The Mediterranean Diet: A Prescription for Healthy Aging and Longevity

In thousands of published studies, the Mediterranean diet has proven again and again to be one of the best lifestyle strategies for extending longevity and avoiding common disorders of aging, including heart disease and cancer.

A 2021 clinical trial showed that those who adhered most closely to a traditional Mediterranean diet appeared less likely to suffer sudden cardiac death than those who least adhered to this diet.¹

This landmark trial showed that a Mediterranean diet rich in extra-virgin olive oil reduced the risk of major cardiovascular events (including heart attack, stroke, and cardiovascular death) by 31%.²

In an observational study, greater adherence to a Mediterranean diet in midlife was related to a 46% better chance of healthy aging, defined as living to 70 years or older with no major physical or mental impairments.³

Of all the many diets currently recommended, the Mediterranean diet is clearly the winner for achieving longevity and heart health.

What Is the Mediterranean Diet?

As a cardiologist, I’ve become convinced that we need to focus on prevention of heart disease rather than waiting for this deadly disease to strike. Our first goal as doctors should be to prevent disease with a healthy lifestyle.

The Mediterranean diet is a vital part of that.

It can help prevent cardiovascular disasters such as heart attacks and strokes. It has also been shown to lower cancer risk and reduce the likelihood of developing Alzheimer’s disease and chronic inflammatory disorders.

The traditional Mediterranean diet is characterized by:⁴

• High consumption of extra virgin olive oil, vegetables, cereals, fruits, legumes, and nuts
• Moderate intake of fish
• Low intake of dairy products, poultry, meat and meat products, and sweets
• Red wine in moderation, consumed with meals

In the early 1990s, a non-profit group called the Oldways Preservation Trust, in cooperation with the Harvard School of Public Health and the World Health Organization, created the first Mediterranean diet pyramid.^5-7

Then, in 1995, in an article in the American Journal of Clinical Nutrition, Walter Willet, MD, who was the Chairman of Nutrition at the Harvard T.H. Chan School of Public Health until 2017, published the first peer-reviewed paper on the Mediterranean diet pyramid.

It was based on food patterns seen in the Mediterranean region including Greece (especially the island of Crete) and southern Italy in the 1960s, where, he has noted:

"adult life expectancy was among the highest in the world and rates of coronary heart disease, certain cancers, and other diet-related chronic diseases were among the lowest."⁸

Why This Diet Works

There are several components to the Mediterranean diet with proven health benefits.

Extra Virgin Olive Oil

Rather than butter or margarine, extra virgin olive oil is consumed in a Mediterranean diet. Studies have shown it can:

• Improve lipid profiles, including decreasing LDL (“bad”) and increasing HDL (“good”) cholesterol,⁹
• Lower post-meal glucose levels,¹⁰
• Reduce chronic inflammation,¹¹
• Fight damaging oxidative stress,^12,13
• Reduce blood clot formation,¹⁴
• Reduce high blood pressure,⁹
• Aid in preventing breast cancer,¹⁵
• Help prevent arrythmias,¹⁶
• Lower heart attack and stroke risk,¹⁶
• Help lower risk of Alzheimer’s disease,¹⁷
• Reduce risk of depression,¹⁸
• Reduce risk of ulcerative colitis, an inflammatory bowel disease, and¹⁹
• Lower risk of pancreatitis²⁰ and liver disease.²¹

Omega-3 Fatty Acids

A Mediterranean diet is abundant in marine and plant sources of essential omega-3 fatty acids.

Fish oil contains the omega-3s EPA and DHA, which are both critical for optimal health. Plants contain ALA, another omega-3 fat, which is converted in small amounts to EPA and DHA.

Unfortunately, most Americans are deficient in EPA and DHA,²² potentially leading to a number of health-related issues.

Among many cardiovascular benefits, omega-3s can:²³

• Lower triglycerides (a fat found in the blood),
• Reduce inflammation and oxidative stress,
• Reduce high blood pressure,
• Lower resting heart rate,
• Reduce the risk of fatal arrhythmias,
• Improve insulin sensitivity,
• Mildly inhibit platelet function, preventing clotting,
• Improve endothelial function, vital to the health of heart and blood vessels, and
• Reduce inflammatory atherosclerotic plaque.

Vegetables and Fruits

Eating a wide variety of colorful plants provides:^24-27

• Dietary fiber, which helps with weight control, can help to maintain a healthy gut, and reduces risk of colorectal cancer, and
• A range of polyphenols, plant nutrients that help fight a wide array of diseases, including heart disease, cancer, type II diabetes, and dementia.

Whole Grains

Brown rice, quinoa, oats, and whole wheat or whole grain breads and pastas are sources of whole grains. These types of grains:^28,29

• Contain a variety of important nutrients, including vitamins, minerals, protein, and fiber,
• Lower the risk of cardiovascular disease,
• Contribute to satiety (feeling full) and lower the risk of obesity, and
• Reduce the risk of diabetes.

