The Mediterranean Diet has been named US Best Diet several years in a row, and with good reason. Research shows that this sustainable diet plan is not only good for your heart and waistline, but it’s also delicious (1).

More recent research out of Israel suggests an even better Mediterranean Diet for heart health. Meet the “Green” Mediterranean/high polyphenols Diet. According to a new study, experts say it’s “twice as good” with promises of unstiffening the aorta—the biggest artery in the body. Lettuce look at what’s on the plate!

The Power of Polyphenols

Polyphenols are natural compounds found primarily in fruits, including apples, berries, cherries, grapes, and pears, as well as vegetables, cereals, and some beverages, such as coffee and green tea. Several fruits may have up to 200–300 mg of polyphenols per 100 grams of fresh fruit.

Polyphenols act to protect the body’s tissues against oxidative stress (think of this as internal rusting in the body). They work in conjunction with other antioxidants such as vitamin C, vitamin E, and carotenoids. Polyphenols help prevent coronary artery disease, cancer, and inflammation.

Food over Pills

It may be tempting to just pop a few antioxidants and call it a day, but experts caution against this. Animal studies have shown that high-dose polyphenol supplements could cause an imbalance in thyroid levels, damage kidneys, and increase tumor growth. In humans, they may increase the risk of stroke and premature death. No, thank you.

The concept of the green-Mediterranean, high polyphenols diet was first suggested by the DIRECT-PLUS trial researchers. The Green Mediterranean diet differs from the original Mediterranean diet because it’s higher in dietary polyphenols and contains fewer red or processed meat servings.

In addition, walnuts are suggested daily, as are three or four cups of green tea and one cup of Wolffia-globosa mankai—a plant-based green shake containing duckweed. This is advised to be consumed for 18 months. The water-based green plant mankai is a good meat substitute as it contains bioavailable iron, vitamin B12, protein, and over 200 types of polyphenols.

Heart Health Benefits

Large-scale clinical research in the DIRECT-PLUS found that the Green Mediterranean/high polyphenols diet drastically reverses proximal aortic stiffness (PAS), a key to reducing vascular aging and cardiovascular risk. When compared to the Mediterranean diet, the Green Mediterranean diet regressed proximal aortic stiffness by 15%. The Mediterranean diet regressed PAS by 7.3% and the healthy dietary guidelines regressed it by 4.8%.

The DIRECT-PLUS study was one of the first to find a significant impact of diet on age-related proximal aortic stiffness. The study, published in the Journal of the American College of Cardiology, had 300 subjects and was done over 18 months. Aortic stiffness was evaluated using MRIs, the most accurate, noninvasive measure of blood vessel wall elasticity.

Aortic stiffness happens when elastin (elastic fibers in the arterial wall) starts to fray from mechanical stress. PAS is a key marker in vascular aging and a solo cardiovascular risk factor that predicts morbidity and mortality.

Diet Modifications for Better Health

One of the first strategies in treating obesity and metabolic complications is diet modification. Intense exercise itself reduces PAS, but the impact of weight loss is unknown. The research team believes the Mediterranean diet is one of the best-researched interventions to lower cardiometabolic risk.

The hypo-caloric, Green Mediterranean diet supplemented with plant-based polyphenols, less meat, and fewer simple sugars may provide benefits over the hypo-caloric Mediterranean diet and healthy dietary guidelines to reduce cardiometabolic risk.

Professor and adjunct professor from the Harvard School of Public Health and honorary professor at the University of Leipzig, Germany, Iris Shai of Ben-Gurion University of the Negev in Beersheba, Israel, led the research. Doctoral student Gal Tsaban, a cardiologist from Soroka University Medical Center, and colleagues from Harvard and Leipzig Universities also participated in the study.

Previous research by this team on the Green Mediterranean/high polyphenols diet showed other beneficial effects, including reshaping the microbiome, stopping brain atrophy, reversing fatty liver, and visceral adiposity (fat stored deep inside the abdomen and wrapped around organs including the liver and intestines).

Dr. Shai notes, “A healthy lifestyle is a strong basis for improving cardiometabolic health. We learned from the results of our experiment that the quality of the diet is crucial for mobilizing atherogenic adipose tissues (involving chronic inflammation and repair of the vessel wall endothelium and smooth muscle cells that result in thickened vessel walls with a narrowed opening), lowering cardiometabolic risk and improving one’s fat profile. Dietary polyphenols—consumed while substituting red meat with equivalent plant-based protein—can significantly improve human health.”

Her study is the first to indicate that PAS could be reversed through a healthy lifestyle beyond weight loss. The Green Mediterranean diet may have a better impact on reducing the risk of cardiovascular disease compared to the original Mediterranean diet. Clearly, not all diets are the same.

How can you help your clients adopt the Green Mediterranean Diet?

• Reduce overall red meat and processed meat consumption to once/week.

• Include more meatless meals with beans, lentils, and soy to reduce cardiovascular risk.

• Start your day with green tea, spread out to three to four cups per day.

• Cut back on refined carbohydrates like candy, cake, and other pastries.

• Add walnuts to your daily diet. Include them in rolled oats, salads, yogurt, or by themselves.

• Include apples, berries, grapes, and green leafy vegetables in your diet regularly for polyphenols.

• Reduce saturated and trans-fat for better arterial health. Cut back on butter, beef fat, full-fat dairy products, poultry skin, fried food, and fast food.

• Go for soluble fiber from rolled oats, barley, beans and lentils, and seasonal fruit.

• Do regular exercise to manage weight and cardiovascular health.

• Look for green mankai online: Our Story – Mankai USA (eatmankai.com).

Lisa Andrews, MEd, RD, LD

References

1.    Delgado-Lista J, Alcala-Diaz JF, Torres-Peña JD, Quintana-Navarro GM, Fuentes F, Garcia-Rios A, Ortiz-Morales AM, Gonzalez-Requero AI, Perez-Caballero AI, Yubero-Serrano EM, Rangel-Zuñiga OA, Camargo A, Rodriguez-Cantalejo F, Lopez-Segura F, Badimon L, Ordovas JM, Perez-Jimenez F, Perez-Martinez P, Lopez-Miranda J; CORDIOPREV Investigators. Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial. Lancet. 2022 May 14;399(10338):1876-1885. doi: 10.1016/S0140-6736(22)00122-2. Epub 2022 May 4. PMID: 35525255.

2.    Gal Tsaban, Aryeh Shalev, Amos Katz, Anat Yaskolka Meir, Ehud Rinott, Hila Zelicha, Alon Kaplan, Arik Wolak, Matthias Bluher, Meir J. Stampfer, Iris Shai, Effect of Lifestyle Modification and Green Mediterranean Diet on Proximal Aortic Stiffness, Journal of the American College of Cardiology, Volume 81, Issue 16, 2023, Pages 1659-1661,ISSN 0735-1097, https://doi.org/10.1016/j.jacc.2023.02.032.