A new study published by JAMA Network Open lends further support to the widely held belief that the Mediterranean diet would be a very healthy diet for more Americans to adopt.  This long-term study was published with the title Mediterranean Diet Adherence and Risk of All-Cause Mortality in Women.  It found the risk of death for the study participants was lowered by 23%.

Although the prevention of illness and death via use of the Mediterranean diet has been reported in other studies, until now there hasn’t been evidence from a study as large as this one. In this study data was obtained from over 25,000 women who were judged as healthy at the start and followed for as long as 25 years. They also specifically looked at the benefits for both cancer mortality and cardiovascular mortality, the two leading causes of death nationwide. The validity of this study is supported by the great number of study subjects it included and the great length of time over which the conclusions were based. DOI: 10.1001/jamanetworkopen.2024.14322

The research was conducted by the Brigham and Women’s Hospital. They also assessed what underlying mechanisms related to this diet explain the reduction in “all-cause mortality” which includes death from any cause. Researcher Samia Mora MD, who is a cardiologist says, “For women who want to live longer, our study says watch your diet! The good news is that following a Mediterranean dietary pattern could result in about one quarter reduction in risk of death over more than 25 years with benefit for both cancer and cardiovascular mortality, the top causes of death in women (and men) in the US and globally.” https://drsobo.com/plant-based-diets-help-stage-4-cancer/

The Mediterranean diet is primarily a plant-based diet that is centered around the intake of fruits and vegetables, whole grains, nuts and seeds and legumes. Olive oil, usually extra virgin (nuts, seeds, fruits, vegetables, whole grains, legumes). The main fat is olive oil- the extra virgin type. Although it is plant based it is not strictly vegetarian and modest intake of animal proteins from eggs, dairy, fish and poultry are allowed. It includes minimal amounts of meat, sugars and processed foods.

The biological mechanisms that underlie this diet’s health benefits were investigated by the measurement of a great number of biomarkers- blood tests and other measurements that provide insight into a variety of biological pathways. They also addressed lifestyle risk factors. the greatest number of biomarkers evaluated are those related to inflammation and metabolism. The next type of biomarkers was in the category of lipids insulin resistance and body fat. Other measurements such as blood pressure readings make up the rest of the elements used to produce the risk related data.

Shafqat Ahmad, PhD, a professor of Epidemiology and was the lead researcher for this study from the Center for Lipid Metabolomics and the Division of Preventive Medicine at the Brigham Hospital. He stated,

“Our research provides significant public health insight: even modest changes in established risk factors for metabolic diseases — particularly those linked to small molecule metabolites, inflammation, triglyceride-rich lipoproteins, obesity, and insulin resistance — can yield substantial long-term benefits from following a Mediterranean diet. This finding underscores the potential of encouraging healthier dietary habits to reduce the overall risk of mortality.”

In their scientific paper the authors take note of the fact that the “Mediterranean diet” as it has been called has been increasingly used throughout the world, gaining in popularity because of the health benefits that are becoming more apparent as more research studies about this nutritional approach have been published. Dr Mora adds, “The health benefits of the Mediterranean diet are recognized by medical professionals, and our study offers insights into why the diet may be so beneficial. Public health policies should promote the healthful dietary attributes of the Mediterranean diet and should discourage unhealthy adaptations.”

Armed with all of the evidence that exists to show the benefits of the Mediterranean diet, in march 2023 Harvard University published A Practical Guide to The Mediterranean Diet.

 https://www.health.harvard.edu/blog/a-practical-guide-to-the-mediterranean-diet-2019032116194

In their introduction they explain that, “The Mediterranean diet has been shown to reduce risk of heart disease, metabolic syndrome, diabetes, certain cancers, depression, and in older adults, a decreased risk of frailty, along with better mental and physical function.”

The traditional Mediterranean diet is based on the foods utilized in countries that border the Mediterranean Sea such as Greece, Spain and Southern France. The primary characteristic of this diet is that it contains mostly plant foods such as vegetables and fruits, along with whole grains, nuts and legumes. Overall, the diet has very little if any processed foods, is grown locally and seasonally fresh.

• The principal source of fat is olive oil
• Fish and poultry are primary protein sources with much less red meat in comparison to the American diet.
• Cheeses and yogurt, are consumed daily in low to moderate amounts
• Fresh fruits are used as dessert, with added sweets or sugars playing a small role
• Wine consumed in low to moderate amounts with meals.
• This NIH and the Cleveland clinic review addresses the practical question of how to implement the Mediterranean diet. https://my.clevelandclinic.org/health/articles/16037-mediterranean-diet
• PRACTICAL SUGGESTIONS FROM THE NIH REVIEW:
•  Incorporate the changes gradually, starting with those you think will be easier for you.
•  Make the change from other fats to extra virgin olive oil. Use it in cooking, and use salad dressing based on olive oil. use olive oil instead of butter on breads.
• Eat nuts and olives. These will serve as healthy replacements for processed snack foods.
• Eat whole-grain bread instead of processed breads
• Try couscous and whole-grain pastas,
• Add salads to your meals, choose dark greens and in season vegetables
• Add extra servings of vegetables to your meals to satisfy your hunger.
• Eat legumes regularly including peas, lentils, and beans.
• Greatly reduce meat intake. Replace meat with poultry and fish. Canned fish is fine as well as fresh. Occasional red meat intake as stews and soups with vegetables as a part of those meals will help to keep down meat intake without giving it up entirely.
• Drink wine in moderation instead of other alcoholic beverages such as beer or liquor. 
• Remove sugary beverages as much as possible. Try to cultivate the habit of drinking water with meals and snacks.
• Try to eliminate high-fat, high-sugar, high fat desserts as much as possible. Fresh fruit is best. Eat cakes and pastries at special occasions only.
• Aim for the freshest and best quality food available. Farmer’s markets are the best sources for locally grown, seasonal foods.

Sample Mediterranean meals:

Breakfast:

• Unsweetened Greek yogurt with nuts and berries.
• Vegetable omelet-any vegetables you prefer cooked in olive oil accompanied by whole grain bread.
• Whole-grain bread topped with low-fat cheese and slices of fresh tomato, with a little extra virgin olive oil

Lunch

• Greek salad made with mixed greens, olives, tomatoes, and feta cheese. Add extra virgin olive oil and fresh lemon.
• Chickpea and salad with onions, red peppers, onions, and oregano. Dress with extra virgin olive oil and lemon.
• Vegetarian pizza made with part-skim mozzarella cheese, onions, green peppers, carrots and broccoli.

Dinner:

• Stir-fried chicken in olive oil. Add vegetables such as asparagus, broccoli, peppers, and cauliflower, served over brown rice
• Shrimp, kabobs with grilled vegetables, quinoa salad, and mixed greens with pine nuts.
• Minestrone soup with vegetables, steamed mussels and spinach salad.