'I'm tablet-free thanks to my mediterranean diet'
As a new study shows that following a Mediterranean diet may be more effective at fighting heart disease than statins, our reporter looks at how we can all incorporate more vegetables and olive oil into our lives, and speaks to 79-year-old Eileen Farrell, who credits the lifestyle change with reducing her cholesterol
Italians have a saying: "At the table no one grows old". According to the latest research on the Mediterranean diet, the Italians were right all along: eat well to live longer.
The world's leading heart experts have now found that a diet rich in fruit and vegetables, fish, nuts, whole grains and olive oil, is more powerful than any drug when it comes to heart health, and following this dietary regime could be better than statins at reducing the risk of heart attack.
In the first major study to look at the impact of the Mediterranean diet on the survival of heart patients, experts found that it cut the chances of early death by 37pc. Previous research has found that just taking statins cuts mortality by 18pc, although experts warn the figures are not directly comparable.
In this country coronary heart disease and heart attacks are still the biggest causes of death every year, although only 6pc of the health care budget is spent on cardiovascular disease. A massive 310,000 people currently take statins - a group of medicines that help lower the level of low-density lipoprotein (LDL) cholesterol, also widely known as "bad cholesterol" in the blood. But with the medical evidence now firmly in favour of lifestyle changes over drugs, is it time to go back to basics when it comes to our overall and heart health?
Professor Sherif Sultan, president elect of the International Society for Vascular Surgery, says in terms of heart health, lifestyle is more important than anything else and he says cholesterol has been demonised and its effects in the body not properly understood.
And he says in terms of primary prevention - where a person has never suffered from cardiovascular disease - statins should not be used at all. In cases like this he says people should be urged to change their lifestyle. And he says where people have cardiovascular disease, they should only be prescribed statins for a short term on a very low dosage.
"Lifestyle is crucial and primary prevention is much better than treatment. The reason people in the Mediterranean live longer is they eat good fat and vegetables and good proteins," says Professor Sultan. "Cholesterol is the most crucial element in the human body, but we need to nourish it and protect it by eating the right foods.
"In terms of primary prevention, don't smoke, don't drink much alcohol, avoid refined sugars, drink about three litres of water a day, walk for 30 to 45 mintues every day, and don't eat a heavy meal after 7pm. We need to go back to basics," says Professor Sultan.
"In my opinion half of the people on statins should not be taking them. For my patients who have a history of cardiovascular disease, I give them a low dose for six to nine months and that's it.
"I say to my patients that what they need are everyday things - go and walk the prom, squeeze three oranges and drink the juice when you get up - that is better than any supplement you will buy on the shelf - and don't eat after 7pm," he says.
"Cholesterol is so important. For a long time we heard cholesterol was bad and don't eat eggs and don't eat butter. But it's recognised now that good fat is very important and must be protected. Cholesterol prevents against cancer, broken bones and depression and yet we hear it's all bad. We need more money spent promoting lifestyle changes and healthy eating," says Professor Sultan.
According to Dublin-based GP Mark Murphy, the most important factors a GP will assess with a patient in terms of their overall health is diet and exercise. He says before a doctor will even mention cholesterol, they will go through a range of lifestyle factors including drinking and smoking with a patient.
After that he says doctors would check a patient's blood pressure and address that with lifestyle changes and perhaps medication followed by a full investigation of their cardiovascular health, including blood tests.
"Usually one of the last things is cholesterol. We are more holistic in our approach. There are issues that are much more important than cholesterol," he says.
At Croi, a Cardiac Foundation, prevention is a key message in their work and the organisation sees 26,000 people every year in prevention programmes and runs 18 different health and lifestyle programmes.
The foundation's director of programmes, Irene Gibson, says the evidence from the recent study is overwhelming. "There's a huge amount people can do themselves. One of the challenges we have as an organisation is convincing people how much ownership they have over their own health.
"We must consider this when you think about the fact that up to 90pc of heart disease and stroke is preventable," she says.
"We all know the Mediterranean diet is good for us, there needs to be an emphasis now on changing behaviours. The majority of people know what they should and shouldn't be doing. It's how to take that first step and stay motivated," says Gibson.
"We try to promote healthy lifestyle by bringing prevention right out into the community. Making lifestyle changes is all part and parcel of good healthy living. We need to build on the results of this study and we can't lose sight of what people can do for themselves in terms of their health," she says.
