Category Archives: Heart Disease

Study Links Artificial Sweeteners to Increased Death Risk

Posted on December 15, 2025 | Leave a comment

Photo by Polina Tankilevitch on Pexels.com

A July 2024 article in the July 31, 2024, Nutrition Journal suggests that artificially sweetened beverage consumption may cause increase risk of death, particularly from cardiovascular disease. From the abstract:

Our systematic review and meta-analysis demonstrated a higher consumption of artificially sweetened beverages in relation to higher risks of all-cause and cardiovascular mortality, whereas no relationship of artificially sweetened beverages with cancer mortality was observed. Compared with the participants in the lowest category of artificially sweetened beverage intakes, those in the highest category had a 13% higher risk of premature death from any cause, and a 26% higher risk of CVD (cardiovascular disease) mortality. Each one additional serving increase in artificially sweetened beverage consumption was associated with 6% and 7% higher risk for all-cause and CVD mortality, respectively. In a dose-response meta-analysis, we also observed a linear association of artificially sweetened beverage consumption with CVD mortality, with a non-linear positive association of artificially sweetened beverages with all-cause mortality. Despite this, substitution of sugary sweetened beverages with artificially sweetened beverages was associated with a lower risk of all-cause and CVD mortality. Various sensitivity analyses and subgroups analyses demonstrated the robustness of the pooled associations. Per NutriGrade, quality of the overall evidence was scored moderate for CVD mortality and all-cause mortality.

Steve Parker, M.D.

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It’s Not Just For Adults: Mediterranean Diet May Benefit Children and Adolescents

Posted on December 5, 2025 | Leave a comment

From a study published in Journal of the American Medical Association Network in July of 2024:

The findings of this systematic review and meta-analysis of randomized controlled trials suggest that Mediterranean-based interventions are associated with reductions in systolic blood pressure, triglycerides, total cholesterol, and LDL-Cholesterol and an increase in HDL-Cholesterol among children and adolescents. These results underscore the importance of promoting healthy eating habits in youths, as these habits may lead to substantially improved cardiometabolic health, even during the early stages of life.

Steve Parker, M.D.

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Introducing George Mann and His Role in the Diet-Heart Hypothesis

Posted on July 22, 2025 | Comments Off

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

It was around 2009 when I was prepared to abandon the time-honored diet-heart hypothesis. I remember wondering if I’d be excommunicated from the medical community, i.e., lose my medical license due heresy. In a nutshell, the diet-heart hypothesis to which I refer was the idea that dietary saturated fat was the clear-cut cause of coronary artery disease and associated angina pectoris, heart attacks, and cardiac deaths.

My re-evaluation of the evidence lead me to create the ketogenic Mediterranean diet, which is in the 2nd edition of my Advanced Mediterranean diet. Search Amazon.com and you’ll find several other subsequent ketogenic Mediterranean diet books; I wonder if any of them cited my work.

Dr. Axel Sigurdsson recently wrote an updated history of the diet-heart hypothesis, focusing on the downfall of the hypothesis and the role of George Mann, whom I’d swear I never herd of. An excerpt:

Ancel Keys changed the world. He was right about many things—that lifestyle matters, that food affects disease, that public health can’t afford to wait forever. But in boiling heart disease down to a single nutrient, he oversimplified a complex truth. His hypothesis became policy before it was fully proven. And once policy hardens, it resists correction.

George Mann was no savior. His critiques were often bombastic, his tone combative. But beneath the fire was a warning science should have heeded: that premature consensus can blind, that evidence must lead—not politics, not personalities, not the noise of institutional momentum.

I recommend the entire article to you. I suspect AI (artificial intelligence) was utilized, mainly judging from the three pictures. Dr. Sigurdsson has been publishing some great articles recently, and I believe credited AI in some of them, which is OK by me.

Steve Parker, M.D.

front cover of KMD: ketogenic mediterranean diet

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Posted in Diet-Heart Hypothesis, Heart Disease, Ketogenic Mediterranean Diet

Ketogenic Diet May Prevent Cardiovascular Disease

Posted on April 4, 2025 | Comments Off

In July, 2023, the journal Nutrients published a review of literature on the effect of ketogenic diets on cardiovascular disease. The abstract mentions potentially beneficial changes blood lipids, inflammation, blood pressure, etc., without going where the rubber meets the road: the effect on mortality and incidence of cardiovascular events in live humans. Click the link to see the entire article.

