The role of blood cholesterol levels in coronary heart disease (CHD) and the true effect of cholesterol-lowering statin drugs are debatable. In particular, whether statins actually decrease cardiac mortality and increase life expectancy is controversial. Concurrently, the Mediterranean diet model has been shown to prolong life and reduce the risk of diabetes, cancer, and CHD. We herein review current data related to both statins and the Mediterranean diet. We conclude that the expectation that CHD could be prevented or eliminated by simply reducing cholesterol appears unfounded. On the contrary, we should acknowledge the inconsistencies of the cholesterol theory and recognize the proven benefits of a healthy lifestyle incorporating a Mediterranean diet to prevent CHD.
Core tip: Traditional efforts to prevent cardiovascular disease have emphasized the benefits of cholesterol lowering and statin drugs. Often overlooked is the fact that numerous studies of cholesterol lowering have failed to demonstrate a mortality benefit and the benefits of statins may have been overstated. The Mediterranean diet has consistently lowered cardiovascular events and mortality in numerous studies and does not typically lower cholesterol levels. Alternative theories of atherosclerosis are independent of cholesterol metabolism and may provide the key to future preventive strategies.
Introduction
Nearly twenty years ago two landmark randomized clinical trials appeared in The Lancet which forever changed the course of medicine for patients with coronary heart disease (CHD). The 4S study employed a cholesterol-lowering statin drug and reported a 30% mortality reduction[1]. The Lyon Diet Heart Study utilized the Mediterranean diet and reported a 70% mortality reduction[2]. Subsequent studies of the Mediterranean diet have confirmed these findings and also shown a reduced risk of cancer, diabetes, and Alzheimer’s disease[3-6]. Subsequent statin studies have led the United States Food and Drug Administration to issue warnings regarding the increased risk of diabetes and decreased cognition with statin drugs. Paradoxically, statins have gone on to become a multi-billion dollar industry and the foundation of many cardiovascular disease prevention guidelines while the Mediterranean diet has often been ignored. We believe this statin-centric cholesterol-lowering approach to preventing CHD may be misguided.
Full study PDF: http://www.wjgnet.com/
12 comments:
The Mediterranean diet differs radically from the one usually promoted on this blog, google the diet's "pyramid" or "plate" and you will see eating whole grains and a reduction in saturated fat are part and parcel of it. Please stay low carb consistent, by the way the Med diet as a dietary model was originally formulated by Ancel Keys.
Weird mashup.
"Mediterranean diet" is a phrase that should immediately set your alarm bells ringing right after "contains healthy antioxidants". Personally I take it to mean stop eating manufactured food but there ain't no such thing as the Mediterranean diet in reality, it's just a dietician's fantasy.
C.
Have an amazing weekend out there.
I agree about the med diet how on earth can you define it, lets face even Ancel Keys version was seriously flawed:
Critics have pointed out that Dr. Keys violated several basic scientific norms in his study. For one, he didn't choose countries randomly but instead selected only those likely to prove his beliefs, including Yugoslavia, Finland and Italy. Excluded were France, land of the famously healthy omelet eater, as well as other countries where people consumed a lot of fat yet didn't suffer from high rates of heart disease, such as Switzerland, Sweden and West Germany. The study's star subjects—upon whom much of our current understanding of the Mediterranean diet is based—were peasants from Crete, islanders who tilled their fields well into old age and who appeared to eat very little meat or cheese.
As it turns out, Dr. Keys visited Crete during an unrepresentative period of extreme hardship after World War II. Furthermore, he made the mistake of measuring the islanders' diet partly during Lent, when they were forgoing meat and cheese. Dr. Keys therefore undercounted their consumption of saturated fat. Also, due to problems with the surveys, he ended up relying on data from just a few dozen men—far from the representative sample of 655 that he had initially selected. These flaws weren't revealed until much later, in a 2002 paper by scientists investigating the work on Crete—but by then, the misimpression left by his erroneous data had become international dogma.
I originally posted this to highlight more evidence to show there's no correlation between high cholesterol and CVD the diet as such is irrelevant, we know LCHF diet is far superior to any other in raising HDL and lowering trigs.
Graham
about the chol and trigs, no dispute! I have had a boost in the ratio of those in less than two years that is far better than any medication can achieve while my HBA1c has dropped to normal levels. Plus I have just realised that I haven't had a cold or flu etc since giving up sugar+wheat+beans+potatoes+vegetable oils. Considering that I work in a school that's a spectacular result. I don't exactly know which one to blame but I'm nevernot going back.
Amongst the real diets that exist around the Mediterranean, my favourites are the ones with eg plates of charcuterie, or lardo, or great lashings of tasty cheeses and eggs ... with one or two small green leaves thrown in for colour and balance.
C.
Ah, I was looking everywhere on the forum for this and it was over here!
The Lyon Diet Heart Study (Michel de Lorgeril) was pretty conclusive. Less well known is that a major part of the intervention was to replace industrially produced Omega 6 margarine with industrially produced Omega 3 margarine.
No-one seems to have heard of Staffan Lindeberg's studies where a "paleo" diet trumps a "mediterranean" diet
Here's one
http://www.ncbi.nlm.nih.gov/pubmed/17583796
admittedly small but convincing enough that larger longer studies should be performed
curiously these works parallel what has been found "anecdotally" by hundreds of people
Hi Chris
Thanks I've posted this live link to the PDF of the full study which is available for free.
http://link.springer.com/article/10.1007%2Fs00125-007-0716-y
Cheers
Graham
Here's one of the ones on diabetes
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2724493/
more here
http://www.ncbi.nlm.nih.gov/pubmed/?term=lindeberg+s
he's a busy lad
Thanks for the links Chris I will check them out.
Eddie
Still going
http://www.dovepress.com/the-western-diet-and-lifestyle-and-diseases-of-civilization-peer-reviewed-article-RRCC
can you tell I've been reading/re-reading a whole bunch of blogs?
chris c said...
can you tell I've been reading/re-reading a whole bunch of blogs
Plain to see but did you know Dr Katharine has a blog ?
http://diabetesdietblog.com/
Good to see you again Chris
Cheers
Graham
Yes but it's worth mentioning it again, get the word out there.
My podiatrist and her husband are low carbers (prediabetes and diabetes respectively), she has told me yet another doctor in a nearby town has now adopted low carb, I already knew of one in another village. I suspect since PCTs were replaced by CCGs GPs have a bit more freedom to pursue health rather than blindly follow rules. However I confidently expect I will be dead (along with a few million others) and she will be retired before The Authorities budge from Low Fat.
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