Is It Time to Abandon the Mediterranean Diet?

Bastian is also skeptical about the health benefits of judicious alcohol consumption. Fair enough.

Hilda Bastian at PLOS Blogs wrote about the recent retraction of a PREDIMED sub-study published in the New England Journal of Medicine in 2013. The suspect conclusion of that study was: “Among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events.”

From Ms Bastian:

A very influential nutrition trial just tanked. It was retracted from the New England Journal of Medicine (NEJM) on 13 June, and re-published with new analyses and toned-down conclusions.Both Gina Kolata, writing in the New York Times, and Alison McCook, writing at NPR, imply, at least to some extent, that it might make no difference to the evidence. But I disagree.

Here’s what’s happened to the trial, and where I think it leaves the overall evidence.Called PREDIMED, it was a multi-center trial from Spain, with the NEJM final report published in 2013. Altogether, 7,447 people at risk of cardiovascular disease (CVD) – heart attack and stroke – were reported as randomized to one of 3 groups:

  • Mediterranean diet with free olive oil provided, along with individual and group training sessions at the start, and then quarterly;
  • Mediterranean diet with free nuts provided, along with individual and group training sessions at the start, and then quarterly;
  • Advice to reduce fat intake, with a leaflet – but after the first 3 years, people in this control group were also offered individual and group training sessions.

The primary endpoint for the trial was a composite one of major cardiovascular events: myocardial infarction, stroke, or CVD-related death. And the trial was stopped early. More people dropped out of the control group than the Mediterranean diet groups.There are several alarm bells here already, and we’ll come back to those.

Source: What Does the PREDIMED Trial Retraction & Reboot Mean for the Mediterranean Diet? | Absolutely Maybe

I encourage you to read Ms Bastian’s article if you enjoy such debates. I consider the 2013 PREDIMED sub-study to be one of numerous pieces of the nutritional puzzle.

I published the 2nd edition of my Advanced Mediterranean Diet in 2012, so the 2013 PREDIMED sub-study was not available to me. At the end of my book you’ll find not one, but 43 scientific references supporting the healthfulness of the Mediterranean diet.

Steve Parker MD, Advanced Mediterranean Diet

Two diet books in one

Steve Parker, M.D.

Fresh Praise for the Mediterranean Diet in NYT

Dead whole fish aren’t very appealing to many folks

From Paul Greenberg’s opinion piece in the New York Times (July 19, 2018):

In 1953, not long before President Dwight Eisenhower suffered a heart attack in office, the social scientist Leland Allbaugh published “Crete: A Case Study of an Underdeveloped Area.” The landmark analysis of the eating patterns of an isolated Greek population strongly suggested that a calorie-limited diet high in fresh fruits and vegetables, whole grains, and olive oil and low in animal protein, particularly red meat, could lower the risk of heart attacks and strokes, decrease chronic disease and extend life.

Medical research over the last half-century has largely borne out this initial finding. Weight-loss fads and eating trends come and go, but the so-called Mediterranean diet has stood fast. “Among all diets,” Dr. Walter Willett of Harvard’s T.H. Chan School of Public Health concluded in an email, “the traditional Mediterranean diet is most strongly supported for delivering long term health and wellbeing.”

Click for a more complete definition of the traditional Mediterranean Diet, which includes alcohol. More from Greenberg:

***

As the clinician Artemis Simopoulos pointed out to me, two meatless days a week are the norm in Greek Orthodox communities. This religious provision encouraged traditional communities to eat fish not only on Fridays but on Wednesdays as well. Recent epidemiological evidence links two portions of seafood a week with lower blood pressure, lower LDL cholesterol and lower triglycerides. In spite of this, American seafood consumption has stayed consistently low compared with other developed countries.

***

And for decades now, even Greeks have been abandoning their traditional foods and eating much more than they previously did. “In my view, the reason the diet worked to prevent heart disease on Crete was because they weren’t overeating,” said Marion Nestle, a professor of nutrition, food studies and public health at New York University. “By the time I got to Crete in the early 1990s, they were, and the hospitals were full of heart attacks and people with type 2 diabetes.”

***

Today, 65 years after Allbaugh returned from Crete, with modern America plagued by one of the highest obesity rates in the world and failing to meet life expectancy averages of almost every other developed nation, it’s worth circling back to the eating patterns of the ancients. For if the United States were to put itself on a Mediterranean diet, we would likely see huge improvements not only in human and environmental health, but also in rural economic stability.

RTWT for Greenberg’s roadmap to an American Mediterranean diet.

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Two diet books in one

Mediterranean Diet Wins Again

The DASH diet fared well, too.

“With so many popular diets that celebs and influencers are ravishing about on social media with their before/after captures, health watchers often feel confused to narrow down on one diet that can help cinch their waistlines. As per a study conducted by US News and World Report on 40 most popular diets including keto, paleo, whole30 and more, the Mediterranean Diet grabbed the first place for being the holy grail of weight loss for real people.”

