The Mediterranean diet and heart health

It is the most studied way of eating in the world, and the heart is where the evidence is strongest. It is not where the evidence stops.

A dietary pattern built on minimally processed plant foods has been linked to lower risk of several chronic diseases and to a longer life. Randomized trials have shown a benefit in cardiovascular disease, type 2 diabetes, atrial fibrillation, and breast cancer.1

About 30 percent fewer heart attacks, strokes, and cardiovascular deaths

In a Spanish trial, 7,447 adults aged 55 to 80 at high cardiovascular risk but with no heart disease at the start were assigned to one of three diets: a Mediterranean diet with extra-virgin olive oil, a Mediterranean diet with nuts, or a reduced-fat diet. After a median of 4.8 years, the olive oil group had 31 percent fewer major cardiovascular events than the control group, and the nut group 28 percent fewer.2

The pattern explained

There is no official Mediterranean diet. What the research measures is a pattern, and the pattern is consistent across the studies.

How often What
Every meal Vegetables, fruit, beans and lentils, nuts and seeds, whole grains, olive oil, herbs and spices.
At least twice a week Fish and shellfish.
Moderate, daily to weekly Yogurt and cheese. Poultry and eggs less often than that.
Rarely Red and processed meat, sweets, sugary drinks, refined grains.

One feature runs through all of it: the food is whole or close to it. That is the part most often lost when the pattern is translated into a restaurant menu or a packaged product.

The heart evidence

Beyond the Spanish trial, two large studies had interesting findings.

Sudden cardiac death

Sudden cardiac death is when the heart stops without warning. Among 21,069 US adults followed for about ten years, those whose eating scored in the top third for the Mediterranean pattern had 26 percent lower risk than the bottom third. Among people who started with no coronary heart disease, the difference was 41 percent.3

Women, studied on their own

Most heart research has been done in men or in mixed groups too small to say anything about women separately. Pooling 16 studies that followed 722,495 women, none of whom had heart disease at the start, closer adherence to a Mediterranean pattern was associated with 24 percent lower risk of developing cardiovascular disease and 23 percent lower risk of dying from any cause. Coronary heart disease was 25 percent lower.4

How it works, and what is still unknown

Nobody has established the mechanism. The pattern changes dozens of things at once, and separating them is hard. A review of the metabolic and molecular research names five effects that look most important.1

  • It lowers blood lipids. Fiber, unsaturated fats, and plant compounds each act on LDL, the cholesterol that collects in artery walls.
  • It reduces oxidative stress, inflammation, and clotting. Oxidative stress is the everyday damage that comes from normal metabolism. Polyphenols from vegetables, fruit, olive oil, and tea are the compounds most associated with countering it.
  • It changes hormones and growth factors involved in cancer. These are the signals that tell cells to grow and divide.
  • It quiets the systems cells use to sense food. Cells read how much protein and energy is arriving and switch between growth and repair accordingly. A pattern lower in animal protein appears to shift that balance.
  • It feeds the gut differently. Gut bacteria break down fiber and polyphenols into compounds that enter the bloodstream and affect metabolism.

Beyond the heart

The same pattern shows up in research on type 2 diabetes, atrial fibrillation, and breast cancer, all with randomized trial evidence behind them.1 It also runs through the cognitive research, where the MIND pattern, a hybrid of Mediterranean and DASH, is the version most studied. That work is covered on the diet and brain health page.

What's in Field Theory

Field Theory Complete Nutrition Shake is a meal made from 27 whole foods common to the Mediterranean, DASH, and MIND patterns. Polyphenols and omega-3 are stated in milligrams, from named foods. Per serving:

1,005 mg Polyphenols
1,650 mg Omega-3 ALA
11 g Fiber
26 g Protein

The polyphenols come from aronia, wild blueberry, matcha, leafy greens, turmeric, and black pepper. The omega-3 comes from flax, chia, pumpkin, and sunflower seeds. The fiber comes from six whole food sources.

Fuller detail is on the polyphenols page and the soluble fiber and cholesterol page. The formulation rationale is in the Field Theory Clinician's Guide.

See the product

References

  1. Tosti V, Bertozzi B, Fontana L. Health benefits of the Mediterranean diet: metabolic and molecular mechanisms. The Journals of Gerontology: Series A. 2018;73(3):318. doi:10.1093/gerona/glx227
  2. Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. New England Journal of Medicine. 2018;378(25):e34. doi:10.1056/NEJMoa1800389
  3. Shikany JM, Safford MM, Soroka O, et al. Mediterranean diet score, dietary patterns, and risk of sudden cardiac death in the REGARDS study. Journal of the American Heart Association. 2021;10(13):e019158. doi:10.1161/JAHA.120.019158
  4. Pant A, Gribbin S, McIntyre D, et al. Primary prevention of cardiovascular disease in women with a Mediterranean diet: systematic review and meta-analysis. Heart. 2023. doi:10.1136/heartjnl-2022-321930
  5. Gardner CD, Vadiveloo MK, Petersen KS, et al. Popular dietary patterns: alignment with American Heart Association 2021 dietary guidance. Circulation. 2023;147(22):1715-1730. doi:10.1161/CIR.0000000000001146

The full formulation rationale, with all nineteen references, is in the Field Theory Clinician's Guide.