$$News and Reports$$

Nov. 24, 2020

A green Mediterranean diet, containing even more plant matter and very little red meat or poultry, may be even better for cardiovascular and metabolic health than the traditional version of the Mediterranean diet --at least in men--suggests research just published online in the journal Heart.

The Mediterranean diet, rich in plant-based foods, is linked to a lower risk of heart disease, stroke, and diabetes and currently forms the backbone of dietary guidelines to stave off coronary heart disease.

It’s thought that its impact is related to higher dietary intake of polyphenols, phytosterols, ‘healthy’ fats, and fibers and lower animal protein intake.

The BGU researchers wanted to find out whether an ultra-green version of this diet that is higher in green plant-protein based food sources and even lower in red meat intake, might be even better for health and for dropping the bad cholesterol (LDL), which is usually challenging to accomplish by diet.

They randomly divided 294 sedentary and moderately abdominally obese people (BMI of 31) with an average age of 51 into three dietary groups.

The first group received guidance on boosting physical activity and basic guidelines for achieving a healthy diet.

The second received the same physical activity guidance and advice on following a calorie-restricted (1500–1800 kcal/day for men and 1200–1400 kcal/ day for women) traditional Mediterranean diet. This was low in simple carbohydrates, rich in vegetables, with poultry and fish replacing red meat. It included 28 g/day of walnuts.

The third group received physical activity guidance and advice on following a similar calorie-restricted green version of the Mediterranean diet (‘green Med’).

This included 28 g/day walnuts, avoidance of red/processed meat, and higher quantities of plant matter, in addition to 3–4 cups/day of green tea and 100 g frozen cubes of Wolffia globosa duckweed (Mankai, cultivated strain, rich in polyphenols and phytosterols) taken as a green plant-based protein shake, which partially substituted animal protein.

After six months, the effect of each of the diets on weight loss and on cardiovascular and metabolic risk factors was assessed.

Those on both types of Mediterranean diet lost more weight: green Med 6.2 kg; Mediterranean 5.4 kg; healthy diet 1.5 kg.

Waist circumference--an indicator of a potentially harmful midriff bulge--shrank by an average of 8.6 cm among those on the green Med diet compared with 6.8 cm for those on the Mediterranean diet and 4.3 cm for those on the healthy diet.

The green Med diet group achieved larger falls in ‘bad’ low-density cholesterol of 6.1 mg/dl, a reduction of nearly 4%. The equivalent figures were 2.3 mg/dl (nearly 1%) for those in the Mediterranean diet group, and null (0.2 mg/dl) for those in the healthy diet group.

Similarly, other cardiovascular and metabolic risk factors improved more among those on the green Med diet, including falls in diastolic blood pressure, insulin resistance, and an important marker of inflammation, C-reactive protein, which has a key role in artery hardening. The ratio of ‘good’ to ‘bad’ cholesterol also increased.

These changes resulted in a substantial nearly 2-fold fall in the 10-year Framingham Risk Score -- a calculation used to predict the likelihood of serious heart disease over the next decade-- among those on the green Med diet.

The researchers caution that their sample included just 35 women.

According to Dr. Gal Tsaban and Prof. Iris Shai (pictured above) of Ben-Gurion University who conducted the study “Education and encouragement to follow a green Med dietary pattern in conjunction with physical activity has the potential to be a major contributor to public health as it may improve balancing of cardiovascular risk factors, eventually preventing cardiovascular morbidity and mortality.”

And they conclude: “Our findings suggest that additional restriction of meat intake with a parallel boost in plant-based, protein- high- polyphenols rich foods such as walnuts, green tea and Mankai, may further benefit the cardiometabolic state and reduce cardiovascular risk, beyond the known beneficial effects of the traditional Mediterranean diet.”

These finding suggest that green-MED diet, containing more green plants and less red meat in a flexitarian diet manner, may better reduce the LDL (i.e. ‘bad’) cholesterol and may have a larger impact on public health.

Research: The effect of green Mediterranean diet on cardiometabolic risk; a randomised controlled trial doi:10.1136/ heartjnl-2020-317802
Journal: Heart

Funding: German Research Foundation; the Israel Ministry of Health; the California Walnuts Commission.

Media Coverage:


The Times of London

The Herald

International Business Times​