More proof Mediterranean diet can ward off heart disease

A Mediterranean diet high in olive oil, nuts, fish and fresh fruits and vegetables may help prevent heart disease and strokes, according to a large study from Spain. Past research suggested people who eat this type of diet have healthier hearts, but those studies couldn't rule out that other health or lifestyle differences had made the difference.

But for the new trial, written up in the New England Journal of Medicine, researchers randomly assigned study volunteers at risk of heart disease to a Mediterranean or standard low-fat diet for five years, allowing the team to single out the effect of diet in particular.

"This is good news, because we know how to prevent the main cause of deaths - that is cardiovascular diseases - with a good diet," said Miguel Angel Martinez-Gonzalez, who worked on the study at the Universidad de Navarra in Pamplona.

He and colleagues from across Spain assigned almost 7,500 older adults with diabetes or other heart risks to one of three groups.

Two groups were instructed to eat a Mediterranean diet - one supplemented with extra-virgin olive oil and the other with nuts, both donated for the study - with help from personalized advice and group meetings. The third study group ate a "control" diet, which emphasized low-far dairy products, grains and fruits and vegetables.

Over the next five years, 288 study participants had a heart attack or stroke, or died of any type of cardiovascular disease.

People on both Mediterranean diets, though, were 28 to 30 percent less likely to develop cardiovascular disease than those on the general low-fat diet, the researchers said.

The new study is the first randomized trial of any diet pattern to show benefit among people initially without heart disease, said Dariush Mozaffarian, who studies nutrition and cardiovascular disease at the Harvard School of Public Health.

It's the blend of Mediterranean diet components, and not one particular ingredient, that promotes heart health, according to Martinez-Gonzalez.

"The quality of fat in the Mediterranean diet is very good," he told Reuters Health. "This good source of calories is replacing other bad sources of calories. In addition, there is a wide variety of plant foods in the Mediterranean diet," he added, including legumes and fruits as desserts.

He suggested that people seeking to improve their diet start with small changes, such as forgoing meat one or two days a week, cooking with olive oil and drinking red wine with meals rather than hard alcohol.

Replacing a high-carbohydrate or high-saturated fat snack with a handful of nuts is also a helpful change, experts said.

"I think it's a combination of what's eaten and what's not eaten," said Mozaffarian, who wasn't involved in the study. "Things that are discouraged are refined breads and sweets, sodas and red meats and processed meats.

"The combination of more of the good things and less of the bad things is important."

Teresa Fung, a nutrition researcher at Simmons College in Boston, said that many people in the trial were already on medications, such as statins and diabetes drugs.

"The way I see it is, even if people are on medication already, diet has substantial additional benefit," she added. "This is a high-risk group, but I don't think people should wait until they become high-risk in order to change." SOURCE: bit.ly/YuyV7v (Reporting from New York by Genevra Pittman at Reuters Health; editing by Elaine Lies)

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Mediterranean diet may be better for your heart than cutting down on fat

If you want to reap heart-healthy benefits, you may want to go on the Mediterranean diet.

A Spanish study, published in the New England Journal of Medicine on Feb. 25, showed the Mediterranean diet was able to help people who were at high risk for cardiovascular disease more than a low-fat diet. What's more, subjects who ate a Mediterranean diet heavy in nuts had the largest reduction in stroke risk.

The Mediterranean Diet asks eaters to follow a pyramid that emphasizes fruits, vegetables, whole grains, olive oil, beans, nuts, legumes, seeds, herbs and spices. People are asked to eat fish and seafood at least two times a week, consume poultry, eggs, cheese and yogurt in moderate daily to weekly amounts and avoid red meats and sweets when they can. Drinking plenty of water and having wine in moderation are also encouraged.

The researchers looked at a group of 7,447 people in Spain who had a risk factors for heart disease including smoking, being overweight, having high cholesterol, high blood pressure and diabetes. All participants were between the ages of 55 to 80 years of age.

The subjects were instructed to follow either a Mediterranean diet that emphasized nuts, a Mediterranean diet that focused on olive oil, or a low-fat diet, and they were followed-up with for about five years. The olive oil group consumed about 34 ounces of olive oil a week, while those in the nuts group ate about one ounce of walnuts, hazelnuts and almonds a day. Both Mediterranean diet groups consumed vegetables, fruits, fish, drank wine with meals and occasionally ate white meat while avoiding red meat.

Groups that ate the Mediterranean diet regardless of if they ate more nuts or olive oil had a 30 percent greater reduction in heart disease risks compared to the low-fat group. Particularly, the olive-oil group had a 33 percent reduction in stroke risk, while the nuts group had a 46 percent lower stroke risk.

Dr. Steven E. Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic Foundation, pointed out to the New York Times that the benefits of low-fat diets have not been as lauded because they are hard to maintain.

"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."

In addition, the Mediterranean diet shows that people don't necessarily need to cut all fats from their life in order to live a healthy lifestyle, Walter Willet, chair of the department of nutrition at the Harvard School of Public Health, told USA Today. The Mediterranean diet is rich in "healthy fats" like omega-3 fatty acids found in salmon and walnuts, but is low in saturated fats from fried foods.

"Fat in the diet continues to be demonized, even though the evidence is clear that some types of fat improve blood cholesterol," Willett said. "This study adds further proof that diets high in healthy fats can be superior to a low-fat diet."

But , Dean Ornish, president of the non-profit Preventive Medicine Research Institute and clinical professor at the University of California, San Francisco -- who created the Ornish diet -- explained to USA Today that the study's low-fat group only lowered their calories from fat consumption from 39 percent to 37.

Ornish said the American Heart Association encourages a diet with less than 30 percent calories from fat, and his diet pushes people to get less than 10 percent of their calories from fat. He believed that the researchers may have exaggerated what they discovered, and that the declines in heart attacks and death found by the researchers may actually just be due to chance.

"The authors should have concluded that the Mediterranean diet reduced cardiovascular risk when compared to whatever diet they were eating before, not when compared to a low-fat diet," Ornish said.

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