If You Eat the Mediterranean Way, Can You Drop Your Heart Meds?

Italian olive oil image credit: Wikipedia

Earlier this week, results from a massive study on the benefits of the Mediterranean diet were published in the New England Journal of Medicine. The study–which lasted five years and included 7,500 participants ages 55-80–was a triumph for the Med diet, but there are a few important caveats to consider.

As you’ve likely heard, the Mediterranean diet is high in olive oil, fish, nuts, wine and vegetables – it’s not a low-fat diet by any means, but the fats mostly come from monounsaturated sources (olive oil and nuts).

Participants in this study who ate the Med way consumed about 200 calories more per day than the participants who ate a low-fat diet heavy on bread, potatoes, pasta, rice, fruits, vegetables and fish and light on baked goods, nuts, oils and red meat.

Despite the additional calories, results showed that participants eating the Med way had a 30 percent lower risk of major cardiovascular problems compared to those who were told to follow a low-fat diet.  Doctors tracked heart attacks, strokes and heart-related deaths over the course of the study; there were 96 in the Mediterranean-olive oil group, 83 in the Mediterranean-nut group and 109 in the low-fat group.

Why is this study different and important?

For years the Med way of eating has been touted as healthier than low-fat diets, but those claims lacked clinical evidence. Until this study, evidence for the Med diet came from observational studies of health outcomes (such as the Seven Countries Study). In the latest study, participants were not only tracked for years, but were given periodic blood tests to ensure people were eating enough nuts and olive oil to make a difference.  The blood tests added a clinical evaluation layer that other studies didn’t have.

Does this study tell us that we can eat the Med way instead of taking cardiovascular medications?

No, it does not. In fact, most of the participants in this study assigned to eating the Med diet were already taking prescription medications for cholesterol and blood pressure, and researchers did not alter those prescriptions in any way. Also worth noting, half of the participants had diabetes.

Does this study show that the Med diet prevents all forms of heart disease?

No, but it does show a general decrease in heart-disease outcomes (heart attacks and strokes) in people eating the Med way. When the results are looked at per individual, strokes were the only heart disease outcome to show a significant decrease due to diet. Overall death rates were not affected by diet at all.

If people want to begin a diet closer to the Med way, what does this study say they should focus on most?

Extra virgin olive oil and nuts–specifically walnuts, hazelnuts and almonds. In the study, the two Mediterranean diet groups were supplemented with either four tablespoons a day of extra virgin olive oil or a fistful of nuts. Of these two groups, the Med way-nut group showed the greatest benefits, but both groups did well compared to the third, low-fat group.

Why “extra virgin” olive oil?

While it’s not entirely clear why, or if, extra virgin olive oil is better than other forms of olive oil with respect to heart health, it is less processed and richer in oleic acid than less expensive olive oils. Oleic acid is a monounsaturated fatty acid that previous research has suggested may be a key to improving heart health.

Sources:

The New England Journal of Medicine

AP News 

The Mayo Clinic

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For Tampa doctor, Mediterranean diet news is mom's wisdom

The latest news about the benefits of the Mediterranean diet came as no surprise to Dr. Carmela Sebastian, a Tampa resident and senior medical director for Florida Blue.

"I'm so glad that the world is finally agreeing with what my parents have been saying for years," said the 50-year-old internal medicine specialist, whose family is Italian. Sebastian, who has a healthy living website and is a frequent TV guest on wellness topics, devotes part of her upcoming book to the Mediterranean diet. Sex and Spaghetti Sauce: My Italian Mother's Recipe for Getting Healthy and Getting Busy in Your 50s and Beyond is due out in mid March.

The New England Journal of Medicine recently reported that the first major trial to evaluate the Mediterranean diet's effect on heart disease risk was stopped early, so overwhelming were the findings. The study of more than 7,000 people in Spain at risk of heart disease found the diet lowered the risk of heart attack, stroke and death from heart disease by 30 percent.

The diet — mostly fresh vegetables and fruit, legumes, nuts, fish several times a week, a glass of wine a day and up to a quarter cup a day of olive oil —is based on what people in Mediterranean countries have eaten for centuries. Study participants were counseled to avoid such known diet downers as prepackaged baked goods, sugary sodas, French fries and red meat.

