Dr. Antoni Chan discusses abstract 2125 with Dr. Marta Sala-Climent at the 2023 ACR Convergence meeting in San Diego, CA.
Mediterranean diet
The Mediterranean diet reduces the risk of having another heart attack
Maimonides Biomedical Research Institute of Cordoba (IMIBIC)
Heart disease is the main cause of death in developed countries. There is evidence that shows that factors related to lifestyle, such as diet, have an influence on developing these kinds of diseases. But, do they have any effect on patients who are already ill?
A team from the University of Córdoba, Queen Sofia University Hospital and the Maimonides Biomedical Research Institute of Cordoba (IMIBIC) has published a study in PLOS Medicine. This study compares the effects of two different healthy diets on the endotheliem, the walls that cover the arteries. 1002 patients who had previously had an acute myocardial infarction took part in the study and were monitored over the course of a year.
The research group had previously worked on a similar study with healthy patients, however, this is the first time it has been done with ill patients, who are more likely to have other heart attacks. “The degree of endothelial damage predicts the occurrence of future cardiovascular events, as in acute myocardial infarctions. If we can take action at the inital stages, prompting endothelium regeneration and better endothelial function, we can help to prevent heart attacks and heart disease from reoccurring”, explains José López Miranda, researcher on the study and coordinator of the “Nutritional Genomics and Metabolic Syndrome” research group at the Maimonides Biomedical Research Institute of Cordoba, made up of researchers belonging to the Internal Medicine Clinical Management Unit at Queen Sofia University Hospital, to the University of Córdoba (UCO) and to CIBERobn, the Online Biomedical Research Centre for Obesity and Nutrition.
During the study, half of the patients were told to follow a Mediterranean diet, based on using plenty of virgin olive oil, eating fruit and vegetables every day, and having three servings of legumes, three of fish and three of nuts a week. In addition, they were told to cut down on eating meat, especially red meat, and to avoid additional fats such as margarine and butter as well as food that is high in sugar.
In contrast, the other group was told to follow a low-fat diet, based on limiting all kinds of fat, both animal and plant, and increasing their intake of complex carbohydrates. They were told to cut down on red meat, to choose low-fat dairy products, to avoid eating nuts and to reduce their intake of sweets and pastries.
In the first place, the vasodilation capacity that the patients’ arteries had was analyzed, which is very important in order to adapt to different circumstances, like exercise or stressful situations. Secondly, the degree of permanent endothelium damage was assessed. Lastly, the reparation ability of the arteries by means of endothelial progenitor cells, or stem cells, was measured.
“We observed that the Mediterranean diet model induced better endothelial function, meaning that the arteries were more flexible in adapting to different situations in which greater blood flow is required. Besides, the endothelium’s ability to regenerate was better and we detected a drastic reduction in damage to the endothelium, even in patients at severe risk”, explains José López Miranda.
Though the Mediterranean diet, rich in monounsaturated fatty acids, had already been proven to be a good strategy in order to improve endothelial function in overweight patients as well as patients with high cholesterol, this is the first time that the benefits of following a Mediterranean diet have been shown among patients with heart disease, helping them to reduce the likelihood of having another heart attack.
Eating a Mediterranean diet ‘may lower your risk of depression’
Mediterranean diet
“Eating a Mediterranean diet may help prevent depression, research suggests,” BBC News reports.
The headline was prompted by a new review of previously conducted studies into the impact of diet on depression. A main finding of the review was that there seemed to be a strong association between eating a Mediterranean-style diet and a reduced risk of developing symptoms of depression or being diagnosed with clinical depression.
There are no strict criteria as to what constitutes a Mediterranean diet, but it normally refers to a diet that includes plenty of vegetables, fruit, pulses and olive oil, but little red or processed meat. Such a diet has long been recognised as being good for heart health, so it could also be the case that what is “good for the body is also good for the mind”.
But there are limitations to the review that mean we can’t be sure diet actually protects against depression.
People may be less likely to prepare and eat healthy meals when they are feeling depressed, so the study could just show that people prone to depression have less healthy diets. Also, people who eat healthy diets tend to have generally healthier lifestyles, including taking more exercise, which is thought to protect against depression. While some of the studies included in this review took account of this, others did not.
Although we should be cautious about the study findings, they represent another potential reason to adopt a Mediterranean diet. We already know the diet is good for our hearts – adopting a healthy diet and lifestyle may well be good for our mood, too.
