Health

Mediterranean ‘Diet’ Is Really a Lifestyle With Benefits

Published

3 years ago

November 13, 2023

Nov. 13, 2023 — What is the first thing that comes to mind when you think about the word “diet?“ For most people, diet means giving up enjoyable foods, regimented eating hours, and counting calories. Dig a bit deeper into the origins of the word and it becomes more palatable: The word “diet” comes from the Greek word “diata,” which means a way of life or living.

For Ancient Greeks, diata meant visits to healing temples, saunas, meditation rooms, and most importantly, enjoyment of a variety of foods in a social atmosphere. This pattern of eating and living created a blueprint for what would eventually be coined the Mediterranean Diet, a holistic approach to life where the whole is much greater than the sum of its parts.

“I like to say that the Mediterranean Diet is a helpful and pleasurable lifestyle plan that allows you to eat a lot of what is good for you — and enjoy a little bit of what isn’t on occasion — without giving anything up,” said Amy Riolo, an award-winning chef, television host, and author of 16 books. Riolo was named as ambassador of Italian cuisine in the U.S. and ambassador of Mediterranean cuisine in the world by the Italian news agency ANSA.

“The diet is more than just about the food you eat,” added Pam Fullenweider, a registered dietitian who specializes in the Mediterranean Diet and a culinary nutritionist. “It’s the lifestyle components of daily exercise and social connectivity – enjoying meals with others – that makes it so unique.”

Lifestyle, With Benefits

For years, the Mediterranean Diet has taken first or second place in U.S. News & World Report’s annual “Best Diets” rankings. There are reams of evidence supporting its value, with multiple studies demonstrating that when the primary pillars of the Mediterranean lifestyle – nutrition/eating, exercise/physical activity, and social connectivity are embraced – a wealth of benefits, including heart health, mental wellness, staving off cognitive decline, blood sugar control, and longevity can be realized.

Stefanos Kales, MD, a preventive medicine doctor and professor of medicine at Harvard Medical School in Boston, has been studying the lifestyle for decades. He also has a personal connection, explaining that his Greek grandmother was the bridge to the Mediterranean, especially Crete.

“When I grew up, I was fortunate that my grandmother, who was well into her 90s, spent a lot of time with us. She was always using olive oil, and would go out and pick what were basically weeds for any other American. But they were valuable greens for cleaning and preparation,” he said.

He noted that later when he was a student, the value of this connection to the past was reinforced time and again.

“Great nutrition professors espoused that the best way to eat was by mimicking what your grandparents were telling you,” he said.

Kales said the Mediterranean lifestyle grew out of necessity. Olives, which are indigenous to the Mediterranean region, cannot be eaten raw, so people learned to cultivate and prepare them, including harvesting the ripe or semi-ripe fruit and pressing it into oil. The diet was plant-forward and relied on wild greens, fruits and vegetables in season, breads made of whole grains, and homemade wine. Meat and dairy were not regularly eaten. The lifestyle was agrarian, and people walked up to 10 km (6.2 miles) daily. They had adequate rest and took siestas in the afternoon.

The social aspect – breaking bread together – was and is essential.

“Incorporating the social aspect of eating, making sure that you’re eating not just to nourish your body but to nourish your soul so that you are not just enjoying the food, but eating and enjoying it with others, is key in the Mediterranean Diet,” said Rahaf Al Bochi, a registered dietitian, nutritionist, and owner of Olive Tree Nutrition, a virtual nutritional consulting practice. Al Bochi, who is also a spokesperson for the Academy of Nutrition and Dietetics, is very familiar with the Mediterranean lifestyle having grown up in the Middle East.

Studies about so-called Blue Zones, where where people consistently live past the age of 100, “talk about the one day meal – the midday meal when everyone’s together and how many psychological effects they reap from that,” said Riolo. In turn, the positive effects of socialization help “fuel the hormones of digestion and metabolism, and how we store fat.”

Getting Started

Unlike many “quick fix” diets that include a specific list of foods or a specific meal plan to follow for a set period of time, the Mediterranean lifestyle is sustainable – namely because it emphasizes flavor, enjoyment, physical activity, and socializing.

