PREDIMED (PREvención con DIeta MEDiterránea)

[pjoshea13]

The following paragraph is from Dr. Myers Prostatepedia blog (11/30/17) [A]:

"In the famous PREDIMED trial, 7,447 subjects who were at high risk for cardiovascular disease but who did not have it were randomized into three groups. One group went on a low fat diet. The other two groups went on a Mediterranean diet: one with olive oil and one with nuts. The trial was supposed to run for 6 years, but stopped at 4.8 years because the two Mediterranean diet groups already showed such a significant reduction in myocardial infarction, stroke, and cardiovascular death." [B]

Why consider a heart-healthy diet? Because men with PCa have increased risk of CVD, even if not on ADT. [C]

The PREDIMED study is actually a Spanish study, so, since Spaniards as a whole are presumed to already be eating a Med-type diet, one would not expect PREDIMED to be much influenced by the foods of Italy, Greece, or any of the other countries around the Mediterranean. The three arms of PREDIMED are therefore (probably) basically Spanish with (i) an olive oil target, (ii) a nuts target, & (iii) a low fat target.

PubMed returns 251 hits for <predimed>, so I searched on <predimed[title]>, which narrowed it down to 118 papers. In the first page returned, all 20 papers were from 2017, so I expect more papers to come from the PreDiMed people.

The following are papers of greatest interest IMO - oldest first, using the PubMed sequence #.

A note in one of the papers (not cited) stated that the main source of polyphenols in the diet was coffee & fruit, but that the Spanish diet was higher in olives & olive oil than other Mediterranean countries.

[116] (2008)

"A total of 1224 participants were recruited from the PREDIMED Study, a multicenter, 3-arm, randomized clinical trial to determine the efficacy of the MedDiet on the primary prevention of cardiovascular disease. Participants were older subjects at high risk for cardiovascular disease. Interventions were quarterly education about the MedDiet plus provision of either 1 (liter/week} of virgin olive oil (MedDiet + VOO) or 30 {grams/day} of mixed nuts (MedDiet + nuts), and advice on a low-fat diet (control diet). All diets were ad libitum, and there was no increase in physical activity for any of the interventions."

"At baseline, 61.4% of participants met criteria for the MetS {metabolic syndrome}. One-year prevalence was reduced by 6.7%, 13.7%, and 2.0% in the MedDiet + VOO, MedDiet + nuts, and control diet groups, respectively"

Med+nuts storms into the lead.

[113] (2009)

"To assess the association between the intake of dietary fibre and carotid intima-media thickness (IMT) in a Mediterranean population at high cardiovascular risk."

{Note: "The carotid intima-media thickness test (CIMT) is a measure used to diagnose the extent of carotid atherosclerotic vascular disease. The test measures the thickness of the inner two layers of the carotid artery - the intima and media - and alerts physicians to any thickening when patients are still asymptomatic." [113a]}

"... energy-adjusted fibre intake showed a significant inverse correlation with IMT"

"In multivariate analyses, a modest, though statistically significant ... inverse association between energy-adjusted fibre intake and IMT was also found."

[111] (2010)

"Since atherosclerosis is nowadays considered a low-grade inflammatory disease, recent studies have explored the anti-inflammatory effects of a Med-Diet intervention on serum and cellular biomarkers related to atherosclerosis."

"Compared to a low-fat diet, the Med-Diet produced favourable changes in all risk factors. Thus, participants in both Med-Diet groups reduced blood pressure, improved lipid profile and diminished insulin resistance compared to those allocated a low-fat diet. In addition, the Med-Diet supplemented with virgin olive oil or nuts showed an anti-inflammatory effect reducing serum C-reactive protein, IL-6 and endothelial and monocytary adhesion molecules and chemokines, whereas these parameters increased after the low-fat diet intervention."

[110] (2011)

"After a median follow-up of 4.0 years, diabetes incidence was 10.1% .., 11.0% .., and 17.9% ... in the MedDiet with olive oil group, the MedDiet with nuts group, and the control group, respectively."

[99] (2013)

"Compared to participants consuming <1 serving/wk of nuts, those consuming >3 servings/wk had lower adjusted odds ratios (OR) for obesity (0.61 ...) MetS (0.74 ...) and diabetes (0.87 ...)".

"Nut consumption was inversely associated with the prevalence of general obesity, central obesity, MetS, and diabetes in subjects at high cardiovascular risk."

[93] (2013)

"An intervention with MedDiets enhanced with either EVOO or nuts appears to improve cognition compared with a low-fat diet"

[90] (2013)

"During a median follow-up of 4.8 years, 323 total deaths, 81 cardiovascular deaths and 130 cancer deaths occurred. Nut consumption was associated with a significantly reduced risk of all-cause mortality ... Compared to non-consumers, subjects consuming nuts>3 servings/week (32% of the cohort) had a 39% lower mortality risk"

[75] (2014)

"Among 6705 participants without prevalent atrial fibrillation at randomization, we observed 72 new cases of atrial fibrillation in the Mediterranean diet with extravirgin olive oil group, 82 in the Mediterranean diet with mixed nuts group, and 92 in the control group after median follow-up of 4.7 years."

