Mediterranean or Low-fat Vegan Diet: Which Is Better for Prevention of Heart Disease and Stroke?

By Carole Bartolotto, MA, RD

Recently, a randomized control trial was published looking at the effects of mediterranean diet picturesthe Mediterranean diet on the primary prevention of heart disease. In other words, does the Mediterranean diet prevent heart disease in people that never had it?

A total of 7,447 men and women were enrolled; none with heart disease, but all were at high risk for it. They were randomized into three groups.

  • A control group, which was advised to reduce dietary fat.
  • An experimental group, which was instructed on the Mediterranean diet with the addition of olive oil
  • Another experimental group, which was instructed on the Mediterranean diet with added nuts (walnuts or hazelnuts).

The investigators found that the Mediterranean diet lowered the risk of major cardiovascular events, in particular stroke. This trial adds even more evidence to the pile of research in support of the Mediterranean diet.

But…there has also been some criticism of this research, primarily from the low-fat vegan crowd. Dr. Ornish wrote an article on this research in the Huffington Post.

He says, and rightly so, that “The comparison (control) group did not follow a low-fat diet. As the authors wrote, “We acknowledge that, even though participants in the control group received advice to reduce fat intake, changes in total fat were small.” This is not surprising, since they gave the control group virtually no support at all in following this diet during the first half of the study.”

He also says that “The authors should have concluded that the Mediterranean diet reduced cardiovascular risk when compared to whatever diet they were eating before, not when compared to a low-fat diet, since patients in the control group (“low-fat diet”) were not consuming a low-fat diet.”

So who’s right?

The great news is that both diets are linked with lower rates of heart disease. That’s not surprising considering that both have some key components in common including lots of plant based foods such as fruits, vegetables, whole grains, beans, peas, lentils, not much or no red meat, and minimal processed foods.

Both diets impact traditional risk factors for heart disease such as high blood cholesterol or blood pressure. But even more compelling, both diets positively impact the novel risk factors highlighted in the graphic below such as inflammation, arrhythmic risk (irregular and deadly heart beats), endothelial dysfunction (unstable plaque), and thrombosis (clot formation).

risk factors

There are a few differences between the diets. Mediterranean diet followers consume higher amounts of DHA and EPA, also known as omega-3 fats, which are linked with lower rates of heart disease. These fats decrease the risk of clots and stabilize the heart beat. But the low-fat vegan diet has been found to actually reverse heart disease. And people who consume this diet have less stiffness of the arteries, which is what causes high blood pressure as we get older. This is practically unheard of in folks consuming meat.

So we have reason to celebrate! We have two viable options for people to consume that will help lower the risk of heart disease. I am hoping you are doing what you can to eat more veggies and less meat.

Eaitng veggies

Copyright © 2013 Carole Bartolotto, MA, RD. All rights reserved.

The Truth About Cholesterol Lowering Drugs: Is Diet a Better Option?

Cholesterol lowering drugs—also known as statins—are one of the most commonly prescribed medications in the world. Almost one quarter of Americans 45 years and older are on a statin drug. You probably know many people who are on a statin or perhaps you are taking one yourself.

It makes a lot of sense to lower your cholesterol since heart disease is still the leading cause of death in the United States. However there are a lot of concerns about whether taking statin drugs is worth the risk.

Studies have found that statins do not decrease mortality rates in healthy people who do not have heart disease. A recent analysis of 11 studies, which included 65,229 healthy but high-risk men and women, found that taking statins did not decrease the risk of dying. A 2011 Cochrane review found similar results.

In addition, when a healthy person takes a statin, the risk of a heart attack or stroke drops from 3 or 4 percent to 2 percent—not very impressive!

The downside to taking statins is they can cause muscle pain, kidney and liver damage, and fatigue. They have also been linked with memory loss and 1 out of 200 people on statins will develop diabetes. In women, the diabetes risk may even be higher. The Women’s Health Initiative found a 48 percent adjusted increased risk of diabetes for women who were taking statins.

Recent animal research has found that rats given these drugs could not run as far as non-medicated rats. The levels of oxidative stress (a marker for possible cell damage) increased by 226% in exercising rats. And the rats had less stored carbohydrate in their muscle (glycogen). Also, the mitochondria—the mechanism in the cell that produces energy—were not working as well or correctly. This probably explains the fatigue that can come with taking statins. Ironically, these drugs make it harder to exercise for the very people who need it the most!

Let’s take a look at the research around diet. There are many published studies but I am only going to mention two. The “Lifestyle Heart Trial” found that a low-fat vegetarian diet, exercise, and other lifestyle changes, lowered cholesterol as much as statin drugs. And the study proved that diet and lifestyle changes could actually reverse heart disease.

The second study compared two diets. One diet was vegetarian, low in fat, and included fiber from bread. This group also took a statin. The other group ate a low-fat vegetarian diet which included a “dietary portfolio of cholesterol-lowering foods” such as beans, lentils, oats, psyllium, almonds, and other veggies and fruit high in water-soluble fiber. The group that ate the “portfolio of foods” lowered their cholesterol as much the group taking statin drugs.

When you consider the potential side effects, and that you can get the same decrease in cholesterol by changing your diet and lifestyle, I can’t help but wonder why anyone without a history of heart disease would take these drugs. You would get more benefit from eating a healthy diet and exercising. Not only will these lifestyle changes lower your cholesterol, they will also help you lose weight, lower your blood pressure, decrease inflammation, make the plaque in your arteries more stable, slow or halt the progression of atherosclerosis (blocked arteries), lower your risk of cancer and improve your mood. Need I say more?

If you are on a statin, and you have never had a heart attack, stent, or bypass surgery, I would seriously consider changing your diet instead of taking this drug. If your doctor recommends that you take a statin, talk with him or her about holding off so you can try making significant changes to your diet for a month or two and then retest your cholesterol.

Physicians Rita Redberg, MD and Mitchell Katz, MD sum it up nicely by saying: “Advising healthy patients to take a drug that does not offer the possibility to feel better or live longer and has significant adverse effects with potential decrement in quality of life is not in their interest.”

Disclaimer: Talk with your health care provider for advice regarding your particular situation.

Copyright © 2012 Carole Bartolotto, MA, RD. All rights reserved.