Advanced Mediterranean Diet

Patients ask me periodically if grape seed extract provides the same health benefit as judicious red wine.  Nobody knows with certainty.  The health benefits of red wine may be due to resveratrol.  Grape seed extract contains potentially healthy antioxidants called proanthocyanidins,

Many people don’t enjoy wine or other alcohol-containing drinks, and others just shouldn’t drink any alcohol.  Should they take a grape seed extract supplement or drink grape juice as a subsitute?  Again, it’s still unclear.  In 2009 I wrote a about a review article looking at the effect of various non-wine grape products and effects on heart disease risk.

A recent meta-analysis out of the University of Connecticut found improvement in two heart disease risk factors in those who take a grape seed extract supplement:

• systolic blood pressure lower by 1.54 mmHg
• heart rate lower by 1.42 beats per minute

No effect was seen on lipids (cholesterol and triglycerides), diastolic blood pressure, and C-reactive protein (a test of systemic inflammation).

Granted, these are tiny effects.  It’s unknown whether they, or other unknown effects of grape seed extract, would translate into clinical benefits such as fewer heart attacks and strokes, and longer lifespans.

Bottom Line

Grape seed extract and other non-wine grape products may be as beneficial as red wine in prolonging lifespan and preventing heart disease.  But we have much stronger evidence in favor of red wine and other alcohol-containing drinks.

Steve Parker, M.D.

 Reference:  Feringa, H.H.H, et al. The Effect of Grape Seed Extract on Cardiovascular Risk Markers: A Meta-Analysis of Randomized Controlled Trials.  Journal of the American Dietetic Association, 111 (2011): 1,173-1,181.

I’ve found that nearly everbody’s eyes glaze over if I try to explain how, physiologically, the Mediterranean diet promotes health and longevity.  Below are some of the boring details, for posterity’s sake, from my 2007 book, The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer.

Many of the nutrient-disease associations I mention below are just that: associations, linkages, not hard proof of a benefit.  Available studies are often contradictory.  For instance, there may be 10 observational studies linking whole grain consumption with reduced deaths from heart disease, while three other studies find no association, or even suggest  higher death rates. (I’m making these numbers up.)  If you want hard proof, you’ll have to wait.  A long time.  Such is nutrition science.  Take it all with a grain of salt. 

Also note that the studies supporting my claims below are nearly all done in non-diabetic populations.

Coronary Heart Disease

Coronary heart disease, also known as coronary artery disease, is the No.1 cause of death in the world. It’s responsible for 40% of deaths in the United States and other industrialized Western countries. The Mediterranean diet is particularly suited to mitigating the ravages of coronary heart disease. Mediterranean diet cardiac benefits may be related to its high content of monounsaturated fat (in olive oil), folate, and antioxidants.

The predominant source of fat in the traditional Mediterranean diet is olive oil, which is rich in monounsaturated fatty acids. High intake of olive oil reduces blood levels of triglycerides, total cholesterol, and LDL (”bad”) cholesterol. HDL or “good” cho-lesterol is unaffected. Olive oil tends to lower blood pressure in hypertensive people. Monounsaturated fatty acids reduce cardiovascular risk substantially, particularly when they replace simple sugars and easily digestible starches. Monounsaturated fatty acids and olive oil may also reduce breast cancer risk. The cardioprotective (good for the heart) and cancer-reducing effects of olive oil may be partially explained by the oil’s polyphenolic compounds.
    
Nuts are another good source of monounsaturated fatty acids and polyunsaturated fatty acids, including some omega-3 polyunsaturated fatty acids. Nuts have been proven to be cardioprotective. They lower LDL and total cholesterol levels, while providing substantial fiber and numerous micronutrients, such as vitamin E, potassium, magnesium, and folic acid. Compared with those who never or rarely eat nuts, people who eat nuts five or more times per week have 30 to 50% less risk of a fatal heart attack. Lesser amounts of nuts are also cardioprotective, perhaps by reducing lethal heart rhythm dis-turbances. 
    
