Mediterranean Diet & Longevity: What the PREDIMED Trial and 50 Years of Research Actually Show

Mediterranean Diet & Longevity: What the PREDIMED Trial and 50 Years of Research Actually Show

By Dr. Tom Biernacki, DPM | Balance Foot & Ankle | Howell & Bloomfield Hills, Michigan

In This Article

• The PREDIMED Trial: What It Found and Why It Matters
• What Is the Mediterranean Diet? The Evidence-Based Definition
• Extra-Virgin Olive Oil: The Most Studied Anti-Aging Food
• Polyphenols and the Longevity Pathway They Activate
• Omega-3 Fatty Acids: Inflammation at the Molecular Level
• The Gut Microbiome Connection
• Mediterranean Diet and Brain Health
• The Clinical Connection: Metabolic Foot Disease and the Mediterranean Diet
• Frequently Asked Questions
• Sources

In 2013, the New England Journal of Medicine published the results of PREDIMED — Prevención con Dieta Mediterránea — a randomized controlled trial that enrolled 7,447 participants in Spain at high cardiovascular risk, randomized them to a Mediterranean diet with extra-virgin olive oil, a Mediterranean diet with mixed nuts, or a control low-fat diet, and followed them for a median of 4.8 years. The trial was stopped early. The Data Safety Monitoring Board halted it because the Mediterranean diet groups showed such clear superiority in preventing major cardiovascular events — a 30% relative risk reduction for myocardial infarction, stroke, or cardiovascular death — that it was deemed unethical to continue denying the control group an effective intervention. A nutritional intervention, not a drug, stopped a major clinical trial early for efficacy.

PREDIMED is the most rigorous nutrition RCT for cardiovascular outcomes ever completed, and its findings have been replicated, extended, and analyzed from every angle over the decade since publication. But the cardiovascular story — as impressive as it is — is only one dimension of the Mediterranean diet’s longevity evidence base. Over 50 years of observational and experimental research, the Mediterranean dietary pattern has accumulated evidence for reduced all-cause mortality, lower rates of Alzheimer’s disease, reduced cancer incidence, improved gut microbiome diversity, telomere preservation, and favorable modulation of virtually every major longevity biomarker. Understanding why — mechanistically — requires examining what the Mediterranean diet actually contains and how its specific components interface with the aging biology we have discussed throughout this series.

The PREDIMED Trial: What It Found and Why It Matters

The PREDIMED trial’s design was unusual for a nutrition study: rather than simply advising participants to eat a Mediterranean diet (low adherence in free-living studies), the trial provided weekly food baskets including either 1 liter of extra-virgin olive oil per week for the olive oil group or 30 grams per day of mixed nuts (walnuts, hazelnuts, almonds) for the nuts group. Trained dietitians delivered quarterly individual and group nutritional education sessions. The result was a study where adherence was meaningfully higher than typical nutrition research — making the observed outcomes attributable to the dietary intervention rather than advisory noise.

The primary endpoint — major adverse cardiovascular events (MACE: myocardial infarction, stroke, or cardiovascular death) — occurred in 96 events in the olive oil group (3.8%), 83 in the nuts group (3.4%), and 109 in the control group (4.4%). The 30% relative risk reduction for MACE in both Mediterranean diet groups versus control is comparable to the benefit of statin therapy in high-risk populations, achieved through diet rather than pharmacotherapy. Importantly, the benefit was observed despite the fact that this was a high-cardiovascular-risk population already under medical management — the Mediterranean diet produced benefits on top of standard care, including established medications.

Beyond the primary endpoint, PREDIMED investigators published numerous secondary analyses: reductions in new-onset atrial fibrillation, lower rates of new-onset type 2 diabetes (52% relative risk reduction in one analysis), improvements in cognitive function and reduced dementia incidence, lower rates of peripheral artery disease, and favorable changes in inflammatory, metabolic, and oxidative stress biomarkers. A 2019 systematic review of prospective cohort studies found that each 2-point increase in Mediterranean Diet Adherence Score was associated with a 9% reduction in all-cause mortality — a robust, consistent dose-response relationship across populations and geographies.

What Is the Mediterranean Diet? The Evidence-Based Definition

The Mediterranean diet is a dietary pattern — not a rigid prescription — characterized by high consumption of specific food categories that, taken together, create a metabolic environment distinct from Western eating patterns. It is defined by its pattern rather than individual foods, which is why it consistently outperforms single-nutrient interventions in clinical trials: its benefit comes from the synergy of multiple components acting on overlapping and complementary biological pathways.