[68] (2014)

"During follow-up, 277 cardiovascular events and 323 deaths occurred. Participants in the highest energy-adjusted tertile of baseline total olive oil and extra-virgin olive oil consumption had 35% ... and 39% ... cardiovascular disease risk reduction, respectively, compared to the reference. Higher baseline total olive oil consumption was associated with 48% ...reduced risk of cardiovascular mortality. For each 10 g/d increase in extra-virgin olive oil consumption, cardiovascular disease and mortality risk decreased by 10% and 7%, respectively."

[65] (201?)

"Dietary intervention with MeDiet supplemented with EVOO or nuts lowers dietary {Glycemic Load } and {Glycemic Index}."

[35] (2017)

"Participants in the highest tertile of changes in urinary TPE {total urinary polyphenol excretion} showed significantly lower plasma levels of inflammatory biomarkers [vascular cell adhesion molecule 1 .., intercellular adhesion molecule 1 .., interleukin 6 .., tumour necrosis factor alpha ... and monocyte chemotactic protein 1 ...] than those in the lowest tertile ...

"In addition, systolic and diastolic blood pressure (BP) decreased and plasma high-density lipoprotein cholesterol increased in parallel with increasing urinary TPE ..."

"Increases in polyphenol intake measured as urinary TPE are associated with decreased inflammatory biomarkers, suggesting a dose-dependent anti-inflammatory effect of polyphenols. In addition, high polyphenol intake improves cardiovascular risk factors- mainly BP and the lipid profile."

[32] (2016)

"Because of the high density of fat, high-fat diets are perceived as likely to lead to increased bodyweight, hence health-care providers are reluctant to recommend them to overweight or obese individuals."

"A long-term intervention with an unrestricted-calorie, high-vegetable-fat Mediterranean diet was associated with decreases in bodyweight and less gain in central adiposity compared with a control diet. These results lend support to advice not restricting intake of healthy fats for bodyweight maintenance."

[17] (2017)

"Higher consumption of extra-virgin olive oil is associated with a lower risk of osteoporosis-related fractures in middle-aged and elderly Mediterranean population at high cardiovascular risk."

-Patrick

[116] ncbi.nlm.nih.gov/pubmed/190...

[113] ncbi.nlm.nih.gov/pubmed/195...

[113a] cedars-sinai.edu/Patients/P...

[111] ncbi.nlm.nih.gov/pubmed/205...

[110] ncbi.nlm.nih.gov/pubmed/209...

[99] ncbi.nlm.nih.gov/pubmed/234...

[93] ncbi.nlm.nih.gov/pubmed/236...

[90] ncbi.nlm.nih.gov/pubmed/238...

[75] ncbi.nlm.nih.gov/pubmed/247...

[68] ncbi.nlm.nih.gov/pubmed/248...

[65] ncbi.nlm.nih.gov/pubmed/252...

[35] ncbi.nlm.nih.gov/pubmed/271...

[32] ncbi.nlm.nih.gov/pubmed/272...

[17] ncbi.nlm.nih.gov/pubmed/281...

[A] prostatepedia.blog/2017/11/...

[B] nejm.org/doi/full/10.1056/N...

[C] ncbi.nlm.nih.gov/pubmed/205...

[chascri]

Thanks Patrick excellent summary. We’ve been cooking with olive oil for several years now and I try to have a handful of mixed nuts daily as a snack.

[pjoshea13]

Thanks! -Patrick

[cesanon]

Myers specifically told me to avoid walnuts for some reason.

And never said anything about cashews or pecans.

[pjoshea13 in reply to cesanon]

Re: walnuts - perhaps because of the ALA (alpha linolenic acid)?

-Patrick

[cesanon in reply to pjoshea13]

I think maybe he did mention that.

What are your opinions on that?

[pjoshea13 in reply to cesanon]

It's the main fatty acid in flax seed. Prudent to stay clear of it. Too many negative studies & no positive ones.

Would the odd walnut make a difference? I doubt it.

-Patrick

[cesanon in reply to pjoshea13]

Oh yeah. I remember that he had issues with flax seed as well.

[cesanon]

Myers is a recently retired Oncologist who is held in fairly high regard by most Oncologists in the Prostate cancer field.

See generally:

prostatepedia.net/blogs/ask...

Certainly no one has a monopoly on truth. But a fair number of us believe that he often, in the past, has found the truth earlier than his colleagues at places of high repute such as National Cancer Institute.

For some time it has seemed that he has basically been front running the major medical centers on prostate cancer treatment protocols by about 5 years. Protocols he was first pioneering five years prior, they seem to adopt five years later.

I was once told by Dr. Mark A. Moyad (of PCRI fame), that until Myers himself was diagnosed with prostate cancer it appeared that his career was on a trajectory for him to become the head of the National Institutes of Health.

So personally, I am actually more trusting of his judgments and intuition on the early interpretation of research than that of committees, such as the quasi governmental committee that discourages PSA testing and even those of the august National Cancer Institute (which I also believe continues to discourage PSA testing).