Another key component of the Mediterranean diet is fish. Fish are excellent sources of protein and are low in cholesterol. Fatty, cold-water fish are particularly good for us because of their omega-3 polyunsaturated fatty acids: eicosapentaenoic acid (EPA) and docosahexanaenoic acid (DHA). The other important omega-3 polyunsaturated fatty acid is alpha-linolenic acid (ALA), available in certain plants. Our bodies can convert ALA into EPA and DHA, but not very efficiently. Fish oil supplements, which are rich in EPA, lead to lower total cholesterol and triglyce-ride levels. Fish oil supplements have several properties that fight atherosclerosis (hardening of the arteries). In people who have already had a heart attack, the omega-3 polyunsaturated fatty acids have proven to dramatically reduce cardiac deaths, especially sudden death, and nonfatal heart attacks. So omega-3 polyunsaturated fatty acids are “cardioprotective.”

The first sign of underlying coronary heart disease in many people is simply sudden death from a heart attack (myocardial infarction) or heart rhythm disturbance. These unfortunate souls had hearts that were ticking time bombs. I have little doubt that a significant number of such deaths can be prevented by adequate intake of cold-water fatty fish. As a substitute for fish, fish oil supplements might be just at beneficial. The American Heart Association also recommends fish twice weekly for the general population, or fish oil supplements if whole fish isn’t feasible. Compared with fish oil capsules, whole fish are loaded with vitamins, minerals, and protein. The richest fish sources of omega-3 polyunsaturated fatty acids are albacore (white) tuna, salmon, sar-dines, trout, sea bass, sword-fish, herring, mackerel, anchovy, halibut, and pompano.
    
Cardioprotective omega-3 polyunsaturated fatty acids (mainly ALA) are also provided by plants, such as nuts and seeds, legumes, and vegetables. Rich sources of ALA include walnuts, butternuts, soy-beans, flaxseed, almonds, leeks, purslane, pinto beans, and wheat germ. Purslane is also one of the few plant sources of EPA. Several oils are also very high in ALA: flaxseed, canola, and soybean. Look for them in salad dressings, or try cooking with them.

Macular Degeneration

Omega-3 fatty acid and fish consumption may also be “eye-protective.” Eating fish one to three times per week apparently helps prevent age-related macular degeneration (AMD), the leading cause of blindness in people over 50 in the United States. While AMD has a significant hereditary component, onset and progression of AMD are affected by diet and lifestyle choices. For instance, smoking cigarettes definitely increases your risk of developing AMD. Other foods associated with lower risk of AMD are dark green leafy vegetables, orange and yellow vegetables and fruits: spinach, kale, collard greens, yellow corn, broccoli, sweet potatoes, squash, orange bell peppers, oranges, mangoes, apricots, peaches, honeydew melon, and papaya. Two unifying phytochemicals in this food list are lutein and zeaxanthin, which are also found in red grapes, kiwi fruit, lima beans, green beans, and green bell peppers. Increasing your intake of these foods as part of the Advanced Mediterranean Diet may well help preserve your vision as you age.      
    
Alzheimer’s Dementia
    
Another exciting potential benefit of fish consumption is prevention or delay of Alzheimer’s dementia. Several recent epidemiologic studies have suggested that intake of fish once or twice per week significantly reduces the risk of Alzheimer’s. Types of fish eaten were not specified. No one knows if fish oil capsules are equivalent. For now, I’m sticking with fatty cold-water fish, which I call my “brain food.”
    
Vitamin E supplements may slow the progression of established Alzheimer’s disease; clinical studies show either modest slowing of progression or no benefit. As a way to prevent Alzheimer’s, however, vitamin E supplements have been disappointing. On the other hand, high dietary vitamin E is associated with reduced risk of developing Alzheimer’s. Good sources of vitamin E include vegetable oils (especially sunflower and soybean), sunflower seeds, nuts, shrimp, fruits, and certain vegetables: sweet potatoes, asparagus, beans, broccoli, Brussels sprouts, carrots, okra, green peas, sweet peppers, spinach, and tomatoes. All of these are on your new diet. 

Wine

For centuries, the healthier populations in the Mediterranean region have enjoyed wine in light to moderate amounts, usually with meals. Epidemiologic studies there and in other parts of the world have associated reasonable alcohol consumption with prolonged lifespan, reduced coronary artery disease, diminished Alzheimer’s and other dementias, and possibly fewer strokes. Alcohol tends to increase HDL cholesterol, have an antiplatelet effect, and may reduce C-reactive protein, a marker of arterial inflammation. These effects would tend to reduce cardiovascular disease. Wine taken with meals provides antioxidant phytochemicals (polyphenols, procyanidins) which may protect against atherosclerosis and some cancers. 

