Health for life

New research shows that a Mediterranean-style diet and diets low in available carbohydrates can offer protection against type 2 diabetes. The study is published in Diabetologia, the journal of the European Association for the Study of Diabetes (EASD), and is by Dr Carlo La Vecchia, Mario Negri Institute of Pharmacological Research, Milan, Italy, and colleagues.

The authors studied patients from Greece who are part of the ongoing European Prospective Investigation into Cancer and nutrition (EPIC), led by Dr. Antonia Trichopoulou, from the University of Athens. From a total of 22,295 participants, actively followed up for just over 11 years, 2,330 cases of type 2 diabetes were recorded. To assess dietary habits, all participants completed a questionnaire, and the researchers constructed a 10-point Mediterranean diet score (MDS) and a similar scale to measure the available carbohydrate (or glycaemic load [GL]) of the diet.

People with an MDS of over 6 were 12% less likely to develop diabetes than those with the lowest MDS of 3 or under. Patients with the highest available carbohydrate in their diet were 21% more likely to develop diabetes than those with the lowest. A high MDS combined with low available carbohydrate reduced the chances of developing diabetes by 20% as compared with a diet low in MDS and high in GL.

The authors say: "The role of the Mediterranean diet in weight control is still controversial, and in most studies from Mediterranean countries the adherence to the Mediterranean diet was unrelated to overweight. This suggests that the protection of the Mediterranean diet against diabetes is not through weight control, but through several dietary characteristics of the Mediterranean diet. However, this issue is difficult to address in cohort studies because of the lack of information on weight changes during follow-up that are rarely recorded."

They point out that a particular feature of the Mediterranean diet is the use of extra virgin olive oil which leads to a high ratio of monounsaturated to saturated fatty acids. But again research here has been conflicting. One review of dietary fat and diabetes suggests that replacing saturated and trans fats with unsaturated fats has beneficial effects on insulin sensitivity and is likely to reduce the risk of type 2 diabetes. However, in a randomised trial of high-cardiovascular-risk individuals who were assigned to the Mediterranean diet supplemented with either free extra virgin olive oil or nuts and were compared with individuals on a low-fat diet (comparison group), there was no difference in diabetes occurrence between the two variants of the Mediterranean diet when compared with the comparison group.

Regarding GL, the authors say: "High GL diet leads to rapid rises in blood glucose and insulin levels. The chronically increased insulin demand may eventually result in pancreatic β cell failure and, as a consequence, impaired glucose tolerance and increased insulin resistance, which is a predictor of diabetes. A high dietary GL has also been unfavourably related to glycaemic control in individuals with diabetes."

They conclude: "A low GL diet that also adequately adheres to the principles of the traditional Mediterranean diet may reduce the incidence of type 2 diabetes.

According to a study, “Mediterranean Diet and Risk of Hyperuricemia in Elderly Participants at High Cardiovascular Risk,” published in the Journals of Gerontology Series A: Biological Sciences and Medical Sciences, a baseline adherence to a Mediterranean diet (MeDiet) is associated with a lower risk of hyperuricemia, defined as a serum uric acid (SUA) concentration higher than 7mg/dl in men and higher than 6mg/dl in women.

Hyperuricemia has been associated with metabolic syndrome, hypertension, type 2 diabetes mellitus, chronic kidney disease, gout, and cardiovascular morbidity and mortality. The MeDiet is characterized by a high consumption of fruits, vegetables, legumes, olive oil, nuts, and whole grain; a moderate consumption of wine, dairy products, and poultry, and a low consumption of red meat, sweet beverages, creams, and pastries. Due to its antioxidant and anti-inflammatory properties, the MeDiet might play a role in decreasing SUA concentrations.

Conducted by Marta Guasch-Ferré and 11 others, this study is the first to analyze the relationship between adherence to a MeDiet in older adults and the risk of hyperuricemia. The five-year study looks at 7,447 participants assigned to one of three intervention diets (two MeDiets enriched with extra virgin olive oil or mixed nuts, or a control low-fat diet). Participants were men aged 55 to 80 years and women aged 60 to 80 years who were free of cardiovascular disease but who had either type 2 diabetes mellitus or were at risk of coronary heart disease.

