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Mediterranean Diet Fights Heart Disease

In a randomized trial in Spain in high-risk people, those who ate the Mediterranean diet supplemented with extra-virgin olive oil or mixed nuts saw a reduction in the rate of major cardiovascular events like heart attacks and strokes by nearly 30 percent compared with a control group eating a low-fat diet, according to Dr. Ramón Estruch of the Hospital Clinic in Barcelona, and colleagues.

The results support the use of the Mediterranean diet for "primary prevention" of heart disease, the researchers wrote online in the New England Journal of Medicine.

The traditional Mediterranean diet, the researchers noted, is characterized by lots of olive oil, fruit, nuts, vegetables, legumes, and cereals, some fish and poultry, and limited amounts of dairy products, red meat, processed meats, and sweets. As well, the diet includes moderate amounts of wine with meals.

To test the idea that the diet protected against heart disease, the researchers randomly assigned 7,447 people, ages 55 to 80, to one of three diets -- a Mediterranean diet with additional extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet, which consisted essentially of advice to reduce dietary fat.

The majority of the participants were women and were free of cardiovascular disease when they started, but either had diabetes or at least three important cardiovascular risk factors, such as smoking, hypertension, or obesity. They received quarterly educational sessions and, depending on group assignment, free extra-virgin olive oil, mixed nuts, or small nonfood gifts

The primary endpoint was a composite of strokes, heart attacks, and cardiovascular death. The olive-oil diet led to a 28 percent reduction in risk, compared with the control diet. The mixed nut diet led to a similar risk reduction.

Traditional Mediterranean meals feature foods grown all around the Mediterranean Sea, and enjoyed along with lifestyle factors typical of this region. Easily adaptable to today's kitchens and busy lives, they include:

Grains, Vegetables & Fruits

Grains, vegetables, and fruits should be eaten at most meals, because they are important sources of vitamins, minerals, energy, antioxidants, and fiber. An eating pattern high in these foods promotes good health and weight control when consumed wisely.

Grains. The majority of grains should be whole grains, such as wheat, oats, rice, rye, barley, and corn. These grains are best consumed in whole, minimally-processed forms, because refining and processing can remove many valuable nutrients, including vitamins, minerals, and fiber.

Vegetables. Vegetables are an important staple of eating patterns of peoples in all the countries bordering the Mediterranean Sea, providing valuable nutrients and satiety. These benefits are amplified because the vegetables are normally cooked or drizzled with olive oil. Raw vegetables are also a healthy vegetable option.

Fruits. Whole fresh fruit is ever-present in the Mediterranean. No-sugar-added fruit juices provide only some of the same nutrition benefits as whole fruit, and attention to portion control and total calories is wise. Fruit "drinks" do not have the benefits of fruit juice.

 

Olives & Olive Oil

Olives and olive oil are central to the Mediterranean diet. Olives are universally eaten whole, and widely used for cooking and flavoring in the countries that border the Mediterranean Sea. Olive oil is the principal source of dietary fat used for cooking, baking, and for dressing salads and vegetables. Extra virgin olive oil is highest in health-promoting fats, phytonutrients and other important micronutrients.

 

Nuts, Beans, Legumes & Seeds

Nuts, beans, legumes and seeds are good sources of healthy fats, protein, and fiber. They add flavor and texture to Mediterranean dishes.
 

 

Herbs & Spices

Herbs and spices add flavors and aromas to foods, reducing the need to add salt or fat when cooking. They are also rich in a broad range of health-promoting antioxidants, and are used liberally in Mediterranean cuisines. Herbs and spices also contribute to the national identities of the various Mediterranean cuisines.

 

Cheese & Yogurt

Cheese and yogurt are eaten regularly in the traditional Mediterranean diet, but in low to moderate amounts. The calcium in cheese and yogurt is important for bone and heart health. Low fat and nonfat dairy products ease concerns of adverse consequences of somewhat higher consumption of dairy products.

 

Fish & Shellfish

Fish and shellfish are important sources of healthy protein for Mediterranean populations. Fish such as tuna, herring, sardines, salmon and bream are rich in essential heart-healthy omega-3 fatty acids, and shellfish and crustaceans including mussels, clams and shrimp have similar benefits. Fish and shellfish are not typically battered and fried in Mediterranean countries.

 

Eggs

Eggs are a good source of high-quality protein, and can be especially beneficial for individuals who do not eat meat. Eggs are regularly used in baking in Mediterranean countries.

