Friday, December 26, 2008

The Mediterranean Diet, heart health and tips

After eating three different Christmas dinners, I am now stuffed and am dedicating myself to reading a new book Glenn got in the mail entitled, The Great American Heart Hoax: Lifesaving Advice Your Doctor Should Tell You About Heart Disease Prevention (But Probably Never Will). Although the book is about how to avoid heart surgery such as angioplasties and coronary bypass, the writer, Dr. Michael Ozner, is a cardiologist who also wrote The Miami Mediterranean Diet, so I decided to fast forward to the chapter, "Follow a Mediterranean Diet" to see if I could learn anything. Frankly, I don't think heart surgeries are a hoax, one saved my life and I am forever grateful to my doctors. I do think the author may be correct that those who are stable may not benefit from some of the tests and procedures, however. But that aside, the chapter on diet starts out with the author stating, "What you eat is the single most important factor in your health."

I don't think I buy that, the single most important factor seems to be one's genes or other factors. However, I do agree with the author that eating is the one thing you can control and I think because of that, people tend to give it top billing to gain a sense of mastery over their fate. The advice given on the Mediterranean diet is nothing earth-shattering but there are good, straight forward tips on what to eat.

Dr. Ozner says to stay away from red meat, eating it at most weekly or monthly and lean cuts only. Avoid high fructose corn syrup as the average American consumes 73.5 pounds of this sweetener each year, a large increase since it was introduced in 1970. High fructose corn syrup increases triglyceride production which is a major risk for heart disease. He is not into milk and says if you must drink it, use fat-free or skim milk.

The main components of a Mediterranean diet are whole (non-refined) grains, fresh fruits and vegetables, nuts such as almonds and walnuts which have omega-3 fatty acids, olive oil, red wine, complex carbohydrates, omega-3 fatty acids, tea, fruit and vegetable juices, cinnamon (some research shows the smell improves brain activity), and finally, dark chocolate. Okay, nothing new here but it's good to hear again to refresh my memory.

The book seems good for those who wish to read up on how to prevent heart disease. Dr. Ozner has a ten-step program with information on how to take command of your blood pressure, reduce free radicals and oxidative stress, and how to avoid unnecessary diagnostic tests and procedures, among others. I will probably refer to it from time to time as I try to improve my overall health, especially now that the holiday eating frenzy is over and spring is around the corner (one can only hope).

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31 Comments:

Blogger papabear said...

Michael Pollan makes similar points in his In Defense of Food, especially with regards to heart disease and its connection to the modern Western diet. Heart disease rises when members of non-Western societies move to the West, and abandon their traditional diets for the modern Western diet.

8:48 PM, December 26, 2008  
Blogger Steve Parker, M.D. said...

Hi, Dr Helen.

I agree with you that your genes are the single most important factor in your health.

And I admit that as the author of a Mediterranean diet weight-loss book.

Regular exercise and avoiding obesity may even be more important than diet.

-Steve

9:36 PM, December 26, 2008  
Blogger Edgehopper said...

As a patent lawyer working on a case where the experts are authors of books on Mediterranean diets and omega-3 fatty acids, it all looks like a bunch of hooey to me. As is usually the case in nutrition "science", the major studies have the following format.

Abstract: Omega-3's are good for you, and everyone should eat a lot of them!
Actual study: When rats are fed diets with absolutely no omega-3s, or diets low in omega-3s, the low omega-3 rats are slightly more likely to suffer adverse effects.
Conclusion: Humans should get X% of their calories from omega-3s.

Optional bonus credit: Write a book or publish a popular (non-peer-reviewed) article talking about how omega-3s are the key to stopping obesity/heart disease/cancer/other forms of random death, and cite frequently to studies of the above form that say no such thing.

There's only one piece of advice that there seems to be uniform agreement on, and that's "exercise frequently". So that's the piece of advice I consider worth following.

10:40 PM, December 26, 2008  
Blogger Edgehopper said...

I also note that very few of these "natives suffer when they move to America" type studies/anecdotes control for the factor that people in the West live long enough without random injury and starvation to get to have diseases like cancer and heart attacks. The rates for those diseases in Zimbabwe, for example, is probably extremely low, because the average person dies of cholera, starvation, diarrhea, or a gunshot wound to the head before building up enough plaque or random mutations to get heart disease or cancer, respectively.

10:43 PM, December 26, 2008  
Blogger Steve Parker, M.D. said...

Hi, Edgehopper.

Here's a link to a scientific article in support of the Mediterranean diet, a meta-analysis of 12 human studies published in peer-reviewed journals:

http://www.bmj.com/cgi/content/full/337/sep11_2/a1344

And my own comments at my healthy lifestyle blog:
http://advancedmediterraneandiet.com/blog/?p=70

-Steve

9:44 AM, December 27, 2008  
Blogger GawainsGhost said...

Hmmm. I believe in eating from the four main food groups: brisket, beans, bread, and beer.

10:05 AM, December 27, 2008  
Blogger Edgehopper said...