The findings below demonstrate the positive health effects of a MeDiet in older adults:

- Rates of reversion were higher among hyperuricemic participants at baseline who had greater adherence to the MeDiet.
- Consuming less than one serving a day of red meat compared with higher intake is associated with 23 percent reduced risk of hyperuricemia.
- Consuming fish and seafood increased the prevalence of hyperuricemia.
- Drinking more than seven glasses of wine per week increased the prevalence of hyperuricemia.
- Consuming legumes and sofrito sauce reduced the prevalence of hyperuricemia.

Reversion of hyperuricemia was achieved by adherence to the MeDiet alone, without weight loss or changes to physical activity.

Olive oil

Fearing that it would have to write about the Oscar award shows vulgar Hollywood humor or Washingtons budgetary caterwauling, the Disease Management Care Blog was happily distracted by a flurry of splashy news reports on a just-published primary prevention trial:

"Mediterranean diet....showed 30% lower risk of having a heart attack, stroke or dying of heart disease....."

"Tasty diet cuts heart disease, study finds."

" ....diet rich in olive oil, nuts, beans, fish, fruits and vegetables prevents about 30% of heart attacks, strokes and deaths from heart disease..."

Fighting the urge to run to the pantry and add years to its life by ingesting some olive oil-drizzled walnuts, the DMCB did something that mainstream news reporters seem incapable of doing: it asked what the diet actually entails and whether the impact was really all that.

Heres the original New England Journal of Medicine study. Disappointingly, the absolute risk reduction was quite small and, for the typical DMCB primary care patient, would involve a major lifestyle change.

The DMCB explains.

The PREDIMED trial ("Prevención con Dieta Mediterránea") was a prospective and randomized clinical trial in which male (age 55 to 80 years) and female (age 60 to 80 years) volunteers with either:

1) diabetes or

2) three other risk factors, such as tobacco use, high blood pressure, abnormal cholesterol levels, obesity and a worrisome family history of premature heart disease,

were randomly assigned to one of three treatment arms:

1) A "Mediterranean diet" supplemented with extra-virgin olive oil (a liter was delivered to the home each week), or

2) A "Mediterranean diet" supplemented with nuts (30 grams of almonds, walnuts and hazelnuts per day) or

3) A control diet.

Whats just what is a Mediterranean diet?  According to the authors:

A) lots of olive oil for cooking and dressing dishes;

B) consumption of ≥ 2 daily servings of vegetables (at least one of them as fresh vegetables in a salad), discounting side dishes;

C) ≥ 2-3 daily servings of fresh fruits (including natural juices);

D) ≥ 3 weekly servings of "legumes" (kidney beans, pinto beans, black beans, chickpeas, lima beans, black-eyed peas, split peas, and lentils);

E) ≥ 3 weekly servings of fish or seafood (at least one serving of fatty fish);

F) ≥ 1 weekly serving of nuts or seeds;

G) selecting white meats (poultry without skin or rabbit) instead of red meats or processed meats such as burgers and sausages;

H) cooking regularly (at least twice a week) with tomato, garlic and onion adding or not other aromatic herbs, and dress vegetables, pasta, rice and other dishes with tomato, garlic and onion adding or not aromatic herbs. This sauce is made by slowly simmering the minced ingredients with abundant olive oil.

I) the limitation of cream, butter,margarine, cold meat, pate, duck, carbonated and/or sugared beverages, pastries, industrial bakery products (such as cakes, donuts, or cookies), industrial desserts (puddings, custard), French fries or potato chips, and out-of-home pre-cooked cakes and sweets.

By the way, the study organizers used genuine olive oil, not this fake stuff.

Patients assigned to the diet had to see a dietitian at the outset of the study and participate in every 3 month group education sessions.  There were no recommendations to lose weight or participate in exercise.

The results?

8713 persons were screened and 7447 were assigned to one of the study arms.  After a median of 4.8 years, 523 persons were lost to follow-up. 288 persons had either a heart attack, stroke or
cardiovascular death.  There were 96 deaths in the extra virgin olive oil group, 83 in the nut group and 109 in the control group. The calculated percents were 3.8%, 3.4% and 4.4%, respectively.  Versus the control group thats an absolute difference of 0.6% and 1.0%. There didnt appear to be any surprises in the subgroups outcomes.

Using a number needed to treat analysis, these data basically mean 100 to 166 persons would need to live on fish, nuts, lima beans, and olive oil without burgers, starches or soda for 5 years to prevent a single heart attack, stroke or death.