What’s a “reasonable” amount of alcohol? An old medical school joke is that a “heavy drinker” is anyone who drinks more than the doctor does. Light to moderate alcohol consumption is generally consi-dered to be one or fewer drinks per day for a woman, two or fewer drinks per day for a man. One drink is 5 ounces of wine, 12 ounces of beer, or 1.5 ounces of 80 proof distilled spirits (e.g., vodka, whiskey, gin). The optimal health-promoting type of alcohol is unclear. I tend to favor wine, a time-honored component of the Mediterranean diet. Red wine in particular is a rich source of resveratrol, which is thought to be a major contributor to the cardioprotective benefits associated with light to moderate alcohol consumption. Grape juice may be just as good—it’s too soon to tell.
    
I have no intention of overselling the benefits of alcohol. If you are considering habitual alcohol as a food, be aware that the health benefits are still somewhat debatable. Consumption of three or more alcoholic drinks per day is clearly associated with a higher risk of breast cancer in women. Even one or two drinks daily may slightly increase the risk. Folic acid supplementation might mitigate the risk. If you are a woman and breast cancer runs in your family, strongly consider abstinence. Be cautious if there are alcoholics in your family; you may have inherited the predisposition. If you take any medications or have chronic medical conditions, check with your personal physician first. For those drinking above light to mod-erate levels, alcohol is clearly perilous. Higher dosages can cause hypertension, liver disease, heart failure, certain cancers, and other medical problems. And psychosocial problems. And legal problems. And death. Heavy drinkers have higher rates of violent and accidental death. Alcoholism is often fatal. You should not drink alcohol if you:
            ■  have a history of alcohol abuse
                or alcoholism
            ■  have liver or pancreas disease
            ■  are pregnant or trying to become
                pregnant
            ■  may have the need to operate
                dangerous equipment or machinery,
                such as an automobile, while under
                the influence of alcohol
            ■  have a demonstrated inability to
                limit yourself to acceptable
                intake levels
            ■  have personal prohibitions due
                to religious, ethical, or other
                reasons. 
    
Cancer

Do you ever worry about cancer? You should. It’s the second leading cause of death. Over 500,000 people die from cancer each year in the United States. One third of people in the United States will develop cancer. Twenty percent of us will die from cancer. About half the deaths are from cancer of the lung, breast, and colon/rectum. Are you worried yet?

According to the American Cancer Society, one third of all cancer deaths can be attributed to diet and inadequate physical activity. So we have some control over our risk of developing cancer. High consumption of fruits and vegetables seems to protect against cancer of the lung, stomach, colon, rectum, oral cavity, and esophagus, although other studies dispute the protective linkage. Data on other cancers is limited or inconsistent. If you typically eat little or no fruits and vegetables, you can start today to cut your cancer risk by up to one half. Five servings of fresh fruits and vegetables a day seems to be the protective dose against cancer. Make it a life-long habit. The benefits accrue over time. Fruits and vegetables contain numerous phytochemicals thought to improve or maintain health, such as carotenoids (e.g., lycopene), lignans, phytosterols, sulfides, isothyocyanates, phenolic compounds (including flavonoids, resveratrol, phytoestrogens, antho-cyanins, and tannins), protease inhibitors, capsaicin, vitamins, and minerals. 
   
In addition to cancer prevention properties, fruits and vegetables provide fiber, which is the part of plants resistant to digestion by our enzymes. The other source of fiber is grain products, especially whole grains. Liberal intake of fiber helps prevent constipation, diverticular disease, hemorrhoids, irritable bowel syndrome, and perhaps colon polyps. Soluble fiber helps control blood sugar levels in diabetics. It also reduces LDL cholesterol levels, thereby reducing risks of coronary heart disease. Whether or not related to fiber, high fruit and vegetable intake may reduce the risks of coronary heart disease and stroke. Legume consumption in particular has been associated with a 10 to 20% lower risk of coronary heart disease, with the effective dose being around four servings per week. 

