Advanced Mediterranean Diet

Mediterranean Diet Linked to Lower Stomach Cancer Risk

Wednesday, December 16th, 2009

The Mediterranean diet is associated with a 33% reduction in stomach cancer, according to a study just published in the American Journal of Clinical Nutrition.

Stomach cancer (aka gastric cancer) is uncommon in the U.S. Most cases are advanced and incurable at the time of diagnosis. So prevention is ideal.

European investigators studied 485,000 people over the course of nine years, during which 449 cases of stomach cancer were found. Surveys determined how closely the food consumption of study participants tracked nine key components of the Mediterranean diet. Compared with people who had low adherence to the Mediterranean diet, those with high adherence had 33% less risk of developing stomach cancer.

The Mediterranean diet has long been associated with a lower risk of cancer: specifically, cancers of the breast, colon, prostate, and uterus. We can add stomach cancer to the list now.

Steve Parker, M.D.

Reference: Buckland, Genevieve, et al. Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study. American Journal of Clinical Nutrition, December 9, 2009, epub ahead of print. doi: 10.3945/ajcn.2009.28209

Posted in Cancer | 2 Comments »

Alcohol Types Other Than Wine Increase Cancer Risk in Men

Monday, September 7th, 2009

Canadian researchers recently reported that Canadian men who are regular alcohol drinkers - on a daily or weekly basis - have a higher risk of cancer of the esophagus, stomach, colon, liver, lung, and prostate. The more men drink, the greater the risk.

The investigators suspect that alcohol may be responsible for up to 5% of all invasive cancer deaths. Their article abstract does not address the possibility that regular drinkers may live longer than non-drinkers despite increased risk of cancer.

Readers of this blog will note that I am a bit of an advocate of alcohol consumption - for carefully selected people - for prolongation of life and reduction of cardiovascular disease. I’m also on record as favoring wine over other alcoholic beverages for these potential benefits.

I happy to report that the Canadians did not find an association between wine consumption and cancer.

Steve Parker, M.D.

Reference: Benedetti, Andrea, et al. Lifetime consumption of alcoholic beverages and risk of 13 types of cancer in men: results of a case-control study in Montreal. Cancer Detection and Prevention, 32 (2009): 352-362.

Posted in Cancer, Alcohol | 4 Comments »

Health Benefits of Nuts

Saturday, March 14th, 2009

I frequently check in at CalorieLab for up-to-date nutrition news.

Karen Collins, M.S., R.D., C.D.N., is a guest contributor there today, writing about the potential health benefits of nuts. I was aware of the cardiovascular benefits; she taught me about possible salutary effects on cancer and diabetes.

From my own literature review, the cardiac benefits are associated with a nut ”dose” of three to five 1-ounce servings a week.

Last December, I blogged about reversal of metabolic syndrome with a Mediterranean Diet supplemented with nuts.

I recommend Ms. Collins’ article to you.

Steve Parker, M.D.

Albert, Christine, et al. Nut consumption and decreased risk of sudden cardiac death in the Physicians’ Health Study. Archives of Internal Medicine, 162, (2002): 1,382-1,387.

Posted in Cancer, Cardiovascular Disease, Diabetes Mellitus, Nuts | Comments Off

Alcohol Consumption and Cancer in Women

Friday, March 13th, 2009

The Million Women Study recently looked at the association between alcohol consumption and the incidence of various cancers in middle-aged women in the United Kingdom.

Here’s the conclusion from the abstract in the Journal of the National Cancer Institute:

Low to moderate alcohol consumption in women increases the riskof certain cancers. For every additional drink regularly consumedper day, the increase in incidence up to age 75 years per 1000for women in developed countries is estimated to be about 11for breast cancer, 1 for cancers of the oral cavity and pharynx,1 for cancer of the rectum, and 0.7 each for cancers of theesophagus, larynx and liver, giving a total excess of about15 cancers per 1000 women up to age 75.

Other cancers seemed to be reduced by increasing levels of alcohol consumption: thyroid, non-Hodgkin lymphoma, renal cell carcinoma.

Comparing wine with other alcohol types, no differences in cancer risks were found.

