Mediterranean Eating: The Role of Diet in Cardiovascular Health
It may come as no surprise that the practice of medicine often goes beyond prescriptions and test results, often integrating diet and lifestyle patterns as effective mechanisms to promote heart health. The overwhelming prevailing opinion among Cardiologists (including from our own Heartbeat Cardiology team w/hundreds of combined years of experience treating cardiovascular disease) is that people can benefit from adopting a Mediterranean diet, so let’s dive in and understand what that really means.
When we talk about any nutrient or food in the context of dietary changes, we must think about the practical application of the diet, which translates to swapping out foods to create room for new ones. On a given day, you are going to get 100% of your calories from all the things you eat, and if you eat more of X as a part of that 100%, you are going to eat less of Y. When we move from one diet to another, we must think about reducing and replacing foods with better choices.
The Mediterranean diet has proved itself as a sustainable and palatable way of living, evidenced by its practice in real-world populations over a span of generations. Not only is it recommended to many patients by our Heartbeat Cardiologists, it is also well-loved by modern food policy and nutritionist brains, from Mark Bittman to Lisa Young. It has many flavors depending on geography, from North Africa, the Middle East, and Southern Europe, notably including some Blue Zone communities. Nutritionist Antonia Trichopoulou identified the key ingredients in the modern Mediterranean diet and what those dietary patterns have in common: beans, legumes, whole grains, vegetables, fruits, and high levels of olive oil, in particular, extra virgin olive oil in both cold and cooked foods. The diet is rather high in fat, which surprises and contradicts most modern thinking, that fat is always bad when in fact there is an important distinction: unsaturated fat from olive oil, nuts, and avocados can actually improve blood cholesterol levels and ease inflammation while saturated fat from butter, sausages and bacon contributes to high cholesterol and high blood pressure which can lead to heart disease.
Modern research starting in the 60s helped to graduate the Mediterranean diet into the medical community. Ancel Keyes in 1963 published pivotal research that for the first time associated the diet with improved health outcomes, more specifically, showed a correlation between the traditional Mediterranean diet and a lower risk of coronary heart disease. Keyes noticed marked differences in populations and was among the first to utilize a scientific lens to determine if differences in lifestyle and dietary patterns could be adopted by other populations to reduce unfavorable health outcomes. In February 2013, the clinical trial known as the PREDIMED Study published in the New England Journal of Medicine produced findings that adhering to a Mediterranean diet reduces the risk of cardiovascular disease by approximately 30% and also reduces the risk of stroke in high-risk patients. This study helped to solidify the place of the Mediterranean diet in the medical community. Shortly thereafter in 2016 and 2019, the American Cardiology Association and American Diabetes Association, respectively, recommended the Mediterranean diet as a healthy dietary pattern to help prevent cardiovascular diseases and type two diabetes.
So, let’s recap; we have identified primary foods: beans, legumes, and fish as principal protein sources, dairy and meat as limited protein sources, fruits, vegetables and whole grains as carbohydrates, and a significant portion of fat from olive oil, avocado, nuts, and seeds. We also know the more of one thing we eat, the less room there is in the same diet for another thing. For example, the more beef you eat the more protein you get from that meat, and the less room there is to get any given percentage of that protein from beans or lentils, which provide not just protein but also unsaturated fat and fiber— which can lower blood pressure and reduce cardiovascular risk.
It takes planning and commitment to adopt a diet from a different culture. Creating structure and meal prepping can be helpful to integrating those foods into lifestyle and habit. We have much to gain by adjusting our food choices, choices that can help to make meaningful improvements towards reducing cardiovascular disease, high cholesterol, and high blood pressure.