You might find interesting my recent review of an article commissioned by the National Institutes of Health in the U.S. It’s at one of my other blogs, Advanced Mediterranean Diet. The NIH panel concluded there’s not much we can do. But are they right?
Steve Parker, M.D.
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Filed under Health Benefits, Mediterranean Diet
The enduring popularity of the Mediterranean diet is attributable to three things:
For our purposes today, I use “diet” to refer to the usual food and drink of a person, not a weight-loss program.
The scientist most responsible for the popularity of the diet, Ancel Keys, thought the heart-healthy aspects of the diet related to low saturated fat consumption. He also thought the lower blood cholesterol levels in Mediterranean populations (at least Italy and Greece) had something to do with it, too. Dietary saturated fat does tend to raise cholesterol levels, both LDL and HDL.
Even if Keys was wrong about saturated fat and cholesterol levels being positively associated with heart disease, numerous studies (involving eight countries on three continents) strongly suggest that the Mediterranean diet is one of the healthiest around. See References below for the most recent studies.
Relatively strong evidence supports the Mediterranean diet’s association with:
■ increased lifespan
■ lower rates of cardiovascular disease such as heart attacks and strokes
■ lower rates of cancer (prostate, breast, uterus, colon)
■ lower rates of dementia
■ lower incidence of type 2 diabetes
Weaker supporting evidence links the Mediterranean diet with:
■ slowed progression of dementia
■ prevention of cutaneous melanoma
■ lower severity of type 2 diabetes, as judged by diabetic drug usage and fasting blood sugars
■ less risk of developing obesity
■ better blood pressure control in the elderly
■ improved weight loss and weight control in type 2 diabetics
■ improved control of asthma
■ reduced risk of developing diabetes after a heart attack
■ reduced risk of mild cognitive impairment
■ prolonged life of Alzheimer disease patients
■ lower rates and severity of chronic obstructive pulmonary disease
■ lower risk of gastric (stomach) cancer
■ less risk of macular degeneration
■ less Parkinsons disease
■ increased chance of pregnancy in women undergoing fertility treatment
■ reduced prevalence of metabolic syndrome (when supplemented with nuts)
■ lower incidence of asthma and allergy-like symptoms in children of women who followed the Mediterranean diet while pregnant
Did you notice that I used the word “association” in relating the Mediterranean diet to health outcomes? Association, of course, is not causation.
The way to prove that a particular diet is healthier is to take 20,000 similar young adults, randomize the individuals in an interventional study to eat one of two test diets for the next 60 years, monitoring them for the development of various diseases and death. Make sure they stay on the assigned test diet. Then you’d have an answer for that population and those two diets. Then you have to compare the winning diet to yet other diets. And a study done in Caucasians would not necessarily apply to Asians, Native Americans, Blacks, or Hispanics.
Now you begin to see why scientists tend to rely on observational rather than interventional diet studies.
I became quite interested in nutrition around the turn of the century as my patients asked me for dietary advice to help them lose weight and control or prevent various diseases. At that time, the Atkins diet, Mediterranean diet, and Dr. Dean Ornish’s vegetarian program for heart patients were all prevalent. And you couldn’t pick three programs with more differences! So I had my work cut out for me.
After much scientific literature review, I find the Mediterranean diet to be the healthiest for the general population. People with particular medical problems or ethnicities may do better on another diet. A low-carb Mediterranean diet should be healthier for type 2 diabetics. Dan Buettner makes a good argument for plant-based diets in his longevity book, The Blue Zones. The traditional Mediterranean diet qualifies as plant-based.
What do you consider the overall healthiest diet, and why?
References:
Buckland, Genevieve, et al. Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study. American Journal of Clinical Nutrition, December 9, 2009, epub ahead of print. doi: 10.3945/ajcn.2009.28209
Fortes, C., et al. A protective effect of the Mediterraenan diet for cutaneous melanoma. International Journal of Epidmiology, 37 (2008): 1,018-1,029.
Sofi, Francesco, et al. Adherence to Mediterranean diet and health status: Meta-analysis. British Medical Journal, 337; a1344. Published online September 11, 2008. doi:10.1136/bmj.a1344
Feart, Catherine, et al. Adherence to a Mediterranean diet, cognitive decline, and risk of dementia. Journal of the American Medical Association, 302 (2009): 638-648.
Scarmeas, Nikolaos, et al. Physical activity, diet, and risk of Alzheimer Disease. Journal of the American Medical Association, 302 (2009): 627-637.
Scarmeas, Nikolaos, et al. Mediterranean Diet and Mild Cognitive Impairment. Archives of Neurology, 66 (2009): 216-225.
Fung, Teresa, et al. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation, 119 (2009): 1,093-1,100.
