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Does The Mediterranean Diet Cut Back Cardiovascular Risk?

By now, most of you lot convey likely heard almost the recent study on the "Mediterranean diet" (1), a diet that was designed yesteryear diet-heart researchers together with is based loosely on the traditional diet of Crete together with sure other Mediterranean regions.  The pop press has been enthusiastically reporting this trial equally long-awaited proof that the Mediterranean diet reduces the adventure of cardiovascular events-- yesteryear a total thirty pct over a 4.8-year period.  I want I could percentage their enthusiasm for the study.

Let me start off yesteryear proverb that I intend the Mediterranean diet is a relatively well for you lot diet pattern, surely a major improvement over the typical diet.  In this detail study, participants were encouraged to swallow to a greater extent than olive oil, nuts, fish, fruit, vegetables, beans, white meat together with wine; together with swallow fewer baked goods, spread fats, reddish meats together with soda.  The Mediterranean diet grouping was split upward into two, alongside ane one-half receiving extra-virgin olive fossil oil together with the other one-half receiving nuts.  Here is how they were instructed together with followed up:
For participants inward the 2 Mediterranean diet groups, dietitians ran private together with grouping dietary-training sessions at the baseline view together with quarterly thereafter. In each session, a 14-item dietary screener was used to assess adherence to the Mediterranean diet (Table S1 inward the Supplementary Appendix) then that personalized advice could live provided to the study participants inward these groups.
The comparing grouping was a "low-fat diet" group.  Diet patterns scarcely changed inward this grouping over time, alongside dietary fatty alone decreasing from 39 to 37% of calories over the course of study of the trial.  The argue becomes clear when you lot read the description of how they were instructed together with followed up:
Participants inward the command grouping likewise received dietary preparation at the baseline view together with completed the 14-item dietary screener used to assess baseline adherence to the Mediterranean diet. Thereafter, during the initiative of all iii years of the trial, they received a leaflet explaining the lowfat diet (Table S2 inward the Supplementary Appendix) on a yearly basis.
So basically, they got preparation at baseline together with a pamphlet inward the postal service in ane lawsuit a year, spell the Mediterranean diet grouping got quarterly visits alongside a dietitian, diet screening, together with "personalized advice".  Anyone reckon a work here?  The investigators did, halfway through the study:
However, the realization that the to a greater extent than infrequent view schedule together with less intense back upward for the command grouping powerfulness live limitations of the trial prompted us to amend the protocol inward Oct 2006 [3 years subsequently the initiative of all of the trial -SG]. Thereafter, participants assigned to the command diet received personalized advice together with were invited to grouping sessions alongside the same frequency together with intensity equally those inward the Mediterranean-diet groups, alongside the purpose of a separate 9-item dietary screener (Table S3 inward the Supplementary Appendix).
Why did they convey a low-fat diet command grouping to laid about with?  The betoken of a command grouping is to eliminate all variables from your comparing except the constituent you're interested in, inward this case, diet.  In this study, they presumably chose a low-fat diet for the command grouping because multiple trials convey shown it to live ineffective at preventing cardiovascular events*.  If you lot desire to reckon a handling effect, you lot necessitate to purpose a relatively ineffective comparing group, or else at that spot volition live no departure betwixt groups.  Since people tend to larn healthier when they adopt whatever form of health-oriented diet change, and/or run into alongside dietitians together with doctors regularly, the low-fat diet intervention should have controlled for this potentially of import variable.

However, since the diet of the command grouping remained to a greater extent than oftentimes than non unchanged, together with it received a less intensive intervention than the Mediterranean diet group, it was non a proper control, together with there's no mode to know how much of the thirty pct reduction inward events was due to the Mediterranean diet itself, together with how much was due to increased diet vigilance together with visiting regularly alongside dietitians.  Dr. Peter Attia late made the same betoken (2).  So spell nosotros tin order that an intensive Mediterranean diet intervention lowers cardiovascular lawsuit adventure to a greater extent than than a low-intensity intervention that has fiddling outcome on diet patterns, strictly speaking nosotros can't order that the Mediterranean diet itself lowers cardiovascular risk.  This betoken volition live lost on most of the pop press together with many researchers, because this study seemed to render the response everyone wanted to hear.

That existence said, if I had to guess, I'd order the Mediterranean diet likely does lower risk.  That's why I notice this study then frustrating-- it came then roughly conclusively demonstrating what other evidence has been hinting at for some time.


* At to the lowest degree inward studies lasting a few years done on people who already convey cardiovascular disease.  That doesn't necessarily hateful a low-fat diet wouldn't forestall atherosclerosis if administered earlier the evolution of disease-- simply these types of trials are virtually impossible inward humans.


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