What Do All the Blue Zones Have in Common?

Do Flexitarians Live Longer.jpg

What accounts for the benefits of a Mediterranean-style diet? An anatomy of health effects was published, and the single most important component was the high consumption of plant foods. In contrast, fish and seafood consumption, the only animal foods promoted in the Mediterranean diet, did not seem to help.

If you look at four of the major dietary quality scoring systems, which have all been associated with extending lifespan and lowering heart disease and cancer mortality, they all share only four things in common: more fruit, more vegetables, more whole grains and more nuts and beans. They are all built on a common core of a diet rich in plant foods, whereas opposite food patterns, rich in animal foods and poor in plant-based foods (in other words, the Western diet), is associated with higher risks. So we need to optimize the food environment to support whole grains, vegetables, fruit and plant-based proteins.

That's one of the things all the so-called Blue Zones have in common: the longest living populations have not only social support and engagement and daily exercise, but nutritionally they all center their diets around plant foods, reserving meat mostly for special occasions. In fact, the population with perhaps the highest life-expectancy in the world, the California Adventist vegetarians, doesn't eat any meat at all.

So if the primary benefits of the Mediterranean diet are due to all the whole plant foods, what if you went back to the famous PREDIMED study and created a "provegetarian" scoring system? We know vegetarians live longer, but because a pure vegetarian diet might not easily be embraced by many individuals, maybe it would be easier to swallow if we just tell people more plant-based foods and less animal-based foods. But would just moving along the spectrum towards more plants actually enable people to live longer? Researchers thought of this food pattern as a "gentle approach" to vegetarianism, figuring that if it improved survival it would be an easily understandable message for health promotion: more plant foods, less animal foods.

On this scoring system, you get points for eating fruit, vegetables, nuts, grains, beans, olive oil and potatoes, but get docked points for any animal fats, eggs, fish, dairy or any type of meat or meat products. Of course that means you get a higher score the more potato chips and French fries you eat. That's why I prefer the term "whole-food, plant-based diet" since it's defined by what you eat, not by what you don't eat. When I taught at Cornell I had "vegan" students who apparently were trying to live off French fries and beer; vegan does not necessarily mean health-promoting.

But did the provegetarian scoring system work? Regardless of healthy versus unhealthy, if you give points to people for any kind of plant food, processed or not, and detract points for any kind of animal product consumption, people with higher scores live longer. The maximum provegetarian score is 60, but even just scoring 40 or more was associated with a 40 percent drop in mortality. In fact, there were so few deaths in the highest category of adherence to the provegetarian diet, they had to merge the two upper categories for their analysis. This is evidence that simple advice to increase the consumption of plant-derived foods with reductions in the consumption of foods from animal sources confers a survival advantage. You can view the graph in my video Do Flexitarians Live Longer?

The researchers conclude, "this modest change is realistic, affordable, and achievable because a sizable proportion of their population was already eating that way. So one can get significant survival benefit without a radical shift to the exclusive consumption of plant foods, a more gradual and gentle approach which is more easily translatable into public policy." A 41 percent drop in mortality rates in the United States would mean saving the lives of hundreds of thousands of Americans every year.

Here are some of my previous videos on the Mediterranean diet:

I've done a few videos on the health of so-called semi-vegetarians or flexitarians ("flexible" vegetarians). See how they rate in:

The Provegetarian Score reminds me of the animal to vegetable protein ratio in Prostate Cancer Survival: The A/V Ratio. My favorite dietary quality index is the one in Calculate Your Healthy Eating Score. How do you rate? Even the healthiest among us may be able to continue to push the envelope.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank / Flickr. This image has been modified.

Original Link

What Do All the Blue Zones Have in Common?

Do Flexitarians Live Longer.jpg

What accounts for the benefits of a Mediterranean-style diet? An anatomy of health effects was published, and the single most important component was the high consumption of plant foods. In contrast, fish and seafood consumption, the only animal foods promoted in the Mediterranean diet, did not seem to help.

If you look at four of the major dietary quality scoring systems, which have all been associated with extending lifespan and lowering heart disease and cancer mortality, they all share only four things in common: more fruit, more vegetables, more whole grains and more nuts and beans. They are all built on a common core of a diet rich in plant foods, whereas opposite food patterns, rich in animal foods and poor in plant-based foods (in other words, the Western diet), is associated with higher risks. So we need to optimize the food environment to support whole grains, vegetables, fruit and plant-based proteins.

That's one of the things all the so-called Blue Zones have in common: the longest living populations have not only social support and engagement and daily exercise, but nutritionally they all center their diets around plant foods, reserving meat mostly for special occasions. In fact, the population with perhaps the highest life-expectancy in the world, the California Adventist vegetarians, doesn't eat any meat at all.

