T. J.’s Mediterranean Salad Recipe, For Your Best Heart Health: The Mediterranean Diet and Reversing Metabolic Syndrome After Heart Disease

Research on the benefits of olive oil and the Mediterranean diet continues to support the role they play in good health. One of the longest and most wide-reaching studies comes from Spain, one of my favorite countries and of course, as Club members know, one of the leading producers of the most flavorful and polyphenol-rich extra virgin olive oils. This study’s scientific findings show that following the Mediterranean lifestyle, diet included, helps not only prevent many health conditions but also reverse some of them. And because it’s delicious as well as good for you, it doesn’t feel like “a diet,” but rather an enjoyable way of life. This week’s recipe also shows how easy it can be!

T. J.’s Mediterranean Salad

• T. J.’s Mediterranean Salad

  Every country around the Mediterranean has its own version of a national salad, usually created with tomatoes, cucumber, and onions with a smattering of fresh herbs. My version brings in the sweet surprise of watermelon—on its own a great pairing with the feta. Speaking of feta, always buy blocks or rounds of feta, not crumbles, which often get dried out in the package. This combination makes a satisfying lunch or dinner, especially on hot days when you want to enjoy a light meal with no cooking needed. It takes only a few minutes to prep, but if you have the time, let it sit on the counter for about 30 minutes before digging in so that the flavors can meld.

  Ingredients

  • 2 large cucumbers
  • 1 pound tomatoes, any variety
  • 1 pound watermelon chunks
  • 1 medium red onion 
  • 1/2 cup fresh parsley, minced
  • 1/4 cup fresh mint, minced
  • 4 tablespoons extra virgin olive oil
  • 2 tablespoons fresh lemon juice, plus more to taste
  • Freshly ground black pepper and sea salt to taste
  • 6-ounce slice feta cheese

  Directions

  Step 1

  Cut the cucumbers (leave the skins on), tomatoes, watermelon, and red onion into an even dice and place in a large glass bowl. Add the herbs, olive oil, and lemon juice, and toss gently. Taste and, if needed, add salt, pepper, and extra lemon juice to your liking.

  Step 2

  Just before serving, crumble the feta over the top.

  Yields 4 servings

For Your Best Heart Health

The Mediterranean Diet: Reversing Metabolic Syndrome After Heart Disease

The study: “Adherence to a Mediterranean lifestyle improves metabolic status in coronary heart disease patients: A prospective analysis from the CORDIOPREV study,” Journal of Internal Medicine, May 2023.

Study Abstract from the Research Team

Background and objectives: A Mediterranean lifestyle may prevent and mitigate cardiometabolic disorders. We explored whether adherence to a Mediterranean lifestyle (MEDLIFE) was prospectively associated with the risk of metabolic syndrome (MetS) among coronary heart disease (CHD) patients.

Methods: The Coronary Diet Intervention with Olive Oil and Cardiovascular Prevention (CORDIOPREV) study was an interventional diet study to compare a Mediterranean diet with a low-fat diet in 1,002 CHD patients. The Mediterranean lifestyle (MEDLIFE) index was used to assess adherence to MEDLIFE at baseline and, after five years, in 851 participants from the CORDIOPREV study. Subjects were classified as having high (13 points or more), moderate (12 to 13 points), and low (less than 12 points) adherence to MEDLIFE. 

Results: During the five-year follow-up, CORDIOPREV participants with high adherence to MEDLIFE had a lower risk of MetS development and a higher likelihood of reversing preexisting MetS compared with participants with low adherence to MEDLIFE. Each additional one-point increment in the MEDLIFE index was associated with a 24% lower risk of MetS development and a 21% higher likelihood of reversing preexisting MetS.

Conclusions: Our results showed that greater adherence to MEDLIFE reduced the risk of subsequent MetS development and increased the likelihood of reversing preexisting MetS among patients with CHD at baseline.

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About Heart Disease and Metabolic Syndrome

In the US, you’re most likely to hear the term coronary artery disease, or CAD, though it is also referred to as coronary heart disease, according to the CDC. By either name, the condition is caused by the buildup of plaque (cholesterol and other substances) in the walls of the coronary arteries, those that supply blood to the heart and other parts of the body. This causes the arteries to narrow over time, partially or totally blocking blood flow. It’s especially dangerous because it can go undetected until it causes a heart attack.

