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Australian Journal of Pharmacy : March 2005
complement complementary medicine Lesley Braun, BPharm, DipAppSci, Phytotherapy, independent technical consultant to Mayne Consumer Products and final year lecturer, Melbourne College of Natural Medicine The Mediterranean diet— getting back to basics SCHAEMIC heart disease, cancer and stroke are the three leading causes of death in Australian society today. It is well accepted that much illness and pre- mature death from cardiovascular dis- ease (CVD) is preventable and, as such, prevention has become a keen focus of public attention and health policy. The leading risk factors attributed to I CVD are recognised as tobacco smoking, physical inactivity, obesity, a lack of fruit and vegetables, abnormal lipids and high blood pressure. The same first four risk factors are considered risk factors for the development of cancer. Much time, effort, money and exper- tise has been allocated to providing new and improved drugs to manage, treat and even cure these diseases or screening tools and programs to detect them in the early stages. Although dietary influences are well recognised, there seems to be insufficient emphasis placed on this as the natural adjunct to medical preven- tion and treatment. It may be that a gen- eral recommendation to increase fruit and vegetables in the diet just doesn’t work and a more specific recommenda- tion is required. Recent research suggests that few diets or drugs can produce the impressive results associated with the Mediterranean diet and maybe it is the ultimate preven- tive medicine. The Mediterranean diet came to the attention of the medical community in the late 1950s, when it was found that the inhabitants of Greece and Southern Italy had a very low incidence of coronary artery disease. Since then, numerous stud- ies have shown that those who consume the traditional Mediterranean diet are at decreased risk of developing heart disease, various cancers and degenerative dis- eases. Epidemiological studies also show they live longer. The impressive reduc- tions in morbidity and mortality are sig- nificant and deserve greater attention. Heart disease In 1999, the Lyon Diet Heart Study was published; it was widely claimed to be a landmark study investigating whether a Mediterranean-type diet could reduce the rate of myocardial infarction.1 It was a randomised secondary prevention trial which used a Mediterranean-type diet (with butter and cream replaced by a mar- garine based on rapeseed/canola oil and rich in a-linolenic acid). At a mean follow- up of 27 months, there was a 73 per cent decrease in combined end points of car- diac death and non-fatal myocardial infarction with a 70 per cent decrease in cardiac death in the group eating the Mediterranean style diet. Benefits were maintained for nearly four years after fol- low-up, which translates to 12 lives saved per 300 people in 27 months. Interest- ingly, these impressive results were obtained without lowering blood pres- sure, LDL cholesterol and triglycerides, or raising HDL cholesterol. Several years later, data from the CAR- DIO2000 multi-centre study was used to investigate the association between acute coronary syndromes (ACS) and a Mediter- ranean-style diet. Once again its was shown that the Mediterranean diet reduced the risk of developing ACS, regardless of the presence of other risk fac- tors such as hyperlipidemia, diabetes mel- litus or a sedentary lifestyle.2 In this instance, primary prevention benefits were observed. The results from these studies suggest that: the Mediterranean diet has both pri- mary and secondary prevention effects; significant prevention benefits are possi- ble without reducing cholesterol levels; and the type of fat eaten may be more important than the amount of fat eaten. 190 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 MARCH 2005 Fish and n-3 fatty acids are obviously key contributing factors. The Gruppo Ital- iano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI-Prevenzione) trial is the largest trial so far to have investigated the protective effects of n-3 fatty acids on car- diovascular disease. General dietary advice toward a Mediterranean-style diet was given to 11,323 coronary heart disease patients together with either low-dose sup- plemental n-3 fatty acids or synthetic vita- min E, both or placebo.4 According to this study, diet combined with low-dose fish oil supplements significantly reduced the cumulative rate of all-cause death, non- fatal MI, and non-fatal stroke. Put another way, the group of subjects who most closely followed the dietary advice had a 49 per cent reduction in the odds of sub- sequent death. Olives and olive oil also provide impor- tant protective fats in the diet. Olive oil is known for its high levels of mono-unsatu- rated fatty acids and is also a source of phytochemicals such as polyphenolic compounds (which have antioxidant properties), flavonoids, squalene, beta carotene, and alpha-tocopherol.5 Oleic acid, the main constituent in olive oil, modifies the vascular response to pro- atherogenic chemicals (such as high levels of cholesterol and the advanced glycation end-products of diabetes) and inhibits endothelial adhesion molecule expression according to test tube studies.6 Other studies have identified the Mediterranean diet in general, and olive oil in particular, as being capable of sig- nificantly reducing arterial blood pres- sure.7–10 One randomised, double-blind, cross- over study investigated this further by comparing the effects of mono-unsatu- rated (MUFA) (extra-virgin olive oil) and poly-unsaturated fatty acids (PUFA) (sun- flower oil) in 23 hypertensive patients over