© 2013 Nancy B. Emerson Lombardo

A stellar research study,*[1] one of the largest high quality human clinical diet trial to date, demonstrates that following the Mediterranean Diet can dramatically reduce one’s risk of heart attack and stroke by 30%, even when one is at high risk for cardiovascular disease and is taking currently recommended medications. This is a seminal study for not only heart health, olive oil and olives

but also for brain health since the two are closely linked.

The clinical trial involved over 7,500 adults aged 55-80 in Spain, with high cardio-vascular risk factors but no previous heart attacks or strokes nor diagnosis of cardio-vascular disease. Many participants were already on meds for cardio-vascular risk factors including high blood pressure meds (80%), statins (55%), diabetes meds (50%); blood thinners (29%). The study was funded by Spain’s national Department of Health.

Two thirds of the study participants were randomized to one of two Mediterranean Diet (Med Diet) groups and the other third to a control, “low-fat” diet.

The results were dramatic.Both Med Diet groups had 30% fewer heart attacks or strokes than the control group over the 4.8 years of study. This 30% drop is clinically relevant as well as statistically significant. The study was stopped early so the control group could begin benefiting from the Med Diet intervention.

* Source: Estruch R & Martinez-Gonzalez MA, et. al.Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. N Engl J Med Feb 25 2013. DOI: 10.1056/NEJMoa1200303    




How did the study work?

Each group was instructed on how to implement the diet goals in their lives. They were given shopping lists, recipes and lots of coaching about how to improve their diet.

Looking more closely to the study’s report on compliance and who was eating what, they discovered that, given it was Spain, at baseline everyone was eating some version of the Mediterranean Diet already, but perhaps with unhealthy distortions, such as eating too much red meat, too many processed foods, or too many sweets, and not enough vegetables, beans, olive oil or fish. All study groups shared some of the same directions:

1) eating at least 3fruits/day,

2) at least 2 vegetable servings/day,

3)eating fish at least 3 times a week,

4)eating more beans and lentils

5)consume no more than two servings PER WEEK of sugary desserts or processed baked goods.


But the control group was encouraged to eat a low fat diet and their three servings of fish were to exclude the more fatty types, whereas the two Med Diet groups were encouraged to eat fatty fish, more olive oil and healthy fats, and were not restricted on total fats.


At the end of the study, researchers discovered that the control group had not been able to really change their diet much at all, and that two of the major changes for the two Med Diet groups was related to the study foods they were GIVEN to add to their regimen.


Med Diet Groups Were Given Free Olive Oil or Nuts

One group was given enough high quality extra virgin olive oil (EVOO) for each participant (and family members) to eat 4 Tablespoons every day.


The other group of participants was given 1 oz/30 gram packets of nuts (a mixture of walnuts (1/2 oz) and almonds and hazelnuts(1/4 oz each)).


The EVOO group increased their olive oil consumption by 50 grams, the NUTS group increased their olive oil consumption by 32 grams. The EVOO group increased average daily nut consumption to .9 servings/week and the NUTS group increased theirs to six 30 gram servings per week.


The other two significant increases in healthy foods were that both groups ate more fish (.3 more servings/week) and more beans and lentils (an extra .4 servings/week), as recommended by the study guidelines.

This writer has learned that the Spanish Med Diet study also included some secondary outcome measures related to cognitive or brain health; we haven’t learned just which tests were used or when the authors plan to publish those results. Stay tuned!


What are the take away messages?  

Yes, do try to adopt as many of the foods in the Mediterranean Diet as you can.

You could start with just the two biggest changes study participants made (though keep in mind most participants were already eating lots of vegetables, beans, lentils and very few sweets):


  • at least 1 oz of nuts and seeds every day, (use seeds Lots of Nuts such as flax, hemp, chia, pumpkin etc if allergic to nuts, or to mix it up since variety is heart and brain healthy)

(See related article on which nuts and seeds to eat)

What other changes toward the Med Diet could I make?


If you want to kick your Med Diet changes up a notch, then also add these elements:

  • Eat fish, especially fatty fish such as salmon, sardines, tuna, at least 3 times a week. Salmon
  • Eat ½-1 cup of lentils or beans 3 times/week or more often.
  • Eat veggies as many times a day as you can.
  • Eat a variety of fruit daily, ideally 3-5 servings.
  • Minimize processed foods.
  • Minimize pastries and baked and other desserts/sweets to no more than 3 times/week, preferably made “from scratch.”       (And if you also follow Dr. Nancy, chose desserts or pastries containing dark chocolate, fruit and/or spices.)


Many people ask me, “What is the difference between the Mediterranean Diet and Dr. Nancy’s Memory Preservation Nutrition® program?” To learn the answer see related article.  


To learn more:


Visit my website (for brain and heart healthy recipes as well as more ideas), as well as the website for the Spanish Med Diet study:  This website also contains, in Spanish only, shopping lists and recipes for the two Med Diet intervention groups (olive oil and nuts). http://predimed.onmedic.net/eng/ImplementationoftheIntervention/RECIPESBYINTERVENTIONGROUPS/tabid/582/Default.aspx     (Ignore the Low Fat section as that did not help people).


Med Pyramid



[1] Estruch R & Martinez-Gonzalez MA, et. al.Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. N Engl J Med Feb 25 2013. DOI: 10.1056/NEJMoa1200303


[2]Abuznait AH, Qosa H, Busnena BA, El Sayed KA, and Kaddoumi A.   Olive-Oil-Derived Oleocanthal Enhances β-Amyloid Clearance as a Potential Neuroprotective Mechanism against Alzheimer’s Disease: In Vitro and in Vivo Studies. ACS Chem. Neurosci., Article ASAP DOI: 10.1021/cn400024q (Feb 13, 2013)


[3] Samieri C, Féart C, Proust-Lima C, Peuchant E, Tzourio C, Stapf C, Berr C, Barberger-Gateau P. Olive oil consumption, plasma oleic acid, and stroke incidence: the Three-City Study. Neurology. 2011 Aug 2;77(5):418-25. Epub 2011 Jun 15.

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