The paper “…reviews cumulative evidence regarding diet and health, incorporating data from landmark clinical trials of the Mediterranean diet and recommendations from recent authoritative guidelines…” to come up with a succinct recommendation on what diet to follow alongside time restricted eating AKA Intermittent Fasting.
A Pesco-Mediterranean diet of plants, nuts, EVOO (extra virgin Olive Oil), and seafood (especially oily fish) has strong cardioprotective evidence.
A daily time-restricted eating window of 8 to 12 h is a central component of this diet with fasting for the remainder.
POINT TO NOTE – This diet is hypothetical and needs prospective and randomized studies to document its efficacy.
Other key take-aways from the study:
A solely plant based vegan diet runs the risk of deficiency in Iron, Zinc, Omega 3’s, B12, Calcium and Vitamin D. Eating seafood predominantly with a little meat, eggs and dairy solves this issue.
In contrast – most people in Western cultures “…overconsume meat, particularly highly processed meat from animals raised in inhumane conditions, fed unnatural foods, and often treated with hormones and antibiotics (1). This predisposes to a wide range of chronic illnesses prevalent in our society including CVD, diabetes, and cancers of the gastrointestinal tract (4,10).
Most people “…will benefit from a reduction in the consumption of meat, especially processed meat (11),…”. However “…modest amounts of wholesome animal-based foods such as fish and fermented dairy products continue to play an essential role in the ideal diet (3,4)…”
The traditional Mediterranean diet shows lower risks for “…all-cause and CVD mortality, coronary heart disease, metabolic syndrome, diabetes, cognitive decline, neurodegenerative diseases (including Alzheimer’s disease), depression, overall cancer mortality, and breast and colorectal cancers (13,14)…”
In USA the News & World Report annually scores 35 of the most popular diets for their health benefits. “…In 2020, for the third consecutive year, the Mediterranean diet was ranked #1 for overall health—described as nutritious, safe, relatively easy to follow, protective against CVD and diabetes, and effective for weight loss (16)…”
Increasing your fish consumption (not fried fish ) “…has been associated with reduced risk of heart failure (20) and a reduction in the incidence of metabolic syndrome (21)…”
Those who consumed a Mediterranean diet supplemented with Extra Virgin Olive Oil (EVOO) and/or nuts “…had statistically significant reductions of 29% for major adverse CVD events —myocardial infarction (MI), stroke, and death from these causes (Figure 1)—and 42% for stroke (23)…”
Why fish and seafood over meat: “…Fish and other seafood are not just rich in ω-3FA, but are generally good sources of zinc, iodine, selenium, B vitamins, calcium, and magnesium. Furthermore, fish and seafood provide high-quality protein, which is both satiating and helpful for the building and maintenance of muscle and bone mass…”
Which fish and how to cook them: “…it is prudent to choose low-mercury fish, such as salmon, sardines, trout, herring, and anchovies, all of which are naturally high in ω-3FA, and scallops, shrimp, lobster, oysters, and clams—which are not as high in ω-3FA, but remain low in mercury (4,28). It is best to use lower temperatures (target internal temperature 145º or until flesh is opaque and separates easily with fork); avoid charring or burning fish/seafood, which can introduce carcinogenic compounds (31)…” I recommend you purchase a Sous Vide machine and bath which is perfect for cooking fish (and also other meats).
Not just any olive oil – choose Extra Virgin Olive Oil (EVOO): “…EVOO is unrefined. It is obtained by cold pressing olives, and in this sense is equivalent to a pure olive juice. EVOO retains hydrophilic components of olives, among them highly bioactive polyphenols, which are believed to underlie many of EVOO’s cardiometabolic benefits, such as reduced LDL-C and increased high-density lipoprotein cholesterol, improved vascular reactivity, enhanced high-density lipoprotein cholesterol functionality, and a lower diabetes risk (23,32). Importantly, the EVOO arm of the PREDIMED trial provided first-level scientific evidence of its cardioprotective effects within the context of the Mediterranean diet (23)…” I buy a great quality EVOO made from Picual olives as it’s high mono-unsaturated content means it can be used in cooking without degrading. The one I purchase is this one.