Nuts

Regular consumption of unprocessed nuts is recommended in any healthy diet. Among the reasons:³⁰

• Five large studies found that increased nut consumption reduces coronary heart disease risk.
• Most fats in nuts are mono- and polyunsaturated fats, which lower LDL (“bad”) cholesterol levels.
• Substitution of nut fat for saturated fat was associated with a 45% reduction in coronary heart disease risk.

Red Wine

Red wine is often consumed in moderation with the main meal of the day. Studies have shown that it can:³¹

• Lower risk of cardiovascular disease,
• Raise protective HDL cholesterol levels,
• Reduce inflammation,
• Lower oxidative stress,
• Prevent harmful blood clots, and
• Decrease post-meal blood sugar levels.

Preventing Cardiovascular Disease

Clinical and observational studies have found particularly strong evidencethat the Mediterranean diet protects the heart and lowersthe risk of heart attacks, strokes, and cardiovascular death.

A landmark study of 7,447 participants (ages 55 to 80 years) found that a Mediterranean diet rich in extra-virgin olive oil prevented 31% of major cardiovascular events (including heart attack, stroke, and cardiovascular death) in high-risk individuals over nearly 10 years of follow-up.²

The REGARDS (Reasons for Geographic and Racial Differences in Stroke) study, for example, found a trend indicating those who adhered most closely to a traditional Mediterranean diet appeared less likely to suffer sudden cardiac death than those with least adherence to this diet.¹

Those who have already suffered heart attacks can find powerful protection in following the diet.

In a study of more than 11,000 men and women with a history of heart attacks, those who most closely adopted a Mediterranean diet had the lowest risk of death over the next 6.5 years.³²

And in the 46-month Lyon Diet Heart Study, a randomized, controlled trial of people who had suffered a first heart attack, those who followed a Mediterranean-type diet had an approximately 50% to 70% lower risk of recurrent heart disease than those on a control diet.³³

Fighting Other Diseases

Published medical studies show that the diet can reduce risk for a wide range of other age-related diseases.

A meta-analysis of 50 studies including nearly 535,000 people found that following the Mediterranean diet was associated with reduced risk of metabolic syndrome. The diet increased HDL (“good”) cholesterol and reduced waist circumference, high blood pressure, high glucose levels, and elevated triglyceride levels.³⁴

Another study of subjects at high cardiovascular risk showed that a Mediterranean diet reduced the risk of developing diabetes by 52% compared to a low-fat diet.³⁵

In a study lasting four years, in patients showing no signs of dementia at baseline, greater adherence to the Mediterranean diet was associated with a significant reduction in risk of developing Alzheimer’s disease.³⁶

In a meta-analysis of 83 studies that included a whopping 2,130,753 subjects, the highest adherence to a Mediterranean diet was associated with the lowest rates of many cancers, including of the colon, breast, stomach, liver, and prostate.³⁷

Those who most closely followed the diet also had the lowest risk of cancer mortality. The study authors’ data analysis found that the diet’s benefits mostly likely resulted from intake of fruits, vegetables, and whole grains.³⁷

Promoting Longevity

Preventing heart disease, cancer, diabetes, and other causes of death can obviously increase overall lifespan.

Several studies have specifically shown that this diet increases longevity.

One study analyzed the diets of 10,670 women in mid-life (with a median age of 59 years). Greater adherence to the Mediterranean diet was related to 46% greater odds of surviving to 70 years or older with no major impairments in physical function or mental health.³

The HALE study of people aged 70 to 90 years found that a Mediterranean diet and healthful lifestyle (including physical activity, moderate alcohol use, and not smoking) was associated with a more than a65% lower rate of death from all causes.³⁸

Another study of adults 65 and over also found that closer adherence to the Mediterranean diet was associated with prolonged survival.³⁹

There are a few ways in which this diet promotes longevity.

Chronic inflammation is so closely tied to accelerated aging that it is sometimes referred to as inflammaging. Many staples of the Mediterranean diet, including omega-3 fatty acids from fish oil and polyphenols from fruits and vegetables, reduce chronic inflammation.⁴⁰

Telomeres are protective caps on DNA that shorten as we age. Telomere length is believed to be closely associated with lifespan. High adherence to a Mediterranean diet has been found to be associated with longer telomeres, and greater activity of an enzyme that maintains telomere length.⁴¹

These benefits, along with its proven disease-preventing capabilities, explain why doctors so often recommend the Mediterranean diet.

Summary

The Mediterranean diet is a highly palatable eating pattern that has been shown to control body weight, improve cardiovascular health, and lower the risk of diabetes, metabolic syndrome, cardiovascular disease, Alzheimer’s disease, and cancer.

