Shahar Madjar, MD

I wanted to tell you about the Mediterranean diet, and then to share a recipe from the Mediterranean cuisine.

Doctors and dietitians believe that the Mediterranean diet can prevent cardiovascular disease such as heart attacks and strokes. This diet recommends a high intake of olive oil, fruits, nuts, vegetables and cereals, a moderate amount of fish and poultry, and a low intake of dairy products, red meat, processed meat, and sweets.

Most of the studies on the Mediterranean diet are observational in nature, but some are randomized. Such a randomized controlled study took place in Spain several years ago. The results were published in the New England Journal of Medicine in 2018. Dr. Ramón Estruch and his colleagues assigned 7,447 study participants into three diet groups. Two of the three groups were asked to adhere to the Mediterranean diet: one of these two groups was asked to supplement their diet with extra-virgin olive oil, while the other was asked to supplement their diet with mixed nuts. The third group of participants wasn’t assigned the Mediterranean diet; instead, participants were asked to just reduce their dietary fat (low-fat diet).

None of the participants were asked to restrict their calorie intake (no calorie-count). All of the participants were at high risk for cardiovascular disease, but none of them had ever experienced a heart attack or a stroke.

The participants in the study were recruited from June 2003 to June 2009. They were then followed by the researchers for 2.8 to 5.8 years (with a median of 4.8 years). The results were surprising: those on the Mediterranean diet (with either supplemental olive oil, or nuts) were less likely to experience a cardiovascular event such as a heart attack, or stroke. They were also less likely to die from a cardiovascular event. The differences among the groups were seemingly small (1.7-2.1%), but yet significant. And, overall, those on the Mediterranean diet were 30% less likely to experience a major cardiovascular event!

This study is not alone in its support for the Mediterranean diet. Monica Dinu from the University of Florence, Italy, and her colleagues conducted an “umbrella review” of the studies on the Mediterranean diet. They reviewed 29 meta-analyses (studies that summarize other studies) with a total of more than 12,800,000 participants and found that adherence to the Mediterranean diet is associated with a reduced risk of cardiovascular diseases, myocardial infarction, overall cancer incidence, neurodegenerative disease, diabetes, and even death.

The positive dietary effect of olive oil is of particular interest. A study by Marta Guasch-Ferré, a research scientist at the Department of Nutrition at Harvard T.H. Chan School of Public Health, published in the Journal of the American College of Cardiology in 2020 looked at 61,181 women from the Nurses’ Health Study, and 31,797 men from the Health Professional’s Follow-up Study. It showed that higher olive oil consumption (1/2 tablespoon a day or more) was associated with a lesser chance of coronary heart disease (18% lower) and cardiovascular disease (14% lower). And that replacing 5 grams a day of margarine, butter, mayonnaise, or dairy fat with the equivalent amount of olive oil can decrease the risk of cardiovascular disease and coronary heart disease by 5-7%.

Want to be healthier? To live longer? Here is a quick recipe for a classic Israeli vegetable salad. It is served at almost every meal. Each restaurant has its own version, but at its core, the recipe is simple, yet delicious.

Ingredients

Vegetables: 3 English cucumbers, 2 medium-size ripe, red tomatoes, 1 small carrot, a handful of thinly chopped parsley leaves.

Dressing: 2 tablespoons of extra virgin olive oil, 1 tablespoon of freshly squeezed lemon juice, a pinch of salt, a pinch of black pepper, and (optional) a pinch of Za’atar, Sumac or both.

Instructions: Dice the vegetables into small pieces (about 1/5 of an inch each) and combine them in a large bowl. Mix the ingredients of the dressing in a cup. Pour the dressing on the diced vegetables. Mix all the ingredients thoroughly. Add salt to taste.

For a classic Israeli breakfast, serve this vegetable salad with an egg, scrambled, or sunny-side-up, and a slice or two of slightly-toasted whole wheat, rye, or pumpernickel bread. Preparing this salad for my date, won me the heart of my then-future, now-current wife. Bon Appetit!

Editor’s note: Dr. Shahar Madjar is a urologist at Aspirus and the author of “Is Life Too Long? Essays about Life, Death and Other Trivial Matters.” Contact him at smadjar@yahoo.com.