Mediterranean diet

<div dir="ltr" style="text-align: left;" trbidi="on"><img alt="Mediterranean diet" src="http://www.trbimg.com/img-512d4268/turbine/la-ol-mediterranean-diet-study-20130226-001/599" /><br /><span style="background-color: #f2f2f2; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 12px;">Sardines and other fish are part of the Mediterranean diet. </span><span class="credit" style="background-color: #f2f2f2; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 12px;">(<span class="photographer">Getty Images</span> / <span class="dateMonth">February </span><span class="dateDay">26</span><span class="dateYear">, 2013</span>)</span><br /><span class="credit" style="background-color: #f2f2f2; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 12px;"><span class="toolSet" style="background-color: white; display: inline-block; font-size: 14px; margin-bottom: 14px; margin-right: -50px; margin-top: 6px; width: 335px;"></span></span><br /><div class="byline" style="color: #292727; float: left; font-size: 13px; margin: 0px 0px 12px; padding: 0px;"><span class="byline" style="display: block;">By Karin Klein</span><div class="date" style="color: #930000; font-size: 11px; font-style: italic; margin-top: 3px; padding: 0px;"><span class="dateString" style="display: inline;">February 26, 2013</span><span class="dateTimeSeparator" style="border-left-color: rgb(0, 0, 0); border-left-style: solid; border-left-width: 1px; color: white; display: inline; font-size: 10px; letter-spacing: -1px; margin-left: 6px;">, </span><span class="timeString" style="display: inline; text-transform: lowercase;">3:39 p.m.</span></div></div><div class="clear" style="clear: both; margin: 0px; padding: 0px;"></div><span style="background-color: white; font-size: 14px;"></span><div id="story-body-text" style="background-color: white; font-size: 14px; line-height: 1.43; margin: 0px; padding: 0px; position: relative;"><div style="margin-bottom: 10px; margin-top: 10px; padding: 0px;">It sounds like a happy hour dream: Now, scientists say, you can have your wine and eat the nuts that go with it, and be healthier in the bargain. A rigorous new study published in the New England Journal of Medicine should finally put to rest any doubts about whether a <a class="taxInlineTagLink" href="http://www.latimes.com/topic/health/diets-dieting/mediterranean-diet-HEDI00008.topic" id="HEDI00008" style="color: #666666; text-decoration: none;" title="Mediterranean Diet">Mediterranean diet</a> -- rich in olive oil or nuts as well as fish, with a glass of wine per day also allowed -- promotes better cardiovascular health than the way most of us eat. It does.</div><div style="margin-bottom: 10px; margin-top: 10px; padding: 0px;">That might not be surprising, but up to now, advice on the Mediterranean diet has been based on correlation: People in Mediterranean areas that tend to follow that way of eating experienced lower incidence of stroke and other cardiovascular problems. Could the difference have been genetic? Could people who ate that way also be doing other things that made the crucial difference? The new study, conducted in Spain, randomly assigned a large number of subjects to different eating styles, made sure they were following it and measured results -- not lab-test results but illness and death.</div><div style="margin-bottom: 10px; margin-top: 10px; padding: 0px;">But what about the long-standing battle between those who believe that a very <a class="taxInlineTagLink" href="http://www.latimes.com/topic/health/diets-dieting/low-fat-diet-HEDI000010.topic" id="HEDI000010" style="color: #666666; text-decoration: none;" title="Low Fat Diet">low-fat diet</a> is the best way to fend off cardiac risk, and those who espouse a way of eating much higher in the so-called good fats? Should all of the people carefully counting their daily fat grams give up the effort and take a spoonful of medicine in the form of olive oil? (Or, as the study had it, four tablespoons a day -- close to 500 calories of fat before you've eaten a solid thing.) Here the situation is much more complicated.</div><div style="margin-bottom: 10px; margin-top: 10px; padding: 0px;">The study meant to compare the two. The control group was supposed to eat a <a class="taxInlineTagLink" href="http://www.latimes.com/topic/health/diets-dieting/low-fat-diet-HEDI000010.topic" id="HEDI000010" style="color: #666666; text-decoration: none;" title="Low Fat Diet">low-fat diet</a>. The problem, as reported in the <a href="http://www.nytimes.com/2013/02/26/health/mediterranean-diet-can-cut-heart-disease-study-finds.html?pagewanted=all" style="color: #2262cc; text-decoration: none;">New York Times</a> and the <a href="http://online.wsj.com/article/SB10001424127887324338604578326160736614012.html?mod=googlenews_wsj" style="color: #2262cc; text-decoration: none;">Wall Street Journal,</a> was that those people barely reduced their fat intake, even after receiving additional coaching. That's why the <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1200303?query=featured_home&#t=articleResults" style="color: #2262cc; text-decoration: none;">article</a> words things this way:</div><div style="margin-bottom: 10px; margin-top: 10px; padding: 0px;">"We designed a randomized trial to test the efficacy of two Mediterranean diets (one supplemented with extra-virgin olive oil and another with nuts), as compared with a control diet (advice on a low-fat diet), on primary cardiovascular prevention."</div><div style="margin-bottom: 10px; margin-top: 10px; padding: 0px;">The researchers could have made that clearer at the get-go: Receiving advice on a diet isn't the same as eating that way most days. So the actual comparison was between a Mediterranean diet and the standard way of eating among Spaniards (who apparently, in many ways, are not following a Mediterranean diet no matter what their geographical location happens to be).</div><div style="margin-bottom: 10px; margin-top: 10px; padding: 0px;">What this study may have shown us about the difference between Mediterranean and low fat is that the former is easier to follow. There were no big problems getting subjects to ingest olive oil, wine and seafood. Low fat? Not so much.</div><div style="margin-bottom: 10px; margin-top: 10px; padding: 0px;">The believers in low-fat diets could legitimately argue that the control group received too little coaching and support for their way of eating. But there's also a reality that has to be taken into account. No matter what future research shows about the value of a low-fat or very low-fat diet, when it comes to improving public health, we might need not just a healthier diet but one that large numbers of people will find sustainable over a lifetime.</div></div></div>

