My August Bank Holiday Monday (29/8/2016) kicked off with an interview on BBC Radio Berkshire to discuss the day’s headline: “Mediterranean diet better than statins for tackling heart disease.” The story was on the front page of The Telegraph and The Times and it was also featured on BBC Breakfast.
There is sadly no paper (yet) for me to review. This story emanated from a cardiovascular conference being held in Rome. A paper was presented at this conference by Professor Giovanni de Gaetano from the IRCCS Neuromed Institute in Pozzilli, Italy. Neuromed Institue is short for Mediterranean Neurological Institute, by the way. Probably no interest in promoting anything Mediterranean ;-)
From the media reports, we know the following:
- 1,200 people with a history of cardiovascular disease (heart attacks, strokes, blocked arteries) were followed for 7 years;
- During this time, 208 patients died;
- The people most closely following “an ideal Mediterranean diet” were 37% less likely to be among the fatalities.
The points to make
1) Anything is better than statins!
In my honest opinion, statins are unfit for human consumption. This is what they do. Find me a study showing statins have a significant absolute benefit, which has not been funded by the pharmaceutical industry and which declares full data (so that I can dissect it). Meanwhile – wonder why your body is making cholesterol right now if cholesterol is trying to kill you.
2) Researchers have invented a Fictitious Mediterranean Diet.
The media articles describe the Mediterranean Diet as “rich in fruit and vegetables, fish and olive oil.” This is the Fictitious Mediterranean Diet (FMD, as I call it). What people really eat in the Med is best summed up as “if it moves, they eat it + white things…” The true Mediterranean Diet is: meat (largely red, but everything available – lamb, beef, pork, rabbit, game, turkey etc); fish (especially oily); eggs; dairy products (cheese, cream, butter, milk); vegetable and fruits (but with meals – not as snacks – and more veg than fruit and seasonally consumed); dark chocolate and red wine. The true Med Diet also features white things (not whole grains – you’ll spend many years looking for a whole grain in the Med): white pasta; white rice; white bread (from French baguettes to Italian Panini) etc. The more of the white stuff the Mediterraneans eat, the more like large ‘Italian mammas’ they become, the more meat/fish/eggs/dairy/veg they eat, the more they look like Vanessa Paradis.
What makes the difference in either the true or the fictitious Mediterranean Diet is two things: i) the absence of junk and ii) the regular meals each day rather than the constant flipping grazing that Brits and Americans do.
3) Even in these super high risk people, the absolute benefit/risk is still tiny.
One of the really interesting findings about this review of the original randomised controlled trials undertaken in patients who already had heart disease, was that 30% of them died during the average five year duration of the studies. The single biggest risk factor in dying from heart disease is having already had heart disease diagnosed! Sounds obvious, but it’s an important point.
These 1,200 high risk people were studied for 7 years and 208 in 8,400 person years died. That’s a death rate of 2.5%.
“2.5% of people highly likely to die from heart disease, die p.a. in a 7 year period.” Is that front page news? Really?
Then we need to turn the 37% relative risk into absolute risk. This turns out to be 2.9% vs 2.1% when the average death rate is 2.5% (Note 1). Follow the FMD for 7 years and the difference might be a bit under 3 in 100 vs a bit more than 2. Front page news? Really?!
Note 1: This is done as simply as possible: work out the 2 numbers (A&B) that together average 2.5% where A/B = 137%. In reality, the distribution around the 2.5% average would be skewed.