The StepMother’s Habits

or Extra virgin olive oil, nuts and the PREDIMED data.....

DNC Draft 1

June 13, 2013



My stepmother has two interesting habits that I’ve been thinking about of late, habits that I think we might do well to copy.


I’ve been thinking because I’ve just finished writing another commentary for the Natural Medicine Journal.  Those of you who subscribe will see it in a few months.


My new review was about how nuts and extra virgin olive oil improve cognition.  That last word, cognition, means how clearly you can think about something.  If you move in the opposite direction you head toward Alzheimer’s.  We want to improve cognition.


Anyway this new study will seem familiar to many of our readers as the researchers used the same volunteers that Estruch et al did last winter when they reported that nuts and extra virgin olive oil decreased risk of stroke and heart attacks (CVD) by about 30%.


That first study on CVD is called the PREDIMED study and was conducted in Spain from May 2005 to December 2010.  It compared two large groups of people following a Mediterranean diet (supplemented with either extra virgin olive oil or mixed nuts) and compared them against a similar group told to follow a low-fat diet.  This newer study simply enrolled participants from the initial trial and gave them some fancy neuropsychological tests to see if there was a difference in how their brains were working based on which dietary intervention they had been assigned to in the first study.

Only 522 people ended up taking part in this second study.  They were kept track of for about 6.5 years.  Mean age was 74.6 and a bit less than half (44.6%) were men.  All participants were at high risk of CVD.


In the initial study, participants were divided into three groups.  Two groups were encouraged to follow a Mediterranean diet.  One of these groups was supplied with supplemental extra virgin olive oil, one liter per week, while the second group was supplied with mixed nuts.  Those receiving olive oil were encouraged to consume ¼ cup per day. Those receiving nuts were told to eat 30 grams per day.  The third group was encouraged to follow a low-fat diet. The neuropsychological tests for cognitive function were given after 6.5 years of following the diets.


People in the group given extra virgin olive oil got higher scores on these tests than any other group, especially those told to follow a low fat diet. There were no significant differences between the nut group and the low fat control group initially.  However, in multivariate regression analyses, (once the statisticians worked the numbers) both the olive oil group and the nut group scored higher than the control group.


There were 60 cases of mild cognitive impairment (MCI) in the entire group of 522 people, 18 in the olive oil arm, 19 in the nut arm and 23 in the low fat arm of the study.  There were 35 cases of dementia in the total group, 12 in the olive oil group 6 in the nut group and 17 in the low fat arm of the study.


If you recall my first article on Estruch et al’s study on CVD, you will remember that I think parts of their study are bogus.  People didn’t change their diets enough to make a difference.  They all ate more or less the same way, the only difference was that those given free extra virgin olive oil ate it instead of regular cheap olive oil (this was Spain after all).  Those given nuts, ate more nuts and those told to eat a low fat diet continued to eat much as they did at the start of the study, basically a Mediterranean style diet.  (This was Spain after all).


This was Spain after all, and even the control group, the people who were supposed to be on a low fat diet, ate a lot of olive oil.  One year into the study, nearly 92% of those in the “low fat diet” group reported that olive oil was their primary culinary fat and nearly 60% of these ‘low fat diet’ people reported eating more than two ounces of olive oil per day.


The bottom line is that we should be trying to eat more nuts and olive oil (of the extra virgin sort).  Trying to really change our diets, may be wasted effort for the most part.


How do we eat more of these two foods? Or eat more of one of these foods?


This brings me back to my stepmother.


The first of her habits I’ve tried to copy is that she warms the dinner plates in the oven before serving food on them. When you consider that she lives in Alberta, this makes sense. Her plates often come out of the kitchen cabinets ice cold. I’ve started warming our plates during the winter.    But this isn’t the habit I was thinking of.


When she comes down to the kitchen each morning, the first thing she does is to cut up a pile of fresh fruit into bite sized chunks and leaves them out on a platter on the counter.  During the day we all snack on them.  They are hard to resist, one bite at a time, they disappear. By day’s end, the plate is empty; we’ve all consumed several servings of fruit. 


We are trying the same thing with nuts.  Each morning I’m going to put out a bowl for each of us and weigh out an ounce of nuts into each.  I bet if they are sitting out on the counter they will disappear before bedtime.


I haven’t figured out what to do about the oil yet.  I’m thinking about marking our oil bottle each week to track our consumption, to see if it’s even possible for us Americans to consume a liter per week like these study participants did.




There is plenty of data from other studies to suggest that Mediterranean diet does prevent cognitive decline.  Tangney et al reported in 2011 that a higher score on Mediterranean diet adherence was associated with slower cognitive decline in a cohort known as the Chicago Health and Aging Project (CHAP). CHAP participants (2280 blacks and 1510 whites) as the name suggests, were drawn from Chicago, Illinois.


A May 2013 meta-analysis combined data from 22 studies looking for a connection between how closely people followed a Mediterranean and risk of Parkinson’s, depression and cognitive impairment.  “High adherence to Mediterranean diet was associated with a 29% reduced stroke risk , a 32% lower risk of depression and a 40% reduction in risk of cognitive impairment.


Though these clinical trials do not prove it, following the Mediterranean diet may certainly be helpful both at lowering risk of CVD and preventing cognitive decline.  The question is whether we can convince people to change their diet?






Estruch R, Ros E, Salas-Salvadó J, Covas MI, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. N Engl J Med. 2013 Feb 25.


Martínez-Lapiscina EH, Clavero P, Toledo E, Estruch R, Salas-Salvadó J, San Julián B, Sanchez-Tainta A, Ros E, Valls-Pedret C, Martinez-Gonzalez MA. Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomised trial.

J Neurol Neurosurg Psychiatry. 2013 May 13.


Tangney CC, Kwasny MJ, Li H, et al. Adherence to a Mediterranean-type dietary

pattern and cognitive decline in a community population. Am J Clin Nutr



Psaltopoulou T, Sergentanis TN, Panagiotakos DB, Sergentanis IN, Kosti R, Scarmeas N. Mediterranean diet and stroke, cognitive impairment, depression: A meta-analysis. Ann Neurol. 2013 May 30.