Tag Archives: Mediterranean diet

Huge U.S. Study Confirms Health and Longevity Benefits of the Mediterranean Diet

Posted on July 27, 2012 | 4 comments

This is a reprint of my very first blog post, from December 24, 2007, at the old Advanced Mediterranean Diet Blog. 

We now have results of the first U.S. study on mortality and the Mediterranean dietary pattern.  380,000 people, aged 50-71, were surveyed on their dietary habits and scored on their conformity to the Mediterranean diet.  They were visited again 10 years later.  As you would expect, some of them died.  12,105 to be exact: 5985 from cancer, 3451 from cardiovascular disease, 2669 from other causes.  However, the people with the highest adherence to the Mediterranean diet had better survival overall, and specifically better odds of avoiding death from cardiovascular disease and cancer.  Compared to the people with low conformity to the Mediterranean diet, the high conformers were 15-20% less likely to die over the 10 years of the study.  The study authors, funded by the National Institutes of Health, noted eight similar studies in Europe and one in Australia with similar results.

Once again, my promotion of the Mediterranean diet is vindicated by the scientific literature.  I’m not aware of any other diet that can prove anywhere near this degree of health benefit.  If you are, please share. 

Reference: Mitrou, Panagiota N., et al.  Mediterranean Dietary Pattern and Prediction of All-Cause Mortality in a US Population,  Archives of Internal Medicine, 167 (2007): 2461-2468.


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Mediterranean Diet Prolongs Life in Alzheimer Disease

Posted on July 26, 2012 | Comments Off on Mediterranean Diet Prolongs Life in Alzheimer Disease

A small scientific study of New York Alzheimer patients demonstrated significant increase in lifespan in those who had the highest adherence to the Mediterranean diet.  192 community-based individuals were followed for an average of 4.4 years (up to 13.6 years).  They were divided into three groups of Mediterranean diet adherence: low, medium, and high.  Compared to the people with low adherence, the others lived between 1 and 4 years longer.  Those with highest adherence lived the longest, suggesting a dose-response effect like we would see with many drugs.  No other diet has demonstrated this effect.

This same research group had previously reported that the Mediterranean diet lowered the risk for developing Alzheimer Disease in the first place.

Unfortunately, they did not report on whether the Mediterranean diet helped preserve brain function.  Prolongation of life by itself may be more of a curse than a blessing in advanced Alzheimer Disease.

Steve Parker, M.D.

Reference: Scarmeas, N., et al.  Mediterranean diet and Alzheimer disease mortality.  Neurology, 69 (2007):1,084-1,093.

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Science In Support of the Mediterranean Diet

Posted on July 17, 2012 | 2 comments

Atherosclerosis is the formal term for “hardening of the arteries.”  Who cares how hard they are, as long as the arteries deliver blood to our organs, right?

Atherosclerosis in the arteries that supply blood to the heart – essentially a hollow muscle that pumps blood – is called coronary heart disease disease (CHD) or coronary artery disease (CAD).

LDL cholesterol is the “bad cholesterol” that is associated with atherosclerosis.  Generally, the higher the LDL, the worse the atherosclerotic complications: plaque build-up leads to poor circulation to vital organs, arterial blood clots, even death of tissue due to blocked arteries.  Oxidation of LDL cholesterol facilitates atherosclerosis.

People at high risk for coronary heart disease include type 2 diabetics, smokers, people with high blood pressure or cholesterol abnormalities, and people with a family history of coronary heart disease.  Advanced age is another strong risk factor.

The ongoing PREDIMED Study is designed to test the the effects of the traditional Mediterranean diet in primary prevention of coronary heart disease in a high risk population.  9000 study participants will be assigned to one of three diets:  1) low-fat, 2) Mediterranean plus extra olive oil, or 3) Mediterranean plus extra nuts.  The Mediterranean diet is moderate in percentage of calories derived from fat, and the main source of fat is olive oil.  Virgin olive oil has a particularly high content of antioxidant phenolic compounds.  Nuts are also a rich source of antioxidant phytochemicals.  These antioxidants can prevent the harmful transmogrification of plain LDL into oxidized LDL.

A group of 372 early study enrollees were randomly assigned to one of the three diet groups.  In both of the Mediterranean diet groups, researchers found reduced oxidized LDL, reduced blood pressures, lower total cholesterol, and lower total-HDL cholesterol ratios, more than in the low-fat diet group.

