IE 11 is not supported. For an optimal experience visit our site on another browser.

A twist on the Mediterranean diet is 'ideal' for heart health, doctors declare

This style of eating has many benefits, especially when it comes to long-term cardiovascular health and longevity.
Mediterranean style food background. Fish, vegetables, herbs, chickpeas, olives, cheese on grey background, top view. Healthy food concept. Flat lay
Getty Images
/ Source: TODAY

If you were to design the ideal eating plan for a healthy heart, plenty of evidence suggests it would be the Pesco-Mediterranean diet with daily intermittent fasting built in, a group of doctors declared this week.

It’s still the plant-rich, olive oil-lubricated Mediterranean diet most people are familiar with, but with more emphasis on seafood as the main source of animal protein.

This style of eating has many benefits, especially when it comes to long-term cardiovascular health and longevity, the authors wrote in a review of studies, published Monday in the Journal of the American College of Cardiology.

It also solves the “omnivore's dilemma.” When you can eat anything — like humans can — what do you choose that’s good for you, but also tasty and sustainable for the long-term?

It’s not the “junky” Western diet high in processed meat, refined carbohydrates and saturated fat, said Dr. James O'Keefe, lead author of the paper and director of preventive cardiology at Saint Luke's Mid America Heart Institute in Kansas City, Missouri.

Vegan diets can reduce cardiovascular disease risk, but also lead to weak bones and muscles, or anemia, he noted.

Enter the Pesco-Mediterranean diet, which O'Keefe himself follows.

“It's is satiating, it's enjoyable, it's delicious and it's super healthy,” O'Keefe told TODAY.

When it came to adding intermittent fasting into the mix, he and his colleagues felt “the science is robust enough now that we can endorse that as a healthy thing to do,” he said.

Plant-based diet

The traditional Mediterranean eating style — which has been called the “gold standard for cardiovascular health” — is primarily a plant-rich diet that incorporates lots of fruits, vegetables, legumes, whole grains, seeds and nuts. Olive oil serves the main fat source, while very few red and processed meats are consumed.

Many studies and randomized clinical trials have found this diet to be associated with lower risks for dying of heart disease or developing coronary heart disease, the authors noted.

The diet should include three or more servings of vegetables and two or more servings of fruit a day.

Fish and seafood

A pescatarian diet — the “Pesco” part of the eating plan endorsed by this paper — is still a plant-rich diet, but with seafood as the main source of meat. Fish is a high-quality protein that’s satiating, and helps build muscle and bone mass. It provides vitamins, minerals and other nutrients that can be missing in vegetarian or vegan diets.

Regular intake of fish has been shown to reduce cardiovascular risk, “so we felt that it deserves a certain spot in the title,” O'Keefe said.

The goal is to eat seafood at least three times a week. Choose low-mercury fish such as salmon, sardines, trout, herring and anchovies. Avoid charring or burning fish while cooking, which can introduce carcinogenic compounds, the authors cautioned.

Fish is high in omega-3s, low in saturated fat and moderate in calories, so it’s better than beef or chicken as a protein source, agreed Lisa Young, a registered dietitian in New York and author of “Finally Full, Finally Slim.”

Studies have found mortality from coronary artery disease was 34% lower in pescatarians compared to regular meat-eaters, the authors noted.

Extra virgin olive oil

Liberal use of extra virgin olive oil is an important part of the Mediterranean diet. It’s crucial to choose high-quality oil made from cold pressing olives, a process that retains their potent antioxidants and creates a product equivalent to “pure olive juice,” the study noted.

The authors recommended consuming four or more tablespoons a day of EVOO, which can be used to dress salads or for light cooking.

“At our household, I can tell you we do not even think about limiting the amount of olive oil, we just use it as much as we want and we go through about a liter of week — just my wife and I,” O'Keefe said.

But Young cautioned against going overboard with the elixir for most people.

“You can’t add a bottle of olive oil to the typical American diet,” Young cautioned. “If you're having full fat cheese, some meat, fried foods and croutons, you don't want to pour a bottle of olive oil on top of that.”

Eggs and dairy

The Pesco-Mediterranean diet allows consumption of eggs, but preferably no more than five yolks per week — though there’s no limit on egg whites. It also cautiously allows fermented low-fat versions of dairy, including yogurt, kefir and soft cheeses.

Nuts and legumes

Nuts, which are packed with unsaturated fats, fiber, protein and nutrients, are “one of the most effective foods for improving long-term health outcomes,” the study noted. They’re filling so they don’t promote weight gain. Young advised swapping a candy bar or another typical afternoon snack for a handful of nuts.

Eating legumes has been linked to improvements in blood sugar, cholesterol levels and blood pressure.

Young recommended eating a variety of both foods to capture the most nutrients: mixed nuts, and lots of legumes including chickpeas, lentils and split peas.

Go for one 1-ounce serving of nuts a day, and three or more servings of legumes a week.


The staple beverage of this diet is water — either still, carbonated or used to make tea or coffee. It can be flavored but not sweetened. Dry red wine is cautiously allowed: one glass a day for women, and up to two glasses for men, consumed with meals.

Intermittent fasting

“Most Americans eat from the moment they get up to the moment they go to bed,” O'Keefe said. “But when we give our body a break from digesting food, it tends to be good for it.”

A daily fast of at least 12 hours, much of it done while sleeping and which can be extended to 16 hours a day, appears to enhance cardiovascular health and lower blood pressure, the study noted.