“Instead of focusing on just weight as an outcome, it focuses on how food makes you feel, gives you energy, helps you feel more vibrant, and helps reduce your risk of chronic diseases,” said Al Bochi.

Key food categories include lots of vegetables, fruits, nuts, legumes, whole and unrefined grains, and olive oil; moderate intake of fish; little dairy, meats, and poultry; and a moderate amount of wine with meals. These categories are adaptable to one’s cultural heritage and background, a point emphasized by both Al Bochi and Riolo. And the overall benefits of the Mediterranean lifestyle — benefits that included a lower risk of dying from any cause and from cancer – reinforce that it is adaptable regardless of where one lives, according to a recent study co-authored by Kales.

Another important factor is that it is never too late to get started:

Take a quick assessment of your plate and identify where the gaps are. “Instead of thinking about what foods you want to limit or avoid, which is usually the diet mentality that people fall into, think about what you can add,” she said. “Is it more fruits, more vegetables, more fiber-rich whole grains or beans and legumes?”
Focus on the quality and freshness of the ingredients, and aim for what’s in season, advised Riolo. Frozen fruits and vegetables might be the freshest and most affordable option and that is perfectly acceptable.
Think about time and your own budget and compare them with your desired outcomes. It’s helpful to decide when you will be able to prepare food. Socializing time can also involve cooking with others or inviting friends for dinner.
Don’t try to or change too many things at once, said Fullenweider; take it one step at a time. “Maybe it is as simple as adding chopped veggies to scrambled eggs or more greens to pasta,” she said.
Consider the whole and not just the individual parts. To fully reap the health and nutrition benefits, the Mediterranean lifestyle also relies on physical activity with the emphasis on what is pleasurable, be it walking, gardening, dancing, swimming, etc., Riolo said.
Avoid cherry picking. Drinking more red wine or adding olive oil to meals won’t result in the totality of the benefits.
Finally, focus on flavor as much as nutrition. “I believe that the Mediterranean lifestyle is a love language,” Riolo said. “There’s a thing in Italian that the food that’s enjoyed more is better digested.”

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Health

Putting a Hole in Our World

Published

2 years ago

May 17, 2024

Desk Report

May 10, 2024 – When we’re young, we take our macula for granted. At the center of our retina – the deepest layer of the eye that’s chock-full of photoreceptors and that confers color to our world – the macula is like a high-resolution camera. As light hits our eyes, the retina’s macula recasts our world in a bloom of color with astoundingly high visual sharpness.

But as you age, your vision dulls. What once stood out sharply becomes foggy, like condensation on a windowpane. After some time, a coal-black smudge or cloudy circular area begins to affect your central vision.

This effective blind spot widens over time if left untreated. What remains is a “macular hole” in the center of your retina.

This unfortunate series of events marks the advanced stage of age-related macular degeneration, a dangerous retinal disease that affects about 20 million people in the U.S., and nearly 200 million people worldwide.

And it’s not getting better. Estimates are that by 2040, the disease may affect nearly 300 million people worldwide. We are very limited in our ability to treat or prevent it. Read on for what to know.

First, What Causes Age-Related Macular Degeneration?

AMD’s causes are varied, and whether it will affect you is mostly determined by age and genetics, said Marco Alejandro Gonzalez, MD, an ophthalmologist and vitreoretinal specialist in Delray Beach, FL.

Because of the different cocktails that we have in terms of our genetic makeup, some people’s photoreceptor cells in the macula “basically start to shut down,” he said.

AMD’s development involves over 30 genes, and if you have a first-degree relative – parent, sibling, child – who has the disease, you’re three times more likely to get it, too.

Gonzalez explained how the expected rise to 300 million cases by 2040 is due mostly to improved diagnostic tools, along with the fact that the world is getting older and living longer. (Usually, an optometrist can detect signs of AMD during a routine eye exam.)

Eye experts still struggle to stop AMD’s most harmful sign – the cause of those muddy, milky, or even coal-colored circles in your central vision: geographic atrophy.

Geographic atrophy can occur in either of the two forms of age-related AMD: “dry” AMD and “wet” AMD.

Nearly every case of AMD begins as the dry kind, affecting 80% to 90% of AMD patients.