These observed changes would tend to reduce the incidence and severity of atherosclerotic complications.  When PREDIMED is completed, we’ll know whether the traditional Mediterranean diet, compared with a low-fat diet, is better at preventing death and disease from coronary heart disease.  That’s where the rubber meets the road.

Steve Parker, M.D.

References:

Montserrat, Fito, et al.  Effect of a Traditional Mediterranean Diet on Lipoprotein Oxidation: A Randomized Controlled Trial.  Archives of Internal Medicine, 167 (2007): 1,195-1,203.

Prevencion con Dieta Mediterranea Study (PREDIMED)  http://www.predimed.org

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Mediterranean Diet Cuts Risk of Type 2 Diabetes

Posted on July 10, 2012 | 1 comment

The traditional Mediterranean diet has long been associated with lower risk of developing cardiovascular disease, cancer, and dementia.  The diet is rich in olive oil, fruits, nuts, cereals, vegetables, and fish but relatively low in dairy products and meat.  Several studies suggest the Mediterranean diet may also help prevent type 2 diabetes.

Researchers at the University of Navarra in Spain followed 13,380 non-diabetic university graduates, many of them health professionals, over the course of 4.4 years.  Average age was 38.  I assume most of the study participants lived in Spain, if not elsewhere in Europe (the article doesn’t say).  Dietary habits were assessed at the start of the study with a food frequency questionnaire.  Food intake for each participant was scored by adherence to the traditional Mediterranean diet.  Participants were labelled as either low, moderate, or high in adherence.  Over an average follow-up of 4.4 years, 33 of the study participants developed type 2 diabetes.  Compared to the participants who scored low on adherence to the Mediterranean diet, those in the high adherence category had an 83% lower risk of developing diabetes.  The moderate adherence group also had diminished risk, 59% less.

How could the Mediterranean diet protect against diabetes?  The authors note several potential mechanisms: high intake of fiber, low amounts of trans fats, moderate alcohol intake, high vegetable fat  intake, and high intake of monounsaturated fats relative to saturated fats.  Olive oil, loaded with monounsaturated fats, is the predominant fat in the Mediterranean diet.  In summary from the authors:

Diets rich in monounsaturated fatty acids improve lipid profiles and glycaemic control in people with diabetes, suggesting that a high intake improves insulin sensitivity.  Together these associations suggest the hypothesis that following an overall pattern of Mediterranean diet can protect against diabetes.  In addition to having a long tradition of use without evidence of harm, a Mediterranean diet is highly palatable, and people are likely to comply with it.

Please give serious consideration to the Mediterranean diet, especially if you are at risk for developing type 2 diabetes.  Major risk factors include sedentary lifestyle, overweight, and family history of diabetes.

Steve Parker, M.D.

Reference: Martinez-Gonzalez, M.A., et al.  Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study.  British Medical Journal, BMJ,doi:10.1136/bmj.39561.501007.BE (published online May 29, 2008).

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Mediterranean Diet Reduces Cancer Risk

Posted on July 7, 2012 | Comments Off on Mediterranean Diet Reduces Cancer Risk

In 2008, the British Journal of Cancer published a report linking the traditional Mediterranean diet “…with markedly and significantly reduced overall cancer….”

Researchers from the University of Athens, the International Agency for Research on Cancer, and the Harvard School of Public Health looked at 25,623 participants of the Greek portion of the European Prospective Investigation into Cancer and nutrition (the EPIC study).  Adherence to the Mediterranean diet was assessed with a food-frequency questionnaire.

Cancer developed in 851 participants over an average follow up of 7.9 years.  Non-melanoma skin cancers were not included since they are usually not serious or life-threatening.  The common cancers in men involved the lung, prostate, colon, and stomach.  For women, common cancers were breast, colon, ovary, and uterus.

Participants’ conformity to the Mediterranean diet was graded on a 10-point scale based on consumption of vegetables, legumes, fruits and nuts, cereals, fish, meat and meat products, dairy products, ethanol (alcohol), and the monounsaturated to saturated lipid ratio.  A score of zero indicated minimal adherence; maximal adherence scored a nine.

Every two-point increase in adherence was associated with a 12% reduction in the incidence of overall cancer.  So those participants with greatest conformity to the traditional Mediterranean diet had a dramatically reduced incidence of cancer compared to those with minimal adherence.