Fiber and Whole Grains

Processed, refined grain products have much less fiber than do whole grains. For instance, white all-purpose enriched flour has only about one fourth the fiber of whole wheat flour. The milling process removes the bran, germ, and husk (chaff), leaving only the endosperm as the refined product, flour. Endosperm is mostly starch and 10–15% protein. Many nutrients are lost during processing. The germ is particularly rich in vitamins (especially B vitamins), polyunsaturated fatty acids, antioxidants, trace minerals, and phytochemicals. Phytochemicals protect us against certain chronic diseases. Bran is high in fiber and nutrients: B vitamins, iron, magnesium, copper, and zinc, to name a few. Enriched grain products are refined grains that have had some, but certainly not all, nutrients added back, typically iron, thiamin, niacin, riboflavin, and folate. Why not just eat the whole grain? Whole grain products retain nearly all the nutrients found in the original grain. Hence, they are more nutritious than refined and enriched grain products.
    
Liberal intake of high-fiber whole grain foods, as contrasted with refined grains, is linked to lower risk of death and lower incidence of coronary heart disease and type 2 diabetes mellitus. For existing diabetics, whole grain consumption can help im-prove blood sugar levels. Three servings of whole grains per day cut the risk of coronary heart disease by about 25 percent compared with those who rarely eat whole grains. Regular consumption of whole grains may also substantially reduce the risk of sev-eral forms of cancer.

Average adult fiber intake in the United States is 12 to 15 grams daily. Expert nutrition panels and the American Heart Association recommend 25 to 30 grams daily from whole grains, fruits, and vegetables.

The health benefits of the Mediterranean diet likely spring from synergy among multiple Mediteranean diet components, rather than from a single food group or one or a few food items. 

Steve Parker, M.D.

Intentional weight loss didn’t have any effect either way on risk of death, according to recent research out of Baltimore.  Surprising, huh?

Obesity tends to shorten lifespan, mostly due to higher rates of cancer and cardiovascular disease like heart attacks and strokes.  Doctors and dietitians recommend loss of excess weight all day long, figuring it will reduce the risk of obesity-related death and disease.  That’s not necessarily the case, however.  It’s called the “obesity paradox“: some types of overweight and obese patients actually seem to do better (e.g., live longer) if they’re above the so-called healthy body mass index of 18.5 to 24.9.  For instance: those with heart failure, coronary artery disease, and advanced kidney disease.

It’s never really been clear whether the average obese person (body mass index over 30) improves his longevity by losing some excess weight.  That’s what the study at hand is about.

Methodology

Baltimore-based investigators followed the health status of 585 overweight or obese older adults over the course of 12 years.  Half of them were randomized to an intentional weight loss intervention.  All of them had a high blood pressure diagnosis.  Average age was 66.  Average body mass index was 31.  Details of the weight-loss intervention are unclear, but it was probably along the lines of “eat less, exercise more.”

What Did They Find?

The weight-loss group lost and maintained an average of 4.4 kg (9.7 lb) over the 12 years of the study.  This is about 5% of initial body weight, the minimal amount thought to be helpful for improvement in weight-related medical problems.  Most of the weight loss was over the first three years.

The men assigned to the weight-loss program had about half the risk of dying over the course of the study, compared to the men not assigned to weight loss.  The authors don’t seem to put much stock in it, however, stating that “…no significant difference overall was found in all-cause mortality between older overweight and obese adults who were randomly assigned to an intentional weight-loss intervention and those who were not.” 

Comments

With regards to the men losing weight, we’re only talking about 100-150 test subjects, a relatively small number.  So I understand why the researchers didn’t make a big deal of the lower mortality: it may not be reproducible.

This same research group did a similar study of 318 arthritis patients and intentional weight loss, finding a 50% lower death rate over eight years.

The authors reviewed many similar studies done by other teams, noting increased death rates from weight loss in some studies, and lesser death rates in others. 

When the studies are all over the place like this, it usually means there’s no strong association either way.  Nearly all the pertinent studies were done on relatively healthy, middle-aged and older folks.  The most reliable thing you can say about the issue is that loss of excess fat weight doesn’t increase your odds of premature death. 

 Remember that patients with coronary heart disease, congestive heart failure, or advanced kidney disease tend to live longer if they’re overweight or at least mildly obese.  It’s the obesity paradox.  Will they live longer or die earlier if they go on a weight-loss program?  We don’t know.

We do know that intentional weight loss helps:

• prevent type 2 diabetes
• maintain reasonable blood pressures (avoiding high blood pressure)
• improves lower limb functional ability

Maybe that’s enough.