The CDC estimates that about 1 in 20 adults age 20 and older have CAD. And CAD doesn’t discriminate: Heart disease is the leading causeof death for both men and women, including most racial and ethnic groups in the United States.

Metabolic syndrome is even more prevalent. About 1 in 3 American adults have it, according to the National Institutes of Health. It encompasses a constellation of factors: having a large waistline, high blood sugar, high blood pressure, high cholesterol, high triglycerides, and low HDL (or good) cholesterol. Having three or more of these factors leads to a metabolic syndrome diagnosis. 

Metabolic syndrome is a risk factor for heart disease. Since many people with heart disease also have metabolic syndrome, the ability to reverse it through the Mediterranean diet is extremely important.

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An editorial published along with the study underlines the importance of the Mediterranean diet for everyone:

“Spain has a proud tradition of nutrition research in the cardiovascular field. The primary preventive PREDIMED study clearly shows the health benefits of professional dietary intervention for individuals with high cardiometabolic risk. The secondary preventive CORDIOPREV study also contributes with important new knowledge about the role of lifestyle, including nutrition, for the prognosis of coronary heart disease. The present study focuses on the role of an overall healthy lifestyle on the prevention and treatment of the metabolic syndrome. Still, the two studies provide complementary knowledge on the health benefits of traditional Mediterranean food. It is important to emphasize that this food pattern is a good model for healthy eating according to the current knowledge. 

“The results from the present CORDIOPREV study are indeed clinically relevant. In recent decades, lifestyle and risk factor patterns in the population as a whole, as well as in patients with coronary heart disease, have changed. The prevalence of the metabolic syndrome is increasing in all parts of the population, especially in at-risk individuals with coronary heart disease because such patients today are often sedentary and have abdominal obesity. The metabolic syndrome is—beyond an increased risk of cardiovascular diseases—also linked to an increased risk of cancer, cognitive impairment, and inflammatory diseases, as well as low quality of life.

“Perhaps, we are approaching the limit for what is achievable by pharmacological treatment alone. Instead, an increased investment in lifestyle might be required to further improve the prognosis for people with coronary heart disease. The important data from the Spanish CORDIOPREV study underline that lifestyle interventions, including dietary changes, are still underused in modern healthcare. This study indicates that much health remains to be gained.”

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Roasted Ratatouille Recipe, For Your Best Heart Health: The Mediterranean Diet Fights Heart Attacks and Stroke

There’s no shortage of “best diet” lists for losing weight, but they don’t always have scientific backing or address the bigger picture that includes taking care of your overall health.

When I share the benefits of olive oil, it’s often in the context of the Mediterranean diet. After all, no matter how delicious the freshest extra virgin olive oil is, you need other foods to enjoy it fully! The Mediterranean diet has scores of studies that support its adoption.

Now a new research review goes a step further: the authors did a deep dive to compare it to six other diets that claim to lower heart attacks and death rates in people with heart disease. These included the Pritikin diet, the Ornish diet, and a very, very low-fat diet, all known to be extremely restrictive. The Mediterranean diet bested them all, with the bonus benefit of stroke prevention (details below), plus it tastes great.

A case in point is the following recipe. For those who only know “Ratatouille” as the lead character from the Disney classic, let me introduce you to the dish that inspired his name…with my own personal twist, of course!

Roasted Ratatouille

• Roasted Ratatouille

  All the flavors of seasonal bounty meld together in this dish. Rather than cooking it on the stovetop, it’s roasted in the oven, with minimal attention. This technique helps preserve the taste and texture of the individual vegetables, even as they cook in each other’s juices, and creates more of a caramelized medley than a stew. Ratatouille makes a delicious side dish, a topping for grilled bread or pasta, and a hearty sauce for roasted chicken or fish.

