If we didn’t quite believe that the Mediterranean diet was one of the best for heart health – not to mention a slew of other areas of health, and longevity – a new study offers even more evidence. People in Greece who adhered strongly to the diet had almost half the risk of developing heart disease in the next decade than people who didn’t stick to it as well. So why aren’t more people converting, given the amount of convincing research on it? Another study, also to be presented at the American College of Cardiology conference, suggests that many doctors don’t know exactly how to recommend it – for instance, they may not know a fatty fish from a non-fatty fish. That might be part of the problem, but it also might just be a symptom of the larger one.
Here’s a quick rundown of the studies. In the first one, the researchers had 2,500 Greek adults provide detailed information about their food intake and health over 10 years. They ranked the people according to how adherent they were to the Mediterranean diet, which includes high amounts of fresh fruits, vegetables, nuts, beans, fish, olive oil, and whole grains; modest amounts of alcohol (especially red wine); and low amounts of dairy, meat, and sweets. It turned out that those who were in the top third were 47% less likely to develop heart disease over the 10-year study period than participants in the bottom third. This was still true even when confounding variables like age, gender, family history, education, body mass index, smoking, blood pressure, diabetes, and high cholesterol were adjusted for.
"Because the Mediterranean diet is based on food groups that are quite common or easy to find," said study author Ekavi Georgousopoulou, "people around the world could easily adopt this dietary pattern and help protect themselves against heart disease with very little cost."
But they’re not. And the question is why, given the onslaught of research on its amazing health benefits. Part of the problem is that doctors may not know exactly how to recommend it, according to another small study. It surveyed 236 heart and internal medicine doctors, and found that although they agreed that nutrition is as important as drugs for heart disease, only 13% of them said they felt educated enough in nutrition to advise patients on it. They often knew that specific elements are good for the heart in theory – soluble fiber and omega-3 fatty acids – but weren’t so sure about how to make practical recommendations to patients. For instance, only 70% of the doctors surveyed knew what foods were high in soluble fiber, and 31% knew what kinds of fish are considered fatty, and therefore rich in heart- and brain-healthy omega-3 fatty acids.
“Nutrition has long been a neglected area in medical education, and while this may be improving, there is a long way to go,” says Dr. David L. Katz, founding director of the Yale University Prevention Research Center. This lack of nutritional education in med school may slowly be starting to change as research continues to show the critical importance of diet in health, and the lack of nutrition education in med school becomes more glaring.
But doctors are only part of the problem – psychology may be the bigger one. In parts of the world known as Blue Zones, like Okinawa and Sardinia, where long lives are the norm and disease rates are very low, healthy eating is just part of the culture, and not something extra you have to think about. So maybe it’s more a matter of cultural psychology than medicine.
“Ultimately, we need to acknowledge that in the places around the world where diets are the healthiest, such as the Blue Zones, it's not because doctors are giving good counseling – it's because good food is the prevailing norm," says Katz. "In other words, while clinics have a role to play in the delivery of good dietary advice as 'medicine,' the spoon that best gets good food to go down is culture, not clinics. If we want to improve diets and health in the U.S., doctors can be part of the solution – but they will certainly never be the whole solution.”
Cost may be another issue, since the Mediterranean diet (and other healthy diets, for that matter) seem more expensive, at least in the short-term. In the long-term, they tend to balance out. But by making simple substitutions were possible, there are ways to eat a Mediterranean style diet for about the same short-term cost as a Western diet.
A shift in the national psychology around food may be starting to happen a bit, as more people value natural and whole foods and reject processed foods. It’s fun to blame the medical community for our dietary problems, but maybe its shortcomings are just another symptom of the bigger issue – a reigning devotion, on our parts, to quickness over goodness. It's not much harder or more costly to grab an apple and a handful of nuts than it is a muffin; and if restaurants and coffee shops would consider this kind of trade-off, it might do a lot to help shift our eating patterns. The ongoing research on diets and nutrition is definitely helpful – but maybe we need to take matters into our own hands, and just eat better already.
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