Category Archives: Mediterranean Diet

March 6, 2024 · 11:48 PM

I Was Right! Mediterranean Diet Prevents Cardiovascular Disease

Branzino, aka European Bass, live in Mediterranean waters

Yet another epidemiologic study supports the contention that the Mediterranean diet reduces cardiovascular disease. The higher the adherence to the Medi diet, the less cardiovascular disease over the next 20 years. I scanned the report down to the Discussion section and, surprisingly, didn’t catch their definition of cardiovascular disease. It usually refers to heart attacks, strokes, angina, congestive heart failure, and hypertension. Some would include aneurysms. The study at hand was done in Greece. You can read the whole thing.

Abstract

Background and aims

Only few studies have assessed longitudinal dietary trends in relation to cardiovascular disease (CVD) risk. We aimed to evaluate the association between adherence to the Mediterranean diet, both baseline and longitudinal, and 20-year CVD incidence.

Methods and results

This was a prospective study among 1988 Greek adults (50% men, age: 45 ± 14years). Adherence to the Mediterranean diet was evaluated at baseline and 10 years through the MedDietScore, based on which longitudinal Mediterranean diet trajectories were identified. CVD incidence was recorded at 20 years. Each one-unit increase in baseline MedDietScore was associated with an 8% reduction in 20-year CVD incidence. Compared to subjects in the lowest tertile of baseline MedDietScore, those in the highest exhibited a 44% lower 20-year CVD risk (relative risk: 0.56, 95% confidence interval: 0.32, 0.97) adjusted for age, sex, baseline body mass index, smoking, physical activity, presence of hypercholesterolemia, hypertension and diabetes mellitus, and family history of CVD; further adjustment for high-sensitivity C-reactive protein, uric acid and estimated glomerular filtration rate attenuated this association. Results were similar in models adjusted for longitudinal changes in body weight, physical activity and smoking, and 10-year medical status. Mediterranean diet trajectory analysis revealed that 24.7%, 8.6%, 45.8% and 20.9% of participants longitudinally sustained a low adherence, moved closer, moved away or sustained a high adherence, respectively; among those, the corresponding CVD incidence was 63.3%, 65.5%, 28.1% and 9.4% (p-value<0.001).

Conclusion

The Mediterranean diet offers long-term protection against CVD, part of which is mediated by inflammation, uricemia and renal function.

Steve Parker, M.D.

PS: The study is in Nutrition, Metabolism & Cardiovascular Disease: “Mediterranean diet trajectories and 20-year incidence of cardiovascular disease: The ATTICA cohort study (2002–2022),” published in January 2024.

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December 10, 2023 · 12:31 AM

Reduce Alzheimer’s Dementia Risk With Mediterranean Diet

Not sure where this is. Leave a comment if you recognize it.

From Queen’s University Belfast:

A Mediterranean diet of seafood, whole grains, nuts, fruit and vegetables could lower the risk of dementia by almost a quarter, according to a recent study.

Significantly the findings suggested that, even for individuals with a higher genetic predisposition to dementia, having a more Mediterranean-like diet reduced the likelihood of developing dementia.

The study which has been ongoing for the past two years, was led by Newcastle University in collaboration with colleagues from Queen’s University Belfast, University of Exeter, the University of East Anglia and the University of Edinburgh and has been published in the medical journal, BMC Medicine.

This was a large-scale project with analysis of data from over 60,000 older adults in the UK, which explored whether individuals who followed a Mediterranean-like diet had a lower risk of developing dementia than those who did not.

The research found that those with the highest level of adherence to a Mediterranean diet had a 23% reduced risk of developing dementia over a nine-year period than those with the lowest level of adherence.

Steve Parker, M.D.

H/T Jan at Low Carb Diabetic.

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September 3, 2022 · 7:27 AM

Dietitian Questions Healthfulness of the Mediterranean Diet

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Shana Spence, RD, wrote at Self.com:

The Mediterranean diet is constantly lauded in the nutrition world—in fact, U.S. News has named it the “best diet overall” for five years straight—but as a registered dietitian, I think it’s time to think about it a little differently: It’s time to dethrone the Mediterranean diet as being the very best way to eat.