  Ingredients

  • 1 small eggplant, about 1 pound 
  • 1-1/2 pounds tomatoes, any variety
  • 1 pound zucchini or summer squash, green and/or yellow
  • 3 yellow, orange, or red bell peppers
  • 1 large onion, about 1 pound
  • 8 cloves garlic, sliced
  • 7 tablespoons extra virgin olive oil, divided, plus more for the pans
  • 2 teaspoons coarse sea salt
  • Freshly ground black pepper, to taste
  • 1 tablespoon balsamic vinegar from Modena, plus more to taste
  • 1 tablespoon chopped fresh flat-leaf parsley

  Directions

  Step 1

  Preheat your oven to 350°F. Cut all the vegetables into roughly 1-inch diced pieces and mix together along with the garlic in a large bowl. Add 6 tablespoons of olive oil and the salt, and toss to coat. Lightly oil two rimmed sheet pans (or line them with parchment paper) and divide the vegetables between them. Roast the veggies for a total of 3 hours.

  Step 2

  After the first hour, as the vegetables give up their moisture and shrink in volume, combine them in one of the sheet pans; after the second hour, flip the veggies with a large spatula.

  Step 3

  When done, transfer the vegetables back to the large bowl, taking care to get all the juices. Season with pepper, drizzle on the last tablespoon of olive oil and the vinegar, and sprinkle with the parsley.

  Serves 8

For Your Best Heart Health

The Mediterranean diet fights heart attacks and stroke

The study: “Comparison of seven popular structured dietary programmes and risk of mortality and major cardiovascular events in patients at increased cardiovascular risk: systematic review and network meta-analysis,” BMJ, March 2023.

The analysis: In the first study of its kind, an international group of researchers from the US, Canada, Brazil, Colombia, Spain, and China analyzed the effects of seven different popular diet plans designed to reduce “the likelihood of death and heart attack in people at heightened risk of cardiovascular disease.” They compared the plans to each other and to “minimal intervention efforts” such as being handed a brochure on healthy diets. 

After searching through research databases, they identified 40 eligible trials involving a total of 35,548 participants who had heart disease—or at least two known risk factors for it—and who were followed for an average of three years on these popular diets: low fat (18 trials), Mediterranean (12 trials), very low fat (six trials), modified fat (four trials), combined low fat and low sodium (three trials), Ornish (three trials), and Pritikin (one trial). Some trials compared two different diets to each other.

The researchers pointed out that, although many of these diets have the aura of heart health and are often recommended to people at risk of heart problems, such recommendations have relied on “low certainty evidence from non-randomized studies.” Translation: there’s a lack of gold-standard studies supporting their benefits.

The researchers found that of the seven programs, based on “moderate certainty evidence,” Mediterranean dietary programs were better than minimal intervention at preventing all-cause mortality (17 fewer deaths per 1,000 over five years), nonfatal heart attack (17 fewer deaths per 1,000), and stroke (seven fewer deaths per 1,000) for patients at intermediate risk of cardiovascular disease. Low-fat programs were superior to minimal intervention, with moderate certainty for prevention of all-cause mortality (nine fewer deaths per 1,000) and nonfatal heart attack (seven fewer deaths per 1,000) but did not impact stroke risk.

“The absolute effects for both dietary programmes were more pronounced for patients at high risk of cardiovascular disease (36 fewer all-cause deaths per 1,000 and 39 fewer cardiovascular deaths per 1,000 among those that followed the Mediterranean dietary programme over 5 years),” the review concluded. “The five remaining dietary programmes generally had little or no benefit compared with minimal intervention typically based on low to moderate certainty evidence.”

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Walnut-Crusted Fish Recipe, Spotlight on Walnuts, The Kitchen Essential Cast Iron, The Benefits of a Good Work-Life Balance, and Beyond Diet and Exercise to Protect Heart Health

Heart disease is our greatest health threat, and the important topic of protecting the heart weaves its way throughout this issue of the newsletter. While a total lifestyle refresh can seem overwhelming, taking smaller steps, including enjoying more extra virgin olive oil and walnuts and finding a better balance between work and your personal life, add up to better health. The more positive choices you make, the more you can reduce your risk from health issues that can really impact the way you want to live.

Walnut-Crusted Fish

• Walnut-Crusted Fish

  This delicious and heart-healthy topping is the perfect upgrade from breadcrumbs, and a cast iron pan makes quick work of cooking the fish.