So if the primary benefits of the Mediterranean diet are due to all the whole plant foods, what if you went back to the famous PREDIMED study and created a "provegetarian" scoring system? We know vegetarians live longer, but because a pure vegetarian diet might not easily be embraced by many individuals, maybe it would be easier to swallow if we just tell people more plant-based foods and less animal-based foods. But would just moving along the spectrum towards more plants actually enable people to live longer? Researchers thought of this food pattern as a "gentle approach" to vegetarianism, figuring that if it improved survival it would be an easily understandable message for health promotion: more plant foods, less animal foods.

On this scoring system, you get points for eating fruit, vegetables, nuts, grains, beans, olive oil and potatoes, but get docked points for any animal fats, eggs, fish, dairy or any type of meat or meat products. Of course that means you get a higher score the more potato chips and French fries you eat. That's why I prefer the term "whole-food, plant-based diet" since it's defined by what you eat, not by what you don't eat. When I taught at Cornell I had "vegan" students who apparently were trying to live off French fries and beer; vegan does not necessarily mean health-promoting.

But did the provegetarian scoring system work? Regardless of healthy versus unhealthy, if you give points to people for any kind of plant food, processed or not, and detract points for any kind of animal product consumption, people with higher scores live longer. The maximum provegetarian score is 60, but even just scoring 40 or more was associated with a 40 percent drop in mortality. In fact, there were so few deaths in the highest category of adherence to the provegetarian diet, they had to merge the two upper categories for their analysis. This is evidence that simple advice to increase the consumption of plant-derived foods with reductions in the consumption of foods from animal sources confers a survival advantage. You can view the graph in my video Do Flexitarians Live Longer?

The researchers conclude, "this modest change is realistic, affordable, and achievable because a sizable proportion of their population was already eating that way. So one can get significant survival benefit without a radical shift to the exclusive consumption of plant foods, a more gradual and gentle approach which is more easily translatable into public policy." A 41 percent drop in mortality rates in the United States would mean saving the lives of hundreds of thousands of Americans every year.

Here are some of my previous videos on the Mediterranean diet:

I've done a few videos on the health of so-called semi-vegetarians or flexitarians ("flexible" vegetarians). See how they rate in:

The Provegetarian Score reminds me of the animal to vegetable protein ratio in Prostate Cancer Survival: The A/V Ratio. My favorite dietary quality index is the one in Calculate Your Healthy Eating Score. How do you rate? Even the healthiest among us may be able to continue to push the envelope.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank / Flickr. This image has been modified.

Original Link

The Two Most Active Ingredients of the Mediterranean Diet

Which Parts of the Mediterranean Diet Extended Life.jpg

Olives and nuts are plant foods, and as such, are packed with antioxidants, raising the antioxidant level of our bloodstream resulting in lower fat oxidation and free radical DNA damage, but what's happening inside people's arteries?

Researchers measured the amount of atherosclerotic plaque in the neck arteries going to the brain in folks who for years were eating added nuts, added extra virgin olive oil or neither to their daily diets. In the control group, the plaque got worse, which is what happens when one continues to eat an artery-clogging diet, but there were no significant changes in the added extra virgin olive oil group, and the plaque in the added nut group appeared to get better. The nuts appeared to induce a regression of the disease, or at least a significant delay in the progression. The nut group was still suffering strokes, but only half as many, perhaps because the reduction in plaque height within the arteries on extra nuts was indicating a stabilization of the plaque, rendering them less likely to rupture. You can see these results in my video Which Parts of the Mediterranean Diet Extended Life?

Adding nuts to our diet may also improve endothelial function, boosting the ability of our arteries to dilate naturally by about 30 percent. If you look at the baseline adherence to Mediterranean diet principles and control for things like smoking and exercise, there were only two factors significantly associated with reduced heart attack and stroke risk: more vegetables and more nuts. No significant association with the olive oil, wine, fish or cutting back on soda and cookies. Among the individual components, only increased consumption of vegetables and nuts were related to reduced cardiovascular events.

On the one hand, cutting stroke risk in half just by eating a handful of nuts a day is pretty amazing, but those in the added nut group didn't appear to live any longer overall. This is in contrast to other studies that suggested that frequent nut consumption may extend life. For example, the Harvard health professionals studies, involving a whopping three million person-years of follow-up over decades, found nut consumption associated with fewer deaths from cancer, heart disease, respiratory disease and most importantly fewer deaths overall. This was confirmed by all the other big major prospective studies in a recent review.

So what's going on here with the study showing no longevity benefit from nuts? Did they just not wait long enough? Just because people were randomized to the nut group didn't mean they actually ate more nuts, and those randomized to the other groups didn't necessarily stay away.