Now, the Mediterranean diet—which emphasizes whole grains and plant foods such as fruits, vegetables, legumes, tree nuts, seeds, and olives, and limits red meat, sugar, and saturated fat—is not the only culturally based way of eating that’s been celebrated. The Japanese diet, rich in foods such as seafood, steamed rice, tofu, natto, seaweed, and pickled fruits and vegetables, has been promoted for its longevity-promoting aspects as well. But as scrolling through social media or even many news and health websites will show, it still doesn’t come close to the Mediterranean diet in terms of widespread recognition.

As an RD, I’ve noticed an overwhelming belief in our society that eating Mediterranean-style is just the way to go. So if your cultural foods don’t hail from one of the countries that make up that area, how does this make you feel?

Spoiler: Probably not so good—and that’s why I believe we need to rethink how we talk about cultural foods and ways of eating.

You know I’m a Mediterranean diet advocate. There are other healthy ways of eating. I’m an advocate of free speech and open debate. No censorship here! Read it and see what you think. I’m not sure what the “Japanese diet” is. I’ve written good things about the Okinawan diet as discussed in Dan Buettner’s Blue Zones books. Click for my review of Blue Zones.

Steve Parker, M.D.

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June 9, 2022 · 4:55 PM

Keto Versus Mediterranean Diet: Which Is Best for T2 Diabetics and Prediabetics?

Use the search box to find the recipe for this LCHF avocado chicken soup

Effect of a Ketogenic Diet versus Mediterranean Diet on HbA1c in Individuals with Prediabetes and Type 2 Diabetes Mellitus: the Interventional Keto-Med Randomized Crossover Trial

Right off the bat, I don’t like that they studied both diabetics and prediabetics. There were only 40 original study participants, with complete data on only 33. Why lump the two together?

Participants followed each diet for 12 weeks then lab data and body weight were assessed.

The researchers conclusions:

HbA1c [a measure of blood sugar control] was not different between diet phases after 12-weeks, but improved from baseline on both diets, likely due to several shared dietary aspects. WFKD [ketogenic diet] was beneficial for greater decrease in triglycerides, but also had potential untoward risks from elevated LDL-C, and lower nutrient intakes from avoiding legumes, fruits, and whole intact grains, as well as being less sustainable.

Triglycerides dropped more on the keto diet, no surprise. Body weight dropped the same for both diets, 7-8%. HDL-cholesterol (the “good cholesterol”) rose 11% on keto and 7% on Mediterranean diet. HgbA1c dropped the same on both diets, about 8% from baseline. Both diets lead to eating ~300 calories less per day than baseline consumption.

Dr Bret Scher addressed the increased LDL-cholesteral (aka “bad cholesterol”) over at DietDoctor.com:

The authors reported that LDL “dangerously” rose 10% on the keto diet. But was it really a dangerous change? Triglycerides went down on the keto diet, as we would expect. And as we saw in 2018 with the Virta Health trial, on average, LDL went up 10%. However, the calculated cardiac risk score went down 12%.

In terms of answering the headline question, Keto Versus Mediterranean Diet: Which Is Best for T2 Diabetics and Prediabetics?, the answer really depends on long-term data concerning longevity and various diseases. This study doesn’t answer the question.

What say you?

Steve Parker, M.D.

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January 6, 2022 · 7:49 AM

Mediterranean Diet Is Ranked Best for Diabetes

…according to U.S. News & World Report. Click through if interested in the two runners-up. I think a low-carb version of Mediterranean is better for most folks.

Steve Parker MD, low-carb diet, diabetic diet
Olives, olive oil, and vinegar: classic Mediterranean foods

I’m surprised they ranked Atkins as the “Best Fast Weight-Loss Diet.” Looks like we’re getting over our collective phobia about saturated fat. “Keto Diet” ranked #4 in that category.

Steve Parker, M.D.

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December 18, 2021 · 9:11 AM

Mediterranean Diet Reduces Cardiovascular and All-Cause Mortality

Caprese salad: mozzarella cheese, tomatoes, basil, extra virgin olive oil

Folks with diabetes have higher-than-average risk of dying from cardiovascular disease, such as heart attacks and strokes. So it’s good to know about dietary habits that enhance longevity.

