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Best Of The Anti-Heart Attack Diet

February 3, 2011 Written by JP    [Font too small?]

Many conventional nutritionists and physicians pass along a standard piece of advice with regard to managing heart disease via diet: follow the guidelines set forth by the American Heart Association (AHA). After all, who better to offer guidance than an organization that specializes in matters relating to cardiovascular disease? My health tip of the day is to discuss different, and I think, more promising, dietary options with your health care team.

The eating model recommended by the AHA is basically a low-fat menu plan that is rich in fruits, grains and vegetables. It allows for some fat-free or low-fat dairy and one average sized serving of lean meat, poultry or seafood per day. This “no-fad diet” discourages the regular consumption of calorically dense foods including nuts, seeds and sweets. But new research presented in The American Journal of Clinical Nutrition suggests that a significantly different way of eating may be more effective in reducing the risk of heart complications in patients with pre-exisitng cardiovascular disease. (1)

The first of the two investigations examined the effects of a Mediterranean diet in 1,000 men and women who had already had a heart attack or suffered from severe angina (chest pain) upon physical exertion. Roughly half of the study volunteers experienced a myocardial infarction during the 2 year evaluation period. However, those consuming a Mediterranean style diet rich in dairy products, fish, fruits, legumes, nuts, olive oil, vegetables and whole grains exhibited a 12% lower risk of “recurrent cardiovascular disease events”. The men and women who adhered closest to this eating plan were also 40% less likely to report heart problems than those who ate diets with the least amount of Mediterranean elements. A specific analysis of the dietary components suggests that nuts, salad and vegetables were probably responsible for most of the benefits noted in this examination. (2,3)

A similar diet referred to as the “Southern European Atlantic Diet” (SEAD), a traditional Portuguese eating regimen, also appears to confer cardiovascular benefits. SEAD is rich in cod and other fish, dairy products, legumes, pork, red meat and wine. Researchers from the University of Porto Medical School in Portugal studied the diets of 820 heart attack survivors and 2,196 men and women who had never had a cardiovascular event. All of the participants resided in a region where the SEAD diet is commonly practiced. The results indicate that those who most closely followed the SEAD diet were 33% less likely to have a heart attack as compared to those who were least compliant with this style of eating. A deeper analysis revealed an almost 60% reduced risk in a sub-group who followed the SEAD diet, but included lesser amounts of pork, red meat and potatoes in their daily routine. (4,5)

Olives and Olive Oil May Confer Multiple Health Benefits
Source: Int J Mol Sci. 2010; 11(2): 458ā€“479. (link)

The secondary findings in both the Mediterranean and Portuguese studies are in line with a recent trial that found that eating a low carbohydrate, Mediterranean style diet can significantly lower multiple cardiovascular risk factors. In that research, Israeli scientists discovered that a carbohydrate-restricted version of the Mediterranean diet was more effective at promoting healthier blood sugar and lipid levels than the official diet advocated by the American Diabetic Association (ADA) and a traditional Mediterranean diet. It’s important to note that the ADA and AHA approved diets are very similar. Here are a few specifics of that study:

  • The low carbohydrate Mediterranean diet resulted in greater weight loss and lower long term blood sugar (HbA1c).
  • There was an increase in “good” (HDL) cholesterol and a larger reduction in triglycerides in the low carb Med diet as compared to the ADA diet. (6,7)

Here’s my personal take on diet and heart disease: I believe that a natural diet that emphasizes low-glycemic, whole foods and a good ratio of omega-3 fatty acids to omega-6 fatty acids is probably the most powerful approach to combating the progression of cardiovascular disease. Where I differ from the AHA is that I don’t believe that healthy fats and protein need to be generally shunned. The above referenced evidence illustrates the power of traditional diets. However, the final study goes one step beyond and suggests a way of possibly improving upon diets that are already health promoting. If you or someone you know is living with heart disease, I strongly recommend discussing this research with your health care team. Ask them if adopting a low-glycemic, Mediterranean or Portuguese style diet might be right for you.

