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Food for Thought

Stick to Your "Mediterranean" Diet

In the Journal of the American Medical Association (JAMA) of February 8, 2006 , there were headline grabbing findings against low fat diets from 3 studies published simultaneously in JAMA. Unfortunately there is more hype than fact generated by these large studies. All 3 studies, on heart disease, breast cancer and colorectal cancer, have major research design flaws. As a result, their results about about diet and the prevention of disease is distorted and misleading.

All three studies were designed more than 10 years ago when most doctors were not paying attention to early studies showing the importance of the type of fat and its impact on health. For the 3 studies, the researchers chose a diet lower in total fat, but with no change in the type of fats consumed. Incredibly, the commentary that accompanies the cardiovascular disease risk study says, "The trial is not a test of the dietary guidelines currently recommended for prevention of CVD [cardiovascular disease]." Today it is accepted that saturated and trans-fatty acids (butter, beef fat and hydrogenated oils) are deleterious to health. Research strongly indicates that monounsaturated fats (olive, nut and seed oils) and omega 3 fatty acids (fish and flax oil) are protective against heart disease and therapeutic for many inflammatory conditions. These JAMA studies were not able to take into consideration these latest findings about good and bad fats so the findings are based on completely outmoded dietary guidelines.

To further understand why these studies are misleading, you need to read the fine print. It is immediately clear that "compliance" or people sticking with the diets that were recommended did not occur. For both the heart study and the breast cancer study, these studies never achieved what recent evidence shows is a more optimal pattern of dietary fat consumption.

Despite this "compliance" problem in the cancer study, the moderately low-fat diet still showed a 9% reduction in incidence of breast cancer. Also, the authors included this caveat in their discussion, "The health implications of a low fat dietary pattern may take years [beyond this study] to be fully realized." In other words, 8.1 years may not be enough time to derive meaningful findings about the impact of diet on the development of cancer.

All three studies were limited by the age of study participants who were all between 50 years and 79 years old when the studies began. Actually the authors themselves in the heart disease study raise the possibility that the effect may have been greater if the diet had been initiated at younger ages. Also, these studies focused on postmenopausal women so the findings should not be applied to disease prevention in younger women.

None of the studies were designed to consider the importance of total lifestyle, and the outdated, single minded focus on cutting only total fat makes the results misleading. In the third study of colorectal cancer, it does not take advantage of what scientists know today about the multiple risk factors for this type of cancer. Research has shown the risk of developing colorectal cancer increases with consumption of a diet high in saturated fats cooked at high heat and especially when those fats come from charred meat. This risk is further increased by smoking. On the "good news" side, more recent research indicates that the increased colorectal cancer risk posed by charred meats is reduced for those who consume green tea and cruciferous vegetables like broccoli, cauliflower and kale. Also, the incidence of colorectal cancer has also been shown to decrease when alcohol consumption is lowered and a regular exercise program is in place.

Contrary to the JAMA headlines, the real message here is the same as for all the above studies. More current research indicates that it is not just how much fat you eat, but the total picture of what you eat and drink, and your total lifestyle including psychological states and physical activity.

There growing body of research about the molecular foundations of nutrition that emphasize the "Mediterranean" diet which is a plant-based, high fiber diet rich in vegetables, fruits, whole grains, nuts, beans, low fat dairy products and fish. Diets in the 3 JAMA studies were not low-enough in fat and included far too many harmful, pro-inflammatory saturated fats. These outdated studies and the hype headlines are more fluff than fact. Bottom line, is that the new "Mediterranean" diets and total lifestyle enhancement remain the most effective recommendations for the prevention of heart disease, breast cancer, and colorectal cancer.

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