| Therapeutic Food
By Sean Henahan, Access Excellence
 STOCKHOLM,
Sweden (August 28, 1997) There is an old Chinese saying that the first
medical text was a cook book. New evidence of the cardiovascular benefits
of the Mediterranean diet, along with new understanding of how these benefits
occur on the molecular level, appear to support this appetizing claim.
Large scale studies in Europe published over the last couple of years
have confirmed that the low-fat, high fish, fruit and vegetable diet characteristic
of Mediterranean countries is helpful in preventing heart disease and subsequent
heart attack and stroke. Studies presented at this year's meeting of the
European Society of Cardiology now show
that switching to this diet also protects people who have already had one
heart attack from having another.
Epidemiologists first reported in the 1950s that the incidence of heart
disease in Europe increased fourfold the farther north you traveled, with
the highest rates being reported in Finland, and the lowest in southern
Italy. Subsequent studies indicated that this difference could not be attributed
to genetic factors or lifestyle factors such as smoking alone. This led
to the hypothesis that there was something in the lifestyle, probably the
diet, to explain the difference.
French researchers conducted a study in which 600 French patients, who
had a heart attack and so were at risk for a second heart attack, were
advised to consume one of two diets. Half of the participants were advised
to consume a diet modeled on that of Crete (more bread and cereals, vegetables,
beans, fruit, olive oil the principle fat, little or no red meat, plenty
of fish. Since the French patients like to have something to spread on
their bread, they also were allowed a special margarine made from rapeseed
oil. The other patients were asked to consume the standard "prudent" diet
suggested for heart patients.
The researchers were astounded by the differences in the two groups.
The patients eating the Cretan diet had a 75% lower incidence of death
and heart attack after two years of follow-up compared with those eating
the prudent diet.
"The results were spectacular and of unexpected magnitude. The protective
effects of the diet began to occur within two months of observation," reported
Professor Serge Renaud, University of Bordeaux, France
The diet was rich in fish containing fatty acids of the same family
as alpha linoleic acid. This suggests that the Cretan diet acted mostly
on preventing coronary thrombosis (clotting within arteries) rather than,
or in addition to, influencing the long process of atherosclerosis, he
noted.
Other factors include the absence of fatty acids known to raise LDL
(low density lipoprotein, i.e. bad) cholesterol levels which predispose
to atherosclerosis, heart attack and stroke. The Mediterranean diet is
also much higher in antioxidant vitamins, most notably vitamin C, E and
beta-carotene.
There is new evidence that diets higher in oleic acid (the monosaturated
fatty acid is found in olive oil) may spare vitamin E in the diet, increasing
antioxidant activity. This is supported by other recent studies showing
that vitamin E can independently reduce the risk of stroke and heart attack,
an effect attributed to its antioxidant effect on LDL (bad) cholesterol.
Moreover, researchers now believe that alpha linoleic acid (found in rapeseed
and soybean oils) can prevent the thrombosis or thickening of the blood
that can lead to heart attack and stroke.
With the exception of vitamin E, few studies show that adding vitamin
supplements alone provides the kinds of benefits reported in these studies.
Rather, it appears to involve the entire diet rich in flavenoids, carotenoids
and essential fatty acids. Even red wine appears to contribute to the effect.
"We don't have to wait for more analysis of individual components of
the diet, it is clear that the whole diet is important. Primary and secondary
prevention studies have shown that a healthy diet reduces coronary heart
disease and mortality," emphasized Jukka Salonen, Ph.D., Professor of Epidemiology,
University of Kuopio, Finland.
The Mediterranean diet also includes chelators that inhibit absorption
of iron, mercury and other heavy metals. These metals are associated with
increased heart risk. There is also some indication that deficiencies in
the Northern European diet increase the risk of coronary heart disease,
he said.
The Mediterranean diet is very high in folic acid, while the Northern
diet is not. There is now a growing amount of evidence suggesting that
this could be a very important component in the protective effects, reported
Ian Graham, MD, Professor of Preventive Medicine, Dublin, Ireland.
"A low intake of folic acid causes an increase in an amino acid called
homocysteine. We know that homocysteine can damage arteries and increase
clotting. Indeed, an increase in homocysteine levels has been shown to
double the risk of heart attack, especially in smokers and those with high
blood pressure," he noted.
"So much health advice is focused on the "don'ts", don't eat butter,
don't smoke, etc. It is nice to be able to focus on some "dos" for
a change-, do eat a diet resembling that common in the southern part of
Europe," he added.
The Mediterranean diet is high in plant foods including bread, pasta,
vegetables, legumes, fruit and olive oil. It also includes moderate amounts
of fish, poultry and dairy, moderate amounts of wine (consumed with the
meal) and moderate amounts dairy products. The diet is notably low in red
meat and saturated fats.
So strong is the evidence for the protective benefits of the Mediterranean
diet that an international panel of medical experts has now released
a consensus statement calling for public education and wider implementation
of this type of diet.
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