If a quarter cup of olive oil a day sounds excessive to you, I should tell you that I was raised on the stuff. Meats, vegetables, rice and beans, the soft boiled eggs I ate every morning as a child — all of it was doused in a swirl of oil from my Puerto Rican mother's decorative cruet, a fixture on the table.

I caught up with Sebastian by phone this week to talk about the new research and how to apply it to everyday living.

What's so magical about the way people in the Mediterranean traditionally ate?

It's the food itself that's powerful and the portion sizes, which are smaller than what most Americans eat. It's not giant plates of spaghetti or Alfredo sauce on pasta. Italians in Italy don't eat like that. It's a small amount of pasta, usually with a light, vegetable and olive oil based sauce. It's a different way of eating that's also a lifestyle.

In the study, the comparison group was put on a low fat diet, but hardly anyone followed it. What do you think happened?

People will only stick to a meal plan that can work with their lifestyle. It is incredibly difficult to maintain a low fat diet. That's what is so good about this study. It proved that whatever diet or meal plan you choose, it has to fit with the way you really eat. It was easy for the Spaniards to live life on the Mediterranean diet. The foods were familiar and commonly eaten there.

People in the study didn't lose weight yet they lowered their heart disease risk.

Right, and they weren't encouraged to restrict calories or to exercise. That wasn't the point of the study. The idea was to find out the metabolic consequences of what we eat and its impact on heart disease and stroke. The food worked because it worked on a cellular level.

So what's the take home message?

That whole, fresh foods really are medicine and if we want to live a healthier life, we need to think about that. My Italian aunt is 95 years old. She has always eaten the Mediterranean way. Her brain is sharp and her skin is amazing.

How does the diet work in your life?

We live it. Tonight we are having lean, grilled pork chops, sweet potatoes and spinach sautéed in olive oil. We eat dinner out maybe once a week.

Have you converted anyone to this way of living?

My mother-in-law came to stay with us for a while when she was recuperating from surgery. She was in bad shape, obese, could hardly walk because of peripheral artery disease and was on 10 medications a day. I prepared all of her meals in the Mediterranean way. My husband, who's a personal trainer, got her up and walking around the neighborhood, eventually walking 2 miles a day. In the six weeks she was with us she lost 20 pounds and was down to just five pills a day. Now, I have to say, when she went back to her own home and her own cooking, she regressed, unfortunately.

For Tampa doctor, Mediterranean diet news is mom's wisdom 02/27/13 [Last modified: Wednesday, February 27, 2013 11:42pm]

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History is full of warnings about fiscal austerity

A Mediterranean diet, the New England Journal of Medicine reported Monday, can lengthen one’s life span. So inhabitants of southern Europe can look forward to long lives – of anxiety and privation.

Already mired in a depression comparable to that of the 1930s, Spain, Greece and Portugal are going to see things grow worse this year, according to an annual economic forecast released by the European Commission on Friday. Unemployment rates in both Spain and Greece – where a quarter of the populations are unemployed and the share of jobless young people exceeds 50 percent – will rise to 27 percent.

At least the leaders in power in 1930 had an excuse when the economy began to collapse. Then, there was genuine bewilderment among economists and governmental chieftains across the political spectrum about how to induce a recovery. From British Laborite Ramsay MacDonald to the German centrist Heinrich Bruning to American conservative Herbert Hoover, leaders cut spending to bring their budgets into balance.

These austerity policies proved an unmitigated disaster. By reducing government spending while business and consumer spending were tanking, these heads of government constricted all economic activity. In turn, unemployment continued to soar.

Frustrated with the inability of mainstream political parties to stop the collapse, voters in some nations turned to extremes – most notably, of course, in Germany.

Unlike their predecessors, today’s leaders have models on how to revive depressed economies. The example of Franklin Roosevelt, whose public investments in jobs and defense turned the U.S. economy around, and the writings of John Maynard Keynes, who demonstrated that the solution to depression is boosting demand, are plain for all to see. Seeing isn’t believing, however, when ideology dims the eye.

Today, in the spirit of the Bourbon kings who reclaimed power in post-Napoleonic France, having learned nothing during their exile, many European leaders are repeating the mistakes that their predecessors made in the ’30s: demanding that governments reduce spending even as their private-sector economies limp along.

Only this time around, the miracle of the euro has greatly the reduced the autonomy of many continental nations while giving their creditor, Germany, control over their destinies. German Chancellor Angela Merkel is imposing austerity budgets on other nations, even Spain, which had a string of balanced budgets before the 2008 collapse.

