Dietary data

A third option for stroke prevention in AF.
December 8, 2012
Long time no see
July 15, 2013

Hi everyone, good to write to you once again.  I apologize that it has been a few months since my last post.  The rest of life gets in the way sometimes!  I have been busy with family and work responsibilities…and a vacation too.

For today I thought I would mention some recent dietary evidence that has become available.  We had previously advised patients to have a straightforward low fat, low sugar diet, low in calories.  While this is still better than an average, unhealthy diet some data had suggested diet did not make a difference for patients already on medications.  As doctors I think we were also skeptical – medications that lower blood pressure or cholesterol are very potent and effective if used properly.  Did diet still make a difference?

A study from Spain gives great evidence that a Mediterranean diet is effective at reducing stroke and cardiovascular disease.  Here is the original study in the New England Journal of Medicine.: http://www.nejm.org/doi/full/10.1056/NEJMoa1200303?query=featured_home&#t=article.  The Guardian does a great job explaining the trial, so I will quote their article here.

Spanish researchers led by Prof Ramon Estruch, a professor of medicine at Barcelona University, studied 7,447 men aged 55 to 88 and women aged 60 to 80 between 2003 and 2009.

None had any cardiovascular disease when they enrolled in the study, but all were at risk of it because they had type 2 diabetes or had at least three risk factors from a list including smoking; high blood pressure; high levels of bad cholesterol in their blood; low levels of healthy cholesterol; being overweight; or having family history of coronary heart disease.
The participants either followed a Mediterranean diet in which they consumed four tablespoons of extra-virgin olive oil a day or another version of the diet in which they had to eat about an ounce a day of walnuts, almonds and hazelnuts.
These two groups were also told to eat fruit thrice daily, vegetables twice daily, fish as well as beans, peas and lentils at least three times a week, and have seven glasses of wine a week with their meals. The third group followed a low-fat diet.
When participants were examined an average of 4.8 years later, 228 had suffered a heart attack or stroke or died of heart problems – 96 occurred in the olive oil-heavy dietary group (3.4% of participants), 83 among those consuming a lot of nuts (3.4%) and 109 in the low-fat group (4.4%).
This corresponded to a drop in risk of 30% for those on the Mediterranean diets compared with the low fat diet.
The key components of those diets which improve risk of survival include moderate consumption of ethanol, from the wine, low consumption of meat and meat products, and high intake of vegetables, fruit, nuts, legumes, fish and olive oil, they said.
The researchers were so impressed with the Mediterranean diet’s benefits that they all began following it.”
I couldn’t summarize it better myself.  This is excellent science and a very well done trial.  Impressively, it shows a difference despite good use of appropriate medications in both arms of the trial, showing that even with meds, diet is still important.
I am now beginning to recommend this diet to all my patients.  In general I would suggest you adapt the features of the diet to your own life as best you can.  For example if you don’t drink, I wouldn’t start just because of this trial!  But you can use the rest.
What do you think?  Do you already eat this way?  Will this change your habits?
Until next time,
Dr. John Vyselaar

1 Comment

  1. Anonymous says:

    Can't say it will move me away from red meat. I will increase my nut intake (more because I love nuts), and they appear to have a positive impact. Don't each much "pre-packaged" food and probaby go overboard on the fruit intake. Would I call my diet low fat, probably not. So will it move me to a strict Med diet, no. A partial move yes.

    I guess it comes down to the numbers. 30% reduciton is huge when it comes to your health, but really it is a reduction from 4.4% to 3.4%. In other words, is following a strict Mediterranean diet worth the 1% reduction? Each person has to weigh their own options.

    I assume you would recieve partial benefit for partial move? It may not be linear but I think a logical assumption.

    Regards,

    Stephen Sutherland

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