The Mediterranean Diet or a Whole Food Plant-Based Diet?

recent studies have shown that higher Mediterranean diet adherence scores are associated with a significant reduction in risk of death heart disease cancer and brain disease but the problem with population studies like these is that people who eat healthier may also live healthier and so how do we know it’s their diet is the American Heart Association position states before advising people to follow Mediterranean diet we need more studies to find out whether the diet itself or other lifestyle factors account for the lower deaths from heart disease how do you do that well there are ways you can control for obvious things like smoking and exercise which many studies did but ideally you’d do an interventional trial the gold standard of nutritional science take people change their diet while trying to keep everything else the same and see what happens and that’s what we got 20 years ago the famous legal diet heart study about six hundred folks who just had the first heart attack were randomized into two groups the control group got no dietary advice apart from whatever their doctors were telling them but the experimental group was told to eat more of a Mediterranean type diet supplemented with a canola oil based spread to give them the plant-based omega-3s they’d normally be get from eating you know weeds and walnuts if they actually lived on a Greek isle in 1950s the Mediterranean diet group did end up taking some of the dietary advice to heart they ate more bread more fruit less deli meat less meat in general and less butter and cream butter than that no significant changes in diet reported in terms of wine olive oil or fish consumption so less saturated fat cholesterol more plant-based omega-3s but not huge dietary changes but at the end of about four years in the control group 44 individuals had a second heart attack either fatal or non-fatal but only 14 so for another attack in the group that changed their diet so they went from having like a 4 percent chance of having a heart attack every year down to like 1% now a cynic might say yes less and disease but the Mediterranean diet continued to feed their heart diseases so much so that 14 of them suffered new heart attacks while on the diet now their disease progressed a lot less than the regular diet group about four times less but what if there was a diet that could stop or reverse heart disease dr. Caldwell Esselstyn and colleagues at the Cleveland Clinic recently published a key series of 198 consecutive patients with cardiovascular disease counseled to switch to a dye composed entirely of whole plant foods of the hundred and ninety eight 177 stuck to the diet whereas the other twenty one fell off the wagon setting up kind of a natural experiment what happened to the 21 this was such a sick group of patients that more than half suffered from like a fatal heart attack or needed angioplasty or a heart transplant in the same time period of about four years of the 177 that stuck to the plant-based diet only one had a major event as a result of worsening disease not half but less than one percent as dean ornish noted in his response to the latest Mediterranean trial a Mediterranean diet is better than what most people are consuming but even better may be a diet based on whole plant foods now this was not a randomized trial so can’t directly be compared to the Leon study and included very determined patients not everyone is willing to dramatically change their diets even if it may literally be a matter of life or death in which case rather than doing nothing eating a more Mediterranean type diet may cut risk for heart attack survivors by about two-thirds and we cutting 99% of risk would be better if esselstyn’s results were replicated in a controlled trial but even a 70% drop in risk could save tens of thousands of lives every year you

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