The jury is in: the Mediterranean diet saves lives, and plenty of them. Just this week at a cardiology conference in Rome (where else?) another large study confirmed it.
So why is it that I so rarely prescribe the Mediterranean diet for my patients?
To answer that, we must examine the dietary advice of GPs in general and, unfortunately, of me in particular.
But first, let’s look at the new evidence from the Moli-sani study.
A group of 1197 Italians with a history of cardiovascular disease were followed for eight years, and their degree of adherence to a Mediterranean diet was assessed on a 9-point score. The all-cause mortality was 37% lower in those who followed the diet (score 6-9) compared to those who didn’t (score 0-3).
That 37% is huge, by the standards of most medication interventions. In comparison, taking a statin (cholesterol medication) reduces mortality by around 25%.
Ah, but association is not causation, you rightly insist! The study can’t show that the diet is the actual cause of the reduction in deaths. Yet in this case, it probably is.
The study showed that for every two-point increase in the diet score, mortality decreased by 21%. This ‘gradient’ effect is very consistent with causation. And previous randomised controlled trials—notably the PREDIMED trial—have found a 30% mortality reduction in a Mediterranean diet group compared to a low-fat diet control group.
So, if fish drizzled in olive oil and a mushroom salad washed down with a glass of vino prevents heart attacks, why am I not insisting all my patients follow it?
Part of the answer is that my dietary advice tends to be fairly general. I usually mention fruit, vegies and cereal, and turn a Mediterranean blind eye to their wine intake as long as it doesn’t exceed their doctor’s.
I also work in a community health service with ready access to a dietitian; or to put it another way, I’ve become lazy. I put my deskilling down to my dietitian’s fantastic knowledge and long appointments.
And of course, most patients don’t make radical food choices just because their doctor tells them. Many even ignore their dietitian.
It takes a celebrity chef, fancy marketing and a weird super-food to sell a diet, at least long enough to buy the book. Then, after the dieter has failed a couple of fad diets, somehow taking a preventative pill each day seems less trouble.
But this latest impressive evidence has convinced me to start naming this particular diet. I seem to spend half my consultations dishing out medication advice for reducing cardiovascular risk, so it seems a disservice not to push the Mediterranean diet just as hard.
I’ll point patients to the excellent Handbook of non-drug interventions (HANDI) and perhaps even google a few recipes.
Hmm…I’m still a bit tempted to get my dietitian to do all this for me.
Then I could get home in time for baked snapper, bean salad and my medicinal portion of shiraz.