Using the `Mediterranean diet’ to prevent coronary heart disease

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Despite the increased evidence that dietary prevention is critical in the post-AMI patient, many physicians (and their patients) remain rather poorly informed about the potential of diet to reduce cardiac mortality, the risk of new CHD complications and the need for recurrent hospitalisation and investigation. There are many reasons for that, the main one probably being an insufficient knowledge of nutrition. For that reason (and knowing the resistance of many physicians to accept the idea that diet is important in CHD), we propose a minimum dietary programme that every CHD patient, whatever his or her medical and familial environment, should know and follow. This minimum `Mediterranean’ dietary programme has been recently described, and should include the following:

Reduced consumption of animal saturated fat (for instance, by totally excluding butter and cream from the daily diet and drastic reduction of fatty meat) and increased consumption of n-3 fatty acids through increased intakes of fatty fish (about 200 g, twice a week). For patients who cannot eat fish (for any reason), taking capsules of n-3 fatty acids (for instance, a mix of alpha­linolenic acid and long-chain n-3 fatty acids) is the best alternative. Very importantly, the patients (and their physicians) should be aware that n-3 fatty acid supplementation will be even more cardioprotective if associated with adequate dietary modifications discussed in the text above.
Increased intake of anti-inflammatory fatty acids (oleic acid and n-3 fatty acids) and decreased intake of pro-inflammatory fatty acids (n-6 fatty acids). The best way is to exclusively use olive oil and canola oil for cooking and salad dressing and canola oil-based margarine instead of butter and polyunsaturated oils and margarines. Patients should also system­atically reject convenience food prepared with fats rich in saturated, polyunsaturated and trans fatty acids.Increased intake of natural antioxidants (vitamins and trace-elements) and folates through increased consumption of fresh fruits and vegetables and tree nuts.
Moderate intake of alcoholic beverages (one or two drinks per day), preferably wine, preferably during the evening meal, and never before driving or making a dangerous technical manipulation.Reduction of sodium intake (below 100 mmol per day if possible). This is a very difficult task at the present time because of the high sodium content of many natural (including typical Mediterranean foods such as olives and cheeses) and convenience foods.

However, patients and (physicians) should keep in mind that an optimal (and individual) dietary prevention programme should be managed under the guidance of a professional dietician aware of the most recent scientific advances in the field.