Rating The Low-Fat Diet

Contrary to previous findings, the traditional low-fat diet recommended by the American Heart Association is just as heart healthy as a Mediterranean diet rich in olive oil and nuts.

That news comes from Katherine Tuttle, M.D., of the Providence Medical Research Center and Sacred Heart Medical Center in Spokane, Wash.

Tuttle's team studied 202 people who had suffered heart attacks in the previous six weeks and found that people on either diet were two-thirds less likely to suffer another heart attack, stroke, or other heart problems or die than people who continued to eat their usual diet.

What made a difference was regular, structured visits with a nutritionist,
Tuttle tells WebMD.

"Both diets are prudent, heart-healthy choices," she says. "But it's very
hard to maintain a lifestyle intervention without reinforcement, so making
regular, repeat visits with a dietitian is important to meeting your
goals."

The study was presented at the annual meeting of the American College of
Cardiology.

Both Diets Low in Fat, Cholesterol

Both the American Heart Association (AHA) and the Mediterranean diets call for consuming fewer than 200 milligrams of cholesterol a day, with less than 7 percent of total calories coming from saturated fat. In contrast, the average American consumes twice that much fat, Tuttle says.

In the study, people assigned to the AHA diet were advised to keep total fat intake to less than 30 percent of calories. Those on the Mediterranean diet were allowed to increase their fat intake to 40 percent, "the difference coming from healthier monounsaturated fats, with a special emphasis on omega-3 fatty acids," Tuttle says.

In fact, the Mediterranean dieters ate omega-rich fish three to five times
per week; their diet was also high in olive oil, nuts, and avocados, she
says.

The AHA low-fat diet put an emphasis on fresh fruit and vegetables, with
moderate intake of lean meats like chicken. People in this group were told to stay away from saturated fats and cholesterol-rich foods like butter, cream, and fatty red meats.

Dietary Counseling Key

Dieters in both groups had frequent one-on-one meetings with a dietitian — two the first month and then every three to six months after that. Additionally, they attended at least six group counseling sessions.

A total of 50 people were assigned to the low-fat diet and 51 to the
Mediterranean diet. On average, most met their dietary goals, Tuttle
says.

Over the next four years, eight people in both groups suffered another heart attack, had a stroke, or developed another heart problem. No one in either group died.

People in both diet groups were then compared with a group of 101 heart attack survivors who did not receive any intensive dietary intervention or nutrition counseling. Among that group, 40 had a heart attack, stroke, other heart problems, or died over the next four years. Additionally, cholesterol levels improved in both diet groups but not in the usual care group.

Robert Eckel, M.D., immediate past president of the American Heart Association and a professor of endocrinology at the University of Colorado, says, "People who have had a heart attack need to get dietary advice on an ongoing basis. Active intervention by a dietitian is an important part of success."

He notes that in the previous study that showed the Mediterranean diet was better for heart health than the AHA diet, only people on the Mediterranean diet got regular dietary advice.

"Without behavior modification, no diet is going to work," Eckel tells
WebMD.

By Charlene Laino
Reviewed by Louise Chang, M.D.
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