There’s Something Fishy in JACC
O’Keefe and colleagues review the virtues of a Pesco-Mediterranean diet with intermittent fasting and suggest that this dietary approach is superior to diets containing ‘”highly processed meat from animals raised in inhumane conditions, fed unnatural foods, and often treated with hormones and antibiotics”. 1 They also consider this diet superior to “prolonged strict veganism” that probably “increases the risk of bone fractures and sarcopenia”. The Pesco-Mediterranean diet consists of plant-based foods including vegetables, fruits, legumes, whole grains, seeds, and nuts plus fish/seafood. The authors consider the Mediterranean diet as the “gold standard for cardiovascular health”. The review cites multiple studies supporting the benefits of this diet, but few negative studies possibly because more positive than negative studies are published (positive publication bias), author bias in only citing articles supporting their position, or the absence of negative studies on the diet, although the latter is doubtful. The health benefits of intermittent fasting (not eating between 9 AM and 6 PM) are also extolled.
Fish-vegetarian diets and intermittent fasting are a great way to eat, but not necessarily easy for patients and families. I encourage my patients, especially those with hyperlipidemia, to follow vegetarian diets while eating “anything from the sea except the cow that fell in”. I am also a fan of intermittent fasting and personally used the technique to cure what my wife described as my appearing “24 weeks pregnant”.2 Starting January 1, not long after a New England Journal of Medicine review of the topic,3 I stopped eating breakfast and lunch and only ate dinner. I was previously on “the see food diet” (you see food and then eat it), but found remarkably little hunger with intermittent fasting. Unfortunately, I find many of my patients unwilling to follow fish/vegetarian diets and to pursue intermittent fasting despite my encouragement. We should still encourage best dietary practices, but I remain a drug dealer … legal drugs.4 I push statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, metformin, and sodium glucose transport-2 (SGLT2) inhibitors and use all the anti-hypertensives available. The present review advocates for a specific approach, but is useful because it reminds us of the utility of diet and calorie control. We should all advocate for similar diets, but also be grateful for the wonderful medications we have available. They are for me the gold standards for cardiovascular health.
References
- O’Keefe JH, Torres-Acosta N, O’Keefe EL, et al. A pesco-mediterranean diet with intermittent fasting: JACC review topic of the week. Journal of the American College of Cardiology. 2020;76(12):1484–1493.
- Thompson PD. https://medium.com/@pauldthompsonmd/me-my-ketogenic-diet-8e300e16e53c. (accessed 30 Sept 2020).
- de Cabo R, Mattson MP. Effects of intermittent fasting on health, aging, and disease. N Engl J Med. 2019;381(26):2541–2551. doi: 10.1056/NEJMra1905136 [doi].
- Thompson PD. Editorial commentary: Confessions of a drug dealer. Trends Cardiovasc Med. 2018;28(8):532–533. doi: S1050–1738(18)30104-X [pii].
This was originall published in Practiceupdate Commentaries
