The Mediterranean Diet

The Mediterranean diet is derived from the traditional diets of Greece, southern Italy and Spain.  Its uniqueness relates to the use of olive oil instead of butter and the daily consumption of nuts, legumes, fruits and vegetables.  People in the Mediterranean countries depending on their local (island, valleys or mountains) eat moderate amount of fish, or meat such as poultry and/or dairy products (mostly as cheese and yogurt).  They also drink a low amount of wine and/or spirits.  According to the American Heart Association, there's no one "Mediterranean" diet but a dietary pattern that includes the above-mentioned foodstuff and the use of olive oil a monounsaturated fat that does not raise blood cholesterol.

The incidence of heart disease and death rates in Mediterranean countries is lower than in the United States.  Although diet appears to have a role, other factors such as genetic, lifestyle, physical activity and extended social and family support systems may also play a part.

Before advising people to adhere to a strict Mediterranean diet, well designed and controlled studies are needed to determine whether the diet itself or other factors (genes, lifestyle, social) account for the lower deaths from cardiovascular disease among humans.  The findings from the following two studies are supportive of the beneficial effect the Mediterranean diet and the consumption of nuts has in our health. 

An important multi-center study that was conducted in Spain was published in the New EnglandJournal of Medicine.  The authors evaluated the effect of the Mediterranean diet in the prevention of cardiovascular disease in individuals who were at high risk for cardiovascular events, but with no apparent cardiovascular disease. A total of 7447 persons were enrolled whose age ranged from 55 to 80 years; with a male to female ratio 43 to 57 percent were randomly assigned, to one of three diets: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet (advice to reduce dietary fat). The end point was the rate of major cardiovascular events such as myocardial infarction, stroke, or death from cardiovascular causes. A primary end-point event occurred in 288 participants.  The group assigned to a Mediterranean diet with extra-virgin olive oil experienced 96 events while and the group assigned to a Mediterranean diet with nuts experienced 83 events, respectively, versus 109 events in the control group. On the basis of these results, the trial was stopped after a median follow-up of 4.8 years as the authors concluded that among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events.

According to a study from the USA that was also published in the New England Journal of Medicine, people who ate a daily handful of nuts were less likely to die from any cause over a 30-year period and were more slender than those who didn’t consume nuts.  For their research, the authors analyzed information from the Nurses’ Health Study that provided data on 76,464 women, and the Health Professionals’ Follow-Up Study that provided data on 42,498 men. The researchers report a 29% reduction in deaths from heart disease and an 11% reduction in death rate from cancer.  It appeared that the protective effect was similar to all types of nuts.  Those who ate nuts less than once a week had a 7 percent reduction in mortality; once a week, 11 percent reduction; two to four times per week, 13 percent reduction; five to six times per week, 15 percent reduction; and seven or more times a week, a 20 percent reduction in death rate. 

Based on this and other smaller studies, the U.S. Food and Drug Administration concluded that eating 1½ ounce per day of most nuts “may reduce the risk of heart disease.”

Middle East Respiratory Syndrome (MERS)

The Center for Disease Control (CDC) reports MERS is caused by a coronavirus called MERS-CoV. It was first reported in Saudi Arabia in 2012.  Most patients with the disease develop fever, cough and shortness of breath with a third of them dying. The virus spreads from patients with the disease to others in close contact.  However, there is no evidence of sustained spreading in community settings.

On May 2, 2014, the first U.S. imported case of MERS was confirmed in a traveler from Saudi Arabia to the U.S. The patient flew from Saudi Arabia via London to Chicago and by bus to his final destination in Indiana.  He was diagnosed, placed in isolation, and treated for a week and half at a hospital in Munster Indiana.  Following his treatment he was declared in good health and was released.  On May 11, 2014, a second U.S. imported case of MERS was confirmed in a traveler who also came from Saudi Arabia. The second patient, in Orlando, Florida, is a medical professional from Saudi Arabia who was visiting family in Florida.   On May 16, 2014, an Illinois resident who had contact with the first case of MERS in the U.S. tested positive for MERS-CoV.

The World Health Organization states that it doesn’t yet see the MERS outbreak as sufficient to declare an international emergency.  A WHO committee concluded that though it is extremely concerning, the outbreak was not a public health emergency as transmission has largely taken place in hospitals, not in the general community.

According to the CDC, MERS is considered a deadlier but less transmissible cousin of the SARS virus that appeared in Asia in 2003 and infected 8,273 people, 9 percent of whom died.

Like SARS it causes lung infections, with patients suffering coughing, breathing difficulties and a temperature. But MERS differs in that it also causes rapid kidney failure.  Currently, there is no vaccine or treatment for the virus.  Health authorities say it is transmissible mainly through close person-to-person contact and in health care settings.

Since MERS appeared in Saudi Arabia in 2012, authorities have recorded 514 infections and 157 deaths.  Saudi Arabia “accounts for the vast majority of the 171 deaths and 571 infections from the virus globally.  While most recorded cases have been seen in Saudi Arabia, other neighboring countries where cases of MERS have been appeared are Jordan, the United Arab Emirates, Kuwait, Oman, Qatar, Yemen, and Lebanon.  Countries with travel-associated cases are United Kingdom, France, Tunisia, Italy, Malaysia, Turkey, Greece, Egypt, the Netherlands, and the United States of America.

WHO Report on Antimicrobial Resistance

On April 30, 2014 the World Health Organization (WHO) reported that antimicrobial resistance is happening in every region of the world and considers it a major threat to public health.

Antimicrobial resistance (AMR) threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi. A “post-antibiotic era”, where common infections and minor injuries could kill, is a real possibility for the 21st Century.

The report focuses on antibiotic resistance in seven different bacteria which are responsible for common but serious diseases, including but not limited to sepsis, pneumonia, and gonorrhea. It emphasizes that resistance to common bacteria has reached alarming levels in many parts of the world, and that the surveillance of this resistance is neither coordinated nor harmonized.  While some countries have taken important steps in addressing the problem, the report suggests every country and individual needs to do more; including taking important actions to prevent infections from happening in the first place. 

Fortunately, the WHO provides information on how individuals can help tackle resistance by. Antibiotics should only be used when prescribed by a physician,and users should complete the full prescription and never share with others.  It strongly suggests to physicians and pharmacists to only prescribe and dispense the correct antibiotic when they are truly needed, and to enhance prevention and control instead.  Policymakers and industry can help tackle resistance by fostering innovation and research, and by advocating cooperation among governments, especially on surveillance that generates reliable data.

The World Health Organization's recent report is not the first mention of this developing situation. In September 2013, the US Centers for Disease Control and Prevention warned of ‘potentially catastrophic consequences’ of drug-resistant microorganisms.  The

CDC estimates that in the United States more than two million people are sickened every year and at least 23,000 are dying as a result.

The report–which also includes information on resistance to medicines for treating other infections such as HIV, malaria, tuberculosis and influenza–provides the most comprehensive picture of drug resistance to date, incorporating data from 114 countries.

Update September 19, 2014:  John Holdren, President Obama’s chief science adviser, called "the problem of antibiotic resistance a potential threat to the nation and the world” that poses “a serious domestic and international challenge to human and animal health, national security and the economy.” At a news conference, Centers for Disease Control and Prevention Director Thomas Frieden, MD, MPH pointed out that antibiotic resistance “is connected to at least 23,000 deaths and two million illnesses each year.”