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Evidence points to Mediterranean diet benefits

Over the past few years, a lot of attention has been paid to the health benefits of a variety of diets. Some seem to contradict others, and many people are confused about which advice makes sense for them. Low fat, no fat, good fat, bad fat.

It's difficult to determine how to change our diets to benefit our health without sacrificing foods we can enjoy with our families. The Lyon Heart Study is one of two recent studies that highlight the benefits of a Mediterranean-style diet for those at risk for heart disease.

Omega-3 fatty acids: the good fat
This study and another presented at the American College of Cardiology, the GISSI Prevention Trial, corroborate other evidence underscoring the benefits of omega-3 fatty acids. In the Lyon study, individuals who ate a diet high in these fatty acids, which are found in canola, olive and fish oils, were 50 to 70 percent less likely to suffer a repeat heart attack. In the GISSI Prevention Trial, participants who took a gram of fish oil per day reduced their risk of a second heart attack by 10 to 15 percent and reduced their risk of dying during the four-year follow-up period by 20 percent.

We don't yet understand the biochemical basis for this benefit, but it is interesting to note that even though Italians have higher cholesterol levels than Americans, they have a lower risk of dying from heart disease. One possible explanation for this discordance is that ingestion of omega-3 fatty acids provide anti-arrhythmic benefits. Somehow this substance reduces the incidence of sudden death from disruptions in the heart's rhythm.

Contributing factors
Of course, there are additional differences in the typical Italian diet. Many Italians drink moderate amounts of red wine, which provide both antioxidant and anticlotting properties. A substance in the skins of red and possibly purple grapes may reduce the risk of arterial clogging by keeping LDL (bad) cholesterol from attaching to coronary arteries. Most Italians also consume higher percentages of grains, fruits and vegetables as well. And we can't rule out stress: most Italians take four to five weeks of vacation each year compared to the typical American two-week break.

My recommendations
I consider the fish oil evidence convincing enough to recommend eating fish three times a week to my patients. For patients who have already had a heart attack, I suggest an additional gram of fish oil by tablet each day. I also suggest what I call "high-color" vegetables: red, green and yellow peppers, broccoli and tomatoes for their antioxidant properties and red wine in moderation, about two ounces a day.

To avoid weight gain from consuming high-fat fish such as salmon, sardines, tuna, bluefish or swordfish, which are also high in calories, I strongly recommend moderate exercise. Twenty to 30 minutes a day of exercise, vigorous enough to result in a light sweat, will not only counteract consuming a few more hundred calories, it also has enormous overall health benefits.

Dr. Mukherjee is a partner with Cardiology Associates of New Haven, 40 Temple Street, New Haven, CT. He is an attending physician at Yale-New Haven Hospital and an assistant clinical professor of medicine and cardiology at the Yale School of Medicine.