THE MEDITERRANEAN DIET FOR HEART HEALTH
By: Richard Feldman, M.D. F.A.C.C.
The great abundance of diets with claims of easy weight loss and various other health benefits attests to the low rate of success of dieting in general.
Unfortunately, until recently, rigorous scientific proof that any of these diets can significantly improve cardiovascular outcomes has been largely lacking. In fact, a large trial published in 2006 which was designed to evaluate the health benefits of the traditional low-fat diet advocated by the American Heart Association failed to show any significant impact on cardiovascular risk. All this changed however with the publication of the landmark “PREDIMED” study from Spain in 2013, which showed that the so- called Mediterranean diet reduced the incidence of heart attack, stroke, and cardiovascular death by a remarkable 30%. What perhaps makes this diet special and more palatable than many others is what it includes rather than what it excludes (see below). Without calorie restriction, portion control, or significant weight loss, the cardiovascular benefits were demonstrated in addition to lowering of the risk of developing diabetes. Factors responsible for these effects included lowering of blood pressure, increased insulin sensitivity, improved LDL and HDL cholesterol patterns, and the reduction of inflammation known to contribute to the development of vascular disease. Participants were in many cases already treated with medications addressing various cardiovascular risk factors, demonstrating the additive effect of the diet, roughly equal to that achieved with the use of Statin drugs alone.
In almost 30 years of practice, I can count on one hand the number of my patients who were able to adhere to calorie limited or highly restrictive diets long enough to realize the health benefits that might result from significant sustained weight loss. It turns out that this is due to powerful physiological mechanisms which have evolved to counteract calorie deprivation. We now have a diet with proven cardiovascular benefits that is palatable and does not result in perpetual calorie cravings. This should bring a truly important and sustainable lifestyle change to our patients who up until now have struggled with the revolving door of diets that ultimately fail to deliver results.
The Mediterranean Diet (As used in the “PREDIMED” study):
- Use Olive oil for cooking and seasoning
- 2 or more servings per day of vegetables with one fresh in a salad
- At least 2-3 servings a day of fresh fruit (or fruit juice)
- At least one serving a week of nuts and seeds
- At least 3 servings a week legumes
- At least 3 servings a week of fish or seafood (at least one with a fatty fish)
- Chicken instead of red meat
- Use sauce including tomato, onion, and garlic simmered with olive oil at least twice a week- on pasta vegetables, rice, etc.
- 1-3 glasses of wine a day
- Consume as desired: nuts, eggs, fish, seafood, low-fat cheese, dark chocolate (>50% cocoa content), whole grain cereals
- Add to above:
- ¼ cup nuts (Almonds, walnuts, hazelnuts) daily and/or:
- 4 tablespoons extra virgin olive oil daily
- Limit or avoid: Cream, butter, margarine, pastries, cake, cookies, donuts, red meat, high fat cheese, soft drinks, French fries, potato chips