Retinal disease expert Tiarnán Keenan, MD, PhD, offered a vivid image of geographic atrophy for those who have dry AMD.

“As time passes, the circular patches of GA expand like a brushfire, taking more and more vision with it, often to the point of legal blindness,” he said.

A researcher in the Division of Epidemiology and Clinical Applications at the National Eye Institute, Keenan recently led a study that tested the efficacy of the antibiotic minocycline in slowing geographic atrophy expansion in dry AMD. The study operated on the grounds that the body’s immune system could be at play in developing the disease.

When your body’s immune system is overactive, microglial cells (central nervous system immune cells) can get into the sub-retinal space and possibly eat away at the macula and its sensitive photoreceptors.

Though minocycline had been shown to reduce inflammation and microglial activity in the eye in diabetic retinopathy, it didn’t slow the expansion of geographic atrophy or vision loss in patients with dry AMD during Keenan’s study.

When asked if microglial activity could have very little to do with the atrophy expansion, Keenan said it’s something to consider: “Maybe microglia are just there as bystanders clearing up the debris … so inhibiting them is less likely to slow down progression.”

In future drug trials, “maybe it’s possible the minocycline or another approach to target microglia would be helpful, but it would be needed in combination with some other therapy and be ineffective by itself,” he said.

Two Sides of the Same Disease

In dry AMD, Gonzalez compares macular degeneration to the loss of pixels on a screen. “Some of those pixels burn out … and that’s the way you lose vision classically in the dry form.”

Wet AMD is a more progressive form of the disease. It causes abrupt vision loss due to abnormal blood vessel growth.

“If you don’t treat wet AMD quickly, it’s game over,” warned Gonzalez. “Wet macular degeneration is the quicker process of vision loss because these blood vessels wreak havoc.” These new blood vessels bleed, causing fluid to build in the macula, which ultimately leads to scarring.

Gonzalez shed light on why wet AMD develops. “The wet form, for some reason, is the body’s last-ditch effort to try to kind of ‘help’ a dying macula. … When these blood vessels start to grow under the retina, they quickly destroy the architecture of the macula.”

Stopping the Bleeding in Wet AMD

Though wet AMD is rarer, it’s more treatable than dry AMD. Signs and symptoms can be eased with various therapies injected into the eye.

Putting it simply, Gonzalez said these therapies to treat wet AMD “all basically do the same thing. They make these new blood vessels regress temporarily before they cause damage to the macula.”

The injected medication clears away those blood vessels and restores the architecture of the macula. People can recover some vision in this way, but it’s only a temporary tune-up, and shots must be given as often as once a month.

“Degeneration of the cells is still the main problem. You’re not stopping that. But degeneration itself is a lot slower than actual vision loss associated with these blood vessels.”

The Struggle in Developing New Treatments

According to Keenan, “nobody has been able to stop geographic atrophy from happening” in either form of AMD. “So, that’s the main work in the field with trials.”

In December 2023, the FDA approved two new drugs: Syfovre and Izervay, both of which only slow geographic atrophy. Degeneration still happens, regardless.

Keenan explained how these two new drugs are “complement inhibitors … given by injection into the eye once a month or so.”

“Complement” refers to the body’s complement pathway, a trigger that activates a cascade of proteins in enhancing immune response.

Clinical trials showed Syfovre slowing the rate of geographic atrophy by up to 22% over 2 years, and Izervay up to 14% over 1 year.

Though these drugs are a new weapon against this troublesome affliction, they aren’t without their complications.

“Anytime you give an injection in the eye, there’s always the risk of an infection because you’re introducing something from the outside. So that’s the biggest risk,” explained Gonzalez.

An infection is uncommon, but potentially devastating, as you can lose your eye altogether. There’s also the chance of a damaging reaction to the shot.

“You have to pick and choose your patients,” said Gonzalez. “Not everybody is a good candidate for those new shots … and the patient is never going to see better. … It’s a harder sell than the ones for wet AMD.”

A Common Protective Measure

Keenan and Gonzalez both have a fair degree of confidence in reducing the risk of AMD with vitamin therapy.