If you re-analyze the data comparing the death rates of those who actually ate more nuts to those who actually didn't, nut consumption was indeed associated with significantly reduced risk of death. If you do the same kind of post hoc analysis with olive oil, even with the extra virgin, there is no benefit in terms of living longer. This is consistent with how Ancel Keys, the so-called Father of the Mediterranean diet, viewed olive oil. He thought of its benefit more as a way of just replacing animal fats; anything to get people to eat less lard and butter.

What is the best kind of nut? The greatest benefits were attributed to walnuts, particularly for preventing cancer deaths. Those eating more than three servings of walnuts a week appeared to cut their risk of dying from cancer in half.

Now it's just a matter of communicating the research to the public. All the major cancer groups emphasize a more plant-based diet, remarkably consistent with the World Health Organization guidelines for healthy eating. The far-reaching positive effects of a plant-based diet--including walnuts--may be the most critical message for the public.

Here are some of my previous videos on the Mediterranean diet:

Think the effects of adding a few nuts to one's daily diet are too good to believe? Check out my video Four Nuts Once a Month. For more on Walnuts and Artery Function check out the video, and for more on nuts and cancer prevention, see Which Nut Fights Cancer Better?

Nuts May Help Prevent Death and so may beans; see Increased Lifespan from Beans. What about Fruits and Longevity: How Many Minutes per Mouthful?

More on protecting ourselves from "brain attacks" in Preventing Strokes with Diet.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: garlandcannon / Flickr. This image has been modified.

Original Link

The Two Most Active Ingredients of the Mediterranean Diet

Which Parts of the Mediterranean Diet Extended Life.jpg

Olives and nuts are plant foods, and as such, are packed with antioxidants, raising the antioxidant level of our bloodstream resulting in lower fat oxidation and free radical DNA damage, but what's happening inside people's arteries?

Researchers measured the amount of atherosclerotic plaque in the neck arteries going to the brain in folks who for years were eating added nuts, added extra virgin olive oil or neither to their daily diets. In the control group, the plaque got worse, which is what happens when one continues to eat an artery-clogging diet, but there were no significant changes in the added extra virgin olive oil group, and the plaque in the added nut group appeared to get better. The nuts appeared to induce a regression of the disease, or at least a significant delay in the progression. The nut group was still suffering strokes, but only half as many, perhaps because the reduction in plaque height within the arteries on extra nuts was indicating a stabilization of the plaque, rendering them less likely to rupture. You can see these results in my video Which Parts of the Mediterranean Diet Extended Life?

Adding nuts to our diet may also improve endothelial function, boosting the ability of our arteries to dilate naturally by about 30 percent. If you look at the baseline adherence to Mediterranean diet principles and control for things like smoking and exercise, there were only two factors significantly associated with reduced heart attack and stroke risk: more vegetables and more nuts. No significant association with the olive oil, wine, fish or cutting back on soda and cookies. Among the individual components, only increased consumption of vegetables and nuts were related to reduced cardiovascular events.

On the one hand, cutting stroke risk in half just by eating a handful of nuts a day is pretty amazing, but those in the added nut group didn't appear to live any longer overall. This is in contrast to other studies that suggested that frequent nut consumption may extend life. For example, the Harvard health professionals studies, involving a whopping three million person-years of follow-up over decades, found nut consumption associated with fewer deaths from cancer, heart disease, respiratory disease and most importantly fewer deaths overall. This was confirmed by all the other big major prospective studies in a recent review.

So what's going on here with the study showing no longevity benefit from nuts? Did they just not wait long enough? Just because people were randomized to the nut group didn't mean they actually ate more nuts, and those randomized to the other groups didn't necessarily stay away.

If you re-analyze the data comparing the death rates of those who actually ate more nuts to those who actually didn't, nut consumption was indeed associated with significantly reduced risk of death. If you do the same kind of post hoc analysis with olive oil, even with the extra virgin, there is no benefit in terms of living longer. This is consistent with how Ancel Keys, the so-called Father of the Mediterranean diet, viewed olive oil. He thought of its benefit more as a way of just replacing animal fats; anything to get people to eat less lard and butter.

What is the best kind of nut? The greatest benefits were attributed to walnuts, particularly for preventing cancer deaths. Those eating more than three servings of walnuts a week appeared to cut their risk of dying from cancer in half.

Now it's just a matter of communicating the research to the public. All the major cancer groups emphasize a more plant-based diet, remarkably consistent with the World Health Organization guidelines for healthy eating. The far-reaching positive effects of a plant-based diet--including walnuts--may be the most critical message for the public.

Here are some of my previous videos on the Mediterranean diet:

Think the effects of adding a few nuts to one's daily diet are too good to believe? Check out my video Four Nuts Once a Month. For more on Walnuts and Artery Function check out the video, and for more on nuts and cancer prevention, see Which Nut Fights Cancer Better?