The DMCBs take:

1. The small amount of benefit is not enough, in the DMCBs estimation, to warrant routine inclusion of a "Mediterranean diet" in disease management care planning for persons with diabetes or multiple cardiac risk factors.

2. The diet was "all or none."  There is no evidence, based on this trial, that substituting crab cakes for that steak once a week and using olive oil on your iceberg lettuce tonight will help you live longer.

3. The "number needed to treat" of 100-166 over 5 years is in the same performance range as statin drugs with a NNT that, according to this study, ranges from 77 to 150 over four years.  No wonder many persons choose to continue with their more tasty burgers and fries along with a daily pill.

4. Its unlikely that persons who are not already on a Mediterranean diet will chose to switch, and given the amount of sacrifice involved and the small reduction in risk, the DMCB cant blame them.

Image from Wikipedia

Mediterranean Diet May Help Women Live Longer, Healthier Lives

Middle-aged women who follow a heart-healthy Mediterranean diet may live a healthier, longer life, a new study published Nov. 5, 2013 in the journal Annals of Internal Medicine suggests.

Women with healthier dietary patterns at midlife were 40 percent more likely to survive to age 70 or over. The women who ate healthier not only lived longer, but they also thrived. They were less likely to have any major chronic diseases and more likely to have no impairment in physical functioning, mental health or thinking skills.Although the study did not look at men, previous studies on diet and healthy aging have found no gender differences, so it seems reasonable to believe that the benefit would be similar.

Mediterranean Diet Boosts Aging Brain

A Mediterranean diet with added extra virgin olive oil or mixed nuts seems to improve the brain power of older people indicates research published online in the Journal of Neurology Neurosurgery and Psychiatry.

Mediterranean Diet’s Health Effects for Older Adults

According to a study, “Mediterranean Diet and Risk of Hyperuricemia in Elderly Participants at High Cardiovascular Risk,” published in the Journals of Gerontology Series A: Biological Sciences and Medical Sciences, a baseline adherence to a Mediterranean diet (MeDiet) is associated with a lower risk of hyperuricemia, defined as a serum uric acid (SUA) concentration higher than 7mg/dl in men and higher than 6mg/dl in women.

Hyperuricemia has been associated with metabolic syndrome, hypertension, type 2 diabetes mellitus, chronic kidney disease, gout, and cardiovascular morbidity and mortality. The MeDiet is characterized by a high consumption of fruits, vegetables, legumes, olive oil, nuts, and whole grain; a moderate consumption of wine, dairy products, and poultry, and a low consumption of red meat, sweet beverages, creams, and pastries.

Mediterranean Diet Helps Cut Risk of Heart Attack, Stroke

Results of the PREDIMED study, aimed at assessing the efficacy of the Mediterranean diet in the primary prevention of cardiovascular diseases, have been published in The New England Journal of Medicine. They show that the Mediterranean diet supplemented with extra-virgin olive oil or tree nuts reduces by 30 percent the risk of suffering a cardiovascular death, a myocardial infarction or a stroke.

Virgin olive oil and a Mediterranean diet fight heart disease

Everyone knows olive oil and a Mediterranean diet are associated with a lower risk for cardiovascular disease, but a new research report published in the July 2010 print issue of the FASEB Journal offers a surprising reason why: These foods change how genes associated with atherosclerosis function.

Notes re above: confirmed here and here. Fascinating read here on Olive Oils Health Benefits and Extra virgin olive oil protects against Alzheimers disease

Mediterranean Diet = Slower Cognitive Decline

In an examination of the association between adherence to a Mediterranean-type diet and cognitive performance and risk of dementia, researchers found that high adherence to the diet was associated with slower decline in some measures of cognitive function but was not associated with decreased risk for dementia, according to a study in the August 12, 2009 issue of JAMA.

Higher adherence to a Mediterranean-type diet is linked to lower risk for mortality and chronic diseases, and "might also have protective effects against cognitive decline in older individuals, because it combines several foods and nutrients potentially protective against cognitive dysfunction or dementia, such as fish, monounsaturated fatty acids, vitamins B12 and folate, antioxidants (vitamin E, carotenoids, flavonoids), and moderate amounts of alcohol," the authors write.

