Benefits of a Green Mediterranean Diet for Regressing Proximal Aortic Stiffness

Proximal aortic stiffness (PAS), a sign of vascular aging and increased risk for cardiovascular disease, significantly decreases following a green Mediterranean diet high in polyphenols. In the large-scale clinical intervention trial DIRECT PLUS, the green Mediterranean diet was compared to the healthy Mediterranean diet and a healthy guideline-recommended control diet. The green Mediterranean diet, the Mediterranean diet, and the healthy dietary guideline-directed diet all reduced proximal aortic stiffness by 15%, 7.3%, and 4.8%, respectively, according to the research.

The study was recently published in JACC (Journal of the American College of Cardiology), the leading cardiology journal. Scientists have for the first time demonstrated that diet has a significant impact on age-related proximal aortic stiffness.

DIRECT PLUS was a large-scale, long term clinical trial of more than year and a half among 300 members, which utilized X-rays to gauge aortic stiffness, the most reliable noninvasive measure.

Aortic stiffness is a measure of the versatility of the blood vessel wall, and it happens when the flexible filaments inside the blood vessel wall (elastin) start to shred because of mechanical pressure. The aortic stiffness of the ascending to the proximal-descending thoracic aorta is represented by the proximal aortic stiffness (PAS). the portion of the aorta that carries oxygen-rich blood away from the heart and is the largest artery in the body. Proximal aortic stiffness is an independent cardiovascular risk factor that can predict morbidity and mortality and is a distinct marker of vascular aging.

Prof. Iris Shai of Ben-Gurion University of the Negev in Israel, an honorary professor at the University of Leipzig in Germany and an adjunct professor at the Harvard School of Public Health, was in charge of the research, along with her Ph.D. student Dr. Gal Tsaban, a cardiologist from Soroka University Medical Center, and colleagues from Harvard and Leipzig Universities.

The green Mediterranean diet high in polyphenols was first introduced by the DIRECT-PLUS trial research team. Polyphenols, which are secondary metabolites of plant compounds that offer various health benefits, are more prevalent in this modified Mediterranean diet, making it distinct from the traditional Mediterranean diet. Red and processed meat are also less prevalent. On top of a daily intake of walnuts (28 grams), the green-Mediterranean dieters consumed 3-4 cups of green tea and 1 cup of Wolffia-globosa (Mankai) plant green shake of duckweed each day over a year and a half. Mankai, a green aquatic plant that is high in protein, bioavailable iron, vitamin B12, and 200 different kinds of polyphenols, makes a good meat substitute.

In previous studies, the team demonstrated that a diet high in polyphenols and green Mediterranean has a number of beneficial effects, including reshaping the microbiome (Gastroenterology 2021), stopping brain atrophy (AJCN 2022), regressing hepatosteatosis (Gut 2021), and reducing visceral adiposity (BMC Med 2022).

“Maintaining a healthy diet alone is associated with PAS regression. The green-Mediterranean diet provides a 15% dramatic reduction in PAS, which is gained by making simple and feasible changes to your diet and lifestyle. The results of our study highlight, once again, that not all diets provide similar benefits and that the green-Mediterranean diet may promote vascular health,” notes Dr. Tsaban.

Extra specialists include: Aryeh Shalev, Amos Katz, Anat Yaskolka Meir, Ehud Rinott, Hila Zelicha, Alon Kaplan, Arik Wolak, Matthias Bluher, and Meir J Stampfer.

Grants from the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Project Number 209933838- SFB 1052 were used to support this work; the grant A2623 from the Rosetrees Trust; Grant 87472511 from the Israel Health Ministry; Grant 3-13604 from the Israel Ministry of Science and Technology; furthermore, the California Walnuts Commission.

The funding providers had no say in the study’s design, execution, or analysis, and they did not have access to the results before they were published.