Article

ABSTRACT

Background

Examining a variety of diet quality methodologies will inform best practice use of diet quality indices for assessing all-cause and CVD [cardiovascular disease] mortality.

Objective

To examine the association between three diet quality indices (Australian Dietary Guideline Index, DGI; Dietary Inflammatory Index, DII; Mediterranean-DASH Intervention for Neurodegenerative Delay, MIND) and risk of all-cause mortality, CVD mortality and non-fatal CVD events up to 19 years later.Design

Data on 10,009 adults (51.8 years; 52% female) from the Australian Diabetes, Obesity and Lifestyle study were used. A food frequency questionnaire was used to calculate DGI, DII and MIND at baseline. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% CI of all-cause mortality, CVD mortality and non-fatal CVD events (stroke; myocardial infarction) according to 1 SD increase in diet quality, adjusted for age, sex, education, smoking, physical activity, energy intake, history of stroke or heart attack, and diabetes and hypertension status.Results

Deaths due to all-cause (n = 1,955) and CVD (n = 520), and non-fatal CVD events (n = 264) were identified during mean follow-ups of 17.7, 17.4 and 9.6 years, respectively. For all-cause mortality, HRs associated with higher DGI, DII and MIND were 0.94 (95% CI: 0.89, 0.99), 1.08 (95% CI: 1.02, 1.15) and 0.93 (95% CI: 0.89, 0.98), respectively. For CVD mortality, HRs associated with higher DGI, DII and MIND were 0.93 (95% CI: 0.85, 0.99), 1.10 (95% CI: 1.00, 1.24) and 0.90 (95% CI: 0.82, 0.98), respectively. There was limited evidence of associations between diet quality and non-fatal CVD events.Conclusions

Better quality diet predicted lower risk of all-cause and CVD mortality in Australian adults, while a more inflammatory diet predicted higher mortality risk. These findings highlight the applicability of following Australian dietary guidelines, a Mediterranean style diet and a low-inflammatory diet for the reduction of all-cause and CVD mortality risk.

Steve Parker, M.D.

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December 14, 2021 · 7:00 AM

Parade: Low-Carb Mediterranean Diet Is the Best for Heart Health

Steve Parker MD, low-carb diet, diabetic diet
Olives, olive oil, and vinegar: classic Mediterranean foods

Parade.com has an article touting the health benefits of a low-carb high-fat Mediterranean diet. Can you believe they didn’t even mention my books?!

In fairness to my readers, I must mention that I scanned the referenced AJCN article and didn’t see the word “Mediterranean” in it.

From Parade:

“If you’re looking to improve your heart health, you may want to try eating a low-carb, high-fat Mediterranean diet. Why? Because a new study published in The American Journal of Clinical Nutrition found that eating a low-carb (no more than 20% of daily calories from carbs), the high fat-style Mediterranean diet may reduce the risk of cardiovascular disease (CVD).For the study, obese study participants reported both improved insulin resistance and cholesterol levels compared to those who ate a moderate carb (40%) or high carb (60%) diet over a five-month period.”

Steve Parker, M.D.

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PS: I also have a low-carb option in my Advanced Mediterranean Diet (2nd Edition). And KMD: Ketogenic Mediterranean Diet is very low-carb.

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October 10, 2021 · 7:00 AM

Is There Anything It DOESN’T Do?: Mediterranean Diet Improves Erectile Dysfunction

From EdenMagnet.com:

A Mediterranean diet is associated with improvements in erectile dysfunction, according to research presented at the European Society of Cardiology Congress 2021.

Erectile dysfunction primarily occurs when small arteries lose the ability to dilate and allow proper blood flow. It is more common in men with hypertension or declining testosterone levels.

“In our study, consuming a Mediterranean diet was linked with better exercise capacity, healthier arteries, and blood flow, higher testosterone levels, and better erectile performance,” says Angelis.

This is news to me.

Steve Parker, M.D.

