A Pesco-Mediterranean Diet With Intermittent Fasting

JACC Review Topic of the Week

James H. O'Keefe, MD; Noel Torres-Acosta, MD; Evan L. O'Keefe, MD; Ibrahim M. Saeed, MD; Carl J. Lavie, MD; Sarah E. Smith, PHD; Emilio Ros, MD, PHD


J Am Coll Cardiol. 2020;76(12):1484-1493. 

In This Article

Traditional Mediterranean Diet: Gold Standard for Cardiovascular Health

The Mediterranean diet is so named because this was the style of eating adopted by many of the cultures living on or near the shores of the Mediterranean Sea. Elizabeth David wrote that the Mediterranean diet comes "from the blessed lands of sun and sea and the olive trees".[12] Ecological abundance fostered the regular consumption of plant foods (fruits, vegetables, legumes, whole grains, seeds, tree nuts, and olives), fish/seafood, and olive oil as the principal fat source, along with moderate amounts of dairy products (particularly yogurt and cheese) and eggs, as well as modest alcohol consumption (ideally red wine with the evening meal), but few red and processed meats (Central Illustration).[12,13]

Central Illustration.

Pesco-Mediterranean Diet Pyramid

Many epidemiological studies and randomized clinical trials indicate that this traditional Mediterranean diet is associated with lower risks for all-cause and CVD mortality, coronary heart disease, metabolic syndrome, diabetes, cognitive decline, neurodegenerative diseases (including Alzheimer's disease), depression, overall cancer mortality, and breast and colorectal cancers.[13,14]

The traditional Mediterranean diet has been endorsed by national guidelines such as the 2015 to 2020 Dietary Guidelines for Americans[15] and the 2019 American College of Cardiology/American Heart Association Guideline on the Primary Prevention of Cardiovascular Disease, which recommends "plant-based and Mediterranean diets along with fruits, nuts, vegetables, legumes and lean vegetable or animal protein—preferably fish".[11] The U.S. News & World Report deploys a panel of 25 nationally recognized experts to annually score 35 of the most popular diets for their health benefits. In 2020, for the third consecutive year, the Mediterranean diet was ranked #1 for overall health—described as nutritious, safe, relatively easy to follow, protective against CVD and diabetes, and effective for weight loss.[16]