The Mediterranean diet’s biological power derives from several distinct mechanistic pillars, each of which addresses major longevity pathways. Rather than focusing on a single mechanism (as most pharmaceutical longevity interventions do), the Mediterranean dietary pattern simultaneously targets inflammation, oxidative stress, gut microbiome composition, insulin signaling, and epigenetic regulation — providing the same kind of multi-pathway redundancy that makes the pattern more robust in clinical trials than single-food or single-nutrient interventions.

Extra-Virgin Olive Oil: The Most Studied Anti-Aging Food

Extra-virgin olive oil (EVOO) is the defining ingredient of the Mediterranean dietary pattern and arguably the most extensively studied individual food in the longevity literature. Its biological activity comes from three major compound classes: oleic acid (a monounsaturated fatty acid comprising 55–83% of EVOO by weight), polyphenols (including oleocanthal, oleuropein, and hydroxytyrosol), and squalene. Each contributes distinct longevity-relevant mechanisms.

Oleic acid’s primary longevity contribution is through its favorable effects on LDL oxidizability. Oxidized LDL — not simply elevated LDL — is the primary atherogenic particle that infiltrates arterial walls and drives atherosclerotic plaque formation. LDL particles enriched in oleic acid are significantly less susceptible to oxidation than particles enriched in polyunsaturated fatty acids (linoleic acid from seed oils), which carry multiple double bonds vulnerable to free radical attack. Populations with high EVOO consumption show measurably lower levels of oxidized LDL at equivalent total LDL concentrations — a finding that helps explain the “Mediterranean paradox” where these populations enjoy excellent cardiovascular outcomes at total cholesterol levels that epidemiological models would predict as higher-risk.

Oleocanthal is the compound in fresh EVOO responsible for the characteristic peppery, stinging sensation at the back of the throat — the sensation that crude olive oil tasters use to estimate phenol content. It is a natural non-selective COX inhibitor (COX-1 and COX-2) with a mechanism of action chemically similar to ibuprofen — demonstrated by Gary Beauchamp and Paul Breslin at the Monell Chemical Senses Center in 2005. Consuming approximately 50 ml of high-phenol EVOO daily delivers an oleocanthal dose comparable to approximately 10% of a standard ibuprofen dose — a pharmacological analogy that, taken across years of daily consumption, represents a sustained anti-inflammatory effect that may partly explain the Mediterranean diet’s consistent reductions in CRP, IL-6, and cardiovascular event rates. Unlike pharmaceutical NSAIDs, oleocanthal does not cause gastrointestinal erosion or cardiovascular adverse effects at dietary doses.

Hydroxytyrosol, olive oil’s most abundant polyphenol, is one of the most potent natural antioxidants identified — with an oxygen radical absorbance capacity (ORAC) value approximately 10 times that of green tea catechins. It activates SIRT1 and AMPK through mechanisms similar to resveratrol but with significantly more robust human absorption data. A 2020 study demonstrated that regular EVOO consumption (4 tablespoons daily for 3 weeks) significantly reduced 8-isoprostane (a validated marker of systemic oxidative stress) in healthy adults, confirming that EVOO’s antioxidant activity translates to measurable systemic effects, not just in vitro observations.

Polyphenols: How Mediterranean Foods Activate Longevity Pathways

Polyphenols — plant secondary metabolites that give fruits, vegetables, legumes, herbs, tea, and red wine their colors, flavors, and biological activity — are present in the Mediterranean diet at concentrations 2–3 times higher than in typical Western dietary patterns. This difference is not trivial. Polyphenols act as hormetic stressors: at low-to-moderate doses, they activate Nrf2 (the master antioxidant transcription factor), SIRT1, AMPK, and FOXO transcription factors through mechanisms that can loosely be called “beneficial stress response activation.” The plants produce these compounds as defense chemicals against insects, UV radiation, and microbial pathogens — their biological activity in human cells is partly a consequence of this stress-response origin.

Resveratrol from red grapes and wine, flavonoids from olives and olive oil, anthocyanins from berries and red wine, quercetin from capers and onions, and luteolin from olive leaves — all present in significant quantities in the Mediterranean diet — converge on SIRT1 activation and NF-κB suppression, the two molecular targets most consistently associated with longevity intervention in model organisms and human biomarker studies. Whether dietary polyphenols achieve tissue concentrations sufficient for direct SIRT1 activation is debated, but their indirect effects through AMPK activation (which raises NAD+ through NAMPT upregulation, thereby activating sirtuins) are well-documented at dietary doses achievable through Mediterranean eating patterns.