The Abstract:

“The most common and increasing causes of death worldwide are cardiovascular diseases (CVD). Taking into account the fact that diet is a key factor, it is worth exploring this aspect of CVD prevention and therapy. The aim of this article is to assess the potential of the ketogenic diet in the prevention and treatment of CVD. The article is a comprehensive, meticulous analysis of the literature in this area, taking into account the most recent studies currently available. The ketogenic diet has been shown to have a multifaceted effect on the prevention and treatment of CVD. Among other aspects, it has a beneficial effect on the blood lipid profile, even compared to other diets. It shows strong anti-inflammatory and cardioprotective potential, which is due, among other factors, to the anti-inflammatory properties of the state of ketosis, the elimination of simple sugars, the restriction of total carbohydrates and the supply of omega-3 fatty acids. In addition, ketone bodies provide “rescue fuel” for the diseased heart by affecting its metabolism. They also have a beneficial effect on the function of the vascular endothelium, including improving its function and inhibiting premature ageing. The ketogenic diet has a beneficial effect on blood pressure and other CVD risk factors through, among other aspects, weight loss. The evidence cited is often superior to that for standard diets, making it likely that the ketogenic diet shows advantages over other dietary models in the prevention and treatment of cardiovascular diseases. There is a legitimate need for further research in this area.”

Steve Parker, M.D.

PS: If you have the 2nd edition of The Advanced Mediterranean Diet, you already have my ketogenic Mediterranean diet.

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Posted in Coronary Heart Disease, Diet Reviews, Heart Disease, Ketogenic Mediterranean Diet, Stroke

Specific Diets That Lower CRP Levels May Prevent Chronic Diseases

Posted on April 3, 2025 | Comments Off

Olive oil is a prominent component of the Mediterranean diet

C-reactive protein (CRP) is a bloodstream marker of body-wide inflammation. A prominent theory is that if your CRP is too high, it causes chronic disease states like hypertension, dementia, and cardiovascular disease. A 2024 meta-analysis published in British Journal of Nutrition looked at the effects of various diets on CRP. The implication is that your odds of developing particular chronic diseases is lowered if you adopt a diet that lowers your CRP. Check the Abstract below to see how your diet stacks up:

Adopting a healthy dietary pattern may be an initial step in combating inflammation-related chronic diseases; however, a comprehensive synthesis evaluating current evidence is lacking. This umbrella review aimed to summarise the current evidence on the effects of dietary patterns on circulating C-reactive protein (CRP) levels in adults. We conducted an exhaustive search of the Pubmed, Scopus and Epistemonikos databases, spanning from their inception to November 2023, to identify systematic reviews and meta-analyses across all study designs. Subsequently, we employed a random-effects model to recompute the pooled mean difference. Methodological quality was assessed using the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) checklist, and evidence certainty was categorised as non-significant, weak, suggestive, highly suggestive or convincing (PROSPERO: CRD42023484917). We included twenty-seven articles with thirty meta-analyses of seven dietary patterns, fifteen of which (50 %) exhibited high methodological quality. The summary effects of randomised controlled trials (RCT) found that the Mediterranean diet was the most effective in reducing circulating CRP levels, followed by Vegetarian/Vegan and Energy-restricted diets, though the evidence was of weak quality. In contrast, Intermittent Fasting, Ketogenic, Nordic and Paleolithic diets did not show an inverse correlation with circulating CRP levels. Some results from combined interventional and observational studies, as well as solely observational studies, also agreed with these findings. These dietary patterns show the potential in reducing CRP levels in adults, yet the lack of high-quality evidence suggests future studies may alter the summary estimates. Therefore, further well-conducted studies are warranted.

Steve Parker, M.D.

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Posted in Alzheimer Disease, Coronary Heart Disease, Dementia, Heart Disease, High Blood Pressure, Stroke

I Told You So: Mediterranean Diet Prevents Cardiovascular Disease

Posted on June 12, 2024 | Comments Off

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.

Regarding the fish above…. I was eating at a fancy French restaurant in Pensacola, FL, about 30 years ago and a table mate ordered fish (du poisson?). When it arrived with head ON, she immediately demanded it be taken back to the kitchen for removal of the head!