 

Meats

Meats are eaten in small portions by Mediterranean peoples, who prefer lean cuts. Poultry is a good source of lean protein without the high levels of saturated fat found in some cuts of red meat. With ground meats, 90 percent lean/10 percent fat is a sound choice.

 

Wine

Wine is consumed regularly but moderately in the Mediterranean, unless discouraged by religious beliefs. “Moderately” means up to one five-ounce glass of wine per day for women and up to two five-ounce glasses for men. Individuals should only drink wine if they are medically able to do so, and should ask their doctors for more information.

 

Water

Water is essential for life, and proper hydration during each day makes a positive contribution to health, well being and energy levels. Individual variations in body sizes, metabolic rates and activity levels mean that some people should drink more water every day than others.

 

Portion Size

Because foods in the bottom section of the pyramid may be eaten in larger amounts and more frequently, portion sizes and frequency of consumption decline in the pyramid’s upper sections.

 

Moderation

Moderation is a wise approach. A balanced and healthy diet accommodates most foods and drinks, so long as moderation and wise choices are the key characteristics. For example, enjoying a small piece of birthday cake, savoring a few slices of grilled steak, or relaxing with family and friends with a glass or two of wine or beer are important aspects of being human. As always, moderation is the wise watchword.

 

Healthy Lifestyle Habits

Daily physical activity is important for overall good health. This includes strenuous exercise like running and aerobics, as well as more leisurely activities such as walking and housework or yard-work, or taking the stairs instead of the elevator.

 

Meals in the Company of Others

The Mediterranean Diet is grounded on the principles of enjoyment and pleasure. Foods, drinks and meals are best eaten with others, when possible, and savored.

 

As you follow the Mediterranean Diet, keep in mind that weight control is very important for good health. Establish your healthy weight range from your doctor or from reputable web sites, and let this healthy weight range be your guide. If you are above this range, cut back on the food and drink you consume, add more exercise, or both. For most people, counting calories obsessively not only detracts from enjoying foods, drinks, and meals, but also doesn’t work very well in the long term. These recommendations and the updated Mediterranean Diet Pyramid are reliable for most adults. However, children and pregnant women and others with special dietary needs may require dietary supplementation. These needs can be accommodated within the Mediterranean Diet in most circumstances.

Pyramid


The key to this longevity is a diet that successfully resisted the last 50 years of “modernizing” foods and drinks in industrialized countries. These modern trends led to more meat (mostly beef) and other animal products, fewer fresh fruits and vegetables, and more processed convenience foods. Ironically, this diet of “prosperity” was responsible for burgeoning rates of heart disease, obesity, diabetes, and other chronic diseases.

Pyramid

The Eating Pattern of The Mediterranean Diet Pyramid

Dietary data from the parts of the Mediterranean region that in the recent past enjoyed the lowest recorded rates of chronic diseases and the highest adult life expectancy are characterized by a pattern similar to the one illustrated in the list below. The healthfulness of this pattern is corroborated by more than 50 years of epidemiological and experimental nutrition research. The frequency and amounts suggested are in most cases intentionally nonspecific, since variation was considerable. The historical pattern includes the following (several parenthetical notes add a contemporary public health perspective):

  • An abundance of food from plant sources, including fruits and vegetables, potatoes, breads and grains, beans, nuts, and seeds.
  • Emphasis on a variety of minimally processed and, wherever possible, seasonally fresh and locally grown foods (which often maximizes the health-promoting micronutrient and antioxidant content of these foods).
  • Olive oil as the principal fat, replacing other fats and oils (including butter and margarine).
  • Total fat ranging from less than 25 percent to over 35 percent of energy, with saturated fat no more than 7 to 8 percent of energy (calories).
  • Daily consumption of low to moderate amounts of cheese and yogurt (low-fat and non-fat versions may be preferable).
  • Twice-weekly consumption of low to moderate amounts of fish and poultry (recent research suggests that fish be somewhat favored over poultry); up to 7 eggs per week (including those used in cooking and baking).
  • Fresh fruit as the typical daily dessert; sweets with a significant amount of sugar (often as honey) and saturated fat consumed not more than a few times per week.
  • Red meat a few times per month (recent research suggests that if red meat is eaten, its consumption should be limited to a maximum of 12 to 16 ounces [340 to 450 grams] per month; where the flavor is acceptable, lean versions may be preferable).
  • Regular physical activity at a level which promotes a healthy weight, fitness and well-being.
  • Moderate consumption of wine, normally with meals; about one to two glasses per day for men and one glass per day for women. From a contemporary public health perspective, wine should be considered optional and avoided when consumption would put the individual or others at risk.
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