A pilot clinical trial has begun at MUSC to determine if the Mediterranean diet is as effective as the traditional low-fat diet in lowering risk factors for heart disease. Investigators are also trying to determine if this diet will be palatable enough for South Carolinians to comply with on a long-term basis.

“It is well known that a high fat diet is associated with increased risk of heart disease,” said Daniel T. Lackland, Dr.P.H., an MUSC epidemiologist and principal investigator in the study. A low-fat diet can help prevent heart disease, but people tend not to remain on a low-fat diet. It has been known for a long time that people living in the Mediterranean countries eat a high-fat diet, yet have low rates of heart disease. The fat used primarily in this area is olive oil as opposed to meat and dairy fats used in the United States. People in the Mediterranean area eat far more pastas, other starches, fruits, vegetables and nuts as opposed to meats and dairy products. It is thought that this type of diet offers protection from heart disease.

The MUSC group consists of Lackland, Michael Assey, M.D., and Peter Gazes, M.D., cardiologists, and Chase Wood, R.D., a dietitian. They are working closely with Curtis Ellison, M.D., head of preventive Medicine at Boston University and international expert on the Mediterranean diet.

“Studies indicate that the effects of the diet tend to produce a beneficial, anti-oxident effect in the same way people take vitamins and asprin, daily,” said Gazes, professor of medicine, Division of Cardiology. “Because the Mediterranean diet study is based mostly on vegetables, fruits, pasta and olive oil and very little fats, it can be easy and palatable for most people.”

At MUSC 50 people who have had heart disease will be enrolled in the study. Following the pilot study at MUSC, Lackland and his group plan to participate in a multicenter, national study, coordinated by the Boston group.

Patients who have had bypass surgery or a heart attack will be asked if they would try the Mediterranean diet instead of a traditional low-fat diet. Those who agree will meet with Wood, who will provide them with information on the diet, menus and olive oil. They will be asked to keep a food log, and she will follow up with them on a weekly basis. In addition they will have their blood drawn to analyze their lipid profile.

After eight weeks, the patients will have their blood drawn again to determine if there were changes in their blood lipid profile that would make them less likely to have further heart disease. Their compliance to the diet will be evaluated, and they will be questioned about whether they like the diet.

“As researchers, we’re concerned how the Mediterranean diet can be appropriate and practical for America’s diverse population,” said Assey, professor of medicine, Division of Cardiology, referring to the positive results gained from a diet study conducted recently in Lyon, France. “The study will determine how patients can learn to change and be proactive in order to benefit from its positive results.”

Imagine a pyramid with the base containing starches such as breads, pasta, rice, couscous, polenta, bulgur, other grains, and potatoes. The next level of this pyramid is the bulk of this menu, fruit, vegetables, beans, legumes and nuts. The third level would contain olive oil at a variable rate. The fourth level is cheese and yogurt. Next is fish, poultry, eggs and sweets, all are recommended a few times per week. At the top of the pyramid is red meat to be eaten a few times per month. Throughout this diet daily physical activity is recommended, and wine is suggested in moderation.