Happy Healthy Long Life

The Mediterranean Diet - It's Better Than the Western Diet - But, It's Definitely Not the Best! Why Settle for Less?

 

 

 

 

The Latest Spanish Study (NEJM) Nudged the Benefits of the Mediterranean Diet Up to a 30% Reduction over the "Western Diet" Control Group - But, There's a Better Choice

 

 

A Small Pilot Study Comparing Omega-3 Levels in a Mediterranean Diet (with fish & olive oil), the Average US Diet, & a Plant-Based No-Oil Diet

 

ALA=plant-based omega-3's

  

DHA=the most important component in Omega-3's

The higher the n3 Index, the better!

The lower the n6:n3 ratio, the better!

In the Spanish Study (Estruch, NEJM) the ALA levels in the best performing group (nuts & olive oil) averaged:  0.45--far below plant-based no-oil.   The researchers speculated that the decrease in cardiovascular events seen in the olive oil/nut group was due to their higher levels of ALA--which were far lower than those in the plant-based in our pilot study.

 

Sorry, guys.  I'm super short on time--so I'm just throwing out some slides & Gayl J. Canfield's excellent analysis of Estruch's Spanish Mediterranean Study before I get busy with vacation & holiday preparations.

I'll leave all the analysis to you!  Sorry, no time to fill in all the details.

For Your Reading Pleasure:

1.  My Experience with the Mediterranean Diet.

2.  What I Learned from the Dr. Caldwell & Ann Esselstyn's "Prevent & Reverse Heart Disease" School

3.  Dr. Dean Ornish on "Does a Mediterranean Diet Really Beat Low-Fat for Heart Health?"

4.  Dr. John McDougall on "NEJM Study Promotes Olive Oil and Dismisses Low-fat Diet"

 

Mediterranean Diet: Better, Not Best?

 

This article, recently published in the online medical news service, Medscape, presents one of the most balanced explanations of the recent Spanish Mediterranean Study that's gotten so much exposure lately.  I posted it on FB today--but it's so good, I wanted to share it with non-FB readers, too.

Are olive oil, nuts, & fatty fish the way to go?

Not by a long-shot.  Yes, it's a much better choice than the Western Diet--which for all intents-and-purposes is what it was compared to in the Spanish study.  Make no mistake--the so-called "low-fat" control in the study was anything but low-fat & heart healthy.

Canfield lays out three diets that are much better choices than the Mediterranean Diet--with the Ornish/Esselstyn Diet (plant-based, no-added-oil, no nuts, with a source of omega-3's) leading the pack, because they provide the highest level of cardiovascular benefits--able to prevent & (sometimes) reverse heart disease.

1.  Ornish/Esselstyn: Plant-based, low-fat, no-added oil, no nuts, & includes adequate omega-3's

2.  Pritikin Diet:  Low-fat, no-added oil, allows up to 4 oz. of animal protein a day.

3.  DASH Diet:  Very high in fruits, vegetables, whole grains, and beans; low in fats, salt, red meats, and sweets; and moderate in fish, poultry, nuts, and low-fat or nonfat dairy foods.

 

 

Gayl J. Canfield, PhD, RD, The author is Director of Nutrition at the Pritikin Longevity Center in Miami, Florida.Medscape.

Mar 19, 2013, Medscape 

 

Mediterranean Diet Better Than Typical American Diet

In light of the recent media attention on the Mediterranean diet,^[1] you may find yourself fielding lots of questions from patients about which diet they should follow. Right now, we cannot say which diet is best because we still need rigorous studies of all of the popular diets that physicians routinely recommend to their patients. Moreover, we cannot unequivocally recommend the Mediterranean diet on the basis of the recently published study because this study was seriously flawed.

One major problem with the study was that the "low-fat" diet being used to compare against the Mediterranean diet was not, in fact, low in fats. The participants in this group started out with a diet that averaged 39% fat, and during the study period they decreased fat intake to just 37%.

Nor was this so-called low-fat diet a healthy, well-designed regimen. Many of the foods eaten by participants were artery-damaging foods such as red meat, commercially baked goods full of refined flour and fat, sugary sodas, and low-fat cheeses. (Though called "low-fat," these cheeses typically get 35% to 60% of their calories from fat.)

Moreover, the "low-fat" diet excluded an important food proven to protect against heart disease: omega 3-rich fish. This category of food is included in many healthy low-fat-diet plans.