Mente, Andrew, et al. A Systematic Review of the Evidence Supporting a Causal Link Between Dietary Factors and Coronary Heart Disease. Archives of Internal Medicine, 169 (2009): 659-669.
Salas-Salvado, Jordi, et al. Effect of a Mediterranean Diet Supplemented With Nuts on Metabolic Syndrome Status: One-Year Results of the PREDIMED Randomized Trial. Archives of Internal Medicine, 168 (2008): 2,449-2,458.
Esposito, Katherine, et al. Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes. Annals of Internal Medicine, 151 (2009): 306-314.
Trichopoulou, Antonia, et al. Anatomy of health effects of the Mediterranean diet: Greek EPIC prospective cohort study. British Medical Journal, 338 (2009): b2337. DOI: 10.1136/bmj.b2337.
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Filed under Health Benefits, Mediterranean Diet
Oldways, the preeminent promoter of the Mediterranean diet, proclaims May to be “Mediterranean Month.” The idea is to spread awareness of the traditional Mediterranean diet.
In addition to “it just plain tastes good,” I’m a Mediterranean diet advocate because of the potential health benefits.
Relatively strong evidence supports the Mediterranean diet’s association with:
Weaker supporting evidence points to associations with:
For ideas on moving your diet in a Mediterranean direction, why not visit this page at one of my other websites, or the Oldways site? You don’t have to go “full Mediterranean” to gain some of the health benefits. Just taking a couple steps in that direction should help.
Diabetics concerned about the relatively high carbohydrate content in the Mediterranean diet should consider the Low-Carb Mediterranean Diet.
Also check out Oldways blog, The Oldways Table.
Disclaimer: All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status. Always consult your personal physican before making any dietary or exercise changes.
Filed under Health Benefits, Mediterranean Diet
Red wine’s beneficial health effects may be related to improved circulation, according to a recent study by Israeli researchers.
Red wine is a time-honored component of the healthy Mediterranean diet. Consumption is associated with longer lifespan and less cardiovascular disease such as heart attacks.
Israeli investigators had 14 young healthy volunteers drink 250 cc of red wine daily for 21 days, while monitoring markers of circulatory function. Endothelial progenitor cells may be particularly important in maintenance, repair, and formation of the arterial circulatory system.
Here’s their conclusion:
The results of the present study indicate that red wine exerts its effect through the up-regulation of CXCR4 expression and activation of the SDF1/CXCR4/Pi3K/Akt/eNOS signaling pathway, which results in increased [endothelial progenitor cell] migration and proliferation and decreased extent of apoptosis. Our findings suggest that these effects could be linked to the mechanism of cardiovascular protection that is associated with the regular consumption of red wine.
I’m not going to tell you I understand all that. Don’t feel bad if you don’t, either. My point is to illustrate one way that Science makes progress. An observant person notices, “Hey, people who drink judicious amounts of red wine seem to live longer and have fewer heart attacks. I wonder how that works.” Perhaps a plausible mechanism is identified. That might lead to isolation of a specific component in red wine that yields the benefit. Then that component is produced and disseminated, leading to the health benefits, without the risks of alcohol consumption.
It’s an expensive, time-consuming enterprise with many blind alleys.
Reference: Hamed, Saher, et al. Red wine consumption improves the in vitro migration of endothelial progenitor cells in young, healthy individuals. American Journal of Clinical Nutrition, April 14, 2010. doi:10.3945/ajcn.2009.28408
Filed under Alcohol, coronary heart disease, Health Benefits, Mediterranean Diet
According to Greek researchers, the components of the Mediterranean diet that contribute to longer lifespan are:
The following didn’t seem to contribute much, if any:
Investigators at the University of Athens examined the Greek portion of the European Prospective Investigation into Cancer (EPIC) and Nutrition, which included 23,349 men and women free of diabetes, cancer, and coronary heart disease at the outset. Food habits were documented by questionnaire.
The focus of this particular study was death rates over an average follow-up of 8.5 years. Adherence to the traditional Mediterranean diet ranged from minimal to high, as would be expected.
As with numerous other studies of the Mediterranean diet, higher adherence to the Mediterranean diet was associated with lower chance of death.
My Comments
The lack of benefit from fish is unexpected. I have no explanation. A preponderance of evidence elsewhere suggests fish consumption helps prolong life via lowered rates of heart disease.
Alcohol can be dangerous, of course. Some people should not partake, ever.
For people with diabetes who wish to avoid the carbohydrate load in cereals and dairy products, you don’t need to worry much about cutting those out of an otherwise Mediterranean-style diet.
Reference: Trichopoulou, Antonia, et al. Anatomy of health effects of the Mediterranean diet: Greek EPIC prospective cohort study. British Medical Journal, 338 (2009): b2337. DOI: 10.1136/bmj.b2337.
