How Certain Diet Styles Work to Lower Heart Disease Risk

DEAR DR. ROACH: Which diet styles in particular are associated with a lower risk of heart disease? Many people get confused about what a healthy diet actually consists of. Is a Mediterranean diet easier than an extreme low-fat diet? -- D.H.H.

ANSWER: There are several styles of diet that have been proven to be healthier than a typical North American diet. Two of the best that have been studied are the ones you mentioned -- the extreme low-fat diet and the Mediterranean-style diet -- but there are many others that show benefit and a few that show harm.

In a landmark study published by Dr. Dean Ornish in 1998, intensive lifestyle changes reduced the amount of heart disease (measured by blockages in the heart arteries) more than those in the control group without medication. This remarkable result required a diet that was mostly vegetarian (egg whites and only 1 cup of milk a day) and no more than 10% fat (the average American diet is 30% to 35% fat).

In addition to dietary changes, participants performed aerobic exercise (3 hours per week), stress management (1 hour per day) and group psychosocial support (4 hours twice a week), and they also had a 100% smoking cessation rate. It is unclear how much of the benefit in reversing heart blockages is due to diet and how much is due to other beneficial behavior changes, or whether they all worked together (which seems likely to me).

The Mediterranean diet, when studied, also reduced risk of heart disease, with a roughly 30% relative-risk reduction in heart attack, stroke or death due to heart disease. This diet is characterized by:

-- An abundant use of olive oil

-- High consumption of plant foods (fruits, vegetables, legumes, cereals, nuts and seeds)

-- Frequent but moderate intake of wine (especially red wine) with meals

-- Moderate consumption of fish, seafood, fermented dairy products (yogurt and cheese), poultry and eggs

-- Low consumption of red and processed meat as well as sweets

There isn’t a doubt that the Mediterranean diet is much easier for most to comply with. The two diets haven’t been compared, so I can’t say which is better, but I more commonly recommend the Mediterranean diet. However, I do not recommend drinking wine for any kind of health benefit. Exercise, stress management and psychosocial support would be likely to improve outcomes with any kind of favorable dietary change.

The DASH diet -- a lower-salt diet with 4 to 5 servings of fruit, 4 to 5 servings of vegetables and 2 to 3 servings of low-fat dairy per day, with less than 25% of daily caloric intake from fat -- has been shown to reduce blood pressure. Moreover, in people with high or normal blood pressure, this diet lowers risk of colorectal cancer, cardiovascular disease and premature mortality. It’s also easy to maintain.

Many people ask me about ketogenic (“keto”) diets, which typically involve large amounts of meat and, consequently, a high proportion of protein and fat. Although these types of diets can cause short-term weight loss, a recent study showed these diets unfortunately increased cholesterol levels and more than doubled the risk of adverse cardiovascular outcomes (heart attack and death).

So, I recommend against following this type of diet and remind readers that weight loss does not necessarily translate into better health. As the above studies have shown, a person of any weight can better their health by having a more plant-based diet, getting regular exercise, managing their stress and receiving psychosocial support. The changes you make do not need to be extreme in order for you to receive better health.

*** Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

© 2023 North America Synd., Inc. All Rights Reserved

Moments In Time

The History Channel

* On June 29, 1613, the Globe Theatre, where most of Shakespeare’s plays debuted, burns down. The Globe was built by Shakespeare’s acting company, the Lord Chamberlain’s Men, in 1599 from the timbers of London’s very first permanent theater, Burbage’s Theater, built in 1576.

* On June 30, 1936, Margaret Mitchell’s “Gone with the Wind,” one of the bestselling novels of all time and the basis for a blockbuster 1939 movie, is published. Scarlett’s name was originally Pansy, but a change was requested by the publisher.

* On July 3, 1989, Martha Ann Johnson is arrested in Georgia for the 1982 murder of her oldest child after an Atlanta newspaper initiated a new investigation into the suspicious death. Her three other children had also mysteriously died. Johnson’s case sparked a trend in which authorities look closely into the sudden deaths of young children.

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Walmart wonderfulness

Thank you so very much to the wonderful man (and his wife!) who chased me down in the Walmart parking lot to tell me I had left my wallet at the checkout counter. I had $1 in that wallet. I also had 10 IDs/store cards, 3 credit cards, 1 $50 gift card, 2 bank cards, and 4 blank checks. (Mostly) all eventually replaceable. Most important to me is an irreplaceable photo of my husband’s grandparents that I am going to have enlarged, which would have been a loss without measure. When the lady at the service desk handed me my wallet (she already had it under lock and key), she said “Have a blessed day!” I told her I just did!

Thank you for following the rules of the road

I’d like to thank those drivers on the roads that use their turn signals, come to complete stops at stop signs, and all the other rules that are not always followed. As a mom who is teaching her teenager to drive and to follow all the laws, it’s nice to see other drivers reinforcing what should be done. By doing things properly we can all help to keep the roads safe for drivers young and old!

Doctors giving disability placards too easily

It is a big problem and it is abused terribly, with disability placards that people truly don't need and people running to the doctors to get their pets signed off as emotional support animal when their pet is not allowed in an apartment building. This is so abused. Why do the doctors just sign off so easily to someone who walks in and wants their pet certified when they don't have a psychological diagnosis or aren't a combat vet? Sure, people just want to take their pet to an apartment building that has a no pet policy. And I know for a fact this is done frequently along with people who truly don't need a disability placard for their car. Doctors need to examine this extensively before just passing out anything to everyone. It's very unfair to people who truly need it. I have seen people struggling with canes because they cannot get a handicap parking spot because of people who abuse it. These doctors need to be held responsible/accountable. Shame on you; you know you are faking.

No license required?

Did I miss something? When did it become legal for off-road recreational vehicles to be ON the road with registered, licensed, insured, and inspected vehicles? Did I also miss a drop in age requirement for drivers on the road? Apparently kids as young as 12-14 are able to drive their UTV's and side by side along the highway at any time of the day. Is it legal for me to buy one of these, slap a "slow moving vehicle" sign on the back and drive it to work? I'm in!! Think of the thousands I'll save in fees!

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Avoid Financial Peril After A Job Loss

Assess your budget carefully.You naturally will have to make concessions that impact finances, particularly as it pertains to spending. Cut back on non-necessities like dining out, gym memberships, streaming subscriptions, and other luxuries. Avoid adding other new debt.