The Mediterranean Diet Or A Whole Food Plant-Based Diet?

“The Mediterranean Diet or
a Whole Food Plant-Based Diet?” Recent studies have shown that higher
Mediterranean 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 studies
like these is that people who eat healthier may also live healthier, and so
how do we know it’s their diet? As the American Heart Association
position states: “Before advising people to follow a Mediterranean diet,
we need more studies to find out whether the diet itself or other lifestyle factors account
for the lower deaths from heart disease.” How do you do that? Well, there are ways you can control for
obvious 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 had
their 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 told
to eat more of a Mediterranean-type diet, supplemented with a canola-oil
based spread to give them the plant-based omega-3s they’d normally be getting from weeds
and walnuts if they actually lived on a Greek isle in the 1950s. The Mediterranean diet group did end up
taking 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 changes
in 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 attack
in the group that changed their diet. So they went from having like a 4% chance
of having a heart attack every year, down to like 1%. Now a cynic might say yes,
less death and disease, but the Mediterranean diet continued
to feed their heart disease, so much so that 14 of them suffered
new heart attacks while on the diet. Now their disease progressed
a lot less than the regular diet group, about four times less, but what if there was a diet that
could stop or reverse heart disease? Dr. Caldwell Esselstyn and colleagues
at the Cleveland Clinic recently published a case series of 198
consecutive patients with cardiovascular disease counseled
to 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 patients
that more than half suffered from like a fatal heart attack, or needed
angioplasty or a heart transplant. In that same time period of
about four years, of the 177 that stuck to the plant-based diet only one had a major event as
a result of worsening disease – not half, but less than 1%. As Dean Ornish noted in his response
to the latest Mediterranean trial, a Mediterranean diet is better
than what most people are consuming, but even better may be
a diet based on whole plant foods. Now this was not a randomized trial, so can’t be directly
compared to the Lyon study, and included very determined patients. Not everyone is willing to dramatically
change their diets, even if it may literally be a matter of life or death. In which case, rather than doing
nothing, eating a more Mediterranean-type diet may cut risk for heart attack
survivors by about two-thirds. Cutting 99% of risk would be better, if Esselstyn’s results were replicated
in a controlled trial, but even a 70% drop in risk could save
tens of thousands of lives every year.
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