Read more advice about how to make your diet more Mediterranean.
Where did the story come from?
The researchers who carried out the study are an international team from University College London in the UK, the University of Montpellier in France, Deakin University in Australia and the University of Las Palmas de Gran Canaria, Spain.
The research was funded by the Medical Research Council, Nordforsk and the Academy of Finland. It was published in the peer-reviewedjournal Molecular Psychiatry.
The study was widely reported in the UK media. Most reports were fairly uncritical, with headlines such as The Daily Telegraph’s “Mediterranean diet cuts depression risk by reducing inflammation, major new study finds.” The suggestion that inflammation increases depression risk is reported as fact when the association between inflammation and depression is a fairly recent hypothesis, described by one expert in metabolic medicine as “highly tenuous”.
The Guardian also suggested that “Eating junk food raises risk of depression”. But the review did not look at the impact of unhealthy foods on mental health.
BBC News provided a good, balanced overview of the study, which included an analysis of other factors that might have influenced the results.
What kind of research was this?
This was a systematic review and meta-analysis that pooled the findings of observational studies that had looked at links between diet and depression.
Systematic reviews are a good way of assessing the evidence on a topic. While observational studies can show links between factors, they cannot show that one (such as diet) directly causes another (such as depression).
What did the research involve?
Researchers looked for studies that assessed people’s diet, and also their mental health. In most cases people filled out food frequency questionnaires, which provide information about their recent diet.
The questionnaires were assessed against a variety of “healthy eating” measures, including how closely they resembled:
the Mediterranean diet
a healthy diet based on the Healthy Eating Index (HEI)
a diet aimed at reducing high blood pressure
an anti-inflammatory diet
Most of the studies assessed people’s depression by asking about depression symptoms, although a few studies defined depression as clinical depression diagnosed by a doctor.
A total of 41 studies were identified, 20 were longitudinal studies, which assess diet and then follow people up to see if they get depression symptoms over a period of years.
The other 21 were cross sectional studies, which assess people’s diet and whether they had depression symptoms at one point in time.
The researchers presented the results of these types of studies separately. Cross-sectional studies are more likely to be inaccurate.
Because of this, we have only reported the longitudinal results here.
Longitudinal studies that exclude people with depression at the start should provide more reliable results, though there is still the potential that other confounding factors may be influencing the results.
Most but not all of the studies adjusted figures to take account of the following factors:
age
sex
smoking
physical activity and body mass index (BMI)
total energy intake from diet
socioeconomic factors
What were the basic results?
The Mediterranean diet had the strongest link to a protective effect against depression symptoms, although there were also signs that people eating a healthy diet based on the healthy eating index or an anti-inflammatory diet were less likely to get depression.
Each result compares the people who stuck closest to the diet in question with those whose diet least resembled the diet in question.
Mediterranean diet
Based on 4 studies including 36,556 people, those who ate a diet closest to the Mediterranean diet were 33% less likely to get depression symptoms (odds ratio (OR) 0.67, 95% confidence interval (CI) 0.55 to 0.82).
Anti-inflammatory diet
Based on 5 studies including 32,908 people, those who stuck closest to an anti-inflammatory diet were 24% less likely to get depression symptoms (OR 0.76, 95% CI 0.63 to 0.92).
Healthy eating
Based on 3 studies including 45,533 people, there was suggestion that those who stuck closest to a Healthy Eating Index diet may be less likely to get depression symptoms. But this result fell just short of statistical significance so may have come about by chance (OR 0.76, 95% CI 0.57 to 1.02).
Diet to reduce high blood pressure
Studies looking at the diet aimed at reducing high blood pressure had conflicting results and did not show an overall effect.
How did the researchers interpret the results?
The researchers said their “exhaustive overview” of the evidence showed a “robust association between both higher adherence to a Mediterranean diet and lower adherence to a pro-inflammatory diet, and a lower risk of depression.”
Conclusion
Depression is a complex condition, with many and varied causes or influencing factors. These may include hereditary, health-related, personal and social factors. It is often difficult to pin down an exact cause.
While any insight into diet or lifestyle factors that might improve mental wellbeing and help reduce the numbers of people affected by the condition is welcome, it’s important to recognise the limitations of this research.