To mark World Heart Day, which falls on September 29 this year, the organisation is asking people to share their photos on social media of what they are doing to make themselves healthy.
Irish Heart Foundation dietitian Sinead Shanley, says :"This is the everyday message that we promote; it just doesn't grab headlines. It's sound advice," she says.
"We need to get families to think not just about how they eat, but the way they eat too. The Mediterranean way of eating is also a cultural way of eating. They sit down together and eat. They don't graze and snack in between meals.".
The message is contained in the foundation's Happy Heart Month campaign, with a focus on healthy meals for five to 12-year-olds. "One of the things we are focusing on is behaviour around meal times. We are saying don't get worked up, try to relax and take the drama out of mealtimes for good," says Shanley.
* World Heart Day is on September 29
'I'm medication free since I changed my diet'
Eileen Farrell from Headford, Co Galway, is a walking advertisement for the benefits of the Mediterranean Diet. She was determined to remain medication-free when she was got blood test results which showed her cholesterol was high.
While her doctor advised her that she would need medication if the level stayed high, Eileen says she embarked on a plan to bring it down by changing her diet and walking more.
Eileen, who turns 80 in November, says while she was always fond of fruit and vegetables, she was also fond of cheese and red meat. “When I was younger I would have eaten a quick ham and cheese sandwich. I suppose I got a little bit lazy,” she says.
When her husband Jim (77) had a stroke a year ago, it was a shot across the bow for them to be more proactive in looking after themselves, says Eileen.
“We try now to have our dinner at midday so we can exercise in the afternoon. I might make some fish with broccoli or cauliflower and potato. Sometimes I’ll make a chicken curry with rice and add loads of vegetables. I’m a better veg eater than my husband.
“We might have red meat once a week. In the past we’d have it every day because my husband wasn’t fond of fish. Occasionally I’ll make a stew with lamb. I’ll cook the meat the night before and in the morning skim the fat off.
“We might just have a snack in the evening – maybe a bit of salad or a boiled egg if I’m really hungry. For breakfast, we have porridge with berries or grapes. I like my porridge with unsweetened almond milk. If I’m hungry between meals, I’ll have a tangerine or a dairy-free yoghurt,” says Eileen.
“I’m very active here in the house. I never sit too long. I walk every day — it could be morning or afternoon. I would walk for up to an hour. I do feel much better since I made these changes,” she says.
Johnnie Cooke's tips for Med-style eating
1. Enjoy your food, and make healthful eating a family affair
The traditional Mediterranean lifestyle emphasises the importance of people eating together with family and friends. Between demanding jobs and busy personal schedules, many of us have gotten away from sitting down together at the kitchen table.
2. Use herbs and spices to season
Using herbs and spices allows you to cut back on added salt, sugar, and fat when cooking. Citrus juice is also a popular option for adding flavour to various dishes.
3. Olive oil is the staple fat used for cooking
Butter, margarine and other solid fats are rarely used in cooking. Solid fats are high in saturated and trans fats which damage your arteries and can increase your cholesterol levels. Olive oil is a good source of monounsaturated fats, which are a type of healthy fat that can help lower cholesterol levels.
4. Beans, nuts, legumes, and whole grains are everyday staples
Beans and whole grains are healthy forms of carbohydrate that can be worked into your meal plan in appropriate portion sizes. Nuts are also a source of healthy unsaturated fats that are an important part of a Mediterranean meal plan.
5. Focus on lean protein and eat fish at least twice per week
A serving of fish or meat is included at least two times each week. Salmon, albacore tuna, halibut, herring, sardines, mackerel and trout contain omega-3 fatty acids which benefits the health of the heart and brain. Chicken, low-fat dairy, eggs and cheese are included in smaller portions daily or a few times per week.
7. Sweets and high-sugar foods are limited
Often, desserts are fruit-inspired dishes. Sometimes, a piece of fruit is simply the dessert itself.