Mediterranean Diet Mediterranean diet

Sardines and other fish are part of the Mediterranean diet. (Getty Images / February 26, 2013)By Karin KleinFebruary 26, 2013, 3:39 p.m.It sounds like a happy hour dream: Now, scientists say, you can have your wine and eat the nuts that go with it, a…

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Mediterranean Diet Shown to Ward Off Heart Attack and Stroke

<div dir="ltr" style="text-align: left;" trbidi="on"><img src="http://graphics8.nytimes.com/images/2013/02/25/science/video-tc-130225-diet/video-tc-130225-diet-articleLarge.jpg" /><br /><span style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 15px; line-height: 22px;">About 30 percent of heart attacks, strokes and deaths from heart disease can be prevented in people at high risk if they switch to a Mediterranean diet rich in olive oil, nuts, beans, fish, fruits and vegetables, and even drink wine with meals, a large and rigorous new study has found.</span><br /><br /><div itemprop="articleBody" style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 1.5em; line-height: 1.467em; margin-bottom: 1em;"><br /></div><div itemprop="articleBody" style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 1.5em; line-height: 1.467em; margin-bottom: 1em;">The findings, <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1200303?query=featured_home#t=article" style="color: #666699;" title="Article from The New England Journal of Medicine">published</a> on The <a class="meta-org" href="http://topics.nytimes.com/top/reference/timestopics/organizations/n/new_england_journal_of_medicine/index.html?inline=nyt-org" style="color: #666699;" title="More articles about New England Journal of Medicine">New England Journal of Medicine</a>’s Web site on Monday, were based on the first major clinical trial to measure the diet’s effect on heart risks. The magnitude of the diet’s benefits startled experts. The study ended early, after almost five years, because the results were so clear it was considered unethical to continue.</div><div itemprop="articleBody" style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 1.5em; line-height: 1.467em; margin-bottom: 1em;">The diet helped those following it even though they did not lose weight and most of them were already taking statins, or <a class="meta-classifier" href="http://health.nytimes.com/health/guides/test/blood-pressure/overview.html?inline=nyt-classifier" style="color: #666699;" title="In-depth reference and news articles about Blood Pressure.">blood pressure</a> or <a class="meta-classifier" href="http://health.nytimes.com/health/guides/disease/diabetes/overview.html?inline=nyt-classifier" style="color: #666699;" title="In-depth reference and news articles about Diabetes.">diabetes</a> drugs to lower their heart disease risk.</div><div itemprop="articleBody" style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 1.5em; line-height: 1.467em; margin-bottom: 1em;">“Really impressive,” said Rachel Johnson, a professor of nutrition at the University of Vermont and a spokeswoman for the American Heart Association. “And the really important thing — the coolest thing — is that they used very meaningful endpoints. They did not look at risk factors like <a class="meta-classifier" href="http://health.nytimes.com/health/guides/nutrition/cholesterol/overview.html?inline=nyt-classifier" style="color: #666699;" title="In-depth reference and news articles about Cholesterol.">cholesterol</a> or <a class="meta-classifier" href="http://health.nytimes.com/health/guides/disease/hypertension/overview.html?inline=nyt-classifier" style="color: #666699;" title="In-depth reference and news articles about Hypertension.">hypertension</a> or weight. They looked at heart attacks and strokes and death. At the end of the day, that is what really matters.”</div><div itemprop="articleBody" style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 1.5em; line-height: 1.467em; margin-bottom: 1em;">Until now, evidence that the Mediterranean diet reduced the risk of heart disease was weak, based mostly on studies showing that people from Mediterranean countries seemed to have lower rates of heart disease — a pattern that could have been attributed to factors other than diet.