Perhaps most importantly, gut microbiota transform many dietary polyphenols into biologically active metabolites with systemic effects. Ellagic acid from walnuts and pomegranates is converted by intestinal bacteria (particularly Akkermansia muciniphila and Bifidobacterium species) into urolithins — potent mitophagy activators that selectively clear damaged mitochondria and have shown lifespan extension in C. elegans models. The approximately 40% of Western populations who produce urolithins from ellagic acid (determined by gut microbiome composition) may represent a distinct biological response stratum to Mediterranean diet adherence, which could explain some of the individual variability in Mediterranean diet outcomes across trials.

Omega-3 Fatty Acids: Inflammation at the Molecular Level

The Mediterranean diet’s fish and seafood consumption — targeting 3+ servings weekly of fatty fish such as sardines, mackerel, anchovies, salmon, and tuna — provides the most concentrated dietary source of long-chain omega-3 fatty acids: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These are not simply “healthy fats” in the generic sense. They are specific bioactive molecules with documented, mechanistically established anti-aging effects that operate primarily through modulation of eicosanoid biology, cell membrane composition, and the specialized pro-resolving mediators (SPMs) that govern the resolution of inflammation.

The modern Western diet has shifted omega-6 to omega-3 ratios from the ancestral approximately 4:1 toward 15:1 to 20:1, driven by displacement of animal fats and olive oil with seed oils high in linoleic acid (omega-6). This ratio shift has profound inflammatory consequences: omega-6-derived arachidonic acid is the substrate for cyclooxygenase-mediated prostaglandin E2 and thromboxane A2 synthesis (pro-inflammatory, pro-thrombotic eicosanoids), while EPA competes with arachidonic acid for the same enzymes, producing the corresponding 3-series prostaglandins and 5-series leukotrienes with significantly weaker inflammatory potency. Additionally, EPA and DHA are the precursors for the specialized pro-resolving mediators — resolvins, protectins, and maresins — that actively resolve inflammation rather than simply suppressing it. Chronic inflammation in aging is partly characterized by impaired resolution, not just excessive initiation; SPM production provides the “off switch” that is deficient in aging and inflammatory disease states.

The VITAL trial — a large-scale, NIH-funded RCT of 25,871 US adults randomized to omega-3 supplementation (1g EPA+DHA daily from fish oil) versus placebo over 5.3 years — provides the most rigorous human evidence for omega-3 supplementation outcomes. VITAL found no significant reduction in the primary endpoint (combined major cardiovascular events) in the overall population, but pre-specified subgroup and secondary analyses showed significant reductions: cardiovascular events reduced 20% in participants with baseline low fish consumption, total cancer mortality reduced 17% in the omega-3 group, and subsequent analyses found significant reductions in autoimmune disease incidence (26% lower) — the most compelling human evidence yet for omega-3’s anti-inflammatory action at a disease prevention level. The Mediterranean diet achieves these omega-3 benefits through food (sardines and mackerel provide approximately 1–2g EPA+DHA per 100g serving) rather than isolated supplementation, likely with synergistic effects from co-occurring polyphenols and other bioactive compounds in the whole food context.

The Gut Microbiome Connection: Why Mediterranean Foods Feed Your Longevity Bacteria

The gut microbiome — the approximately 38 trillion bacteria inhabiting the human gastrointestinal tract — is one of the most dynamic interfaces between dietary pattern and biological aging, and the Mediterranean diet is the best-characterized diet for promoting microbiome diversity, anti-aging bacterial species, and short-chain fatty acid (SCFA) production. As explored in detail in the gut microbiome longevity post in this series, the connection between microbiome composition and healthspan is established across multiple mechanisms: intestinal permeability, immune regulation, SCFA signaling in muscle and adipose tissue, and direct production of neurotransmitter precursors and signaling molecules that influence brain, metabolic, and inflammatory health.