The bottom line is that the study authors were not really comparing a Mediterranean diet with a nutritious low-fat diet. It would be much more accurate to say that they were comparing a Mediterranean diet with a typical American-style diet. But it did not do justice to a well-constructed low-fat diet.

 

Healthy "Low-Fat" Diets

A substantial body of research exists that has documented the heart-healthy benefits of 2 well-known low-fat diets, Pritikin and Ornish [H.L.'s note: similar to Esselstyn's Diet]. In fact, the data are so strong that Medicare now covers cardiac rehabilitation programs based on the Pritikin and Ornish plans for people with a history of cardiovascular disease.^[2] Both programs also include exercise and lifestyle-change components.

The Ornish Program [H.L.'s note: similar to Esselstyn's Diet] has been proven to regress heart disease,^[3,4] and the Pritikin Program has been proven to significantly reduce many modifiable risk factors for cardiovascular disease, including low-density lipoprotein (LDL) cholesterol, triglycerides, blood glucose, hypertension, inflammatory markers such as C-reactive protein, and excess weight/obesity.^[5-7]

Both programs recommend an eating plan with about 10% to 15% of calories coming from fat, and both emphasize hearty consumption of fruits, vegetables, whole grains, and legumes such as beans. The Ornish Program is completely vegetarian, whereas the Pritikin Program allows up to 4 oz of animal protein daily, such as omega-3-rich fatty fish, skinless white poultry, or lean meat such as bison.

Both of these programs are a far cry from the "low-fat" diets of the 1980s and 1990s, many of which were anything but healthy. Often, the "low-fat” and "fat-free" products people were eating (remember "fat-free" cookies?) were essentially junk food themselves -- very high in sugar, salt, and/or refined white flour.

Low-fat plans such as Pritikin and Ornish, by contrast, focus on real food -- whole, minimally processed, naturally fiber-rich foods that, as Michael Pollan wrote in his superb book In Defense of Food, "are foods our great grandmothers would have recognized as food."

Another low-fat diet that has proven to be particularly beneficial for blood pressure control is the DASH (Dietary Approaches to Stop Hypertension) diet. Several studies funded by the National Institutes of Health (NIH) have found that the DASH diet lowers blood pressure as well as or better than medications. DASH also promotes menus that are high in fruits, vegetables, whole grains, and beans; low in fats, salt, red meats, and sweets; and moderate in fish, poultry, nuts, and low-fat or nonfat dairy foods.

In one study, NIH researchers found that 8 weeks of following the DASH regimen resulted in reductions in blood pressure in all groups of men and women studied.^[8] Even those who started with a normal blood pressure (systolic pressure < 120 mm Hg) saw improvements. The biggest reductions in blood pressure were observed in the individuals who were hypertensive (systolic pressure >140 mm Hg), emphasizing the fact that diet is a major factor in determining blood pressure in most hypertensive patients.

In another DASH study, 3 groups of people followed the diet but took in varying levels of sodium (3300 mg, 2400 mg, or 1500 mg per day). The researchers found that the biggest drops in blood pressure occurred in the group on the 1500 mg/day diet.^[9]

 

Life Lessons

After nearly a decade of teaching healthy eating at the Pritikin Longevity Center, I can say with certainty that people can change. They really can revamp their behaviors and live better, healthier lives. But it takes much more, unfortunately, than simply handing them a diet pamphlet. What works is a solid education in several key skills for healthy living: classes in grocery shopping, reading food labels, cooking, and dining out healthfully. In addition, we provide classes that teach why these skills are so vital and how they benefit the body.

What matters, too, is taking time away from what I call the "American assault on our taste buds" -- a week or more spent eating foods that are completely free of salt, sugar, and grease, so that our palates have a chance to rediscover the good flavors of good food.

If, as a nation, we can institute educational programs like these, we can begin to empty our hospitals of patients needing angioplasties or coronary bypass surgeries; we can lighten the load of nursing facilities filled with people stricken with diabetic- and cardiovascular-related strokes, kidney failure, and amputations.

We know that the Mediterranean diet is better than the typical American diet. We also know that healthy, well-designed low-fat diets are better than the typical American diet. We need more research -- rigorous, randomized trials -- to identify not only the best diets but also the best ways to teach these diets.

In doing so, we can achieve real change across America, change that can not only curtail the staggering economic costs of chronic disease but also help people feel better and live better.

References

1. Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;DOI:10.1056/NEJMoa200303.

2. [No authors listed] Ornish, Pritikin get Medicare okay for cardiac rehab. Harv Heart Lett. 2010;21:7.

3. Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet. 1990;336:129-133. Abstract

4. Chainani-Wu N, Weidner G, Purnell DM, et al. Changes in emerging cardiac biomarkers after an intensive lifestyle intervention. Am J Cardiol. 2011;108:498-507. Abstract

5. Barnard RJ. Effects of life-style modification on serum lipids. Arch Intern Med. 1991;151:1389-1394. Abstract

6. Sullivan S, Samuel S. Effect of short-term Pritikin diet therapy on the metabolic syndrome. J Cardiometab Syndr. 2006;1:308-312. Abstract

7. Wegge JK, Roberts CK, Ngo TH, Barnard RJ. Effect of diet and exercise intervention on inflammatory and adhesion molecules in postmenopausal women on hormone replacement therapy and at risk for coronary artery disease. Metabolism. 2004;53:377-381. Abstract

8. Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med. 1997;336:1117-1124. Abstract

9. Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001;344:3-10. Abstract

 

The Mediterranean Diet Myth - Vegetables, Fruit, Naturally Low Caloric Density, Hard Physical Work, Yes! Olive Oil, Nuts, Seeds, & Chocolate? I Don't Think So!

 

I Thought Those High HDL's Were My Ace in the Hole - Until I Read Dr. Lawrence Rudel's Research

 

The Green African monkeys metabolize fat in the same way as humans, so they're good stand-ins.. 

At the end of five years, their autopsies showed that the monkeys who were fed monounsaturated oil (olive) had higher HDLs (the good cholesterol) and lower LDLs (the bad cholesterol) than the ones fed the saturated fat diet.  The big surprise here:  Both groups had exactly the same amount of coronary artery disease.  The higher HDLs & lower LDLs of the olive oil group were meaningless.

 -Dr. Lawrence Rudel-

 

 

If you received this post via email, click here to get to the web version with all the links--and to post a comment.

One week until my Utah "Centenarian Strategies" presentation--and except for some minor tweaking, it's finished! 

After May 3rd I'll be back to blogging!  I've really missed it.  Posting on Facebook is just not the same.

I wanted to share a few slides that help explain why in spite of eating what I thought was a healthy diet--and exercising regularly--my weight continued to climb as I got older.

Maybe you've noticed the same thing yourself--& wondered why.

My weight continued to climb.

My cholesterol continued to climb.

My blood pressure continued to climb.

 

The Myth of the Mediterranean Diet - It Can Get You Fat

 

After seeing the Greek islands for myself last May, I understood why the Mediterranean Diet got its reputation for being heart healthy.  Steep hills, homegrown food, and isolation.

Imagine living on a craggy isolated Greek island, post-World War II.  You had to walk up and down steep hills everyday to tend to your garden and your animals.  There was no processed food coming onto the island. 

You lived off of what you could grow yourself--tomatoes, greens, vegetables, fruits, and the wild purslane (high in omega-3s) growing on the hillside.  Sure you had a little cheese, fish, wine & olive oil--and fava beans. 

You were heart-healthy because you worked hard, ate lots of plants, a little fish, and a little wine.  And that heart health came in spite of the olive oil--not because of it.

What's the real story behind the virtues of the Mediterranean Diet?

The authentic post-World War II Mediterranean diet of Crete--lots of physical labor coupled with lots of fruits, vegetables, legumes, and just a little bit of olive oil, wine, & fish.

Br J Nutr. 2004--when researchers went back to Crete to look at the health of the islanders 50 years later--the group with the highest olive oil (MUFA) consumption had the highest heart disease, and those with the lowest olive oil intake had the the lowest heart disease.  Click here and here for more about why olive oil & the monounsaturated fats aren't exactly health food.

The data on which the Mediterranean Diet is based came from the 1950's.

At that time the people on the Isle of Crete had the lowest all-cause mortality. It was post-WWII, they were poor, didn't have a lot to eat, ate mostly fresh fruits & veggies from their gardens, walked 9 miles a day, worked at hard physical labor and the highest consumption of oil was 3 TBS a day--and small amounts of fish. Big difference from how we live today.

