It turns out to be a total rout. It appears that the right oils are
even beneficial. The point is that a thirty percent differential is
huge and the study was large and well designed. It was halted at the
five year mark because it became unethical to continue.
I think we all know how to cook this way. It is simply a matter of
no longer buying red meat products and ramping up the fish component.
We really do not have good completely trusted explanations for why
this is all true, but that is surely irrelevant as even good
explanations often lead to incorrect conclusions. What we do know is
that ample vegetables and fish will go a long way to protecting
against heart disease.
The take home is that this study was decisive. Henceforth, all
medical advice will adhere closely to the Mediterranean diet
protocol.
Mediterranean diet,
with olive oil and nuts, beats low-fat diet
By Melissa Healy
February 25, 2013
In a head-to-head contest, a Mediterranean diet, even drenched in
olive oil and studded with nuts, beat a low-fat diet, hands-down, in
preventing stroke and heart attack in healthy older subjects at high
risk of developing cardiovascular disease.
The latest smack-down
in the diet wars appears to deal a knock-out blow to the notion that
high-fat olive oil and tree nuts — walnuts, almonds and hazelnuts —
are a no-no for those wishing to improve their health. On the
contrary, Spanish researchers concluded that the consumption of
extra-virgin olive oil and nuts "were probably responsible for
most of the observed benefits" attained by those in the two
groups following a Mediterranean diet.
The study's findings,
released Monday by the New England Journal of Medicine, also add to
mounting evidence contradicting a long-held tenet of dieting to
improve health: that all calories are equal.
The
benefits of the Mediterranean diet were pretty substantial too:
compared with a group of 2,450 subjects who were urged to follow a
low-fat diet, the 4,997 who followed a Mediterranean diet
supplemented either with nuts (2,454 subjects) or with extra-virgin
olive oil (2,543 subjects) were 30% less likely to suffer one of the
following outcomes: a heart attack, stroke or death attributed
to cardiovascular disease.
The Mediterranean dieters were almost 40% less likely than the
low-fat dieters to have a stroke during the follow-up
period. And the superiority of the Mediterranean diet over a low-fat
diet was consistent across virtually all sub-categories of
participants -- men, women, older and younger subjects, and those
with or without every risk factor for cardiovascular disease. Only
among the small group of subjects without hypertension did a low-fat
diet show better results.
All of the trial's subjects were ages 55 to 80 (women were 60 to
80) and either had type 2 diabetes or satisfied at least three of the
following criteria: they were active smokers, were overweight or
obese, had a family history of premature heart disease or had
hypertension or worrisome cholesterol readings. After randomizing the
subjects to the low-fat diet group, the Mediterranean diet with tree
nuts group or the Mediterranean diet with olive oil group,
researchers followed the subjects for a median of 4.8 years to ensure
they were adhering to their recommended regimen and to gauge how many
in each group suffered a heart attack or stroke or died of
cardiovascular disease.
Many studies have
suggested the Mediterranean diet -- which is rich in fatty fish,
fruits, vegetables and fatty acids -- trumps other diets meant to
induce weight loss when the measure of success is heart health. But
the current trial is the first to meet the "gold standard"
of biomedical research, in which large numbers of patients are
randomly assigned to distinct groups, followed for several years and
compared on the basis of predetermined outcomes.
The study's findings "blow the low-fat diet myth out of the
water," said Cleveland Clinic cardiologist Steven
Nissen, who was not involved in the current research. Nissen, an
expert on the effects of drugs and nutrition on cardiovascular risk,
called the study "spectacular" and touted the findings as
impressive.
Almost entirely
missing from the Mediterranean dieters' daily intake was red meat and
meat products. Those subjects were urged to keep to a minimum sodas
and fats that are in partially solid form and to limit consumption of
commercially baked sweets and pastries to no more than three times a
week. They were given a weekly supply of either almonds, walnuts or
hazelnuts and told to eat about a quarter-cup a day of one of them.
Or they were supplied a liter of extra-virgin olive oil each week and
instructed to consume at least 4 tablespoons a day.
At the same time,
Mediterranean dieters were told they should feel free to drink wine
moderately — about seven glasses per week.
Aside from those
guidelines, subjects in the Mediterranean diet arms of the trial had
an "energy unrestricted" diet: They did not have a calorie
limit.
Low-fat dieters were
told to avoid nuts and vegetable oils of all kinds (including olive
oil), to limit their store-bought sweets to fewer than one per week
and to remove visible fat from all meats. In addition to fruits and
vegetables, they were encouraged to eat three servings of low-fat
dairy product and three or fewer servings of bread, potatoes, pasta
or rice each day.
But since the study
was conducted in several centers in Spain, even the low-fat dieters
tended to eat lots of fruits, vegtables and leaner meats. The
researchers found that, while eating slightly more legumes and fish,
the Mediterranean dieters largely differed from the low-fat dieters
in their nut-and-olive-oil consumption.
While their suspicions
fell on nuts and olive oil, the researchers were wary of ruling out
the contribution of other elements of the Mediterranean diet to
improved cardiovascular health.
"Perhaps there is
a synergy among the nutrient-rich foods included in the Mediterranean
diet that fosters favorable changes" in the physiological
responses, such as inflammation and insulin insensitivity, that give
rise to cardiovascular disease, the researchers wrote.
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