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Pesco-Mediterranean diet with fasting proposed to optimize heart health

Journal of the American College of Cardiology
Reuters Health - 14/09/2020 - A Pesco-Mediterranean diet with intermittent daily fasting would be optimal for heart health, researchers suggest. In addition to vegetables, fruits, nuts legumes and whole grains, the proposed diet includes extra-virgin olive oil, fish/seafood and fermented dairy products.

"There is a great deal of confusion among patients and their physicians about the ideal diet to follow for health," Dr. James O'Keefe of the University of Missouri-Kansas City told Reuters Health by email. "We wanted to put together a practical and sustainable diet that has the best scientific evidence behind its benefits for cardiovascular health and general well-being."

Clinicians should be discussing this diet with their patients right now, he said, because it "can make a big difference for improving their patients' health and well-being."

"The intermittent fasting is an important part of this diet," he added. "People should start by fasting at least 12 hours overnight, and gradually reduce the time window of eating during the day to not more than 8-10 hours.

As reported in the Journal of the American College of Cardiology, the team's cumulative review found substantial support for the proposed Pesco-Mediterranean diet, including:

- Endorsement for the traditional Mediterranean diet by national guidelines such as the 2015-2020 Dietary Guidelines for Americans and the 2019 American College of Cardiology/American Heart Association Guideline on the Primary Prevention of Cardiovascular Disease, which recommends "plant-based and Mediterranean diets along with fruits, nuts, vegetables, legumes and lean vegetable or animal protein--preferably fish."

- The randomized PREDIMED trial (https://bit.ly/32rIP1U), which compared a Mediterranean diet supplemented with extra-virgin olive oil (EVOO), a Mediterranean diet supplemented with mixed nuts (walnuts, almonds, and hazelnuts); and a low-fat diet. The Mediterranean diet - with either EVOO or nuts - led to statistically significant reductions of 29% for major adverse cardiovascular events.

- In one arm of the PREDIMED trial, a daily serving of mixed nuts led to a 28% reduction in cardiovascular disease risk.

- Regarding fish, the 2015-2020 Dietary Guidelines for Americans recommend adults consume fish at least twice a week instead of red meat, poultry or eggs. A meta-analysis of five prospective dietary studies found coronary artery disease mortality was 34% lower in those following a pescatarian diet compared to those who ate red meat regularly.

"There is no clear consensus among nutrition experts" regarding dairy products and heart risks, the authors acknowledge; however, they are permitted on the Pesco- Mediterranean diet. "Fermented low-fat versions, such as yogurt, kefir, and soft cheeses, are preferred," they note. "Butter and hard cheese are discouraged, because they are high in saturated fats and salt."

Eggs - preferably no more than five yolks per week - are also permitted.

Three nutrition experts commented on the proposed diet in emails to Reuters Health.

Dr. Nieca Goldberg; Medical Director of the NYU Women's Heart Program, said the diet "is optimal for heart health. It is also is easy to follow. It is also easy to explain to patients."

"The timed eating form of intermittent fasting may help with weight loss," she added. "Counseling patients to eat at a certain time interval may bring about greater compliance."

Dr. Nivee Amin, Director of the Women's Heart Program and Preventive Cardiology at Weill Cornell Medicine and NewYork-Presbyterian in New York City commented, "I agree with the move away from land-animals as a source of protein. Other studies have suggested that land-animal protein consumption can contribute to future atherosclerotic cardiovascular disease risk."

"The element of intermittent fasting still needs further review," she said. "But, I encourage my patients to eat their evening meals early and consider lighter meals in the evening."

Registered dietitian Dr. Michele Smallidge of the University of New Haven, Connecticut, added that clinicians should discuss the importance of eating a plant-based Mediterranean diet with their patients. However, she said, "not only should we be emphasizing the healthier choices, but we should be encouraging the reduction of processed, packaged, pre-prepared and fast foods, which are typically low in nutritional value and high in empty calories, high in sodium, bad fats, preservatives and fillers."

By Marilynn Larkin

SOURCE: https://bit.ly/35BAJpe Journal of the American College of Cardiology, online September 14, 2020.

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