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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Posted in Coronary Heart Disease, Heart Disease, Longevity

Congestive Heart Failure: You May Be Cutting Out TOO MUCH Salt

Posted on May 28, 2023 | Comments Off

From DailyMail:

Salt has long been seen as enemy number one for people with heart problems, with doctors telling patients to cut down on the amount of sodium they consume.

But new research suggests that restricting salt too much may actually raise the risk of an early death in heart failure patients.

Their work builds upon a growing body of research that posits the benefits of cutting out salt to this subset of patients may be overblown.

And the findings could mean a more exciting diet for the more than six million Americans with heart failure.

Compared to those CHF patients consuming over 2.5 grams of sodium daily, those eating below that limit were 80% more likely to die during the observation period. The Daily Mail article shares the sodium content of some common foods and will convince you that keeping sodium under 3 grams/day requires meticulous attention. If you have CHF, consult your personal physician before making significant dietary changes.

Steve Parker, M.D.

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Posted in Heart Disease

Reduce Risk of Death and Cardiovascular Disease With Coffee

Posted on February 9, 2023 | Comments Off

A pinch of salt may cut the bitterness in a cup of coffee

From the European Journal of Preventive Cardiology:

Decaffeinated, ground, and instant coffee, particularly at 2–3 cups/day, were associated with significant reductions in incident cardiovascular disease and mortality.

“Cardiovascular disease” includes coronary artery disease (e.g., heart attacks), heart failure, and ischemic strokes.

The study was done by Australian researchers using a UK database.

Steve Parker, M.D.

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Posted in Coronary Heart Disease, Heart Disease, Stroke

Registered Dietitian Seriously Questions Healthfulness of Mediterranean Diet

Posted on September 22, 2022 | 1 comment

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 Shana’s article 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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Posted in Coronary Heart Disease, Heart Disease, Longevity

CT Versus Invasive Angiography in Stable Chest Pain

Posted on April 30, 2022 | Comments Off

We’re all gonna die of something, right?

The #1 cause of death in the U.S. is coronary artery disease (CAD), which causes heart attacks and sudden cardiac death. Blockage in the heart arteries typically develops over years and many people are walking around not knowing it’s there. The lucky ones develop warning signs like chest pain or shortness of breath on exertion. After consulting a physician, the next step may be a “stress test” or some sort imaging of the arteries of the heart.

Angiography refers to imaging of arteries or veins. Angiography of the heart arteries is helpful in diagnosing blockage of arteries that may cause heart attacks or sudden cardiac death in the future.

CT stands for computerized tomography: x-rays obtain images that are then manipulated by computer technology to provide more information than plain x-ray technology alone. CT angiography of the heart arteries is done with iodinated contrast injected into the low-pressure venous system of circulation. In contrast, standard arterial angiography involves introduction of a needle (and catheter) into the high-pressure arterial system, usually the femoral artery in the groin or the smaller radial artery in the wrist. Standard arterial angiography is associated with a higher risk of complications such as leakage of blood from the artery. Another potential complication is embolization of arterial plaque or clots downstream from the arterial puncture. Because of the higher complication rate in the arterial system, standard angiography is considered “invasive.”

The study at hand asks which is a better way to image heart arteries in a patient with stable chest pain: CT versus standard arterial angiography. The article abstract doesn’t define “stable” chest pain. I assume the researchers did not include acute myocardial infarctions (heart attacks) and unstable angina.

European researchers concluded that:

Among patients referred for invasive coronary angiography (ICA) because of stable chest pain and intermediate pretest probability of coronary artery disease, the risk of major adverse cardiovascular events was similar in the CT group and the ICA group. The frequency of major procedure-related complications was lower with an initial CT strategy.

I bet the non-invasive CT is also less expensive that standard arterial angiography.

Steve Parker, M.D.

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Posted in Coronary Heart Disease, Heart Disease

Category Archives: Heart Disease

Study Links Artificial Sweeteners to Increased Death Risk

It’s Not Just For Adults: Mediterranean Diet May Benefit Children and Adolescents

Introducing George Mann and His Role in the Diet-Heart Hypothesis

Ketogenic Diet May Prevent Cardiovascular Disease

Specific Diets That Lower CRP Levels May Prevent Chronic Diseases

I Told You So: Mediterranean Diet Prevents Cardiovascular Disease