Update: February 2011 – The latest news about Mediterranean-style eating continues to impress. A study appearing in the December 2010 issue of the journal Cardiology Research and Practice reports that long term adherence to a Mediterranean-style diet results in significant improvements in several risk factors for cardiovascular disease and diabetes in overweight men. The beneficial shifts included a decline in blood glucose and blood pressure, insulin, LDL cholesterol, oxidative stress and triglycerides. Higher HDL or “good” cholesterol was also noted in the men who took part in this particular trial that compared a “MED” diet to a “conventional” diet. What’s more, when caloric restriction and exercise were added to the mix, a rather pronounced weight loss of about 31 lbs. occurred over the 24 month period. At the same time, other researchers are documenting alternative pathways by which Mediterranean diets and their components may influence heart health for the better. A just published review in the journal Public Health describes the potential of select compounds (antioxidants and nutrients) found in Mediterranean foods in offsetting environmental threats caused by passive or secondhand smoke. In addition, relatively obscure phytochemicals in olives may likewise contribute important protective activity. The January 2011 issue of the European Journal of Nutrition reveals that naturally occurring chemicals in olives, alperujo, effectively combat inflammation and promotes healthier circulation via multiple mechanisms. All of this evidence points to a growing consensus that the traditional diet and lifestyle of the Mediterranean region has much to teach us in the 21st century. (8,9,10)

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!


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Posted in Food and Drink, Heart Health, Nutrition

10 Comments & Updates to “Best Of The Anti-Heart Attack Diet”

  1. Pradip Gharpure Says:

    Great post. Really the diet we take has a long term effect on our body in various respect. If we can succeed in controlling diet we can controll many diseases.

  2. anne h Says:

    I love – and am amazed – at how much detail and care you put into writing every article, JP!
    You are a wonderful writer…. so informative, too.

  3. JP Says:

    Many thanks, Anne! You’re too kind! šŸ™‚

    Be well!


  4. JP Says:

    Update: Higher intake of dietary calcium may lower cardiovascular and all-cause mortality risk in older adults …


    J Bone Miner Res. 2015 Mar 31.

    Higher Dietary Calcium Intakes are Associated With Reduced Risks of Fractures, Cardiovascular Events and Mortality: A Prospective Cohort Study of Older Men and Women.

    The aim of this population-based, prospective cohort study was to investigate long-term associations between dietary calcium intake and fractures, non-fatal cardiovascular disease (CVD), and death from all causes. Participants were from the Melbourne Collaborative Cohort Study which was established in 1990-1994. A total of 41,514 men and women (āˆ¼99% aged 40-69 years at baseline) were followed-up for a mean (SD) of 12 (1.5) years. Primary outcome measures were time to death from all causes (nā€‰=ā€‰2,855), CVD-related deaths (nā€‰=ā€‰557), cerebrovascular disease-related deaths (nā€‰=ā€‰139), incident non-fatal CVD (nā€‰=ā€‰1,827), incident stroke events (nā€‰=ā€‰537) and incident fractures (nā€‰=ā€‰788). 12,097 participants (aged ā‰„50 years) were eligible for fracture analysis and 34,468 for non-fatal CVD and mortality analyses. Mortality was ascertained by record linkage to registries. Fractures and CVD were ascertained from interview āˆ¼13 years after baseline. Quartiles of baseline energy-adjusted calcium intake from food were estimated using a food frequency questionnaire. Hazard ratios (HR) and odds ratios (OR) were calculated for quartiles of dietary calcium intake. Highest and lowest quartiles of energy-adjusted dietary calcium intakes represented unadjusted means (SD) of 1,348 (316) mg/d and 473 (91) mg/d, respectively. Overall there were 788 (10.3%) incident fractures, 1,827 (9.0%) incident CVD; and 2,855 people (8.6%) died. Comparing the highest with the lowest quartile of calcium intake, for all-cause mortality, the HR was 0.86 (95%CI; 0.76 to 0.98, Ptrend ā€‰=ā€‰0.01);for non-fatal CVD and stroke, the OR was 0.84 (95%CI; 0.70 to 0.99, Ptrend ā€‰=ā€‰0.04) and 0.69 (95%CI; 0.51 to 0.93, Ptrend ā€‰=ā€‰0.02), respectively, and the OR for fracture was 0.70 (95%CI; 0.54 to 0.92, Ptrend ā€‰=ā€‰0.004). In summary, for older men and women, calcium intakes of up to 1,348 (316) mg/d from food were associated with decreased risks for fracture, non-fatal CVD, stroke and all-cause mortality.

