And, happily, the study notes that
the heart-healthy participants on the Mediterranean diet were advised to drink
at least (!) seven glasses of wine per week with dinner, assuming they were
already drinkers. So even if you're eating to keep your heart healthy, no need
to skimp on the vino with your olio.
By GINA KOLATA
from The New York Times
About 30 percent of heart attacks, strokes and deaths from heart disease can
be prevented in people at high risk if they switch to a Mediterranean diet rich
in olive oil, nuts, beans, fish, fruits and vegetables, and even drink wine
with meals, a large and rigorous new study has found.
The findings,
published on The
New England Journal of Medicine’s Web site on Monday, were based on the first
major clinical trial to measure the diet’s effect on heart risks. The magnitude
of the diet’s benefits startled experts. The study ended early, after almost
five years, because the results were so clear it was considered unethical to
continue.
The diet helped those following it even though they did not lose weight and
most of them were already taking statins, or
blood
pressure or
diabetes drugs
to lower their heart disease risk.
“Really impressive,” said Rachel Johnson, a professor of nutrition at the
University of Vermont and a spokeswoman for the American Heart Association.
“And the really important thing — the coolest thing — is that they used very
meaningful endpoints. They did not look at risk factors like
cholesterol
or
hypertension
or weight. They looked at heart attacks and strokes and death. At the end of
the day, that is what really matters.”
Until now, evidence that the Mediterranean diet reduced the risk of heart
disease was weak, based mostly on studies showing that people from
Mediterranean countries seemed to have lower rates of heart disease — a pattern
that could have been attributed to factors other than diet.
And some experts had been skeptical that the effect of diet could be
detected, if it existed at all, because so many people are already taking
powerful drugs to reduce heart disease risk, while other experts hesitated to
recommend the diet to people who already had weight problems, since oils and
nuts have a lot of calories.
Heart disease
experts said the study was a triumph because it showed that a diet was powerful
in reducing heart disease risk, and it did so using the most rigorous methods.
Scientists randomly assigned 7,447 people in Spain who were overweight, were
smokers, or had diabetes or other risk factors for heart disease to follow the
Mediterranean diet or a low-fat one.
Low-fat diets have not been shown in any rigorous way to be helpful, and
they are also very hard for patients to maintain — a reality borne out in the
new study, said Dr. Steven E. Nissen, chairman of the department of
cardiovascular medicine at the Cleveland Clinic Foundation.
“Now along comes this group and does a gigantic study in Spain that says you
can eat a nicely balanced diet with fruits and vegetables and olive oil and
lower heart disease by 30 percent,” he said. “And you can actually enjoy life.”
The study, by Dr. Ramon Estruch, a professor of medicine at the University
of Barcelona, and his colleagues, was long in the planning. The investigators
traveled the world, seeking advice on how best to answer the question of
whether a diet alone could make a big difference in heart disease risk. They
visited the Harvard School of Public Health several times to consult Dr. Frank
M. Sacks, a professor of cardiovascular disease prevention there.
In the end, they decided to randomly assign subjects at high risk of heart
disease to three groups. One would be given a low-fat diet and counseled on how
to follow it. The other two groups would be counseled to follow a Mediterranean
diet. At first the Mediterranean dieters got more intense support. They met
regularly with dietitians while members of the low-fat group just got an
initial visit to train them in how to adhere to the diet, followed by a leaflet
each year on the diet. Then the researchers decided to add more intensive
counseling for them, too, but they still had difficulty staying with the diet.
One group assigned to a Mediterranean diet was given extra-virgin olive oil
each week and was instructed to use at least 4 four tablespoons a day. The
other group got a combination of walnuts, almonds and hazelnuts and was
instructed to eat about an ounce of the mix each day. An ounce of walnuts, for
example, is about a quarter cup — a generous handful. The mainstays of the diet
consisted of at least three servings a day of fruits and at least two servings
of vegetables. Participants were to eat fish at least three times a week and
legumes, which include beans, peas and lentils, at least three times a week.
They were to eat white meat instead of red, and, for those accustomed to
drinking, to have at least seven glasses of wine a week with meals.
