SPECIAL FROM Next Avenue
It's not so much the specific foods, but your overall eating pattern. Which plan is right for you?
Multiple factors influence the development and progression of cardiovascular disease. So while most experts agree that diet plays a big role in prevention and treatment of heart disease, there are definite controversies surrounding which diet is best. Still, general agreement is that a diet for heart health focuses on an overall eating pattern rather than particular foods that can lower cholesterol levels, blood pressure or heart disease risk.
As far as overall patterns go, the Mediterranean Diet still holds top honors in many health organizations. Yet two newer regimens are coming to light that might protect the heart just as well, if not better.
Which plan is best for you? Here’s a look at the latest findings and a brief description of each.
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The Mediterranean Diet
The specifics Billed as the traditional diet of sun-drenched Mediterranean locales, this plan is loosely defined as one that focuses on filling the plate with plenty of fruits, vegetables, whole grains and moderate amounts of healthy fats, like nuts and olive oil. Fish and poultry, eaten in moderate amounts, are preferred over red and processed meats. Dairy products and sweets are kept to a minimum, but a little wine with meals is fine.
The science Multiple studies have linked a Mediterranean eating style with lower heart disease risk. Yet, a 2013 clinical study published in the New England Journal of Medicine gives such strong support to the diet's positive impact that researchers ended up stopping the study early, after almost five years, because the results were so clear it would have been unethical to continue.
University of Barcelona scientists divided nearly 7,500 volunteers age 55 to 80 into three groups and followed them for five years. One group consumed a low-fat diet; the two others ate a Mediterranean-style diet enhanced with either nuts or olive oil. Participants following either Mediterranean plan lowered cardiovascular disease endpoints -- heart attacks, stroke, death -- a whopping 30 percent. Current thinking is that this style diet could be even as effective as drug therapy but without negative drug side effects.
“Even the best available drugs, like statins, reduce heart disease by about 25 percent, which is in the same ballpark as the Mediterranean diet,” Walter Willett, chair of the Department of Nutrition at Harvard School of Public Health, said in The Boston Globe. “But the statins increase the risk of diabetes, whereas this diet can help reduce the risk.”
Is it for you? Probably. It’s an easy plan to follow since the emphasis isn’t on restricting fat but rather on eating moderate amounts of healthy fats like nuts, olive oil and avocados. A splash or two of red wine isn’t hard to swallow either. Check out the Mayo Clinic for recipes and more details.
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The Anti-Inflammatory Diet
The specifics The theory is that chronic or low-grade levels of inflammation (the same body response that helps you heal from a wound, but on a much milder level) are bad for the heart and health in general. One integrative cardiologist goes so far as to suggest that inflammation, not elevated cholesterol levels, is the real cause of heart disease.
Whether it is or not, anti-inflammatory diets are a mixed bag of advice depending on which website or book you read. Foods to avoid could include everything from omega 6 fatty acids found in vegetable oils, sugar and processed foods to common allergens, like soy, peanuts and wheat.
The science One word describes the scientific back-up for anti-inflammation eating plans: shaky. The consensus is there’s a lot more research to be done about inflammation -- and the foods that might tame it -- before any real diet-heart disease links can be confirmed.
Researchers at the Helfgott Research Institute and the General Clinical Research Center at Oregon Health and Science University hope to tackle the anti-inflammatory diet/disease link with a group of diabetics and pre-diabetics. They want study participants to follow the anti-inflammatory diet or one based on American Diabetic Association recommendations for six weeks. "If the anti-inflammatory diet reduces inflammatory cytokines," they say, "it may be an important diet for people with various conditions, including inflammatory autoimmune diseases, such as multiple sclerosis, rheumatoid arthritis and IDDM," or type I diabetes.
As for the connection between heart disease and inflammation, “My best advice is to stay tuned," says Dr. Brent Bauer of the Mayo Clinic. “This is a huge area of interest in the medical world and there are bound to be discoveries down the road that can improve well-being and the quality of health.”
Is it for you? Maybe. Most anti-inflammatory diets promote good choices that are remarkably similar to a Mediterranean-style way of eating. But the foods they restrict -- for example, wheat (gluten), dairy and nightshade vegetables (peppers, eggplant, tomatoes and potatoes) -- might be unnecessary changes for most people.
The Plant-Based Diet
The specifics The all-plant diet that President Bill Clinton endorses is actually code for a vegan diet that eschews all animal products and also limits fat, including such heart-healthy ones as olive oil, avocados and nuts.
The science There are no randomized, double-blind, controlled clinical trials that have tested the vegan diet and its relationship to cardiovascular events, like heart attack or stroke. But even as far back as 1998, an editorial in the Journal of the American College of Nutrition suggested that several international studies have linked plant-based diets to a lower risk for ischemic heart disease. And retired Cleveland Clinic cardiologist Dr. Caldwell B. Esselstyn Jr., a cardiologist who worked at the Cleveland Clinic, offers 20 years of evidence from his patients showing dramatic drops in cholesterol and a widening of coronary arteries (based on angiograms) and what he calls a reversal of heart disease with a vegan, low oil diet. “In the world’s poorer nations, many people subsist on a primarily plant-based diet, which is far healthier, especially in terms of heart disease,” Esselstyn said in the journal Preventive Cardiology.
Is it for you? It’s not going to be popular with meat lovers or those who don’t want to limit healthy fats, like olive oil. And it’s far, far, different from the high-fat, highly processed Western diet. But groaning and complaining aside, this diet is entirely doable, particularly if you love, or at least keep an open mind about, meals that highlight fresh fruits, vegetables, legumes and whole grains.
Ed Begley Jr.