Low to moderate alcohol consumption is associated with prolonged life, lesser risk of dementia, and lower rates of cardiovascular disease. The article abstract doesn’t mention these issues, nor the possibility that the benefits of judicious alcohol consumption may outweigh the cancer risks.

^{Steve Parker, M.D.}

^References:

^{Allen, Naomi, et al. Moderate Alcohol Intake and Cancer Incidence in Women. Journal of the National Cancer Institute, 101 (2009): 296-305.}

^{Lauer, Michael and Sorlie, Paul. Alcohol, Cardiovascular Disease, and Cancer: Treat With Caution. Journal of the National Cancer Institute, 101 (2009): 282-283.}

Szwarc, Sandy. In Vino Veritas - Part Two. Junkfood Science blog, March 1, 2009. Accessed March 10, 2009. A quote from Ms. Szwarc regarding the Million Women Study:

The bottom line is that scary claims that “there is no level of alcohol consumption that can be considered safe,” simply was not supported by the data. This study actually found no credible link between alcohol consumption and cancers at all. Or, if you want to split hairs and believe the small computed numbers, it found that the lowest risk for cancers was associated with women drinking up to 1-2 drinks a day.

Posted in Cancer, Alcohol | 9 Comments »

How Do You Change Lifelong Eating Habits?

Tuesday, March 10th, 2009

A recent study published in the Journal of the American Dietetic Association documents one way to change eating habits: exchange lists.

Your basic exhange list is a list of recommended foods, with serving sizes and frequencies. For example, I could give you note recommending you eat three pieces of fruit, four 1-cup servings of vegetables, and two tablespoons of healthy oils daily. Then I give you a list fruits, vegetables, and oils from which to choose. You decide which fruits to eat from the list, just be sure to eat three servings daily. One fruit is as good as the other: they are exchangeable. You check off your intake as you go through the day. People with diabetes have used exchange lists for years.

Researchers with the University of Michigan Health System plan to test a Mediterranean-style diet for breast cancer prevention. Several previous observational studies have associated the Mediterranean diet with lower rates of breast cancer (along with lower rates of colon, uterus, and prostate cancer). The researchers wondered how to get women to change their diet in the direction of a Greek-Mediterranean diet. They devised an exchange list to promote high intake of monounsaturated fats and fruits and vegetables. Would women follow it?

Methodology

Sixty-nine women, ages 25 to 59, were enrolled to either continue their usual diet or to follow a six-month intervention diet designed to:

decrease usual fat intakes by about half and to replace those fats with olive oil and other high–monounsaturated fatty acid foods; increase fruit and vegetable intakes to 7 to 9 servings/day, depending on energy intake; and consume at least one serving per day each of culinary herbs and allium vegetables.

Allium vegetables include onions, leeks, chives, garlic, and shallots.

Dietitians designed a Mediterranean diet exchange list, specified exchange goals, and provided individualized telephone counseling. Counseling was in-person at the start of the study and three months later.

Here’s a quote from the University of Michigan Health System news release:

In this new study, specific suggestions in the exchange list included:

8-10 servings (or exchanges) each day of high monounsaturated fatty acid (MUFA), such as olive or hazelnut oil, avocado and macadamia nuts

Limits on fats that are low in MUFA, such as corn oil, margarine, tahini, pine nuts and sesame seeds.

One or more servings a day of dark green vegetables, such as broccoli, peas and spinach

At least one exchange per day of garlic, onions and leeks

One tablespoon or more per day of green herbs, such as basil, cilantro, peppermint and sage

One or more servings a day of red vegetables, such as tomatoes, tomato sauce and salsa

One or more servings a day of yellow or orange vegetables, such as carrots, red bell peppers and pumpkin

One or more servings a day of other vegetables, such as artichokes, cucumber, green beans and sugar snap peas

One or more servings a day of vitamin C fruits, such as oranges, mangoes and strawberries

One or more servings a day of other fruits, such as apples, bananas and grapes

Results

Compared to the non-intervention (control) group, the Mediterranean group:

increased dietary monounsaturated fat by 48% (with no change in total fat intake)
increased fruit and vegetable intake from 4 to 8.6 servings a day

Researchers’ Conclusions

Results demonstrated that counseling using the Mediterranean exchange list was effective for large dietary changes relative to the nonintervention group.