Observational studies, as you know, are the weakest medical evidence; all the studies in that meta-analysis were observational. Quoting from the paper:

"
Sample sizes varied between 161 and 214 284, with a follow-up time ranging from 3.7 to 18 years. Outcomes of interest were overall mortality, cardiovascular mortality, incidence of or mortality from neoplastic disease, and incidence of Parkinson’s disease and Alzheimer’s disease. Only six out of 12 studies were done in Mediterranean populations.w1 w3-w6 w12 The remaining cohorts comprised US populations,w8-w11 northern Europeans,w5-w7 and a cohort of Europeans living in Australia.w3 The total number of subjects in the included studies was 1 574 299."

So, half the studies were done in Mediterranean populations, with substantially different genetic populations. The other half were done in the West, and remember that America in particular is very genetically diverse. An obvious problem may be that the sorts of people who are willing and able to adhere to a Mediterranean diet are more affluent, have a different ethnic breakdown and therefore different genetics, or have other significant differences introducing systemic bias.

Another problem is that you're comparing a Mediterranean diet, which presumably automatically assumes that the diet's limited to a certain quantity, to the general population rather than diets of a similar profile. It may just be the case that any 2000 Cal diet will show that kind of effect over an average American diet (I want to say ~2500-2700 Cals?)

At best, the meta-analysis showed that people who adhered to a Mediterranean diet had a slightly decreased risk of mortality from CV and similar diseases (The risk dropped 9%, not 9 percentage points; an important difference. A decrease in risk from 10% to 9.1% is a 9% decrease, for example.) I'll admit it's better than most of the studies I've seen, but if this is the best that Mediterranean diet proponents can come up with, I don't find it particularly convincing. That's not to say that it's an unhealthy diet, but I'm very skeptical of any particular claimed health benefits. I'm even more skeptical of any diet/nutrition book including sensational phrases like "Miracle", "Hoax", "(But probably never will)", and similar.

10:20 AM, December 27, 2008  
Blogger Ern said...

eating is the one thing you can control

It is certainly one thing that you can control, and it's an important one. It's not the only one, however. As Dr Parker points out, regular exercise and avoiding obesity (perhaps an epiphenomenon of proper diet and sufficient exercise) are important. I'd add getting enough sleep. I don't know of any studies supporting my contention, but it sure seems to work for me.

11:12 AM, December 27, 2008  
Blogger I R A Darth Aggie said...

Hmmm...eat healthy, exercise regularly, die anyway.

On the other hand, isn't a staple of the Mediterranen lunch a bottle of wine? maybe not so bad after all.

11:38 AM, December 27, 2008  
Blogger Steve Parker, M.D. said...

Wow, Edgehopper, you're fast!

The Mediterranean diets in the British Medical Journal meta-analysis were not calorie-restricted or controlled. In this context, "diet" refers to a habitual way of eating. Like a horses "diet" is pasture grass or hay.

You are right that titles and marketing reveal much about a weight-loss book or program. Example: Dr Seth Roberts' Shangri-La Diet, subtitled "The No Hunger Eat Anything Weight-Loss Plan."

Yeah, right.

That's why I was disappointed to see Dr Connie Gutterson's Sonoma Diet subtitled "Trimmer waist, better health in just 10 days!" It's a great book, despite the sensational subtitle, and based on the Mediterranean diet. I bet her publisher tagged it on.

Either diet has no effect on longevity and chronic illness, or it does. If it does, what are you gonna eat?

-Steve

12:06 PM, December 27, 2008  
Blogger Sparks said...

The main components of a Mediterranean diet are whole (non-refined) grains, fresh fruits and vegetables, nuts such as almonds and walnuts which have omega-3 fatty acids, olive oil, red wine, complex carbohydrates, omega-3 fatty acids, tea, fruit and vegetable juices, cinnamon (some research shows the smell improves brain activity), and finally, dark chocolate.

I can't see how anybody can argue with that. We keep hearing over and over that these things individually are being touted for their health benefits. They're all delicious too. Who knew that a healthy diet could taste so good.

I didn't hear that cinnamon was linked to brain activity. I love cinnamon. BTW, you want to taste some real cinnamon, let me suggest that you try the Vietnam or China Cassia Cinnamon that you can get from Penzey's. Your standard supermarket cinnamon by comparison tastes like wood dust with slight hints on cinnamon flavor. Penzey's cinnamon, especially those two varieties are amazing. Licking your finger, covering it with cinnamon, and putting it in your mouth is like putting a fireball in your mouth. Amazing.

I'm not affiliated with Penzey's in any way. Just passing on some good information for cinnamon lovers.

Get a 1 lb bag if it and share some with your friends.

12:37 PM, December 27, 2008  
Blogger fred said...

Edgehopper: Bill Rogers, winner of a lot of marathons, worked out by running 20 per day, every day of the week.Tested by his pal, a doctor, for health via blood work, Rogers discovered that all the junk food he consumed daily was clogging his veins and he had to switch to a healthier diet. He did and his blood work oddly enough improved considerably. Moral? more than exercise needed.

12:50 PM, December 27, 2008  
Blogger Edgehopper said...

