The Mediterranean Diet:Impact on Longevity,

Chronic Disease Prevention and Deconstructing the Specific Elements

Presented by:

Solmaz Amirnazmi, M.D.

Summit Medical Group

Department of Internal Medicine

June 2015

Why the Mediterranean Diet?

• Committed to and passionate about healthy eating and how it relates to prevention of chronic illness and death

• Delicious and sustainable way of life

By the end of this talk…

• What is the Mediterranean Diet?• Why is it so good for you?• Should I really use olive oil versus other

oils or butter?• Should I be eating more fish/taking fish

oil supplements?

What is the “Traditional Mediterranean Diet”?

History of the “Traditional Mediterranean Diet”:Geographical Influence

• Dietary lifestyle inspired by the people of the Southern Mediterranean region, specifically Greece, Crete and Southern Italy circa 1960s

• Time when chronic disease rates were lowest and adult life expectancy was highest in the setting of limited medical services

What is the Mediterranean Diet?

1. Fruits and nuts2. Vegetables3. Legumes4. Cereals5. Olives and

olive oil*6. Dairy product7. Fish and

seafood8. Low meat

consumption9. Moderate

ethanol

*MUFA:SFA ratio

How do we know the Mediterranean Diet is really healthy?

The Seven Countries Study• In 1958, Dr. Ansel Keys launched this

study and followed sixteen groups for over 25 years.

• Men aged 40 to 59 were recruited from Yugoslavia, Italy, Greece, Finland, the Netherlands, Japan, and the United States.

• He found that in countries where fruits, vegetables, grains, beans, and fish were a major part of diet, the men rarely suffered from heart attacks!

If I already had a heart attack, is it too late to benefit from a healthy diet?

Lyon Heart Study• Tested the benefit of a Mediterranean type

diet on patients who suffered a heart attack

• 605 patients• Patients were encouraged to consume

more fruits, vegetables, fish and to eat less red meat, replace butter/cream with healthier oil

And the results showed!...

Figure 1: Cumulative survival without cardiac death and nonfatal myocardial infarction

Figure 2: Cumulative survival without major secondary end points.

De Lorgeril, M. et al. Circulation 1999;99:779-785

To prevent heart attacks

• Your doctors usually test and treat for medical conditions or risk factors for heart attacks during your regular visits

• Uncontrolled high blood pressure, high cholesterol, high sugar or diabetes can increase your risk for heart attacks

• Smoking can also elevate your risk

Healthy diet can reduce the risks of heart attack independently!

• Lyon heart study showed that the Mediterranean Diet did not reduce blood pressure or cholesterol significantly

• Still it reduced the risk of heart attack• Healthy diet can reduce the risk of heart

attack even if your blood pressure and cholesterol are not lowered significantly

So, the Mediterranean Diet can reduce the chance of heart attack. Is it beneficial in any other ways?

Meta-Analysis:British Medical Journal 2008

• 12 studies were analyzed with a total of over 1.5 million subjects who were followed for a time ranging from 3-18 years.

• More vegetables, legumes, fruits, nuts, cereals, fish, and seafood.

• Less dairy products and meat products.• 1 serving of alcohol per day.

Results!Overall Mortality Mortality from Cardiovascular Disease

Incidence or Mortality from Cancer Incidence of Parkinson’s and Alzheimer’s

Sofi, F et al: BMJ 2008;337:a1344

P<0.0001 P<0.0001

P<0.0001 P=0.004

Summary of ConclusionsMediterranean Diet can lead to:

Reduction in overall death (9%) Reduction in death from heat attacks(9%) Reduction in diagnosis or death from cancer (6%) Reduction in diagnosis of Parkinson’s Disease and

Alzheimer’s Disease (13%)

Sofi, F et al: BMJ 2008;337:a1344

Should I start using olive oil as my primary fat source?

Your doctors want to know your cholesterol

• Bad cholesterol is sticky and can clog up your arteries leading to heart disease and stroke

LDL Triglyceride

• Good cholesterol can clean up your arteries

HDL

The role of olive oil in reducing your risk of heart disease

• Compared fats namely butter, vegetable oil, and olive oil

• 4903 Italian men and women 20-59 years old

Trevisan, M et al; JAMA, February 2, 1990-Vol 263, No. 5

Olive Oil Results

Trevisan, M et al; JAMA, February 2, 1990-Vol 263, No. 5

Benefit of Olive Oil in Diabetic Patients Looked at the health outcomes in type 2 diabetics who

consumed a diet high in olive oil versus carbohydrates

• Figure 2:

Garg, A; Am J Clin Nutr 1998; 67: 577S-82S

Olive Oil and its Many Benefits

Increased good cholesterol HDLDecreased total cholesterolDecreased bad cholesterol triglycerideReduced blood glucoseReduced blood pressure

Covas, MI et al; J Cardiovasc Pharmacol, Vol 54, Number 6, December 2009.

Doctor, should I be eating more fish?

Fish and Omega-3-Fatty Acids

• Fish are rich in omega-3 fatty acids• Omega-3 plentiful in oily fish such as salmon,

sardines and herring• Look for eicosapentaenoic acid (EPA), and

docosahexaenoic acid (DHA) on labels for fish oil capsules

Possible ways fish oil benefits your health

• Reduce irregular heart beats• Reduce clots from developing in your blood • Relaxes your blood vessels and decrease blood pressure• Anti-inflammatory• Decrease triglyceride

Mayo Clin Proc. 2008;83(3):324-332

Fish and Omega-3• Fish oil and its benefits have been well studied• Endorsed by American Heart Association (AHA)

for preventing second heart attack• FDA has approved omega-3 fatty acid for

treatment of very high triglyceride levels

Mayo Clin Proc. 2008;83(3):324-332Wang C, et al. Am J Clin Nutr. 2006; 84(1):5-17.