The researchers cite three independent studies that found a similar association between the Mediterranean diet and cancer.  The study at hand was not sufficiently powered to determine reliably which specific cancers were reduced with the Mediterranean diet.  Other studies indicate that the reduced cancers are prostate, breast, colon, and uterus.

The researchers surmise that the cancer-reducing benefit of the Mediterranean diet relates to the whole diet rather than to individual components.

To move your way of eating in a Mediterranean direction, review the diet here.

Steve Parker, M.D.

Reference:  Benetou, V., et al.  Conformity to traditional Mediterranean diet and cancer incidence: the Greek EPIC cohort.  British Journal of Cancer, 99 (2008): 191-195.

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Mediterranean Diet Improves Asthma

Posted on July 4, 2012 | 2 comments

Researchers in Portugal found that high adherence to the Mediterranean diet reduced by 78% the risk of out-of-control asthma.

Other recent studies have associated the Mediterranean diet with 1) lesser incidence of asthma-like symptoms and allergies in children of women who followed the Mediterranean diet while pregnant, and 2) reduced risk of chronic obstructive pulmonary disease in men who eat Mediterranean-style.

The Mediterranean diet is famous for prolonging life and reducing rates of cardiovascular disease, cancer, and dementia.  Type 2 diabetes mellitus was recently added to the list of diseases prevented by the Mediterranean diet.  We have to consider adding lung disease to the list next.

In my capacity as a hospitalist, I see lots of poorly-controlled asthmatics.  The standard therapeutic approach is avoidance of allergens when possible, and administration of multiple drugs with multiple potential adverse effects.  So the following study involving diet and asthma caught my eye.

Scientists in Portugal studied 174 asthmatics with an average age of 40.  They administered an Asthma Control Questionnaire and measured lung function and exhaled nitric oxide.  Food intake was determined with a food frequency questionnaire, and a diet score was used to determine conformity to the Mediterranean diet.

Asthmatics felt to be under good control comprised 23% of the participants.  Were there dietary factors associated with good control?

I’m glad you asked.  The answer is , “Yes”:

  • high adherence to the Mediterranean diet
  • higher intake of fresh fruit
  • lower intake of ethanol (alcohol)

The researchers note that “the traditional Mediterranean diet is claimed to possess antioxidant and immune-regulatory properties in several chonic diseases.  Typical Mediterranean foods have recently been associated with improvement of symptoms of asthma and rhinitis [runny nose, often allergy-related] in children” in Crete and Spain.

This study is good news for people with asthma.  But association of well-controlled asthma with the Mediterranean diet does not prove that the diet is causing the improvement.  Next, we need a study that educates people with asthma on the Mediterranean diet, monitors adherence, and follows them over time while checking for improvement in asthma and comparing to a control group on a standard diet.

Steve Parker, M.D.

Reference:  Barros, R., et al.  Adherence to the Mediterranean diet and fresh fruit intake are associated with improved asthma control.  Allergy, vol. 63 (2008): 917-923.

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Does Food Affect Lung Disease?

Posted on July 3, 2012 | 1 comment

In another blog post, I provided evidence that diet may indeed affect lung function and disease, specifically asthma.  Another common lung condition is chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema.  COPD is usually associated with smoking.

By the way, a couple years ago “chronic lower respiratory tract disease” finally surpassed stroke to become the third leading cause of death in the U.S.  These lung diseases are mostly emphysema, COPD, and asthma.

In 2007, scientists with the Harvard School of Public Health, Harvard Medical School, and Simmons College concluded that “in men, a diet rich in fruits, vegetables, and fish may reduce the risk of COPD whereas a diet rich in refined grains, cured and red meats, desserts and French fries may increase the risk of COPD.”

The Boston, MA, researchers included academic heavyweights such as Teresa Fung, Walter Willett, and Frank Hu.  They studied 42,917 men in the Health Professionals Follow-up Study via detailed periodic questionnaires.  The men at baseline had never had asthma or COPD.  Onset of COPD between  1986 and 1998 was evaluated by questionnaire and was defined as an “affirmative response to physician-diagnosed chronic bronchitis or emphysema and by the report of a diagnostic test at diagnosis (pulmonary function testing, chest [x-ray] or chest CT scanning).”  Participants reported 111 new cases of COPD.

