Mediterranean Diet Fail – Nutrition Disinformation, Part I.

Do not get your hopes up, do not pass GO!  do not collect $200.  The Mediterranean Diet.  Fail.

Primary Prevention of Cardiovascular Disease with a Mediterranean Diet (Estruch et al., 2013)

This is one of the biggest diet studies we’ve seen in a while, and no doubt it was a very good one.  It very effectively put the Mediterranean Diet to the test.

I felt compelled to write about this study out of fear for the nutrition disinformation that it would likely inspire.  The Mediterranean Diet is associated with all good things, happiness, red wine and olive oil; whereas the Atkins Diet is associated with artery clogging bacon-wrapped hot dogs and a fat guy who died of a heart attack.  Nutrition disinformation.

If you ran a diet study with 3 intervention groups for 5 years, and by the end of the study everybody (in all 3 groups) was on more prescription medications, would you conclude any of the diets were “healthy?”  If so, then we should work on your definition of “healthy.”

Study details: big study, lasted roughly 5 years, and the diet intervention was pristine.  Mediterranean diet plus extra virgin olive oil (EVOO) vs. Mediterranean diet plus nuts vs. low fat control.  They even used biomarkers to confirm olive oil and nut intake (hydroxytyrosol and linoleate, respectively).  Compliance was good.

Mediterranean diet

Don’t get me wrong, the Mediterranean diet, as well as any other diet that excludes processed junk food is healthier than SAD

So? - What could be more zen than empty calories?

So? – What could be more zen than empty calories?

But even in this ultra-high risk population, there was no statistically significant effect on mortality.mortality

andmortality II

Mediterranean diet plus EVOO came close, but this is neither horseshoes nor hand grenades.

Whom, in this study, fared the best?  Obese, dyslipidemic, hypertensive patients with excess visceral fat, who never smoked, did not have a family history of premature CHD, and already ate a Mediterranean diet at baseline*.  Is this you?  If so, then keep doing what you’re doing and you might not stroke out so soon.  (I got all this from the subgroup analysis, in case you were wondering.)

*I find this particularly interesting.  One could extrapolate that those who ate a Mediterranean diet at baseline and were assigned to the Mediterranean diet had fewer strokes than those who ate a Mediterranean diet at baseline but were assigned to a low fat diet.  Worded another way: those who were switched from a Mediterannean diet to a low fat diet stroked out sooner than planned.  Hmmm…

 

This is eerily reminiscent of the WHI.  

In 2006, the WHI showed us that switching to a low fat diet for 8 years had no effect on heart health and was even detrimental for people with CVD at baseline.  I repeat, CVD patients assigned to the low fat dietary intervention experienced more cardiovascular events than those in the control group; in fact, this was the only statistically significant finding. 

For further reading, see: “An adult conversation” about the Look AHEAD study  

 

Overall nutrient intake wasn’t markedly different between the groups.  Mediterranean dieters ate slightly more fat and fewer carbs, whereas low fat dieters ate a little bit less fat and more carbs.  Since the study was so big, many of these between group differences reached statistical significance.

 

Fail #1: no effect on all-cause mortality.  Conclusion #1: switching from a modestly healthy Mediterranean diet to a low fat diet could increase stroke risk.

 

Fail #2: none of the diets actually made these people healthier.  Prescription medications at baseline:meds at baseline

Prescription medications at follow-up:meds at follow-up

Data presentation on the part of the authors is horrendous – they grouped the classes of drugs differently at baseline and follow-up, and since any given patient could be taking more than one drug in a category, it is impossible to make a direct comparison for most categories.

Most.

Anti-platelet therapy, insulin, and antidiabetic drugs got lucky.  Not so much for the people taking them:change in med usage

With prescription drugs consistently increasing across the board, would YOU call any of these diets “healthy?”     If so, perhaps we should work on your definition of “healthy.”

calories proper

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  • tess

    i gave this study credit for minimizing variables (after reading Attia’s discussion)…. :-) that’s about all! your discussion about the medications is interesting, too — i guess i’d want to ask if the “follow-up doctors” were more aggressive prescribers than their original physicians. it’s academic, though — i for one would be a metabolic MESS if i followed any of their “healthy interventions”!

    • http://www.caloriesproper.com/ William Lagakos

      Hi Tess,

      Thanks for the comment. I too give this study a lot of credit- I really think it was done well.

      That’s an interesting point about the prescribers – there is no information about this in any of the supplementals either. It would explain a lot, but I’m almost more inclined to think these subjects were also a “metabolic MESS” on those diets (and their baseline diets too – they were all very high risk to begin with)

      My question is: instead of TWO separate Mediterranean Diet groups, why not throw in a low carb group? Did they really expect to see a robust difference between EVOO & nuts? Really?

      Best,
      Bill

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  • A Melmed

    I think there are two ways of looking at the results. One would be that Mediterranean diet prevents strokes and cardiovascular events. The other is that Low Fat diet increases these.

    The establishment mindset is so convinced that a low fat diet is healthy that they called it the control group. Their intervention was supposedly introducing the Mediterranean diet as the test condition. The data show some outcomes were better in the MD compared to “control”. The media touted MD as saving lives. In fact, what happened is that they took people (in Spain) and had 1/3 of them eat a low fat diet. This ended up being the test group, not the control. This diet showed that a low fat diet causes more strokes and heart attacks, not that MD prevented them.

    • http://www.caloriesproper.com/ William Lagakos

      ergo, nutrition disinformation.