Blogfinger

Photo: The Vancouver Sun

By Paul Goldfinger, MD, FACC

In the 1960’s and 1970’s, a link was found between diet and coronary heart disease.  Countries that had diets heavy with saturated fats (e.g. the US)  had the highest rates, while countries that had a lot of fish and vegetables  (e.g. Japan) had low rates.  Many Americans began to reduce their intake of red meat, and the government advocated low fat diets.

But clinical trials that attempted to show the preventive benefits of such diets failed to show reduced end-points such as heart attack rates.  Later a link with cholesterol was found, and doctors preferred to achieve prevention by severe lowering of  blood cholesterol levels with statin drugs.  For the most part, doctors have ignored nutrition as a potent way to protect our cardiovascular systems.

In recent years, the prevention community began to suggest that the best diet for prevention was a modified Mediterranean diet based on how people eat in places such as southern Italy and France.

This is what I had to say about this subject in our book: “Prevention Does Work: A Guide to a Healthy Heart”  2011:

“Mediterranean diets have been linked to a reduction in risk due to the fact that they contain monounsaturated fat from olive oil, plus fruits, whole grains, fiber, vegetables, garlic, nuts, legumes, red wine, poultry, and ocean fish. This diet is not necessarily low in fat, but the fats consumed are unsaturated “good fats”. There are quite a few countries bordering the Mediterranean, and there are some variations in their diets. Avoid the ones that contain a lot of pork, cheese, butter, milk and beef. Make believe you are a fisherman from Sicily or Crete.”

On February 25, 2013, a controlled study of 7,447 apparently healthy people in Spain, who were at increased risk of cardiovascular disease, was published in The New England Journal of Medicine and reviewed in the New York Times. The study group was placed on a Mediterranean diet. The control group was on a low fat diet.  Of interest is that this study group was already on statin drugs and medicines for hypertension and diabetes.

The trial showed that the Mediterranean diet reduced the risk of  coronary heart disease, cardiac death, and stroke by 30%. This is the first large controlled study to show a significant prevention benefit of diet using major end points.  The results were so impressive that the trial was terminated early after nearly five years.

To be specific, the study group in this trial was instructed to eat daily:  at least 4 tablespoons of extra virgin olive oil, an ounce of nuts  (almonds, walnuts, and hazelnuts,) at least 3 servings a day of fruits and at least two servings of vegetables  (a salad counts as one,) fish at least three times per week (especially fatty fish like tuna, salmon or sardines,)  and legumes  (beans, peas, garbanzos, and lentils) at least 3 times per week.  They were instructed to eat white meat instead of red  (remove the chicken skin), and for those who drink, have at least seven glasses of wine a week with meals.  Pastries, cookies, and donuts are forbidden, however, you can eat as much chocolate as you like—but it should be over 50% cocoa  (i.e. dark chocolate). Avoid desserts that are not homemade and avoid processed meats.

You can  have pasta, whole grain cereals, eggs, and rice. The study groups were told to limit dairy products and to use low fat cheeses.  You can make a healthy sauce of tomatoes, garlic, onions and extra virgin olive oil to use over fish, veggies or rice.  Note that this group did not gain weight despite unlimited nuts and olive oil.

Eileen’s original 34 heart-healthy recipes in our book follows these principles and is still not out of date.

Dr. Steven E. Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic Foundation said, “This gigantic study in Spain shows that you can eat a nicely balanced diet with fruits and vegetables and olive oil,  and lower heart disease by 30 percent, and you can actually enjoy life.”

Paul Goldfinger, MD, FACC, Dean of the Blogfinger Off-Shore School of Medicine in Ocean Grove, NJ, concluded the following in his 2011 book:  “There are a variety of heart healthy diets available, and there are debates about which are best. All good heart healthy diets restrict saturated fats and encourage maintaining an ideal weight. At this time, we seem to be evolving towards recommending a Mediterranean type diet as the most sensible choice for prevention.”

This study now makes it quite clear as to what diet to follow, but don’t forget to limit salt, get your cholesterol level to target, make sure that your blood pressure is normal, get plenty of exercise, don’t smoke, limit stress, have sex at least three times per week, get good sleep, portion control, count calories, and get your weight down. If you drink wine, there is reason to believe that red is best.

Learn about prevention by reading my book. It’s still in print.   We all need to be advocates for our own good health.

Everybody Likes Fruits and Vegetables. by Jake Makita