Does the Mediterranean diet really exist?

There's been a lot written about the Mediterranean diet in recent years. One reason is the low incidence of heart disease in some Mediterranean countries.

Mediterranean diet

In truth, the so-called "Mediterranean diet" doesn't really exist. The countries along the Mediterranean basin have different religions, cultural traditions and diets. In other words, there is not just one Mediterranean diet, but several.

The incidence of heart disease in Mediterranean countries is lower than in the United States. Many believe this is because people living there eat less saturated fat, thought to be the "villain" responsible for the rise in cholesterol levels said to cause heart disease.

According to conventional wisdom, coronary heart disease is the final stage of a three-step process.

In the first step, the amount of saturated fat in your diet determines blood cholesterol levels. This rise in cholesterol is then said to lead to a thickening of the arteries. The third and final step is coronary heart disease, caused by the build-up of plaque in the arteries.

This theory appears logical. Yet, despite its almost universal acceptance, there's a growing body of evidence suggesting that the link between saturated fat, cholesterol and heart disease isn't as simple as the "expert committees" would like you to believe.

Some evidence comes from a trial known as the Lyon Diet Heart Study. The study was conducted by two French researchers — Michel de Lorgeril and Serge Renaud. They assigned 302 heart attack survivors to one of two groups. Group one followed one of the diets recommended by American Heart Association. The second group was assigned to a modified version of the Cretan diet.

The medical community first became interested in the diet of people living on Crete (one of the largest islands in the Mediterranean) when a fifteen-year study showed that men from Crete were healthier than men surveyed in other countries — Finland, Yugoslavia, Japan, Greece, Italy, the Netherlands and the United States [3].

Heart disease

Compared to men living in the United States, men in Crete had one-twentieth of the mortality from heart disease. The men from Crete also had half the overall death rate from Italy, even though both groups were eating a Mediterranean-style diet.

After just four months, there were significantly fewer deaths in the group following the Cretan diet. As the months passed, the trend continued. In fact, the study was brought to a halt after two years. The Cretan diet had proven itself so superior at reducing the risk of death from heart disease that to continue the research would have been unfair to the group following the conventional diet [2].

The final report on the Lyon Diet Heart Study shows a striking 50-70% reduction in the risk of recurrent heart disease — despite the fact that cholesterol levels in subjects following both the Crete diet and the prudent Western-type diet were virtually identical [1].

Total cholesterol

Mediterranean diet 6.20 mmol/L
Prudent Western-type diet 6.18 mmol/L

HDL cholesterol

Mediterranean diet 1.29 mmol/L
Prudent Western-type diet 1.28 mmol/L

LDL cholesterol

Mediterranean diet 4.17 mmol/L
Prudent Western-type diet 4.23 mmol/L

The bottom line is that total, HDL and LDL cholesterol are just three of many risk factors for heart disease. Many other factors, such as insulin resistance, homocysteine, C-reactive protein and lipoprotein [a] are also important.

If you're concerned about your cholesterol levels, the VAP (Vertical Auto Profile) Test, developed by Atherotech, might help. Like routine tests, the VAP Test measures total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides, along with homocysteine and C-reactive protein. You can learn more at www.atherotech.com

References
1. de Lorgeril, M., Salen, P., Martin, J.L., Monjaud, I., Delaye, J., & Mamelle, N. (1999). Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation, 99, 779-785
2. de Lorgeril, M., Renaud, S., Mamelle, N., Salen, P., Martin, J.L., Monjaud, I., Guidollet, J., Touboul, P., & Delaye, J. (1994). Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet, 343, 1454-1459
3. Keys, A., Menotti, A., Karvonen, M.J., Aravanis, C., Blackburn, H., Buzina, R., Djordjevic, B.S., Dontas, A.S., Fidanza, F., & Keys, M.H. (1986). The diet and 15-year death rate in the seven countries study. American Journal of Epidemiology, 124, 903-915