The Mediterranean diet has long been touted as being extremely good for us - and now new research appears to back that up.
Rammed with lots of vegetables, fruits, beans, cereals and cereal products, such as wholegrain bread, pasta and brown rice, the traditional southern Europe way of dining has always been considered a healthy one.
Add to this the de rigueur fish, white meat and dairy, it's no wonder the popular diet is often adopted across the world.
And now a global review has found it can lower the risk for hundreds of millions of people who have an increased possibility of cardiovascular disease, stroke, heart attack or early death.
A diet festooned in nuts, olive oil, seafood, whole grains and vegetables has previously been linked to a wide range of benefits.
Yet until now the evidence to back this up has been rather scant.
But it appears it can indeed help people with an increased risk of cardiovascular disease, including hundreds of millions of people living with type 2 diabetes, obesity, high cholesterol or high blood pressure and those who are physically inactive, smoke or drink too much alcohol.
Anyone at a higher risk of heart issues is currently recommended various diets which tend to be based on low-certainty evidence from non-randomised studies.
But a first-of-its-kind global study involving more than 35,000 people has provided some compelling data to shore this up.
According to the first comparative review of seven programmes published in the BMJ journal, Mediterranean and low-fat diets lessen the likelihood of heart attack and death in people at heightened risk of cardiovascular disease,
The study’s authors wrote: “Moderate-certainty evidence shows that programmes promoting Mediterranean and low-fat diets, with or without physical activity or other interventions, reduce all-cause mortality and non-fatal myocardial infarction [heart attacks] in patients with increased cardiovascular risk.
“Mediterranean programmes are also likely to reduce stroke risk.”
Forty trials involving some 35,548 people – who were monitored for an average of three years across seven diet programmes – were reviewed by researchers from China, the US, Canada, Spain, Colombia and Brazil.
What were the seven diets?
The seven diets were:
1. Mediterranean
2. Low fat
3. Very low fat
4. Modified fat
5. Combined low fat and low sodium.
6. Pritikin (a plant-based diet, limiting processed food)
7. Ornish (a vegetarian diet, low in fat and refined sugar).
Based on moderate-certainty evidence, Mediterranean diet programmes were superior than minimal intervention at warding off all-cause mortality, non-fatal heart attack and stroke in people at risk of cardiovascular disease.
The low-fat programmes were also better than minimal intervention, with moderate certainty, for preventing all-cause mortality and non-fatal heart attack.
Interestingly, the remaining five diets didn't offer much benefit when compared with minimal intervention, typically based on low-to moderate-certainty evidence.
There were several limitations to the study, duly acknowledged by the researchers.
They were unable to measure how well a person stuck to their diet programmes plus there was a chance that some of the benefits could have been due to other elements within the programmes, such as drug treatments and support to stop smoking.
Yest despite this, the BMJ still deemed it a comprehensive review.
'A Mediterranean-style diet is good for your heart'
Tracy Parker, a senior dietitian at the British Heart Foundation, said: “It’s long been known that eating Mediterranean-style is good for your heart, but it’s encouraging to see programmes like this lower the risk of death and heart attacks in patients already at risk of cardiovascular disease.
“Whether you are at risk or not, a healthy lifestyle which includes a balanced diet like the Mediterranean-style diet can help you to lower your risk of developing heart and circulatory diseases,” she said.
“The risk factors associated with cardiovascular disease such as type 2 diabetes, obesity, high blood pressure and high cholesterol are also reduced with a Mediterranean diet.
“It’s easy to do – make sure you are eating plenty of fruit and vegetables, beans, lentils, whole grains, fish, nuts and seeds, along with some low-fat dairy and fat from unsaturated sources like olive oil. It’s also important to eat less processed meat, salt and sweet treats.”
'I'm worried about my cholesterol - what foods can help bring it down?
Charity Heart UK says there are FOUR of them:
Foods with added sterols and stanols
These are plant chemicals similar in size and shape to cholesterol.
