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Mediterranean Diet
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When advising patients on diet, I recommend the Mediterranean approach.  This diet has been proven over and again to reduce the risk of heart disease.  By emphasizing fresh fruits and vegetables, healthy oils (olive oil and nuts), and tomato sauces, it has the benefits of maximizing nutritional density for each calorie consumed. 

Advantages:   Has been shown to reduce the risk of heart disease and some cancers.  Uses lots of olive oils and garlic! 
Disadvantages:  Not much meat for those carnivores out there. 

The Mediterranean diet consists of olive oil (mono-unsaturated fats), fruits, vegetables, legumes (beans), nuts, cereals, fish and tomato sauces.  Remember that avocadoes are another rich source of mono-unsaturated fats (and a great source of vitamins C, E, B-6 and folate, and have more potassium per ounce than bananas!).

The Lyon Heart Study examined whether the Mediterranean diet could reduce the risk of future cardiac events in patients with heart disease as compared to a prudent Western diet(Lancet 1994).  The study was stopped earlier than planned because of a compelling decrease in cardiovascular mortality and non-fatal disease in the Mediterranean diet group.  This benefit was maintained for at least 4 years. 

Over 11,000 men were studied in the GISSI Prevention Trial (EuroJClinNutri2003) in Italy.  Those who ate the most Mediterranean-type foods (fish, fruit, raw and cooked vegetables, and olive oil) had a 50% decrease in mortality over 6 1/2 years as compared to controls.  The men who supplemented their diet with fish oil (1 gram/d) had a 20% reduction in mortality from any cause, a 30% reduction in cardiovascular death, and 45% reduction in sudden death.

The Epic Trial (BMJ2005) examined more than 70,000 patients in Europe, aged 60 and older.  Mediterranean diet was associated with a lower death rate (overall 8% reduction). 

The Omni-Heart Trial (JAMA2005) compared the risk of cardiovascular disease with 3 diets: low carb, low fat and Mediterranean.  This cross-over designed study had participants stay on each diet for 6 weeks. 

  • Blood pressure, LDL cholesterol, and estimated cardiac risk were lower with each diet as compared to baseline
  • The low fat (high protein) diet was associated with reduced physical activity, reduced appetite and increased bloating

The 'Portfolio' Diet was a low fat, vegetarian diet with added soy, soluble fiber (including oats, barley, legumes, eggplant, okra and metamucil), plant sterols, and almonds (JAMA2003).  Twenty-five volunteers consumed a standard low-fat diet, or the 'Portfolio' diet.  After one month, LDL cholesterol fell an average of 12% on the low fat diet, and 35% on the Portfolio diet (as much as one would expect with 20 mg of the statin, simvastatin).  HDL cholesterol was preserved and CRP reduced on the Portfolio diet.

Benefits on the risk of dementia:

  • Linked with a lower risk of dementia (Neurol1993:43(9))
  • Daily administration of omega-3's DHA and EPA 0.6g for 6 months was associated with a decreased decline in patients with mild dementia (Lancet2006;63)
  • Use of antioxidants, antiinflammatory drugs, gingko, vitamin E or aspiring has not panned out to show reduction in the risk of dementia
  • The Women's Health Initiative studies have shown a possible association between diet and dementia
  • Physical exercise seems to improve cognitive function to a degree

lA large, prospective, cohort study (NEJM 2003) of almost 4 years duration and more than 22,000 patients showed remarkable improvements with a Mediterranean diet:
  • l33% reduction in CAD
  • l24% reduction in death due to cancer
  • lCRP dropped by 20%
  • lInterleukin-6 dropped by 17%
  • lFibrinogen dropped by 6%
  • lHomocysteine dropped by 15%
  • lWBC by 14%

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A recent randomized study (NEJM2008;359:229) compared a calorie-restricted Mediterranean diet to a low fat - DASH diet and a low carb non-restrictive diet.  Three hundred and twenty-two individuals with an average BMI or 31 were randomly assigned.  The results are summarized as:
  • Mean weight loss was 4.4 kg for the Mediterranean diet, 4.7 kg forthe low carb diet, and 2.9 for the low fat - Dash diet
  • Relative reduction in total cholesterol/HDL cholesterol was 20% for the low carb diet, 12% for the low fat diet
  • Improvement in fasting glucose was best among those on the Mediterranean diet
  • Changes in leptin and adiponectin were similar in all groups, and correlated with weight loss
  • C-reactive protein was decreased significantly only in the Mediterranean and low carb group

Click here for more information on the Mediterranean diet:

http://www.mayoclinic.com/health/mediterranean-diet/CL00011

Click here for some tips on how to move from the American to a Mediterranean diet:

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