Investigators identified two distinct major dietary patterns at baseline:

  1. “Prudent” pattern:  high intake of vegetables, fruits, fish, poultry and whole grains.
  2. “Western” pattern:  high consumption of cured and red meats, refined grains, desserts and sweets, French fries, eggs and high-fat dairy products.

The prudent dietary pattern was inversely associatied with the risk of newly diagnosed COPD, regardless of smoking status.  In other words, the higher an individual’s conformity to the prudent pattern, the lower the risk of new COPD.

On the other hand, the Western pattern was positively associated with the risk of newly diagnosed COPD, again regardless of smoking status.

They did not note any association between either dietary pattern and the risk of developing asthma.

Clearly, there are similarities between the prudent dietary pattern and the traditional Mediterranean diet.  The main differences are that the Mediterranean diet includes significant amounts of olive oil, limited red meat and eggs, and judicious amounts of wine.  The Mediterranean diet incorporates the prudent pattern.  But the Mediterranean diet is not the “prudent dietary pattern” studied at Harvard.  Whether the Mediterranean diet would match or supercede the prudent diet in prevention of COPD is a matter of speculation.  The smart money would bet in favor of the Mediterranean diet reducing rates of COPD to at least some degree.

In view of a study associating improved asthma control with the Mediterranean diet, you gotta wonder if the researchers would have confirmed it, if they had been looking.  Are there substances in olive oil, or other aspects of the Mediterranean diet, that  improve lung function?

Many people are aware that dietary patterns have an effect on heart disease, overweight and obesity, high blood pressure, diabetes, dementia, cancer, and strokes.  We can add chronic lung disease to the list now.

Steve Parker, M.D.

Reference:  Varraso, Raphaelle, et al.  Prospective study of dietary patterns and chronic obstructive pulmonary disease among US men.  Thorax, vol. 62, (2007): 786-791.

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Mediterranean Diet May Prevent Melanoma (Serious Invasive Skin Cancer)

Posted on June 18, 2012 | Comments Off on Mediterranean Diet May Prevent Melanoma (Serious Invasive Skin Cancer)

A 2008 study suggests a protective effect of the Mediterranean diet for cutaneous melanoma. This is the first study to examine melanoma’s association with the Mediterranean diet.

Melanoma is the seventh most common cancer in Americans, and the most common fatal malignancy among young adults. Lifetime risk of developing melanoma is one in 71. Incidence of melanoma in the white U.S. population has more than tripled in the last 20 years. The U.S. had 62,000 new cases of melanoma in 2008.

The researchers in Rome, Italy, used a hospital-based case-control method including 304 cases of melanoma and 305 matched controls who did not have melanoma. Information on sun exposure, skin pigmentation, smoking, medical history, and socio-demographic characteristics was collected.

The researchers report:

After careful control for several sun exposure and pigmentary characteristics, we found a protective effect for weekly consumption of fish, shellfish, fish rich in omega-3 fatty acids, daily tea drinking and high consumption of vegetables in particular carrots, cruciferous and leafy vegetables and fruits, in particular citrus fruits.

[For the sake of clarity, I have omitted odds ratios and confidence intervals. Odds ratios for many of these associations were around 0.50, meaning half the risk of developing melanoma.]

Conclusion overall: Our findings suggest that some dietary factors present in the Mediterranean diet might protect from cutaneous melanoma.

Prior studies have demonstrated lower incidence of breast, colon, prostate, and uterus cancer in people who adhere to the traditional Mediterranean diet. Note also that death rates from cancer are lower. We can probably add melanoma to the list of cancers prevented with a Mediterranean-style diet, although I would have more confidence if the current study had included more participants.

Steve Parker, M.D.

Reference: Fortes, C., et al. A protective effect of the Mediterraenan diet for cutaneous melanoma. International Journal of Epidmiology, 37 (2008): 1,018-1,029.

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Mediterranean Diet + Nuts = Reversal of Metabolic Syndrome

Posted on June 13, 2012 | 1 comment

An article published in 2008 by Bloomberg.com presents results of a scientific study in Spain that showed reduction in “metabolic syndrome” by the Mediterranean diet supplemented with nuts. CBSnews.com, Reuters, and others helped spread the news. The Bloomberg article was written by Nicole Ostrow.

