Roasted Salted Almonds Recipe Plus the Research Behind the Mediterranean’s Diet Long-term Secondary Prevention of Cardiovascular Disease

Much research on the benefits of olive oil as part of the Mediterranean diet centered on preventing heart disease, or primary prevention. Now a team involved in one of those studies has examined whether this diet can also be helpful for secondary prevention, meaning for people who already have heart issues such as coronary heart disease (CHD). The health benefits of olive oil as a cornerstone of the Mediterranean diet continue to shine through. Nuts also get high marks, so I’m sharing my favorite way to enjoy them.

Roasted Salted Almonds

• Spicy Roasted Almonds

  Add some spice to the healthful nuts you’re snacking on. Roasted almonds also make a great addition to a charcuterie or cheese board. Feel free to substitute other nuts such as hazelnuts, cashews, walnut halves, or pistachios for the almonds. If you own a smoker, try smoke-roasting the nuts the next time you fire it up. 

  Ingredients

  • 2 cups whole skinless almonds (about 7 ounces)
  • 1/4 cup extra virgin olive oil
  • Coarsely ground sea salt to taste
  • 1-1/4 teaspoons Spanish smoked paprika (pimentón de la Vera) or ground cumin 

  Directions

  Step 1

  Preheat your oven to 325°F. Put the almonds on a rimmed baking sheet and drizzle with the olive oil. Stir with a wooden spoon until they are evenly coated, then spread them out in a single layer. Roast the almonds until they are a light golden brown, about 20 to 30 minutes, stirring every five minutes. Drain on paper towels.

  Step 2

  Transfer the almonds to a bowl, season with salt and paprika, and toss to coat. Serve warm or at room temperature. Store in an airtight container for up to 3 days. 

  Yields 6-8 servings

For Your Best Health

A diet refresh for heart health

The study: “Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial,” The Lancet, May 14, 2022.

For this study, Javier Delgado-Lista, MD, PhD, of the Universidad de Córdoba in Córdoba, Spain, and his team compare the effects of the Mediterranean diet to a low-fat diet, both of which are healthier than the typical Western diet. They randomly assigned 1,002 participants with CHD (60 percent of whom had already had one heart attack) to one diet or the other and monitored them over 7 years. In that time frame, both diets did well at preventing more heart events, which included heart attacks, ischemic stroke, peripheral artery disease, and cardiovascular-related death, but the Mediterranean diet had the edge. 

According to a report of the study written by TCTMD, a network of the Cardiovascular Research Foundation, “Patients with CHD who ate a Mediterranean diet rich in extra virgin olive oil (EVOO), fatty fish, and nuts had roughly a 25 percent lower risk of recurrent major adverse cardiovascular events…compared to those who stuck with a reduced-fat approach during 7 years of follow-up. 

“For the Mediterranean diet, participants consumed 35 percent of their calories from fat, mostly monounsaturated (22 percent) and polyunsaturated fat (6 percent). Protein made up 15 percent of the diet and the remaining calories were comprised of carbohydrates (< 50 percent). The diet included 40 to 60g of extra-virgin olive oil, three or more servings of especially fatty fish per week, and three or more servings of nuts per week, among other foods. Wine was optional, but if participants were habitual wine drinkers, it was capped at one to two glasses per day for women and men, respectively. 

“For the low-fat diet, less than 30 percent of calories were derived from fat, 15 percent from protein, and 55 percent or more from complex carbohydrates. Participants ate low-fat dairy two or three times per day and chose lean fish instead of fatty kinds. Nuts were limited, as was EVOO. Instead, the intervention recommended only 20 to 30g of sunflower or regular olive oil. Wine was not allowed. 

“No physical activity was prescribed, nor was any type of caloric restriction. To make sure patients adhered to the diet, they had face-to-face visits with dieticians, internists, or cardiologists every 6 months, group sessions every 3 months, and telephone calls every 2 months. In total, participants had at least 12 interactions with the study team each year.

“After 7 years of follow-up, there were 198 primary outcome events: 17.3 percent in the Mediterranean arm and 22.2 percent in the low-fat group. In the unadjusted and adjusted models, the Mediterranean diet was associated with a significantly lower risk of the primary endpoint. Adjusted for age and sex alone, eating the diet rich in EVOO, fatty fish, and nuts was associated with a 26.2 percent lower risk of the primary outcome. In the fully adjusted model, the Mediterranean diet lowered the risk of the primary outcome by 28.1 percent compared with the low-fat diet. The was no significant difference in the risk of any of the primary endpoint’s individual components.

