"The Mediterranean Diet ora Whole Food Plant-Based Diet?" Recent studies have shown that higherMediterranean diet adherence scores are associated with a significant reduction in the risk of death, heart disease,cancer and brain disease.
But the problem with population studieslike these is that people who eat healthier may also live healthier, and sohow do we know it's their diet? As the American Heart Associationposition states: "Before advising people to follow a Mediterranean diet,we need more studies to find out whether the diet itself or other lifestyle factors accountfor the lower deaths from heart disease.
" How do you do that? Well, there are ways you can control forobvious things like smoking and exercise, which many of the studies did, but ideally you'd do an interventional trial, the gold standard of nutritional science.
Take people, change their diet,while trying to keep everything else the same, and see what happens.
And that's what we got 20 years ago,the famous Lyon Diet Heart Study.
About 600 folks who had just hadtheir first heart attack were randomized into two groups.
The control group got no dietary advice,apart from whatever their doctors were telling them, but the experimental group was toldto eat more of a Mediterranean-type diet, supplemented with a canola-oilbased spread to give them the plant-based omega-3s they'd normally be getting from weedsand walnuts if they actually lived on a Greek isle in the 1950s.
The Mediterranean diet group did end uptaking some of the dietary advice to heart.
They ate more bread, more fruit,less deli meat, less meat in general, and less butter and cream, but other than that no significant changesin diet reported in terms of wine, olive oil, or fish consumption.
So less saturated fat and cholesterol,more plant-based omega 3s, but not huge dietary changes, but at the end of about four years,in the control group, 44 individuals had a second heart attack,either fatal or nonfatal, but only 14 suffered another attackin the group that changed their diet.
So they went from having like a 4% chanceof having a heart attack every year, down to like 1%.
Now a cynic might say yes,less death and disease, but the Mediterranean diet continuedto feed their heart disease, so much so that 14 of them sufferednew heart attacks while on the diet.
Now their disease progresseda lot less than the regular diet group, about four times less, but what if there was a diet thatcould stop or reverse heart disease? Dr.
Caldwell Esselstyn and colleaguesat the Cleveland Clinic recently published a case series of 198consecutive patients with cardiovascular disease counseledto switch to a diet composed entirely of whole plant foods.
Of the 198, 177 stuck to the diet,whereas the other 21 fell off the wagon, setting up kind of a natural experiment.
What happened to the 21? This was such a sick group of patientsthat more than half suffered from like a fatal heart attack, or neededangioplasty or a heart transplant.
In that same time period ofabout four years, of the 177 that stuck to the plant-based diet only one had a major event asa result of worsening disease – not half, but less than 1%.
As Dean Ornish noted in his responseto the latest Mediterranean trial, a Mediterranean diet is betterthan what most people are consuming, but even better may bea diet based on whole plant foods.
Now this was not a randomized trial, so can't be directlycompared to the Lyon study, and included very determined patients.
Not everyone is willing to dramaticallychange their diets, even if it may literally be a matter of life or death.
In which case, rather than doingnothing, eating a more Mediterranean-type diet may cut risk for heart attacksurvivors by about two-thirds.
Cutting 99% of risk would be better, if Esselstyn's results were replicatedin a controlled trial, but even a 70% drop in risk could savetens of thousands of lives every year.