Heart UK explains: "They are absorbed from the intestines into the blood stream.
"They block some cholesterol from being absorbed, lowering the cholesterol in your blood."
There are yoghurt drinks, fat spreads, milk, and actual yoghurts that have plant sterols or stanols added to them.
Heart UK adds: "These fortified foods lower your cholesterol gradually, over a few weeks."
The exact amount to which sterols and stanols help to lower your cholesterol 'depends on the amount you eat'.
Oats and barley
These are rich in the fibre beta glucan.
When eaten, beta gluten forms a gel that binds to cholesterol-rich bile acids in the intestines.
"This helps limit the amount of cholesterol absorbed from the gut into your blood," the charity says.
"Your liver then has to take more cholesterol out of your blood to make more bile, which lowers your blood cholesterol."
Oats and barley can be found in:
- Porridge
Oatcakes
- Oat-based cereal
- Pearl barley.
Nuts
These contain unsaturated fats, fibre, vitamin E, magnesium, and potassium, which can help lower cholesterol levels.
A bonus of snacking on nuts is that they are rather filling, meaning you are less likely to eat things which are bad for your cholesterol - such as ice cream.
Nuts to eat include: cashew nuts, almonds, macadamias, brazil nuts, peanuts, hazelnuts, pistachios, walnuts, and pecans.
Soya foods
Found in such things as soya milk, soya mince, edamame beans, and tofu, this often overlooked legume is a real secret weapon in your war against bad cholesterol.
"Try to eat some of these every day as part of your healthy diet," the charity advises.
"The more you add them to what you eat, the more they can help lower your cholesterol, especially if you cut down on saturated fat as well."
Vitamins - what they do and which foods they are in
A (Retinol): Supports vision, skin, bone and tooth growth, immunity and reproduction. Found in: Mango, carrots, butternut squash, pumpkin, broccoli and beef liver.
B1 (Thiamin): Supports energy metabolism and nerve function. Found in: Watermelon, tomato, spinach, soy milk, lean ham, pork chops and sunflower seed.
B2 (Riboflavin): Supports energy metabolism, normal vision and skin health. Found in: Spinach, broccoli, mushroom, milk, egg, liver, oysters and clams.
B3 (Niacin): Supports energy metabolism, skin health, nervous system and digestive system. Found in: Spinach, potatoes, tomato, lean ground beef, chicken breast, shrimp, tuna (canned in water) and liver.
B12: Used in new cell synthesis, helps break down fatty acids and amino acids, supports nerve cell maintenance. Found in: Milk, meats, poultry, fish, eggs and shellfish.
B6 (Pyridoxine): Amino acid and fatty acid metabolism, red blood cell production. Found in: Banana, watermelon, tomato, potatoes, broccoli, spinach, chicken breast and white rice.
C (Ascorbic Acid): Used in new cell synthesis, helps break down fatty acids and amino acids, supports nerve cell maintenance. Found in: Mango, orange, lemon, grapefruit, strawberries, kiwi, spinach, broccoli, red peppers, pes and tomato.
D: Promote bone mineralisation. Found in: Milk, egg yolk, liver, fatty fish and sunlight.
E: Antioxidant, regulation of oxidation reactions, supports cell membrane stabilisation. Found in: Avocado, cod, shrimp, tofu, wheat and sunflower seed.
K: Synthesis of blood-clotting proteins, regulates blood calcium. Found in: Spinach, broccoli, Brussels sprouts, leafy green vegetables and liver.
Folate: Supports DNA synthesis and new cell formation. Found in: Tomato, broccoli, spinach, asparagus, okra, green beans and black-eyed peas.
Biotin: Energy metabolism, fat synthesis, amino acid metabolism, glycogen synthesis. Found in: A widespread array of foods..
Pantothenic Acid: Supports energy metabolism. Found in: A widespread array of foods.