</div><div itemprop="articleBody" style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 1.5em; line-height: 1.467em; margin-bottom: 1em;">And some experts had been skeptical that the effect of diet could be detected, if it existed at all, because so many people are already taking powerful drugs to reduce heart disease risk, while other experts hesitated to recommend the diet to people who already had weight problems, since oils and nuts have a lot of calories.</div><div itemprop="articleBody" style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 1.5em; line-height: 1.467em; margin-bottom: 1em;"><a class="meta-classifier" href="http://health.nytimes.com/health/guides/disease/coronary-heart-disease/overview.html?inline=nyt-classifier" style="color: #666699;" title="In-depth reference and news articles about Heart Disease.">Heart disease</a> experts said the study was a triumph because it showed that a diet was powerful in reducing heart disease risk, and it did so using the most rigorous methods. Scientists randomly assigned 7,447 people in Spain who were overweight, were smokers, or had diabetes or other risk factors for heart disease to follow the Mediterranean diet or a low-fat one.</div><div itemprop="articleBody" style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 1.5em; line-height: 1.467em; margin-bottom: 1em;">Low-fat diets have not been shown in any rigorous way to be helpful, and they are also very hard for patients to maintain — a reality borne out in the new study, said Dr. Steven E. Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic Foundation.</div><div itemprop="articleBody" style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 1.5em; line-height: 1.467em; margin-bottom: 1em;">“Now along comes this group and does a gigantic study in Spain that says you can eat a nicely balanced diet with fruits and vegetables and olive oil and lower heart disease by 30 percent,” he said. “And you can actually enjoy life.”</div><div itemprop="articleBody" style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 1.5em; line-height: 1.467em; margin-bottom: 1em;">The study, by Dr. Ramon Estruch, a professor of medicine at the University of Barcelona, and his colleagues, was long in the planning. The investigators traveled the world, seeking advice on how best to answer the question of whether a diet alone could make a big difference in heart disease risk. They visited the Harvard School of Public Health several times to consult Dr. Frank M. Sacks, a professor of cardiovascular disease prevention there.</div><div itemprop="articleBody" style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 1.5em; line-height: 1.467em; margin-bottom: 1em;">In the end, they decided to randomly assign subjects at high risk of heart disease to three groups. One would be given a low-fat diet and counseled on how to follow it. The other two groups would be counseled to follow a Mediterranean diet. At first the Mediterranean dieters got more intense support. They met regularly with dietitians while members of the low-fat group just got an initial visit to train them in how to adhere to the diet, followed by a leaflet each year on the diet. Then the researchers decided to add more intensive counseling for them, too, but they still had difficulty staying with the diet.</div><div itemprop="articleBody" style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 1.5em; line-height: 1.467em; margin-bottom: 1em;">One group assigned to a Mediterranean diet was given extra-virgin olive oil each week and was instructed to use at least 4 four tablespoons a day. The other group got a combination of walnuts, almonds and hazelnuts and was instructed to eat about an ounce of the mix each day. An ounce of walnuts, for example, is about a quarter cup — a generous handful. The mainstays of the diet consisted of at least three servings a day of fruits and at least two servings of vegetables. Participants were to eat fish at least three times a week and legumes, which include beans, peas and lentils, at least three times a week. They were to eat white meat instead of red, and, for those accustomed to drinking, to have at least seven glasses of wine a week with meals.</div><div itemprop="articleBody" style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 1.5em; line-height: 1.467em; margin-bottom: 1em;">They were encouraged to avoid commercially made cookies, cakes and pastries and to limit their consumption of dairy products and processed meats.