Mediterranean Diet Has Hearty Goodness

Besides cobblestone streets and bocci ball, what do Italy, Greece, France, and Spain have in common? Each country has developed a style of Mediterranean eating that researchers have linked to almost 50 percent fewer deaths from heart attacks than people of the United States.

Before the people of the island of Crete in Greece adopted more Western-style eating habits, they had the lowest rate of heart attacks in the world, low rates of cancer, diabetes, and other chronic illnesses — contributing to their long life expectancy.

For centuries Cretans consumed a diet rich in vegetables, fresh fruits, nuts, legumes, unprocessed whole grains, fish, lean poultry, whole-milk cheeses, olives, olive oil, a few eggs per week, and moderate amounts of red meat and red wine.

They also had higher levels of certain types of healthful blood fats called alpha-linolenic fatty acids (ALA), also known as omega-3 fatty acids found in certain vegetables, oils, nuts and fish.

In addition to diet, there may be other lifestyle factors such as more time spent walking, working on their feet, and traditional family values that keep heart and other disease risk factors low. But we won’t know for sure until more research is done.

It’s no wonder that the Heart Institute of Spokane is in the midst of conducting a two-year study to help determine why the Mediterranean-style diet is so effective at reducing heart attack risk.

A recent French study, called the Lyon Heart Study, published in Circulation in February 1999 caught the eye of researchers at Spokane’s Heart Institute. The Lyon study randomly assigned 605 people who had suffered a first attack into two groups: a control group following a “prudent Western-style diet” or an experimental group following a Mediterranean-style diet.

After two years, those on the Mediterranean-style diet showed a 70 percent reduction in the number of cardiovascular events, including heart attacks, angina (chest pain), and heart bypass surgery.

The Heart Institute’s study is working to validate the findings of the Lyon study. In addition, the Heart Institute’s study is designed to develop specific dietary guidelines using an American population, test the impact of nutrition follow-up with patients, and measure a large number of risk factors by measuring blood and urine components like homocysteine, vitamin E, insulin, cholesterol and a urinary protein called microalbuminuria.

Participants in the Heart Institute’s study are randomly assigned to either a Mediterranean-style eating plan or the American Heart Association’s low-fat eating guidelines. Critical to both eating plans, is controlling caloric intake and regular exercise.

Canola oil is a type of mostly monounsaturated fat that played a critical role in the Lyon study. Participants were told to use a canola-oil based margarine instead of butter and cream whenever possible. Canola oil is nutritionally similar to olive oil, except it’s richer in the omega-3 (alpha-linolenic acid). Omega-3 oils are shown to reduce tissue inflammation, which may be helpful for reducing blood pressure and other inflammatory diseases.

The Center For Science in the Public Interest (CSPI) September publication discusses “a growing body of evidence that it’s not just the slow, steady build-up of plaque in the coronary arteries that cuts off blood to the heart muscle.” It may be the rupture of the plaque that causes the heart attack.

Obesity, cigarette smoking, and possibly genetics heighten inflammatory response. Moderate exercise, aspirin and cholesterol-lowering drugs called statins help reduce inflammation. Omega-3 fats may be a Mediterranean remedy for reducing tissue inflammation.

A book available at local book stores called “The Omega Diet” by Dr. Artemis P. Simopoulos and Jo Robinson discusses the role of omega-3 fats and offers practical suggestions on the Mediterranean-style diet.

Compared to the standard USDA’s (United States Department of Agriculture) food pyramid, the Mediterranean diet is lower in carbohydrate and higher in fat. But not just any fat, the Mediterranean diet contains primarily monounsaturated and omega-3 fats.

There are nine levels to the Mediterranean pyramid - compared to the USDA’s four.

The base level of the Mediterranean pyramid contains fewer - six to eight - recommended daily servings of whole grains, pasta, rice, couscous, polenta, bulgur, starchy vegetables, and/or potatoes than the USDA’s six to 11 servings.

The second Mediterranean pyramid tier contains three to five servings of fibrous vegetables like broccoli, cauliflower, zucchini, tomato, mushroom, onion, etc., two to four servings of fresh fruit, and two to three servings of beans/legumes and nuts. Most nuts are high in monounsaturated fat. And walnuts are a good source of healthful omega-3 fats.

Tier three contains five to six servings of olive oil and other monounsaturated fats. Monounsaturated fats help raise good cholesterol (HDL) and lower bad cholesterol (LDL).

Good sources of monounsaturated fats include, olive oil, canola oil, sesame oil, avocado, black and green olives, most nuts, peanut butter, canola mayonnaise (try Safeway Select), canola margarine (try Saffola soft tub) and almond butter. Two new oils high in monounsaturated fat are “high-oleic” safflower oil and “high-oleic” sunflower oil.

Tier four is two to three servings of cheese and yogurt. The last 5 tiers contain recommendations for weekly consumption of food, such as three to five servings of fish per week, two to three servings of poultry per week, no more than four eggs per week, sweets less than four times per week, and red meat once a week.

Daily physical activity is considered as crucial as eating your vegetables. Keeping red wine to a single four to five ounce glass is also acceptable. Red wine appears to play a role in increasing good (HDL) cholesterol.

The Mediterranean food pyramid can be found in the Heart Institute’s 28-page booklet. It also contains recipes from local cardiologists and nutrition information - available for free at Tidyman’s supermarkets and in the lobby of the Heart Institute at 122 W. Seventh.

The Mediterranean-style eating plan shows promise that Americans can lower their risk of heart disease. The Heart Institute’s study will help illuminate what components of the diet are helpful for keeping Americans’ heart vessels open, given our fast-paced and no-time-for-exercise lifestyle. Studies on the long-term impact of the Mediterranean-style of eating for Americans will still be needed. Bocci ball anyone?