    Be well!


  5. JP Says:

    Update 05/18/15:


    Nutrition Research – May 13, 2015

    Paleolithic nutrition improves plasma lipid concentrations of hypercholesterolemic adults to a greater extent than traditional heart-healthy dietary recommendations

    Recent research suggests that traditional grain-based heart healthy diet recommendations, which replace dietary saturated fat with carbohydrate and reduce total fat intake, may result in unfavorable plasma lipid ratios, with reduced high-density lipoprotein (HDL) and an elevation of low-density lipoprotein (LDL) and triacylglycerols (TG). The current study tested the hypothesis that a grain-free Paleolithic diet would induce weight loss and improve plasma total cholesterol (TC), HDL, LDL and TG concentrations in non-diabetic adults with hyperlipidemia to a greater extent than a grain-based heart healthy diet, based on the recommendations of the American Heart Association. Twenty volunteers (10 male, 10 female) aged 40 to 62 years were selected based on diagnosis of hypercholesterolemia. Volunteers were not taking any cholesterol-lowering medications and adhered to a traditional heart healthy diet for four months, followed by a Paleolithic diet for four months. Regression analysis was used to determine whether change in body weight contributed to observed changes in plasma lipid concentrations. Differences in dietary intakes and plasma lipid measures were assessed using repeated measures ANOVA. Four months of Paleolithic nutrition significantly lowered (P < 0.001) mean TC, LDL, and TG and increased (P < 0.001) HDL, independent of changes in body weight, relative to both baseline and the traditional heart healthy diet. Paleolithic nutrition offers promising potential for nutritional management of hyperlipidemia in adults whose lipid profiles have not improved after following more traditional heart healthy dietary recommendations. Be well! JP

  6. JP Says:

    Update 05/19/15:


    Alzheimers Dement. 2015 Jun 15.

    Mediterranean-dietary approach to systolic hypertension diet intervention for neurodegenerative delay diet slows cognitive decline with aging.

    BACKGROUND: The Mediterranean and dash diets have been shown to slow cognitive decline; however, neither diet is specific to the nutrition literature on dementia prevention.

    METHODS: We devised the Mediterranean-dietary approach to systolic hypertension diet intervention for neurodegenerative delay (MIND) diet score that specifically captures dietary components shown to be neuroprotective and related it to change in cognition over an average 4.7 years among 960 participants of the Memory and Aging Project.

    RESULTS: In adjusted mixed models, the MIND score was positively associated with slower decline in global cognitive score (Ī² = 0.0092; P < .0001) and with each of five cognitive domains. The difference in decline rates for being in the top tertile of MIND diet scores versus the lowest was equivalent to being 7.5 years younger in age. CONCLUSIONS: The study findings suggest that the MIND diet substantially slows cognitive decline with age. Replication of these findings in a dietary intervention trial would be required to verify its relevance to brain health. Be well! JP

  7. JP Says:

    Updated 04/14/16:


    J Transl Med. 2016 Apr 12;14(1):91.

    Predictive role of the Mediterranean diet on mortality in individuals at low cardiovascular risk: a 12-year follow-up population-based cohort study.