</div><div itemprop="articleBody" style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 1.5em; line-height: 1.467em; margin-bottom: 1em;">To assess compliance with the Mediterranean diet, researchers measured levels of a marker in urine of olive oil consumption — hydroxytyrosol — and a blood marker of nut consumption — alpha-linolenic acid.</div><div itemprop="articleBody" style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 1.5em; line-height: 1.467em; margin-bottom: 1em;">The participants stayed with the Mediterranean diet, the investigators reported. But those assigned to a low-fat diet did not lower their fat intake very much. So the study wound up comparing the usual modern diet, with its regular consumption of red meat, sodas and commercial baked goods, with a diet that shunned all that.</div><div itemprop="articleBody" style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 1.5em; line-height: 1.467em; margin-bottom: 1em;">Dr. Estruch said he thought the effect of the Mediterranean diet was due to the entire package, not just the olive oil or nuts. He did not expect, though, to see such a big effect so soon. “This is actually really surprising to us,” he said.</div><div itemprop="articleBody" style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 1.5em; line-height: 1.467em; margin-bottom: 1em;">The researchers were careful to say in their paper that while the diet clearly reduced heart disease for those at high risk for it, more research was needed to establish its benefits for people at low risk. But Dr. Estruch said he expected it would also help people at both high and low risk, and suggested that the best way to use it for protection would be to start in childhood.</div><div itemprop="articleBody" style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 1.5em; line-height: 1.467em; margin-bottom: 1em;">Not everyone is convinced, though. Dr. Caldwell Blakeman Esselstyn Jr., the author of the best seller “Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure,” who promotes a vegan diet and does not allow olive oil, dismissed the study.</div><div itemprop="articleBody" style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 1.5em; line-height: 1.467em; margin-bottom: 1em;">His views and those of another promoter of a very-low-fat diet, Dr. Dean Ornish, president of the nonprofit Preventive Medicine Research Institute, have influenced many to try to become vegan. Former President Bill Clinton, interviewed on CNN, said Dr. Esselstyn’s and Dr. Ornish’s writings helped convince him that he could reverse his heart disease in that way.</div><div itemprop="articleBody" style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 1.5em; line-height: 1.467em; margin-bottom: 1em;">Dr. Esselstyn said those in the Mediterranean diet study still had heart attacks and strokes. So, he said, all the study showed was that “the Mediterranean diet and the horrible control diet were able to create disease in people who otherwise did not have it.”</div><div itemprop="articleBody" style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 1.5em; line-height: 1.467em; margin-bottom: 1em;">Others hailed the study.</div><div itemprop="articleBody" style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 1.5em; line-height: 1.467em; margin-bottom: 1em;">“This group is to be congratulated for carrying out a study that is nearly impossible to do well,” said Dr. Robert H. Eckel, a professor of medicine at the University of Colorado and a past president of the American Heart Association.</div><div itemprop="articleBody" style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 1.5em; line-height: 1.467em; margin-bottom: 1em;">As for the researchers, they have changed their own diets and are following a Mediterranean one, Dr. Estruch said.</div><div itemprop="articleBody" style="background-color: white; font-family: georgia, 'times new roman', times, serif; font-size: 1.5em; line-height: 1.467em; margin-bottom: 1em;">“We have all learned,” he said.</div></div>

Mediterranean Diet Mediterranean Diet Shown to Ward Off Heart Attack and Stroke

About 30 percent of heart attacks, strokes and deaths from heart disease can be prevented in people at high risk if they switch to a Mediterranean diet rich in olive oil, nuts, beans, fish, fruits and vegetables, and even drink wine with meals, a lar…

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