The Mediterranean diet’s microbiome benefits derive primarily from its high fiber content — from legumes (15–20g fiber per cup), vegetables, fruit, whole grains, and nuts — and from its abundant polyphenol content. Dietary fiber is the primary substrate for SCFA-producing bacteria including Faecalibacterium prausnitzii (the most abundant beneficial bacterium in a healthy microbiome, consistently reduced in inflammatory bowel disease, obesity, and chronic disease states), Roseburia intestinalis, and Bifidobacterium species. SCFAs — particularly butyrate, propionate, and acetate — serve as the primary energy source for colonocytes (intestinal lining cells), maintain the tight junctions that prevent intestinal permeability (“leaky gut”), signal to immune cells to suppress NF-κB and maintain regulatory T cell populations, and activate GPR41/43 receptors on adipose tissue that improve insulin sensitivity and reduce adipogenic signaling.

A 2020 study by Ghosh and colleagues — the largest and most comprehensive dietary intervention study on gut microbiome aging conducted to date — examined the effects of a Mediterranean diet versus habitual diet on gut microbiome composition in 612 elderly adults across five European countries over 12 months. Mediterranean diet adherence was associated with increased abundance of Faecalibacterium prausnitzii, Roseburia hominis, and other SCFA producers; increased production of propionate and butyrate; and reduced abundance of pro-inflammatory species. These microbiome changes correlated with reductions in inflammatory markers (CRP, IL-6, IL-8) and improvements in frailty scores, cognitive function, and grip strength — providing human evidence that dietary-driven microbiome changes translate to meaningful clinical outcomes in aging populations, not merely compositional shifts on 16S rRNA sequencing.

Mediterranean Diet and Brain Health: From PREDIMED-Plus to the MIND Diet

Cognitive decline and dementia represent the longevity outcomes most feared by patients — and the Mediterranean diet’s brain health evidence is among the most compelling of any dietary intervention. PREDIMED included cognitive function as a secondary outcome: the Mediterranean diet groups showed significantly better performance on cognitive function tests at 6.5 years follow-up compared to control, with the olive oil group showing the most robust protection. PREDIMED-NAVARRA, a sub-study with longer follow-up, found a 66% relative risk reduction in cognitive impairment in the Mediterranean diet plus olive oil group compared to the low-fat control.

The MIND diet — developed by Martha Clare Morris at Rush University — is a hybrid of the Mediterranean and DASH diets specifically optimized for brain health based on the neuroscience evidence for individual food components. It emphasizes the Mediterranean diet’s leafy green vegetables, berries, fish, olive oil, and nuts while specifically incorporating evidence for blueberries and leafy greens (particularly spinach, kale, and collards) as foods with the strongest independent associations with cognitive preservation. A 2015 observational study of 923 older adults found that strict MIND diet adherence was associated with 53% lower risk of Alzheimer’s disease — a reduction larger than that seen with either the Mediterranean or DASH diet alone in the same population, suggesting that the brain-specific refinements of the MIND diet provide additive cognitive protection beyond the Mediterranean base.

The mechanisms are multiple and mutually reinforcing. DHA from fatty fish is the primary structural fatty acid in neuronal membranes — particularly in the synaptosomal and myelin compartments — and dietary DHA availability directly affects synaptic membrane fluidity, signaling efficiency, and neuroinflammatory cytokine production. Polyphenols from olive oil, berries, and vegetables cross the blood-brain barrier (some more efficiently than others, particularly those metabolized to smaller lipophilic compounds by gut bacteria) and activate Nrf2, BDNF, and SIRT1 in neurons. Flavonoids from berries and citrus have documented effects on hippocampal neurogenesis and spatial memory in both animal and human studies. The gut-brain axis, through SCFA and microbiome composition effects on vagal nerve signaling, modulates hippocampal BDNF expression and neural inflammation. The Mediterranean diet engages all of these pathways simultaneously, providing the kind of systems-level brain protection that no single pharmaceutical agent has yet achieved.

The mechanism specific to leafy green vegetables — the food category most consistently associated with cognitive preservation across the dietary aging literature — is likely their high vitamin K content (particularly phylloquinone), alongside folate, lutein, and nitrate. Vitamin K activates Gas6, a protein that maintains myelin sheath integrity through Tyro3, Axl, and Mer receptor signaling — a pathway only recently characterized in brain aging research but whose importance is increasingly recognized given that myelin degradation is one of the most consistent structural changes in aging brain white matter. Plasma lutein levels — a marker of vegetable intake — are directly associated with cognitive performance and cortical thickness on MRI in older adults, independently of other dietary variables.