“The observed reduction in risk was more pronounced among men than among women, who in fact saw no significant reduction in risk, although the researchers note that this might have been the result of insufficient power. Less than 18 percent of study participants were women, and future studies will be needed to determine if this observed sex-related difference is real. 

“Delgado-Lista said the results are straightforward: patients with ischemic heart disease should follow a Mediterranean diet. Find a professional to help you learn what the Mediterranean diet is and how to eat it, he said, ‘and always consume extra virgin olive oil as the main source of fat in that diet.’” 

Fitness Flash

Brain boosts abound

Every day we learn more about protecting brain health and avoiding dementia. If you’re looking for all these breakthroughs in one place, look no further than the Alzheimer’s – The Science of Prevention series developed by neurologist David Perlmutter, MD, featuring more than 20 additional specialists from across the country. It originally aired on July 20, but you can catch it on a weekend replay from August 5 to 7.

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Garlicky Kale and Ricotta Crostini Recipe, How the Mediterranean Diet Got Its Name, The Cultural Benefits of Olive Oil and The Key to Sustainable Eating

When we read about the benefits of olive oil, they’re usually centered on its amazing health boosts to the heart, brain, and more. Surprising as it may seem at first glance, there are also cultural benefits from having olive oil as the cornerstone of the Mediterranean diet. These benefits stem from traditions surrounding the growing and pressing of olives, choosing other seasonal and local foods, and preparing and enjoying meals with family and friends. I experience that conviviality firsthand every time I’m at an olive harvest, and it’s exhilarating! What’s more, because olive oil and most components of the diet are plant based, it’s a very sustainable way of eating for our planet. I’m sharing insights from three reports on the importance of olive oil and the Mediterranean diet to inspire you to not only embrace healthy eating, but also to better our environment.

How the Mediterranean Diet Got Its Name

The history of the Mediterranean diet is itself fascinating. According to the article “Impact of Mediterranean Diet on Chronic Non-Communicable Diseases and Longevity,” published in Nutrients in June 2021, the diet was formally described in the Seven Countries Study from the 1950s. The study identified the diet’s health benefits: “Southern European populations from countries where olive trees grow naturally exhibited longevity among the highest in the world, with the lowest incidence of coronary heart disease, cancer, and other non-communicable diseases. These populations did not follow a specific dietary pattern, but some traditional eating and lifestyle habits [that] originated centuries before.” That description piqued the interest of everyone—from scholars to foodies—from that day forward. It’s not hard to argue that the Mediterranean way of life became the inspiration for each of today’s wildly popular plant-based diets.

That early research showed that over 60% of the calories in the Mediterranean diet came from plant foods, compared to just 37% in the American diet, and though both populations ate the same number of fat calories, the main source of these calories among Mediterranean people was olive oil, not the animal fat preferred in the US. The researchers of the study were surprised by how healthy the Mediterranean people were despite living without the so-called advances of the Western industrialized world! People in the region might have wished for more meat in their diet, but it was precisely the lack of meat and the emphasis on plant-based foods, including the physical activity of cultivating, gathering, and cooking them, that kept certain diseases at bay.

The Cultural Benefits of Olive Oil

As more studies were done, it also became clear that the Mediterranean diet wasn’t only about food, but also about traditions and practices that were passed down through generations, “extending from the countryside and food production to the ways of cooking, which provide a feeling of belonging and permanency to the community. Mediterranean traditional cuisines are rich in aromas, colors, and memories, highlighting the taste and the synchronization with nature, and emphasizing the significance of preparing and consuming foods jointly with family and friends,” states the article in Nutrients. 

The way of life connected to the Mediterranean diet is so unique that in 2010 UNESCO, known for designating geographical areas as world heritage sites, gave the diet its cultural registration of “Intangible Cultural Heritage of Humanity,” first singling out Greece, Italy, Morocco, and Spain and then adding Croatia, Cyprus, and Portugal in 2013.

