Tag Archives: death

THIS Is Why I Love the Mediterranean Diet

Italian researchers reviewed the medical/nutrition literature of the last three years and confirmed that the Mediterranean diet 1) reduces the risk of death, 2) reduces  heart disease illness and death, 3) cuts the risk of getting or dying from cancer, and 4) diminishes the odds of developing dementia, Parkinsons disease, stroke, and mild cognitive impairment.

These same investigators published a similar meta-analysis in 2008, looking at 12 studies.  Over the ensuing three years (as of June, 2010), seven new prospective cohort studies looked at the health benefits of the Mediterranean diet.  The report at hand is a combination of all 19 studies, covering over 2,000,000 participants followed for four to 20 years.  Nine of the 19 Mediterranean diet studies were done in Europe.

The newer studies, in particular, firmed up the diet’s protective effect against stroke, and added protection against mild cognitive impairment.

So What?

The Mediterranean diet: No other way of eating has so much scientific evidence that it’s healthy and worthy of adoption by the general population.  Not the DASH diet, not the “prudent diet,” not the American Heart Association diet, not vegetarian diets, not vegan diets, not raw-food diets, not Esselstyne’s diet, not Ornish’s diet, not Atkins diet, not Oprah’s latest diet, not the Standard American Diet, not the  . . . you name it. 

Not even the Low-Carb Mediterranean Diet.

Just as important, the research shows you don’t have to go full-bore Mediterranean to gain a health and longevity benefit.  Adopting  just a couple Mediterranean diet features yeilds a modest but sigificant gain.  For a list of Mediterranean diet components, visit Oldways or the Advanced Mediterranean Diet website. 

Steve Parker, M.D.

Reference:  Sofi, Francesco, et al.  Accruing evidence about benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis.  American Journal of Clinical Nutrition, ePub ahead of print, September 1, 2010.  doi: 10.3945/ajcn.2010.29673

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Filed under coronary heart disease, Health Benefits, Mediterranean Diet

Rosiglitazone Severely Restricted by FDA

MedPageToday reported yesterday on the U.S. Food & Drug Administration’s ruling that the diabetes drug rosiglitazone should be used in new patients only if blood sugars are not controlled with other diabetes drugs, such as pioglitazone.

It sounds as if new users and their doctors may have to jump through some paperwork hoops to get the drug, which is more reason not to prescribe it.

The problem is that scientific studies suggest that rosiglitazone increases the risk of heart attack, heart failure, and death.

Steve Parker, M.D.

3 Comments

Filed under Diabetes Complications, Drugs for Diabetes

Rosiglitazone On the Ropes

A week ago, MedPageToday reported that a British advisory commission recommended the diabetes drug rosiglitazone (Avandia) be withdrawn from the market.

On July 6, I wrote about evidence that rosiglitazone users seem to incur a higher risk of stroke, heart failure, and death.

If I were taking Avandia, I’d be asking my doctor about alternatives. 

Steve Parker, M.D.

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Filed under Drugs for Diabetes

Are Most Statin Prescriptions a Waste of Money?

A recent medical journal article suggests that three of every four statin prescriptions do nothing to prevent death, since they’re taken by people without an established diagnosis of cardiovascular disease.  The researchers don’t address whether statin drugs prevent heart attacks or strokes or otherwise improve quality of life. 

Most of the “healthy” people taking statins are trying to prevent heart attacks associated with high cholesterol levels.  You’d think if statins prevented heart attacks, they’d prolong life.  That’s not what these researchers found.

Details are at my recent Self/NutritionData Heart Health Blog post.

Steve Parker, M.D.

11 Comments

Filed under coronary heart disease

Whole Grains in Diabetics: A Double-Edged Sword

 Whole grain and bran consumption are linked to reduced overall death rates and cardiovascular disease deaths in white women with type 2 diabetes, according to recent research from Boston-based investigators.

This is an important association since diabetics are prone to develop cardiovascular disease and suffer premature death.  Anything that can easily counteract those trends is welcome.

Several prior studies have found lower rates of cardiovascular disease in the general public eating whole grains.  I’m referring to fewer heart attacks and strokes, and fewer deaths from cardiovascular disease.

On the other hand, the carbohydrate content of whole grain products has the potential to complicate day-to-day management of diabetes by spiking blood sugars too high.  Too-high blood sugars aren’t healthy.  So, there’s the double edge.

What’s the Evidence That Whole Grains and Bran Prevent Death in Diabetics ?

ResearchBlogging.orgThe Harvard researchers followed 7,822 type 2 diabetic women in the massive Nurses’ Health Study over 26 years, during which 852 women died from any cause, including 295 from cardiovascular disease (195 from coronary heart disease, 100 from stroke).  Food-frequency questionnaires were administered periodically to the participants, with attention to whole grain and its components: cereal fiber, bran, and germ.  The hard clinical end-point in this study was death—from any and all causes, and from cardiovascular disease.   

