I don't intend to do a series on diets, so why this post on the Mediterranean diet?
I had started on a "fats" post & realized that I needed to deal with the common preconception that fats are inherently bad for health. In my post on sugar, I suggested that one cannot have control over glucose, insulin & triglycerides if one eats a high-carbohydrate / low-fat diet. With adequate fat, glucose levels rise only modestly, and the risk for the metabolic syndrome is much reduced.
My reason for tackling the Mediterranean diet is that it is a 40% fat diet. It can be somewhat lower, but it is a world away from the Dean Ornish 10% fat diet. If fats in general are unhealthy, this would be the diet to demonstrate that.
Dr. Charles Myers recommends the Mediterranean diet for men with PCa. Myers is ultra-cautious when recommending supplements. With well over a hundred lycopene studies, he has yet to see one that he likes. As an ex-researcher, he has high standards as to study design. So it's a surprise that he would single out the Mediterranean diet when there is no evidence (by his standards) that it might benefit a man with PCa.
But Myers has complained that new PCa patients are at increased risk for death from cardiovascular disease. The Mediterranean diet has been shown to be useful in CVD & Myers has said that his main concern has been to prevent patient deaths from CVD.
But what effect does the diet have on PCa?
In video [1] "Low Fat Diets Are Deadly", Myers talks about the Mediterranean diet, with special mention of the Predimed study [3]. He notes that PCa patients on a low fat diet do not do well.
Video [2] seems to have been prompted by a backlash response to [1]. Both are worth watching.
WHO Table [4] lists countries in PCa mortality rate sequence (click on "Mortality"). Placing the cursor on a colored bar will expose the rate for 100,000 males. [The rates have been age-standardized.]
Map [5] shows countries with a Mediterranean coastline.
The lowest five rates in [4] are for Med countries:
- Albania - 13.4
- Malta - 13.6
- Italy - 14.1
- Bosnia - 15.1
- Spain - 15.2
That alone might convince many men to try the Med diet.
Croatia, on the other hand has double the Albania rate - 26.0. Montenegro is 22.1, while Bosnia, sandwiched between the two, is only 15.1.
Looking at the Nordic countries, high up on the list, one might get the idea that latitude (vitamin D exposure potential) is more important than diet. Would a Med diet really protect men in Malmö?
Looking at only the Med countries (see map), I wouldn't care to define exactly what The Mediterranean Diet is or isn't.
Walter Willett (Harvard School of Public Health) has firm views on the subject [6]:
"This Mediterranean diet pyramid is based on food patterns typical of Crete, much of the rest of Greece, and southern Italy in the early 1960s, where adult life expectancy was among the highest in the world and rates of coronary heart disease, certain cancers, and other diet-related chronic diseases were among the lowest. Work in the field or kitchen resulted in a lifestyle that included regular physical activity and was associated with low rates of obesity. The diet is characterized by abundant plant foods (fruit, vegetables, breads, other forms of cereals, potatoes, beans, nuts, and seeds), fresh fruit as the typical daily dessert, olive oil as the principal source of fat, dairy products (principally cheese and yogurt), and fish and poultry consumed in low to moderate amounts, zero to four eggs consumed weekly, red meat consumed in low amounts, and wine consumed in low to moderate amounts, normally with meals." His version is 25-35% fat.
I'm not surprised that Willet mentions Crete. He was & remains an Ancel Keys disciple. After WWII when Keys was collecting data for his "Seven Countries Study", Crete stood out. Crete had emerged from the war in a very poor state, following a brutal occupation by German forces, & struggled to recover. After the study was published, a Cretan complained that the traditional diet was much more varied & richer than Keys had recorded. The relatively brief period of dietary austerity could not explain longevity statistics.
Dr. Myers' emphasis on olive oil implies that the type of fat is important, but Malta - 2nd lowest PCa mortality rate, at 13.6 - uses very little olive oil. Northern Italy uses olive oil for salad dressing, but favors lard & butter for cooking.
!n 2008, among the 19 countries of the European Union, Malta was top of the list for obesity. Something of an anomaly for a country second from the bottom in PCa mortality. [7]
In contrast, ~50% French men were overweight (40%) or obese (10%), compared to ~70% Maltese men who were overweight (45%) or obese (25%). France actually does well in terms of PCa mortality (17.7) & heart disease, but I don't know how far north the Mediterranean influence is felt. There is, of course, the "French Paradox" [8]:
"The French paradox is a catchphrase, first used in the late 1980s, that summarizes the apparently paradoxical epidemiological observation that French people have a relatively low incidence of coronary heart disease (CHD), while having a diet relatively rich in saturated fats, in apparent contradiction to the widely held belief that the high consumption of such fats is a risk factor for CHD."
It might be easier for Americants to accept a high fat Mediterranean diet centered on olive oil, than a French diet with triple-crème bries washed down with bottles of red wine.
With the Med diet, as defined by Willett, one imagines it as being historically a common diet of poor people. The experience in China, is that affluence increases PCa risk. It takes discipline to eat frugally. The French experience is something else. An affluent society that has relatively low obesity, heart disease & PCa mortality. A society that has not demonized fat.
Fat types & PCa will be discussed in a future post.
-Patrick
[1] askdrmyers.wordpress.com/20...
[2] askdrmyers.wordpress.com/20...
[3] nejm.org/doi/full/10.1056/N...
[4] eco.iarc.fr/eucan/CancerOne...
[5] worldatlas.com/aatlas/infop...
[6] ajcn.nutrition.org/content/...
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