Trending Clinical Topic: Mediterranean Diet

Ryan Syrek


September 17, 2021

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The Mediterranean diet frequently tops regularly published lists of best overall diets. Although the health benefits have long been touted, several recent studies have suggested additional advantages, resulting in this week's top trending clinical topic.

An observational study of 250 middle-aged men found a host of benefits associated with diets closely matching the Mediterranean one (see Infographic below). The research was presented at the recent European Society of Cardiology (ESC) Congress 2021. The findings suggest that the benefits of eating patterns emphasizing fruits, vegetables, whole grains, and olive oil, with modest consumption of dairy products and limited red meat, persisted even after adjusting for age, body mass index, type 2 diabetes, statin use, and smoking. In a press release from the ESC, the authors state that "it seems plausible that this dietary pattern may improve fitness and erectile performance by enhancing function of the blood vessels and limiting the fall in testosterone that occurs in midlife."

This research "adds to the growing evidence that a Mediterranean diet is protective against erectile dysfunction," said Joseph Whittaker, MSc, a clinical nutritionist from the University of Worcester, United Kingdom, and co-author of a related meta-analysis about dietary fat and testosterone. "However, most of the research to date is observational," he cautioned, which often has a "healthy user bias" — that is, the men eating a Mediterranean diet are probably health-conscious individuals with other healthy habits such as exercise, good sleep, and low stress. "So, was it the diet, the healthy habits, or both?" Randomized studies are needed to replicate the positive results of observational studies like this one, Whittaker added. In the meantime, "a Mediterranean diet will probably improve your health anyway," he noted, "so trying it for the purposes of erectile function (before starting drugs) is a viable option."

The Coronary Diet Intervention With Olive Oil and Cardiovascular Prevention (CORDIOPREV) — an ongoing randomized controlled trial involving more than 1000 patients — released new data showing that the Mediterranean diet was superior to a low-fat diet in reducing progression of atherosclerosis. During the study, half of the patients follow a Mediterranean diet rich in extra-virgin olive oil, fruits and vegetables, whole grains, fish, and nuts. The other half follow a diet low in fat and rich in complex carbohydrates. New findings show that the Mediterranean diet has produced a greater decrease in intima-media thickness of the common carotid arteries and carotid plaque maximum height, compared with the low-fat diet.

Earlier this summer, results of a separate study also showed that the Mediterranean diet was not inferior to the restrictive, grain-free Specific Carbohydrate Diet for achieving symptom remission in adults with mild to moderate Crohn's disease. In the randomized trial of 194 patients with Crohn's disease, at 6 weeks, the percentage of patients who achieved symptom remission with the Specific Carbohydrate Diet (46.5%) was comparable to that with the Mediterranean diet (43.5%). Also, the Specific Carbohydrate Diet was not shown to be superior to the Mediterranean diet in regard to the proportion of patients who achieved fecal calprotectin response (Specific Carbohydrate Diet - 34.8% vs Mediterranean diet - 30.8%) or C-reactive protein (CRP) response (5.4% vs 3.6%). "While we would have loved to have seen that one diet was clearly superior to the other, our findings remain important for patients and their providers," said lead study author James Lewis, MD. Even so, the results suggest that clinicians should be able to recommend either diet option to patients with mild to moderate symptoms of Crohn's disease, said Maria Abreu, MD, director of the Crohn's & Colitis Center at the University of Miami Miller School of Medicine.

This latest batch of research only bolsters the case that doctors can make to patients in recommending the Mediterranean diet. Considering how important eating is to overall health, the findings prompted a big response, leading to this week's top trending clinical topic.

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