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The personal blog of Peter Attia, M.D.A low-carbohydrate diet is associated with favorable changes in cardiovascular disease risk factors at 2 years. Dieting is the practice of eating food in a regulated and supervised fashion to decrease, maintain, or increase body weight. Is it the MUFA or polyphenols or other? So, my only minor critique of this is the semantics of calling this a primary prevention trial. Hello Hellen, it depends on different factors like your daily calories goal. Some studies find fault with high-salt, high-sugar deli meats and then attempt to paint fresh red meat with the same faults. March 23, at
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Download Free Cookbook With Weekly Mediterranean Diet Meal PlanLike Muslims, they refrain from all drinking and eating unless they are children or are physically unable to fast. Endovascular presence of viable Chlamydia pneumoniae is a common phenomenon in coronary artery disease - Journal of the American College of Cardiology - The truth can be found in the forward section of Dr. Tekturna is a kidney renin blocker that can be taken in the morning at least 30 minutes before breakfast. Homocysteine can also interfere with the normal blood clotting mechanism and can increase the risk of clots that can cause a stroke or heart attack. Glycated hemoglobin is one of the causes for coronary artery disease. Fibrinogen - A therogenic - A protein molecule that promotes clotting and thickens the blood. Homocysteine is known to damage blood vessels by injuring the 2 day diet plan for someone with coronary heart disease cells that line arteries and by stimulating the growth of smooth muscle cells. High triglycerides are a prime indicator of heart disease risk. His blood sugar would surge when he ate his normal high-carbohydrate meals but plunge later giving the hexrt symptoms of someone who is pre-diabetic. Dxy we go back to the other endpoints, let me comment quickly on the hazard ratio for this endpoint. The standard medical procedure for the treadmill heart stress test is to stress the heart to the point of damage that is confirmed by the instruments. From Wikipedia, the free encyclopedia. The mechanism of these variable reactions could not be explained by demographic, psychological, laboratory, or physiological measures.
The study received a considerable amount of attention, including an article in the NY Times. The objective of this study, as its name suggests, was to study the impact of a Mediterranean Diet on the primary prevention of CVD. Primary prevention of X implies looking at patients ideally those susceptible to X who have not yet had X to see if your intervention prevents X.
Such trials are more difficult i. A primary prevention trial for CVD would study subjects who have never had a heart attack or stroke, and look for which treatment e. A secondary prevention trial would study subjects who have already suffered some MACE and look at interventions to prevent a recurrence.
This study, a primary prevention trial, enrolled about 7, patients who were at high risk for CVD, but who had not suffered any MACE, and randomized them to one of three diets — two variants of a Mediterranean Diet, and a low fat diet.
Table 1 shows the dietary targets. The two variants of the Mediterranean Diet were i one that emphasized extra virgin olive oil EVOO and ii another that emphasized nuts. As an aside, my 40 th birthday is coming up soon and my wife suggested to my daughter that they make me a cake for my birthday. Suffice it to say, if I were in this study, I would have done really well on the nuts arm, though I think I eat closer to 5 or 6x the amount they were recommended per day. As you can see all three arms were discouraged from consuming bakery goods, sweets, pastries, red meat, processed meats, and spread fats.
Table 2, below, shows you the baseline characteristics of the subjects in each arm. I must admit, before I saw the results of trial, but knew it was going on, I was a bit surprised at how audacious the investigators were. Primary prevention trials are really challenging!
Why do I say that? You get the point. Virtually everyone enrolled in this study had metabolic syndrome. This is not a criticism of the study, to be clear. In fact, this is exactly what the authors sought in the enrollment.
They specifically looked for high risk patients who had not yet suffered a MACE. In my humble opinion, this was a very good choice for two reasons:. So, my only minor critique of this is the semantics of calling this a primary prevention trial. It would be more accurate to call it a primary prevention trial of patients with diagnosed metabolic syndrome.
The authors of this particular study you can read about this in the methods section did a good job avoiding this. This brings me to macro point 2. For example, this might look like the following 3 arms: Mediterranean diet pick one of the 2 from this study. The other two groups would have a sizable intervention effect, while this true control arm would be left on their own.
The final point I want to make is more of a so-called teaching point. Broadly speaking, there are two and an emerging third types of studies in human nutrition:. So, at best, we are really looking at the difference between two dietary interventions. Table 3 shows the outcome of the study and commensurate hazard ratios. Consider the first row, the primary end point recall: The first row shows the number of crude events. Of course, to see this in an apples-to-apples fashion the number needs to be normalized to a common denominator, in this case events per 1, person-years.
