Are there good ways to promote heart health? A reader wonders whether dietary advice to avoid fat and cholesterol is still valuable, or whether a Mediterranean-style diet would be more helpful.
Diet Advice from the 1960s:
Q. My father had a heart attack when I was a teen in the early 1960s. The whole family had to go to classes to learn about a “heart-healthy” diet. The experts pushed margarine, skim milk and low-fat cheese instead of butter and whole milk products. They also recommended corn oil for cooking and sugar substitutes like saccharine. Overall, it was a low-meat, high-carb diet, heavy in whole wheat.
Over the last 60 years doctors have told me numerous times to totally eliminate fat from my diet. I did, but have gradually added dairy, olive oil and avocado oil.
Now some advocate the Mediterranean diet, but others are still pushing the no-fat, low-protein, whole-grain regimen. Maybe doctors are trying to cover all the bases because they still don’t know what really works.
The Diet Wars Continue:
A. The diet wars have been some of the most contentious in modern medicine. The American Heart Association continues to recommend only fat-free or low-fat dairy products. A large multinational epidemiological study contradicts that recommendation, though (Lancet, Nov. 24, 2018).
The authors concluded that:
“Dairy consumption was associated with lower risk of mortality and major cardiovascular disease events in a diverse multinational cohort.” The dairy products were mostly milk and yogurt.
A follow-up analysis of these data showed that people consuming whole fat dairy were less likely to have metabolic syndrome, high blood pressure or diabetes (BMJ Open Diabetes Research & Care, April, 2020).
Which Dietary Pattern Helps Most?
One distinguishing characteristic of a Mediterranean-style diet is olive oil as the principal fat. Studies show that olive oil is associated with a lower risk of death from heart disease (JACC, Jan. 2022). Although many nutrition experts still recommend low-fat diets, one controlled trial found that a low-carb diet was more effective for improving blood fats and lowering insulin resistance (American Journal of Clinical Nutrition, Jan. 2022). Leading researchers are now suggesting that high-carb diets may also contribute to obesity (American Journal of Clinical Nutrition, Sep. 13, 2021).
Medical Consensus Advisory
Recommendations to follow a diet low in fat, with next to no saturated fat, but without restrictions on processed foods are being replaced. Many nutrition scientists now find a Mediterranean-style diet heavy on vegetables and fish offers more benefits for heart health.
Other Studies Support a Mediterranean-Style Diet for Heart Health:
The STABILITY Trial:
A few years ago, an international study showed that people eating more vegetables and fruits, as in a Mediterranean-style diet pattern, are less likely to suffer a heart attack or stroke (European Heart Journal, July 2016). The scientists conducted the study as a clinical trial of a heart drug in development. Consequently, they recruited 15,482 people who had stable coronary heart disease. That put them at high risk for having a heart attack or a stroke.
When they first entered the trial, the volunteers filled out a simple questionnaire on their eating habits. Their answers allowed the researchers to calculate both a Mediterranean diet score, based on consumption of vegetables, legumes, fruit, fish and whole grains, as well as a Western diet score measuring consumption of desserts, sweets, refined grains and deep fried foods.
What the Research Showed:
The participants were followed up for almost four years, and what the researchers found was a bit surprising. In this group of high-risk individuals, the Mediterranean-style diet was quite protective. For every hundred people eating the most Mediterranean-style diet, there were three fewer deaths, strokes or heart attacks compared to those who ate the fewest vegetables and the least fish. That is comparable to or better than the record for atorvastatin, which was advertised as offering a 36% reduction in heart attack risk although it resulted in one fewer heart attack per hundred people in a similar time span.
Concentrate on Veggies and Fish in a Mediterranean-Style Diet:
The surprise was that those who ate more desserts and had a higher Western diet score didn’t have a correspondingly higher risk of cardiovascular complications.
The lead researcher remarked:
“The research suggests we should place more emphasis on encouraging people with heart disease to eat more healthy foods, and perhaps focus less on avoiding unhealthy foods.”
That sounds like good advice to us, especially since vegetables can be so delicious when cooked with care, spices and a little extra-virgin olive oil.
Moli-Sani Study Supports the Mediterranean-Style Diet:
More recently, Italian investigators reported on their dietary analyses from the Moli-sani study (European Journal of Nutrition, March 2021). In this research, 22,849 Italian adults answered questionnaires about their diet and health and provided blood samples for analysis. The researchers followed up on their progress for an average of eight years.
The people who scored highest on a measure of how closely they followed a Mediterranean eating pattern were less likely to die during the study. Those whose diets adhered to DASH (Dietary Approaches to Stop Hypertension) were also more likely to survive. Paleolithic and Nordic diets did not appear to protect their followers from premature death due to cardiovascular causes.
If you would like to learn more about how to follow a Mediterranean eating pattern, you may be interested in our book, The People’s Pharmacy Quick & Handy Home Remedies, which has an explanation.
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