The economies of Mediterranean nations, the Merkelites complain, lag behind the productivity rates of their northern European neighbors. But boosting productivity – a goal that everyone embraces – requires more, not less, public investment in worker training, education, new industries and unemployment support.

The relationship between austerity and heightened productivity, whose existence Merkel continually proclaims, is real enough – but in Europe’s current economy, that relationship is inverse.

As in the 1930s, despair about the economic options before them has driven many voters to bizarre extremes. A quarter of Italian voters cast ballots this week for the anti-austerity xenophobic party of a professional comedian. In Spain, a movement for Catalonian separatism is growing.

More ominously, in Greece, an avowedly racist, fascist party involved in numerous instances of violence has won a bloc of seats in parliament. You might think Merkel would be cognizant of the links between economic hopelessness and the rise of fascism – but if she is, it hasn’t affected her austerity economics by so much as a pfennig.

The euro zone isn’t the only part of Europe where austerity is turning out to be a disaster. Britain is the one European nation that, since Prime Minister David Cameron’s conservatives came to power in 2010, has deliberately opted for punishing austerity to bring its budget into balance.

As a result, the British economy has slowed to a crawl, and its budget remains in the red. Last week, Moody’s stripped Britain of its AAA credit rating. In anti-Keynesian theory, austerity economics are supposed to protect one’s triple-A rating, not endanger it.

So much for anti-Keynesian theory.

The United States isn’t immune to Europe’s madness. The sequester slated to begin taking effect Friday is a particularly mindless form of an already stupid policy, poised to inflict a kind of blindfolded austerity at a time when unemployment remains high.

Republican opponents of government spending, not to mention tea party activists, like to think of themselves as true-blue Americans while disparaging the Democrats as Euro-socialists. But it’s the Republicans who are embracing Europe’s failed economics while Democrats attempt to adhere to the American success story of the New Deal.

Republicans might want to bone up on American history; it contains all kinds of valuable lessons.

Harold Meyerson is editor-at-large of The American Prospect. He wrote this for The Washington Post.

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Mediterranean Diet Decoded: What’s On The Menu For Mediterranean Dieters

Health experts are frequently touting the benefits of the “Mediterranean diet,” and with good reason: People prone to this way of eating tend to have better heart health, better brain health and greater longevity overall. A large, randomized Spanish study published online today provides solid evidence that the diet can seriously reduce heart attacks, stroke and death, even among high-risk groups like smokers and diabetics.

But though the term “Mediterranean diet” is tossed around frequently these days, it generally comes with little explanation. Something about fish, something about wine, something about nuts. Add olive oil and stir. Have further questions? Consult elsewhere.

Unlike commercial diet plans or those geared around some half-credible hook (the blood type diet, for instance), the Mediterranean diet actually doesn’t include an extensive set of rules. This is because no one “created” the Mediterranean diet; people in the region simply ate that way, organically, and at some point researchers began to take note of their good health.

With no creator to lay down laws and no publisher screaming for simplification, the Mediterranean diet is refreshingly flexible—more about guidelines than maxims; more eating a certain way that eat-this-not-that. The most important of these is to avoid processed snacks and junk food, focusing instead on fresh fruit, fresh vegetables, good fats and whole grains. Dairy and meat are to be limited; red wine is encouraged.

Here’s a look at what Mediterranean dieters in the new Spanish study ate. While not the only way to follow a Mediterranean diet, it provides an excellent general blueprint.

Recommended foods: 

Extra virgin olive oil: At least 4 tablespoons per day (this is including any oil used in cooking, salad dressings, etcetera).

Fresh fruit: At least three servings per day.

Vegetables: At least two servings per day.

Nuts: At least three servings per week are recommended. Study participants were given one serving of nuts daily, composed of walnuts (15 grams), almonds (7.5 grams) and hazelnuts (7.5 grams).

Seafood: At least three servings per week, especially of fatty fish like anchovies, salmon and sardines.

Legumes: At least three servings per week. This includes beans, peas and lentils.

Wine: At least 7 glasses per week, for those inclined to it; the researchers don’t recommend anybody take up drinking alcohol if they don’t already.

Sofrito: At least two servings per week. Sofrito is a sauce made of tomato and onion, often with garlic and other simmered herbs.

Foods to be limited: White meat. Dairy.

