The Mediterranean Diet: A Refinement on the Idea of Real, Whole Food

The Best Diet for a Longer Healthier Life

In the United States, there has been a huge shift in what we eat that has made us fat and sick. Many of us get most of our calories from highly processed foods. That is a new development over the last fifty or sixty years. I have written extensively about diet as the root cause of the related epidemics of obesity, type 2 diabetes and cardiovascular disease. I have also written extensively about a change in diet to real, whole food as part of the answer to this epidemic. The Mediterranean diet is a further refinement of that idea.

 “Among all the diets examined, adherence to the Mediterranean diet demonstrated the most pronounced and consistently beneficial impact on both anthropometric parameters (weight, BMI, muscle to fat ratio) and cardiometabolic risk factors. For the first time, we have 25 years of follow-up testing the benefit of the Mediterranean diet on health. In this analysis the Women’s Health Study, higher adherence to the Mediterranean diet was associated with 23% lower risk of all-cause mortality. A higher Mediterranean diet score was associated with decreased risks of all-cause, cardiovascular, and cancer mortality in a linear fashion. That benefit was partially explained by effects on multiple cardiometabolic factors. That is huge news. All-cause mortality is the hardest of hard endpoints. Either you are dead or you aren’t—no controversy there, and patients on the Mediterranean diet week much more likely to be alive after 25 years. These women entered the study at an average age of 55. Twenty-five years later is age 80. Many more women on the Mediterranean diet reached that age.

The  Mediterranean diet is based on eating patterns In countries around the Mediterranean Sea. This healthy diet includes an emphasis on plant foods, including fruits, vegetables, beans, peas, nuts, and whole grains, nuts and legumes preferably fresh, and grown locally, olive oil as the principal source of fat, cheese and yogurt consumed daily in low to moderate amounts, seafood and poultry, consumed in low to moderate amounts a few times a week, and red meat, consumed infrequently and in small amounts. Not only is the Mediterranean diet the most effective approach to a healthier longer life, it is the easiest path. This is delicious real food that sticks to your ribs and satisfies your appetite. All you need to do is get away from highly processed irresistible combinations of fat, salt, sugar, and carbs, and eat like people in the Mediterranean countries have for hundreds, even thousands, of years. If you eat like that consistently, you will lose a pound or two a month— No muss, no fuss, no calorie counting, no food diaries, no exercise boot camp. Just lose weight and improve weight by eating real food until you aren’t hungry.  

Over 25 years of follow-up, the Mediterranean diet reduced all-cause death by 23%. To put this in perspective, the longest follow-up we have for the new, expensive obesity drugs like Wegovy is 4 years. Studies of drugs like Wegovy showed a reduction in all-cause mortality of 11%. Maybe they would have more impact in a longer study. We just don’t know. Other expensive drugs like Jardiance reduced all‐cause deaths from 21 to 14%. The Mediterranean diet benefit is on the same order of magnitude as these very expensive drugs.

These medications are beneficial, but they are not the most beneficial. There is another study with 21 years of follow-up documenting the benefits of best practice medical management on all-cause mortality. Optimal medical therapy for patients with type 2 diabetes consisting of generic, inexpensive drugs like lisinopril, losartan, amlodipine or hydrochlorothiazide for high blood pressure, atorvastatin for cholesterol, and metformin for diabetes reduced mortality by 45% compared with usual care—the care that most people receive.

But that is not the most impressive result. The patients with diabetes were high-risk because they also had chronic kidney disease. Patients with chronic kidney disease have such a high mortality risk that most of them don’t live long enough to go on dialysis. Thirteen years into the diabetes study, at an average age of 68, half of the patients with diabetes in usual care were dead. These are not the highest risk patients. Someone who has already had a heart attack is the highest risk patient for premature death. The higher the risk, the more beneficial optimal medical therapy (OMT) is. In this study from the Kaiser Permanente Health system in Colorado, six hundred and twenty-eight patients received OMT from a team of nurses and pharmacists and six hundred and twenty-eight continued to receive the care most Americans receive. During a five year follow-up there were 16 all-cause deaths in the OMT group and 188 all-cause deaths for the usual care group. You can review the study in this link and satisfy yourself this data is valid. Twelve times as many people were dead in the usual care group after just five years. That is the most effective medical treatment that I know of and yet most Americans have no access to that kind of care.

Now we have evidence for the best diet to increase healthy lifespan and the best medication approach. Both have over two decades of evidence to support them. They have never been used together and we now have evidence to support combining them for even more benefit. It is time to combine the Mediterranean diet with optimal medical therapy at scale using advanced primary care teams and scale it to improve health and reduce healthcare costs.