Mediterranean Diet: Truly Heart-Healthy?
Recently, news outlets were touting the 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.
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, “Heart 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.
What is the Mediterranean Diet?
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. On 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. Marinara means from the sea.
2 glasses of red wine.
Dessert: Poached pear with yogurt, or baked apple with nuts, fresh fruit salad
The Foods in a Mediterranean Diet
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 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.
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.
Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. Estruch R,et. al. N Engl J Med. 2013 Feb 25.PMID: 23432189