Review points to "Pesco-Mediterranean" diet with intermittent fasting for heart health

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A Pesco-Mediterranean diet rich in plants, nuts, whole grains, extra-virgin olive oil, and fish or seafood, in combination with intermittent fasting, is ideal for optimizing cardiovascular health, according to a new cumulative review published in the Journal of the American College of Cardiology.

The traditional Mediterranean diet has been endorsed by national guidelines as well as the 2019 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline on the Primary Prevention of Cardiovascular Disease. The Mediterranean diet consists of plant foods including fruits, vegetables, legumes, whole grains, seeds, tree nuts, and olives, fish and seafood, olive oil, and moderate amounts of dairy products like yogurt or cheese and eggs. Multiple studies and randomized clinical trials have indicated that the diet is associated with lower risk for heart disease, diabetes, cognitive decline, depression, and some cancers, the researchers said.

Previous studies have supported including fish as a part of a heart-healthy diet. The 2015-2020 Dietary Guidelines for Americans recommend adults consume fish at least twice a week in place of red meat, poultry, or eggs. A pescatarian diet includes fish or seafood as the primary source of protein and minimizes the consumption of red meat or poultry. A meta-analysis of five prospective dietary studies found that compared to regular meat-eaters, coronary artery disease mortality was 34 percent lower in those following a pescatarian diet.

A Pesco-Mediterranean diet also emphasizes using extra-virgin olive oil in place of butter or other fats. Extra-virgin olive oil is a higher-quality, unrefined olive oil, and has been shown in previous studies to have cardiometabolic benefits, such as reducing low density lipoprotein or “bad” cholesterol and increasing high density lipoprotein or “good” cholesterol. The researchers recommend using generous amounts of extra-virgin olive oil, which is high in polyphenol antioxidants, along with vegetable dishes. To provide an additional source of healthy fats and fibers, the Pesco-Mediterranean diet includes tree nuts. The PREDIMED trial, a randomized clinical trial of primary heart disease prevention, showed a daily serving of mixed nuts resulted in a 28 percent lower risk of heart disease, the study said.

Intermittent fasting, the practice of limiting daily intake of calories in a specific time window, usually between eight to 12 hours, each day, has been shown to reduce inflammation and improve insulin sensitivity by forcing the body to switch from burning glucose to fatty acids, usually from belly fat, as the primary metabolic fuel. The most common form of intermittent fasting is timed-restricted eating, consisting of limiting to two, rather than three, meals per day and shortening the calorie-consumption window. Evidence regarding time-restricted eating is preliminary and requires more research, the researchers said.

"Although humans are omnivores and can subsist on a myriad of foods, the ideal diet for health remains a dilemma for many people," said James O'Keefe, MD, lead author of the study and director of preventive cardiology at Saint Luke's Mid America Heart Institute, in a statement. "Plant-rich diets reduce cardiovascular disease risk. However, veganism [is] difficult to follow and can result in important nutrient deficiencies. On the other hand, many people in modern Western cultures over-consume meat, particularly highly processed meat from animals raised in inhuman conditions. We propose the Pesco-Mediterranean diet as a solution to this…dilemma about what to eat."