My Comments

I can’t wait to see the larger prospective study regarding breast cancer reduction with a Greek-Mediterranean diet. But it will take years. And the dietary effects likely are cumulative over years of eating, not just six months. This is a start.

We have seen with weight-loss diets that people typically return to their old ways of eating six to twelve months after making a change. That’s why it’s so difficult to demonstrate irrefutably that one diet is healthier than another. How do you get 10,000 people to make major dietary changes and sustain them for 10-20 years, and another similar group of 10,000 people to make no changes? [After 20 years, you compare the health status of both groups.]

I suppose we could study prisoners serving life terms. Hmmm . . .

Many of us can’t wait 10 or 20 years for study results. We have to make food decisions now, based on the best available data.

My Advanced Mediterranean Diet uses an exchange list system - Daily Logs & and Grocery Shopping List - to approximate the Mediterranean diet. People seem to like the flexibility.

Steve Parker, M.D.

References:

Djuric, Zora, et al. Design of a Mediterranean Exchange List Diet Implemented by Telephone Counseling. Journal of the American Dietetic Association, 108 (2008): 2,059-2,065.

University of Michigan Health System news release, “Women double fruit, veggie intake with switch to Mediterranean diet,” December 17, 2008.

Posted in Cancer, Food, Shameless Self-Promotion | 2 Comments »

Olive Oil Suppresses Breast Cancer Gene

Thursday, December 18th, 2008

The traditional Mediterranean diet has long been associated with a reduced incidence of cancers of the breast, prostate, colon, and uterus.

A new study out of Spain indicates that chemicals in extra virgin olive oil can kill breast cancer cells, which may help explain the lower incidence of breast cancer seen in adherents of the Mediterranean diet. Olive oil is the predominant form of fat in the traditional Mediterranean diet. Robert Preidt writes about the new research findings at MedlinePlus (HealthDay) today: Phenols in Quality Olive Oil Suppress Breast Cancer Gene.

Phytochemical polyphenols (i.e., lignans and secoiridoids) inhibited the breast cancer gene HER2, leading to death of cultured breast cancer cells. This is test tube stuff not involving actual cancer cells in actual humans.

The researchers hope their findings lead to new breast cancer drugs based on these natural chemicals. Don’t we all.

According to a December 16, 2008 article by Reuters-India, Spain is the largest producer of olive oil, although much of it is bottled and re-exported from Italy.

The healthy version of the Mediterranean diet is heavily influenced by the cuisines of Greece and southern Italy. It’s great to see increasing numbers of supportive scientific studies originating in Spain.

Steve Parker, M.D.

Additional information: Related article at WebMD.com.

Posted in Cancer | 2 Comments »

U.S. Cancer Incidence and Cancer Death Rates Both Down

Thursday, November 27th, 2008

The National Institutes of Health reports the good news in the headline above, the first time since the annual reports were started in 1998.

Cancer rates could be reduced further by wider adoption of the traditional Mediterranean diet.

Earlier this year the U.S. Centers for Disease Control and Prevention reported lower rates of death for 11 of the top 15 causes of death, and an unprecedented prolongation of lifespan in the U.S.

Thank you, God.

Happy Thanksgiving!

Steve Parker, M.D.

Posted in Cancer | 1 Comment »

Mediterranean Diet May Prevent Melanoma (Serious Invasive Skin Cancer)

Monday, October 27th, 2008

A recent study suggests a protective effect of the Mediterranean diet for cutaneous melanoma. This is the first study to examine melanoma’s association with the Mediterranean diet.

Melanoma is the seventh most common cancer in Americans, and the most common fatal malignancy among young adults. Lifetime risk of developing melanoma is one in 71. Incidence of melanoma in the white U.S. population has more than tripled in the last 20 years. In 2008 in the U.S., 62,000 new cases of melanoma are expected.

The researchers in Rome, Italy, used a hospital-based case-control method including 304 cases of melanoma and 305 matched controls who did not have melanoma. Information on sun exposure, skin pigmentation, smoking, medical history, and socio-demographic characteristics was collected.

