Advanced Mediterranean Diet

New York researchers reported in Archives of Neurology this month that a particular eating pattern does seem to lower the risk of Alzheimers Disease, the most common type of dementia.  Manhattanites were significantly less likely to develop dementia if they had . . .

Higher consumption of:

• salad dressing
• nuts
• tomatoes
• fish
• poultry
• cruciferous vegetables (e.g., cabbage, radish, broccoli, kale, collard greens, cauliflower, turnips, brussels sprouts)
• fruits
• dark and green leafy vegetables

Lower consumption of:

• high-fat dairy products
• red meat
• organ meats
• butter

The study involved over 2000 people over age 65 who were followed for the onset of dementia for four years.  The researchers used a sophisticated analytic technique called “reduced rank regression.”  See the original article for details.

The study authors note similarities of this anti-dementia dietary pattern to the Mediterranean diet, long associated with lower risk of dementia.  They also document (again) the strong association of moderate alcohol consumption with lower dementia risk, although it was not part of their predetermined anaylytic technique.

Alzheimers Dementia has a strong tendency to run in some families.  As lifespans increase, we’re going to be seeing lots more of it.  If you make it to age 85, your odds of having dementia are 50:50.

If you worry about developing Alzheimers, perhaps because of family history, you may be doing yourself and others a favor by adopting either the dietary pattern above or the Mediterranean diet.

On the other hand . . .

MedPageToday on April 28, 2010, reported the conclusions of a panel convened by the (U.S.) National Institutes of Health:

The independent panel . . . determined that the causes of Alzheimers disease are still unknown and that no reliable evidence has shown that anything can prevent the disease or stop it from progressing.

Steve Parker, M.D.

Disclaimer:  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physician before making any dietary or exercise changes. 

References: 

Gu, Yian, et al.  Food combination and Alzheimer Disease risk.  Archives of Neurology, 67 (2010).  Epub ahead of print.  doi: 10.1001/archneurol.2010.84

Walker, Emily P.  NIH panel provides no help in unraveling Alzheimers disease.  MedPageToday, April 28, 2010.  Accessed online April 28, 2010.

Dietitian Melanie Thomassian at her Dietriffic blog April 27, 2010, notes that nuts are not fattening, contrary to popular belief.  This is documented in a guest post by Matthew Denos.  Most of the evidence refers to almonds, so I’m not sure other nuts would be equally non-fattening. 

We’re talking about one or two ounces (up to 60 grams) a day.  Could someone gain fat weight eating more than that?  Probably, especially if they have a high-carbohydrate eating pattern.  Do I have scientific studies to back me up?  No. 

Nuts are a classic component of the traditional Mediterranean diet, which is one reason I included them in the Ketogenic Mediterranean Diet.  The other reason is that nut consumption is associated with lower heart disease risk.

Steve Parker, M.D.

Red meat and processed meat consumption are associated with “modest” increases in overall mortality and deaths from cancer and cardiovascular disease, according to National Institutes of Health researchers.  This goes for both sexes.

Data are from the huge NIH-AARP Diet and Heart Study, a prospective cohort trial involving  over 550,000 U.S. men and women aged 50-71 at the time of enrollment.  Food consumption was determined by questionnaire.  Over the course of 10 years’ follow-up, over 65,000 people died.  Investigators looked to see if causes of death were related to meat consumption.

What do they mean by red meat, processed meat, and white meat?

Red meat:  all types of beef and pork [wasn’t there a U.S. ad campaign calling pork “the other white meat”?]

White meat:  chicken, turkey, fish

Processed meat:  bacon, red meat sausage, poultry sausage, luncheon meats (red and white), cold cuts (red and white), ham, regular hotdogs, low-fat poultry hotdogs, etc.

What did they find?

See the first paragraph above.

Studies like this typically look at the folks who ate the very most of a given type of food, those who ate the very least, then compare differences in deaths between the two groups.  That’s what they did here, too.  For instance, the people who ate the very most red meat ate 63 grams per 1000 caories of food daily.  Those who ate the least ate 10 grams per 1000 cal of food daily.  That’s about a six-fold difference.  Many folks eat 2000 calories a day.  The high red meat eaters on 2000 cals a day would eat 123 grams, or 4.4 ounces of red meat.  The low red meat eaters on 2000 cals/day ate 20 grams, or 0.7 ounces.

The heavy consumers of processed meats ate 23 grams per 1000 cal of food daily.  The lowest consumers ate 1.6 grams per 1000 cal.