 

 

Drs. Lawrence Rudel, Dean Ornish & Robert Vogel on Olive Oil

 

• Vogel:  Contrary to our hypothesis, our study found that omega-9 (oleic acid)--rich Olive Oil, impairs endothelial function after eating.  If you've been using olive oil because you think it's healthy, it's time to think again. The olive oil constricted blood flow by a whopping 31% after a meal in a Vogel's study.  Dr. Robert Vogel

• Rudel:  Rudel ran a five year study feeding olive oil and saturated fat to African Green monkeys.  The monkeys metabolize fat in the same way as humans, so they're good stand-ins.. At the end of five years, their autopsies showed that the monkeys who were fed olive oil had higher HDLs (the good cholesterol) and lower LDLs (the bad cholesterol) than the ones fed the saturated fat diet.  The big surprise here:  Both groups had exactly the same amount of coronary artery disease.  The higher HDLs & lower LDLs of the olive oil group were meaningless.  Rudel later repeated the study on rodents, and got the same results.  Dr. Lawrence Rudel

• Ornish:  It's 100% fat and 14% of it is saturated. At 120 calories a tablespoon it's very easy to eat too much of "a bad thing".  It won't raise your LDL as much as butter or other saturated fats will,  so it might look like it's reducing your cholesterol, but it's still raising it.  It's just not raising it as much other fats would!  It's the omega-3's that reduce inflammation and are "heart healthy", and olive oil has very little omega-3, maybe 1%. It's mostly omega-9, which has been shown to impair blood vessel function. 

 

The Myth of High HDL's

 

There's no doubt about it.

Eat a lot of nuts & olive oil, drink alcohol & you'll raise your HDL's.  But, are all high HDL's created equal?

Turns out, there's good HDL & there's bad HDL.  Bet you didn't know that!

It's not about how high your HDL's are.  It's about how effective they are--and that's called "Efflux Capacity".

The HDL Catch-22:  HDL is altered in the presence of systemic inflammation and its ability to inhibit inflammation & transport LDL becomes compromised.

• Nuts are loaded with inflammatory omega-6s, that could impair HDL.
• Belly fat is an engine for inflammation, that could impair HDL.
• Olive oil is inflammatory, and may impair HDL.
• The typical Western DIet is inflammatory, and may impair HDL.
• A diet devoid of vegetables & fruit is inflammatory, and impair HDL.
• A diet where the omega-6s (found in oil, nuts, saturated fat, animal products, & processed foods) far exceeds the omega-3s (found in flax, chia, greens, vegetables, & fish) is inflammatory, and may impair HDL.
• Worry less about how high or low your HDL's are--and worry more about what you're eating that's inflaming your blood vessels.

Read more about HDL's & Efflux Capacity here.  A must read!

Read more about Olive Oil here.

 

 

Check Out the Omega-6 to Omega-3 Content of Nuts & Seeds

 

Chart Created by Joanne L. Mumola Williams, PhD, Foods for a Long Life

 

The ideal omega-6 to omega-3 ratio should be between 1:1 to 4:1, to prevent inflammation--and it's not so easy to do!  The typical Western diet has a ratio of 17:1.  

Oil, nuts, seeds, corn-fed animal products, trans-fats, & processed foods are the biggests sources of inflammatory omega-6's.

The more omega-6's you are eating, the harder it is for plant-based omega-3's like greens/flax/chia to convert into the kind of omega-3's you need to prevent inflammation!

But, if you cut out the oil & nuts--then the chia/flax/greens REALLY DO CONVERT into DHA and EPA--the kind of anti-inflammatory omega-3s we need for a healthy brain/arteries/body.   I had mine tested.  I know that plant-based no-added oil or nuts really works!

 

Why I Gained Weight & Inflammation on the Mediterranean Diet

 

Eating just a small 1/3 cup of almonds a day. 

Eating just a few squares of super-dark 85% cacao chocolate a day.

Eating just 3 TBS. of olive oil a day. I used it to cook with, to roast vegetables, in my salad dressings, & as a "dip" for my bread.  

I had no idea how much fat & calories were in these Mediterranean gems until I tracked them for this presentation slide.

 

846 extra calories a day from chocolate, nuts, & olive oil.

84% of those calories are from fat.

21% of those calories are from saturated fat.

I was consuming 84.3 grams of fat  (21.1 grams as saturated fat) just from nuts, olive oil & chocolate - and that's a conservative estimate.

 

 

 

The Veg-Heavy Green Smoothie Snack Compared to Handful of Almonds????  No Contest!!

 

 

 

Compare the Nutrients in the Green Smoothie to the Nuts?

 

For some perspective--those 5815 mgs of omega-6's from almonds are practically a day's worth--although it's relative to how many omega-3's you consume.  If you're also eating tahini, more nuts & seeds, oils, meat, & processed foods---you can only imagine what your omega-6 to omega-3 ratio looks like!

 

Anyone as surprised as I was from these statistics?  I'd love to hear your feedback!