    BACKGROUND: Adherence to the Mediterranean diet reduces the risk of all-cause and cardiovascular (CV) mortality and the incidence of CV events. However, most previous studies were performed in high-risk individuals. Our objective was to assess whether the adherence to the Mediterranean diet, evaluated by the MED score, was associated with all-cause and CV mortality and incidence of CV events in individuals at low CV risk from a population-based cohort, after a 12-year mean follow-up.

    METHODS: A cohort of 1658 individuals completed a validated food-frequency questionnaire in 2001-2003. The MED score was calculated by a 0-9 scale. Anthropometric, laboratory measurements, and the vital status were collected at baseline and during 2014. The baseline CV risk was estimated by the Framingham risk score. Participants were divided into two groups: individuals at low risk (CV < 10) and individuals with CV risk ā‰„10. RESULTS: During a 12-year mean follow-up, 220 deaths, 84 due to CV diseases, and 125 incident CV events occurred. The adherence to the Mediterranean diet was low in 768 (score 0-2), medium in 685 (score 4-5) and high in 205 (score >6) individuals. Values of BMI, waist circumference, fasting glucose and insulin significantly decreased from low to high diet adherence only in participants with CV risk ā‰„10. In a Cox-regression model, the hazard ratios (HRs) in low-risk individuals per unit of MED score were: HR = 0.83 (95 % CI 0.72-0.96) for all-cause mortality, HR = 0.75 (95 % CI 0.58-0.96) for CV mortality, and HR = 0.79 (95 % CI 0.65-0.97) for CV events, after multiple adjustments. In individuals with CV risk ā‰„10, the MED score predicted incident CV events (HR = 0.85; 95 % CI 0.72-0.99), while the associations with all-cause (HR = 1.02; 95 % CI 0.90-1.15) and CV mortality (0.94; 95 % CI 0.76-1.15) were not significant.

    CONCLUSIONS: Greater adherence to the Mediterranean diet was associated with reduced fatal and non fatal CV events, especially in individuals at low CV risk, thus suggesting the usefulness of promoting this nutritional pattern in particular in healthier individuals.

    Be well!


  8. JP Says:

    Updated 06/02/16:


    Am J Clin Nutr. 2016 May 25.

    Dietary epicatechin intake and 25-y risk of cardiovascular mortality: the Zutphen Elderly Study.

    BACKGROUND: Prospective cohort studies have shown that the consumption of cocoa and tea is associated with lower risk of cardiovascular diseases (CVDs), and cocoa and tea have been shown to improve CVD risk factors in randomized controlled trials. Cocoa and tea are major dietary sources of the flavan-3-ol epicatechin.

    OBJECTIVE: We investigated the associations of dietary epicatechin intake with 25-y CVD mortality in elderly Dutch men.

    DESIGN: We used data from the Zutphen Elderly Study, which was a prospective cohort study of 774 men aged 65-84 y in 1985. Epicatechin intake was estimated 4 times in 15 y with the use of the crosscheck dietary history method. Time-dependent Cox proportional hazards models were used to investigate repeated measures of epicatechin intake in relation to 25-y CVD mortality.

    RESULTS: Mean intake of epicatechin was 15.2 Ā± 7.7 mg/d, and the major dietary sources were tea (51%), apples (28%), and cocoa (7%). During 25 y of follow-up, 329 men died from CVD, 148 died from coronary heart disease (CHD), and 72 men died from stroke. Risk of CHD mortality was 38% lower in men in the top tertile of epicatechin intake than in men in the bottom tertile of epicatechin intake (HR: 0.62; 95% CI: 0.39, 0.98). Epicatechin intake was also significantly associated with 46% lower risk of CVD mortality in men with prevalent CVD (HR: 0.54; 95% CI: 0.31, 0.96) but not in men who were free of CVD.

    CONCLUSIONS: We show, for the first time to our knowledge, that epicatechin intake is inversely related to CHD mortality in elderly men and to CVD mortality in prevalent cases of CVD. More studies are needed before conclusions can be drawn.

    Be well!


