Further Reflections on the Mediterranean Diet Findings

Michael Milken
Michael Milken

There’s been a lot of euphoria, I think mistaken, over the recent research  findings evaluating the Mediterranean diet.  (See my earlier post, “On the New Mediterranean study:  Proceed with Caution” [March 1, 2013.])  Not only was the alternative low fat diet administered in pedestrian fashion,  e. g., inadequate counseling, but a substantial number of those on the Mediterranean diet suffered heart attacks or strokes.  We need to remember that none of the participants had a history of either at the outset of  the experiment.

But let me be fair.  We’re all different and there’s no plug-in diagnostic that’s going to yield a universal physical metric.  This applies to diet, surely, and explains the plethora of approaches which work for some, but not others.  What we do know is that following a diet that emphasizes complex carbohydrates, low sugar, minimal saturated fats, and plenty of nutrient dense fruits and vegetables along with reduced sodium intake is beneficial.

The Mediterranean diet thus moves in the right direction, but would be even more effective were it to reduce meat and dairy product content.  We might then see not only reduction in coronary disease, but its reversal, which truly low fat diets (10% consumption of total calories) have consistently demonstrated in extended government studies.

But let me bring up the Michael Milken story.  Do you remember him?  One of Wall Street’s top investors, he was indicted by the government in 1989 for racketeering and securities fraud and served 22 months in prison.  What followed is a story that moves us with its redemption.

Worse than prison, Mike was diagnosed in 1993 with Stage IV prostate cancer at just age 46.  Biopsy indicated it had metastasized and spread to his lymph nodes; consequently, his doctor advised that his scheduled prostatectomy wouldn’t save him.

Mike responded where others might have given-up, launching vigorous research, founding the CaP Cure foundation, and making major changes in his diet by adopting a nonfat, vegetarian regimen.  For Mike, a typical diet will feature mushroom barley soup, a tofu mock egg salad sandwich replete with tofu, carrots and lettuce, and a black bean and corn salad, accompanied by a soy drink.

Mike also founded and heads the Prostate foundation, working closely with Major League Baseball and matching every donated dollar.

It’s now 20-years since that fatal diagnosis.  Mike?  He’s still out there going strong and giving hope to thousands.

You’ll find many of Mike’s favorite low fat, soy-based foods, compiled with the aid of Beth Ginsberg, a grad of the Culinary Institute of America, gathered in The Taste for Living World Cookbook.  With its subtly delicious recipes, it’s a best buy.

On the new Mediterranean Diet Study: Proceed with Caution

I’ve been reading about the excitement in the medical community over the results of the first sustained clinical study of the effects of switching to the much touted Mediterranean diet for those at high risk for cardiac disease.  You can read the results in detail at the the New England Journal of Medicine website (NEJM.org).  You’ll recall that this diet abounds in olive oil, nuts, beans, vegetables and fish.  Whether participants took statins, were diabetic, or hypertensive, or overweight, the results across the board showed a 30% reduction in heart attacks, stroke, and death.

The study, encompassing 7,447 people in Spain, employed two diet regimens:  the Mediterranean and a low fat diet.  Up to now, evidence for the efficacy of the Mediterranean diet has been inconclusive, while the low fat approach hasn’t been shown to be effective in previous studies, primarily because many people find it hard to stay with.

Unfortunately, appearance, as in so many things, may not be the reality, given the human tendency, even in the sciences, to make unwarranted associations; for example, while the medical establishment has pummeled cholesterol as the primary villain in cardiac disease and urged us to cut down on organic meats, the truth is that only about 20% of our total cholesterol derives from our food.  That helps explain why nearly half of those suffering heart attacks have low LDL levels.  Inflammation, not cholesterol, is more likely a primary instigator.

While olive oil, a staple of the Mediterranean diet, is widely believed to reduce inflammation, thus promoting a healthy heart, it actually impairs endothelial function like most oils and should be avoided.  I have to scratch my head sometimes at the absurdity of health authorities telling us to reduce saturated fat foods, then waxing enthusiastic about olive oil, which is 14% saturated fat!  Ironically, canola and flax seed oil are better for you because of their greater omega-3 content, though still to be avoided.  (See Vogel RA. Corretti MC. Plotnick GD. The postprandial effect of components of the Mediterranean diet on endothelial function. Journal of the American  College of Cardiology. 36(5):1455-60, 2000 Nov 1).

Behind the diet’s success lies its plethora of vegetable, fish, whole grains and, yes, red wine.  In any event, the new research doesn’t halt or reverse heart disease because it doesn’t limit oils. On the other hand, low fat diets (10 % max) do succeed when consistently followed. The problem is getting people to stick with a sharply reduced fat diet ( i. e., vegan), an admitted weakness in the just concluded study. Not incidentally, those on the low fat diet were, for a time, not given the ample support those on the Mediterranean diet enjoyed, which in my view suggests bias or pedestrian methodology from the very outset.

What’s more, the study’s low fat group consumption was a mere 37%, and not the 10% of truly low fat diets shown to prevent and reverse heart disease. It should be noted, as well, that many of the study’s proponents have ties to food interests, including the Spanish government.

But let’s look at the facts about the original Lyon Heart Study (1995), which utilized the Mediterranean diet, specifically Cretan version, for its research findings, launching near universal medical endorsement along with a tsunami of new cookbooks. Mortality rates from heart disease declined by 70% among those on the Cretan diet vs those on a normally prescribed diet for reducing coronary risk.

In retrospect, the facts are that the Lyon diet actually reduced total fat consumption from the 40% in the Cretan diet to 30% and limited dairy intake and meats, while emphasizing salads, vegetables and grains.

But then why did the Cretans enjoy a lower mortality rate, considering their higher fat in-take?  For one thing, they still ate a largely plant diet and worked very hard.  For another, the study found that canola oil with its high omega-3 fatty acids was a significant  factor, not olive oil, which has a low omega-3 content.  Omega-3 fatty acids reduce inflammation whereas omega-6 fatty acids can increase it.

However, what the media ignores is that by the end of the Lyon Diet Heart Study, nearly four years after its start, fully 25% of the subjects on the Mediterranean Diet had either died or undergone a cardiovascular event.

If you’re like me, you’ve grown tired of medical flip-flops.  In some circles, physicians like Dr. Walter Willett at Harvard’s school of Public Health have been promoting unlimited quantities of so called “good fats.” The truth is that fats play a leading role in fostering heart disease through weight gain. Saturated fat can mount up and is especially dangerous.  Olive oil is rich in the latter.  The clincher for me, at least, is the Vogel study I alluded to earlier.

The bottom line, as in so many areas of life, is to be wary of new enthusiasms in medicine that have their vogue, only to fade quickly–in part, because they’ve often proven dangerous. The Mediterranean diet goes right in its emphasis on whole grains, vegetables, and omega-3 fatty acids.  It goes wrong when we misuse it to overeat or
overload with fats of any kind.

A low fat diet at 10% of total calories combined with unrefined foods and low glycemic load remains the pathway to optimal digestive and coronary health. When adhered to, its potential to reverse heart disease has been demonstrated consistently, something the Mediterranean diet per se cannot claim.


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