The list of so-called "science-backed diets" is ever-growing, and includes everything from the ketogenic diet to intuitive eating. But according to a team of cardiologists and internists, evidence indicates one dietary approach is better than the rest: the Pesco-Mediterranean diet.
In a recent review of decades of research on the diet, researchers outline why going Pesco-Mediterranean is "ideal" for health and longevity.
This diet is associated with a myriad of health effects: lower risk of heart disease, diabetes, cognitive decline, depression, and some cancers.
When paired with intermittent fasting or "time-restricted eating," the review authors argue these dietary choices gives people the chance to prevent and potentially reverse chronic diseases.
"This dietary strategy has the best evidence for reducing the risk of heart attack, stroke, cardiac death, and premature mortality," James O'Keefe, lead author of the study and director of preventive cardiology at Saint Luke's Mid America Heart Institute, tells Inverse.
"If you're interested in health and longevity, this is your best bet."
The review was published Monday in the Journal of American College of Cardiology.
Modern diet, ancient traditions — The traditional Mediterranean diet is "not a fad diet," O'Keefe stresses. In fact, people living off the coast of the Mediterranean sea have been eating this way for centuries, and exhibit some remarkable health outcomes.
The Mediterranean diet includes an abundance of:
- Extra virgin olive oil
- Whole Grains
- Fish and seafood
The diet also includes a moderate amount of dairy and alcohol, as well as little consumption of red meat.
"We find it a very easy diet to stick with because it tastes good and it does really improve health and vitality," O'Keefe says.
Decades ago, after observing communities living in the so-called Mediterranean "blue zone," researchers started studying the particular physiological and mental health effects of the Mediterranean diet. This review outlines the multiple diet studies and clinical trials that have examined how this diet, along with periodic fasting, actually works.
"We find it a very easy diet to stick with ... "
After combing through this massive data set, researchers found some stunning results: Across the board, the Mediterranean diet appears to help protect the heart and stave off health issues like metabolic syndrome, diabetes, obesity, depression, breast and colorectal cancer, and neurodegenerative diseases like Alzheimer's disease. It's also shown to lower the risk of early death from any cause.
"Arguably diet is the most important variable for long term health from a cardiovascular standpoint, but also for general health," O'Keefe says. The Pesco-Mediterranean diet is "the science-based approach" to an ideal diet for health and well being, especially from a cardiovascular standpoint, he says.
What the studies suggest — In a 2018 randomized controlled trial examining cardiovascular disease prevention in high-risk elderly individuals, people consuming the Mediterranean diet supplemented with extra virgin olive oil or nuts had a 29 percent reduced risk of major adverse cardiovascular events and death from these causes. The group also had a 42 percent lower risk of stroke.
When extra fish is added in, there are even better outcomes. A meta-analysis of five prospective dietary studies found that compared to regular meat-eaters, heart disease mortality was 34 percent lower in those following a pescatarian diet.
The same goes for nuts: Randomized controlled trials suggest that diets enriched with nuts produce cardiometabolic benefits including improvements in insulin sensitivity, LDL cholesterol, and inflammation.
"This is not a diet that's going away," O'Keefe says. "This is the future of the eating pattern with respect to what's ideal for health, especially cardiovascular health, but also if you're trying to keep a sharp mind and prevent depression, obesity, diabetes, osteoarthritis, all those kinds of things."
A new eating pattern — The team also recommends time-restricted eating, a form of intermittent fasting where people opt out of eating for 12 hours a day. That may seem extreme, the researchers say, but it's actually quite simple. This form of intermittent fasting could mean having a late breakfast and an early dinner, then leaving 12 hours without food consumption.
Growing evidence, primarily in animals, shows intermittent fasting can reduce inflammation and extend lifespan. O'Keefe notes that scientists still aren't exactly sure how this intermittent fasting impacts human beings in the long term.
"What is clear is that the single biggest problem with the American diet is there's too many calories," O'Keefe says. "Time-restricted eating is a really great way to kind of gently reduce your calorie intake and it also changes your hormones."
Your insulin and cortisol levels go down and your sleep tends to improve when you space at least four hours between when you finish eating to you when you go to bed, O'Keefe explains.
Changing what and when you eat is often more challenging than it sounds, especially because of economic, accessibility, and convenience constraints.
However, O'Keefe stresses that making these adjustments to adopt a Pesco-Mediterranean diet that includes fasting is well worth the investment of time and energy. Changing food choices can also pay dividends in reduced hospital bills down the line, he adds.
"There are a lot of people in America who are waking up to the fact that nutrition is really important, and if they don't take control of this, their health isn't going to be optimal," O'Keefe says. "I'm very confident that we're going to be turning this around. Because when we know better, we do better and diet is a great place to start because so many people are way off track."
"What's it worth to have a sharp mind and a good heart and normal blood pressure and normal waist circumference and not diabetes or dementia?"
LONGEVITY HACKS is a regular series from Inverse on the science-backed strategies to live better, healthier, and longer without medicine.
HOW THIS AFFECTS LONGEVITY — Decades of research suggest the Pesco-Mediterranean diet is associated with a lower risk of heart disease, diabetes, cognitive decline, depression, and some cancers.
WHY IT'S A HACK — Essentially, the Pesco-Mediterranean diet helps people live longer lives and spend less time in the hospital. Researchers also suggest intermittent fasting can help compound these positive effects.
SCIENCE IN ACTION — Going Pesco-Mediterranean doesn't mean cutting out the occasional treat. It just means loading your plate with fruits, vegetables, whole grains, legumes, and fish.
HACK SCORE OUT OF 10 — 🐟🐟 (Experts recommend one to two servings of fish or seafood each week for longevity.)
Abstract: As opportunistic omnivores, humans are evolutionarily adapted to obtain calories and nutrients from both plant and animal food sources. Today, many people overconsume animal products, often-processed meats high in saturated fats and chemical additives. Alternatively, strict veganism can cause nutritional deficiencies and predispose to osteopenia, sarcopenia, and anemia. A logical compromise is a plant-rich diet with fish/seafood as principal sources of animal food. This 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 support the hypothesis that a Pesco-Mediterranean diet is ideal for optimizing cardiovascular health. The foundation of this diet is vegetables, fruits, nuts, seeds, legumes, whole grains, and extra-virgin olive oil with fish/seafood and fermented dairy products. Beverages of choice are water, coffee, and tea. Time-restricted eating is recommended, whereby intermittent fasting is done for 12 to 16 h each day.