Comparing these two quintiles of high and low consumption of red and processed meats, overall mortality was 31-36% higher for the heavy red meat eaters, and 16-25% higher for the heavy processed meat eaters.  [The higher numbers in the ranges are for women.]  Similar numbers were found when looking at cancer deaths and cardiovascular deaths (heart attacks, strokes, ruptured aneurysms, etc).

It’s not proof that heavy consumption of red and processed meats is detrimental to longevity, but it’s suggestive.  The “Discussion” section of the article reviews potential physiological mechanisms for premature death.

The researchers called these differences “modest.”  I guess they use “modest” since most people eat somewhere between these extreme quintiles.  The numbers incline me  to stay out of that “highest red and processed meat consumer” category, and lean more towards white meat and fish.

The traditional Mediterranean diet and Advanced Mediterranean Diet are naturally low in red and processed meats.

Steve Parker, M.D. 

Reference:  Sinha, Rashmi, et al.  Meat intake and mortality: a prospective study of over half a million people.  Archives of Internal Medicine, 169 (2009): 562-571.

Only half of Americans with prediabetes take steps to avoid progression to diabetes, according to a recent report in the American Journal of Preventive Medicine.

Prediabetes is defined as:

1. fasting blood sugar between 100 and 125 mg/dl (5.56–6.94 mmol/l) or
2. blood sugar level 140–199 mg/dl (7.78–11.06 mmol/l) two hours after drinking 75 grams of glucose

Prediabetes is a strong risk factor for development of full-blown diabetes.  It’s also associated with increased risk for cardiovascular disease such as heart attack and stroke.  One of every four adults with prediabetes develops diabetes over the next 3 to 5 years. 

The progression can often be prevented by lifestyle modifications such as dietary changes, moderate-intensity exercise, and modest weight loss.  

Investigators looked at 1,402 adult participants in the 2005-2006 National Health and Nutrition Examination Survey (NHANES) who had fasting blood sugar tests and oral glucose tolerance tests diagnostic of  prediabetes.  

The researchers estimate that 30% (almost one out of every three) of the adult U.S. population had prediabetes in 2005-2006, but only 7% of them (less than one in 10) were aware they had it.

Only half of the prediabetics in this survey reported attempts at preventative lifestyle changes in the prior year.  Only one of every three prediabetics reported hearing about risk reduction advice from their healthcare provider.

People, we’ve got to do better! 

The U.S. Centers for Disease Control and Prevention predicts that one of every three Americans born in 2000 will develop diabetes.  The great majority of this will be type 2 diabetes.  You understand now why James Hirsch, author of Cheating Destiny, calls diabetes America’s leading public health crisis.  I agree.

Steve Parker, M.D.

Reference:  Geiss, Linda S., et al.  Diabetes risk reduction behaviors among U.S. adults with prediabetes.  American Journal of Preventive Medicine, 38 (2010): 403-409.

Since Eve ate the apple, much depends on dinner.

                                                        -Lord Byron

Arizona’s Constitution of 1912 has always held that “the right of the individual citizen to bear arms in defense of himself or the state shall not be impaired.”

Arizona’s governor just signed into law a bill restoring Arizonans’ freedom to carry firearms discreetly without a permit.  Previously, we had to ask the state for written permission, but could carry a handgun openly.  The “open carry” option sometimes scared hoplophobes.  And some of us didn’t want the bad guys to know we were armed.

Why mention this here?  Note my tagline above: Ruminations on weight loss, health, and longevity via the Mediterranean diet.

If a bad guy’s coming after you or your family with the intention of violent physical harm, your longevity is at risk!

Remember: When seconds count, the police are only minutes away.

Steve Parker, M.D.

PS: The new law doesn’t take effect until sometime in July, 2010.

The Healthy Librarian at the Happy Healthy Long Life blog wrote about a small scientific study documenting an incredibly easy way to increase blood levels of vitamin D in people taking supplemental vitamin D: 

Take the supplement with the largest meal of the day

Subjects of this research were taking vitamin D supplements—often a very high dose—for medical reasons, yet blood levels remained unacceptably low.  Blood levels of vitamin D (25-hydroxyvitamin D) rose by 50% simply by taking the same dose with the largest daily meal. 

Other people, including young healthy adults, may or may not respond the same way.  Do you know?

As for me, I’ll be sure to take my vitamin D supplement with my largest meal.

Steve Parker, M.D.

