Doctors in the UK are urging those who are at risk of cardiovascular disease to consider adopting the Mediterranean diet, rather than relying solely on medications like statins.
A paper published last week in healthcare journal Prescriber claimed that almost 80 per cent of cardiovascular disease is caused by “modifiable lifestyle factors such as nutrition, physical activity and smoking”.
Though research on the Mediterranean diet and its protective effects stems back some 20 years, academic dietician Catherine Itsiopoulos tells Neos Kosmos an appreciation of the diet’s benefits has gained momentum in medical circles in the last 12 months thanks to a growing body of evidence.
“The Lyon Diet Heart Study published in the late 1990s demonstrated that people who were put onto a Mediterranean diet had a 70 per cent reduced risk of developing a second heart attack, as opposed to those on the low-fat diet.
“That was quite remarkable and a lot of people wrote about it, but it wasn’t believed by the cardiology world,” says Dr Itsiopoulos.
Leader of La Trobe University’s Mediterranean diet research group, Dr Itsiopoulos says she chose the traditional Cretan diet as the group’s main reference model.
“It’s really a post-World War II peasant-style diet; people who lived in a rural area in villages and survived on food from the land. So it’s a fresh food diet with minimal or no processed foods, predominantly plant foods with a ratio of four to one of plant food versus animal food, with extra virgin olive oil being the main fat used in cooking and in salads.”
The research group has been using the diet to manage a range of chronic diseases such as heart disease, as well as diabetes, dementia, and even depression.
But the study that really put the diet on the map was published in 2013 in Spain.
In the largest clinical trial to date, 7,500 people of middle age and at high risk of heart disease took part.
Two-thirds of the group were put on the Mediterranean diet – half supplemented with extra virgin olive oil and the others with nuts – and a third placed on a low fat, high carbohydrate diet.
After five years the results were overwhelmingly in favour of the southern European diet.
“Those on the Mediterranean diet, whether it was olive oil or nuts, had a 30 per cent less chance of developing or dying from heart disease, and a 52 per cent less chance of developing diabetes,” says Dr Itsiopoulos.
While medications can be extremely effective in targeting the affected area, in the dietician’s experience “it doesn’t necessarily mean they’re going to be healthy”, with the drug managing a single risk factor, often accompanied by side effects.
So if the evidence has existed for so long, why has it taken health professionals this long to get on board?
“It’s the weight of the evidence; one trial doesn’t change practice. Now we have multiple systematic reviews featuring the Mediterranean diet,” she says.
No matter how many trials are conducted showing healthy lifestyle changes impact positively on heart disease and cholesterol, Dr Itsiopoulos says it all depends on the individual’s risk profile.
“Statins are very widely used and in some people who have high levels of cholesterol and very low levels of good cholesterol, they may need to go straight onto medication, which is effective very quickly.
“For someone who’s got mildly elevated lipids, then having a trial of diet first is something that’s quite acceptable in the medical profession.
“Primary prevention is the key. You should always focus on diet and lifestyle. It’s better not to have a condition, rather than have something that we need to treat.”