It’s true that there have been a limited number of studies of the effects of the Mediterranean Diet on blacks and Hispanics in the United States. Fortunately a study in the American Journal of Clinical Nutrition (2011;94:1458-64) seeks to close that information gap with a prospective (following people over time as opposed to asking them to recall past information) study involving over 2500 men and women living in Northern Manhattan in New York City.Mediterranean Diet not just for Mediterranean people

Q: My niece is a strict vegetarian – no animal products. She just had a miscarriage. When they were drawing her blood, they saw large white chunks floating in the blood. Do you know what this could be? Her doctor thinks it’s plaque, but has no suggestions to remedy this. Do you have any idea what this could be and if it could be caused by her diet?

A: I am not sure what this is, but it could be the fats in the blood we call lipids. If the cholesterol or triglyceride levels are high they can be seen in the blood when it is drawn up into glass tubes.Cholesterol and Vegetarians

Q: My father has been on Coumadin for 4 weeks and his doctor told him he could not eat home-grown garden tomatoes – just hot-house tomatoes! From viewing your website, the tomato is low in vitamin K, so what is the deal?

A: I must admit that I very much enjoyed your question. My first reaction was that tomatoes are tomatoes but when answering Ask Dr. Gourmet questions I always want to make sure that the reply is correct. As I wasn’t 100% certain that a tomato is a tomato when it comes to Vitamin K content, I consulted some experts at the USDA.Is a tomato a tomato?

Q: I was put on a low fat or no fat diet and lost 23 pounds, but am now too skinny. I was given this diet after a heart attack. I have trouble gaining weight even though I eat fairly well. Except for fats – now the dietician says to use butter on toast and olive oil in my salad. I am 5 foot 7 and weigh 120 pounds–23 less than when I came out of the hospital.

Does this loss have something to do with the function of my heart? There was some damage, so I was put on a very light exercise program. I hate losing this weight as there seems to be very little fat on my body. I have an appointment to see my general practitioner but not till three weeks time.

A: You are not underweight. You can calculate your Body Mass Index on the Dr. Gourmet website here: Dr. Tim Says… How Much Should You Weigh?

When you do this you will find that your weight is at the low end of what is considered normal. For someone who has had a heart attack, being within a normal BMI is associated with less risk for another heart attack. Weight Loss and Heart Disease

Have a question? Send it to askdrgourmet@drgourmet.com and your question may be answered in this column. Read more Ask Dr. Gourmet questions – over 500 questions already answered!

The bad news, however, is that research on coffee and blood pressure has largely been limited to those who do not already have high blood pressure. Fortunately, a group of researchers in Spain noticed this and looked at 15 different studies of coffee and caffeine intake in order to evaluate the effect of coffee on those with mild to moderate high blood pressure (Am J Clin Nutr 2011;94:1113-26).Coffee and High Blood Pressure

Win one of five signed copies of Dr. Harlan’s new book by entering the sweepstakes on Facebook! This is a 6-week plan that will have you and your family eating well and eating healthy, while learning how to improve your life and your health, one plate at a time.

Sweepstakes ends on June 7, 2011, when the book is released, so don’t wait! Sign up to win your copy of Just Tell Me What to Eat!

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;21:237-244). Mediterranean Diet and Heart Disease

We know that those people following a Mediterranean-style diet are less likely to be overweight or obese, and that a Mediterranean-style diet can help reduce blood pressure and improve cholesterol scores and insulin levels. But for those who are already overweight, are there advantages to a Mediterranean diet? Researchers in Greece used information from an ongoing health and nutrition survey to find out. Mediterranean Diet Advantages Not Limited to Normal Weight

There’s been some concern about the long term health risks of such diets. We’ve seen that those eating higher protein diets that were also high in saturated fat were more likely to develop heart diseasethan those whose higher protein diet came from vegetable protein sources. Such extremely-low-carbohydrate diets also seem to affect your thinking abilities. Low-Carb Diets and Type 2 Diabetes

Unlike an overview, which details the results of many studies on an individual, study-by-study basis, a meta-analysis combines the results and data of several studies to yield results as if they were all one study. (Those of you with a science background will recognize that this explanation is rather simplified.) The strength of a meta-analysis lies in the fact of its aggregate size: the larger and longer a study is, the more reliable are its results. The drawback, of course, is that this is a grouping of studies, all performed by different people with different standards and methods. More on Sugary Beverages and Your Health

Recently a team of researchers at Harvard published an overview of current research on sugar-sweetened beverages and obesity, type 2 diabetes and other metabolic disorders in the journal Physiology & Behavior.

