It is almost noon and doctor Jordi Salas-Salvadó (Reus, 64 years old) still does not know for sure what he will have on the table to eat.
He almost certainly predicts a salad or a good plate of legumes, which is what they usually eat at home "three or four times a week," he says.
The doctor, Professor of Nutrition at the Rovira i Virgili University and principal investigator of the Center for Network Biomedical Research (CIBER) for Physiopathology of Obesity and Nutrition at the Carlos III Health Institute, leads by example: a benchmark in nutrition research and eminence in the study of the health effects of the Mediterranean diet, assures that he takes care of his diet conscientiously, but without dogmatism.
Some cola or a bit of jabugo ham falls from time to time.
"I eat meat, I eat everything,
Salas-Salvadó is presented moved to 2023. Scientifically speaking.
Nature
magazine
, a paradigm of science at the highest level, has highlighted his research in a compilation of clinical trials that will illuminate medicine this year.
The scientific community is waiting for the results of his latest studies on the impact of the Mediterranean diet to prevent cardiovascular diseases.
Question.
Nature
cites his clinical trial as one that will “shape medicine” in 2023. What is he up to?
Reply.
It is a long history of 20 years.
We started with the Predimed study, on the prevention of cardiovascular disease through the Mediterranean diet, and we found a 30% reduction in the incidence of new cases of cardiovascular disease and mortality from this cause in patients who took the Mediterranean diet compared to those who followed a low-fat diet.
And this was an important revolution because it changed the world dietary guidelines: there was always talk that, to prevent disease, the best thing was a low-fat diet;
and here we were not convinced of this because we thought that fat of vegetable origin has many good substances for the body.
And we did this study to prove it.
But we do not stop there: I have been the promoter of this other study [Predimed Plus] that tries to resolve an unresolved question.
It is also a cardiovascular disease prevention study: in people who are overweight or obese and also have metabolic syndrome [conditions with cardiovascular risk, such as hypertension or high cholesterol, among others], but who do not have cardiovascular disease, we try to get people to lose weight with a hypocaloric Mediterranean diet and promotion of physical exercise.
The grace of this is that no one has shown that losing weight, keeping it off for a long time with a healthy diet and physical exercise, prevents the occurrence of myocardial infarction, stroke and mortality from these causes.
Q.
It seems obvious that yes, right?
A.
Yes, but no one has proven it.
We know that when you go on a diet, when you have obesity or diabetes, your blood pressure drops, your metabolism improves... But we don't know if this ultimately has an impact on what is important: that there is more life expectancy and that the end of life is reached with the highest possible quality.
Those who do the Mediterranean diet well are the elderly.
The younger you are, the less trend there is
Q.
How is the study going?
A.
The international community is looking forward to these results enormously.
We have carried out an intervention that has lasted six years: this December we finished it and we are going to follow this population for two more years.
There are two major objectives: to see the effect of the intervention on body composition and on cardiovascular disease.
This year we are going to get the results in relation to body composition, weight and redistribution of fat within the body, which we know is related to cardiovascular risk factors and mortality from this cause.
Q.
If all this research comes out positive, how can the results be specified?
R.
It will change the disease prevention treatment guidelines because we not only look at what happens with cardiovascular diseases, but we also look at the appearance of new types of cancer, we are recording whether diabetes appears or not, what happens with depression or with cognition... We will be able to say if really losing weight with a healthy diet, such as the Mediterranean, has benefits that even go beyond cardiovascular benefits
.
Q.
All your research focuses on the bonanzas of the Mediterranean diet, but really, who follows it?
R.
This is the big problem.
Basically, those who do it well are older people.
The younger you are, the less Mediterranean diet trend there is.
There is not enough evidence to recommend that the population drink small doses of wine”
Q.
Why is this happening?
R.
It is the way we live, that we run and do not give importance to certain things.
Food preparation habits, for example, have been lost.
Before, the whole week's food was prepared;
Now nobody plans anything, people eat what is in the freezer or the fridge, a lot of prepared, ultra-processed food, with a lot of salt, sugar and saturated fat.
Q.
Does adherence to the Mediterranean diet depend on time?
A.
Time plays a role.
To eat legumes, you have to soak them a day before and this, if you have not planned it, you do not do it.
You have the possibility of buying a boat of legumes already prepared, but it is already processed.
And another problem is that we don't have seasonal and local things.
Q.
Does that influence adherence to this diet?
A.
Sure.
The Mediterranean diet is not avocados as they sell us;
avocados will be healthy, but they are not from the Mediterranean diet.
It is a whole set: the food industry pressures us and gives us what we want and it is very difficult to go against this.
The food industry puts pressure on us and gives us what we want
Q.
When it comes to avocados, superfoods and fads often crop up.
Are there many myths in nutrition?
R.
All this about superfoods is absurd.
In the end, there are no good or bad foods, what there is is a correct or incorrect way of eating.
You can diet very well, but go overboard with one thing a lot and spoil the diet.