The word paella comes from the name of the pan it is made in - the Latin term patella, a flat plate on which offerings were made to the Gods. If you would like to make a vegetarian version; use vegetable stock instead of chicken and substitute cooked white beans, chargrilled aubergine, artichoke hearts and piquillo peppers for the seafood and chicken. Paella is a great one "pot" classic Spanish dish that originated in Valencia, although they are numerous versions throughout Spain. As a general rule the nearer the coast the more seafood is used while further inland they feature meat such as rabbit and chicken. In this recipe, the Andalusian sauce can be used as a Soffrito. Traditionally it is cooked in a shallow cast-iron pan, cooked outside over a boxwood fire.
3 tablespoons of olive oil
4 skinless and boneless chicken thighs or breast fillets, each cut into eight pieces
1 onion, finely chopped
200g Spanish short grain rice (Calasparra, Bomba or paella rice)
100g raw chorizo, outer casing removed and chopped small dice
2 garlic cloves, finely chopped
4 tablespoons of Andalusian sauce paste
A good pinch of saffron strands, soaked in a little white wine or water
2 bay leaves
400g can of whole peeled or chopped tomatoes
1 litre of hot chicken stock
8 whole raw king prawns
20 large clams and/or mussels, cleaned
8 small cherry tomatoes
1 red pepper, seeded and cut in batons
100g petit pois (fresh or frozen)
1 lemon, quartered
Sea salt and freshly ground black pepper
Lightly dressed rocket salad and crusty bread, to serve
1. Heat some olive oil in a paella pan, add the chicken and sauté for 1-2 minutes until sealed and lightly golden. Remove from the pan and set aside.
2. Add the onion to the pan and sauté until slightly caramelised. Add the rice, chorizo and sauté for 2 minutes, then add the garlic and Andalusian sauce paste and sauté for another few minutes.
3. Return the chicken to the rice mixture and stir in the saffron liquid, bay leaves, canned tomatoes and pour in the stock - it should come to the level of the rice, breaking down the tomatoes as necessary.
4. Add the prawns to the pan along with the clams and/or mussels and red pepper batons. Ensure ingredients in the pan are just covered with the stock but no more. Scatter the cherry tomatoes over and season to taste. Bring to the boil, then reduce the heat and simmer gently for 20 minutes or until the rice is completely tender and all of the liquid has been absorbed.
5. Sprinkle the petit pois over the paella for the last few minutes of cooking, then garnish with the lemon wedges. Serve the paella straight to the table with a bowl of rocket salad and a basket of crusty bread.
This tagine is a little richer than is traditional in Morocco. It could be made with any type of stewing beef or chicken, just cut the cooking time in half and use dried apricots instead of dates. Alternatively, try using a mixture of roughly chopped root vegetables and use vegetable stock. The flavour of this tagine only improves with time, just leave it to cool completely, then place in the fridge for up to two days. The Moroccan Sauce is a wonderful multifunctional base for fish, meat and vegetables.
1.5kg lamb shoulder, well-trimmed and cut into bite-sized pieces
4 tablespoons of Moroccan Sauce
4 garlic cloves, chopped
2.5cm piece root ginger, peeled and chopped
3 onions, roughly chopped
2 tablespoons olive oil
600ml tomato juice
450ml chicken or lamb stock (from a cube is fine)
2 tablespoons of clear honey
225g Medjool dates, cut in half and stones removed
50g toasted flaked almonds
Sea salt flakes and freshly ground black pepper
Couscous, to serve
Greek-strained yoghurt and fresh coriander leaves, to garnish
1. Place the lamb in a large bowl and stir in half of the Moroccan World Pesto until evenly combined. Cover with cling film and marinate for at least 15 minutes at room temperature or if time allows chill overnight.
2. Preheat the oven to 160C (325F), Gas mark 3. Place the garlic, ginger and onions into a food processor and pulse until finely minced. Heat a large heavy-based casserole. Add half of the oil and brown off the marinated lamb in batches. Add the remaining oil to the pan and then add the onion mixture cook for a few minutes until softened but not coloured. Stir in the rest of the Moroccan Sauce and cook for another minute or so until well combined.
3. Pour the tomato juice and stock into the pan and then add the browed lamb with the honey, stirring to combine. Bring to the boil, cover and transfer to the oven. Cook for 1 hour, then stir in the dates and cook for another hour until the lamb is tender and sauce has thickened and reduced. Season to taste.
4. Arrange the lamb tagine on plates with the couscous. Scatter over the toasted almonds and then garnish with a dollop of the Greek yoghurt and coriander.
Health & Living