Source: Shed that Spare Tire with Mediterranean Diet or Just Follow DASH

How Did the U.S. Get Fat?

Your average Americans

There’s no shortage of speculation as to why 70% of us in the U.S. are overweight or obese. A few possibilities include:

  • we’re too sedentary
  • we eat too many carbohydrates
  • we eat too much fat
  • our foods are over-processed
  • we eat away from home too often
  • we eat too many industrial seed oils
  • our water and food are contaminated with persistent organic pollutants that disrupt our endocrine systems

I was reading an article at Nutrition Today and came across this graph of calorie consumption change from 1971 to 2004 (or 2000?):

The verbal summary is from this article cited by the cited by the Nutrition Today authors: During 1971—2000, a statistically significant increase in average energy intake occurred. For men, average energy intake increased from 2,450 kcals to 2,618 kcals, and for women, from 1,542 kcals to 1,877 kcals. So men’s daily calorie intake went up by 168, and women’s by 335.

The original article I read states, alternatively, that men’s daily caloric consumption rose from 2450 to 2693, a gain of 243. I can’t explain the discrepancy between 243 and 168, nor why 2004 is in the graph instead of 2000.

Maybe you don’t think an extra 168 calories a day is much. If you believe in the validity of the Energy Balance Equation, those 168 daily calories will turn into  17.5 pounds of fat in a year unless you “burn them off” somehow. If you weigh 150 lb (68 kg), you can burn those 168 calories by doing a daily 15-minute jog at 5.5 mph (8.9 km/hr). But you ain’t gonna do that. (I’m not getting into a debate about validity of the equation now; for another perspective, read Lyle McDonald.)

But year 2000 was a long time ago. How much are Americans eating now? According to a 2016 report from Pew Research Center:

Broadly speaking, we eat a lot more than we used to: The average American consumed 2,481 calories a day in 2010, about 23% more than in 1970. That’s more than most adults need to maintain their current weight, according to the Mayo Clinic’s calorie calculator. (A 40-year-old man of average height and weight who’s moderately active, for instance, needs 2,400 calories; a 40-year-old woman with corresponding characteristics needs 1,850 calories.)

Bottom line? We’re eating more than we did in 1970. Which could explain why we’re fat. Unless we’re burning more calories than we did in 1970. Which I doubt.

Steve Parker, M.D.

PS: In scientific literature, kcal is what everybody else calls a calorie.

Poor Sleep Linked to Alzhieimer’s Disease

“A 2017 analysis combined results of 27 studies that looked at the relationship between sleep and cognitive problems, including Alzheimer’s. Overall, poor sleepers appeared to have about a 68 percent higher risk of these disorders than those who were rested, researchers reported last year in Sleep. That said, most studies have a chicken-and-egg problem. Alzheimer’s is known to cause difficulty sleeping. If Alzheimer’s both affects sleep and is affected by it, which comes first?For now, the direction and the strength of the cause-and-effect arrow remain unclear. But approximately one-third of U.S. adults are considered sleep deprived (getting less than seven hours of sleep a night) and Alzheimer’s is expected to strike almost 14 million U.S. adults by 2050 (5.7 million have the disease today). The research has the potential to make a big difference.”

Source: The brain may clean out Alzheimer’s plaques during sleep | Science News

U.S. Army Plans to Replace APFT With ACFT

Not quite combat-ready

I have long advocated measuring your fitness level periodically and seeing how you stack up against a benchmark. My favorite benchmark is the U.S. Army Physical Fitness Test (APFT).

The new Army standard testing will be too complicated for most non-military folks.

UPI has the story:

The U.S. Army is introducing an extensive overhaul of its physical fitness test that, with minor changes, has mostly been the same since 1980.The new test, announced this week, changes the name from the Army Physical Fitness Test to the Army Combat Fitness Test and is planned to become gender and age neutral. It will include a series of physical events, while the APFT was a series of pushups, situps and a 2-mile run.

The new standards call for deadlift tests, throwing ten-pound balls for distance backwards, and hand-relaese pushups that require hands to be taken off the ground for greater muscle tension. It also includes sled drags to simulate casualties, sprints with 40-pound kettle bells, hanging from a pull-up bar with legs up and the standard 2-mile run.

Source: U.S. Army to introduce new physical fitness test – UPI.com

You may also find the comment section interesting.

Late-life high blood pressure may harm brain

What kind of blood pressures are we talking about here? 147 mmHg systolic versus 134.

“Autopsies on nearly 1,300 older people, including about 640 clergy members, found more signs of damage and one of the hallmarks of Alzheimer’s disease in the brains of those with higher blood pressure than among those with pressure closer to normal, researchers reported Wednesday.”

Source: Late-life high blood pressure may harm the brain, study says – ABC News