More Evidence for Med Diet! – Vancouver Functional Medicine and Naturopathic Medicine Clinic

This recent systematic review study on supplementation for reducing cardiovascular risk shows support for the Mediterranean Diet! Of the nutritional supplements reviewed, only reduced salt intake, omega-3 LC-PUFA use, and folate supplementation could reduce risk for some cardiovascular outcomes in adults. This combination of recommendations parallels very well to the Mediterranean Diet which would include the regular consumption of fish (ideally not fish from the Mediterranean ocean though due to toxicity), and whole plant foods such as spinach, kale, lettuces, beet greens, chard and other leafy greens.

Interestingly, like many other studies before this one, supplemental calcium (plus vitamin D) “might” increase the risk for stroke. This is most likely due to the existence of arterial inflammation from free radical damage, infections or environmental toxicity leading to calcification and increased clotting risk. I always recommend supplementing with vitamin K2 when people take vitamin D3 for this exact reason (except in infants and young adults who need the vitamin D for development).

One this topic I just had my first Coronary Calcium Score completed in January this year down in Everrett! It only cost me $99 US (which has recently gone up to $199 🙂 and I got a 0 score …. which is the best score you can get on this test! Since then I have sent quite a few clients down to have their calcium score tested with several interesting results.

The traditional Med Diet (with calorie restriction) is clearly the most scientifically supported diet strategy out there! Although, it is not as flashy as “popular” diets like Paleo, Keto and Carnivore, it is seemingly the best preventative foundation to reduce cardiovascular (and I would argue Cancer) risk. As a result Emily, little Arlo and I are going to do some first hand investigative work in the Mediterranean September 9th! Stay tuned.

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Khan SU, Khan MU, Riaz H, et al. Effects of Nutritional Supplements and Dietary Interventions on Cardiovascular Outcomes: An Umbrella Review and Evidence Map. Ann Intern Med. 2019 Jul 9. pii: 2737825. doi: 10.7326/M19-0341. (Systematic review)

Abstract

Background: The role of nutritional supplements and dietary interventions in preventing mortality and cardiovascular disease (CVD) outcomes is unclear.

Purpose: To examine evidence about the effects of nutritional supplements and dietary interventions on mortality and cardiovascular outcomes in adults.

Data Sources: PubMed, CINAHL, and the Cochrane Library from inception until March 2019; ClinicalTrials.gov (10 March 2019); journal Web sites; and reference lists.

Study Selection: English-language, randomized controlled trials (RCTs) and meta-analyses of RCTs that assessed the effects of nutritional supplements or dietary interventions on all-cause mortality or cardiovascular outcomes, such as death, myocardial infarction, stroke, and coronary heart disease.

Data Extraction: Two independent investigators abstracted data, assessed the quality of evidence, and rated the certainty of evidence.

Data Synthesis: Nine systematic reviews and 4 new RCTs were selected that encompassed a total of 277 trials, 24 interventions, and 992 129 participants. A total of 105 meta-analyses were generated. There was moderate-certainty evidence that reduced salt intake decreased the risk for all-cause mortality in normotensive participants (risk ratio [RR], 0.90 [95% CI, 0.85 to 0.95]) and cardiovascular mortality in hypertensive participants (RR, 0.67 [CI, 0.46 to 0.99]). Low-certainty evidence showed that omega-3 long-chain polyunsaturated fatty acid (LC-PUFA) was associated with reduced risk for myocardial infarction (RR, 0.92 [CI, 0.85 to 0.99]) and coronary heart disease (RR, 0.93 [CI, 0.89 to 0.98]). Folic acid was associated with lower risk for stroke (RR, 0.80 [CI, 0.67 to 0.96]; low certainty), whereas calcium plus vitamin D increased the risk for stroke (RR, 1.17 [CI, 1.05 to 1.30]; moderate certainty). Other nutritional supplements, such as vitamin B6, vitamin A, multivitamins, antioxidants, and iron and dietary interventions, such as reduced fat intake, had no significant effect on mortality or cardiovascular disease outcomes (very low- to moderate-certainty evidence).

Limitations: Suboptimal quality and certainty of evidence.

Conclusion: Reduced salt intake, omega-3 LC-PUFA use, and folate supplementation could reduce risk for some cardiovascular outcomes in adults. Combined calcium plus vitamin D might increase risk for stroke.

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