Mediterranean Diet

A very important study about the Mediterranean diet was recently published. The news media loved it and patients loved it. It is a very important study for many reasons. It was large, including about 7400 individuals from the Mediterranean area, primarily from Spain. The investigators compared two so-called Mediterranean diets (one supplemented with extra-virgin olive oil and one supplemented with nuts) with a low-fat diet, which we tend to consider appropriate for heart disease and stroke prevention.

The interesting thing about this study is that the participants were very high-risk people. More than 80% of patients were hypertensive, about 40% had diabetes, and they were on multiple medications. Usually we start with the diet as a platform and add medicines rather than start with the medicines and change the diet. The problem with all nutritional studies thus far, with 1 or 2 exceptions, is that they were very small. They used surrogate endpoints, they didn’t have outcomes, and people got very confused. One day a certain diet was recommended and the next day another diet was recommended. What do we do?

The important thing about this Mediterranean diet was that there was a 30% reduction in the primary endpoint, which was a combination of stroke, heart attack and death.  Considering that weight loss was not recommended, exercise was not necessarily recommended this is a remarkable outcome.

The study was stopped early because the Mediterranean diet was successful. They also looked at whether adding walnuts was better than adding extra-virgin olive oil. Both resulted in pretty much the same reduction in the primary endpoint.

One of the things that we have heard is that there are no outcomes studies using a nutritional intervention. That is no longer the case.

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