(confirmed here: Mediterranean Diet Associated With Slower Rate of Cognitive Decline)


Longer life = specific foods in Mediterranean diet

Some food groups in the Mediterranean diet are more important than others in promoting health and longer life according to new research published on bmj.com.

Eating more vegetables, fruits, nuts, pulses and olive oil, and drinking moderate amounts of alcohol, while not consuming a lot of meat or excessive amounts of alcohol is linked to people living longer.

However, the study also claims, that following a Mediterranean diet high in fish, seafood and cereals and low in dairy products were not indicators of longevity.

While several studies have concluded that the Mediterranean diet improves chances of living longer, most recently the study described here, this is the first to investigate the importance of individual components of the diet.

Mediterranean Diet Associated with Lower Risk of Cognitive Impairment

Eating a Mediterranean diet appears to be associated with less risk of mild cognitive impairment—a stage between normal aging and dementia—or of transitioning from mild cognitive impairment into Alzheimer’s disease, according to a report in the February 2009 issue of Archives of Neurology, one of the JAMA/Archives journals.

Mediterranean Diet: Stronger adherence was associated with reduced all cause, cardiovascular and cancer mortality, as well as decreased incidence of Parkinson’s and Alzheimer’s diseases

A recent meta-analysis of prospective cohort studies using an a priori score to assess adherence to a Mediterranean diet found that stronger adherence was associated with reduced all cause, cardiovascular and cancer mortality, as well as decreased incidence of Parkinson’s and Alzheimer’s diseases (1).

Two intervention studies have supported the benefits of a Mediterranean style diet on metabolic risk factors (2) (3). In a Spanish study, men and women with elevated levels of cardiovascular risk factors were randomized to either of two “Mediterranean” diets and provided with either olive oil or nuts, or to a control low fat diet. After 3 months the Mediterranean diet groups had lower mean plasma glucose, systolic blood pressure and total/HDL cholesterol ratio than the control group (2). Italian adults with the Metabolic Syndrome were randomized to a “Mediterranean” diet or a “prudent” diet, both with similar macronutrient composition. The “Mediterranean” diet was associated with greater improvements in markers of vascular risk and endothelial function than the control group (3). It should be noted however that in both studies the “Mediterranean” diet groups received more nutrition education than the control groups.

The Lyon Heart Study demonstrated that a modified Cretan diet low in butter and meats, and high in fish, fruits and enriched with _-linolenic acid from canola oil was more effective than a ‘prudent’ diet in the secondary prevention of coronary events and overall mortality (4). We have also shown that a Cretan style diet reduced HbA1c from a mean of 7.1% (95% CI: 6.5-7.7) to 6.8% (95% CI: 6.3-7.3) (p=0.012), in people with type 2 diabetes (unpublished data).

Simopoulos (5) notes that the traditional Greek diet resembles the Paleolithic diet in terms of fibre, antioxidants, saturated and monounsaturated fat, thus is consistent with human evolution. While traditional diets must lect the regionally available foods, the characteristics of the traditional Greek diet can be applied in many countries, notwithstanding the likely effect of environment and growing methods on the nutrient composition of plant and animal foods. The evidence suggests that a traditional Greek or Cretan style diet is consistent with what humans have evolved to consume and may protect against common chronic diseases, including prostate cancer.

References:
1. Sofi F, Cesari F, Abbate R, Gensini GF, Casini A. Adherence to Mediterranean diet and health status: meta-analysis. Bmj 2008;337:a1344._2. Estruch R, Martinez-Gonzalez MA, Corella D, et al. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med 2006;145:1-11._3. Esposito K, Marfella R, Ciotola M, et al. Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. J Am Med Assoc 2004;292:1440-6._4. de Lorgeril M, Salen P. Modified Cretan Mediterranean diet in the prevention of coronary heart disease and cancer. In: Simopoulos AP, Visioli F, eds. Mediterranean Diets. World Review Nutr Diet. Basel: Karger, 2000:1-23._5. Simopoulos AP. The traditional diet of Greece and cancer. Eur J Cancer Prev 2004;13:219-30.

More reports:

Mediterranean-style Diet Boosts Fertility

Mediterranean diet protects against type 2 diabetes

Mediterranean diet = skin cancer prevention

Mediterranean diet improves heart function

Mediterranean Diet: Good for a Heart Health

Mediterranean-like diet lowers risk of brain infarcts, or small areas of dead tissue linked to thinking problems.

