Mediterranean Diet better than statins?
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.
15 thoughts on “Mediterranean Diet better than statins?”
Whatever the diet is called, it works. A diet high in fruits, vegetables, whole-grains, plant proteins (legumes/pulses/beans) and unsaturated fats found in olive oil, nuts, seeds and oily fish is beneficial for one’s health. Evidence from randomized control trials and prospective cohort studies both demonstrate this. Certainly, you’ll see a greater effect size than anything you’ll get on the kinds of diets that extreme low-carb dieters eat.
It seems to me that most all of these so-called dietary intervention trials ( and pharma RCTs) as well as the associated meta studies are a case of garbage in garbage out. Since the raw data together with the way in which the ‘confounding factors’ are rarely discussed it is unlikely that they are of any value. Results that show absolute risk changes of a few or even less than 1% difference between groups are just noise. If eating meat was bad for you then I doubt the western world would have evolved the way it has.
What I am more impressed by is people doing their own research and in many cases changing their lives in a matter of months without the ‘help’ of the commercial diet companies or yet another flawed epidemiological study. Perhaps if we took all these n=1 (the usual way the ‘professionals’ dismiss an individuals success by looking into and practising say a HFLC diet) and used the thousands of cases available to conduct a meta study then it may tell us something (tongue in cheek here).
I have been practising LCHF diet for 20 years and I weigh the same as I did when I was 30, I am now 63. My wife and I look at our friends, especially those living in Canada and the US and see them dealing with a range of ailments most of which are being ‘treated’ by pharma. They are confused about diet as they seem to be in awe of ‘experts’ in the media and believe current national guidelines are correct. I worry too about a generation of children growing up on primarily carbohydrate diets in the belief that all that fruit,veg, pasta and fruit juice are going to sustain them.
Oops this is an n=1 again, well n=2 actually as my wife follows the same regime. I think that looking at so called studies and drawing any inferences from them is a fools errand and has no real scientific value and can lead to people making conclusions that are not valid.
My most hated expression ‘they say’. Who the hell are ‘they’.
PS I was taking statins for two years, I came off them as they made me feel unwell in a number of ways. This was before the statin side effect row took off. I doubt the change for the better in my wellbeing was a placebo effect since 8 years later the symptoms have not returned.
The only diet that has been proven to reverse heart disease let alone halt it is a whole food plant based diet. It seems obvious therefore that such a diet would be best whether you have HD or want to avoid it.
Where’s the evidence for this?
Best wishes – Zoe
Ornish published in the Lancet back in 1991 both he and Esseltyn have continued to treat HD with a plant based diet since with success
If you mean this (http://www.thelancet.com/journals/lancet/article/PII0140-6736(90)91656-U/abstract): 1990 not 1991; multi-factorial intervention (so cannot isolate diet); very small numbers; risk factors uneven between intervention and control (inevitable with such small numbers) – control 4 years older/total chol 8% higher and LDL 10% higher at baseline; not blinded; non generalisable; surrogate end points/not outcomes. Any real evidence? Ideally more recent than 26 yrs ago?!
Best wishes – Zoe
In that case adopt all factors from the intervention although I am sure deep down you feel that if the trial is truly representative of future results then diet was probably a big if not the biggest player. With regard to Cholesterol please Zoe, you are talking to a cholesterol sceptic and correct me if I am wrong but so are you. To pull cholesterol out of the hat when it suits is really a poor argument. Also we both no its nigh on impossible to blind diet based trials for obvious reasons. When people adopt a whole food plant based diet all markers improve with the one caveat that B12 needs checking. Can you cite a meat based intervention in which heart disease was reversed ?. I am not anti meat its just that to consume meat healthily one need to be able source and afford to buy grass fed meats. For the great majority of people this is impossible given the plethora of junk meat available to them at affordable prices. The best option for health or for existing HD sufferers is therefore to go whole food plant based. This is easy to follow in the sense that affording and acquiring the raw material is cheap and unambiguous.
Looks like we could have heated agreement on two things:
1) I am indeed a cholesterol sceptic (https://www.amazon.co.uk/Cholesterol-Cause-Attacks-Statins-Solution/dp/190779753X) and would never “use it when suits” and resent the accusation. The point being made was that the evidence you offered was so rubbish the control and intervention groups couldn’t even be matched for cholesterol/smartie colour preference/whatever.
2) No one should be able to cite a meat based intervention in which heart disease was reversed – and you should also stop trying to do the same (cherry picking) with whole foods. See my 4 papers on this link (https://www.zoeharcombe.com/2014/11/academic-studies-questioning-current-dietary-advice/) RCTs at the time of the guidelines and now; epidemiological evidence at the time of the guidelines and now. The STARS study in your other post (the JAMA) link is more cherry picking. This is in the RCTs currently available paper (Open Heart 2016). I have looked at the totality of the evidence and it offers no support for any dietary intervention. The closest anyone got was fish/DART/1989, but the team tried to repeat this and failed (reported in 2003).
I don’t think any one or few foods IN a diet can make any difference to heart disease (or any other chronic illness for that matter). I do think that any one or few foods OUT of a diet can make a difference – sugar/flour and veg oils being the top 3 that could make a difference. This is why vegan and paleo diets should do similarly well – not because of what each group eats but because of the commonalities in what they don’t eat.
Back to work!
Best wishes – Zoe
I would also welcome your thoughts on this study, sorry for asking here but your Saturated fat post is closed for comments.
Please see other reply
I agree Sugar, white flour(wheat) and oils out will be a big help. As I said I dont have a problem with the Paleo diet if people can source and afford non grain fed, anti biotic injected and more fed meats. Then if they can source them can they afford them. I think its safer to go veggie or as I do Pescitarian (spelling?) with fish caught only in certain seas. The other point is that one or two aspects of control may not have been perfect in his report but remember he measured artery blockages using imagery. Do you really think that the improvements shown in the treated groups arteries were because they were on average 4 years younger or had lower LDL levels ?. Some times you have to look at imperfect evidence and ask on balance is he on to something. If a Paleo diet can do the same thing then I am happy for meat eaters but I have not seen a trial, perfect or slightly imperfect. Have a good day.
Zoe how does this sit with you
“Substituting SFAs with animal protein, cis monounsaturated fatty acids, polyunsaturated fatty acids (PUFAs), or carbohydrates was significantly associated with higher IHD risks (HR per 5% of energy: 1.27–1.37).”
Take from one of your listed papers at http://ajcn.nutrition.org/content/early/2016/01/20/ajcn.115.122671.abstract
I wonder if WHEN people eat (and siesta) are also important, my observation of the healthy senior citizens in the south of France amongst whom I live is that they all follow the same timetable. We know that shiftwork correlates with poor cardiovascular health and we know some of the mechanics of this; I’m suggesting that as shiftwork is Bad, mediterranean timetable is Good.
What is the Mediterranean timetable?
Italian news papers has summed up the hole conference in the message that “LDL MUST be lowered under 100″…..does it make any sense?