Discouraged: Red meat. Soda. Commercial bakery goods. Processed meats.

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'Mediterranean diet' of olive oil, fish, veggies may cut heart risks like stroke

A woman pours some olive oil onto a plate in this undated photo. (KABC Photo)

Pour on the olive oil, preferably over fish and vegetables: One of the longest and most scientific tests of a Mediterranean diet suggests this style of eating can cut the chance of suffering heart-related problems, especially strokes, in older people at high risk of them.

The study lasted five years and involved about 7,500 people in Spain. Those who ate Mediterranean-style with lots of olive oil or nuts had a 30 percent lower risk of major cardiovascular problems compared to others who were told to follow a low-fat diet. Mediterranean meant lots of fruit, fish, chicken, beans, tomato sauce, salads, and wine and little baked goods and pastries.

Mediterranean diets have long been touted as heart-healthy, but that's based on observational studies that can't prove the point. The new research is much stronger because people were assigned diets to follow for a long time and carefully monitored. Doctors even did lab tests to verify that the Mediterranean diet folks were consuming more olive oil or nuts as recommended.

Most of these people were taking medicines for high cholesterol and blood pressure, and researchers did not alter those proven treatments, said the study's leader, Dr. Ramon Estruch of Hospital Clinic in Barcelona. But as a first step to prevent heart problems, "we think diet is better than a drug" because it has few if any side effects, Estruch said. "Diet works." Results were published online Monday by the New England Journal of Medicine and were to be discussed at a nutrition conference in Loma Linda, Calif.

People in the study were not given rigid menus or calorie goals because weight loss was not the aim. That could be why they found the "diets" easy to stick with - only about 7 percent dropped out within two years. There were twice as many dropouts in the low-fat group than among those eating Mediterranean-style. Researchers also provided the nuts and olive oil, so it didn't cost participants anything to use these relatively pricey ingredients. The type of oil may have mattered - they used extra-virgin olive oil, which is richer than regular or light olive oil in the chemicals and nutrients that earlier studies have suggested are beneficial.

The study involved people ages 55 to 80, just over half of them women. All were free of heart disease at the start but were at high risk for it because of health problems - half had diabetes and most were overweight and had high cholesterol and blood pressure.

They were assigned to one of three groups: Two followed a Mediterranean diet supplemented with either extra-virgin olive oil (4 tablespoons a day) or with walnuts, hazelnuts and almonds (a fistful a day). The third group was urged to eat a low-fat diet heavy on bread, potatoes, pasta, rice, fruits, vegetables and fish and light on baked goods, nuts, oils and red meat.

Independent monitors stopped the study after nearly five years when they saw fewer problems in the two groups on Mediterranean diets. Doctors tracked a composite of heart attacks, strokes or heart-related deaths. There were 96 of these in the Mediterranean-olive oil group, 83 in the Mediterranean-nut group and 109 in the low-fat group.

Looked at individually, stroke was the only problem where type of diet made a big difference. Diet had no effect on death rates overall. The Spanish government's health research agency initiated and paid for the study, and foods were supplied by olive oil and nut producers in Spain and the California Walnut Commission. Many of the authors have extensive financial ties to food, wine and other industry groups but said the sponsors had no role in designing the study or analyzing and reporting its results.

Rachel Johnson, a University of Vermont professor who heads the American Heart Association's nutrition committee, said the study is very strong because of the lab tests to verify oil and nut consumption and because researchers tracked actual heart attacks, strokes and deaths - not just changes in risk factors such as high cholesterol.

"At the end of the day, what we care about is whether or not disease develops," she said. "It's an important study."

Rena Wing, a weight-loss expert at Brown University, noted that researchers provided the oil and nuts, and said "it's not clear if people could get the same results from self-designed Mediterranean diets" - or if Americans would stick to them more than Europeans used to such foods.

A third independent expert also praised the study as evidence diet can lower heart risks.

"The risk reduction is close to that achieved with statins" - widely used cholesterol drugs, said Dr. Robert Eckel, a diet and heart disease expert at the University of Colorado.

"But this study was not carried out or intended to compare diet to statins or blood pressure medicines," he warned. "I don't think people should think now they can quit taking their medicines."

(Copyright ©2013 by The Associated Press. All Rights Reserved.) Get more Healthbeat »

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Mediterranean diet tops list of 'livable' diets

We’ve all seen ads for miracle diets that promise to help us shed weight in days, weeks, or months.