Metabolic syndrome is a constellation of clinical factors that are associated with increased risk of type 2 diabetes and atherosclerotic complications such as heart attack and stroke. (Sometimes metabolic sydrome is called Syndrome X, which I sorta like. Oh, the mystery!) One in six Americans have the syndrome. Diagnosis requires at least three of the following five conditions:

  • High blood pressure (130/85 or higher, or using a high blood pressure medication)
  • Low HDL cholesterol: under 40 mg/dl in a man, under 50 in a women (or either sex taking a cholesterol-lowering drug)
  • Triglycerides over 150 mg/dl (or taking a cholesterol-lowering drug)
  • Abdominal fat: waist circumference 40 inches or greater in a man, 35 inches or greater in a woman
  • Fasting blood glucose over 100 mg/dl

The scientific study at hand is part of the PREDIMED study being conducted in Spain. For this portion of the study, 1,224 participants at high risk for cardiovascular disease were randomized to follow a 1) low-fat diet (considered the control group), 2) Mediterranean diet plus 1 liter virgin olive oil per week, or 3) Mediterranean diet plus 30 gm daily of mixed nuts.

Note that the nuts used in this study were walnuts, almonds, and hazelnuts. Half of all nuts were walnuts; a quarter of the nuts were almonds and a quarter were hazelnuts.

Participants were 55-80 years old, and 61% had metabolic syndrome at baseline. Participants could eat all they wanted, and there was no increase in physical activity for any of the groups. Participants were given instructions at baseline and quarterly.

After one year of intervention, the prevalence of metabolic syndrome was reduced by 14% in the Mediterranean diet plus nuts group compared to the control, low-fat diet group. The Mediterranean diet plus extra olive oil group reduced prevalence of metabolic syndrome by 7%, but this did not reach statistical significance (P=0.18).

New cases of metabolic syndrome continued to develop at about the same rate in all three groups. I.e., incident rates were not significantly different. So, the lower prevalence of metabolic syndrome after one year reflected reversion or clearing of the syndrome in many people who had it at baseline. Compared to the control group, people in the nutty group were 70% more likely to resolve their metabolic syndrome. Individuals in the oily group were 30% more likely than controls to resolve the condition.

(Feel free to consult a dictionary for definitions of “prevalence” and “incidence.”)

The researchers conclude that:

A traditional Mediterranean diet enriched with nuts could be a useful tool in the management of the metabolic syndrome.

My Comments:

Thirty grams (daily) of nuts is a decent-sized snack of about 180 calories. Thirty grams of almonds formed a heap in the palm of my hand, not touching my fingers. This is more than the “two tablespoons” reported by CBSnews.com December 9.

If you have metabolic syndrome, you might want to try reversing it with all the usual methods (e.g., lose excess fat weight, exercise more) along with a traditional Mediterranean diet enriched with 30 gm of mixed nuts daily. As usual, check with your personal healthcare provider first. Be aware that many of them won’t know about this study.

The puzzling thing to me is: If the Mediterranean diet plus extra nuts is so effective in reversing metabolic syndrome, why didn’t that study cohort see fewer new cases of metabolic syndrome?

Steve Parker, M.D.

Additional reference: Salas-Salvado, Jordi, et al. Effect of a Mediterranean Diet Supplemented With Nuts on Metabolic Syndrome Status: One-Year Results of the PREDIMED Randomized Trial. Archives of Internal Medicine, 168 (2008): 2,449-2,458.

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Mediterranean Diet and Lifestyle Associated With Reduced Alzheimer Dementia

Posted on June 6, 2012 | Comments Off on Mediterranean Diet and Lifestyle Associated With Reduced Alzheimer Dementia

Alzheimer disease is a progressive brain disorder resulting in memory loss, personality change, functional impairments, and a decline in various types of thinking (e.g., math ability, problem-solving, spatial orientation). It is the most common form of dementia in the eldery, causing about 70% of cases and afflicting four million people in the U.S.

TheBostonChannel.com recently published a news release from Beth Israel Deaconess Medical Center on how to prevent Alzheimers Disease. It is a Q&A interview with Dr. Daniel Press, neurologist and Alzheimer specialist.

Dr. Press made favorable comments about the Mediterraean diet and pointed out that avoidance of obesity and diabetes may also help prevent Alzheimer disease. Regular aerobic exercise, 30 minutes daily, also seems to be protective. The potential protective effect of alcohol consumption was not mentioned.

For details on how to accomplish all this, see the Do-It-Yourself Mediterranean Diet, the Alzheimer disease prevention article at WebMD.com, or The Advanced Mediterranean Diet book.

Steve Parker, M.D.

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