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Mediterranean + Intermittent Fasting: The World’s Healthiest Cuisine

intermittent fasting, clock handles with mediterranean diet in between clock hands to demonstrate healthy eating during time windowWhat you consume is among the most important determinants of your health - and unlike many other things that we currently are dealing with, this one is something that largely is under your control. You can go a long way toward keeping your immune system strong and avoid ending up in the hospital, by paying close attention to what you do or don’t choose to eat and drink.
Mediterranean Diet - The Gold Standard for Health
The Mediterranean diet is so named because it was the cuisine adopted by many of the cultures living on or near the shores of the Mediterranean Sea. In the words of Elizabeth David, the Mediterranean diet comes “from the blessed lands of sun and sea and the olive trees.”
The natural abundance of fruits, vegetables, legumes, tree nuts, olives and olive oil, fish, and seafood made it easy for the Mediterranean peasants down through the centuries to eat this way. They also tended to consume moderate amounts of dairy products (particularly yogurt and cheese) and eggs, as well as modest amounts of alcohol (ideally red wine with the evening meal), but very little red meat and processed meat.
Many studies demonstrate that adherence to a traditional Mediterranean diet promotes longevity, and reduces risks for heart attack, stroke, and cardiovascular death. It also lowers risks for diabetes, Alzheimer’s disease, depression, breast, and colorectal cancers. What’s more, a Mediterranean diet, especially supplemented with olive oil and nuts, appears to improve immunity, which should help to prevent infections, and dampen down harmful chronic inflammation.
This diet was studied in the Prevención con Dieta Mediterránea (PREDIMED) study, which in our opinion is the most important and impressive diet study ever done. PREDIMED was done using 7,500 volunteers in Spain, who were randomly assigned to eat a Mediterranean diet supplemented with extra virgin olive oil or nuts versus a low-fat diet. The subjects who followed the Mediterranean diet had a lower rate of the combined endpoint of heart attack, stroke, or cardiovascular death.
The cardiovascular benefits of the Mediterranean diet have been recognized and recently the American College of Cardiology, as well as the American Heart Association, have endorsed it as the ideal diet to follow. Moreover, it has been ranked for three consecutive years as the #1 recommended diet for overall health by U.S. News & World Report.
Key Components of the Mediterranean Diet - Fish and Seafood
Omega-3 fatty acids found in fish and seafood are fundamental components of the Mediterranean diet. Fish and seafood are rich in omega-3 fats, zinc, iodine, selenium, B vitamins, calcium, magnesium, and high-quality protein. The cardioprotective properties of omega-3s have been linked to a reduced risk of fatal and non-fatal heart attacks, heart failure, metabolic syndrome, and stroke. For example, in the Adventist Health Study 2 including 96,000 individuals, the pescetarians (plant-rich diet with fish as the main source of meat) had the lowest risk for all-cause mortality, heart disease, and death from other causes when compared to non-vegetarians, semi-vegetarians, vegans, and lacto-ovo vegetarians. Other studies have found similar results with pescetarians having the greatest cardiovascular benefits of all vegetarians’ groups.
Despite the rich nutritional properties found in seafood, attention should be paid to the mercury content found in some fish. Examples of low-mercury/high-omega-3 content fish include salmon, trout, sardines, herring, and anchovies. Other good options include scallops, shrimp, lobster, and clams, which are not as high in omega-3 but are still low in mercury. The 2015 - 2020 Dietary Guidelines for Americans and the American Heart Association recommend at least 2 seafood meals per week. This amounts to 8 to 10 ounces or more per week of seafood.
Extra Virgin Olive Oil
Extra virgin olive oil (EVOO) is another integral component of the traditional Mediterranean diet. The polyphenols (micronutrients that have potent disease-fighting and antiaging properties) found in EVOO are obtained through cold pressing olives, equivalent to pure olive juice. The abundance of polyphenols in EVOO can be recognized by a throat-burning sensation when swallowed.