Steve Parker, M.D.

Reference: Shea MK, Nicklas BJ, Houston DK, Miller ME, Davis CC, Kitzman DW, Espeland MA, Appel LJ, & Kritchevsky SB (2011). The effect of intentional weight loss on all-cause mortality in older adults: results of a randomized controlled weight-loss trial. The American journal of clinical nutrition, 94 (3), 839-46 PMID: 21775558

The Mediterranean diet preserves heart muscle performance and reduces future heart disease events, according to Greek researchers reporting in the American Journal of Clinical Nutrition, May 19, 2010.

Reuters and other news services have covered the story.

The Mediterranean diet is well-established as an eating pattern that reduces the risk of death or illness related to cardiovascular disease—mostly heart attacks and strokes.  Most of the studies in support of the heart-healthy diet looked at development of disease in general populations.  The study at hand examined whether the diet had any effect on patients with known heart disease, which has not been studied much.

How Was the Study Done? 

 The study population was 1,000 consecutive patients admitted with heart disease to a Greek hospital between 2006 and 2009.  In this context, heart disease refers to a first or recurrent heart attack (70-80% of participants) or unstable angina pectoris.  Acute heart attacks and unstable angina are “acute coronary syndromes.”  Average age was 64.  Sixty percent had a prior diagnosis of cardiovascular disease (coronary heart disease or stroke).  Thirty percent had diabetes.  At the time of hospitalization, half had diminished function of the main heart pumping chamber (the left ventricle), half had normal pump function.  Men totalled 788; women 212.

On the third hospital day, participants were given a 75-item food frequency questionnaire asking about consumption over the prior year.  If a potential enrollee died in the first two hospital days, he was not included in the study.  A Mediterranean diet score was calculated to determine adherence to the Mediterranean diet.  Mediterranean diet items were nonrefined cereals and products, fruits, nuts, vegetables, potatoes, dairy products, fish and seafood, poultry, red meats and meat products, olive oil, and alcohol. 

Left ventricle function was determined by echocardiogram (ultrasound) at the time of study entry, at the time of hospital discharge, and three months after discharge.  Systolic dysfunction was defined as an ejection fraction of under 40%.  [Normal is 65%: when the left ventricle is full of blood, and then squeezes on that blood to pump it into the aorta, 65% of the blood squirts out.]

Participants were then divided into two groups: preserved (normal) systolic left ventricular function, or diminished left ventricular function. 

They were followed over the next two years, with attention to cardiovascular disease events (not clearly defined in the article, but I assume including heart attacks, strokes, unstable angina, coronary revascularization, heart failure, arrhythmia, and death from heart disease or stroke.

Results

• Four percent of participants died during the initial hospitalization.
• At the three month follow-up visit, those with greater adherence to the Mediterranean diet (a high Mediterranean diet score) had higher left ventricular performance (P=0.02).
• At the time of hospital admission, higher ejection fractions were associated with greater adherence to the Mediterranean diet (P<0.001).
• Those who developed diminished left ventricular dysfunction had a lower Mediterranean diet score (P<0.001)
• During the hospital stay, those in the highest third of Mediterranean diet score had lower in-hospital deaths (compared with the lower third scores) (P=0.009).
• Among those who survived the initial hospitalization, there was no differences in fatal cardiovascular outcomes based on Mediterranean diet score.
• Food-specific analysis tended to favor better cardiovascular health (at two-year follow-up) for those with higher “vegetable and salad”  and nut consumption.  No significant effect was found for other components of the Mediterranean diet score.
• Of those in the highest third of Mediterranean adherence, 75% had avoided additional fatal and nonfatal cardiovasclar disease events as measured at two years.  Of those in the lowest third of Mediterranean diet score, only 53% avoided additional cardiovascular disease events.   

The Authors’ Conclusion

Greater adherence to the Mediterranean diet seems to preserve left ventricular systolic function and is associated with better long-term prognosis of patients who have had an acute coronary syndrome.

My Comments

I agree with the authors’ conclusion.

We’re assuming these patients didn’t change their way of eating after the initial hospitalization.  We don’t know that.  No information is given regarding dietary instruction of these patients while they were hospitalized.  In the U.S., such instruction is usually given, and it varies quite a bit.