The Clinical Connection: Mediterranean Diet, Metabolic Foot Disease, and Wound Healing

The Mediterranean diet’s relevance to podiatric medicine is more direct and more urgently clinical than its association with longevity in healthy populations might suggest. My patients at Balance Foot & Ankle with diabetic foot ulcers, peripheral arterial disease, and treatment-resistant wound healing failures are living with the downstream consequences of dietary patterns antithetical to the Mediterranean model: processed food consumption driving the insulin resistance-visceral fat-inflammation cascade, inadequate omega-3 intake maintaining a pro-inflammatory eicosanoid environment that prevents healing, and fiber-depleted diets that impoverish the gut microbiome bacteria whose SCFA production is necessary for normal intestinal barrier function and immune regulation. Recommending a dietary transition is not merely a lifestyle suggestion in these patients — it is addressing an active pathological driver of their clinical condition.

Diabetic foot ulcer healing is fundamentally impaired by the metabolic inflammation of insulin resistance and chronic hyperglycemia. Advanced glycation end-products (AGEs) accumulate in collagen fibers, impairing fibroblast migration and cross-linking; VEGF-driven angiogenesis fails in hyperglycemic and pro-inflammatory tissue; and neutrophil phagocytic function is reduced in both the acute and chronic phases of wound healing. The Mediterranean diet addresses each of these mechanisms: EVOO polyphenols reduce AGE formation through direct carbonyl-trapping chemistry; omega-3-derived resolvins restore normal macrophage phenotype switching from M1 (inflammatory) to M2 (pro-healing); fiber-driven butyrate production improves insulin sensitivity and reduces post-meal glucose excursions that drive acute AGE formation. This is not a theoretical framework — PREDIMED documented a 52% reduction in new-onset type 2 diabetes in Mediterranean diet adherents, a magnitude of effect that, if applicable to patients already diabetic, would represent a fundamental shift in their wound healing biology.

Peripheral arterial disease — the single most powerful predictor of diabetic foot ulcer non-healing and amputation — is directly addressed by the Mediterranean diet’s well-documented cardiovascular benefits. Beyond the PREDIMED primary endpoint data, prospective cohort studies show 40–60% lower rates of peripheral artery disease in high Mediterranean diet adherence groups compared to low adherence groups, after adjusting for other cardiovascular risk factors. For patients who present with early-stage PAD (ankle-brachial index 0.7–0.9) or claudication without critical limb ischemia, a Mediterranean dietary transition represents an evidence-based intervention for slowing plaque progression and preserving peripheral perfusion — with an efficacy comparable to low-dose aspirin therapy in some endpoints, without the gastrointestinal bleeding risk.

Chronic plantar fasciitis and Achilles tendinopathy with systemic inflammatory drivers respond meaningfully to the Mediterranean diet’s anti-inflammatory effects in my clinical experience. The combination of oleocanthal-mediated COX inhibition, omega-3 competitive eicosanoid displacement, and polyphenol NF-κB suppression creates a dietary anti-inflammatory environment that, maintained consistently over months, reduces the circulating inflammatory mediator burden that perpetuates these conditions. I consistently advise patients with treatment-resistant foot and ankle inflammatory conditions — those who have been through multiple injection series, physical therapy courses, and orthotic programs without adequate response — to evaluate their dietary pattern as part of a comprehensive systemic inflammation assessment, not as a last resort but as an early and central component of care.

Frequently Asked Questions About the Mediterranean Diet and Longevity

Does the Mediterranean diet actually cause weight loss?

The Mediterranean diet is not primarily a weight loss diet — it does not restrict calories or any macronutrient class. In most RCTs comparing Mediterranean diet to other dietary patterns at equivalent caloric intake, weight loss outcomes are modest and roughly comparable to other whole-food dietary approaches. The PREDIMED trial showed minimal weight change in either Mediterranean diet group compared to the low-fat control, yet the cardiovascular benefits were dramatic. This is a critical point: the Mediterranean diet’s longevity benefits are not mediated primarily through weight loss. They operate through dietary composition — the specific foods and their bioactive components — independent of caloric balance. For patients who want both weight loss and longevity benefits, the Mediterranean diet can be combined with caloric restriction or intermittent fasting protocols, but its longevity benefits accrue even in the absence of a caloric deficit.

What is the best olive oil to buy for health benefits?

Extra-virgin olive oil (EVOO) is the specific grade with longevity evidence. “Olive oil” or “light olive oil” designations indicate refined oils from which the polyphenols have been largely removed during processing — these provide oleic acid but lack the oleocanthal, hydroxytyrosol, and oleuropein that account for much of EVOO’s biological activity. Within EVOO, polyphenol content varies substantially: early harvest EVOO (from greener, less ripe olives) contains 2–5 times more polyphenols than later harvest oil; recently pressed oils retain more polyphenols than older oils; and cold-pressed single-estate oils from Mediterranean cultivars (Koroneiki, Picual, Coratina) consistently contain higher polyphenol levels than mass-produced blends. Practical guidance: buy EVOO with a harvest date (not just best-by date) within the past 18 months, stored in dark glass, from a reputable producer, and use at least 3–4 tablespoons daily as your primary cooking and dressing fat.

Is the Mediterranean diet healthy for people with diabetes?

Yes — and it is one of the most evidence-supported dietary patterns for people with type 2 diabetes specifically. A 2020 meta-analysis of 17 RCTs found that the Mediterranean diet reduced HbA1c by an average of 0.30–0.47% compared to control diets in patients with type 2 diabetes — a clinically meaningful reduction comparable to the first-line pharmacological agent metformin’s typical glycemic effect when adding 500 mg twice daily to existing treatment. Additionally, the Mediterranean diet’s insulin-sensitizing effects (through fiber, omega-3, polyphenols, and weight-neutral improvement in metabolic health) address the root pathophysiology of type 2 diabetes rather than simply managing glycemia. For patients with diabetic peripheral neuropathy, retinopathy, or nephropathy, the anti-inflammatory and vascular-protective effects of the Mediterranean diet address the specific mechanisms driving microvascular complication progression — something that glycemic control alone does not fully achieve.

How long does it take to see results from the Mediterranean diet?

The timeline for Mediterranean diet benefits tracks with the biological process being measured. Inflammatory markers — CRP, IL-6 — begin declining measurably within 4–8 weeks of consistent adherence. LDL oxidizability improves within 2–4 weeks as oleic acid incorporates into LDL particle membranes. Gut microbiome diversity changes are detectable within 2–3 weeks of dietary pattern change. Fasting insulin and glucose improvements emerge at 8–12 weeks. Cardiovascular structural improvements — endothelial function, carotid intima-media thickness progression — are documented at 12 months. Cognitive protection benefits appear to require sustained adherence of years to decades to manifest in observational studies. The Mediterranean diet is not an acute treatment for acute conditions — it is a long-term dietary environment that progressively reduces the biological aging burden over time. The earlier a patient establishes the pattern, the greater the compounding benefit.

Does the Mediterranean diet work for everyone?

The Mediterranean diet is one of the most consistently beneficial dietary patterns across diverse populations in the published literature, but individual responses vary. The most important source of response variability is gut microbiome composition: individuals who harbor ellagic acid-metabolizing bacteria (producing urolithins) derive greater mitophagy benefits from walnut and legume consumption; those with lower Akkermansia muciniphila abundance may show less robust metabolic benefit from polyphenol intake until microbiome composition improves. Genetic variation in fatty acid metabolism genes (FADS1/2 — the enzymes that convert ALA to EPA and DHA) affects how efficiently dietary fish consumption translates to tissue DHA enrichment. APOE4 carriers — who carry the highest Alzheimer’s genetic risk — may need to be particularly attentive to the olive oil and omega-3 components of the Mediterranean diet, as EVOO polyphenols have been specifically shown to reduce Alzheimer’s-associated pathology in APOE4 mouse models. In practice, Mediterranean diet adherence benefits the vast majority of patients consistently, with genetic and microbiome differences affecting the magnitude rather than the direction of benefit.

Sources

1. Estruch R, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. New England Journal of Medicine. 2018;378(25):e34.
2. Morris MC, et al. MIND diet associated with reduced incidence of Alzheimer’s disease. Alzheimer’s & Dementia. 2015;11(9):1007-1014.
3. Ghosh TS, et al. Mediterranean diet intervention alters the gut microbiome in older people reducing frailty and improving health status. Gut. 2021;70(7):1236-1245.
4. Manson JE, et al. Marine n-3 Fatty Acids and Prevention of Cardiovascular Disease and Cancer (VITAL). New England Journal of Medicine. 2019;380(1):23-32.
5. Beauchamp GK, et al. Phytochemistry: ibuprofen-like activity in extra-virgin olive oil. Nature. 2005;437(7055):45-46.
6. Martínez-González MA, et al. Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. BMJ. 2008;336(7657):1348-1351.

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