Tag Archives: death prevention

Which Components of the Mediterranean Diet Prolong Life?

Posted on May 22, 2012 | 1 comment

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 study. British Medical Journal, 338 (2009): b2337. DOI: 10.1136/bmj.b2337.

Additional Information: Childs, Dan. Take it or leave it? The truth about 8 mediterranean diet staples. ABC News online, June 24, 2009. Accessed June 25, 2009.

Addendum:

Here’s a direct quote from the study at hand:

Among the presumed beneficial components of the Mediterranean diet score, high consumption of all but fish and seafood was inversely associated with mortality, although none of these associations was statistically significant.

“. . . none of these associations was statistically significant.” So I can understand some skepticism about this journal article. The researchers had to use some very sophisticated statistical manipulation to come up with the “healthy components” list. I’m not saying that’s wrong. I will admit that the statistical analysis is beyond my comprehension, so I’m trusting the authors and peer-review process to be honest and effective. My college statistics course was too many years ago.

The take-home point for me is that the health benefits of the Mediterranean diet probably stem from an overall combination of multiple foods rather than any single component.

And remember to exercise regularly, maintain a healthy weight (BMI 18.5-25), keep your blood pressure under 140/90, and don’t smoke.

-Steve

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Heart Patients, Listen Up: Mediterranean Diet to the Rescue

Posted on May 8, 2012 | 1 comment

The Mediterranean diet preserves heart muscle performance and reduces future heart disease events, according to Greek researchers reporting in the American Journal of Clinical Nutrition, May 19, 2010.

Reuters and other news services have covered the story.

The Mediterranean diet is well-established as an eating pattern that reduces the risk of death or illness related to cardiovascular disease—mostly heart attacks and strokes. Most of the studies in support of the heart-healthy diet looked at development of disease in general populations. The study at hand examined whether the diet had any effect on patients with known heart disease, which has not been studied much.

How Was the Study Done?

The study population was 1,000 consecutive patients admitted with heart disease to a Greek hospital between 2006 and 2009. In this context, heart disease refers to a first or recurrent heart attack (70-80% of participants) or unstable angina pectoris. Acute heart attacks and unstable angina are “acute coronary syndromes.” Average age was 64. Sixty percent had a prior diagnosis of cardiovascular disease (coronary heart disease or stroke). Thirty percent had diabetes. At the time of hospitalization, half had diminished function of the main heart pumping chamber (the left ventricle), half had normal pump function. Men totalled 788; women 212.

On the third hospital day, participants were given a 75-item food frequency questionnaire asking about consumption over the prior year. If a potential enrollee died in the first two hospital days, he was not included in the study. A Mediterranean diet score was calculated to determine adherence to the Mediterranean diet. Mediterranean diet items were nonrefined cereals and products, fruits, nuts, vegetables, potatoes, dairy products, fish and seafood, poultry, red meats and meat products, olive oil, and alcohol.

Left ventricle function was determined by echocardiogram (ultrasound) at the time of study entry, at the time of hospital discharge, and three months after discharge. Systolic dysfunction was defined as an ejection fraction of under 40%. [Normal is 65%: when the left ventricle is full of blood, and then squeezes on that blood to pump it into the aorta, 65% of the blood squirts out.]

Participants were then divided into two groups: preserved (normal) systolic left ventricular function, or diminished left ventricular function.

They were followed over the next two years, with attention to cardiovascular disease events (not clearly defined in the article, but I assume including heart attacks, strokes, unstable angina, coronary revascularization, heart failure, arrhythmia, and death from heart disease or stroke.