It has also been shown to increase overall longevity.

Everyone should follow a healthy lifestyle which includes optimal nutrition and regular physical activity. The Mediterranean diet should be at the center of that. Don’t wait—the time to act is now.

If you have any questions on the scientific content of this article, please call a Life Extension Wellness Specialist at 1-866-864-3027.

Michael Ozner, MD, FACC, FAHA, is one of America’s leading advocates for heart disease prevention. He is a board-certified cardiologist, a Fellow of the American College of Cardiology and of the American Heart Association, Medical Director of Wellness & Prevention at Baptist Health South Florida, and a well-known regional and national speaker in the field of preventive cardiology. Dr. Ozner is on the Scientific Advisory Board of Life Extension Magazine® and is the Symposium Director for “Cardiovascular Disease Prevention,” an annual international meeting highlighting advances in preventive cardiology and dedicated to treatment and prevention of heart attack and stroke. He is also the author of The Great American Heart Hoax, Heart Attack Proof, The Complete Mediterranean Diet, and Heart Attacks Are Not Worth Dying For.

Dr. Ozner’s definitive book, The Complete Mediterranean Diet, explains the vast health benefits of the Mediterranean Diet and provides over 500 easy-to-follow recipes.

To order, call 1-800-544-4440 or visit www.LifeExtension.com

Item #33867 • Price: $9.99

References

1. Shikany JM, Safford MM, Soroka O, et al. Mediterranean Diet Score, Dietary Patterns, and Risk of Sudden Cardiac Death in the REGARDS Study. J Am Heart Assoc. 2021 Jul 6;10(13):e019158.
2. Estruch R, Ros E, Salas-Salvado J, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. N Engl J Med. 2018 Jun 21;378(25):e34.
3. Samieri C, Sun Q, Townsend MK, et al. The association between dietary patterns at midlife and health in aging: an observational study. Ann Intern Med. 2013 Nov 5;159(9):584-91.
4. Davis C, Bryan J, Hodgson J, et al. Definition of the Mediterranean Diet; a Literature Review. Nutrients. 2015 Nov 5;7(11):9139-53.
5. Available at: https://oldwayspt.org/traditional-diets/mediterranean-diet. Accessed September 24, 2021.
6. Available at: https://www.sevencountriesstudy.com/mediterranean-dietary-patterns/. Accessed September 24, 2021.
7. Available at: https://www.sevencountriesstudy.com/about-the-study/history/. Accessed September 24, 2021.
8. Wang DD, Nguyen LH, Li Y, et al. The gut microbiome modulates the protective association between a Mediterranean diet and cardiometabolic disease risk. Nat Med. 2021 Feb;27(2):333-43.
9. Kontogianni MD, Panagiotakos DB, Chrysohoou C, et al. The impact of olive oil consumption pattern on the risk of acute coronary syndromes: The CARDIO2000 case-control study. Clin Cardiol. 2007 Mar;30(3):125-9.
10. Carnevale R, Silvestri R, Loffredo L, et al. Oleuropein, a component of extra virgin olive oil, lowers postprandial glycaemia in healthy subjects. Br J Clin Pharmacol. 2018 Jul;84(7):1566-74.
11. Casas R, Estruch R, Sacanella E. The Protective Effects of Extra Virgin Olive Oil on Immune-mediated Inflammatory Responses. Endocr Metab Immune Disord Drug Targets. 2018;18(1):23-35.
12. Yazihan N, Akdas S, Olgar Y, et al. Olive oil attenuates oxidative damage by improving mitochondrial functions in human keratinocytes. Journal of Functional Foods. 2020 2020/08/01/;71:104008.
13. Marcelino G, Hiane PA, Freitas KC, et al. Effects of Olive Oil and Its Minor Components on Cardiovascular Diseases, Inflammation, and Gut Microbiota. Nutrients. 2019 Aug 7;11(8):1826.
14. Ruano J, Lopez-Miranda J, de la Torre R, et al. Intake of phenol-rich virgin olive oil improves the postprandial prothrombotic profile in hypercholesterolemic patients. Am J Clin Nutr. 2007 Aug;86(2):341-6.
15. Sealy N, Hankinson SE, Houghton SC. Olive oil and risk of breast cancer: a systematic review and dose-response meta-analysis of observational studies. Br J Nutr. 2021 May 28;125(10):1148-56.
