Updated 01 November 2013

Eat a heart-healthy diet

A Spanish study has found that approximately 30% of heart attacks, strokes and death from heart disease can be prevented by eating a Mediterranean Diet.

We have know for many years that eating a Mediterranean Diet has health benefits. Until last week, however, the actual benefits, especially for heart health, had not been backed up by a large scale scientific study. This changed last week when the results of a major scientific study conducted in Spain by Dr Ramon Estruch and his team (2013), were published in the prestigious New England Journal of Medicine. The study found that approximately 30% of heart attacks, strokes and death from heart disease can be prevented by eating a Mediterranean Diet.

Spanish Study

Dr Estruch and his coworkers enrolled 7 447 Spanish adults of both sexes between the ages of 55 to 80 years who had no cardiovascular disease at the start of the study. The subjects were not excluded from the study because of other lifestyle problems such as type 2 diabetes, smoking, hypertension, overweight/obesity, raised LDL-cholesterol levels or a family history of coronary heart disease (Estruch et al, 2013). In contrast to most other studies investigating heart disease, the PREDIMED (Prevención con Dieta Mediterránea), selected subjects who had at least 3 of the above mentioned lifestyle risk factors. In other words, the members of this study population already had the odds stacked against them when it came to the potential of developing heart disease.

Dietary Interventions

The study population were randomly divided into 3 dietary intervention groups, namely:
  • A Mediterranean diet supplemented with extra-virgin olive oil (about 1 litre per week or 4 tablespoon of olive oil per day)
  • A Mediterranean diet supplemented with 30 g mixed nuts daily (15 g walnuts, 7,5 g hazelnuts and 7,5 g of almonds per day)
  • A low-fat control diet as generally recommended to lower the risk of heart disease

All the groups were given individual dietary training sessions by dietitians, but initially the low-fat diet group only received such training at the start of the study period. The researchers soon realised that the difference in dietary training support could be regarded as a factor influencing the success or failure of a given dietary treatment. Thereafter the control group were also exposed to the same intensity of personalised dietary advice and group sessions as the Mediterranean diet groups.

None of the participants were encouraged to lose weight or take part in physical activity. In other words, no other standard interventions to boost heart health, except the use of a Mediterranean diet were used to influence the outcome of the study.


After a study period of about 5 years, the research found a 30% reduction in both morbidity (heart attacks, stroke) and mortality (deaths due to cardiovascular diseases), in study participants, who were classified as “high-risk persons” in relation to cardiovascular disease, using either one of the Mediterranean diet (olive oil or nuts) (Estruch et al, 2013). This result was obtained without weight reduction or an increase in physical activity.

It is interesting to note that the“dropout rates” on the Mediterranean diet (either with added olive oil or nuts), were lower than on the low-fat diet, namely 4,9% versus 11,3% (Estruch et al, 2013).

The Mediterranean Diet

The Mediterranean Diet used in this study had the following characteristics:
  • low intake of meat, meat products, especially red meat
  • high intake of vegetables, fruits, nuts, legumes, fish and olive oil
  • moderate intake of ethanol (mostly from wine)
The Oldways Organisation in the USA encourages people to use traditional diets like the Mediterranean diet and to enjoy their food. They also promote the use of olive oil and eating Mediterranean foods such as plain yoghurt, feta cheese, legumes, hummus, olives and fish.

Oldways Mediterranean Pyramid

The Oldways Mediterranean Pyramid consists of:
  • The broad base of fruits, vegetables, grains (mostly whole grains), olive oil, beans, nuts, legumes, seeds, herbs and spices which should be used at every meal
  • The second smaller layer of fish and seafood which should be eaten often, but at least twice a week.
  • The even smaller layer of poultry, eggs, cheese and yoghurt which can be eaten in moderate portions daily to weekly (for example, eating plain, unsweetened yoghurt daily, and chicken one or twice a week)
  • The tip or narrowest part of the pyramid accommodates meats and sweets which one should eat less often
  • The Oldways Mediterranean Pyramid also encourages people to be physically active and to enjoy meals with others
  • Drinking water is recommended, but wine can also be consumed in moderation.
    (Oldways, 2013)

In regard to the latter bit of advice, I can already hear all the prohibitionists proclaiming doom and gloom on any health message that even mentions the intake of an alcoholic beverage unless it advocates a total ban.

People living in Mediterranean countries such as Italy, Greece and the South of France have been drinking the distillations of the fruit of the vine for millennia without descending into wholesale depravity. The key is of course the word “moderation”. If you are not able to drink wine in moderation, then stick to water.

In addition, Ms Baer-Sinnott (2012), the lecturer from Oldways who spoke about the principles that guide the Oldways approach at the “Managing Sweetness Symposium” I attended in 2012, emphasised that the recommendation regarding alcohol in the Oldways Mediterranean Pyramid did not apply to anyone who did not drink alcohol for any reason  whatsoever (children, teenagers, pregnant and lactating women, individuals who do not drink for religious reasons, who are sensitive to alcohol or have a tendency towards alcoholism or are recovering alcoholics, etc). This is, thus not an encouragement to start dinking alcohol, but a suggestion that individuals who do drink alcoholic beverages can drink moderate quantities of wine as part of a philosophy of eating and living that emphasises ‘management not banishment’ of foods and drinks (Baer-Sinnott,2012).

The report based on the findings of the large Spanish study of the effects of the Mediterranean Diet on heart health has made headline news throughout the world (Kolata G, 2013) and hopefully holds the key to a healthier future. If you have never tried eating a Mediterranean diet, then now is the time to start applying the basic principles to your own life.

(References: Baer-Sinnott, (2012). Managing Sweetness South Africa, Feb 2012. Opening address at Managing Sweetness, An Oldways Event in association with ADSA and SAAFoST, 23 February 2012. Sandton Convention Centre, Johannesburg. Estruch R et al (2013). Primary prevention of cardiovascular disease with a Mediterranean diet.; Oldways (2013). Kolata G (2013). Mediterranean Diet can cut heart disease, study finds. The New York Times, Feb 25, 2013. ; Oldways Mediterranean Pyramid.

Dr Ingrid van Heerden is a registered dietician and holds a doctoral degree in Nutrition and Biochemistry. She believes that "we are what we eat" and offers free nutrition and weight loss advice via her DietDoc service on Read more of her articles.


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