The Mediterranean diet, which emphasizes nutrient-rich whole foods, plants, and healthy fats, has been long-hailed by nutrition experts as the best of the best when it comes to healthy diets.
It's less of a diet and more of a way of eating, based on the traditional cuisine of people in Greece, Italy, Morrocco, and other countries around the Mediterranean sea where populations boast lower rates of cardiovascular heart disease.
Heart disease is the No. 1 killer of women in the United States, per the U.S. Centers for Disease Control and Prevention, but it has historically been stereotyped as a "man's disease" by the public and members of the medical community alike, TODAY.com previously reported.
Although research has shown that the Mediterranean diet (or MedDiet for short) is linked to a reduced risk of heart disease, no systematic reviews have focused on this relationship specifically in women — until now.
Researchers at the University of Sydney analyzed data from 16 studies, looking at 22,495 women total, and found that the women who most closely stuck to the Mediterranean diet had a 24% lower incidence of heart disease, as well as a 23% lower risk of mortality.
The findings, recently published in the journal Heart, underscore the important role diet plays in the prevention of heart disease and death among women.
These study results are not surprising, Dr. Icilma Fergus, director of cardiovascular disparities at Mount Sinai Medical Center, tells TODAY.com. Not only does a diet rich in plants and whole foods help with overall cardiovascular health, it also helps lower LDL (bad cholesterol) and improve blood sugar control, Fergus adds.
Which foods are part of the Mediterranean diet?
"The Mediterranean diet is focused on fiber-rich plant foods like fruits, vegetables, herbs, nuts, seeds, beans, lentils, and whole grains," Frances Largeman-Roth, registered dietitian nutritionist, tells TODAY.com.
Other mainstays include seafood and olive oil, says Largeman-Roth, as well as moderate amounts of dairy, eggs and poultry, and small amounts of red meat. "It does not emphasize processed foods, added sugars, saturated fat and refined carbohydrates (which have) all been shown to increase inflammation,” says Largeman-Roth.
Many foods in the Mediterranean diet provide nutrients that are linked with better heart health, says Largeman-Roth, and all the plants add up to a meaningful amount of fiber, which can lower cholesterol and improve digestion.
Some studies have found that the Mediterranean diet can have benefits for women in menopause, Largeman-Roth points out.
The Mediterranean diet is popular because it is simple, flexible and focuses on the addition of delicious foods rather than restriction, TODAY.com previously reported. It's more of a lifestyle than a "diet," the experts note.
So which foods included in the Mediterranean diet are some of the best choices for women eat for better heart health?
Walnuts are rich in omega-3 fatty acids, which have been shown to help improve cardiovascular health, per the American Heart Association, and lower the risk of heart disease and stroke.
“Studies demonstrate that including walnuts in a healthy diet may play a role in helping maintain and improve both physical and cognitive health as we age,” says Largeman-Roth.
One recent study found that the heart-healthy benefits from walnuts may be linked to how they change the gut microbiome. Researchers at Texas Tech University found that walnuts alter the microbes in the gut in a way that produces more of a particular amino, which may play a role, according to a press release.
Participants who consumed a walnut-heavy diet showed a higher expression of genes that play a key role in increasing the body's production of L-homoarginine — a deficiency of which has been linked an increased risk of cariovasuclar disease, according to the study authors.
"In women with metabolic risk factors (such as obesity, hypertension and high triglycerides), a Mediterranean diet that included both walnuts and almonds has been shown to help reduce maternal weight gain and reduce the risk of gestational diabetes," says Largeman-Roth.
Dark leafy greens
Low levels of the mineral magnesium have been linked to elevated markers of inflammation, says Largeman-Roth, which can increase your risk of heart disease. Dark leafy greens are rich in magnesium, the experts note, and a great source of fiber and protein.
These include spinach, bok choy, swiss chard, kale, arugula and mustard greens, many of which can be enjoyed both raw or cooked.
Mustard greens are particularly nutritious because they are very high in vitamin K, which is important for blood to clot properly, says Largeman-Roth.
"One cup of cooked mustard greens is packed with beta-carotene, lutein and zeaxanthin," says Largeman-Roth, adding that these can help benefit eye health, as well.
Regular intake of seafood (or twice weekly) is linked with a lower risk of cardiovascular events, says Largeman-Roth. “In one study, replacing 3% of calories from processed meat with seafood was linked with a 31% decreased risk of dying from cardiovascular disease,” she adds.