Filed under Alcohol, Dairy Products, Fish, Fruits, Grains, Health Benefits, legumes, Mediterranean Diet, nuts, olive oil, Vegetables
I ran across a good summary of the health benefits of Mediterranean-style eating at Medical News Today, published online May 6, 2009. An excerpt:
The following health benefits have been observed by people who have a Mediterranean diet:
Not mentioned above is the lower risk of Parkinson’s Disease and chronic obstructive pulmonary disease. You’ll also find a fair description of the traditional Mediterranean diet.
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Harvard researchers suggest that our food consumption does indeed influence our risk of suffering a stroke. This matters since stroke is the third leading cause of death in the U.S.
Scientists looked carefully at 121 different studies—published between 1979 and 2004—on the relationship between dietary factors and stroke. High blood pressure is a major modifiable risk factor for stroke, so it also was considered. Dietary factors included fats, minerals, animal protein, cholesterol, fish, whole grains, fiber, carbohydrate quality, fruits and vegetables, antioxidants, B vitamins, and dietary patterns.
I quote their conclusions:
Diets low in sodium and high in potassium lower blood pressure which will likely reduce stroke risk.
Consumption of fruits and vegetables, whole grains, folate, and fatty fish are each likely to reduce stroke risk.
A prudent or traditional Mediterranean dietary pattern, which incorporates these individual dietary components as well as intake of legumes and olive oil, may also prevent stroke.
Evidence is limited or inconsistent regarding optimal levels of dietary magnesium, calcium, antioxidants, total fat, other fat subtypes, cholesterol, carbohydrate quality, or animal protein for stroke prevention.
A diet low in sodium, high in potassium, and rich in fruits, vegetables, whole grains, cereal fiber, and fatty fish will likely reduce the incidence of stroke.
Take Home Points
The article abstract does not address the optimal intake amount of these various foods, vitamins, and minerals. That’s probably not known with any certainty.
The traditional Mediterranean diet incorporates many of these stroke-preventing foods. The Advanced Mediterranean Diet helps people lose weight while teaching how to eat Mediterranean-style.
The very low-carb Ketogenic Mediterranean Diet includes these stroke-preventing foods and minerals, except for whole grains and a tendency to be low in potassium. The KMD is high in total fat and animal protien, and potentially high in cholesterol; this study indicates those issues are nothing to worry about in terms of future strokes.
I’ll use articles such as this to recommend long-term food consumption for followers of any future Diabetic Mediterranean Diet.
Reference: Ding, E.L, and Mozaffarian, D. Optimal dietary habits for the prevention of stroke. Seminars in Neurology, 26 (2006): 11-23.
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Filed under Fish, Fruits, Grains, Health Benefits, legumes, Mediterranean Diet, olive oil, Stroke, Vegetables
Nutrition scientists think that plants have small amounts of numerous “bioactive compounds,” sometimes referred to as phytonutrients, that protect us against disease.
Many scientific studies have looked at groups of people over time, noting the various foods they eat as well as the diseases they develop. These are called epidemiologic, ecological, or observational studies. One finding is that lower rates of heart disease, vascular disease, and cancer are seen in people consuming plant-based diets. “Plant-based” isn’t necessarily vegetarian or vegan. The traditional Mediterranean diet, for example, is considered by many to be plant-based because meat, fish, and poultry are not prominent compared to plants.
In contemplating what source of carbohydrates a person with diabetes should eat, I’ve been reviewing the scientific literature to see which sources of carbs might provide the biggest bang for the buck in terms of health and longevity benefits.
Here are some quotes from a 2002 review article in the American Journal of Medicine:
Phenolic compounds, including their subcategory, flavonoids, are present in all plants and have been studied extensively in cereals, legumes, nuts, olive oil, vegetables, fruits, tea, and red wine. Many phenolic compounds have antioxidant properties, and some studies have demonstrated favorable effects on [blood clotting] and [growth of tumors]. Although some epidemiologic studies have reported protective associations between flavonoids or other phenolics and cardiovascular disease and cancer, other studies have not found these associations.
Hydroxytyrosol, one of many phenolics in olives and olive oil, is a potent antioxidant.
Resveratrol, found in nuts and red wine, has antioxidant, [anti-blood-clotting], and anti-inflammatory properties, and inhibits [malignant tumor onset and growth].
Lycopene, a potent antioxidant carotenoid in tomatoes and other fruits, is thought to protect against prostate and other cancers, and inhibits tumor cell growth in animals.
Organosulfur compounds in garlic and onions, isothiocyanates in cruciferous vegetables, and monoterpenes in citrus fruits, cherries, and herbs have [anti-cancer] actions in experimental models, as well as [heart-healthy effects].