In this study, lower risk of cardiovascular death was linked to the Mediterranean diet only during the initial hospital stay.  Most experts on the Mediterranean diet would have predicted lower cardiovascular death rates over the subsequent two years.  Mysteriously, the authors don’t bother to discuss this finding.

For those who don’t enjoy red wine or other alcoholic beverages, this study suggests that the Mediterranean diet may be just as heart-healthy without  alcohol.  A 2009 study by Trichopoulou et al suggests otherwise.

Steve Parker, M.D.

Reference:
Chrysohoou, C., Panagiotakos, D., Aggelopoulos, P., Kastorini, C., Kehagia, I., Pitsavos, C., & Stefanadis, C. (2010). The Mediterranean diet contributes to the preservation of left ventricular systolic function and to the long-term favorable prognosis of patients who have had an acute coronary event American Journal of Clinical Nutrition DOI: 10.3945/ajcn.2009.28982

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.

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 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.

I loved the sound of this phrase - hari hachi bu - even before I knew what it meant.

“Hari hachi bu” comes from the Japanese islands of Okinawa.  It refers to eating a meal until you’re only 80% full, then stop eating.  It’s a method to control weight. 

Okinawa, remember, is one of the longevity hot spots in Dan Buettner’s Blue Zones. 

But would it really work for many in Western culture?  Probably not.  We don’t have the discipline to stick with it long-term.  Maybe for a day.

One of the currently popular dieting gimmicks is to eat every 3-4 hours while awake.  The rationale is, “you need the energy.”  If you eat 5-6 meals a day, you’re not cutting back on total calories even if you eat only until 80% full.

As long as you’re eating a fair amount of carbohydrates, you can store plenty of energy as glucose in glycogen - in your liver and muscles - to easily live without eating for at least 8-12 hours.  So, there’s no “need” to eat every 3-4 hours.  If there were, we would have gone extinct years ago.  At rest, you’re getting about 60% of your energy supplied by metabolism of fats, not carbohydrates.  Most people can live without all food, but not water, for about two months.

Plenty of people have said, “I’m going to lose weight by cutting back on food intake.”  I don’t have scientific data to back it up, but I’d bet that a food diary works better.

A simple weight-loss or management plan that would work better for Western world inhabitants would be:

Don’t eat anything man-made.

So off limits are bread, rolls, soft drinks, table sugar, high fructose corn syrup, pancakes, pizza, potato chips, Pringles, pies, cookies, cake, casseroles, cannolis, Doritos, Ding-Dongs, Snickers, etc.  I’d complicate it just a bit by also avoiding naturally starchy foods like potatoes and corn. 

For those who don’t like the negativity of “don’t eat that,” here’s the positive spin:

Eat only natural, minimally processed food.

In other words, eat fresh fruit, fresh vegetables, eggs, meat, chicken, fish, olive oil, nuts, etc.  These are God-made foods, not man-made.

Steve Parker, M.D.

Here’s my review of  The Blue Zones: Lessons for Living Longer From the People Who’ve Lived the Longest, a 2008 book by Dan Buettner.  I give the book four stars on Amazon.com’s five-star system (”I like it”). 

The publisher donated three copies of The Blue Zones as give-aways which I will mail to the first three readers who request one, as long as the shipping address is in the U.S.  Win a book by emailing me at steveparkermdATgmailDOTcom.  Expect three weeks for delivery.  (Update Dec. 31, 2009: Sorry - no free books left.)

♦   ♦   ♦

The lifestyle principles advocated in The Blue Zones would indeed help the average person in the developed world live a longer and healthier life.  The book is a much-needed antidote to rampant longevity quackery.  Dan Buettner’s idea behind the book was “discovering the world’s best practices in health and longevity and putting them to work in our lives.”  He succeeds. 

Mr. Buettner assembled a multidisciplinary team of advisors and researchers to help him with a very difficult subject.  Do people living to 100, scattered over several continents, share any characteristics?  Do those commonalities lead to health and longevity? 

They studied four longevity hot spots (Blue Zones):

• Okinawa islands (Japan)
• Barbagia region of Sardinia (an island off the Italian mainland)
• Loma Linda, California (a large cluster of Seventh Day Adventists)
• the Nicoya Peninsula (Costa Rica). 

Research focused on people who lived to be 100. 