Disclaimer:  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physician before making any dietary, nutritional supplement, or exercise changes.

The traditional Mediterranean diet has long been associated with longer lifespans and lower rates of chronic diseases: heart disease, strokes, dementia, and cancer (breast, prostate, lung, uterus).  Recent research has expanded the benefit list.

I ran across a good summary of the health benefits of Mediterranean-style eating at Medical News Today, published online May 6, 2009.  An excerpt:

The following health benefits have been observed by people who have a Mediterranean diet:

• Longer lifespan
• Lower risk of dying at any age
• Lower risk of dying from heart disease
• Lower risk of dying from cancer
• Lower risk of developing Type 2 diabetes
• Lower risk of hypertension (high blood pressure)
• Lower risk of raised cholesterol levels
• Lower risk of becoming obese
• Lower risk of developing Alzheimer’s disease

Not mentioned above is the lower risk of Parkinson’s Disease and chronic obstructive pulmonary disease.  You’ll also find a fair description of the traditional Mediterranean diet.

Steve Parker, M.D.

We’re in the midst of Passover, a major Jewish holiday.  My Lord and Savior, Jesus Christ, was a Jewish carpenter while he was walking the Earth.  I figure he must have observed Hebrew traditions.  In preparation for teaching my children about Passover, I reviewed it at Wikipedia.  Here’s a brief summary:

Passover is the Jewish celebration of the Hebrews’ release from enslavement by Pharaoh in Egypt.  Before release, the Lord brought ten plagues to Egypt.  The tenth plague was the killing of the firstborn - all in the area: humans (including Pharaoh’s firstborn), even cattle.

The Hebrews were instructed to mark their doorposts with the blood of a spring lamb.  The spirit of the Lord would pass over those homes, sparing the firstborn therein.

The Wikipedia article is a quick read full of interesting details on Passover customs.

Steve Parker, M.D.

Fruit and vegetable consumption does not seem to reduce the risk of heart attacks (coronary heart disease), according to a recent literature review by French epidemiologists.

I recently wrote about a study that found no overall reduced risk of cancer via consumption of fruits and vegetables.

Heart attacks and cancer are the first and second leading causes of death in the developed world.

So just why, again, are we supposed to be eating our fruits and vegetables?

Here’s most of the abstract written by the epidemiologists:

This Review summarizes the evidence for a relationship between fruit and vegetable consumption and the occurrence of coronary heart disease…Most of the evidence supporting a cardioprotective effect comes from observational epidemiological studies; these studies have reported either weak or nonsignificant associations.  Controlled nutritional prevention trials are scarce and the existing data do not show any clear protective effects of fruit and vegetables on coronary heart disease.  Under rigorously controlled experimental conditions, fruit and vegetable consumption is associated with a decrease in blood pressure, which is an important cardiovascular risk factor.  However, the effects of fruit and vegetable consumption on plasma lipid levels, diabetes, and body weight have not yet been thoroughly explored.  Finally, the hypothesis that nutrients in fruit and vegetables have a protective role in reducing the formation of atherosclerotic plaques and preventing complications of atherosclerosis has not been tested in prevention trials.  Evidence that fruit and vegetable consumption reduces the risk of cardiovascular disease remains scarce thus far.

What do they mean by controlled prevention trials?  Here’s an example.  Find 20,000 people with similar characteristics.  Randomly assign half of them to eat significantly more fruits and vegetables, and make sure they do it.  The other half eats their usual way, and make sure they do it.  Analyze the entire group’s health and food consumption after 10 years and see which half has more or less heart disease.   

Such a study is very difficult and costly.  Even if the fruit and veggie group had less heart disease, someone would argue that the heart benefit was gained because of what they cut out of their eating to make way for the fruits and veggies!  “They quit eating Cheetos; that’s why they had fewer heart attacks.”

Bottom Line

Fruits and vegetables don’t prevent heart disease, according to these researchers.

Fruits and vegetables are components of overall healthy diet patterns such as the Mediterranean diet, the DASH diet, and the “prudent diet.”  Is it possible they reduce the risk of stroke, the second leading cause of death?  I’ll leave that for another day.

I’m starting to think if I read enough nutritional literature, I won’t know anything with certainty.

Steve Parker, M.D. 

Dauchet L., Amouyel, P., and Dallongeville, J. (via MedScape).  Fruits, vegetables and coronary heart disease.  Nature Reviews Cardiology, 6 (2009): 599-608.  doi: 1011038/nrcardio.2009.131