By Jaimie Dalessio, Everyday Health Staff Writer
All roads lead to Rome when eating for heart health, a major study has found — or at least they point to the advantages of the Mediterranean diet for those at high risk for heart disease.
Researchers in Spain found that the Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced incident of major cardiovascular events, according to a study published online today in the New England Journal of Medicine.
All 7,447 people (57 percent women) in the study were at high risk for heart disease at the start, but none had experienced a cardiac event — a heart attack or stroke. Each was randomly assigned to one of three dietary plans: a Mediterranean diet supplemented with extra-virgin olive oil in place of ordinary olive oil; a Mediterranean diet supplemented with mixed nuts — one serving a day of walnuts, almonds, and hazelnuts instead of the Mediterranean diet's recommended three or more servings per week; or a control diet in which participants were simply advised to reduce dietary fats.
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"The interesting thing about this study is that most people think, 'Oh a low-fat diet is good,' but this is saying it's more than just changing your fat intake, it's the quality of the nutrients and the synergy of all the nutrient rich foods," says Jackie Topol, MS, RD, a clinical dietician at New York-Presbyterian/Weill Cornell Medical Center in New York City, who did not work on the study.
Several reports have associated adherence to the Mediterranean diet with a lower risk of heart disease and cardiovascular events like heart attack and stroke, as well as death from such events. Less a traditional diet than a style of eating, the Mediterranean diet has also been tied to better brain health and even to lower incidence of cancer.
The Mediterranean diet stresses healthy fats, plant-based foods, and whole grains — specifically eating plenty of olive oil, fruit, vegetables, and nuts; moderate amounts of fish and chicken; limited amounts of red meat; and drinking wine with meals.
While past observational studies and a secondary trial had tied the Mediterranean diet to better heart health, the researchers of this new study set out to analyze how the diet would work for primary prevention of cardiovascular events in a randomized trial setting. The research is part of the Prevencion con Dieta Mediterranea (PREDIMED) study, a multi-year clinical trial designed to assess the effects of a Mediterranean diet on cardiovascular diseases.
The researchers observed a relative risk reduction of roughly 30 percent for those who followed a Mediterranean diet supplemented with either extra-virgin olive oil or nuts. The researchers theorize in their report that the nutrient-rich foods in a Mediterranean diet protect the body from some cardiometabolic risk factors, including high cholesterol, insulin resistance, and inflammation.
The findings are relevant, the study authors write, given the challenges of achieving and maintaining weight loss. Topol points out that the Mediterranean diet is less restrictive than some other plans.
"I think there's a lot of room for creativity. It's more inclusive and tells you what you can have. Eat more of this and less of this, and a lot of variety within each of those things," she says. "I think pretty much everyone can find something that will work for them within this."
It may not be the hottest, trendiest eating plan, but the Mediterranean diet continues to earn doctor recommendations.
"The Mediterranean diet includes a lot of foods that have a lot of antioxidants in them, omega-3 fatty acids, and those things are very good for your health," says Topol. "Just taking fat out of your diet won't give you those things, and that's why it's so beneficial."