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August 21, 2021 · 7:00 AM

Prevent Second Heart Attack With the Mediterranean Diet

Heart attacks and chest pains are linked to blocked arteries in the heart

Most patients with a heart attack have underlying atherosclerosis (“hardening of the arteries”) in the heart, called coronary artery disease. Around the time of a heart attack (if not before), doctors and patients should focus on mitigating risk factors for future heart attacks and other cardiac events. This is called “secondary prevention.” Risk factor modification might include smoking cessation, regular exercise, stress reduction, and diet modification. For years, I’ve been recommending the Mediterranean diet. Many others recommend a low-fat diet instead. A recent study supports my diet recommendation.

One way to assess risk of progressive atherosclerosis is to measure the thickness of the the carotid artery wall by ultrasound. Increasing thickness of the artery wall is linked to higher risk of atherosclerotic complications like heart attack and stroke. To drill down deeper, it’s the thickness of the innermost two layers of the artery wall, called the intima-media, that matters. The study at hand showed a reduction in carotid artery intima-media thickness over five years on a Mediterranean diet compared to a low-fat diet. Here’s the abstract:

Background and Purpose:

Lifestyle and diet affect cardiovascular risk, although there is currently no consensus about the best dietary model for the secondary prevention of cardiovascular disease. The CORDIOPREV study (Coronary Diet Intervention With Olive Oil and Cardiovascular Prevention) is an ongoing prospective, randomized, single-blind, controlled trial in 1002 coronary heart disease patients, whose primary objective is to compare the effect of 2 healthy dietary patterns (low-fat rich in complex carbohydrates versus Mediterranean diet rich in extra virgin olive oil) on the incidence of cardiovascular events. Here, we report the results of one secondary outcome of the CORDIOPREV study. Thus, to evaluate the efficacy of these diets in reducing cardiovascular disease risk. Intima-media thickness of both common carotid arteries (IMT-CC) was ultrasonically assessed bilaterally. IMT-CC is a validated surrogate for the status and future cardiovascular disease risk.

Methods:

From the total participants, 939 completed IMT-CC evaluation at baseline and were randomized to follow a Mediterranean diet (35% fat, 22% monounsaturated fatty acids, <50% carbohydrates) or a low-fat diet (28% fat, 12% monounsaturated fatty acids, >55% carbohydrates) with IMT-CC measurements at 5 and 7 years. We also analyzed the carotid plaque number and height.

Results:

The Mediterranean diet decreased IMT-CC at 5 years (−0.027±0.008 mm; P<0.001), maintained at 7 years (−0.031±0.008 mm; P<0.001), compared to baseline. The low-fat diet did not modify IMT-CC. IMT-CC and carotid plaquemax height were higher decreased after the Mediterranean diet, compared to the low-fat diet, throughout follow-up. Baseline IMT-CC had the strongest association with the changes in IMT-CC after the dietary intervention.

Conclusions:

Long-term consumption of a Mediterranean diet rich in extra virgin olive oil, if compared to a low-fat diet, was associated with decreased atherosclerosis progression, as shown by reduced IMT-CC and carotid plaque height. These findings reinforce the clinical benefits of the Mediterranean diet in the context of secondary cardiovascular prevention.

Reference

Parker here again. Undoubtedly, it would be more helpful if the investigators reported the actual rates of heart attack, stroke, and death in the two diet groups over five years. I suspect that will be in a future report.

An article in Clinical Cardiology states the serious nature of coronary artery disease (CAD) in those with diabetes (DM): “CAD is the main cause of death in both type 1 and type 2 DM, and DM is associated with a 2 to 4-fold increased mortality risk from heart disease. Over 70% of people >65 years of age with DM will die from some form of heart disease or stroke. Furthermore, in patients with DM there is an increased mortality after MI [myocardial infarction], and worse overall long-term prognosis with CAD.”

Steve Parker, M.D.

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March 9, 2021 · 10:35 PM

More Low-Carb Mediterranean Diet Recipes

Ketogenic compatible

Check out Diet Doctor for over 60 low-carb Mediterranean diet recipes! Diet Doctor usually provides carbohydrate counts, so you can fit these into the Low-Carb Mediterranean Diet.

Click on “recipes” at left for my own low-carb Mediterranean diet recipes.

Steve Parker, M.D.

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