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good prospective study of the Mediterranean diet
Posted: 25 February 2013 08:30 PM   [ Ignore ]
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For anyone who wants to reduce their risk of heart disease there is some solid support now for the Mediterranean diet. Perviously we only had population studies but this is a well designed PCT that seems to show that this diet may reduce the relative risk of cardiovascular disease by as much as 30%.

Details here: http://www.nejm.org/doi/full/10.1056/NEJMoa1200303?query=featured_home&#t=articleDiscussion

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Posted: 25 February 2013 08:50 PM   [ Ignore ]   [ # 1 ]
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Fascinating.

I inadvertently eat by some of the Med diet guidelines, and find them to be fairly workable, but I wonder how practical it is for many average Americans to follow?

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Posted: 25 February 2013 09:34 PM   [ Ignore ]   [ # 2 ]
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The traditional Mediterranean diet is characterized by a high intake of olive oil, fruit, nuts, vegetables, and cereals; a moderate intake of fish and poultry; a low intake of dairy products, red meat, processed meats, and sweets; and wine in moderation, consumed with meals.

.....weeeell, I use olive oil for any cooking and salads, eat a lot of fruits, nuts and cereals, moderate on the fish and poultry, eat red meat once or twice a year, occasional drink, but I LOVE dairy (lattes) and cheese, and the occasional sweet treat….

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Posted: 26 February 2013 05:37 AM   [ Ignore ]   [ # 3 ]
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A “solid support,” macgyver? Based on ONE study? Run the study again, say in Russia, and then we’ll see.

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Posted: 26 February 2013 05:59 AM   [ Ignore ]   [ # 4 ]
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George - 26 February 2013 05:37 AM

A “solid support,” macgyver? Based on ONE study? Run the study again, say in Russia, and then we’ll see.

You’re absolutely right George. These matters are never entirely settled and its possible that if you run it in a different population you may see different results, but this was a very well run PCT involving several thousand participants over 5 years and the results were pretty significant. While the difference between the groups could have come about by chance, my point was that this is the first study to actually show evidence of a causative relationship rather than just an association.

Many of the individual components of a mediterranean diet had already been studied in isolation ie. more fresh fruits and vegetables, more fish and white meat, less red meat, and wine in moderation, fewer baked goods, so while we’re waiting for the Russian study to come ( wink ) out it seems reasonable to make some adjustments where possible to bring our diets more in line with these recommendations.

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Posted: 26 February 2013 06:06 AM   [ Ignore ]   [ # 5 ]
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Okay, hurry up, everybody, and try the Mediterranean diet while it still works.  wink

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Posted: 26 February 2013 06:46 AM   [ Ignore ]   [ # 6 ]
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What about this map showing the mortality rate from cardiovascular disease in Europe in the year 2000? Is the Mediterranean diet of the Greeks less Mediterranean than that of the Dutch? And what’s up with Spain? Their cigarette consumption per capita is three times as high as that of Scandinavia? How come they are not dying of heart attacks? Maybe it is the extra-virgin olive oil after all. (You can smoke, but dip it first in an olive oil.  cool smirk ) But then, what about Greece’s extra-virgin olive oil? What a mess…

Anyway, how about chocolate and red wine? Are they still good for us?  smirk

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Posted: 26 February 2013 08:17 AM   [ Ignore ]   [ # 7 ]
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IIRC, some research has shown that seafood and legumes are good for the CV system - because of the omega fatty acids.

So there’s that.

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Posted: 26 February 2013 08:38 AM   [ Ignore ]   [ # 8 ]
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This study only looked at this particular diet. Obviously when you look at large populations you may not find a direct correlation because there are many other risk factors that are not equal among different pockets of the population and across national borders. All things being equal smoking is a huge risk factor for cardiovascular disease but all things are not equal when you look at entire nations and continents. If you really wanted to find out why death rates from cardiovascular disease don;t follow the exact geographic pattern you would expect you have to start teasing out all the other contributing issues like genetics, diabetes incidence, rates of hypertension, smoking, and access to health care etc. Most likely there are additional risk factor we are unaware of and of course cultural variations can be dramatic from one town to the next resulting in subtle differences in diet that may be important.

As far as chocolate goes there are no PCT’s that I can find concerning that food item. Most of what you have heard about chocolate and health have to do with particular chemicals ( flavinoids - the magical antioxidants)  in chocolate that in small short term studies seem to have beneficial effects on things like cholesterol but that applies primarily to dark chocolate. There are no good studies showing that the long term inclusion of chocolate in the diet has beneficial effects on longevity and with all the fat and sugar in most commercial chocolate I think its good bet that the regular consumption of chocolate would have net negative effect. Wine seems to be helpful in moderation but too much wine has the reverse effect and increases the risk of heart disease so when it comes to chocolate and wine, everything in moderation George.

The whole field of diet and disease is really not as much of a mess as the public often concludes. Its simply a matter of looking at the sort of studies which the media is quoting. The vast majority of studies you hear about on the evening news are population studies or biochemical lab based studies ( ie food item A increases the level of good cholesterol.. and then the media gives the public the false impression that the medical community is now promoting consumption of this item). Unfortunately the media makes very little effort to educate the public on the strength of the evidence in the study being quoted, so when a better study comes out a few years later that contradicts the first one the public is left thinking “Its all a mess”.

