Mediterranean Diet Improves Cardiovascular Health, Studies Say; see how to do it

In the 1950s, researchers from around the world undertook a comprehensive and ambitious study. For decades, they have analyzed the diets and lifestyles of thousands of middle-aged men living in the United States, Europe and Japan, and then examined how these traits impacted their risk of developing cardiovascular disease.

The Seven Countries Study, as it later became known, became famous for discovering associations between saturated fat, cholesterol levels and coronary heart disease. But the researchers also reported another noteworthy finding: People who lived in the Mediterranean region — countries like Italy, Greece and Croatia — had lower rates of cardiovascular disease than participants who lived elsewhere. Her diet, rich in fruits, vegetables, legumes, whole grains, nuts, seeds, lean proteins and healthy fats, appeared to have a protective effect.

Since then, the Mediterranean diet has become the mainstay of heart-healthy eating, with well-studied health benefits including lower blood pressure and cholesterol, and reduced risk of type 2 diabetes.

“It’s one of the few diets that has the research to back it up,” says Sean Heffron, a preventive cardiologist at New York University Langone Health Hospital. “It’s not a diet invented by someone to make money. It’s something that has been developed over time by millions of people because it’s really tasty. And it turns out to be healthy.”

Here are some of the most studied questions about the Mediterranean diet, answered by experts.

What is the Mediterranean Diet?

The Mediterranean diet isn’t exactly a strict eating plan but a lifestyle, says Julia Zumpano, a registered dietitian specializing in preventive cardiology at the Cleveland Clinic in Ohio. People following the Mediterranean diet tend to “eat foods that your grandparents would recognize,” Heffron adds. Whole, unprocessed foods with little or no additives.

The diet favors whole grains, fruits, vegetables, legumes, nuts, herbs, spices and olive oil. Fish rich in omega-3 fatty acids, such as salmon, sardines and tuna, are the preferred source of animal protein. Other lean animal proteins, such as chicken or turkey, are consumed to a lesser extent. And foods high in saturated fat, like red meat and butter, are rarely eaten. Eggs and dairy products such as yogurt and cheese can also be part of the Mediterranean diet, but in moderation. Moderate consumption of alcohol is permitted, such as a glass of wine with dinner.

Breakfast could be mashed avocado with whole-wheat toast, fresh fruit and a low-fat Greek yogurt, Heffron points out. For lunch or dinner, a plate of vegetables and grains cooked in olive oil and seasoned with herbs: roasted root vegetables, leafy greens, some hummus and small portions of pasta or wholemeal bread, with a protein lean like grilled fish.

“It’s very easy to follow, very sustainable, very realistic,” says Zumpano.

What are the health benefits?

Several rigorous studies have found that the Mediterranean diet contributes to improved health in many ways, especially heart health. In a study published in 2018, researchers evaluated nearly 26,000 women over the age of 12 and found that those who adhere to the Mediterranean diet consistently had an approximately 25 percent lower risk of developing cardiovascular disease.

This was mainly due to changes in blood sugar, inflammation and body mass index, the researchers reported. Other studies, involving both men and women, have come to similar conclusions.

Research has also found that diet can protect against oxidative stress, which can cause DNA damage, contributing to chronic conditions such as neurological disease and cancer. And some studies suggest it may help reduce the risk of developing type 2 diabetes.

The diet may also have profound health benefits during pregnancy, says Anum Sohail Minhas, assistant professor of medicine at Johns Hopkins Medicine. In a recent study of nearly 7,800 women published in December, researchers found that those who followed the Mediterranean diet more strictly around the time they conceived and during the early stages of pregnancy had an approximately 21 percent lower risk of complications. of pregnancy, such as preeclampsia, gestational pregnancy, diabetes or premature birth.

“There definitely seems to be a protective effect,” says Minhas.

But the Mediterranean diet alone isn’t a cure-all, Heffron points out. It doesn’t eliminate the chances of developing cardiovascular disease and it doesn’t even cure a disease. It’s important for people to heed other principles of good heart health as well, such as exercising regularly, getting enough sleep, and not smoking.

Does the Mediterranean diet help you lose weight?

Dieting can lead to weight loss, Zumpano says, but you still need to watch your calories.

“Foods rich in nutrients aren’t necessarily low in calories,” says Heffron, who notes that the diet includes foods like olive oil and nuts, which are heart-healthy but high in calories and can lead to an increase of weight when consumed in large portions. . But if you’re changing your diet from, say, one high in calories, saturated fat and added sugar to one that prioritizes leaner vegetables, fruits and proteins, that could result in some weight loss, she says.

The Mediterranean diet does not want to be a gimmick to lose weight quickly. Instead, it should inspire long-term change in eating behavior. In a study of more than 30,000 people living in Italy, for example, researchers found that those who strictly followed the Mediterranean diet for about 12 years were less likely to be overweight or obese than those who followed the Mediterranean diet with less constancy.

A smaller study, released in 2020, enrolled 565 adults who had intentionally lost 10 percent or more of their body weight in the previous year. It was found that those who reported strictly following the Mediterranean diet were twice as likely to maintain their weight loss as those who did not strictly follow the diet.

How long does it take to get the benefits?

If you’re just starting out on the Mediterranean diet, limited evidence suggests there may be some cognitive improvements — including attention, alertness and contentment, according to a review of studies published in 2021 — within the first 10 days or so. But for there to be sustained rewards in terms of heart health over the long term, people need to practice it optimally throughout their lives, says Zumpano.

That said, she adds, the diet allows for some flexibility — an occasional pie or steak won’t undo its overall benefits.

Are there any downsides?

The diet generally offers a balanced mix of nutrients and adequate protein, so there aren’t typically significant risks associated with sticking to it, says Heffron.

However, since the diet recommends minimizing or avoiding red meat, it’s wise to make sure you’re getting enough iron. Good sources of iron include nuts, tofu, legumes, and dark leafy greens like spinach and broccoli.

Foods rich in vitamin C, such as citrus fruits, peppers, strawberries and tomatoes, can also help the body absorb iron. And since the diet minimizes dairy, you may want to talk to your doctor about whether you need to take a calcium supplement.

Still, for the average person, the benefits of the Mediterranean diet likely outweigh any potential downsides, Minhas says. “These are things we can all try to include in our lives.”

Translated by Luiz Roberto M. Gonçalves

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