Here’s how UNESCO describes it:

The Mediterranean diet involves a set of skills, knowledge, rituals, symbols and traditions concerning crops, harvesting, fishing, animal husbandry, conservation, processing, cooking, and particularly the sharing and consumption of food. Eating together is the foundation of the cultural identity and continuity of communities throughout the Mediterranean basin. It is a moment of social exchange and communication, an affirmation and renewal of family, group or community identity. The Mediterranean diet emphasizes values of hospitality, neighbourliness, intercultural dialogue and creativity, and a way of life guided by respect for diversity. It plays a vital role in cultural spaces, festivals and celebrations, bringing together people of all ages, conditions and social classes. It includes the craftsmanship and production of traditional receptacles for the transport, preservation and consumption of food, including ceramic plates and glasses. Women play an important role in transmitting knowledge of the Mediterranean diet: they safeguard its techniques, respect seasonal rhythms and festive events, and transmit the values of the element to new generations. Markets also play a key role as spaces for cultivating and transmitting the Mediterranean diet during the daily practice of exchange, agreement and mutual respect.

With so much focus on its social and cultural aspects, it’s no wonder that a group of researchers reimagined the food pyramid. In their version, olive oil, fruits and vegetables, and grains are the food foundation, but the base level of the pyramid illustrates the activities and traditions highlighted by UNESCO.

The Key to Sustainable Eating

In the paper “Looking for Commensality: On Culture, Health, Heritage, and the Mediterranean Diet,” published in March 2021 in the International Journal of Environmental Research and Public Health, the Mediterranean diet gets the nod as a way to feed the planet in a sustainable way. The paper refers to the report from the EAT-Lancet Commission on healthy diets from sustainable food systems “that highlighted the evidence that a diet rich in plant-based foods and fewer foods of animal origin confers not only optimal health outcomes but also environmental benefits. The Commission presented an integrated framework providing scientific targets for healthy diets and sustainable food production. It estimates that the transformation to healthy diets by 2050 will require that the world’s consumption of fruit, vegetables, nuts, seeds, and legumes doubles, and the consumption of foods such as red meat and sugar should be reduced by more than 50%.” That’s an important reminder, as over the past decades the diets of many people living around the Mediterranean have become Westernized and Western illnesses are gaining a foothold.

How can you adopt this way of life? The report “Mediterranean Diet as Intangible Heritage of Humanity: 10 Years On,” published in June 2021 in Nutrition, Metabolism & Cardiovascular Diseases, mentions making olive oil, described as a cornerstone of the Mediterranean diet, our main source of fat. It also talks about using the Mediterranean diet and the activities surrounding it as a global model for health and sustainability since “humanity as a whole will benefit from its preservation and scientific-based evidence.” 

The article in Nutrients outlines a guiding philosophy you might follow. It includes: 

• Choosing fresh, locally produced foods
• Connecting with and respecting nature
• Cooking flavorfully
• Eating moderate portion sizes
• Doing moderate physical activity every day
• Preparing and eating meals in the company of others

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Garlicky Kale and Ricotta Crostini

• Garlicky Kale and Ricotta Crostini

  In keeping with the convivial aspect of the Mediterranean diet, here’s a delicious recipe to make and share with loved ones.

  Ingredients

  • 1 12-inch baguette, sliced diagonally into 1/2-inch slices
  • 4 tablespoons extra virgin olive oil, plus more for brushing
  • 4 cloves garlic, peeled; 2 halved, 2 minced
  • 1 large bunch baby kale, or another specialty type, stems removed and leaves coarsely torn or chopped 
  • 1/2 teaspoon anchovy paste
  • 1/2 teaspoon crushed red pepper flakes
  • 1 to 2 tablespoons red wine vinegar
  • 1 teaspoon finely grated orange zest
  • Salt and freshly ground pepper to taste
  • 1/2 cup fresh ricotta 

  Directions

  Step 1

  Preheat your oven to 350°F. Make the crostini: Generously brush each slice of bread on both sides with olive oil and transfer to a baking sheet. Bake for 10 to 15 minutes, turning once, until the bread is lightly browned on both sides. Remove from the oven and rub both sides of the bread slices with the halved cloves of garlic and set aside.

  Step 2

  Heat a large sauté pan over medium heat. Film the bottom of the pan with 3 tablespoons of olive oil. Add the kale and sauté for 4 to 5 minutes. Add 1 or 2 tablespoons of water if the kale seems to be getting dry. Push the kale to one side of the pan and add 1 tablespoon of olive oil to the other side. Add the minced garlic to the oil along with the anchovy paste and crushed red pepper flakes. Sauté for 1 to 2 minutes, until the garlic is fragrant. Combine with the kale.

  Step 3

  Stir in the vinegar, zest, and salt and pepper to taste. Cover the pan and cook for 2 to 3 minutes more to blend the flavors.

  Step 4

  To serve, spread each crostini with a bit of ricotta and top with the sautéed kale.

  Yields 6 to 8 servings

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