Give Me Mediterranean Food or Give Me Death!

On Tuesday I flew on a business trip from Germany to Boston. As with all these long flights you can never have enough to do to keep yourself occupied when sleep eludes, so on the way into the plane I grabbed the International Herald Tribune (which announced this week it will be henceforth be known as the International New York Times), it being the only paper plane side where every word didn’t start and end with “furter”.

I was captivated right away by the top front page story called “Diet Brings Clear Benefits for the Heart, Study Finds,” which details a recently completed scientifically validated study that demonstrates that the so-called Mediterranean diet is not only delicious, but may reduce heart attacks, strokes and deaths from heart disease by as much as 30%.  Viva Italia! is what I have to say to that. (here is a link to the companion story at the NY Times site).

The Mediterranean diet is basically what they eat–wait for it–in the areas around the Mediterranean Sea, and includes such staples as olive oil (4 tablespoons per day believe it or not), certain nuts (walnuts, almonds, hazelnuts; sadly not ballpark peanuts), three servings per day of fruit, two servings per day of vegetables, three servings of fish per week and no red meat, and, best of all, at least seven glasses of red wine per week (AA program not included).  There is no word on whether the olive oil can be consumed in the form of olives that you pluck from your martini and squish between your teeth to get the oil out.  This is an obvious limitation of the study.

Participants in the Mediterranean diet arm were also asked to avoid commercially processed sweets and limit dairy consumption.  Cows everywhere are thrilled at their prospects, as they are the primary source for several of the banned foods.  Perhaps this is the reason that the terminal-to-terminal tram at the Zurich airport, where I had my layover, issues a resounding “MOO!” when it teaches each stop–an homage to cow liberation.  I will add, parenthetically, that the article about the study was placed exactly next to one about the European Union horsemeat scandal, where Mr. Ed was mysteriously labeled as beef and sold thought Europe, probably even in the Mediterranean.  Fortunately study participants would be avoiding beef and thus would have dodged this bullet instead of coughing up the Ikea packaged meatballs featured in the article.  Ikea sells meatballs?  Do you have to assemble them at home with Swedish instructions?  Too bad that the loose part they accidentally leave out isn’t the horsemeat.  Hi Ho Silver, Away!  But I digress.

It is worth noting that the Mediterranean study diet was conducted with serious rigor and thus was published by the New England Journal of Medicine, normally not known for its recipes.  The study was randomized and had three arms comprised of over 7000 people, far larger than most randomized clinical trials and more definitive than the results of those typically conducted in the medical industry.  One of the study groups was directed to eat a low-fat diet, which turned out to mean eat whatever they normally eat (“Can I have fries with that?”) since no one could stick to such a diet even with training and coaching.  Importantly, all of the people in the study already had serious risk indicators for heart disease, such as known hypertension, high cholesterol, Type II diabetes, obesity and/or smoking habits. 30 % of the people in the study that should have had near death or actual death experiences did not over the five year follow up period, a result deemed so profound that they stopped the study for ethical reasons (hopefully to free study monitors to immediately begin pumping olive oil into the drinking water of the low-fat diet arm).

Virtually all of the study participants were already taking Lipitor, Lisinopril, Metformin or similar drugs for high cholesterol, hypertension or diabetes/pre-diabetes. It is interesting to note that the 30% reduction in heart attacks and strokes was in addition to whatever benefit these people already got from taking those drugs, assuming they were compliant with their drug regimens, which is atypical.  I bet the study participants were far more compliant with their seven glasses of wine requirement, although they apparently did have greater trouble walking a straight line when asked to do so by a police officer.  “Honestly officer, I was only drinking for science.  Want an olive? Hiccup!”

The obvious conclusion to draw from this is that doctors need to give more advice about nutrition so they can give less advice about pharmaceuticals.  Furthermore, we must start in childhood to teach children how to eat properly.  Note that exercise wasn’t even a part of this study, so if we teach kids to live a life of healthy eating and exercise the next generation is likely to have a very different level of heart health than our own, which lists heart disease, hypertension and diabetes as three of the four top killers (cancer being the other).  It is also believed by many scientists that healthy diets guard against many cancers, so we can hit a Grand Slam home run on the healthcare front through better nutrition without filing one single health care claim.  Put that in your actuarial pipe and smoke it.  Actually don’t–smoking is really bad for you.

A number of healthcare companies of all stripes, including insurers, pharmaceutical manufacturers, hospitals, are beginning to recognize that food may well be the next therapeutic frontier.  They are figuring out new products and services to aid consumers to make better food choices or getting into the game themselves.  Notably food is seen as a normal consumer purchase and thus we would not likely see consumers unwilling to pay for food the way they are unwilling to pay for their own healthcare.  People who will go to their death before paying a $10 copay will readily she’ll out 10x that much at Whole Foods to get organic foods of no documented advantage.

This is as much a public health issue as any other and it will be essential for governments to help underserved communities overcome their food ghetto status so they can benefit as much as those with ready access to buckets of affordable extra virgin olive oil. If it helps cut the cost of state Medicaid programs, which spend more than twice as much per beneficiary with heart disease ($9694/year) vs. those without heart disease ($4456/year), it is definitely worth it.

Schools (not to mention parents) must also play a role here, replacing the tater tots and green jello blobs in their cafeterias with healthy foods kids will eat.  Cooking those sloppy joe things in olive oil doesn’t count.  Do they still serve those? This is a great opportunity for the lunch lady re-imagined as Rachael Ray or Rocco DiSpirito.  In the interest of public health, instead of “MOO!” maybe the airport trams can be reprogrammed to say “EVOO!*”

*EVOO is extra virgin olive oil in Rachel Ray speak