By Aleksandar Borisov,
Canadian healthcare in the 21st century is at an important crossroads. Over the past 50 years, Canadians’ needs have changed, however, our healthcare system has remained almost unchanged. What was once an effective healthcare system equipped well to deal with acute disease is today struggling in certain aspects and ranked 9th out of 11 developed countries in The Commonwealth Fund report.5 The leaps in medical advancements made in the past half century now allow us to quickly and affordably treat most acute diseases. However, as our life expectancy has increased by over 10 years since the 1960’s and continues to do so, we are becoming burdened with significantly more expensive chronic illnesses, with the main two being cardiovascular disease (CVD) and cancer.
A fundamental shift in our approach towards disease is necessary. This involves concentrating funds and efforts on preventative methods such as advocating for better health and lifestyle choices and enhancing societies access to these services. Specifically, focusing on an evidence-based diet to enhance cardiovascular health, as diet is one of the most important risk factors of CVD.
The most well studied diet pertinent to cardiovascular health is the Mediterranean diet.1-4,6 It gained popularity in Europe in the latter half of the 20th century when multiple studies found that while individuals living in the olive tree-growing areas of the Mediterranean basin consumed some of the largest amounts of fat worldwide, they had the lowest cardiovascular mortality rate.6 Some of the scientifically proven cardio-protective components of the Mediterranean diet include olive oil, non-starchy fruits and vegetables, legumes, seafood, wine and whole grains.1 The main physiological adaptations from adherence to the diet are a decrease in HDL (colloquially known as bad fat), and protection from oxidative stress, inflammation and platelet aggregation, all of which are known factors that can lead to CVD. The protective effects of the diet are attributable to its several distinguishing components: a high fat intake, predominantly from olive oil, as well as an abundant consumption of fruits and vegetables rich in antioxidant compounds and whole grains and cereals, which are low on the glycemic index.3 Many articles over the last 50 years, including several meta-analyses have found that a greater adherence to the Mediterranean diet (Table 1) causes a significant reduction in hard clinical CVD events such as coronary heart disease, myocardial infarction, and stroke.1-4,6 Reason being the diet’s components protect against CVD risk factors such as increased waist circumference, BMI, blood pressure, lipids and glucose levels.1,6 It is important to note however, that the extent of the benefits associated with this diet depend predominantly upon the duration of time it is adhered to as well as a combination of other healthy life habits such as exercising.
More recently, researchers have begun testing how transferable this diet is to North America, as previous studies have almost exclusively been carried out on Southern European populations. Nevertheless, the 2015-2020 Dietary Guidelines for Americans have already taken steps towards adapting the Mediterranean diet to a non-Mediterranean population, as its cardioprotective effects cannot be overlooked. It is also important to note that while the Mediterranean diet does include modest amounts of fish and white meat consumption, substitution of a single component for a vegetarian or vegan option will still provide the benefits of adhering to the overall diet. The approach to introducing a proper Mediterranean diet in Canada will have to be multi-faceted and involve teaching healthy living at a young age to help mitigate CVD progression, which in the long term will help make our healthcare system more cost effective. It will also involve personalized education by clinicians with their patients and a public willingness to combat cardiovascular disease – the leading cause of morbidity and mortality in the world.6
Table 1: Practical approaches for adopting the Mediterranean Diet.3
1 Grosso G., et al. (2017). A comprehensive meta-analysis on evidence of Mediterranean diet and cardiovascular disease: Are individual components equal? Critical Reviews in Food Science and Nutrition. Vol. 57, No. 15, 3218-3232.
2 Martinez M.A., et al. (2009). Mediterranean diet and the incidence of cardiovascular disease: a Spanish cohort. Nutrition, Metabolism & Cardiovascular Diseases. 21, 237-244.
3 Martinez M.A., Hershey M.S., Zazpe I., Trichopoulou A. (2017). Transferability of the Mediterranean diet to non-Mediterranean countries. What is and what is not the Mediterranean diet. Nutrients. 9, 1226.
4 Nordmann A.J., et al. (2011). Meta-analysis comparing Mediterranean to low-fat diets for modification of cardiovascular risk factors. The American Journal of Medicine. 124, 841-851.
5 Schneider E.C., Squires S.D., Shah A., and Doty M.M. (2017). Mirror, mirror 2017: International comparison reflects flaws and opportunities for better U.S. health care. The Commonwealth Fund.
6 Widmer J., Flammer A.J., Lerman L.O., Lerman A. (2015). The Mediterranean diet, its components, and cardiovascular disease. The American Journal of Medicine. 128, 229-238.