• Salman Rana Punjab Institute of Cardiology, Lahore
  • Ahmed Noeman Punjab Institute of Cardiology, Lahore
  • Saqib Shafi Sheikh Punjab Institute of Cardiology, Lahore


Since the dawn of industrialization and birth of modern medicine a question has long puzzled the researchers "what is the ideal human diet?". Availability of caloric dense food and sedentary lifestyle have led to many young people developing chronic illnesses once considered diseases of old age. Genetics and other factors do play a significant role but it is the diet and life style that are more important in the development of ischemic heart disease. In 2010 American Heart Association identified 7 health metrics that play a leading role in development of ischemic heart disease called Life's Simple 7: Blood pressure, Fasting blood glucose, Cholesterol, Diet, Physical activity, Smoking and Body mass index1. If we carefully examine all these metrics, diet influences all other metrics except physical activity. Something is terribly wrong with the diet of modern humans. When we take into consideration the pattern of food consumption of different regions and cultures across the globe, we come across some very important facts. In the areas where the incidence of ischemic heart disease is significantly low and the average life span of humans is longer than other regions, people consume food items which are different from those of other regions both in terms of variety and quantity of different food items. One such area where incidence and prevalence of Ischaemic heart disease is significantly lower than other areas is Mediterranean region particularly countries of Greece, Italy, France and Spain. They have much lower incidence of ischemic heart disease as compared to Nordic countries of Europe. Keeping this data in mind researchers have come up with a diet called Mediterranean diet to prevent the occurrence of ischemic heart disease. There is no single definition of Mediterranean Diet. Broadly speaking it is high in fruits, vegetables, legumes, beans, moderate consumption of dairy products, weekly intake of fish and other seafood, eggs and poultry, olive oil and a little consumption of red meat 2 . This diet is mostly plant based with occasional consumption of seafood and chicken. What makes Mediterranean diet heart healthy? Number of theories and hypotheses have been put forward to explain this relationship. As we all know consumption of olive oil has been part and parcel of the cuisine of these countries for millennia. Heart healthy fats like omega three fatty acids and other antioxidants are abundant in olive oil . Furthermore, extra virgin olive oil contains antioxidants like phenolic acids, phenolic alcohols, flavonoids which slow down the process of aging. Another explanation is, because these countries have a little warmer climate and fruits and vegetables are in plenty and they are quite essential part of their diet. Proximity to Mediterranean sea and inclusion of variety of fish particularly sardines, mackerel, albacore tuna, herring salmon and lake trout in their diets which are rich source of omega three fatty acids make this diet a healthy combination of whole grain plant based diet with lots of fibre, good source of proteins and heart healthy fats. Moreover, people over there live in hilly areas and spend more time outdoors and keep themselves busy in day to day work because climate is good, not too cold as in northern Europe and not too hot as in neighbouring countries of middle east across the Mediterranean .There is little need to consume soft drinks as weather is not too hot and clean drinking water is abundant in contrast to Middle East where excessive use of sugar based soft drinks have led to some of the highest prevalence of Diabetes in the world. In Northern Europe where winters are harsher and availability of fruits and vegetables is scarce and people traditionally rely on caloric dense foods like red meat and consumption of alcohol is more rampant, prevalence of Ischaemic heart disease is greater than countries of southern Europe around the Mediterranean. Like other blue zones of world where people live a long and healthy life, Mediterranean countries of Europe are uniquely placed in terms of geography and climate where people enjoy a favourable climate and abundant supply of heart healthy foods and follow a lifestyle that lays emphasis on work till the ripe old age. Mediterranean diet has become quite popular in recent years among researchers and general public alike for its presumed health benefits and its inclusion of variety of fruits, vegetables, sea food and fermented dairy products. As compared to other popular diets to prevent and reverse ischemic heart disease like completely vegetarian diet, vegan diet advocated by Dr Michael Greger and Ketogenic diets put forward by Dr Jason Fung and many others, It allows far more flexibility and adherence to this diet in the long run is more feasible and it offers many great recipes that can elicit a Pavlovian response.

Author Biographies

Salman Rana, Punjab Institute of Cardiology, Lahore

Punjab Institute of Cardiology, Lahore

Ahmed Noeman, Punjab Institute of Cardiology, Lahore

Professor of Cardiology,

Punjab Institute of Cardiology, Lahore

Saqib Shafi Sheikh, Punjab Institute of Cardiology, Lahore

Head of the Institution,

Professor of Cardiology,

Punjab Institute of Cardiology, Lahore