But what happens next?

Do people stay the course and maintain the loss, or regain the weight with a vengeance?

A team of Israeli researchers followed participants for four years after an initial two-year workplace-based study to try and answer these questions. Participants followed one of three weight loss plans: a low-fat, low-calorie diet; a Mediterranean-style, low-calorie diet; or a low-carb eating plan without calorie restrictions. 

Overall, the Mediterranean diet led to the most dramatic changes, but people on the other diets also did pretty well. A Mediterranean diet is rich in fruits, vegetables, fish, whole grains, legumes, healthy fats like olive oil, and moderate amounts of alcohol. It is also low in sweets, meats, and saturated fats like butter.

Eighty-six percent of the participants were men, and most were considered moderately obese when the study began. Researchers also educated their spouses about the diet so changes could be made at home, too.

At two years, 85% of the participants were still following their diet programs. Participants on the Mediterranean diet and low-carb diet lost more weight than those on the low-fat diet.

Four years after the study officially ended, 67% of participants were still on their eating plan, 11% had switched to another a type of diet, and 22% were not dieting at all.

Mediterranean Diet Is the Winner

Everyone regained some of the weight they had lost in the original study, but all were thinner than when the study first began. The weight loss was highest in the Mediterranean and low-carb groups for the entire six-year period: about 7 pounds and close to 4 pounds, respectively. All participants also showed improvements in their total cholesterol levels.

“Our study suggests that the Mediterranean and low-carb diets have better [cholesterol] effects, as well as less weight regain,” says researcher Dan Schwarzfuchs, MD, of the Negev Nuclear Research Center in Dimona, Israel. “When a person needs to change their life habits, I try to tailor the diet to their personal preferences with precedence to Mediterranean or low-carb diets.”

Schwarzfuchs says the study has a "real life" aspect to it in both the weight lost and the health benefits. And even the fact that it took place in the workplace added a dimension to it: "When dealing with a change in lifestyle, the workplace is a great platform to generate a change, since we spend most of our waking hours at work."

Importantly, after those two initial study years, there was no further support, and the employees were not committed in any way to the study.  “At four years follow-up, the intervention still has positive effects, especially in the Mediterranean and low-carbohydrate groups," he says.

The findings are published in the New England Journal of Medicine.

Keeping It Off

“Most anyone can lose weight, but keeping it off is the harder part,” says Nancy Copperman, RD. She is the director of public health initiatives at the North Shore-Long Island Jewish Health System in Great Neck, N.Y.

“The Mediterranean diet seems to be the winner,” she says. “This is a livable diet and has positive physiologic benefits.”

But whether Mediterranean, low-carb, or another eating plan, choosing a diet that best fits with your lifestyle is a key to long-term success, Copperman says. It is more than just diet: “Getting regular physical activity also counts,” she says. “All in all, this is very impressive to me that so many participants kept going.”

Allison Krall, RD, is a dietitian from Ohio State University Wexner Medical Center in Columbus, Ohio. She reviewed the study for WebMD. “The Mediterranean diet won out overall. It is a more balanced diet with more options and choices,” she says. “Finding ways of eating that a person can stick to over the long haul is the key to losing weight and keeping it off because yo-yo dieting is dangerous.”

Preventive cardiologist Suzanne Steinbaum, DO, at Lenox Hill Hospital in New York City, is a big fan of the Mediterranean diet.

“Everyone can go on a diet and eventually they go off,” she says. "It is really about making healthy choices that you can live with over the long haul.”

Low-carb diets are restrictive and tend to be hard to stick to. “Choose a diet that is best for you, but is not too restrictive.” This is where the Mediterranean diet shines, she says. “It includes all food groups including whole grains and healthy carbs, so it is easier to stick with.”

SOURCES: Schwarzfuchs, D. New England Journal of Medicine, 2012.Dan Schwarzfuchs MD, Negev Nuclear Research Center, Dimona, Israel.Allison Krall, RD, dietitian, Ohio State Wexner Medical Center, Columbus, Ohio.Suzanne Steinbaum, DO, preventive cardiologist, Lenox Hill Hospital, New York City.Nancy Copperman, MS, RD, director, public health initiatives, Office of Community Health, North Shore-Long Island Jewish Health System, Great Neck, N.Y.

© 2012 WebMD, LLC. All rights reserved.

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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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