The topic of the Mediterranean diet and cholesterol is a tricky one. For one thing, past generations of Mediterranean populations didn’t really give cholesterol much thought at all. Low cholesterol levels were simply a consequence of an overall healthy lifestyle. In fact, the “discovery” that the Mediterranean diet is heart-healthy was made by the American physiologist Ansel Keyes

Further, the debate about cholesterol levels is not as straightforward as it would seem. There has been a lot of controversy over the importance of cholesterol levels, what those levels should be, and the aggressive prescribing of cholesterol lowering medications. 

For example, when discussing the Mediterranean diet and cholesterol, many countries such as Italy and Spain place their thresholds much higher than in the U.S. In the United States, we are told that total serum cholesterol must be maintained below 200 mmol/L. In Europe and Canada, that number is 240 5.2 mmol/L. A difference of 20%!

And even that might be an exaggeration. There was a documentary made by Spanish journalist Jordi Evole Salvados called, “Overmedicated,” that examined these recommended numbers, and he researched the history behind how they were established. Spoiler alert: the thresholds were tweaked based on economic data rather than scientific data. 

The documentary is in Spanish, but it’s available on YouTube if you’re interested. In Spanish, the title is: Sobremedicados

Below is my summary, which delves into the whole idea of the Mediterranean diet and cholesterol, and how modern medicine has hijacked something that could be managed much more efficiently and economically with food and lifestyle choices. 

Why Has the Importance of Blood Cholesterol Levels Been Oversold?

The documentary Sobremedicados explores the concerns about overmedication in Spain, where it is noted that Spain is the second-highest consumer of pharmaceuticals per capita in the world, after the United States. 

Experts and doctors express their worries about the increasing trend of prescribing medication for minor issues that could be managed without drugs. They highlight the comfort and convenience of prescribing medication and the influence of pharmaceutical companies on doctors’ prescribing habits.

The documentary also delves into the financial incentives for doctors to prescribe certain medications, such as gifts, invitations to conferences, and other benefits provided by pharmaceutical representatives. These practices are criticized for potentially leading to biased prescribing habits that may not always be in the best interest of patients.

Furthermore, the documentary discusses the impact of patent laws on drug prices and the difference between brand-name drugs and generic drugs. It is mentioned that the industry often prioritizes profit over public health, leading to situations where diseases are over-medicated or even medicalized without a genuine need.

The influence of pharmaceutical companies on health policies and the education of medical professionals is also examined. The documentary suggests that there is a need for more independent and unbiased information for both doctors and patients to ensure that medication is prescribed appropriately and that public health is prioritized over profit.

The Mediterranean Diet and Cholesterol Re-Examined

Overall, the documentary raises important questions about the role of pharmaceutical companies in the healthcare system and the need for more transparency and regulation to prevent over-medication and ensure the best outcomes for patients.

In the documentary, it was mentioned that pharmaceutical companies have had a significant influence on the recommended prescription protocols for cholesterol medications. Here’s how it was described:

  1. Lowering Cholesterol Guidelines: Experts in the documentary noted that the guidelines for what is considered “normal” cholesterol levels have been lowered over the years. For example, in the early 1990s, the normal level of cholesterol was considered to be 290, but by the mid-1990s, it was lowered to 270. Nowadays in Spain it is 240 (and even lower in the U.S.). This change in guidelines meant that more people were diagnosed with high cholesterol and, therefore, more people were prescribed cholesterol-lowering medications.
  2. Conflict of Interest: It was revealed that many of the experts who were responsible for setting these cholesterol guidelines had financial ties to pharmaceutical companies that produce cholesterol-lowering drugs. For instance, of the nine members of a particular committee that recommended lowering the cholesterol levels, eight declared conflicts of interest, such as receiving payments from pharmaceutical companies.
  3. Incentives for Doctors: The documentary also highlighted how family doctors and cardiologists were incentivized to prescribe more cholesterol-lowering drugs. Pharmaceutical representatives, also known as “detailers,” would visit doctors and provide them with gifts, meals, and invitations to conferences, which could influence their prescribing habits. Some doctors were even offered more significant incentives, such as trips to conferences in exotic locations, which were often thinly veiled vacations.

These practices raise concerns about the over-medication of patients for the purpose of increasing corporate profits. The documentary suggests that the close relationship between the pharmaceutical industry and the medical community can lead to biased recommendations and over-prescription of medications, which may not always be in the best interest of patients’ health.

Mediterranean Diet to Lower Cholesterol

All of that said, the Mediterranean diet is renowned for its abundance of foods that naturally help manage and lower cholesterol levels. But here’s the important point: the lowering of cholesterol levels is a consequence of the overall healthy lifestyle, and NOT the primary motivation. 

So then, which foods can we choose to incorporate in our daily lives that will help us be more heart-healthy? I’ve discussed all of this at length in various posts throughout this website, but here is a quick summary:

Olive Oil: Central to the Mediterranean diet, olive oil is a primary source of monounsaturated fats. Unlike saturated fats, monounsaturated fats help lower LDL cholesterol without affecting HDL cholesterol. Olive oil is also rich in antioxidants known as polyphenols, which can reduce inflammation and improve cardiovascular health.

Nuts and Seeds: Almonds, walnuts, flaxseeds, and chia seeds are staples in the Mediterranean diet that contribute to heart health. These nuts and seeds are high in plant-based omega-3 fatty acids, fiber, and other heart-healthy fats. Regular consumption of a moderate amount of nuts has been shown to lower LDL cholesterol levels and improve the lining of the arteries.

Whole Grains: Whole grains like oats, barley, and whole wheat are integral to the Mediterranean diet. They contain soluble fiber, which reduces the absorption of cholesterol into the bloodstream. This type of fiber binds with cholesterol in the digestive system and drags it out of the body before it can circulate in the blood.

Fish: Fish, particularly fatty types like salmon, mackerel, and sardines, are important in the Mediterranean diet for their high levels of omega-3 fatty acids. Omega-3s are known for lowering triglycerides (a type of fat in the blood), reducing blood pressure, and decreasing the risk of heart rhythm abnormalities.

Incorporating these foods into your daily diet can significantly impact your cholesterol levels and overall cardiovascular health. By adopting the eating habits of the Mediterranean diet, you can enjoy a flavorful and varied diet that not only enhances health but also supports a sustainable and heart-healthy lifestyle.

Rick Zullo

Former doctor, current science teacher, and life-long food lover, Rick's passion for Mediterranean cuisine was ignited while living as an expat in Rome, Italy. 


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