Steve-

That wasn't my criticism of the study--diet doesn't necessarily mean calorie controlled, of course. But someone who consciously decides to adhere to a Mediterranean diet in America may, for example, be more likely to follow a more restricted calorie diet than someone who does absolutely nothing. That alone could make a difference, or it could be the case that another set of factors that influences whether someone is willing to follow a particular diet leads to better mortality results. For example, a more affluent person may be more inclined to shop for the particular high end foods that make a Mediterranean diet more pleasant, and have much better access to health care; you have to control for health care to conclude that the diet was the important factor in an observational study.

Fred-

The plural of anecdote is not data--even if the anecdote is a really good one. I'd have to see some good data to conclude that there's something special and good about the Mediterranean diet. Remember, it was only a few decades ago that dietary fat in all its forms was the villain, and olive oil and similar components of the Mediterranean diet were considered bad.

I'm not saying there's anything bad about a Mediterranean diet, just that there doesn't seem to be any good evidence that there's anything particularly good about it either. And if you enjoy following such a diet, then have fun. But there is a cost to following particular ways of eating if you don't actually enjoy them. Doctors, especially nutritionists, have a tendency to forget that. The benefits may be worth the cost for some patients with particular medical conditions (diabetics should severely restrict sugar intake, for example.) But if you're prescribing a particular diet for the general population, you need some good data to back it up.

6:59 PM, December 27, 2008  
Blogger Steve Parker, M.D. said...

Edgehopper, your last comments to me are quite valid.

Thanks for the civility. I often hesitate to get involve with diet debates since diet preferences are like a religion to some people.

I strive to defend my positions with facts. But facts don't change someone's faith.

-Steve

8:06 PM, December 27, 2008  
Blogger br549 said...

Trying to get away from high fructose corn syrup will make grocery shopping quite a job. It's amazing. That stuff is everywhere.

I guess it's true........if it tastes good, spit it out.

Rats.

7:28 AM, December 28, 2008  
Blogger fred said...

My "issue" here is only with the notion that exercise all by itself will take care of any and all diet problems.Though I am a firm believer in exercise I also believe that what you eat has some impact. I distrust most diets, or at least do not believe in them as regimen. Moderation in how much and how often and the sizes of portions seems a good idea. Have just read a study that raises questions about the uses of microwaved food and what it does to the food and to the body. But that is off topic.

9:37 AM, December 28, 2008  
Blogger Dragon Hawk said...

> (diabetics should severely restrict sugar intake, for example.) <<

Actually, this is not true. Diabetic diets are considerably more complex than this. Table sugar has a lower glycemic index then, say, a baked potato, for example, though it is true that in the past diabetics were told to shun sugar, even fruit of any kind in some cases. Some diabetics were even told not to eat carrots because they had a high sugar content. But carrots, like most non-starchy veggies, have a pretty low glycemic index. But no longer is a "carb is a carb is a carb is a carb". Some are better than others. I know because I'm a diabetic who tests blood glucose daily, and I can see immediately how different foods and different activities impact blood glucose levels.

More proof that the "science" of diets continues to evolve. People need to do their own investigations, and do a little experimentation of their own, different bodies respond differently to different diets. It's not easy. Is the Mediterranean diet a good one? Probably for some, maybe even most people. If you have health issues, I'd get a bunch of blood work done, try the diet for 6 months, then do the blood work again. YMMV

1:29 PM, December 28, 2008  
Blogger Mel said...

Jesus. H. Christ.

STOP DIETING.

EAT SENSIBLE PORTIONS OF MINIMALLY PROCESSED FOODS.

TURN OFF YOUR TV AND GO FOR A WALK.

GO TO BED AT A DECENT HOUR.

Seriously.

12:14 PM, December 29, 2008  
Blogger Evan M. Thomas said...

I read this while eating a hamburger at a bar. Thanks for helping my meal go well :)

As to the article, the cultivation of the cow helped lead to the creation of human society - by providing an easy source of protein in meat and milk. This can be seen in recent genetic adaptations by humans and their cats to allow consumption of cow's milk.

So I will enjoy my burger and know that without the cow there would probably not be a diet guru around to tell me not to.

8:45 PM, December 29, 2008  
Blogger El Duderino said...

I once went to Greece for a month with a dozen friends. We ate huge breakfasts that were only interrupted by lunch. We ate out every night at nice restaurants and in thirty days I lost about thirty pounds. Was it the food or the fact that for thirty days I didn’t sit on one couch or watch one second of TV? I think it was the non stop snorkeling, hiking, dancing, etc.. I don’t think the Greeks know anything about HFCS or anything else invented since Pericles died, but they sure as hell can cook and they had some great fruit particularly on Naxos.

4:24 AM, December 30, 2008  
Blogger Joe said...

Take a 100 people, do full medical exams and blood work on them. Give the raw material to the best doctors in the world and have them predict who will have heart attacks, diabetes, heart disease, etc. Turns out, this has been tried and the doctors did no better than chance with one exception--if the patient had high blood pressure (though even then the correlation was weak.)

* * *

"reduce free radicals and oxidative stress"

That screams scam right there. What a load of hooey.

4:53 PM, December 30, 2008  
Blogger 信次 said...

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