‘Evidence Is Compelling’ on Mediterranean Diet

Mediterranean Diet photo:  6a0120a4dc5af5970b014e88978475970d-800wi.jpg


Eric J. Topol, MD

Mar 07, 2013


Mediterranean Diet Study

Hello. I am Dr. Eric Topol, Editor-in-Chief of Medscape. I am thrilled to be the new editor-in-chief; this is an extraordinary way for information to be disseminated to the medical community, and I am hoping to contribute with all the staff and our physician colleagues working around the globe to take Medscape to an “über level.”

In this brief segment today, I will talk about the Mediterranean diet study. This is a study that was published in the February 25 New England Journal of Medicine.[1] I will try to get some commentary, either from myself or other colleagues, about really important studies, and I believe that this is one of them.

We don’t talk enough about diet in medicine, but this is the largest randomized trial to date. The Mediterranean diet has been studied previously in randomized trials but not in a trial as large as this. It is fascinating that this was a study of more than 7400 individuals who were randomly assigned to 3 different diets. Two were Mediterranean diets enriched with either extra-virgin olive oil or nuts and other Mediterranean foods, both including more than 7 glasses of wine per week. The control diet was a low-fat diet, which some people have argued is not an ideal control. There was very good compliance with the diets in this large number of people for many years. The primary endpoint was death, heart attack, or stroke. There was a very important significant reduction of this cluster endpoint in the Mediterranean diet groups. Particularly noteworthy, even by itself, was the reduction in stroke.


Clinical Impact of the Mediterranean Diet Study

We now have dietary evidence that is fairly compelling. The absolute size reduction was not large, but the fact that the Mediterranean diets tested in this trial had such a positive impact gives us some anchoring about a diet that does lower critical cardiovascular endpoints. For many years, there has been discussion about this low-fat diet and whether it had a meaningful clinical impact. At one point, the Mediterranean diet was very much supported by the American Heart Association and other organizations. Now we see that it appears to be superior. The trial has had criticism, particularly honing in on the low-fat control arm of the study, but nonetheless, the evidence is compelling.

Why is this trial unique? It was funded by the Spanish government. This is a country that isn’t known these days for having extraordinary resources to fund research, but the government of Spain got behind an important trial, perhaps the most impressive diet-randomized trial that has been performed. We have to give a lot of credit to them, because this trial was done with that level of funding and with superb investigators throughout the country of Spain, and it makes a lasting contribution. We are always in search of more information about what we eat, and this is welcome. It is particularly nice to know that you can have 7 glasses of wine or more each week and it might have a favorable effect.

We will be trying to highlight similar studies that are interesting, taking us across the whole spectrum of diagnostics, medical devices, genomics, wireless medicine, and topics such as diet and nutrition, to broaden some of the special coverage that we have at Medscape. Thanks very much for your attention.


  1. Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013 February 25. [Epub ahead of print]. http://www.nejm.org/doi/full/10.1056/NEJMoa1200303 Accessed March 6, 2013.