Not only does seafood have heart-healthy fats, it’s packed with protein and important nutrients for women like vitamin D, calcium and zinc, says Largeman-Roth, adding that fatty fish are the most beneficial for heart health — such as salmon, tuna and sardines.
Wild salmon in particular is packed with healthy monounsaturated fats and omega-3 fatty acids, says Fergus, which have been shown to reduce the risk of heart disease and stroke, per the AHA.
“Wild seafood tends to have a better ratio of omega-3 to omega-6 fatty acids,” says Largeman-Roth, adding that Sockeye salmon provides two types of omega-3 fatty acids (DHA and EPA) and has the highest vitamin D content of all salmon species.
One observational study from the U.K. found a link between a diet high in fatty fish and legumes and a delayed onset of menopause, Largeman-Roth says.
Legumes, a key component of the Mediterranean diet, include pulses, beans, lentils and peas, the experts note.
“Niacin is a B vitamin that is excellent for your heart because it increases HDL (good) cholesterol," says Largeman-Roth, adding that foods rich in niacin include green peas, as well as avocados and pumpkin seeds. Green peas are an excellent heart healthy option to add to your diet, and they can be added to a variety of dishes for a pop of color and nutrients.
Some studies have shown that eating legumes three or more times per week was associated with decreased severity of menopausal symptoms, such as hot flashes or night sweats, says Largeman-Roth.
Olive oil is a cornerstone of the Mediterranean diet. "Rich in antioxidants and polyphenols, extra virgin olive oil is the least refined type of olive oil and provides anti-inflammatory benefits," says Largeman-Roth.
Among all edible plant oils, olive oil has the highest percentage of monounsaturated fat, which can help lower LDL, per the AHA, and it has also been shown to help lower blood pressure.
Olive oil is eaten widely throughout the Mediterranean, Largeman-Roth notes, and it can be used as the primary fat for both cooking and baking. It's also a great base for salad dressings, she adds.
Chickpeas or garbanzo beans are another food commonly found in Mediterranean cuisine. In addition to being a smart food for heart health, chickpeas are also helpful for maintaining a healthy weight and a healthy gut, says Largeman-Roth.
"Garbanzos are rich in both plant protein and fiber (soluble and insoluble), and also contain the B vitamin folate, as well as iron and phosphorus, which is important for bone health," Largeman-Roth adds. The versatile legumes make a great addition to salads, soups, stews, curries and more.
"Berries are excellent because they're loaded with great nutrients and antioxidants," says Fergus. Blueberries contain high amounts of flavonoids, which have anti-inflammatory properties and have been shown to lower the risk of heart disease and blood pressure, per the AHA.
They're also full of fiber and nutrients, the experts note, such as vitamin C, potassium and iron. "When the when the fruits are darker, you're getting a lot of really great nutrients out of out of them," says Fergus.
"Potassium is another essential mineral for heart health, which is why it’s a cornerstone of the DASH (Dietary Approaches to Stop Hypertension) Diet, says Largeman-Roth.
Potassium- and fiber-rich butternut squash is also full of carotenoids, which have been linked with a reduced risk of heart disease, the experts note.
It can be enjoyed on its own or as a rich base for soups and sauces.
"Whether you enjoy them fresh or dried, figs are a nutrient powerhouse," says Largeman-Roth. These fiber-rich fruits are popular in Mediterranean cuisine and an important heart-healthy choice for women, the experts note.
One serving of figs (three to four) can provide five grams of fiber, 10% of your potassium needs for the day and 6% of your daily calcium needs, says Largeman-Roth. Figs also have a high concentration of phenolic compounds, which act as antioxidants, she adds.
Fresh figs can be enjoyed on their own or added to a variety of dishes, and dried figs are a good source of natural sugar to add to baked goods.
Whole grains, a key part of the Mediterranean diet, include brown rice, whole wheat, oats, quinoa, buckwheat and barley.
All of these are beneficial thanks to their fiber and mineral content, says Largeman-Roth, but barley is the highest in fiber — particularly, a type of fiber called beta-glucan. "This helps reduce LDL cholesterol, stabilize blood sugar and support immune system function," says Largeman-Roth.
Barley also contains resistant starch, a type of carbohydrate that acts like fiber and helps you feel full longer, Largeman-Roth adds. Barley can be eaten on its own or added to salads or soups, and barley flour can be used in baked goods.