As a bit of background on how vitamins were found to act as a sort of preventive measure, Gonzalez said, “In the early and late ‘90s, there were series of studies which were called the age-related eye disease studies.” These are now referred to as AREDS 1 and AREDS 2.

Researchers proved that a certain cocktail of vitamins slowed down degeneration. The most is a combo of antioxidants: vitamins C and E and lutein and zeaxanthin, all of which are in the AREDS 2 formula.

People who took these vitamins had a lower chance of losing their vision over the next 2 to 5 years. “[The combo] seems to be complementary and additive … with a combined treatment effect of 55% to 60%, an excellent safety record, and very low cost,” Keenan said.

Gonzalez recommends the AREDS 2 formula of vitamins to every patient of his. “It’s such an easy thing to take, and the downside is minimal.”

Unfortunately, if your genes make you more likely to have the condition, a change in diet or vitamin use could have no effect.

Dire? Possibly. But not all is lost in this fight.

Vigilance with AMD and What to Do Next if You’re Diagnosed

Gonzalez is adamant in educating his patients before time has run out on treating AMD. Recognition is key. “The most common reason a lot of these people get to me ‘too late’ is they don’t realize there’s a problem.”

He explained a typical scenario: “Let’s say you have macular degeneration in both eyes at different stages. One of your eyes starts developing wet macular degeneration … so the better eye takes over and you may not notice there’s a problem.”

Even after a patient is diagnosed with AMD, they usually see a specialist only twice a year. Gonzalez often tells his patients to cover one of their eyes to make sure their vision is intact in both eyes. “You’ll be able to pick up on subtle differences” in each eye, he said.

This type of self-care and vigilance can be the difference between successfully living with and treating the disease for the rest of your life, and trying to get help when it’s simply too late.

For wet AMD, as mentioned before, a round of injections is basically what everyone does. Without quick, invasive treatment, the point of no return approaches rapidly.

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Health

Federal Experts Talk Bird Flu ‘What Ifs’ in WebMD Live Event

Published

2 years ago

May 17, 2024

Desk Report

May 16, 2024 – Multiple U.S. agencies are working to contain the recent bird flu outbreak among cattle to prevent further spread to humans (beyond one case reported in early April) and use what we learned before, during, and after the COVID-19 pandemic to keep farm workers and the general public safe.

Fingers crossed, the bird flu will be contained and peter out. Or the outbreak could continue to spread among dairy cattle and other animals, threatening the health and livelihoods of farmers and others who work with livestock.

Or the virus could change in a way that makes it easier to infect and spread among people. If this happens, the worst-case scenario could be a new influenza pandemic.

With so many unknowns, WebMD brought together experts from four federal agencies to talk prevention, monitoring, and what the “what ifs” of bird flu might look like.

Communication with the public “about what we know, what we don’t know, and ways you and your family can stay safe is a priority for us at CDC,” said Nirav D. Shah, MD, JD, the CDC’s principal deputy director. “We at the federal level are responding, and we want the public to be following along.”

People should consult the websites for the CDC, FDA, U.S. Department of Agriculture (USDA), and the Administration for Strategic Preparedness and Response (ASPR) for updates.

It is essential to not only stay informed, but to seek trusted sources of information, Shah said during “Bird Flu 2024 – What You Need to Know,” an online briefing jointly sponsored by the CDC and WebMD.

An ‘Experimental Hamburger’

If one take-home message emerged from the event, it was that the threat to the general public remains low.

The retail milk supply is safe, although consuming raw or unpasteurized milk is not recommended. “While commercial milk supply is safe, we strongly advise against drinking raw milk,” said Donald A. Prater, DVM, acting director for the FDA’s Center for Food Safety and Applied Nutrition.

As for other foods, thoroughly cooked eggs are less risky than raw eggs, and the nation’s beef supply remains free of the virus as well.

For years, federal inspectors have purchased and tested meat at retail stores, said Eric Deeble, DVM, USDA deputy assistant secretary for the Office of Congressional Relations. So far, H5N1, the virus behind bird flu, has not been detected in beef.

The USDA took testing a step further and recently cooked ground beef from dairy cows in their lab. Using what Deeble described as an “experimental hamburger,” the agency showed cooking beef to 165 F or higher kills the virus if it ever becomes necessary.

