The National Institutes of Health (NIH)-AARP study found that a Mediterranean
diet was associated with a reduction in all-cause mortality. A study in the Netherlands
found that 10 years of adherence to the Mediterranean diet was significantly
related to lower mortality. The study scored adherence to four healthy lifestyle
factors: Mediterranean diet, not smoking, normal weight (BMI 18.5 to 25), and
regular physical activity. The highest-scoring women could be expected to live
15.1 years longer than the least healthy with low scores. The corresponding longer
life expectancy for men was 8.4 years. This study suggests that adherence to four
modifiable healthy lifestyle factors can substantially reduce premature mortality.

Substantial media attention was given to the PREDIMED (Prevencion con Dieta
Mediterreanea) trial when the results were published in the New England Journal
of Medicine in 2013. The study of subjects with established cardiovascular disease
compared the cardiovascular events of a “low-fat” control group with study subjects
on a modified Mediterranean diet supplemented with extra-virgin olive oil or nuts.
Over the nearly five-year study, the dietary intervention was claimed to have major
cardiovascular benefits.

Critics of the original PREDIMED trial noted that the reduction in CVD events
was attributable only to a lower death rate from stroke. And although the trends
for other cardiovascular events appeared favorable, there was no statistically significant
reduction in the rates of heart attack, death from cardiovascular causes, or
death from any cause compared to the control group. Furthermore, the study was
not a true comparison of low-fat eating compared to the Mediterranean diet because
among the low-fat control group, total fat consumption was high and decreased
insignificantly, from 39% to 37%.

A separate analysis of the PREDIMED trial
found a benefit, a decrease in peripheral artery disease among those on the modified
Mediterranean diet supplemented with extra-virgin olive oil or nuts.298
A 2015 study also indicates that foods prominent in the Mediterranean dietary pattern
are beneficial. It found that when unsaturated fats, especially polyunsaturated
fats, and/or unrefined whole-grain carbohydrates replace saturated fats, cardiovascular
disease risk is reduced.

A 2016 meta-analysis of evidence from several
randomized controlled trials (RCTs) suggests that a Mediterranean diet with no
restriction on fat intake may be associated with reduced incidence of cardiovascular
events, breast cancer, and type 2 diabetes, but does not affect all-cause mortality.
Although there is evidence for the CVD and other health benefits of the classic
Mediterranean diet, today’s inhabitants of Mediterranean countries now eat more
meat and other processed foods. It is worth noting that CVD is the leading cause
of death in several countries that could be considered to be Mediterranean: Spain,
France, Italy, and Greece. Another concern about Mediterranean diets is that among
some patients, the high levels of olive oil that are advocated result in a failure to
achieve a low level of blood cholesterol. And Mediterranean diets seem somewhat
less effective at preventing subsequent CVD events among those at high risk
than the ULF diets advocated by Ornish and Esselstyn.

This blog presents opinions and ideas and is intended to provide helpful general information. I am not engaged in rendering advice or services to the individual reader. The ideas, procedures and suggestions in that are presented are not in any way a substitute for the advice and care of the reader’s own physician or other medical professional based on the reader’s own individual conditions, symptoms or concerns. If the reader needs personal medical, health, dietary, exercise or other assistance or advice the reader should consult a physician and/or other qualified health professionals. The author specifically disclaims all responsibility for any injury, damage or loss that the reader may incur as a direct or indirect consequence of following any directions or suggestions given in this blog or participating in any programs described in this blog or in the book, The Building Blocks of Health––How to Optimize Your Health with a Lifestyle Checklist (available in print or downloaded at Amazon, Apple, Barnes and Noble and elsewhere). Copyright 2021 by J. Joseph Speidel.