These bioactive polyphenols reduce the levels of “bad cholesterol” (LDL) and increase the levels of “good cholesterol” (HDL). Also, EVOO was used in one of the Mediterranean diet arms of the PREDIMED, proving its remarkable cardiovascular benefits.
Tree Nuts
Nuts are one of the best foods to promote robust health and great longevity. They are packed with wholesome nutrients, including unsaturated fats, fiber, proteins, polyphenols, phytosterols (plant molecules related to cholesterol that lower LDL-C), vitamin E, and minerals.
A diet rich in nuts has been shown to lower bad cholesterol, insulin, and inflammation. Moreover, nut consumption reduces your chances of developing diabetes, dying of cardiovascular disease, getting dementia or having atrial fibrillation. In the PREDIMED study, the group assigned to a Mediterranean diet plus nut consumption had a 28% reduction in cardiovascular disease, again providing high-quality scientific evidence of the cardioprotective properties of tree nuts.
Legumes are also a central component of the Mediterranean diet as they provide vegetable protein, folate, magnesium, polyphenols, and fiber. Similar to fish and nuts, they are an excellent substitute for red meat and processed meat, while improving blood sugars, cholesterol, blood pressure, and body weight.
Dairy and Eggs
Eggs provide an excellent source for proteins, essential amino acids, multiple minerals, and a wide variety of vitamins (A, D, B2, B12). Even though the egg yolk is rich in cholesterol, recent studies have not shown eggs increase cardiovascular risk. Generally, we recommend you not consume more than 5 egg yolks per week, but you can eat all the egg whites you want.
Regarding dairy, fermented low-fat yogurt, kefir and soft cheeses are preferred over butter and hard cheeses. There is no consensus whether there is an increase or decrease in cardiovascular risk, but fermented dairy was an integral component of most traditional Mediterranean diets. Dairy provides vitamin D, probiotics, minerals, and proteins, and is a good replacement for sugary drinks and unhealthy snack food.
Historically, Americans have regarded pasta, pizza, and bread to be essential components of a typical Mediterranean diet. Homemade pizza, pasta, and rice dishes, such as paella, are genuine Mediterranean dishes.
Despite being a refined carbohydrate, pasta does not raise blood sugars significantly and there is no evidence that it increases obesity or cardiovascular risk when prepared in the context of the Mediterranean diet. Whole grains such as barley, whole oats, rye, buckwheat, and brown rice are preferred over refined grains as they provide fiber, antioxidants, and B vitamins. White rice in moderation also is a healthy component of this diet when home-cooked with vegetables and olive oil. The predominant beverage in this diet should be water. Sparkling water, as long as it has no sugar or artificial sweeteners in it, is a healthy beverage. Unsweetened tea and coffee are rich in antioxidants and naturally calorie-free. These are encouraged in the Mediterranean diet, but it’s best to avoid sweeteners in the coffee or tea. If alcohol is consumed, dry red wine should be the choice, with no more than 1 glass for women and 2 glasses per day for men.
Intermittent Fasting
Our ancestors did not have the luxury of 3 meals a day plus snacks. They had to undergo periods of intermittent fasting while engaged in the daily struggle to gather food which made them more resistant to stress. Time-restricted feeding, a type of intermittent fasting, is the practice of limiting caloric intake to a window of 4-12 hours out of the 24-hour period.
During fasting periods, our body switches from sugar to fat as the main fuel to produce energy which reduces free radical production (molecules that damage our DNA and cells). Over time, restricted feeding has shown benefits by improving blood pressure, heart rate, cholesterol, blood sugar, and inflammation, in addition to burning off intra-abdominal fat and reducing cancer risk.
The integration of the Mediterranean eating patterns with fish and seafood as its main animal protein, combined with intermittent fasting, make it the ideal cardioprotective diet.
In Good Health,
Noel Torres-Acosta, MD, James H. O’Keefe, MD, Joan O’Keefe, RD, and Emilio Ros, MD, PhD