The federal government now requires all cattle be tested and be free of bird flu virus before crossing any state lines. The government is also reimbursing farmers for veterinary care and loss of business related to the outbreak, and supply personal protective equipment (PPE) like gloves, masks, and face shields to workers.

Vaccination Not Recommended Now

Federal scientists know enough about H5N1 virus to create vaccines against it quickly if the need arises. It’s more about planning ahead at this point. “Vaccines are not part of our response right now,” said David Boucher, PhD, director of infectious diseases preparedness and response at the Administration for Strategic Preparedness and Response.

If the virus changes and becomes a bigger threat to people, “we have the building blocks to produce a vaccine,” Boucher added.

An event attendee asked if the seasonal flu shot offers any protection. “Unfortunately, the flu shot you got last year does not provide great protection from the avian flu,” Shah responded. “It might do a little bit … but that is the vaccine for seasonal flu. This is something more novel.”

Treatments Stockpiled and Ready

Antiviral medications, which if given early in the course of bird flu infection could shorten the severity or duration of illness, are available now, Shah said. The dairy farmer who was infected with bird flu earlier this year responded to oseltamivir (Tamiflu) treatment, for example.

When it comes to bird flu symptoms, the fact that the only infected person reported so far this year developed pink eye, also known as conjunctivitis, is interesting, Shah said. Officials would have expected to see more typical seasonal flu symptoms, he added.

“Influenza is not a new virus,” Boucher said. “With this strain of influenza, we are not seeing any genetic markers associated with resistance to antivirals. That means the antivirals we take for seasonal influenza would also be available if needed to treat H5N1.”

ASPR has stockpiled Tamiflu and three other antivirals. “We do have tens of millions of courses that can be distributed around the country if we need them,” he added.

“Influenza is an enemy we know well,” Boucher said. That is why “we have antivirals ready to go now and many types of PPE.”

Science in Action

The feds intend to stay on the case. They will continue to monitor emergency department visits, lab test orders, and wastewater samples for any changes suggesting a human pandemic risk is growing.

“While we’ve learned a great deal, there are still many things we do not know,” Deeble said.

Shah added, “As in any outbreak, this is an evolving situation and things can change. What you are seeing now is science in action.”

For the latest updates on bird flu in the United States, visit the CDC’s H5N1 Bird Flu: Current Situation Summary website.

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Health

Federal Experts Talk Bird Flu ‘What Ifs’ in WebMD Live Event

Published

2 years ago

May 16, 2024

Desk Report

Or the virus could change in a way that makes it easier to infect and spread among people. If this happens, the worst-case scenario could be a new influenza pandemic.

With so many unknowns, WebMD brought together experts from four federal agencies to talk prevention, monitoring, and what the “what ifs” of bird flu might look like.

People should consult the websites for the CDC, FDA, U.S. Department of Agriculture (USDA), and the Administration for Strategic Preparedness and Response (ASPR) for updates.

An ‘Experimental Hamburger’

If one take-home message emerged from the event, it was that the threat to the general public remains low.

As for other foods, thoroughly cooked eggs are less risky than raw eggs, and the nation’s beef supply remains free of the virus as well.

Vaccination Not Recommended Now

If the virus changes and becomes a bigger threat to people, “we have the building blocks to produce a vaccine,” Boucher added.

Treatments Stockpiled and Ready

ASPR has stockpiled Tamiflu and three other antivirals. “We do have tens of millions of courses that can be distributed around the country if we need them,” he added.

“Influenza is an enemy we know well,” Boucher said. That is why “we have antivirals ready to go now and many types of PPE.”

Science in Action

The feds intend to stay on the case. They will continue to monitor emergency department visits, lab test orders, and wastewater samples for any changes suggesting a human pandemic risk is growing.

“While we’ve learned a great deal, there are still many things we do not know,” Deeble said.

Shah added, “As in any outbreak, this is an evolving situation and things can change. What you are seeing now is science in action.”

For the latest updates on bird flu in the United States, visit the CDC’s H5N1 Bird Flu: Current Situation Summary website.

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