affecting the health of the American population. This survey is called the National Health and Nutrition Examination Survey (NHANES). The NHANES survey includes interviews and examinations of thousands of people across the country.

The interview includes dietary, health-related, demographic, and socioeconomic questions. The examination component includes laboratory tests plus medical, dental, and physiological measurements. The NHANES database is used for many studies such as this one.

The current study (F Chen et al, Annals of Internal Medicine, doi:10.7326/M18-2478, published April 9, 2019) used data from 30,899 US adults aged 20 years or more who participated in 6 cycles of the NHANES survey from 1999 to 2010. The dietary portion of the survey taken by these participants contained questions on the dietary supplements they had used in the 30 days prior to the survey.

The NHANES data were linked to the National Death Index mortality data so that the effect of nutrient intake and supplement use on mortality could be assessed. The median follow-up for the participants in the study was 6.1 years. During that time, 3613 deaths occurred, 945 from heart disease and 805 from cancer.

Of the participants:

  • 71% were white, 11% were non-Hispanic black, and 13% were Hispanic.
  • 9% were female, 49.1% were male.
  • 2 % of the participants reported supplement use in the 30 days preceding the survey.
  • Among the supplement users, the major supplements reported were:
    • Multivitamin/multimineral (74.8%).
    • Vitamin C (40.3%).
    • Calcium (38.6%).
    • Vitamin D (37.6%).
    • Zinc (34.5%).
    • Magnesium (33.3%).

When they compared supplement users with non-supplement users, the supplement users were:

  • More likely to be female and non-Hispanic white.
  • Have higher levels of family education and income.
  • Eat a healthier diet and be more physically active.
  • Less likely to be current smokers, heavy drinkers, or obese.

These are all factors that favor a longer lifespan.  However, the supplement users were also:

  • Older (average age = 50.7 versus 42.8 for non-supplement users).
  • Sicker (They were more likely to have cancer, heart disease, diabetes, high blood pressure, and high cholesterol levels).

These are factors that favor a shorter lifespan.

These are what statisticians refer to as confounding variables. They can influence the results of a study in unexpected ways.

 

Can Supplements Help You Live Longer?

When they looked at the raw data, supplemental use of most-individual nutrients was associated with a lower risk for all-cause death. In simple terms, supplementation appeared to increase lifespan.

However, when the data were statistically adjusted for all of the confounding variables (age, sex, race/ethnicity, education, physical activity, smoking, alcohol intake, diet quality, BMI [a measure of obesity], and diseases the participants had when they entered the study), the effect of supplementation on lifespan became non-significant.

The authors concluded: “Use of dietary supplements was not associated with mortality benefits among a nationally representative sample of U.S adults.”  Those are the headlines you saw from your favorite news source.

What Does This Study Mean For You?

Let’s go back to the two questions I posed about the study at the beginning of this article.

  • Is it true? Can supplements help you live longer?  The study had many weaknesses, which the authors identified in their discussion. Of course, the people writing the headlines never bothered to read the paper, so they were unaware of its weaknesses. Here are some of the major weaknesses reported by the authors:
  • The NHANES questionnaire only asked about supplement use over the preceding 30 days. We have no idea how long the participants had been using those supplements. It could have been years, or it could have been a month. In the words of the authors: “Dietary supplement use was assessed in the previous 30 days, which may not reflect habitual use or capture changes in use [before or] after the baseline assessment.”
  • The supplement users were more likely to have been diagnosed with health conditions such as cancer, heart disease, diabetes, and high blood pressure. It is well documented that diagnosed health conditions motivate some people to initiate supplement use.
  • Finally, there were multiple confounding variables in this study. The conclusion of the study rested on a statistical adjustment of the data to correct for those confounding variables. In the words of the authors: “Residual confounding may still be present.”

That last point reminds me of the famous Mark Twain quote: “There are lies. There are damn lies. And then there are statistics.” Don’t misunderstand me. I am not accusing the study authors of lying. They are some of the top scientists in the field. What Mark Twain and I are saying is that when you rely on statistics, sometimes bad things happen. You can come to erroneous conclusions.

  • Is it important? Even if the conclusion of this study is true, we should ask if it is important. If there had been widespread claims that supplements make you live longer, this would be an important finding. However, nobody I know is making that claim. This study simply reaffirms what most people assumed anyway. There is no fountain of youth.

By the way, the situation is similar for diets. There have been a few claims in the past that healthy diets will help you live longer. However, when those claims have been rigorously evaluated, there is very little effect of diet on lifespan. There have been some studies that have reported a decrease in premature death due to heart disease or cancer. However, death from all causes usually remains unchanged. Once again, the fountain of youth has eluded us.

You may be asking, if supplements don’t increase lifespan, what good are they? The answer is simple. They increase healthspan. Simply put, that means you spend a greater portion of your lifespan in good health.

Of course, now you are probably really confused. You’ve read all those headlines saying that supplements don’t have any effect on your health. The problem is that the studies generating those headlines are flawed. They aren’t asking the right questions. When you look at populations with poor diets, increased needs, genetic predisposition, and/or pre-existing disease, supplementation is often beneficial. I cover this in the second half of my book, “Slaying the Supplement Myths.”  That section is called “The Myths Of The Naysayers.”

 

The Bottom Line

 

A recent study reported that supplements do not reduce mortality. They won’t make you live longer. In this article I provide a detailed analysis of that article. The two important take-aways are:

  • There are several weaknesses in the study. The conclusion may not be accurate.
  • Even if it is accurate, it may not be important. If there had been widespread claims that supplements make you live longer, this would be an important finding. However, nobody I know is making that claim. This study simply reaffirms what most people assumed anyway. There is no fountain of youth. Could it be that the study generating the recent headlines was designed to disprove a claim nobody was making?

The real benefit of supplementation isn’t in increasing your lifespan. It is increasing your healthspan. I cover that in my book, “Slaying The Supplement Myths.”

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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