Nuts May Help Prevent Death and so may beans; see Increased Lifespan from Beans. What about Fruits and Longevity: How Many Minutes per Mouthful?

More on protecting ourselves from "brain attacks" in Preventing Strokes with Diet.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: garlandcannon / Flickr. This image has been modified.

Original Link

How to Protect Our Telomeres with Diet

NF-Apr21 Telomeres - Cap It All Off with Diet.001.jpeg

In my video, Does Meditation Affect Cellular Aging?, I discussed how stress reduction through meditation might be able to lengthen telomeres, the protective caps at the tips of our chromosomes that tend to deplete as we age.

What about exercise? We can't always change our situation in life, but we can always go out for a walk. London researchers studied 2,400 twins, and those who exercised more may have pumped up their telomeres along with their muscles. Apparently it doesn't take much either. The "heavy" exercise group was only averaging about a half-hour a day.

These were mostly folks in their 40's, but does it still work in your 50's? Yes. A study out of South Korea found that people in their 50's who work out three hours a week had longer telomeres.

In my video, Telomeres: Cap It All Off with Diet, you can see the telomere lengths of young healthy regular folk controls at around age 20, and then at age 50. As we'd expect, the older subjects' telomeres were significantly shorter. What about athletes? The young athletes started out in the same boat, with nice, long, young, healthy telomeres capping all their chromosomes. The older athletes, in contrast to the controls, appeared to still have the chromosomes of 20-year-olds. But these were marathon runners, triathletes running 50 miles a week for 35 years.

What was it about the Ornish intervention that so powerfully protected telomeres after just three months? We saw that stress management seems to help, but what about diet and exercise? Was it the plant-based diet, was it the walking 30 minutes a day, or was it just because of the weight loss? In 2013 a study was published that can help us anser just that question.

The researchers took about 400 women and randomized them into four groups: a portion-controlled diet group, an exercise group, a portion controlled diet and exercise group, and a control group for a full year. In the video, you can see a comparison of the length of each group's telomeres. After a year of doing nothing, there was essentially no change in the control group, which is what we'd expect. The exercise group was 45 minutes of moderate-to-vigorous exercise like jogging. After a year of that, they did no better. What about just weight loss? Nothing. The same thing for exercise and weight loss, no significant change either.

So as long as we're eating the same diet, it doesn't appear to matter how small our portions are, or how much weight we lose, or how hard we exercise. After a year, the subjects saw no benefit. On the other hand, the Ornish group on the plant-based diet, who lost the same amount of weight after just three months and exercised less than half as hard, saw significant telomere protection.

It wasn't the weight loss or the exercise: it was the food.

What aspects of a plant-based diet make it so protective? Studies have associated more vegetables and fruit, and less butter, with longer telomeres. From the latest review, foods high in fiber and vitamins are strongly related to longer telomeres. However, the key may be avoiding saturated fat. Swapping just 1% of saturated fat calories in our diet for anything else can add nearly a whole year of aging's worth of length onto our telomeres.

Saturated fats like palmitic acid, the primary saturated fat in salmon, and found in meat, eggs, and dairy in general, can be toxic to cells. This has been demonstrated in heart cells, bone marrow cells, pancreatic cells, and brain cells. The toxic effects on cell death rates happen right around what you'd see in the blood stream of people who eat a lot of animal products. It may not be the saturated fat itself, however, as saturated fat may just be a marker for the increased oxidative stress and inflammation associated with those foods.

With this link to saturated fat, it's no wonder that lifelong low cholesterol levels have been related to longer telomeres and a smaller proportion of short telomeres--in other words, markers of slower biological aging. In fact, there's a rare congenital birth defect called progeria syndrome, where children age 8-10 times faster than normal. It seems associated with a particular inability to handle animal fats.

The good news is that "despite past accumulated injury leading to shorter telomere lengths, current healthy behaviors might help to decrease a person's risk of some of the potential consequences like heart disease." Eating more fruit and vegetables and less meat, and having more support from friends and family, attenuate the association between shorter telomeres and the ravages of aging.

To summarize: inflammation, oxidation, damage and dysfunction are constantly hacking away at our telomeres. At the same time, our antioxidant defenses, healthy diet, exercise and stress reduction are constantly rebuilding them.


I've asked this diet versus exercise question in a few other contexts. See:

Though dietary change appears more impactful, I'm a big fan of walking. See Longer Life Within Walking Distance and for my personal favorite exercise, Standing Up for Your Health.

For more on the role saturated fat may play in disease, see, for example, my videos Heart Disease Starts in Childhood and Treating Multiple Sclerosis with the Swank MS Diet.

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: AJC ajcann.wordpress.com / Flickr

Original Link