Note, one uses person-years to also normalize for and remove any impact of time in study. So, even though the first is listed as 8. So, the authors do it for us in the last two columns. The right-most column compares the control low-fat to the Med Diet nuts , while the column to the left of that compares the control group to the Med Diet EVOO.
The smaller the better, and generally a number below 0. Before we go back to the other endpoints, let me comment quickly on the hazard ratio for this endpoint. A hazard ratio is essentially the probability of an event in the treatment group divided by the probability the same event occurs in the control group hence, control groups have a hazard ratio of 1. So, the hazard ratio of 0. For the sake of time and space, I will not go into the details of unadjusted and multivariate adjusted analyses.
As you can see from Table 3, there was no statistically significant difference in death CVD or otherwise or MI across the three groups. Remember that pesky little statistical thing called power. Figure 1, below, shows the Kaplan-Meier estimates for the primary end point A and total mortality B. Each figure shows both the full y-axis which always varies from 0 to 1 and, in the upper right corner, a zoomed view to show the difference.
The fact that the zoom view is necessary tells you something about the absolute risk reduction. This is called the number needed to treat NNT.
Well, it depends on the intervention. Obviously, we could not justify treating people to save 1, if 3. For perspective, most drugs fall into this second category e. While this approach is not used in the United States perhaps it should be , it is certainly the cornerstone of other healthcare systems, such as the NHS in the United Kingdom.
So, what to make of the modest ARR in this study? Well, question 1 should be: Question 2 should be: The former is objective but has not been quantified to my knowledge. The latter is subjective, and each person needs to answer it for themselves. Overall, I think this is a good study, and a better study than the study prompting it, the famous Lyon Heart Study. That said, I would have much preferred to see only one Mediterranean arm in retrospect this is obvious, of course, given the lack of difference between them , in favor of a true control or another arm such as Very Low Carb.
Remember, I think the Low Fat arm in this study experienced an enormous benefit over their baseline. His practice focuses on longevity and healthspan.
His clinical interests are nutrition, lipidology, endocrinology, and a few other cool things. Thanks for this overview. Any thoughts on this? This is where the full biomarker panel would have been helpful.
Look at the supplement, S5 table, at 5 years and note the reported composition of diets. The only difference between the arms: Think about the sweets made in Sicily, which are mostly done without sugar but with honey and nuts — this is the typical Arabic cousins, which you also find in parts of Spain, and reflect Arabic domination on those regions.
Or pasta, which is massively produced only after the 50s — Italian cultural food goes back much, much more and includes lots of typical cheeses, salamis and so on. Or in North Italy polenta is used instead. When we try to classify traditions we should be looking very closely at the history and not use common places.
It may be that this arm is something not too far from the SSD Standard Spanish Diet , especially since all of us, Spaniards included, have been bombarded with anti-fat dietary advice for years now anyway. Peter, glad to see you back. From my perspective his diet is so drab, boring and unappealing that no one other than a zealot could follow it for very long. I wish they had left one group eating their standard diet, and like you said have a HFLC arm. Dave, I never went anywhere! They only found a significant reduction in death from stroke Table 3.
They only found a reduction in cardiovascular causes when these were pooled with deaths from stroke Table 3. At the age of 61 I had a surgical intervention angioplasty with 2 stents inserted. I began the Ornish diet immediately after. About 4 years later I had an angiogram necessitated by the bias between 2 different scanners which showed that in fact my arteries had improved. I have maintained this improvement since, as confirmed by an angiogram 1 year ago. So I eat a Mediterranean diet, which includes pasta made from real durum wheat, and which in most respects reflects the Ornish diet.
I was not as impressed as you with this study. Buried in the supplementary appendix is a table showing what the members of the three arms actually ate, as well as the biomarkers gathered. So how much fat did the MeDiet group eat at the start of the study? And the low-fat group? Or reducing your carb intake from What really stood out was that the three arms were eating almost identical quantities of everything.
The only notable difference was that the nut group was getting more of the fats that one gets from eating a lot of nuts. Even the fatty acids that come from olive oil were nearly identical across the three groups. The best you can say about it was that the MeDiet had three arms, and no control. The low-fat group increased its olive oil consumption from I wonder, though, what accounted for the separation?
Both arms were advised not to eat too much fat, the diet was designed by fat-phobic dieticians, not from shipping off the Med wing to Tuscany or Athens. It may have been something else, also.