Results

  • Four percent of participants died during the initial hospitalization.
  • At the three month follow-up visit, those with greater adherence to the Mediterranean diet (a high Mediterranean diet score) had higher left ventricular performance (P=0.02).
  • At the time of hospital admission, higher ejection fractions were associated with greater adherence to the Mediterranean diet (P<0.001).
  • Those who developed diminished left ventricular dysfunction had a lower Mediterranean diet score (P<0.001)
  • During the hospital stay, those in the highest third of Mediterranean diet score had lower in-hospital deaths (compared with the lower third scores) (P=0.009).
  • Among those who survived the initial hospitalization, there was no differences in fatal cardiovascular outcomes based on Mediterranean diet score.
  • Food-specific analysis tended to favor better cardiovascular health (at two-year follow-up) for those with higher “vegetable and salad” and nut consumption. No significant effect was found for other components of the Mediterranean diet score.
  • Of those in the highest third of Mediterranean adherence, 75% had avoided additional fatal and nonfatal cardiovasclar disease events as measured at two years. Of those in the lowest third of Mediterranean diet score, only 53% avoided additional cardiovascular disease events.

The Authors’ Conclusion

Greater adherence to the Mediterranean diet seems to preserve left ventricular systolic function and is associated with better long-term prognosis of patients who have had an acute coronary syndrome.

My Comments

I agree with the authors’ conclusion.

We’re assuming these patients didn’t change their way of eating after the initial hospitalization. We don’t know that. No information is given regarding dietary instruction of these patients while they were hospitalized. In the U.S., such instruction is usually given, and it varies quite a bit.

In this study, lower risk of cardiovascular death was linked to the Mediterranean diet only during the initial hospital stay. Most experts on the Mediterranean diet would have predicted lower cardiovascular death rates over the subsequent two years. Mysteriously, the authors don’t bother to discuss this finding.

For those who don’t enjoy red wine or other alcoholic beverages, this study suggests that the Mediterranean diet may be just as heart-healthy without alcohol. A 2009 study by Trichopoulou et al suggests otherwise.

Steve Parker, M.D.

Reference:

Chrysohoou, C., Panagiotakos, D., Aggelopoulos, P., Kastorini, C., Kehagia, I., Pitsavos, C., & Stefanadis, C. (2010). The Mediterranean diet contributes to the preservation of left ventricular systolic function and to the long-term favorable prognosis of patients who have had an acute coronary event American Journal of Clinical Nutrition DOI: 10.3945/ajcn.2009.28982

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Exercise Prevents Death

Posted on April 19, 2012 | 1 comment

January 1 this year, many folks made New Years’ resolutions to start exercising in conjunction with their other resolution to lose excess weight. I’ve got bad news for them.

Exercise is overrated as a pathway to major weight loss. Sure, a physically inactive young man with only five or 10 pounds (2 to 4 kg) to lose might be able to do it simply by starting an exercise program. That doesn’t work nearly as well for women. The problem is that exercise stimulates appetite, so any calories burned by exercise tend to be counteracted by increased food consumption.

“Should I go with aerobic or strength training….?”

On the other hand, exercise is particularly important for diabetics and prediabetics in two respects: 1) it helps in avoidance of overweight, especially after weight loss, and 2) it helps control blood sugar levels by improving insulin resistance, perhaps even bypassing it.

Even if it doesn’t help much with weight loss, regular physical activity has myriad general health benefits. First, let’s look at its effect on death rates.

EXERCISE PREVENTS DEATH

As many as 250,000 deaths per year in the United States (approximately 12% of the total) are attributable to a lack of regular physical activity. We know now that regular physical activity can prevent a significant number of these deaths.

Exercise induces metabolic changes that lessen the impact of, or prevent altogether, several major illnesses, such as high blood pressure, coronary artery disease, diabetes, and obesity. There are also psychological benefits. Even if you’re just interested in looking better, awareness of exercise’s other advantages can be motivational.

The traditional Mediterranean diet of the mid-20th century may owe some of it’s healthfulness to a physically active lifestyle.

Exercise is defined as planned, structured, and repetitive bodily movement done to improve or maintain physical fitness.