They were encouraged to avoid commercially made cookies, cakes and pastries
and to limit their consumption of dairy products and processed meats.
To assess compliance with the Mediterranean diet, researchers measured
levels of a marker in urine of olive oil consumption — hydroxytyrosol — and a
blood marker of nut consumption — alpha-linolenic acid.
The participants stayed with the Mediterranean diet, the investigators
reported. But those assigned to a low-fat diet did not lower their fat intake
very much. So the study wound up comparing the usual modern diet, with its
regular consumption of red meat, sodas and commercial baked goods, with a diet
that shunned all that.
Dr. Estruch said he thought the effect of the Mediterranean diet was due to
the entire package, not just the olive oil or nuts. He did not expect, though,
to see such a big effect so soon. “This is actually really surprising to us,”
he said.
The researchers were careful to say in their paper that while the diet
clearly reduced heart disease for those at high risk for it, more research was
needed to establish its benefits for people at low risk. But Dr. Estruch said
he expected it would also help people at both high and low risk, and suggested
that the best way to use it for protection would be to start in childhood.
Not everyone is convinced, though. Dr. Caldwell Blakeman Esselstyn Jr., the
author of the best seller “Prevent and Reverse Heart Disease: The
Revolutionary, Scientifically Proven, Nutrition-Based Cure,” who promotes a
vegan diet and does not allow olive oil, dismissed the study.
His views and those of another promoter of a very-low-fat diet, Dr. Dean
Ornish, president of the nonprofit Preventive Medicine Research Institute, have
influenced many to try to become vegan. Former President Bill Clinton,
interviewed on CNN, said Dr. Esselstyn’s and Dr. Ornish’s writings helped
convince him that he could reverse his heart disease in that way.
Dr. Esselstyn said those in the Mediterranean diet study still had heart
attacks and strokes. So, he said, all the study showed was that “the
Mediterranean diet and the horrible control diet were able to create disease in
people who otherwise did not have it.”
Others hailed the study.
“This group is to be congratulated for carrying out a study that is nearly
impossible to do well,” said Dr. Robert H. Eckel, a professor of medicine at
the University of Colorado and a past president of the American Heart
Association.
As for the researchers, they have changed their own diets and are following
a Mediterranean one, Dr. Estruch said.
“We have all learned,” he said.
Spaghetti with Clams
Ingredients
- 6 1/2 pounds clams
- 6 tablespoons olive oil divided
- 1/2 cup dry white wine, divided
- 3 garlic
cloves, sliced, divided
- 3 small
dried chiles, crumbled, divided
- 1 pound spaghetti or linguine
- Kosher salt and freshly gound black pepper
- 3 tablespoons chopped flat-leaf parsley
Preparation
- Place
clams in a sink filled with cold water. Scrub shells well with a coarse
brush to remove any sand. Drain water and soak clams in clean water,
repeating until water remains clean.
- Heat 2
Tbsp. oil in a large pot with a lid over medium heat. Add ¼ cup wine, 1
garlic clove, and 1 chile. Add half of clams, cover, and cook over high
heat, shaking pan frequently, until clams open (keep lid on pot so heat is
not released, making cooking time longer). As soon as clams open, transfer
clams and their juices to a large bowl (discard any clams that do not
open). Repeat process with 2 Tbsp. oil, remaining ¼ cup wine, 1 garlic
clove, 1 chile, and remaining clams.
- Meanwhile,
cook pasta in a large pot of boiling salted water, stirring occasionally,
until tender but al dente; drain, reserving 1 cup pasta cooking liquid.
- Heat
remaining 2 Tbsp. oil in pot with lid over medium heat. Add remaining 1
garlic clove and remaining 1 chile; stir until garlic is fragrant and
light golden, 1–2 minutes. Return clams and their juices to pot; toss to
coat and remove from heat. Add pasta and toss to coat evenly with juices,
adding pasta cooking liquid by ¼-cupfuls if pasta is dry. Season to taste
with salt and pepper. Sprinkle parsley over.
