News of the sudden death of entertainers and athletes in their prime has raised the alarm bell that heart disease may attack the younger generation. In addition to regular health screening, eating habits are the first line of defense against heart disease or its progression.

For the third year in a row, the Mediterranean diet has been named the No. 1 overall healthy diet and No. 2 heart healthy diet, according to the 2020 U.S.News & World Report.

Mediterranean diet

The Mediterranean diet is a way of eating that’s based on the traditional cuisines of Greece, Spain, France, Italy and other southern European countries that border the Mediterranean Sea. Vegetables and fruits, fish, whole grains, legumes and olive oil are the foundation of the diet.

Mediterranean diet’s benefits to health shown by epidemiological studies and randomized clinical trials:

• Lower the low-density lipoprotein (or “bad”) cholesterol levels and blood pressure, and lower the risk of cardiovascular death from heart disease.

• Weight management

• Lower the risk of Type 2 diabetes

• Reduces the risk of certain types of cancer

• Improve brain function

• Good for eye health

• Prolong life

• Joint health

A 2020 study published in the Journal of the American College of Cardiology suggested that a traditional Mediterranean diet, combined with intermittent fasting, was more positively protective of cardiovascular health.

Key ingredients of the Mediterranean diet:

Fish and seafood are an important part of the Mediterranean diet. The 2015-2020 Dietary Guidelines for Americans recommended adults eat at least two servings of fish and/or seafood (no frying) per week, totaling at least 8 to 10 ounces per week (about 240 to 300 grams per week).

Extra virgin olive oil is the daily cooking oil in the Mediterranean diet. It contains polyphenols with high biological activity, which can protect heart health through reducing low-density lipoprotein (or “bad”) cholesterol and increasing high-density lipoprotein (or “good”) cholesterol levels and improving vascular response. Studies have found that the group on Mediterranean diet supplemented with extra virgin olive oil had a statistically significant 29% reduction in deaths from myocardial infarction and stroke.

Nuts, a part of the traditional Mediterranean diet, are rich in nutrients. Studies have shown that nut intake is associated with reduced morbidity and mortality from cardiopulmonary disease and coronary heart disease, as well as reduced risk of atrial fibrillation and diabetes. One serving of mixed nuts per day can help lower a 28% risk of cerebrovascular disease.

Legumes also play a central role in the traditional Mediterranean diet, and their intake has been associated with a reduced risk of cardiovascular disease, as well as improvements in blood sugar, cholesterol, blood pressure and body weight. Legumes, like fish/seafood, are protein substitutes for red and processed meats.

The study also suggests that intermittent fasting, i.e. limiting daily eating to 6 to 12 hours, can improve glucose metabolism, reduce the risk of diabetes, systemic inflammation, cardiovascular disease, cancer and neurodegenerative diseases. (PS: The combination of the traditional Mediterranean diet and intermittent fasting is a hypothetical pattern and requires more prospective and randomized studies.)

The Mediterranean diet emphasizes the intake of fruit and vegetables; According to USDA recommendations, we should have at least half a plate of fruits and vegetables for each meal, which shows how the nutrients in vegetables and fruits can effectively protect the cardiovascular system. 

A study published in the international journal Circulation in 2021 found that people who ate about 5 servings of fruits and vegetables, or 2 servings of fruits and 3 servings of vegetables, had a 12% lower rate of death from cardiovascular disease, a 10% lower rate of death from cancer, and even a 35% lower death from respiratory diseases. However, it should be noted that the consumption of starchy vegetables (such as potatoes, corn, and peas) and fruit juice was not associated with the study results.

A healthy diet and lifestyle are the best weapons to fight against cardiovascular disease, according to the American Heart Association. And here are the suggestions given:

1. First, it is important to understand the individual’s energy intake needed every day, and do physical activity, to maintain a healthy weight.

2. Have meals based on the Mediterranean diet pattern which emphasizes:

• All kinds of fruits and vegetables

• Whole grains

• Low-fat dairy products

• Skinless poultry and fish

• Nuts and beans

• Extra virgin olive oil

Limit the consumption of saturated fat, trans fat, sodium, red meat, candy and sugary drinks.

The example of heart-healthy meals (1500 kilocalorie)

Breakfast: Steamed pumpkin with cheese (85g pumpkin + 1 slice of cheese + chopped nuts)+ 240ml low-fat milk + 85g grapes.

Lunch: Rice 70g + tofu 200g + sweet pepper and mushroom 100g

Dinner: Whole-wheat pasta 70g + Salmon 105g + Spinach 200g

Dinner Snack: 2 Passion Fruits

References:

【1】Fruit and Vegetable Intake and Mortality Circulation. 2021;143:1642–1654.

【2】A Pesco-Mediterranean Diet With Intermittent Fasting: JACC Review Topic of the Week J Am Coll Cardiol.?2020 Sep 22;76(12):1484-1493.