These include:
the poor quality of some of the studies included, especially cross-sectional studies that cannot show the direction of cause and effect
use of depression symptoms rather than clinically diagnosed depression as an outcome in most of the studies
potential inaccuracy of the food frequency questionnaires, which rely on people remembering what they’ve eaten, sometimes over previous weeks, months or even a year
potential influence of other confounding factors – even studies that accounted for things like exercise and socioeconomic factors may not have been able to fully remove their influence
Having a healthy lifestyle, which includes not smoking, plenty of physical activity and drinking alcohol only in moderation, is linked to a reduction in depression. But that doesn’t mean people get depressed because they have a less healthy lifestyle. It’s very hard to stick to a healthy lifestyle if you are struggling with symptoms of depression. It can be hard to shop, prepare and eat healthy meals while depressed, similarly you may feel less motivated to socialise and take exercise.
Clearly, it’s a good thing to eat a healthy diet, whether that’s for your physical or mental health. But it’s also important not to make people with depression feel that it’s their own fault for not eating more vegetables.
Read more advice about what you can do to help relieve feelings of low mood and depression.
What are superfoods? This is eye opening
Superfoods
What are superfoods?
We examine the evidence behind the health claims of 10 of the most popular so-called superfoods.
So-called, because there is no official definition of a “superfood” and the EU has banned health claims on packaging unless supported by scientific evidence.
But that hasn’t stopped many food brands from funding academics to research the health benefits of their product.
The superfood trend exploits the fact that healthy lifestyle choices, including diet, can reduce our risk of chronic diseases like heart disease, stroke and cancer.
The food industry wants to persuade us that eating some foods can slow down the ageing process, lift depression, boost our physical ability, and even our intelligence.
Many of us want to believe that eating a single fruit or vegetable containing a certain antioxidant will zap a diseased cell.
The problem is that most research on superfoods tests chemicals and extracts in concentrations not found in the food in its natural state.
Garlic, for example, contains a nutrient alleged to help reduce cholesterol and blood pressure. But you’d have to eat up to 28 cloves a day to match the doses used in the lab – something no researcher has yet been brave enough to try.
Foods that have been elevated to superfood status in recent years include those rich in antioxidants (such as beta-carotene, vitamins A, C, E, flavanoids and selenium) and omega-3 fatty acids.
Antioxidants are chemicals thought to protect against the harmful effects of free radicals, which are chemicals naturally produced in every living cell and known to cause cell damage.
However, evidence about this and other health benefits of antioxidants is inconclusive. In a review of the scientific evidence in 2011 (PDF, 188kb), the European Food Safety Authority (EFSA) found no evidence that the antioxidant action on free radicals observed in the lab was of any benefit to human health.
On the other hand, some research suggests that certain antioxidant supplements may be harmful (PDF, 2.72Mb).
While the concept of a “miracle food” remains a fantasy, it’s pretty well-established that obesity and alcohol are the two most common causes of major long-term illness and increased risk of premature death.
Importance of a balanced diet
Diet plays an important role in our health, but there is concern that too much focus on individual foods may encourage unhealthy eating.
“No food, including those labelled ‘superfoods’, can compensate for unhealthy eating,” explains Alison Hornby, a dietitian and spokesperson for the British Dietetic Association (BDA).
“If people mistakenly believe they can ‘undo’ the damage caused by unhealthy foods by eating a superfood, they may continue making routine choices that are unhealthy and increase their risk of long-term illness.”
Dietitians avoid the term “superfood” and prefer to talk of “super diets”, where the emphasis is on a healthy, balanced diet, rich in fruit and vegetables and wholegrain foods.
There is good evidence that the Mediterranean diet can reduce the risk of some chronic diseases and increase life expectancy.
This diet includes plenty of fruit and vegetables, olive oil and legumes, and less meat and dairy foods than the typical Western diet.
Hornby says: “When it comes to keeping healthy, it’s best not to concentrate on any one food in the hope it will work miracles.
“All unprocessed food from the major food groups could be considered ‘super’. All these foods are useful as part of a balanced diet.
“You should eat a variety of foods, as described by the eatwell plate, to ensure you get enough of the nutrients your body needs. Focusing on getting your five portions of fruit and vegetables a day is a perfect way to start.”
We’ve teamed up with the BDA to look at the best available research to see if the health claims of 10 popular “superfoods” add up. Click on the foods listed below to see the evidence: