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Mediterranean diet

Rated best diet for 2024 & 2025 by U.S. News & World Report [84] Indications: - optimal brain health - cardiovascular risk reduction - 18% reduction of stroke in women [91] - 16% reduction in ischemic stroke - 25% reduction in hemorrhagic stroke - non-alcoholic fatty liver disease (NAFLD) [40] - prevention of frailty [45] - prevention & treatment of depression [48] - treatment of irritable bowel syndrome [90] * also see Notes (below) Contraindications: - Mediterranean diet offers no benefit over low-calorie DASH diet for weight reduction (MKSAP) [86] Benefit/risk: - number needed to treat: - 61 for 5 years to prevent 1 stroke, myocardial infarction or death in subjects without known heart disease [15,24] - 30 to prevent 1 death or 1 cancer after myocardial infarction [25] - 556 to prevent one case of breast cancer/year in postmenopausal women [27] - no harmful effects noted - Mediterraean diet containing 0.5-2.5 oz/day of lean beef improves blood pressure & arterial stiffness, presumptively not adversely affecting vascular function [68] Physiology: - associated with beneficial microbiome-related metabolomic profile - may be due to high-level consumption of plant foods [34] - increases in intestinal Prevotella & some fibre-degrading Firmicutes - increases levels of fecal short-chain fatty acids [34] - reduced inflammation (putative) - inflammatory dietary advanced glycation end-products are unchanged on the Mediterranean diet but decreased on a low-fat vegan diet [81] Laboratory: - lower levels of - serum C-reactive protein - serum interleukin-6 - serum homocysteine - plasma fibrinogen - lower WBC counts Management: Recommendations: 1) increase servings of fruits & vegetables - 2 servings of fruit & 3 servings of vegetables/day associated with lowest mortality [60] 2) increase servings of legumes & whole-grain vegetables 3) increase monounsaturated fats: olive oil - canola oil may not be advisable [data from mouse model] 4) eat fish 3-4 times/week; poultry 2 times/week 5) eat red meat only 2-3 times/month 6) drink red wine in moderate amounts: Total kcals = 1500 Protein = 17% Fat = 33% Carbohydrate = 50% * Green Mediterranean diet is enriched with plant polyphenols & lower in red or processed meat & simple carbohydrates [75] Notes: A Mediterranean diet 1) reduces all-cause mortality in healthy elderly [2,6,79] including mortality due to cardiovascular disease [18] a) (RR = 0.79) & cancer (RR = 0.83) [6] b) greatest contribution to mortality reduction from: 1] moderate consumption of alcohol 2] low intake of meat 3] high consumption of vegetables, fruits, nuts, monounsaturated fats, & legumes [9] c) no reduction in all-cause mortality [31] d) reduces all-cause & cardiovascular mortality in persons with cardiovascular risk factors [74] 2) reduces cardiovascular risk a) reduces risk of myocardial infarction [21 b) reduces risk of stroke [21] c) reduces risk of peripheral arterial disease; RR=0.34-0.5 [21] - olive oil seems more effective than nuts d) reduces risk of major cardiovascular events by 30% in people at high risk [15,16,17,47,71] - after reanalysis of data, conclusions remain unchanged [47] e) better than low-fat diet in reducing cardiovascular risk [3,15] & in reducing progression of atherosclerosis [62] - better in men, but not in women [66] f) associated with 29% fewer cardiovascular events [31] g) Mediterranean diet enriched with virgin olive oil improves HDL-mediated protection from atherosclerosis [36] h) Mediterranean diet supplemented with extra-virgin olive oil or nuts reduces major cardiovascular events in high-risk patients vs reduced fat diet [71] i) equally beneficial vs vegetarian diet in reducing weight & improving cardiovascular risk profiles i) cardiovascular benefit of pesco-Mediterranean diet in connection with time-restricted eating [58] k) healthiest diet available to prevent cardiovascular disease [70] l) green Mediterranean diet induces regression of proximal aortic stenosis [75] m) no effect no effect on mortality or cardiovascular disease [52] (suboptimal quality of the evidence) 3) reduces risk of metabolic syndrome [76] 4) beneficial effect on brain in the elderly - in combination with excercise, reduces risk of dementia [10] - reduces risk of brain infarcts (mostly silent infarcts) [13] - reduces white matter hyperintensities on MRI - protective effects for stroke (RR=0.71), depression (RR=0.68), cognitive impairment (RR=0.60) - in older subjects (mean age= 67), a Mediterranean diet supplemented with olive oil or nuts is associated with improved cognition [26] - may preserve total brain volume, total gray matter volume, & total white matter volume in elderly [28] - higher fish intake & lower red meat intake associated most strongly with preservation of brain volume [28] - adherence to a Mediterranean diet associated with higher cerebral cortex thickness [33] - higher frontal cortex, parietal cortex, occipital cortex, & average lobar cortical thickness [33] - higher gray matter volume in right parahippocampal gyrus & right hippocampus [61] - legume & fish beneficial effects in particular noted - higher carbohydrate & sugar intakes were associated with lower entorhinal cortical thickness [33] - lower CSF p-tau & CSF Abeta42/Abeta40 [61] - associated with slower rates of cognitive decline [32] - diminished risk of Alzheimer's disease [56] - improvements in cognitive function - cognitive domains found to benefit include - memory (delayed recognition, long-term, & working memory) [61] - executive function - visual constructs [32] - adherence to a Mediterranean diet associated with lesser brain atrophy in the elderly [35] - fish & meat consumption does not account for this - may slow cognitive decline in community-dwelling elderly [43] - may delay onset of Parkinson's disease [59] - may have synergistic effects with DASH diet (see MIND diet) - adherence to a Mediterranean diet is associated with maintenance of cognition among middle-aged & older Hispanic adults [68] - among factors of fruit, vegetables, processed meat, unprocessed red meat & unprocessed poultry, fish, cheese, wholegrains, only fish comsumption & fruit consumption reduced risk of dementia (RR=0.84-0.85) - nutrients with favorable effects on cognitive function & brain health from the Mediterranean Diet include fatty acids, antioxidants, carotenoids & vitamins [80] 5) reduces mortality in Alzheimer's disease patients [5] 6) may have protective role in the prevention of depression [12] - may reduce risk of depression in the elderly [51] 7) a Mediterranean diet is associated with better cognition in people with multiple sclerosis [73] 8) associated with lower risk of type 2 diabetes [7,31] & improved glycemic control in diabetes type-2 [11] a) even without weight loss [20] b) olive oil better than nuts for reducing risk of type 2 diabetes [20] c) healthiest diet available to prevent type 2 diabetes [70] 9) may reduce risk of macular degeneration (39%) [38,46] 10) reduces oxidized LDL [4] 11) may reduce chronic inflammation a) serum CRP decreased b) serum IL6 decreased c) serum homocysteine decreased d) plasma fibrinogen decreased e) WBC count decreased [16] f) reduces risk of seropositive rheumatoid arthritis in men [50] g) upregulates specific receptors that have neuroprotective effects - reduces neuroinflammatory profiles in hippocampus [83] 12) reduces incidence of frailty in community-dwelling elderly [42] 13) Mediterranean diet supplemented with extra-virgin olive oil may have a beneficial effect in the primary prevention of breast cancer [27,29,31], no benefit [85] - may have reduced risk for all-cause cancer & lung cancer [31] - reduces risk of obesity-related cancer (~6%) [85] 14) Mediterranean diet may help slow or prevent progression of prostate cancer in men on active surveillance [57 15) positive association between a Mediterranean diet & response to treatment with immune checkpoint inhibitors in patients with advanced cutaneous melanoma [72] 16) in combination with alkaline water may be beneficial for treatment of laryngopharyngeal reflux [39 17) better than low fat diet for weight loss [8] - adherence to a Mediterranean diet even without energy restriction is associated with weight maintenance, not weight gain [70] 18) olive oil-rich Mediterranean diet helpful for weight reduction & reduction in waist circumference [30] 19) combination of a reduced calorie Mediterranean diet & exercise may mitigate age-dependent changes in body composition [77] including facilitating weight reduction without loss of bone density [87] 20) adherence to Mediterranean diet among women results in longer peripheral blood leukocyte telomeres [23] 21) may lower risk of gestational diabetes [53] 22) reduces risk of preeclampsia (RR=0.78) [65] 23) ties with DASH diet for best overall diet [41] 24) 'Green' Mediterranean diet is the addition of green tea & substitution of red meat for a plant-based (Mankai) protein shake at dinner [63] - may help improve insulin sensitivity & reduce visceral fat by increasing levels of ghrelin 25) adherence to a Mediterranean-style diet & higher total carotenoid intake may delay or prevent later life frailty, especially in adults < 60 years [67] 26) Mediterranean diet associated lower risk of all-cause mortality (RR=0.68) in cancer survivors [78] 27) high adherence to Mediterranean diet is a protective factor against COVID-19, - unclear benefits against COVID-19 symptoms & severity [82] 28) Mediterranean diet & plant-based diets reduce risk of constipation in middle-aged & elderly people [89]

Related

olive oil

Specific

Green Mediterranean (Green-MED) diet Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet

General

healthy diet weight loss diet

References

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