Or, the other way around: you are on a fast food diet, but you eat a lot of fruit and with this you already think that you are dieting very well: 'I eat avocados or nuts and that's it'.
That is the problem with superfoods, that people think that taking this is already doing things right.
The Mediterranean diet, in the end, is a way of eating healthy.
Q.
You also have controversial points, such as accepting the moderate consumption of wine.
How is it explained?
R.
This is another of the big questions we have.
The wine there is controversial because there are some studies that show that small doses could have a small cardiovascular benefit, but it is not known if it is because of the ethanol itself or because of the polyphenols and other substances it contains.
But, there are no clinical trials behind it and, without them, it is very difficult to make any recommendations.
On the other hand, we know that excessive alcohol is harmful.
So, at this time, there is not enough evidence to recommend that the population drink small doses of wine.
Dr. Salas-Salvadó, at the Faculty of Medicine of the Rovira i Virgili University, in Reus (Tarragona).Gianluca Battista
Q.
But you are on the Mediterranean diet.
Isn't that contradictory?
A.
No. Given the lack of scientific evidence, it is better not to recommend anything.
My philosophy is the following: if you take a reasonable amount [one unit if you are a woman;
two, if you are a man] wine with meals, which is something typical Mediterranean, I do not make any recommendation because there is no evidence that this is bad.
If you take more than this, I have to recommend that you reduce the consumption and if you are an alcoholic person, I have to recommend that you reduce it to zero.
And if you are taking less than this amount that we do not know exactly if it is beneficial, I am not going to recommend that you take it either.
Q.
The incidence of overweight and obesity in the world is skyrocketing.
Also type 2 diabetes. Where is the population failing?
R.
During the last few years, doctors have made a great effort to lower cholesterol and blood pressure with drugs and we have succeeded.
But we have made all the effort here and that is a mistake, because there is a cause of causes.
The cause of having high blood pressure or diabetes is lifestyle.
We all have to have a healthy lifestyle and each time there is a section of the population in developed countries that is more aware of the importance of health.
But there is a population that does not.
And this is directly related to the socioeconomic and cultural level: the higher the level, the more care about yourself;
people of lower social level or with less education, since they give priority to other things than health.
Q.
Isn't this stigmatizing for a part of the population?
R.
The problem is that we are not fair on a social level.
There are social inequalities that produce all this.
Public health strategies have to be made aimed precisely at these populations that are most vulnerable.
The big problem we have is that there are no brave public health strategies, among other things, because there are food multinationals that oppose it.
There are no brave public health strategies because there are food multinationals that oppose it
Q.
What is the weight of the industry in this lack of changes in lifestyle?
How are the responsibilities distributed?
R.
You cannot blame an obese patient, we cannot demonize him.
I think we have to blame society itself and there are strategies that are very easy to implement and are not done.
Q.
For example?
R.
With tobacco we are all clear that if you prohibit smoking in public places, you reduce smoking.
But with food, we are not so incisive.
VAT on food could be a strategy to improve public health.
Q.
It has already been done, taxing sugary drinks.
R.
Yes, timidly, a little bit, and that almost does not change consumption at all.
It has to be recorded well for there to be an effect.
Why not tax those things that we know are being taken in excess in the population and that this is used to put the VAT on fruit to zero?
Q.
And what prevents it?
R.
In this case, it is clear that it is the pressure of some multinationals.
The other thing [in which intervention could be made] is nutritional labels, which the consumer does not understand: there is a lot of information, but people do not look at it and do not understand it.
Against the NutriScore logo [a frontal labeling of foods] there has been a horrible pressure.
Q.
NutriScore has been quite controversial.
R.
Yes, a lot, for the industry.
The food industry is the one that has opposed it.
The problem is that all public health strategies want to be delayed and there is noise, so that they are not implemented or done later.
All of us who are dedicated to this are convinced that we need something clearer on the labels and NutriScore has small flaws, but more than 40 scientific articles defend their position.
There are no good or bad foods, but a correct or not correct way of eating”
Q.
What is the level of knowledge of people about nutrition?
A.
Relatively low.
Among other things, because of the noise there is.
I have been dedicating myself to this for 40 years and I have to listen to being told that the diet of a famous person loses weight.
Everyone has an opinion because everyone eats every day and they think they are a bit of an expert in this.
Q.
There are many miracle diets and superfoods.
A.
There are no miracle diets.
They do not work.
All miracle diets are unbalanced or cannot be carried out in the long term and you have to give up.
It's all lies, diets that sometimes have companies behind them.
What it sells is the miracle diet, the superfood, but there is enormous misinformation.
Q.
Intermittent fasting has also become very fashionable, which has scientific studies with contradictory results.
How do you see it?
A.
There is not enough evidence yet and what is there is controversial, both for [lowering] body weight and for diabetes, for example.
When there is no scientific evidence, you cannot make a recommendation to the population.
It is best to shut up.
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