16. Martinez-Gonzalez MA, Toledo E, Aros F, et al. Extravirgin olive oil consumption reduces risk of atrial fibrillation: the PREDIMED (Prevencion con Dieta Mediterranea) trial. Circulation. 2014 Jul 1;130(1):18-26.
17. Abuznait AH, Qosa H, Busnena BA, et al. Olive-oil-derived oleocanthal enhances beta-amyloid clearance as a potential neuroprotective mechanism against Alzheimer’s disease: in vitro and in vivo studies. ACS Chem Neurosci. 2013 Jun 19;4(6):973-82.
18. Li Y, Lv MR, Wei YJ, et al. Dietary patterns and depression risk: A meta-analysis. Psychiatry Res. 2017 Jul;253:373-82.
19. Laino C. Olive Oil May Protect Against Ulcerative Colitis. webMD. 2010.
20. Millán MBL. Virgin olive oil & fish fatty acids help prevent acute pancreatitis. EurkaAlert. 2011.
21. Pinto X, Fanlo-Maresma M, Corbella E, et al. A Mediterranean Diet Rich in Extra-Virgin Olive Oil Is Associated with a Reduced Prevalence of Nonalcoholic Fatty Liver Disease in Older Individuals at High Cardiovascular Risk. J Nutr. 2019 Nov 1;149(11):1920-9.
22. Murphy RA, Devarshi PP, Ekimura S, et al. Long-chain omega-3 fatty acid serum concentrations across life stages in the USA: an analysis of NHANES 2011-2012. BMJ Open. 2021 May 10;11(5):e043301.
23. De Caterina R. n-3 fatty acids in cardiovascular disease. N Engl J Med. 2011 Jun 23;364(25):2439-50.
24. Slavin JL, Lloyd B. Health benefits of fruits and vegetables. Adv Nutr. 2012 Jul 1;3(4):506-16.
25. Lee J, Shin A, Oh JH, et al. Colors of vegetables and fruits and the risks of colorectal cancer. World J Gastroenterol. 2017 Apr 14;23(14):2527-38.
26. Dai Q, Borenstein AR, Wu Y, et al. Fruit and vegetable juices and Alzheimer’s disease: the Kame Project. Am J Med. 2006 Sep;119(9):751-9.
27. Koch W. Dietary Polyphenols-Important Non-Nutrients in the Prevention of Chronic Noncommunicable Diseases. A Systematic Review. Nutrients. 2019 May 9;11(5).
28. Aune D, Keum N, Giovannucci E, et al. Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies. BMJ. 2016 Jun 14;353:i2716.
29. Karl JP, Saltzman E. The role of whole grains in body weight regulation. Adv Nutr. 2012 Sep 1;3(5):697-707.
30. Hu FB, Stampfer MJ. Nut consumption and risk of coronary heart disease: a review of epidemiologic evidence. Curr Atheroscler Rep. 1999 Nov;1(3):204-9.
31. Ditano-Vazquez P, Torres-Pena JD, Galeano-Valle F, et al. The Fluid Aspect of the Mediterranean Diet in the Prevention and Management of Cardiovascular Disease and Diabetes: The Role of Polyphenol Content in Moderate Consumption of Wine and Olive Oil. Nutrients. 2019 Nov 19;11(11):2833.
32. Barzi F, Woodward M, Marfisi RM, et al. Mediterranean diet and all-causes mortality after myocardial infarction: results from the GISSI-Prevenzione trial. Eur J Clin Nutr. 2003 Apr;57(4):604-11.
33. de Lorgeril M, Salen P, Martin JL, et al. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999 Feb 16;99(6):779-85.
34. Kastorini CM, Milionis HJ, Esposito K, et al. The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol. 2011 Mar 15;57(11):1299-313.
35. Salas-Salvado J, Bullo M, Babio N, et al. Reduction in the incidence of type 2 diabetes with the Mediterranean diet: results of the PREDIMED-Reus nutrition intervention randomized trial. Diabetes Care. 2011 Jan;34(1):14-9.
36. Scarmeas N, Stern Y, Tang MX, et al. Mediterranean diet and risk for Alzheimer’s disease. Ann Neurol. 2006 Jun;59(6):912-21.
37. Schwingshackl L, Schwedhelm C, Galbete C, et al. Adherence to Mediterranean Diet and Risk of Cancer: An Updated Systematic Review and Meta-Analysis. Nutrients. 2017 Sep 26;9(10).
38. Knoops KT, de Groot LC, Kromhout D, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA. 2004 Sep 22;292(12):1433-9.
39. Bonaccio M, Di Castelnuovo A, Costanzo S, et al. Mediterranean diet and mortality in the elderly: a prospective cohort study and a meta-analysis. Br J Nutr. 2018 Oct;120(8):841-54.
40. Casas R, Estruch R. Dietary Patterns, Foods, Nutrients and Chronic Inflammatory Disorders. Immunome Research. 2016;12(2).
41. Boccardi V, Esposito A, Rizzo MR, et al. Mediterranean diet, telomere maintenance and health status among elderly. PLoS One. 2013;8(4):e62781.