Physical fitness is a set of attributes that relate to your ability to perform physical activity. These attributes include resting heart rate, blood pressure at rest and during exercise, lung capacity, body composition (weight in relation to height, percentage of body fat and muscle, bone structure), and aerobic power.

Aerobic power takes some explanation. Muscles perform their work by contracting, which shortens the muscles, pulling on attached tendons or bones. The resultant movement is physical activity. Muscle contraction requires energy, which is obtained from chemical reactions that use oxygen. Oxygen from the air we breathe is delivered to muscle tissue by the lungs, heart, and blood vessels. The ability of the cardiopulmonary system to transport oxygen from the atmosphere to the working muscles is called maximal oxygen uptake, or aerobic power. It’s the primary factor limiting performance of muscular activity.

Aerobic power is commonly measured by having a person perform progressively more difficult exercise on a treadmill or bicycle to the point of exhaustion. The treadmill test starts at a walking pace and gets faster and steeper every few minutes. The longer the subject can last on the treadmill, the greater his aerobic power. A large aerobic power is one of the most reliable indicators of good physical fitness. It’s cultivated through consistent, repetitive physical activity.

Physical Fitness Effect on Death Rates

Regular physical activity postpones death.

Higher levels of physical fitness are linked to lower rates of death primarily from cancer and cardiovascular disease (e.g., heart attacks and stroke). What’s more, moving from a lower to a higher level of fitness also prolongs life, even for people over 60.

Steve Parker, M.D.

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Alcohol Consumption Linked to Lower Rates of Death and Heart Attack

Posted on April 10, 2012 | Comments Off on Alcohol Consumption Linked to Lower Rates of Death and Heart Attack

Canadian and U.S. researchers report that moderate alcohol consumption seems to reduce 1) the incidence of coronary heart disease, 2) deaths from coronary heart disease, and 3) deaths from all causes. Reduction of death from all causes is a good counter-argument to those who say alcohol is too dangerous because of deaths from drunk driving, alcoholic cirrhosis, and alcohol-related cancers such as many in the esophagus.

Remember, we’re talking here about low to moderate consumption: one drink a day or less for women, two drinks or less a day for men. That’s a max of 12.5 alcohol for women, 25 g for men. No doubt, alcohol can be extremely dangerous, even lethal. I deal with that in my patients almost every day. Some people should never drink alcohol.

The recent meta-analysis in the British Medical Journal, which the authors say is the most comprehensive ever done, reviewed all pertinent studies done between 1950 and 2009, finally including 84 of the best studies on this issue. Thirty-one of these looked at deaths from all causes.

Compared with non-drinkers, drinkers had a 25% lower risk of developing coronary heart disease (CHD) and death from CHD. CHD is the leading cause of death in develop societies.

Stroke is also considered a cardiovascular disease. Overall, alcohol is not linked to stroke incidence or death from stroke. The researchers did see strong trends toward fewer ischemic strokes and more hemorrhagic strokes (bleeding in the brain) in the drinkers. So the net effect was zero.

Compared with non-drinkers, the lowest risk of death from any cause was seen in those consuming 2.5 to 14.9 g per day (one drink or less per day), whose risk was 17% lower. On the other hand, heavy drinkers (>60 g/day) had 30% higher risk of death.

In case you’re wondering, the authors didn’t try to compare the effects of beer versus wine versus distilled spirits.

On a related note, scientists at the Medical University of South Carolina found that middle-aged people who took up the alcohol habit had a lower risk of stroke and heart attack. Wine seemed to be more effective than other alcohol types. They found no differences in overall death rates between new drinkers persistent non-drinkers, perhaps because the study lasted only four years and they were following only 442 new drinkers.

This doesn’t prove that judicious alcohol consumption prevents heart attacks, cardiac deaths, and overall deaths. But it’s kinda lookin’ that way.

Steve Parker, M.D.

Reference: Ronksley PE, Brien SE, Turner BJ, Mukamal KJ, & Ghali WA (2011). Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ (Clinical research ed.), 342 PMID: 21343207

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