Thursday, January 17, 2019

Going Mediterranean to prevent heart disease

Medical myths die hard. Maybe that’s because there’s no agreement on whether a common belief is indeed a myth.

For example, there’s the longstanding belief that weather affects arthritis pain. Many of my patients notice a clear connection; some are so convinced of the link, they believe they can predict the weather better than the TV meteorologists. And maybe that’s true.

But that’s not what the science says. A recent study finds no connection between rainy weather and symptoms of back or joint pain. This conclusion was based on a staggering amount of data: more than 11 million medical visits occurring on more than two million rainy days and nine million dry days. Not only was there no clear pattern linking rainy days and more aches and pains, but there were slightly more visits on dry days.

Still not convinced? That’s understandable. Maybe it’s not rain or shine that matters — maybe it’s barometric pressure, changes in weather, or humidity that matters most. Or maybe the study missed some key information, such as when symptoms began or got worse — after all, it can take days or even weeks after symptoms begin to see a doctor.
What does past research say about weather and arthritis pain?

The question of whether there’s a link between weather and aches and pains has been studied extensively. While a definitive answer is nearly impossible to provide — because it’s hard to “prove a negative” (prove that something doesn’t exist) — researchers have been unable to make a strong case for a strong connection.

For example, a 2014 study in Australia found no link between back pain and rain, temperature, humidity, or air pressure. This study collected data regarding features of the weather at the time of first symptoms, and compared it to the weather a week and a month before. But, an earlier study found that among 200 patients followed for three months, knee pain increased modestly when temperature fell or barometric pressure rose.
Does research matter when you have personal experience?

That’s a fair question. And it’s something I’ve even heard in TV commercials about headache medicines: “I don’t care about the research. I just know what works for me.” But it’s worth remembering that humans have a remarkable tendency to remember when two things occur or change together (such as wet, gloomy weather and joint pain), but remember less when things do not occur together. That rainy day when you felt no better or worse is unlikely to be so notable that you remember it. If you rely solely on memory rather than on more rigorous, data-based evidence, it’s easy to conclude a link exists where, in fact, none does.
There is a mountain of high-quality research supporting a Mediterranean-style diet as the best diet for our cardiovascular health. But what does this diet actually look like, why does it work, and how can we adopt it into our real lives?
What is a Mediterranean diet?

The Mediterranean diet is not a fad. It is a centuries-old approach to meals, traditional to the countries bordering on the Mediterranean Sea. The bulk of the diet consists of colorful fruits and vegetables, plus whole grains, legumes, nuts and seeds, fish and seafood, with olive oil and perhaps a glass of red wine. There is no butter, no refined grains (like white bread, pasta, and rice), and very little red or processed meat (like bacon). There is also an emphasis on sitting down and enjoying a meal among family and friends, as well as avoiding snacking, and getting plenty of activity. It’s not just about the food: it’s a way of being.
What’s a Mediterranean-style diet?

The food part is similar to most other healthful diet approaches in that it’s plant-based. And the recipes do not have to be Italian or Greek, which is why I refer to it as a Mediterranean-style diet. Every meal should have vegetables and fruits as the base. Any grains should be whole grain, like quinoa, brown rice, corn, farro, or whole wheat. Legumes are an excellent source of plant protein, things like lentils, garbanzo, kidney, cannellini, or black beans. Nuts and seeds have protein and healthy fats, and olive oil provides even more healthy fat. Including fish and seafood is traditional, but not required. I advise people not to stress about dairy, poultry, and eggs; these are okay in small amounts. A glass of wine a day may be beneficial, but not for everyone, and there is no reason for non-drinkers to take it up.
Why does this way of eating produce such impressive health benefits?

In a recent study published in JAMA Network Open, researchers looked at data from over 25,000 women over 45 (with an average age of 55) and with no history of heart disease.

Using the baseline dietary questionnaire, a Mediterranean diet “score” was calculated. Basically, there was one point given for each of these nine main components: higher than average intake of fruits, vegetables, whole grains, legumes, nuts, fish, and healthy fats; healthy level of alcohol intake; and lower than average intake of red and processed meats. Participants were divided into groups based on low, medium, and high Mediterranean diet consumption (scores of 0–3, 4–5, and 6–9).

After 12 years average follow-up time, 1,030 participants had some kind of serious cardiovascular issue (including heart attack, angina with stent placement, peripheral vascular disease requiring intervention, or stroke). The women in the medium and high Mediterranean diet groups had significantly lower risk (23% and 28% lower, respectively).

Higher Mediterranean diet scores were also associated with lower body mass index and blood pressure, as well as more optimal lab data like lower inflammatory markers (high-sensitivity CRP), lower diabetes risk (insulin resistance), and a better lipid profile (higher HDL). These findings suggest the pathways through which the diet benefits the body: by decreasing inflammation and promoting healthy blood cholesterol and sugar levels.
How to “go Mediterranean”

Adopting the Mediterranean diet in our busy, high-tech world may seem daunting. But there are tips and tricks to change your eating habits and reduce your risk of heart disease.

My book, Healthy Habits for Your Heart, teaches you the basics of behavior change, as well as step-by-step methods to make these changes happen in your real life. Chapter 5, “Eat For Your Life: Nutrition Habits” takes you through the science-backed recommendations for adopting a heart-healthy, plant-based Mediterranean-style diet. One suggestion is:

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