  9. JP Says:

    Updated 10/24/18:


    Am J Clin Nutr. 2018 Oct 22.

    A Mediterranean diet supplemented with dairy foods improves markers of cardiovascular risk: results from the MedDairy randomized controlled trial.

    Background: The Mediterranean diet (MedDiet) offers benefits to cardiovascular health but may not meet Western recommendations for calcium and dairy intake, which could impede long-term adoption.

    Objective: The current study aimed to determine the effect of a MedDiet supplemented with dairy foods on cardiovascular risk factors.

    Design: A randomized, controlled, crossover design compared a MedDiet with 3-4 daily servings of dairy (MedDairy) and a low-fat (LF) control diet. Forty-one participants aged ā‰„45 y and at risk of cardiovascular disease (CVD) were randomly allocated to their first intervention, either the MedDairy or LF diet. Participants followed each intervention for 8 wk, and an 8-wk washout period separated interventions. The primary outcome was home-measured systolic blood pressure (SBP) assessed in the morning, afternoon, and evening. Secondary outcomes included clinic-measured blood pressure (morning), body composition, blood lipids, C-reactive protein (CRP), plasma glucose, serum insulin, and the Framingham Risk Score.

    Results: Compared with the LF intervention, the MedDairy intervention resulted in a significantly lower morning SBP (mean difference: -1.6 mm Hg; 95% CI: -2.8, -0.4 mm Hg; P = 0.01), lower morning diastolic blood pressure (mean difference: -1.0; 95% CI: -1.7, -0.2 mm Hg; P = 0.01) and clinic SBP (mean difference: -3.5 mm Hg; 95% CI: -6.4, -0.7 mm Hg; P = 0.02), significantly higher HDL cholesterol (mean difference: 0.04 mmol/L; 95% CI: 0.01, 0.06 mmol/L; P < 0.01), lower triglycerides (mean difference: = -0.05 mmol/L; 95% CI: -0.08, -0.01 mmol/L; P < 0.01), and lower ratio of total to HDL cholesterol (mean difference: -0.4; 95% CI: -0.6, -0.2; P < 0.001). No effects were observed for other outcome measures. Conclusions: Following a MedDiet with additional dairy foods led to significant changes in markers of cardiovascular risk over 8 wk. The MedDiet supplemented with dairy may be appropriate for an improvement in cardiovascular risk factors in a population at risk of CVD. Be well! JP

  10. JP Says:

    Updated 02/08/19:


    Evid Based Complement Alternat Med. 2019 Jan 6;2019:2069701.

    Natural Killer Response and Lipo-Metabolic Profile in Adults with Low HDL-Cholesterol and Mild Hypercholesterolemia: Beneficial Effects of Artichoke Leaf Extract Supplementation.

    The aim of the present study is to evaluate the effects of 60-day artichoke leaf extract (ALE) supplementation (250mg, twice daily) on cytokines levels, natural killer cell (NK) response, and lipo-metabolic profile (HDL, LDL, and total-cholesterol, triglycerides (TG), ApoB, ApoA, lipid accumulation product (LAP), glucose, insulin, and homeostasis model assessment of insulin resistance (HOMA-IR)) in twenty adults (9/11 males/females, age=49.10 Ā± 13.74 years, and BMI=33.12 Ā± 5.14 kg/m2) with low HDL-C and mild hypercholesterolemia. Hierarchical generalized linear model, adjusted for sex, BMI, and age, has been used to evaluate pre-post treatment changes. A significant increase for HDL-C (Ī²=0.14, p=0.0008) and MCP-1 (Ī²=144.77, p=0.004) and a significant decrease for ApoB/ApoA (Ī²=-0.07, p=0.03), total-C/HDL-C ratio (Ī²=-0.58, p<0.001), and NK response at stimulus low (Ī²=0.43, p=0.04), medium (Ī²=0.40, p<0.001), and high (Ī²=0.42, p=0.001) have been found. These results support the benefits of ALE supplementation on metabolic profile.

    Be well!


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