The researchers report:

After careful control for several sun exposure and pigmentary characteristics, we found a protective effect for weekly consumption of fish, shellfish, fish rich in omega-3 fatty acids, daily tea drinking and high consumption of vegetables in particular carrots, cruciferous and leafy vegetables and fruits, in particular citrus fruits.

[For the sake of clarity, I have omitted odds ratios and confidence intervals. Odds ratios for many of these associations were around 0.50, meaning half the risk of developing melanoma.]

Conclusion overall: Our findings suggest that some dietary factors present in the Mediterranean diet might protect from cutaneous melanoma.

Prior studies have demonstrated lower incidence of breast, colon, prostate, and uterus cancer in people who adhere to the traditional Mediterranean diet. Note also that death rates from cancer are lower. We can probably add melanoma to the list of cancers prevented with a Mediterranean-style diet, although I would have more confidence if the current study had included more participants.

Steve Parker, M.D.

Reference: Fortes, C., et al. A protective effect of the Mediterraenan diet for cutaneous melanoma. International Journal of Epidmiology, 37 (2008): 1,018-1,029.

Posted in Cancer | 2 Comments »

Prostate Cancer Deaths Linked to Overweight and High Insulin Levels

Monday, October 6th, 2008

Lancet Oncology this week published a report associating worse prostate cancer outcomes - death, that is - with overweight, obesity, and hyperinsulinemia.

Researchers looked at data from the respected Physicians’ Health Study, finding 2,546 men who developed prostate cancer during many years of observation. Of these men, 38.8% were overweight (body mass index 25-30) and 3.4% were obese (BMI over 30).

[For definitions of overweight and obesity, and to calculate your body mass index, click here.]

Compared with normal-weight men (BMI under 25) who developed prostate cancer, overweight men with prostate cancer were one-and-a-half times more likely to die from the cancer. Obese men with prostate cancer were two-and-a-half times more likely to die.

A blood test called C-peptide is a marker of insulin resistance and hyperinsulinemia. Obesity is often accompanied by high insulin levels and insulin resistance. Overweight, not so much. Eight hundred twenty-seven of the men with prostate cancer had C-peptide levels drawn at baseline, before diagnosed with cancer. Men with the highest C-peptide levels were almost two-and-a-half times more likely to die of prostate cancer than men with the lowest C-peptide levels.

Study participants having both excess body weight and high C-peptide levels had the worst outcome.

Prostate cancer is the most common invasive cancer in U.S. men, with about 185,000 cases diagnosed every year. It is one of the cancers that is apparently prevented by following the traditional Mediterranean diet for years. The other prevented cancers are breast, uterus, and colorectal. Obesity predisposes men to cancer of the prostate, colon, rectum, kidney, and esophagus.

The study at hand suggests that if you are overweight or obese and then develop prostate cancer, you have a greater risk of dying from the cancer compared with healthy-weight men. Given that prostate cancer is so common, why not cut your risk of getting it and dying from it by controlling your weight with a Mediterranean-style diet?

Steve Parker, M.D., author of The Advanced Mediterranean Diet

Reference: Ma, Jing, et al. Prediagnostic body mass index, plasma C-peptide concentration, and prostate cancer-specific mortality in men with prostate cancer: a long-term survival analysis. Lancet Oncology, online publication October 6, 2008. DOI: 10.1016/S1470-2045(08)70235-3

Posted in Cancer, Overweight/Obese | Comments Off

Huge Study Confirms Health and Longevity Benefits of the Mediterranean Diet

Friday, September 19th, 2008

Italian researchers reported in the September 11, 2008, online issue of the British Medical Journal what is already known:

“Greater adherence to a Mediterranean diet is associated with a significant improvement in health status, as seen by a significant reduction in overall mortality (9%), mortality from cardiovascular diseases (9%), incidence of or mortality from cancer (6%), and incidence of Parkinsons’s disease and Alzheimer’s disease (13%). These results seem to be clinically relevant for public health, in particular for encouraging a Mediterranean-like dietary pattern for primary prevention of major chronic diseases.”

Methodology

Researchers, mostly at the University of Florence, performed a meta-analysis of 12 other published studies that looked at the effects of a Mediterranean-style eating pattern on health and longevity. [Meta-analyses are popular, in part, because they are cheap. This study required no specific funding.]