Until recently, two of the Blue Zones—the Nicoyan Peninsula and Sardinia—were quite isolated, with relatively little influence from the outside world. 

Mr. Buettner et al identify nine key traits that are associated with longevity and health in these cultures.  Of course, association is not causation, which Mr. Buettner readily admits.  He draws more conclusions from the data than would many (most?) longevity scientists.  Scientists can wait for more data, but the rest of us have to decide and act based on what we know today.  Here are the “Power Nine”:

1. regular low-intensity physical activity
2. hari hachi bu (eat until only 80% full—from Okinawa)
3. eat more plants and less meat than typical Western cultures
4. judicious alcohol, favoring dark red wine
5. have a clear purpose for being alive (a reason to get up in the morning, that makes a difference)
6. keep stress under control
7. participate in a spiritual community
8. make family a priority
9. be part of a tribe (social support system) that “shares Blue Zone values”

Of these, I would say the available research best supports numbers 1, 4, 7, 8, and the social support system.

I doubt that hari hachi bu (eat until you’re only 80% full) will work for us in the U.S.  It’s never been tested rigorously.  The idea is to avoid obesity.  

The author believes that average lifespan could be increased by a decade via compliance with the Power Nine.  And these would be good, relatively healthy years.  Not an extra 10 years living in a nursing home.

Appropriately and early on, Mr. Buettner addresses the issue of genetics by mentioning a single study of Danish twins that convinces him longevity is only 25% deterimined by genetic heritage.  Environment and lifestyle choices determine the other 75%.  I believe he underestimates the effect of genetics. 

Over half the population of the Nicoya Peninsula Blue Zone are of Chorotega Indian descent, not from Spanish Conquistadores.  Would a Danish twin study have much to say about Chorotega Indians’ longevity?  We don’t know, but I’m skeptical.  Also, the Sardinians and Okinawans would seem to have centuries of a degree of inbreeding, too, according to Buettner’s own documentation. 
 
Do the Adventists tend to marry and breed with each other (like Mormons), thereby concentrating longevity genes?  You won’t find the question addressed in the book.

Because I think genetics plays a larger role in longevity than 25%, I’d estimate that the healthy lifestyle choices in this book might prolong life by six or seven years instead of 10.  But I’m splitting hairs.  I don’t have any better evidence than Mr. Buettner, just a hunch plus years of experience treating diseased and dying patients.

These four Blue Zones do share a mostly plant-based diet of natural foods with minimal processing.  Two of the populations—the Okinawans and Costa Ricans—didn’t seem to have any choice.  Heavy meat consumption just wasn’t an option available to them.  Rather than promoting a low-meat plant-based diet, it might be more accurate to conclude that “you don’t have to eat a lot of meat, chicken, or fish to live a long healthy life.”

In other words, it may not matter how much meat you eat as long as you eat the healthy optimal level of fruits, vegetables, and whole grains.  It’s a critical difference not addressed in this book except among the Adventists.

Even if you could live an extra two years as a vegan, I’m sure many people would choose to eat meat anyway.  By the way, this book conflates vegan, lacto-vegetarian, lacto-ovo vegetarian, near-vegetarian, and vegetarian into one: vegetarian.  They are not necessarily the same.  It’s a common problem when considering the health aspects of vegetarianism.   

By the same token, plenty of my patients have told me they don’t like any kind of exercise and they won’t do it, even if it would give them an extra two years of life.  What many don’t realize is that from a functional standpoint, regular exercise makes their bodies perform as if they were ten years younger.  There’s a huge difference between the ages of 80 and 70 in terms of functional abilities.

Why read the book now that you have the Power Nine?  To convince you to change your unhealthy ways, and indispensible instruction on how to do so.

Steve Parker, M.D. 

Disclosure:  The publisher’s representative did not pay me for this review, nor ask for a favorable review.  They offered me a review copy and three give-aways, and I accepted.  I figure the cost of the books to the publisher was $16 USD total. 

Gertrude Baines died yesterday in Los Angeles at the age of 115, according to the Associated Press.

She liked to eat fried chicken, bacon, and ice cream.

Her physician, Charles Witt, M.D., said, “She told me that she owes her longevity to the Lord, that she never did drink, and never did smoke, and she never did fool around,” according to CNN.com (Sept. 12, 2009)

Steve Parker, M.D.