Here are just a few highlights of the articles they mention which cite large-scale studies: Sugary Beverages and Your Health

A group of researchers in Scotland recently published a study focused on the effect of higher whole-grain food intake on fairly healthy individuals. Whole Grains and Heart Disease Risk

Of course we know what the outcome is of such overeating: holiday weight gain followed by a New Year’s resolution to diet and exercise.

A group of Swedish researchers looked at the long term effects of such overeating in a small study that was just released by the journal Nutrition & Metabolism. Short Term Splurge – Long Term Fat

Q: I am on the MAOI Parnate and I cannot have anything with tyramine in it. Could you tell me exactly what is in the Acai Berry fruit? I ordered the freeze dried berry in a capsule. I’m just not sure if I can have it.

A: It is possible that acai berries may contain tyramine. Many fruits do, including grapes, figs, plums and pineapple. As fruits age, the levels of tyramine they contain increase, so fresh fruit may not be as much of a problem.

All of that said, the freeze dried acai that you ordered is likely to be a scam. Acai Berry Supplements

Q: Which salt substitute would you recommend?

A: Generally speaking I don’t recommend salt substitutes. I believe that it’s more important to learn to use salt carefully. Here’s some information on how to get started and understand sodium better: Salt

Q: Since I have high blood pressure one of my major concerns is salt content. Some recipes (like eggplant parmesan) call for salting items like eggplant, zucchini, and cucumber to either cut down on bitterness or excess water.

I have usually skipped the salting because I am concerned that it significantly increases the sodium content of the recipe, even if the salt is rinsed off the vegetable after the soaking. Does covering the vegetables in salt result in significant absorption of sodium? If it does, are there alternative methods that will achieve the same goals?

A:I never salt eggplant (or other vegetables, for that matter) in the way you describe. There are two suggested reasons for doing this. One is to remove moisture and the other bitterness. My experience is that moisture is fine for eggplant and helps keep it tender. Salting Eggplant

Leaving aside for the moment the medical terms, just look at what’s being researched and upon whom: alcohol-free beer and elderly women. You have to ask yourself: where did these researchers find a group of elderly women to drink alcohol-free beer?

A recent study published in the journal of the American Heart Association, Circulation, takes a closer look at the connection between red meat, processed meats, and heart disease and diabetes. Red Meat is Fine! Redux

That’s a tablespoon and a half (4.5 teaspoons), for men, and about 1 tablespoon of salt (3 teaspoons) for women.

We know that reducing the amount of salt we eat can help reduce blood pressure and your risk of heart disease – from stroke to heart attack. If everyone in the United States over 35 years old reduced their salt intake by only 3 grams per day, what kind of impact would that have on our country’s overall health? Quantifying the Effects of Less Salt

But what about the reverse? If you don’t smoke, get enough exercise, and maintain a healthy weight are you actually less likely to get sick or die? The Effects of Being Healthy

Recently a study focusing on the effects of consuming fructose versus glucose was published in The Journal of Clinical Investigation. A multi-university team of researchers recruited 32 men and women between the ages of 40 and 72 to participate in a feeding study. A Serious Look at Fructose

Researchers from the Centers for Disease Control worked with scientists at the German Institute of Human Nutrition on a study that included over 23,000 men and women between the ages of 35 and 65. At the start of the study, each person received a score of 1 or 0 (yes or no) on four positive health factors. Sometimes It’s Just That Simple

A: There was a time when nutritionists and dieticians recommended avoiding butter and using margarine because of the amount of saturated fat in butter.  We know now that while too much saturated fat can promote heart disease, it is trans-fats that are far more of a problem.  While these types of fats do occur in nature, they do only in small amounts.  Unfortunately, for a long time many products that were produced were very high in trans-fats. The Truth About Butter vs. Margarine

A: Avocados are really good for you. While they do have a lot of calories and are high in fat we know that the monounsaturated fats are really good for you. They do contain a moderate amount of Vitamin K, however. A half cup of slices (about 3 ounces) will have 15 micrograms (mcg) of Vitamin K. That’s a reasonable amount of Vitamin K. Note that most of the 117 calories in that half cup is from fat at about 100 calories with a whopping 7 grams of monounsaturated fat. More About Avocados

The key is moderation.

The earliest meaningful research was done by a cardiologist named Arthur Klatsky. He noticed that many of his patients with heart disease were not drinkers. This led him to do a retrospective study of over 80,000 patients and he discovered those who drank more had a much lower risk of dying from a heart attack. The Mediterranean Diet: Alcohol

Studies have shown that drinking moderate amounts of alcohol has helped those with heart disease avoid heart attacks as well as improving their cholesterol scores. Red wine, in particular, contains a high amount of antioxidants called polyphenols. Red Wine Good for Old and Young

Leaving aside for the moment the medical terms, just look at what’s being researched and upon whom: alcohol-free beer and elderly women. You have to ask yourself: where did these researchers find a group of elderly women to drink alcohol-free beer? Alcohol-Free Beer: an Antioxidant?

