Too much Southern food can cause a sudden heart attack, but Mediterranean diet reduced risk

You don't have to be Southern to love fried chicken, buttered biscuits, sausage gravy, sweet tea or any of the other fried and fat- or sugar-laden foods typical of this American region.

But a new study found eating a steady diet of traditional Southern food can make you 46% more likely to die from a sudden cardiac death -- that's when the heart suddenly stops -- than people who don't often eat those foods.

Sudden cardiac death is a common cause of death and "accounted for 1 in every 7.5 deaths in the United States in 2016, or nearly 367,000 deaths," according to an American Heart Association statement. When this type of heart attack occurs, the AHA says, death typically comes within an hour.

The study, published Wednesday in the Journal of the American Heart Association, also examined the impact of eating a Mediterranean-style diet on the risk of sudden cardiac death.

Researchers found people who most closely followed the traditional Mediterranean diet had a 26% lower risk of sudden cardiac death than people who rarely ate the Mediterranean way. However, this was only true for people with no history of coronary heart disease at the start of the study.

"Improving one's diet -- by eating a diet abundant in fruits, vegetables, whole grains and fish such as the Mediterranean diet -- and low in fried foods, organ meats and processed meats, characteristics of the Southern-style dietary pattern, may decrease one's risk for sudden cardiac death," said lead author James Shikany, in a statement.

Shikany is a professor of medicine and associate director for research in the Division of Preventive Medicine at the University of Alabama at Birmingham.

Stroke belt

In what researchers are calling the first observational study to evaluate the role of dietary patterns in sudden cardiac death, the team analyzed data from a national study called Regards (Reasons for Geographic and Racial Differences in Stroke).

Sponsored by the National Institutes of Health, Regards was designed to discover why "Southerners and Black Americans have higher rates of stroke and related diseases that affect brain health." The study enrolled 30,239 Black and White participants between 2003 and 2007 and followed them for 10 years.

Shikany and his team examined data from some 21,000 people. More than half were from the "stroke belt," an area of 11 states in the Southeast where rates of stroke are traditionally high. For this study, those states included North Carolina, South Carolina, Georgia, Tennessee, Alabama, Mississippi, Arkansas and Louisiana.

According to the US Centers for Disease Control and Prevention, people who live in the stroke belt are two to four times more likely to die from stroke than in other regions of the country. Prior studies have shown that people eating a predominately Southern diet had a higher risk of death from any cause and a greater risk of coronary heart disease.

The study raised some interesting health equity and food security concerns, said Dr. Stephen Juraschek, a member of the American Heart Association's Nutrition Committee, who was not involved in the study.

"The authors describe the 'Southern Diet' based on the U.S. geography associated with this dietary pattern, yet it would be a mistake for us to assume that this is a diet of choice," said Juraschek, in a statement.

"The gap in healthy eating between people with means and those without continues to grow in the U.S., and there is an incredible need to understand the complex societal factors that have led and continue to perpetuate these disparities," he added.

Five dietary patterns

The study looked at five dietary patterns: People who regularly ate sweets; those who mostly ate fast food and other convenience items; a "salad and alcohol" pattern which mixed beer, wine and alcohol with salad fixings; a plant-based diet (such as Mediterranean); and the traditional Southern diet.

"All participants had some level of adherence to each pattern, but usually adhered more to some patterns and less to others," Shikany said. "For example, it would not be unusual for an individual who adheres highly to the Southern pattern to also adhere to the plant-based pattern, but to a much lower degree."

Besides the decrease in risk for sudden heart attack from a plant-based diet, the study also found something unusual: People with a history of heart disease who ate a lot of sweets had a 51% lower risk of sudden cardiac death than those who ate few sweets.

Why would that be? Researchers had no idea, saying there was "no viable explanation for the inverse association of the sweets dietary pattern with risk of sudden cardiac death in those with a history of coronary heart disease."

Plant-based diets

It's not surprising that a plant-based diet was shown to be healthier for the heart. Three plant-based diets, the Mediterranean, the Ornish and the DASH diet tied for the top spot in the 2021 U.S. News and World Report ranking of best heart-healthy diets.

The Ornish diet was created in 1977 by Dr. Dean Ornish, founder of the nonprofit Preventive Medicine Research Institute in California. Ornish calls the diet the only scientifically proven program to reverse heart disease in a randomized clinical trial without drugs or surgery. Experts have said the diet is restrictive and hard to follow, however.

The DASH diet is often recommended to lower blood pressure. Studies have shown that following the DASH diet can reduce blood pressure in a matter of weeks.

Its premise is simple: Eat more veggies, fruits and low-fat dairy foods while cutting way back on any food high in saturated fat and limit your intake of salt.

The meal plan includes three whole-grain products each day, four to six servings of vegetables, four to six servings of fruit, two to four servings of dairy products and several servings each of lean meats and nuts/seeds/legumes.

The Mediterranean diet features simple, plant-based cooking, with the majority of each meal focused on fruits and vegetables, whole grains, beans and seeds, with a few nuts and a heavy emphasis on extra virgin olive oil.

Say goodbye to refined sugar and flour except on rare occasions. Fats other than olive oil, such as butter, are consumed rarely, if at all.

Red meat can make a rare appearance, usually only to flavor a dish. Instead, meals may include eggs, dairy and poultry, but in much smaller portions than in the traditional Western diet. Fish, however, are a staple.

Numerous studies have found the Mediterranean diet can reduce the risk for diabetes, high cholesterol, dementia, memory loss, depression and breast cancer. Meals from the sunny Mediterranean region have also been linked to stronger bones, a healthier heart and longer life.

"To the extent that they can, people should evaluate the number of servings of fruit and vegetables they consume each day and try to increase the number to at least 5-6 servings per day, as recommended by the American Heart Association," Juraschek said in the statement. "Optimal would be 8-9 servings per day."

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