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Is Nutrition Really the Key to Good Health?

The Mediterranean Diet put to the test.

by
Theodore Dalrymple

Bio

April 13, 2013 - 7:00 am

Having recently returned from Madrid, I confess that I saw little evidence of the Mediterranean diet being consumed there (apart, that is, from the red wine): though, of course, Madrid is in the middle of the peninsula, far from the Mediterranean. Perhaps things are different on the coast. Nevertheless, at over 80 years, Spain has one of the highest life expectancies in the world.

Is this because of the much-vaunted Mediterranean diet? Spanish research recently reported in the New England Journal of Medicine provides some – but not very much – support for the healthiness of that diet.

The researchers divided 7000 people aged between 55 and 80 at risk of heart attack or stroke because they smoked or had type 2 diabetes into three dietary groups. One group (the control) was given dietary advice concerning what they should eat; the two other two groups were cajoled by intensive training sessions into eating a Mediterranean diet, supplemented respectively by extra olive oil or nuts, supplied to them free of charge.

They were then followed up for nearly five years, to find which group suffered from the most (or the least) heart attacks and strokes. The authors, of whom  there were 18, concluded:

Among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events.

The authors found that the diets reduced the risk of the subjects suffering a heart attack or stroke by about 30 percent. Put another way, 3 cardiovascular events were prevented by the diet per thousand patient years. You could put it yet another way, though the authors chose not to do so: 100 people would have to have stuck to the diet for 10 years for three of them to avoid a stroke or a heart attack. This result was statistically significant, which is to say that it was unlikely to have come about by chance alone, but was it significant in any other way?

Such significance is in the eye of the beholder, or rather in the opinion of the patient. There are reasons for liking the Mediterranean diet other than health reasons, namely aesthetic ones; and this is important, because if it were discovered that a diet of raw cabbage and boiled fish without salt produced the same result, would anyone other than a masochist contemplate adhering to it? After all, only hypochondriacs turn their meals into medicines and nothing else.

Even if the study had found much more dramatic results than it did find, it would have been severely limited in its application. It does not follow from the fact that the diet prevents stroke or heart attack in people at relatively high risk of having one in the first place that it would prevent either or both of them in people at much lower risk.

On the other hand, it is also possible that the Mediterranean diet would have prevented the development of the high risk in the first place if taken early enough in life. It is true that Mediterraneans, on the whole, have fewer heart attacks and strokes than people of more northerly climes; what is not so clear is how far Mediterraneans actually consume a Mediterranean diet. The idea that diet is the sovereign way to health is a very old one, but given the fact that nations of the most diverse dietary habits are among those with the highest life expectancy, it might not be correct.

In any case, the Spanish research involved the monitoring and one might almost say the badgering of patients to get them to comply with the diet. What is found in the context of a trial is not necessarily transferable to “real” life.
*****

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Shutterstock image courtesy Sasa Komlen

Theodore Dalrymple, a physician, is a contributing editor of City Journal and the Dietrich Weismann Fellow at the Manhattan Institute. His new book is Second Opinion: A Doctor's Notes from the Inner City.

Comments are closed.

All Comments   (22)
All Comments   (22)
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Who wants to stick around here any longer than they have to anyway?
1 year ago
1 year ago Link To Comment
Teddy, the answer is YES diet does matter. Same as in computers, garbage in = garbage out. Eat the Paleo diet way and enjoy what you eat and be healthier for it.
1 year ago
1 year ago Link To Comment
Okinawans have the longest life expectancy of any society on earth.
There are comparisons of the Asian/Mediterranean diets for ready review.
But, what are you worried about?
Obamacare will fix all our problems and Michelle will conjure up diets much more healthy than anyone ever imagined. And for ready reference to that, just examine our current middle school kids. (snort!)
1 year ago
1 year ago Link To Comment
Seriously, do you think we'll ever definitively know this??
1 year ago
1 year ago Link To Comment
My husband and I are in our 60s, smoke and have yet to develop any health problems or have any reason to see a doctor. We hardly ever eat restaurant food, fast food and avoid processed food. We make most of our food from scratch and I suppose we do eat a Mediterranean diet in that we do a lot of Italian cooking with tomato sauce, olive oil and our snack of choice is olives. I've always believed in the old-fashioned advice "all things in moderation" and it seems to be working for us. We eat sensibly, thoroughly enjoy our food but we don't over-indulge in anything. Except red wine sometimes.
1 year ago
1 year ago Link To Comment
Eat Right, Exercise and...

DIE ANYWAY!

Just eat what you enjoy you are dead anyway in the long run.
1 year ago
1 year ago Link To Comment
I used to take care of a 95 year old gentleman who suffered from mild asthma. He was a non-smoker and possessed a keen mind and lively sense of humor. I asked him one day what was the secret of his good health and longevity; he replied "Buttermilk."

1 year ago
1 year ago Link To Comment
I grew up eating a lot of traditional Mediterranean food (my mom is Italian), plus some French and Spanish. I can tell you from first-hand experience that the "Mediterranean Diet" is not what people think it is. Get any mass-market cookbook by Marcella Hazan, Julia Child, etc. and you'll see that Mediterranean food is chock full of white carbs, saturated fat, and cholesterol, more so than much American food. The difference is that people who live in the Mediterranean don't stuff their faces like starving pigs.
1 year ago
1 year ago Link To Comment
Earlier studies of the French observed lower rates of cardiovascular disease despite a high incidence of cigarette consumption, and a diet rich in cholesterol and saturated fats. One theory advanced attributed this paradox to their generous wine consumption. Me, I think it's due to their poor bathing habits.
1 year ago
1 year ago Link To Comment
The alleged research doctors have relied on for years has never been peer reviewed, and repeated - it is not backed up by science. The fat =heart attack, and high cholesterol = heart attack is being shown to be a myth.
Hell, the food pyramid is junk science. The Primal/Atkins type diets are really the way to go if you go with the provable data.
1 year ago
1 year ago Link To Comment
Cut back on the weed, man
1 year ago
1 year ago Link To Comment
Karloff - I still think you look like a more attractive John Kerry.
1 year ago
1 year ago Link To Comment
I think climate might have more of a role than diet.
1 year ago
1 year ago Link To Comment
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