Go Nuts over Tree Nuts: “…Tree nuts are an integral component of the traditional Mediterranean diet (33). Nuts are nutrient-dense foods rich in unsaturated fats, fiber, protein, polyphenols, phytosterols, tocopherols, and nonsodium minerals. This unique nutritional profile makes nuts one of the most effective foods for improving long-term health outcomes (34). RCTs have shown that diets enriched with nuts produce cardiometabolic benefits including improvements in insulin sensitivity, LDL-C, inflammation, and vascular reactivity (33,34). Observational studies have suggested that nut consumption is associated with decreased incidence and mortality rates from both CVD and CAD, as well as decreased risks of atrial fibrillation and diabetes (35). In 1 arm of the PREDIMED trial, 1 daily serving of mixed nuts resulted in a 28% reduction in CVD risk, again providing first-level scientific evidence for the cardioprotective effect of nuts within the context of the Mediterranean diet (23). Generous intake of nuts does not promote weight gain because of increased satiety and reduced metabolizable energy (part of nuts’ fat is lost in the feces because of incomplete digestion) (33,36)…” I purchase milled nuts and seeds and sprinkle them on everything I eat.
Pass the beans: “…Legumes also play a central role in the traditional Mediterranean diet, and they are an excellent source of vegetable protein, folate, and magnesium and fiber, and like other seeds, are rich in polyphenols (37). Consumption of legumes has been linked to a reduced risk of incident and fatal CVD and CAD, as well as improvements in blood glucose, cholesterol, blood pressure, and body weight (37). Legumes, like fish, are a satiating and healthy substitute for red meat and processed meats…”
Choose your dairy wisely: “…Fermented low-fat versions, such as yogurt, kefir, and soft cheeses, are preferred; butter and hard cheese are discouraged, because they are high in saturated fats and salt (38)…”
The importance of Eggs: “…Eggs are composed of beneficial nutrients including all essential amino acids, in addition to minerals (selenium, phosphorus, iodine, zinc), vitamins (A, D, B2, B12, niacin), and carotenoids (lutein, zeaxanthin). Although each yolk contains about 184 mg of dietary cholesterol, large prospective cohorts suggest that egg consumption is unrelated to serum cholesterol, and does not increase CVD risk (39,40). Eggs are allowed in the Pesco-Mediterranean diet, preferably no more than 5 yolks/week (egg whites can be consumed without limit). Eggs are another satiating and healthy substitute for red meat and processed meats…”
Choose wholegrain pasta: “…Pasta is an example of a starchy food that has a low glycemic index despite being a refined carbohydrate. In the context of a low glycemic index dietary pattern such as the Mediterranean diet, pasta does not adversely affect adiposity and may even help reduce body weight according to a recent meta-analysis of RCTs (42). The results of 2 recent large Italian cross-sectional studies concur with the RCTs’ findings (43,44). Likewise, there is no evidence that consumption of pasta promotes cardiometabolic risk factors (41,44,45)…In Mediterranean cultures, white rice, like pasta, is usually prepared with a sofrito sauce including EVOO, tomatoes, other vegetables, and aromatic herbs, thereby adding beneficial nutrients and bioactives to these starchy but nutritive foods that are likely to further lower their glycemic index. So, if homecooked and prepared the Mediterranean way, mixed pasta and white rice dishes are both tasty and healthy ingredients to the Pesco-Mediterranean diet.” I would still eat pasta and rice sparingly in terms of portion size as it is a carb after all. I prefer to get my carbs from Legumes as they are truly slow release carbs that keep you fuller for longer.
Load up on the un-sweetened water, coffee and tea: “…The staple beverage of this diet is water—either still or carbonated, which can be flavored but not sweetened. Unsweetened tea and coffee are noncaloric beverages rich in antioxidants, particularly polyphenols, and are associated with improved CVD outcomes (48,49). If alcohol is consumed at all, dry red wine is recommended, with the ideal amount being a single glass (≤6 oz) for women and 1 or 2 glasses/day for men (6 to 12 oz) consumed with meals (50)…”
Combine with intermittent fasting for super, turbo-charged results: “…Time-restricted eating, 1 type of intermittent fasting, is the practice of limiting the daily intake of calories to a window of time usually between 6 to 12 h each day. Intermittent fasting when done on a regular basis has been shown to decrease intra-abdominal adipose tissue and reduce free-radical production (51,52). This ancient evolutionarily conserved adaptation also elicits powerful cellular responses that improve glucose metabolism and reduce systemic inflammation, and may also reduce risks of diabetes, CVD, cancer, and neurodegenerative diseases (52)…”