Make your patient's diet more Mediterranean

But a big difference is that the Mediterranean diet INCLUDES moderate to high amounts of "good fats" from olive oil and nuts. These fats seem to...
Mahitab Hany, BS Pharm, PGDipClinPharm, PGDipClinNutrition

Many more patients will now ask about the MEDITERRANEAN DIET due to new reports that it lowers the risk of heart disease. For years we've been telling heart patients to follow a low-fat diet. But it's hard for patients to stay on it and there's not much solid evidence that it actually lowers cardiovascular risk.

          The Mediterranean diet also consists of veggies, fruits, beans, whole grains, and fish and limits red meat and sweets. But a big difference is that the Mediterranean diet INCLUDES moderate to high amounts of "good fats" from olive oil and nuts. These fats seem to LOWER inflammatory factors that contribute to heart disease. Now evidence suggests the Mediterranean diet reduces the relative risk of CARDIOVASCULAR (CV) events by about 30% in 5 years similar to the drop seen with some statins. This works out to about 3 fewer major CV events for every 1000 high-risk patients per year on a Mediterranean diet, compared to patients trying to follow a low-fat diet.

KEY POINTS
Explain that not all fat is bad...
    • Steer patients toward monounsaturated or polyunsaturated fats from fatty fish, olive oil, nuts, avocados, etc. And advise patients to limit saturated fats from red meat or dairy and avoid trans fat.
    • If patients want to substitute olive oil for other fats, suggest about 4 TABLESPOONS per day of the EXTRA VIRGIN variety. It may contain more "heart healthy" polyphenols than refined olive oil.
    • Or suggest about 30 grams/day of nuts rich in omega-3s, such as about 14 walnut halves, 24 almonds, or 21 hazelnuts.
    • Caution that 4 TABLESPOONS of olive oil is almost 500 calories and 30 g of nuts up to 200 calories. Advise patients to substitute these foods for less healthy foods rather than adding them to their usual diet.

REFERENCES

  • Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Basora J, Muñoz MA, Sorlí JV, Martínez JA, Martínez-González MA; PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013 Apr 4;368(14):1279-90. Available at: https://www.nejm.org/doi/10.1056/NEJMoa1200303?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200www.ncbi.nlm.nih.gov

    Shai, I., Schwarzfuchs, D., Henkin, Y., Shahar, D.R., Witkow, S., Greenberg, I., Golan, R., Fraser, D., Bolotin, A., Vardi, H., Tangi-Rozental, O., Zuk-Ramot, R., Sarusi, B., Brickner, D., Schwartz, Z., Sheiner, E., Marko, R., Katorza, E., Thiery, J. and Fiedler, G.M. (2008). Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. The New England journal of medicine, [online] 359(3), pp.229–41. Available at: https://www.ncbi.nlm.nih.gov/pubmed/18635428