The Mediterranean DietWritten by Dr. Randy Knipping, Medical Director
(1) abundant amounts of fresh, locally grown fruits and vegetables;

Beware the ides of March and the ides of belly!  Heart disease continues to be the principle reaper of vitality and longevity in the West and much research has been published on the role diet plays.  The core knowledge points are simple, and are based on the Mediterranean diet [Hu FB: The Mediterranean diet and mortality olive oil and beyond.  N Engl J Med  2003; 348:2595-2596.] 

(1) abundant amounts of fresh, locally grown fruits and vegetables;

(2) complex carbohydrates such as whole grains, nuts, beans, and hearty breads;

(3) minimally processed foods;

(4) olive oil as the main source of fat;

(5) low to moderate amounts of dairy, fish, and poultry;

(6) red meat rarely; and

(7) low amounts of wine with meals 

More recent research on the endovascular endothelium inflammation model of heart disease indicates this diet also reduces the body’s tendency to mount an excessive and inappropriate inflammatory attack on the lining of blood vessels.  [Esposito K, Marfella R, Ciotola M, et al: Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: A randomized trial.  JAMA  2004; 292:1440-1446.].   

In the Lyon Heart Study, which is one of the studies that determined why French people had a lower risk of heart disease in spite of eating French sauces (in very small moderation, mind you).  This diet was confirmed as not only preventing heart disease, but also reducing heart disease complications after a cardiac event, and in being effective within 30 days of starting. [de Lorgeril M, Salen P, Martin JL, et al: Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: Final report of the Lyon Diet Heart Study.  Circulation  1999; 99:779-785.]  

Foods which have both nutrient value and also reduce disease are known as functional foods and research in this area has increased dramatically.  For example, specific foods that lower cardiovascular risk, included in the Mediterranean Diet, include almonds, chocolate, tea, soy, plant sterols, and viscous fibers such as oats, psyllium, and eggplant. [Franco OH, Bonneux L, de Laet C, et al: The Polymeal: A more natural, safer, and probably tastier (than the Polypill) strategy to reduce cardiovascular disease by more than 75%.  BMJ  2004; 329:1447-1450. ]    

Whereas pharmaceutical companies are investigating the benefits of a “polypill” that combines aspirin with low dose medications for cholesterol and blood pressure, presumably for “everyone over 40”, research on diet suggests that a polydiet would work far better.  One study looking at a dietary portfolio of these cholesterol-lowering foods had a similar effect as a statin in lowering cholesterol in hypercholesterolemic participants. [Jenkins DJ, Kendall CW, Marchie A, et al: Direct comparison of a dietary portfolio of cholesterol-lowering foods with a statin in hypercholesterolemic participants.  Am J Clin Nutr  2005; 81:380-387]  Interestingly, Jenkins is a Canadian Researcher right here in Toronto at St. Michael’s Hospital (and was one of my professors!) 

And does diet have to be boring and tasteless and un-pleasurable?  Not at all,  Tea and chocolate, both flavinoids, are remarkable in that they reduce free-radicals that damage blood vessels and shorten telomeres (see my article on fish oil).  What’s more, they reduce the risk of acute myocardial infarction (heart attack) and the flavinoids in green tea have particular antithrombotic activities, decreasing platelet aggregation and reducing heart attack deaths through this mechanism.  [Geleijnse JM, Launer LJ, Van der, Kuip DA, et al: Inverse association of tea and flavonoid intakes with incident myocardial infarction: The Rotterdam Study.  Am J Clin Nutr  2002; 75:880-886.] [Son DJ, Cho MR, Jin YR, et al: Antiplatelet effect of green tea catechins: A possible mechanism through arachidonic acid pathway.  Prostaglandins Leukot Essent Fatty Acids  2004; 71:25-31.]   
 
Plant sterols mimic human cholesterol and the addition of 2 gm of sterol ester to a standard Western diet results in about a 10% decrease in LDL-C levels, without a significant effect on high-density lipoprotein -C and triglyceride levels. [33. Lissin LW, Cooke JP: Phytoestrogens and cardiovascular health.  J Am Coll Cardiol  2000; 35:1403-1410.]   

Eating a small handful of nuts such as roasted unsalted almonds or raw walnuts is a great snack, especially if taken with a large glass of fresh water, cuts the appetite and shows  a significant beneficial reduction in heart disease risk.  [Hu FB, Stampfer MJ, Manson JE, et al: Frequent nut consumption and risk of coronary heart disease in women: Prospective cohort study.  BMJ  1998; 317:1341-1345.]  

Below is a wall chart you can tape to your fridge and take with you grocery shopping.  Human beings are social creatures of habit, so share this with you family.  Especially important is that the person who purchases, prepares and plates your food is the one responsible for your nutrition, so have a chat about diet and make some creative and delicious changes to your palate this month.