I think it would be a great idea if the NIH or the AAAS put together a rating system the media could use that would assess the study in terms of it value in making public health recommendations. That way if there is a study saying Broccoli decreases the level of a certain neurotransmitter associated with increased rates of Alzheimer’s they could give it a D rating ( Which would be displayed prominently on the screen) indicating that this information is not reliable information upon which to make recommendations or lifestyle changes.

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Posted: 26 February 2013 08:39 AM   [ Ignore ]   [ # 9 ]
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George - 26 February 2013 06:46 AM

What about this map showing the mortality rate from cardiovascular disease in Europe in the year 2000? Is the Mediterranean diet of the Greeks less Mediterranean than that of the Dutch? And what’s up with Spain? Their cigarette consumption per capita is three times as high as that of Scandinavia? How come they are not dying of heart attacks? Maybe it is the extra-virgin olive oil after all. (You can smoke, but dip it first in an olive oil.  cool smirk ) But then, what about Greece’s extra-virgin olive oil? What a mess…

Anyway, how about chocolate and red wine? Are they still good for us?  smirk

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Interesting map. I wonder why some areas of the Green (light and dark) are better than others, and what is the reason for that spot of yellow in the middle of Italy?  That bears investigating, I think.  What are they doing different from their neighbors?

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Posted: 26 February 2013 09:16 AM   [ Ignore ]   [ # 10 ]
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Well, as the story usually goes (or as it sometimes doesn’t, as we are still, for example, awaiting the conclusion of Jared Diamond’s “Guns, Germs, and Steel”), there is more to us than just the environment. What we eat (or smoke or drink or whatever) is one thing, but what we, or rather our ancestors, have been eating in the past is just as important.

And a few more things to remember:
1.) Epidemiological studies cannot really prove causation; and
2.) As John Maynard Smith once said, “Statistics is the science that lets you do twenty experiments a year and publish one false result in Nature.”

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Posted: 26 February 2013 09:37 AM   [ Ignore ]   [ # 11 ]
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macgyver - 26 February 2013 08:38 AM

If you really wanted to find out why death rates from cardiovascular disease don;t follow the exact geographic pattern you would expect you have to start teasing out all the other contributing issues like genetics, diabetes incidence, rates of hypertension, smoking, and access to health care etc.

Well, shouldn’t you do the same and take things like genetics into consideration before giving a medical advice on how to reduce a risk of heart disease to people who are not Spaniards (i.e., all of us here on this forum)? Again, what if an olive-oil diet shows up to be harmful at worst and ineffective at best to, say, Eastern Europeans (i.e., me)?

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Posted: 26 February 2013 09:38 AM   [ Ignore ]   [ # 12 ]
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This is why I say eat what you want.  It doesn’t matter anyway.

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Posted: 26 February 2013 10:22 AM   [ Ignore ]   [ # 13 ]
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George - 26 February 2013 09:37 AM

Well, shouldn’t you do the same and take things like genetics into consideration before giving a medical advice on how to reduce a risk of heart disease to people who are not Spaniards (i.e., all of us here on this forum)? Again, what if an olive-oil diet shows up to be harmful at worst and ineffective at best to, say, Eastern Europeans (i.e., me)?

Of course we do take genetics into account when making recommendations. I don’t give the same advice to someone who’s dad died at 45 of a heart attack as I do to an individual who has no heart disease risk in the family, but you can only work with the information you have. There is no reason to believe that Spaniards are so different from Americans or Canadians as to make this information irrelevant and obviously we don’t have the time or resources to perform a separate study on every conceivable demographic. Even if we did, there will be genetic differences between you and your brother so who’s to say those genetic variations aren’t important?. Imperfect information is not the same as useless information however.

As we often say this is about probability not promises. Even if the data applies perfectly to you it only reduces your probability of having a heart attack by 30%. You could stick to the diet religiously and still have a heart attack Does that mean the advice was wrong for the other 70%? Of course not. As you go through life you try to make choices that will provide the greatest possibility for the best outcome for you and your family. A smart person will play the game so the odds are in their favor even if that doesn’t provide a guarantee. All you can be expected to do is make the best decision based on the available evidence at the time.

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Posted: 26 February 2013 11:10 AM   [ Ignore ]   [ # 14 ]
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macgyver - 26 February 2013 10:22 AM

Even if we did, there will be genetic differences between you and your brother so who’s to say those genetic variations aren’t important?.

Sure they are important. But until we get to the day when we have the resources and knowledge to test everyone and make sense of the role genetics play here (looking at the map I am inclined to believe Spaniards are different enough from the English to take genetics into consideration—although that could be the racist in me speaking again), we should at least try to stay away from making sweeping assumptions like the one based on the Mediterranean diet study. We no longer tell all the kids they should drink milk, do we?

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Posted: 26 February 2013 11:59 AM   [ Ignore ]   [ # 15 ]
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From the map, it appears that there’s a moderate correlation between cardiac related mortality and latitude.  I guess I should move to Panama to lower my risk of a cardiac incident. smile

And, using anecdotal thinking, I love chocolate and dairy products and I’m older than than the average caucasian male death age, they must be good for me.  LOL

Occam

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