The Mediterranean Diet and Cardiovascular Health

As a dietetics student, through many lectures, I have constantly heard about the benefits of the mediterranean diet on cardiovascular (CV) health.  

The mediterranean diet got its name from the countries surrounding the Mediterranean Sea that follow a specific diet. This diet is widely known and many individuals across the world follow this diet. The mediterranean diet consists of fish, monounsaturated fats from olive oil, fruits, vegetables, whole grains, legumes/nuts, and moderate alcohol consumption.(1)

In the listicle below, I will focus on several food components of the mediterranean diet and their benefits as a whole on CV health as evidenced in the review by Widmer, R. et al “The Mediterranean diet, its components, and cardiovascular disease”(1) It is important to know that focusing on one component will not give the cumulative benefit on CV health that the whole mediterranean diet provides. 

1. OMEGA-3 POLYUNSATURATED FATS, SUCH AS FISH:

• Possible dysrhythmia (irregular heartbeat) protection.(2)

• Potential CV disease morbidity and mortality benefit for mainly secondary prevention.(3)
• Beneficial effects of fish on CV disease includes improved lipid profiles(4) and reduced blood pressure (BP).(5)
• Fish should be consumed 2-3 times per week.

2. UNSATURATED FATS, SUCH AS OLIVE OIL:

• Compounds in olive oil have potent antioxidant properties.(6)

• Exhibits cardioprotective effects.
• Has an inflammatory protective potential.(7)
• Increase your intake, e.g. substitute your creamy salad dressings with extra virgin olive oil.

3. FRUITS AND VEGETABLES:

• Dietary use of fruits and vegetables reduces CV disease risk.(2)

• An increased fruits and vegetables intake is associated with a lower body mass index (BMI).
• The prospective Chicago Western Electric Study showed a slight benefit on blood pressure compared with intake of red meat over a 7-year period.(8) The study showed that an increased red meat consumption produced a net blood pressure elevation in middle-aged men whereas an increased fruit and vegetable did not result in an increase of blood pressure.
• Consume 2-3 portions of fruit & 3-4 portions of vegetables daily.

4. WHOLE GRAIN FOODS HIGH IN FIBER:

• An increase in whole grains have a beneficial effect on CV disease morbidity and mortality.

• Diets high in fiber facilitates lipid lowering in the body.(9)
• A randomized controlled trial (RCT) showed beneficial effects in BMI and waist circumference (WC) in the group randomized to hypocaloric whole grains as opposed to hypocaloric refined grains.(10)
• Have a daily intake of fiber from your diet of 25-30g from whole foods.

5. NUTS AND LEGUMES:

• A reduction in CV disease risk with an isocaloric consumption of nuts as a major source of fat.(10)

• A study showed that substituting walnuts, peanuts, almonds, or other nuts for a serving of carbohydrates or saturated fats reduced blood lipids as well as the risk for cardiovascular disease by 30% and 45%, respectively.(11)
• One meta-analysis study saw a significant reduction in low density lipoprotein (LPL) cholesterol, inflammatory and oxidants mediators with increased walnut consumption.(12)
• Legumes are considered to be low-glycaemic and a good dietary source of protein and fiber.
• Consume 4 servings of nuts per week and 4 servings of legumes per week.

I am very fond of the mediterranean diet as I love the food it consists of. Remember that one does not have to transition to a mediterranean diet completely and strictly for its health benefits. Incorporate all these food types in your dietary habits if you have not been eating it already. As we have seen it is the food and the nutrients contained within that gives the mediterranean diet its healthy aspects. Take slow and steady steps and enjoy the journey of eating healthy for your body!

Written by Anri Pretorius: My name is Anri Pretorius, I am a South African citizen busy with my third year in dietetics. I am studying at the University of Stellenbosch in Cape Town. I love eating healthy foods and am particularly fond of spicy foods. I enjoy participating in any sport and see exercising as one of my favourite hobbies. The most recent sport I took up is cycling. I am a bibliophile and spend my vacations at home reading any book I can find that interests me. I also have two pets, a miniature French poodle and a rescue cat.

References:

1. Widmer RJ, Flammer AJ, Lerman LO, Lerman A. The Mediterranean diet, its components, and cardiovascular disease. Vol. 128, American Journal of Medicine. Elsevier Inc.; 2015. p. 229–38. 

2. Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, et al. European guidelines on cardiovascular disease prevention in clinical practice: Executive summary - Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by . Vol. 28, European Heart Journal. 2007. p. 2375–414. 

3. Bucher HC, Hengstler P, Schindler C, Meier G. N-3 polyunsaturated fatty acids in coronary heart disease: A meta-analysis of randomized controlled trials. Vol. 112, American Journal of Medicine. Elsevier Inc.; 2002. p. 298–304. 

4. Balk EM, Lichtenstein AH, Chung M, Kupelnick B, Chew P, Lau J. Effects of omega-3 fatty acids on serum markers of cardiovascular disease risk: A systematic review. Vol. 189, Atherosclerosis. Elsevier; 2006. p. 19–30. 

5. Appel LJ, Miller ER, Seidler AJ, Whelton PK. Does Supplementation of Diet With ‘Fish Oil’ Reduce Blood Pressure?: A Meta-analysis of Controlled Clinical Trials. Arch Intern Med [Internet]. 1993 Jun 28 [cited 2020 Sep 4];153(12):1429–38. Available from: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/617401

6. Fuhrman B, Aviram M. Flavonoids protect LDL from oxidation and attenuate atherosclerosis. Vol. 12, Current Opinion in Lipidology. 2001. p. 41–8. 

7. Visioli F, Caruso D, Grande S, Bosisio R, Villa M, Galli G, et al. Virgin Olive Oil Study (VOLOS): Vasoprotective potential of extra virgin olive oil in mildly dyslipidemic patients. Eur J Nutr. 2005 Mar;44(2):121–7. 

8. Miura K, Greenland P, Stamler J, Liu K, Daviglus ML, Nakagawa H. Relation of Vegetable, Fruit, and Meat Intake to 7-Year Blood Pressure Change in Middle-aged Men: The Chicago Western Electric Study. Am J Epidemiol. 2004 Mar 15;159(6):572–80. 

9. Van Horn L. Fiber, lipids, and coronary heart disease: A statement for healthcare professionals from the nutrition committee, American Heart Association. Vol. 95, Circulation. Lippincott Williams and Wilkins; 1997. p. 2701–4. 

10. Katcher HI, Legro RS, Kunselman AR, Gillies PJ, Demers LM, Bagshaw DM, et al. The effects of a whole grain-enriched hypocaloric diet on cardiovascular disease risk factors in men and women with metabolic syndrome. Am J Clin Nutr [Internet]. 2008 Jan 1 [cited 2020 Sep 10];87(1):79–90. Available from: https://academic.oup.com/ajcn/article/87/1/79/4633302

11. Hu FB, Stampfer MJ. Nut consumption and risk of coronary heart disease: a review of epidemiologic evidence. Curr Atheroscler Rep [Internet]. 1999 [cited 2020 Sep 10];1(3):204–9. Available from: https://link.springer.com/article/10.1007/s11883-999-0033-7

12. Banel DK, Hu FB. Effects of walnut consumption on blood lipids and other cardiovascular risk factors: a meta-analysis and systematic review. Am J Clin Nutr [Internet]. 2009 Jul 1 [cited 2020 Sep 10];90(1):56–63. Available from: https://academic.oup.com/ajcn/article/90/1/56/4596930