A recent study known as the ARIC study included over 14,000 African-American and white men and women between the ages of 45 and 64 (J Am Diet Assoc 2008;108:1881-1887). At the beginning of the study, in 1987, the participants completed a food questionnaire that asked how often they ate specific foods or beverages. Less of This, More of That

Researchers in Italy recently pooled the results of 12 previously-performed studies of the effects of the Mediterranean Diet on people’s overall health (BMJ 2008; 337:a1344). These studies included, in total, over 1.5 million people….

Discussion and training on diet, exercise and lifestyle change such as stopping smoking was given to two groups of about 250 people.  In the study group more intensive intervention was offered and this included follow up over a year’s time.  Regular contact was made in person n person or over the telephone at 2 weeks, 6 weeks, 3 months, 6 months, and 9 months.  During that time there was reinforcement of the original teaching.

Unfortunately, it didn’t work.  At one year there was reduction in LDL in both groups but the HDL (good) cholesterol went down more in the group that had more intensive instruction.

This was a small study and the authors to feel that a reassessment of how we discuss intervention with those at risk may be what is needed most

Keep in mind that this is a heart failure study and not one of atherosclerosis / heart attack.  We do know that the other whole grains help there as well but so do fruit & veg, fish and nuts.

Dr. Gourmet

http://www.adajournal.org/article/S0002-8223(08)01558-7/abstract

Take heart attacks and stroke, for instance. We know that those who are overweight or obese are at a higher risk for high blood pressure, poor cholesterol scores and diabetes, which are all known risks for heart disease and stroke. (For those doing the math at home: A is overweight or obese; high blood pressure, poor cholesterol scores and diabetes are B; and C is heart disease and stroke.) But what we don’t know for sure is if A = C (overweight or obesity are causes for heart disease and stroke). Medicine just isn’t that linear.

On the other hand, sometimes it is – at least statistically.

It’s not just the monounsaturated fatty acids that are the healthy component of olive oil, however: it also contains high amounts of substances called phenolic compounds, which are powerful antioxidants. Antioxidants are known to help combat that low-grade inflammation which is suspected to contribute to heart disease.

Researchers in Barcelona, Spain, noted that virgin (unrefined) olive oils contain more phenolic compounds than refined olive oils. As part of a larger study on olive oil, twenty-eight men and women participated in a comparison of the effects….

Since poor cholesterol scores and high blood pressure can lead to heart disease, it seems reasonable to think that the DASH diet would help reduce the risk of heart disease and stroke. Yet there have been studies of the DASH diet that did not support that conclusion—in fact, one study showed no difference in blood pressure that couldn’t have been chalked up to the amount of weight lost by the test subjects while on the diet.

But that’s not the end of the story.

A recently-published study performed by researchers at the Universities of Minnesota and North Carolina made use of data collected for a long-term study performed between 1987 and 1998 (Circulation 2008; 117:754-761.). Over 9500 men and women over the age of 45 filled out a detailed dietary questionnaire, provided information about medication use, smoking, and exercise levels, and underwent blood tests for cholesterol and glucose levels.

The dietary questionnaire included 66 food items, and the participants could select their frequency of intake from a 9-level range, from never or less than one serving per month to six servings or more per day. The scientists then grouped most of the items into 5 major food groups: meat, dairy, fruits and vegetables, refined grains and whole grains. The other, specific items were: fried foods; sweetened beverages, including sugared soda and fruit drinks; diet soda; nuts; and coffee, both regular and decaffeinated.

The researchers had hypothesized that a more Western dietary pattern, consisting mostly of meat, refined grains, fried foods, and sweetened beverages would be associated with a greater risk of Metabolic Syndrome, while what they termed a “prudent” dietary pattern – fruits and vegetables, whole grains, dairy products and coffee – would not.

They were right. At the conclusion of the study they found that those participants whose diet contained high intakes of refined grains, processed and red meat, and fried foods, were 18% more likely to develop Metabolic Syndrom than those whose diets were mostly vegetables and fruit, fish, and poultry. Most interestingly, however, they found also that consumption of specific foods were also associated with an increased risk of Metabolic Syndrome. Those who tended to eat more fried foods increased their risk by 25%, and drinking more diet soda increased a participant’s risk by 34%. By contrast, those who consumed the most dairy products had a lower risk of developing Metabolic Syndrome.

What this means for you

What the scientists in this study termed a “prudent” dietary patterns sounds remarkably like the Mediterranean Diet; it’s true. But the real take-away here is the increased risk associated with eating a lot of fried foods and drinking a lot of diet soda (or even regular soda). Make fried foods and sodas of all kinds an occasional indulgence, at best.

|