Mediterranean diet = reduced risk of depression

Mediterranean diet wards off childhood respiratory allergies

Mediterranean diet = lower heart disease

Mediterranean Diet Halves Risk of COPD (chronic obstructive pulmonary disease)

Results of the PREDIMED study, aimed at assessing the efficacy of the Mediterranean diet in the primary prevention of cardiovascular diseases, have been published in The New England Journal of Medicine. They show that the Mediterranean diet supplemented with extra-virgin olive oil or tree nuts reduces by 30 percent the risk of suffering a cardiovascular death, a myocardial infarction or a stroke.

The study has been coordinated by the researcher Ramon Estruch, from the Faculty of Medicine of the UB and the Hospital Clínic -- affiliated centres with the health campus of the UB, HUBc -- and has had the collaboration of the professor Rosa M. Lamuela and her team from the Natural Antioxidant Research Group of the Faculty of Pharmacy -- located at the campus of international excellence BKC -- which determined the biomarkers of Mediterranean diet consumption.

The research is part of the project PREDIMED, a multicentre trial carried out between 2003 and 2011 to study the effects of the Mediterranean diet on the primary prevention of cardiovascular diseases. The study was funded by the Carlos III Health Institute by means of the cooperative research thematic network (RETIC RD06/0045) and the CIBER of Physiopathology of Obesity and Nutrition (CIBERobn).

A total of 7,447 people with major cardiovascular risk factors participated in the study. They were divided into three dietary intervention groups: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with nuts (walnuts, almonds, hazelnuts), and a low-fat diet (animal and vegetable). A dietician visited the patients every three months and they attended dietary training group sessions, in which they received detailed information about the Mediterranean and the low-fat diet, and the food included in each one. Moreover, they were provided with shopping lists, menus and recipes adapted to each type of diet and each season of the year.

During the study, those participants who followed any of the two types of Mediterranean diet received freely extra-virgin olive oil (one litre per week), and nuts (30 grams per day; 15 grams of walnuts, 7.5 grams of almonds and 7.5 grams of hazelnuts).

After five years, it has been proved that participants who followed any of the two types of Mediterranean diet showed a substantial reduction in the risk of suffering a cardiovascular death, a myocardial infarction or a stroke.

According to the researchers, the results of PREDIMED study are relevant as they prove that a high-vegetable fat diet is healthier at a cardiovascular level than a low-fat diet. The authors state that the study has been controversial as it provides new data to reject the idea that it is necessary to reduce fats in order to improve cardiovascular health.

Hopefully, these results will provide new erences to prevent cardiovascular diseases. In addition, the design and methodology used can be easily transferred to the biomedical sector.

Women who watch their weight and closely follow a Mediterranean-style diet high in vegetables, vegetable oils, fish and beans may increase their chance of becoming pregnant, according to dietitians at Loyola University Health System (LUHS).

"Establishing a healthy eating pattern and weight is a good first step for women who are looking to conceive," said Brooke Schantz, MS, RD, CSSD, LDN, LUHS. "Not only will a healthy diet and lifestyle potentially help with fertility, but it also may influence fetal well-being and reduce the risk of complications during pregnancy."

Thirty percent of infertility is due to either being overweight or underweight, according to the National Infertility Association. Both of these extremes in weight cause shifts in hormones, which can affect ovulation. Reducing weight by even 5 percent can enhance fertility.

Schantz recommends the following additional nutrition tips for women who are looking to conceive:

-Reduce intake of foods with trans and saturated fats while increasing intake of monounsaturated fats, such as avocados and olive oil

-Lower intake of animal protein and add more vegetable protein to your diet

-Add more fiber to your diet by consuming whole grains, vegetables and fruit

-Incorporate more vegetarian sources of iron such as legumes, tofu, nuts, seeds and whole grains

-Consume high-fat dairy instead of low-fat dairy

-Take a regular womens multivitamin

Approximately 40 percent of infertility issues are attributed to men, according to the American Society for Reproductive Medicine. Among them is low sperm count and poor sperm motility, which are common in overweight and obese men.

"Men who are looking to have a baby also have a responsibility to maintain a healthy body weight and consume a balanced diet, because male obesity may affect fertility by altering testosterone and other hormone levels," Schantz said.