It has been well documented that a Mediterranean Diet (MD) can have resounding effects on lowering cardiovascular risks. In fact, a systematic review ranked the Med Diet most likely to provide protection against coronary heart disease. It originates in the regions surrounding the Mediterranean Sea and the food cultures that have been established there. The MD first showed cardioprotective effects in Ancel Keys’ Seven Countries Study, where it was observed that there were fewer cardiovascular disease states in the seven countries surrounding the Mediterranean basins. Many studies have been published to date on the Mediterranean diet as a whole and on individual items included in it.
In a major study of the MD, researchers analyzed the diet and health outcomes of 25,994 women for 12 years. Those most closely following a Mediterranean diet were 28 percent less likely to develop heart disease than those not following a Mediterranean diet. Even those who were only moderately following a Mediterranean diet had a 23 percent lower risk of heart disease, indicating that even small lifestyle changes can have a meaningful impact on health. The researchers suspect that part of the heart health benefits might be related to lower inflammation, as women most closely following the Mediterranean diet had significantly lower levels of biomarkers of inflammation.1
Now that we have a sense of how powerful this eating pattern can be on heart health, let’s take a deeper dive into what the Mediterranean diet is. It is important to note that the diet is more than a diet in traditional form, but rather, a lifestyle. It encompasses social interaction, mindfulness at mealtimes, stress management, and daily physical activity. The core of dietary intake is plant-based with a strong emphasis on local, seasonal fruits and vegetables, whole grains, beans, herbs and healthy fats such as olive oil and nuts/seed. Fish and seafood are the primary protein sources, enjoyed 2-3 times per week. Other central protein sources are yogurt, cheese and poultry. A “sometimes” category includes meats and sweets, which are enjoyed sparingly. Water is the primary beverage of choice, but individuals who drink alcohol enjoy small amounts of red wine daily at mealtime.
Let’s take a closer look at a few essential ingredients of the MD and some research surrounding them:
Olive oil and nuts: One of the most highly regarded landmark studies that assessed the effects of the Mediterranean Diet on the primary prevention of cardiovascular disease is the PREDIMED (translated to Prevention with Mediterranean) study. In this study, roughly 7,000 Spaniards at high risk of heart disease (but without a diagnosis) were followed over 5 years and enrolled in 1 of 3 diets: MD supplemented with extra virgin olive oil, MD supplemented with nuts/seeds or a low-fat diet (control). The results showed a Mediterranean Diet including nuts or olive oil reduced the risk of cardiovascular diseases by 30 percent and reduced the risk of stroke by 49 percent when compared to the low-fat control diet.2
In another large study of U.S. men and women, researchers found that higher intake of olive oil was associated with significantly lower risk of cardiovascular disease and coronary heart disease and that replacing margarine, butter, mayonnaise, and dairy fat with olive oil was associated with lower incidence of cardiovascular events.3
Fish: It is now estimated that individuals whose diets include a higher intake of fish, particularly those high in Omega-3s, reduce their risk of heart disease by roughly 47 percent of those individuals who do not. So, how much should you consume? Based on research, it is recommended that eating fish twice a week will provide distinct health benefits. This translates into 10-12 oz. of fish per week, or roughly 200-400 mg of Omega-3 fatty acids per day.4
Beans: A powerhouse with cholesterol-lowering fiber, beans tout 8 grams of fiber per ½ cup serving. Did you know that they also are rich in many other elements that contribute to heart health, including antioxidants, magnesium, B6 and folic acid? Folic acid and Vitamin B6 have been shown to reduce homocysteine-A, elevated levels of which are an independent risk factor for certain vascular diseases and are found in 20-40 percent of patients with heart disease.
Dark Leafy greens: Results of a recent study indicate that eating 1 cup of dark leafy greens per day can significantly reduce your risk of heart disease. This study examined data from ~50,000 individuals over 23 years and found that people who consumed the most nitrate-rich vegetables had about a 2.5 mmHg lower systolic blood pressure and between 12 to 26 percent lower risk of heart disease. The greatest reduction in risk was for peripheral artery disease (26 percent), but they also found people had a lower risk of heart attacks, stroke, and heart failure.5
We know that dietary choices are a modifiable risk factor for heart disease. We have only scratched the surface of the heart-health benefits of the Mediterranean Diet and a few of its all-stars, I encourage you to leap into incorporating Mediterranean-inspired meals into your repertoire. Flavorful and functional, your taste buds and heart will thank you!
1- JAMA Network Open. 2018 Dec 7;1(8):e185708. doi:10.1001/jamanetworkopen.2018.5708 (Ahmad S et al.)
2- Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet [retracted in: N Engl J Med. 2018 Jun 21;378(25):2441-2442]. N Engl J Med. 2013;368(14):1279-1290. doi:10.1056/NEJMoa1200303
3- Guasch-Ferré M, Liu G, Li Y, et al. Olive Oil Consumption and Cardiovascular Risk in U.S. Adults. J Am Coll Cardiol. 2020;75(15):1729-1739. doi:10.1016/j.jacc.2020.02.036
4- Bonaccio M, Ruggiero E, Di Castelnuovo A, et al. Fish intake is associated with lower cardiovascular risk in a Mediterranean population: Prospective results from the Moli-sani study. Nutr Metab Cardiovasc Dis. 2017;27(10):865-873. doi:10.1016/j.numecd.2017.08.004
5- Edith Cowan University. “One cup of leafy green vegetables a day lowers risk of heart disease.” ScienceDaily. ScienceDaily, 4 May 2021. <www.sciencedaily.com/releases/2021/05/210504112604.htm>
6- Lăcătușu C-M, Grigorescu E-D, Floria M, Onofriescu A, Mihai B-M. The Mediterranean Diet: From an Environment-Driven Food Culture to an Emerging Medical Prescription. International Journal of Environmental Research and Public Health. 2019; 16(6):942. https://doi.org/10.3390/ijerph16060942