That Mediterranean Diet Study From 2013, Why Are People Saying The Opposite?

I was reading:

I Was Wrong – We Should Be Feasting On Fat, Says The Fast Diet Author Dr. Michael Mosley, Daily Mail, 17 July 2014

“A study last year put a further nail in the low-fat diet’s coffin. A group of 7,500 men and women were randomly allocated a low-fat diet or a much higher-fat Mediterranean one. On this diet, along with fruit, vegetables, meat and fish, they were to eat oily nuts, olive oil and have a glass of wine with their meal.

Again, the trial was stopped early. But this time it was because those on the Mediterranean diet were doing so much better than those on the low-fat diet, with a 30% drop in heart attacks and strokes.”

Dr. Mosley said the Mediterranean diet reduced heart attacks in the PREDIMED study. It didn’t. Why did he say it did? And why did he say the control group was eating a “low-fat” diet? I blogged about that study when it came out:
Is The Mediterranean Diet Really All That?, 26 February 2013

Here’s the study:
Primary Prevention of Cardiovascular Disease with a Mediterranean Diet, New England Journal of Medicine, 25 February 2013

Three points:

1. The “low-fat” control group was not eating low fat. From Table S7 you can see they were eating 37% of their calories from fat, and the exact same amount of saturated fat (9%) as the Mediterranean diet groups. The American Heart Association says you should be getting less than 30% total and only 5% to 6% saturated. The Cubans and Okinawans get less than 15% total fat. By any standard, this was not a “low-fat” diet. Why does Mosley say it is?

2. The Mediterranean diet did not reduce risk for heart attack. It did not reduce deaths from cardiovascular causes, or deaths from any cause. You can see that in Table 3. It’s right there. Why does Mosley say the opposite? (There was a reduction in strokes which was thought to be a result of more vegetables, fruits, and beans in the Mediterranean diet groups.)

3. 179 people assigned to eat the Mediterranean diet, and who increased their fat intake, experienced a “major cardiovascular event” in the ~4.8 years of the study. They had “no cardiovascular disease at enrollment.” They ate more fat and had heart attacks, in under 5 years! Dr. Esselstyn took people with advanced coronary artery disease, put them on a low-fat plant-based diet, and 12 years later those who were compliant had no more cardiac events!

6 thoughts on “That Mediterranean Diet Study From 2013, Why Are People Saying The Opposite?

  1. Bix Post author

    I think the reason both Mediterranean diet groups had the same number of heart attacks as the control group is because they were eating so much fat. They were getting over 41% of their calories from fat. They were eating a low-carb, high-fat diet with lots of olive oil and nuts and vegetables/fruits but it didn’t prove any better than what was essentially a standard American diet.

    That’s not to say the Mediterranean diet isn’t any good. I think it’s good when it approaches a low-fat, whole food, plant-based diet.


  2. Bix Post author

    Here’s a letter to the NEJM editor that was published in the same journal:

    “The PREDIMED study is highly flawed. The control group did not follow a low-fat diet. This is not surprising, since researchers gave the control group little support in following this diet during much of the study. In the “low-fat” control group, total fat consumption decreased insignificantly from 39 to 37% (Table S7 in the Supplementary Appendix, available with the full text of the article by Estruch et al. at This level of consumption is much higher than the level recommended in American Heart Association guidelines for a low-fat diet (<30% fat) or a diet that can reverse coronary heart disease (<10% fat).1-5 There was no significant reduction in the rates of heart attack, death from cardiovascular causes, or death from any cause. The only significant reduction was in the rate of death from stroke (see Table 3 of the article).”

    It was spun this way, lumped together, to make make it sound better, to justify the study … which was paid for by the California Walnut Commission, the International Nut and Dried Fruit Council, the Mediterranean Diet Foundation, and on…


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  6. Richard Curtin

    Dr Esselstyn—Hero. Tough diet to get used to … but if someone wants to live a long relatively heart disease free life, he builds a strong case for his program. The man has so much integrity! The longer you stay with his program, the easier it gets. Learn a few recipes,… you are on your way.



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