Results

  • After adjustment for age and lifestyle and other dietary factors, only bran consumption was inversely associated with all-cause mortality: 25% lower risk of death for those eating an average of 10 g per day compared to 1 g per day.  In other words,the women who ate the most bran had the lowest risk of dying from any cause.
  • After adjustment for age and lifestyle and other dietary factors, whole grain intake trended towards protection against all-cause death, but not quite to the point of statistical significance.  Average highest consumption was 33 g per day, compared to lowest intake at 5 g per day. 
  • Bran consumption was consistently associated with lower risk of cardiovascular death: 35% lower risk comparing highest (10 g/day) with lowest consumption (1 g/day). 
  • “Added bran” was as protective against cardiovascular death as naturally occuring bran. 
  • Whole grain tended to protect against cardiovascular death, but did not reach statistical significance in the model adusting for lifestyle and other dietary variables (even when comparing 33 g/day to 5 g/day)
  • Whole grain and cereal fiber were inversely associated with all-cause and cardiovascular mortality when the investigators adjusted only for age, disregarding the possible effects of smoking, alcohol, overweight, physical activity, family history of heart disease, hormone therapy, duration of diabetes, total energy intake, fat intake (polyunsatrurated, trans-, saturated), magnesium, and folate.

The Researchers’ Conclusions

Whole-grain and bran intakes were associated with reduced all-cause and cardiovascular disease-specific mortality in women with diabetes mellitus. These findings suggest a potential benefit of whole-grain intake in reducing mortality and cardiovascular risk in diabetic patients.

The authors point out that whole grain and its components may be protective since they:

  • reduce blood lipids
  • lower blood pressure
  • reduce hyperinsulinemia and improve glucose control
  • improve performance of the arterial wall lining (endothelium)
  • reduce oxidative stress and iflammation

My Comments

Whole grain and bran consumption may indeed protect against death and cardiovascular disease in diabetic white women, but the effect is by no means dramatic.  I had speculated earlier whether whole grain intake might be particularly protective in diabetics, but this study suggests not.  Clearly, whole grains are no panacea. 

Diabetics hoping to avoid cardiovascular disease are well-advised to pay attention to—and modify—non-dietary risk factors for heart disease, such as obesity, smoking, and sedentary lifestyle.  Non-dietary issues probably outweigh the effects of diet, assuming blood sugars are reasonably controlled.

The traditional Mediterranean diet—prominently featuring whole grains—is associated with longer lifespan and less cardiovascular disease.   Canadian researchers in 2009 found moderately strong evidence that whole grains protect against coronary heart disease in the general population.  Yet a 2009 study did not find cereals contributing to the longer lifespan. 

I’m starting to think that the effect of diet on chronic disease is not as powerful as we have hoped.  

Steve Parker, M.D.

Reference: 
He, M., van Dam, R., Rimm, E., Hu, F., & Qi, L. (2010). Whole-Grain, Cereal Fiber, Bran, and Germ Intake and the Risks of All-Cause and Cardiovascular Disease-Specific Mortality Among Women With Type 2 Diabetes Mellitus Circulation, 121 (20), 2162-2168 DOI: 10.1161/CIRCULATIONAHA.109.907360

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Filed under coronary heart disease, Grains

Which Components of the Mediterranean Diet Prolong Life?

We're pro-life

We're pro-life

Researchers at Harvard and the University of Athens (Greece) report that the following specific components of the Mediterranean diet are associated with lower rates of death:

  • moderate ethanol (alcohol) consumption
  • low meat and meat product intake
  • high vegetable consumption
  • high fruit and nut consumption
  • high ratio of monounsaturated fat to saturated fat
  • high legume intake

Minimal, if any, contribution to mortality was noted with high cereal, low dairy, or high fish and seafood consumption. 

The researchers examined diet and mortality data from over 23,000 adult participants in the Greek portion of the European Prospective Investigation into Cancer and nutrition.  You’ll be hearing more about the EPIC study for many years.  Over an average follow-up of 8.5 years, 1,075 of participants died.  652 of these deaths were of participants in the lower half of Mediterranean diet adherence; 423 were in the upper half.

Alcohol intake in Greece is usually in the form of wine at mealtimes. 

The beneficial “high ratio of monounsaturated fat to saturated fat” stems from high consumption of olive oil and low intake of meat. 

It’s not clear if these findings apply to other nationalities or ethnic groups.  Other research papers have documented the health benefits of the Mediterranean diet in at least eight other countries over three continents. 

The researchers don’t reveal in this report the specific causes of death.  I expect those data, along with numbers on diabetes, stroke, and dementia, to be published in future articles, if not published already.  Prior Mediterranean diet studies indicate lower death rates from cardiovascular disease and cancer.   

Steve Parker, M.D.

Reference:  Trichopoulou, Antonia, et al.  Anatomy of health effects of the Mediterranean diet: Greek EPIC prospective cohort studyBritish Medical Journal, 338 (2009): b2337.  DOI: 10.1136/bmj.b2337.

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Filed under Alcohol, Health Benefits, Mediterranean Diet