Most, if not all, of these 12 studies were observational, and involved 1,574,299 participants. Six of the 12 studies were in Mediterranean countries, the others were in the U.S., northern Europe, and Australia. Study participants were followed between 3.7 and 18 years.

The researchers devised their very own Mediterranean diet scale based on study participants’ intake of various foods. Participants were given a point if they had higher than average intake of vegetables, fruits, legumes, cereals, fish, and red wine during meals. They were given a point if they had lower than average intake of red meat, processed meats, and dairy products. Due to differences among the 12 studies, “the total adherence scores…varied from a minimum of 0 points indicating low adherence to a maximum of 7-9 points reflecting high adherence to a Mediterranean diet.”

[This version of a Mediterranean diet score is problematic. Curiously, olive oil - the predominant source of fat in the traditional Mediterranean - is not in the score. Olive oil is a key characteristic of the Mediterranean diet. Furthermore, the study authors also state that dairy products are ”presumed not to form part of a Mediterranean diet.” Most experts would argue that cheese and yogurt are a significant part of the Mediterranean diet, if only in low amounts. I also doubt that participants in the 12 original studies were surveyed whether they drank red wine -as contrasted with white - and whether it was with meals or not. I admit I did not read each of the 12 component studies. The underlying cause of this idiosyncratic definition of the Mediterranean diet is that the 12 original studies themselves used different definitions of the Mediterranean diet. The meta-analysts had to pigeonhole the data. There are a handful of respected Mediterranean diet scores in existence, but the authors of this study couldn’t apply them across the board due to database inconsistency or inadequacy.]

Results

“The cumulative analysis of 12 cohort studies shows that a two point increase [emphasis added] in the score for adherence to a Mediterranean diet determines a 9% reduction, in overall mortality, a 9% reduction in mortality from cardiovascular diseases, a 6% reduction in incidence of or mortality from neoplasm [cancer], and 13% reduction in incidence of Parkinson’s disease and Alzheimer’s disease.”

The only one of the 12 original studies focused on Alzheimer’s disease, and it showed a 17% reduction in participants with high adherence to the Mediterranean diet. The two studies that focused on Parkinson’s disease revealed a 7% reduction in men, and 15% reduction in women. These reduced incidence figures, again, apply to a two-point increase in Mediterranean diet adherence score.

Discussion

The authors indicate that their report is the first ever meta-analysis of the data associating the Mediterranean diet with reduced mortality and chronic disease in the general population. Congratulations, guys!

The authors’ idiosyncratic Mediterranean diet score is unusual and won’t be widely adopted. However, the 12 studies comprising the meta-analysis did have reasonable Mediterranean diet characteristics.

Combining Alzheimer’s data with Parkinson’s data doesn’t make sense to me, nor did the authors try to explain it. You could lump them into the category of “neurodegenerative diseases,” but they aren’t the only ones by any means. The single Alzheimer’s study, by the way, was quite small compared to the two Parkinson’s studies.

Nearly all the popular media stories reported the findings as I did in my first paragraph above, which may be misleading. The specific improvements in mortality and various disease rates is per two-point increase in Mediterranean diet score. For example, consider the 9% reduction in overall mortality. If a population increased its Mediterranean score by four points, would overall mortality be reduced by 18%? I’ve read this study four times and cannot answer my own question. But I suspect that the answer is “yes.” So the news here may better than it seems at first blush.

In other words: If a population’s score goes from 5 to 7, the death rate is reduced by 9%. If that same population then moved its score from 7 to 9, would mortality improve another 9%? I think so, but this study as written does not make it clear.

I’m starting to see why the popular media simplified the study findings. The reporting on this study is amazingly uniform. They must have all gotten the same news release.

Of course, “populations” don’t die or get cancer, heart attacks, strokes, Alzheimer’s, or Parkinson’s disease. Individuals do that. If I as an individual had a low Mediterranean diet score, I would try to improve my score by at least two points. A good place to start would be a review of the Mediterranean Diet Pyramid promoted by Oldways Preservation and Exchange Trust (reproduced with permission):

Oldways Mediterranean Diet Pyramid