GISSI-Prevention Study

• Investigating the benefit of omega 3 fatty acids and vitamin E in patients with history of heart attack

• 11324 patients with preexisting heart disease• 1 gram of omega-3 fatty acids, vitamin E, both or neither

(control)• Group consuming omega-3 fatty acids had a 20% decrease in

death and a 30% decrease in deaths due to heart attack

Lancet vol 354. August 7, 1999.

JELIS Trial• 18,645 patients (70%

women; average age, 61 years)

• Looking at the effect of fish oil on heart attack

• Serum total chol>=250• Statin alone vs. statin and

fish oil• 5-year study• Fish oil reduced cardiac

events by 19%

Mayo Clin Proc. 2008;83(3):324-332

So omega-3 fatty acids are good for me…But how much should I take?

Dose Responses of Fish and Fish Oil Intake

Mozaffarian D and Rimm EB; JAMA, October 18, 2006-vol 296, No 15.

Safety of Fish

• Regulated by EPA and FDA

• Contain significant levels of:

Methylmercury Polychlorinated

biphenyls (PCBs) Dioxins

• Must be aware of both benefit and risk

• Children, pregnant, and lactating women increased risk

• Benefit far outweigh the risks for middle-aged and older men and postmenopausal women

Kris-Etherton, PM et al; Circulation 2002; 106:2747.

DHA and EPA in Fish Fish Oil Supplement

• 1000mg fish oil capsule contains 180mg of EPA and 120mg of DHA (can vary depending on brand)

Mayo Clin Proc. 2008;83(3):324-332

Lovaza

• 1-gram capsule contains:• 900 mg of the ethyl esters

of omega-3 fatty acids EPA - approximately

465 mg DHA - approximately

375 mg

Harris, WS et al; J Cardiovasc Risk. 1997; 4:385-391.

Summary of Recommendations

Population Recommendation

Patients without documented heart disease

Eat variety of fish at least twice a weekOr 1-2 capsules fish oil/day (300-600 mg DHA and EPA)

Patients with documented heart disease

3-4 capsules fish oil/day (900-1200 mg DHA and EPA)

Patients needing triglyceride lowering 5-7 capsules fish oil/day (3000-4200 mg DHA and EPA)

Mayo Clin Proc. 2008;83(3):324-332

So, when the Mediterranean Diet refers to drinking ‘in moderation’…

how many drinks is that exactly?

What’s Moderate Drinking?Women: No more than 1 drink a day

Men: No more than 2 drinks a day

Count as a drink...

Alcohol is BAD for you?(in excess!)

• World Health Organization estimates approximately 2 billion people consume alcoholic beverages worldwide- 76.3 million have ETOH use disorders

• 1.8 million deaths a year

Alcohol and Heart Disease

• Moderate alcohol consumption can reduce the risks of coronary heart disease

Increase in HDL, your good cholesterol Increase in breakdown and decrease in

formation of clots in your blood vessels Reduced inflammation within blood vessel

linings

Rimm EB, et al; BMJ. 1999; 319: 1523-1528.Estruch R, et al. Atherosclerosis. 2004; 175:117-123.

Alcohol good for the heart?

• Evaluate the relationship between wine

and beer consumption and vascular risk.

• Meta-analysis• 26 studies

Di Castelnuovo, A et al; Circulation 2002; 105; 2836-2844

Meta-Analysis of Wine Consumption in

Relation to Vascular Risk

Di Castelnuovo, A et al; Circulation 2002; 105; 2836-2844

Alcohol saves lives?

• Objective: investigate association of alcohol with death

• Meta-analysis• 34 studies, over one million subjects• In past relationship between alcohol and death

depicted as J-shaped curve

Di Castelnuovo, A et al; Arch Intern Med. 2006;166:2437-2445

Relative risk of death and alcohol intake

Di Castelnuovo, A et al; Arch Intern Med. 2006;166:2437-2445

Doctor, this all sounds great, but how can I afford to eat

healthy?

The cost of eating healthy

• Consumers believe that healthy diet is more expensive

• 12 wk nutritional intervention

• 73 healthy women• Showed no difference in

cost

Goulet, J et al; J. Nutr. 138: 54–59, 2008.

Live Longer with the Mediterranean Diet!

• Nurses Health Study: BMJ 2014

• Mediterranean Diet associated with longer telomeres (biomarker of aging)

• All about the antioxidant and anti-inflammatory effects of the diet which positively impact telomere length!

Mediterranean Diet Summary • Mediterranean diet can:

Reduce the risks of death from all causes(9%) and death from heart disease (9%)

• Specific components of Mediterranean diet that can reduce the risks of death are:

Moderate alcohol consumption (23.5%)

Low consumption of meat and meat products (16.6%)

High consumption of vegetable (16.2%), fruits and nuts (11.2%), olive oil (10.6%), and legumes (9.7%)

• Olive Oil can reduce heart disease risk by: Increase HDL Decrease total cholesterol and

triglyceride Reduce oxidative stress Lower blood pressure Lower blood sugar

• Fish and Omega-3 Fatty Acids: Moderate consumption of fish and

Omega-3 Fatty Acids (DHA and EPA) can reduce the risk of death and heart disease

Safety of fish consumption must be factored due to environmental contaminants

• Alcohol: moderate consumption leads to

decreased heart disease risk and death

• Cost: Mediterranean diet is not

significantly different from traditional western diet

• Longevity: Longer telomeres means a longer

life!

All Is Well That Eats Well

Website: www.alliswellthateatswellFacebook:www.facebook.com/alliswellthateatswellTwitter: @DrSolmazA

Questions?