In summary, numerous bioactive compounds appear to have beneficial health effects. Much scientific research needs to be conducted before we can begin to make science-based dietary recommendations. Despite this, there is sufficient evidence to recommend consuming food sources rich in bioactive compounds. From a practical perspective, this translates to recommending a diet rich in a variety of fruits, vegetables, whole grains, legumes, oils, and nuts.
The article discusses phytoestrogens—plant chemicals that act in us like the female hormone estrogen—but effects are complex and I suspect we know much more now than we did in 2002 . Soy products are the most well-known source of phytoestrogens.
The traditional Mediterranean diet is rich in all of the foods mentioned above, except for tea. Even the Ketogenic Mediterranean Diet includes the aforementioned foods except for tea (I need to add tea and coffee), cereals, and cherries.
Reference: Kris-Etherton, P.M., et al. Bioactive compounds in foods: their role in the prevention of cardiovascular disease and cancer. American Journal of Medicine, 113 (2002. Supplement 9B): 71S-88S.
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Filed under cancer, coronary heart disease, Fruits, Grains, Health Benefits, legumes, Mediterranean Diet, nuts, olive oil
How many times have you heard how important it is to eat fruits and vegetables? Now, is it five or nine servings a day? Why are fruits and veggies always lumped together? What does a watermelon have in common with spinach?
The author of a 2004 article in the Journal of Postgraduate Medicine answered some of these questions. Here are a few quotes from from the summary:
The intake of 400-600 g/d of fruits and vegetables is associated with reduced incidence of many common forms of cancer, and diets rich in plant foods are also associated with a reduced risk of heart disease and many chronic diseases of ageing.
These foods contain phytochemicals that have anti-cancer and anti-inflammatory properties which confer many health benefits. Many phytochemicals are colourful, and recommending a wide array of colourful fruits and vegetables is an easy way to communicate increased diversity of intake to the consumer. For example, red foods contain lycopene, the pigment in tomatoes, which is localized in the prostate gland and may be involved in maintaining prostate health, and which has also been linked with a decreased risk of cardiovascular disease. Green foods, including broccoli, Brussels sprouts and kale, contain glucosinolates which have also been associated with a decreased risk of cancer. Garlic and other white-green foods in the onion family contain allyl sulphides which may inhibit cancer cell growth. Other bioactive substances in green tea and soybeans have health benefits as well.
Consumers are advised to ingest one serving of each of the seven colour groups daily, putting this recommendation within the United States National Cancer Institute and American Institute for Cancer Research guidelines of five to nine servings per day. Grouping plant foods by colour provides simplification, but it is also important as a method to help consumers make wise food choices and promote health.
Asking U.S. consumers to eat one serving from each of seven fruit and vegetable color groups daily is a bit much. I don’t see that happening. But the suggestion is a start. Darya Pino (Summer Tomato blog) probably does it every day, but I don’t know any others. My simplified message: Eat a variety of colorful fruits and veggies daily.
Note that the very low-carb Ketogenic Mediterranean Diet provides 400 grams of vegetables and fruits daily, and I count seven colors (assuming you allow me to include black olives). On the KMD document I list avocado, cucumber, and tomato under “vegetables,” but they are indeed fruits. Heck, I guess olives are fruit, too.
“So, what’s your point, Parker,” you might well ask. I don’t expect anyone to follow the Ketogenic Mediterranean Diet for life. When it’s time to move on to a “Diabetic Mediterranean Diet,” I’m considering adding more options: traditional fruits and some colorful vegetables like purple beets, yellow corn, and orange carrots and sweet potatoes.
I still don’t know why “fruits and vegetables” are joined at the hip. Legumes, grains, and dairy products all rate their very own category. It’s just not fair.
Reference: Heber, D. Vegetables, fruits and phytoestrogens in the prevention of diseases. Journal of Postgraduate Medicine, 50 (2004): 145-9.
Filed under Fruits, Health Benefits, Vegetables
"I just wish we'd found this cancer a year ago"
Stomach cancer (aka gastric cancer) is uncommon in the U.S. Most cases are advanced and incurable at the time of diagnosis. So prevention is ideal.
European investigators studied 485,000 people over the course of nine years, during which 449 cases of stomach cancer were found. Surveys determined how closely the food consumption of study participants tracked nine key components of the Mediterranean diet. Compared with people who had low adherence to the Mediterranean diet, those with high adherence had 33% less risk of developing stomach cancer.
The Mediterranean diet has long been associated with a lower risk of cancer: specifically, cancers of the breast, colon, prostate, and uterus. We can add stomach cancer to the list now.
Reference: Buckland, Genevieve, et al. Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study. American Journal of Clinical Nutrition, December 9, 2009, epub ahead of print. doi: 10.3945/ajcn.2009.28209
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Bible Verse of the Day
Diabetic Mediterranean Diet 
