Mindful Eating

Michael J. Muschel, MD FACC MS

Open the newspaper, turn on the radio or television, or read the magazine covers in the checkout line at the supermarket and you’ll be bombarded with tips and tricks for weight loss. Eat for your blood type, or only raw produce, or no carbs, or protein shakes, or powerhouse smoothies. Our country has a mind-boggling obsession with WHAT to eat for weight loss but precious little focus on HOW to eat.

This point was driven home powerfully during my recent trip to Southern France. On the final day of the trip, members of our tour group sat and reminisced about the week we had spent together and discussed what each of us found the most interesting. What did I find particularly interesting? A quizzical look on our tour guide’s face one afternoon.

Let me explain. We were returning from shopping and browsing in a small village market. As we boarded the tour bus, our guide – a genteel and elegant French woman – stared at something in the hands of one of the members of our tour. “Where did you get that?” she asked, incredulous. “That’s very unusual since most stores wouldn’t sell that here.”

The item in question? A cup of coffee in a paper to-go cup. “Look out the window at the people on the street,” the guide continued. “Do you see anyone holding a coffee to-go? Certainly not!” And she proceed to explain that in Provence, a person who wants coffee sits down in a cafe, often in the company of another, and is served coffee. Seated. At a table. The coffee is served in a china or ceramic mug. That’s the way the French people drink – with more attention to HOW than to WHAT. And that’s the way they eat.

What a great lesson. It brought to mind the cardiologist’s “French paradox”– the famous observation that the French do not have much heart disease, especially considering the croissants, butter, creamy dressings, and desserts that are staples of their cuisine.

Could the regular intake of red wine, with its heart-protective antioxidant compounds, explain this? Maybe. But an equally compelling explanation is the French way of eating, which contrasts dramatically with the eating habits in the US and other Western countries. This not a new observation, nor even my own. Mireille Guiliano, wrote her best-selling book, “French Women Don’t Get Fat,” based on this idea. For me, seeing the idea live, looking at that busy pedestrian-packed street with nary coffee cup to be found, eating rich dinners French-style for an entire week in a French chateau, and taking mental notes was uniquely instructive.

What are some of the characteristics of French eating? They are eating-related practices that reflect mindful eating that is never distracted or absent-minded, hurried, or multitasked.

The phrase “mindful eating” refers to being actively engaged and fully present in our culinary experiences. In contrast, mindless eating implies the very opposite, eating when distracted and without full awareness, a practice that can cause you to eat too much.

I have a new commitment to eat more like the French, and be slimmer and healthier for it. I encourage you to give it a try.

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For Heart-healthy Eating, Try Mediterranean

Michael J. Muschel, MD FACC MS

In early 2013, The New York Times reported on a scientific study that adds another bit of support to the link between a Mediterranean-style diet and heart disease prevention. Since the 1950s, we have known that people living in countries and regions bordering the Mediterranean Sea — Southern Italy, Greece, Spain — have less heart disease than people living in other westernized countries.

Epidemiologists and scientists have long suspected that the “Mediterranean diet” common to these populations, one that is high in fruits and vegetables, whole grains, legumes, nuts, and olive oil and includes red wine, while restricting red meats and dairy products, is responsible for this health benefit.

Observational studies over the years have indeed confirmed that population groups whose diet closely adheres to these Mediterranean dietary principles have a lower risk of heart disease. But these early reports on large groups of people needed to be confirmed by clinical trials that track and compare the health of subjects who are randomly assigned to different diets.

Dietary Modifications Save Lives

The first of such randomized clinical trials, the Lyon Heart Study, began in 2001. In this French study, patients who had suffered a heart attack (myocardial infarction, or MI) were randomized to follow either a carefully supervised Mediterranean diet or a standard low-fat, low-cholesterol diet. The Mediterranean diet group had dramatically lower incidence of recurrent heart attacks, supporting the idea that dietary modifications could indeed save the lives of heart disease patients.

So what makes this study so exciting?

It was the gold standard, a large, randomized clinical trial that looked at whether heart disease might be outright prevented by following a specific diet. This means that the results can be applied to the general population at large rather than just to those with heart disease or a history of heart attacks

30% Lower Occurrence of Heart Attacks

The 7,500 individuals enrolled in this new study, conducted in Spain, had heart disease risk factors, e.g., smoking, high blood pressure, family history of heart disease, and/or high blood cholesterol but were healthy otherwise. About one-third were instructed and regularly coached in the details of a traditional heart-healthy, low-fat diet. Another third were instructed in the specifics of a Mediterranean diet and were closely monitored. This group also received large quantities of olive oil for daily use. The remaining one-third also regularly received guidance and provided feedback on Mediterranean eating, but was supplied with large quantities of nuts. After about five years, the number of new heart attacks, strokes and cardiac deaths was 30 % lower in each of the Mediterranean diet groups as compared with the low- fat group. This study supports the potential role of the Mediterranean diet in preventing cardiovascular disease.

Start Eating Mediterranean Now

Can this good news motivate those of us at risk for heart disease to eat in a more heart-healthy way? Some of my patients despairingly tell me that it is too late for them since their blood vessels and heart are too far gone. That’s not true. The average age of subjects in this most recent study was over 60 years!! Even participants with years of heart-unhealthy eating lowered their risk after switching to a Mediterranean diet. I also hear from patients that diet won’t make a difference because they already are taking Lipitor, Crestor or another cholesterol-lowering drug. They’re wrong. Many of the patients in the Spanish study were in fact taking these very medications and still benefited. This shows that diet and medication work together for even greater effects – each is good and both are better.

So start today by making one or two small changes to bring more Mediterranean foods into your diet. Your heart, and your taste buds, will thank you!

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