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What do you think of Dr. Esselstyn's 'Heart Attack Proof' Diet?
His diet recommendations counter many items in the Mediterranean Diet. See this excerpt below from his website and please clarify! Now I'm really unsure what to eat. Fish? No fish? Nuts, no nuts? Olive oil, or no oils whatsoever? No avocados?

Body Mass Index and the Link to Heart Disease or Stroke
Medicine does not follow the algebraic formula many of us learned in school, where if A equals B and B equals C, then A equals C. Often the cause of one condition (A equals B) which can lead to another condition (C) does NOT mean that the cause of the first condition is also the cause of the second.

Sodium and Stroke
The United States Department of Agriculture recommends that Americans limit their sodium intake to less than 2400 milligrams per day. The American Heart Association, however, recommends a limit of 1500 milligrams per day. We know that high levels of sodium in the diet are linked to high blood pressure and thus to the risk of stroke, but until recently many studies have not tried to link sodium and stroke more directly.


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Mediterranean Diet and Heart Disease

I've reported on dozens of studies that have focused on the health benefits of the Mediterranean Diet and heart disease, but the vast majority of them have focused on the benefits of specific components of the diet, such as olive oil (Bite, 01/19/07), cereal grains (Bite, 06/16/06) or fish (Bite, 01/22/06). A recent study published in Nutrition, Metabolism & Cardiovascular Diseases looks at the effects of the Mediterranean Diet as a whole and its effects on the rates of heart disease and stroke in middle-aged adults (2011;21(4):237-244).

The study was carried out in the area of Navarra, Spain and utilized data gathered from an ongoing, large-scale study of graduates of the universities throughout Spain. Beginning in 1999, graduates were enrolled yearly on a continuing basis. At their initial enrollment, the graduates provided height, weight and other demographic information, then also filled out a food frequency questionnaire specifically designed to be used in Spain, which included 136 items. The participants were then re-contacted every two years, again on an ongoing basis.

For the purposes of this study, the researchers included over 13,000 men and women who had no history of cardiovascular disease. The average time of participation in the study was 4.9 years.

The researchers assigned each participant a score from 0 to 9 based on their adherence to a Mediterranean diet, with "high adherence" being a score of 7, 8 or 9 and "low adherence" being a score of 2 or less. (Take our quiz to see what your Mediterranean Diet score is, along with tips for improving your score.) They then compared the diets of those who developed heart disease or had a stroke with the diets of those who did not.

After adjusting for Body Mass Index and other variables, those with the highest Mediterranean Diet scores were 59% less likely to develop cardiovascular disease than those with the lowest scores. A score increase of just two points reduced the risk of cardiovascular disease by 20%.

What this means for you

Improving your diet (and thereby improving your health) doesn't mean a wholesale makeover of your entire life and changing everything you eat. Far from it! This study shows you that small changes in your diet can have a huge impact on your health. These changes can be as easy as eating more fruits and vegetables (snack on apples and carrots sticks) and switching just one serving of your daily grains from more refined flours to whole grains (say, switching from regular pasta to whole wheat or quinoa pasta).

First posted: May 25, 2011