Swap Statins for Mediterranean Diet, say Leading Cardiologists

07 Sep 2015 --- Leading doctors and cardiologists believe that making small yet significant dietary and lifestyle changes can reduce the incidence of cardiovascular disease (CVD) risks more than taking statins.

They are advising to eat a Mediterranean diet (plenty of fresh fruit and vegetables, olive oil, fish, legumes and some wholegrains), undertake physical exercise and stop smoking, saying these changes are “more effective in reducing the incidence of heart disease than taking pharmaceuticals.”

The trio of doctors which includes Dr Aseem Malhotra who has long been an advocate of reducing statin prescriptions, wrote an editorial which appeared in the healthcare journal Prescriber stating that bodies such as the National Institute for Health and Clinical Excellence (NICE), who advise the NHS on clinical care, should not be so quick to recommend medical intervention in the form of pharmaceuticals for cardiovascular disease risk.

The NICE guidelines have recently changed, reducing their recommendation of statins to anyone with a 10% risk of a cardiovascular incident within the next 10 years of life, whereas the guide was previously 20%, meaning more patients will be recommended and prescribed statins by their healthcare provider. This would mean a more costly approach to the problem as statins cause side effects and cost money, whereas a dietary approach would come at no cost at all. Common side effects of statins include muscle aches caused by a depletion of the nutrient CoQ10 and in some cases, the development of diabetes.

Dr Malhotra says that the key elements of the Mediterranean diet are not only the inclusion of healthy whole foods such as vegetables but also the almost complete absence of added sugars and the high amounts of fats in the diet. A true Mediterranean diet “contains almost no added sugars whatsoever” and also contains “a high percentage of fat compared to the typical Western diet.” He says that reducing added sugars (such as sugary drinks) by just 15% would lead to a decrease in obesity of 180,000 people. Likewise, plenty of healthy fats can protect against CVD related disease.

Reducing starchy carbohydrates such as bread, pasta and other refined wheat products would naturally reduce the sugars in the diet and lead to an increase in healthy fats due to the types of foods being consumed in their absence. Dr Malhotra states that the important message from this study is that the “benefits are independent of cholesterol”; that is to say, the focus needs to shift away from cholesterol numbers towards inflammation and quality of cholesterol particles. According to him, we need a “shift away from the cholesterol obsession”, which is only a factor for CVD if combined with inflammation and should focus instead on reducing inflammation and improving cholesterol particle quality.

The benefits of a Mediterranean diet are not so much that it reduces cholesterol but that it reduces inflammation and leads to a healthier type of cholesterol – often, cholesterol numbers will barely change. Contrary to this, patients who consume the recommended low-fat high-carbohydrate diet may find their cholesterol levels dropping, but often develop obesity and other related issues such as CVD regardless.

Another element of the Mediterranean diet which may be useful in reducing cholesterol levels is the presence of niacin-containing foods such as organ meats, poultry and oily fish. Niacin has also been shown in research to be more effective than statins at reducing cholesterol levels.

One of the key factors in implementing these guidelines is increased GP-patient consultation times, so that Dr’s can explain adequately the benefits of dietary and lifestyle changes.