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Australian Journal of Pharmacy : March 2005
t ary medicine six months.10 MUFA intake resulted in sig- nificantly reduced resting blood pressure compared to the PUFA diet but, most impressively, daily drug dosage was sig- nificantly reduced with the MUFA diet (–48 per cent versus –4 per cent, P<.005). Overall, the Mediterranean diet improves both traditional and non-tradi- tional cardiovascular risk factors. Several different mechanisms are involved in pro- viding protective cardiovascular benefits which cannot be attributed to one specific food as a synergistic effect seems to occur between various dietary components.11 More specifically, fish and n-3 fatty acids reduce triglyceride levels, incidence of car- diac arrhythmias and improve endothelial function,12 Foods Fish Olives, olive oil Nuts Vegetables Fruit Garlic Red wine Red meat Dairy products Change required Increase intake or consider fish oil supplements Increase intake Increase intake, especially walnuts Increase intake especially, dark green leafy types and coloured vegetables Increase intake of fresh fruit in season Increase intake Moderate amounts taken with meals (one glass daily) Decrease consumption Decrease consumption (especially trans fatty acids) Processed foods Decrease consumption (especially high glycaemic index foods) Longevity phytochemicals in fruit, veg- etables and red wine reduce inflammation and oxidation, and mono-unsaturated fats in olive oil affect the clotting process, blood pressure and possibly oxidation of LDL cholesterol. The reduced intake of trans- fatty acids (mainly from dairy products and red meat) and high glycaemic index foods (chiefly processed foods) further decrease risk of increased inflammation and raised lipoprotein (a). Cancer This is mostly accounted for by the lower incidence of large bowel, breast, endometrium, and prostate cancers which are forms of cancer associated with dietary factors, particularly low consump- tion of vegetables and fruit and, to a cer- tain extent, high consumption of meat. One review calculated that up to 25 per cent of the incidence of colorectal cancer, about 15 per cent of breast cancer, and about 10 per cent of prostate, pancreas, and endometrial cancer, could be pre- vented if the populations of Western countries could shift to the Mediterranean diet.15 The incidence of cancer overall in Mediterranean countries is lower than in Scandinavian countries, the UK and the US.13,14 These figures are just estimates, but data from observational studies is now considered strong enough to suggest that the traditional Mediterranean diet should be actively promoted to reduce the inci- dence of cancer.16 In 2002, Panagiotakos et al found that adherence to a Mediterranean diet and healthy lifestyle (non-smoking, physically active, moderate drinking) is associated with a greater than 50 per cent lower rate of all causes and cause-specific mortality, such as from coronary heart disease, CVDs, and cancer.17 The cohort study involved 1,507 apparently healthy men and 832 women, aged 70 to 90 years, in 11 European countries and was con- ducted from 1988 until 2000. A year later, Trichopoulou et al also reported a positive association between longevity and the Mediterranean diet.18 This study showed the benefits are signif- icant in people aged 55 years and older. More recently, a 2004 review of five cohort studies further confirmed these findings and concluded that there is now sufficient evidence to show that diet does indeed influence longevity and the opti- mal diet for the prevention of both coro- nary heart disease and cancer is likely to extensively overlap with the traditional Mediterranean diet.19 Although it is uncertain which specific components in the Mediterranean diet are most impor- tant for its protective health benefits, olive oil, fish, plant foods and moderate wine consumption are likely candidates. Whose Mediterranean diet and what is it? The Mediterranean diet studied in these trials is based on the traditional diet of Greece. Extensive studies indicate that this consists of a higher intake of fruits, vegetables, nuts, unrefined cereals (mostly sourdough bread), olives and olive oil, less milk and more low fat cheese and yoghurt, more fish, less meat and moder- ate amounts of wine compared to diets in other Mediterranean countries.20 Overall, the beneficial Mediterranean diet is low in saturated and high in monounsaturated fat (oleic acid, 18:1 omega-9), mainly from olive oil; high in complex carbohydrates, from legumes; and high in fibre, mostly from vegetables and fruits. Total fat may be high (>40 per cent of total energy intake), but the mono- unsaturated-to-saturated fat ratio is around two. The high content of vegeta- bles, fresh fruits, cereals, and olive oil guarantees a high intake of beta-carotene, vitamins B6, B12, C, and E, polyphenols, and various minerals. In particular, this should become standard practice when coun- selling any patient taking medication for known CVD risk factors, such as lipid low- ering or antihypertensive drugs. Based on the reviewed literature, the common ben- eficial components of these diets are listed above. The protective effect of this traditional diet against atherosclerosis, hypertension, platelet aggregation, the systemic inflam- matory response, cardiac arrhythmias, endothelial function and cancer should prompt pharmacists to advise all patients to increase their intake of Mediterranean foods.21–23 References available on request THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 MARCH 2005 ? 191