  Ingredients

  • 1 cup shelled walnut halves or pieces
  • 4 tablespoons extra virgin olive oil, divided, plus more for drizzling
  • 1 tablespoon creamy Dijon mustard
  • 1 tablespoon fresh, chopped flat-leaf parsley 
  • 1 clove garlic, minced
  • 1-1/2 pounds thick white fish fillet, like cod, halibut, or bass, wild caught if available
  • Optional garnishes: lemon slices, fresh dill

  Directions

  Step 1

  Preheat your oven to 375°F. Put the walnuts in a food processor or coffee bean grinder and pulse until they take on the texture of meal—go slowly because you don’t want the contents to turn to nut butter. Add 2 tablespoons of olive oil, the mustard, parsley, and minced garlic, and pulse just until blended.

  Step 2

  Heat a 10″ cast iron skillet until hot. While you’re waiting for it to heat up, pat both sides of the fish dry with paper towels and then press the walnut mixture evenly across the top surfaces. 

  Step 3

  When the skillet is hot, add 2 tablespoons of olive oil. As soon as it shimmers, use a long spatula to transfer the fish to the skillet. Cook for about 5 minutes, until the bottom browns.

  Step 4

  Transfer the skillet to the top third of your oven and cook for 8-12 minutes, until the fish feels firm (you can test on the side); this will depend on the thickness of your fish. 

  Step 5

  Turn your oven to broil to quickly toast the crust. Don’t walk away—this should only take 2 or 3 minutes. 

  Step 6

  Turn off the oven and, using high-heat-resistant oven mitts, carefully transfer the skillet to a heat-resistant pad on your counter. Drizzle the fish with more olive oil and garnish as desired.

  Yields 4 servings

Healthy Ingredient Spotlight

Walnuts’ Wallop of Nutrients

There’s good reason—many good reasons, in fact—that walnuts consistently make the list of the healthiest foods. A great source of anti-inflammatory omega-3 alpha-linolenic acids, walnuts also deliver protein, fiber, polyunsaturated fatty acids, and numerous vitamins and minerals. Their unique nutrient profile is likely what makes them so good for heart health. Now, using a newly developed technology that can quantify gene expression levels in the gut and monitor how these levels shift in response to various dietary changes, a team of scientists may have found out more specifically how walnuts help the heart. 

“Research has shown that walnuts may have heart-healthy benefits like lowering cholesterol levels and blood pressure,” said Mansi Chandra, a researcher at Juniata College in Huntingdon, Pennsylvania. “This motivated us to look at how walnuts benefited the gut microbiome and whether those effects led to the potential beneficial effects. Our findings represent a new mechanism through which walnuts may lower cardiovascular disease risk.”

Chandra and her colleagues discovered that introducing walnuts into a person’s diet led to higher levels of Gordonibacter bacteria. This bacterium converts the plant polyphenols ellagitannins and ellagic acid into metabolites that allow them to be absorbed by the body. Study participants who ate a walnut-rich diet also showed higher levels of expression for several genes that are involved in important metabolic and biosynthetic pathways, including ones that increase the body’s production of the amino acid L-homoarginine—a deficiency has been linked to higher risk for cardiovascular disease.

Quick Kitchen Nugget

Get Cookin’ with Cast Iron

Many chefs swear by their cast iron skillet because the metal holds heat so well and so uniformly that cooking is a breeze, especially when you need high heat. It’s also the ultimate stovetop-to-oven pan—just be sure you have excellent oven mitts to protect your hands from a hot handle. 

Either a 10″ or 12″ size is very versatile. Most cast iron skillets from companies like Field, Lodge, and Victoria come pre-seasoned and ready to go, so prepping them doesn’t present the issue it once did.

As I always suggest with any pan, heat your cast iron skillet before adding any food, including olive oil. In a hot pan, it will take mere moments for your EVOO to take on the distinctive shimmer of readiness, and then just a few minutes to cook your food. 

One fear home cooks have is about cast iron is caring for it. It’s not complicated, but it is necessary to wash and dry it well before storing in order to avoid a rusty surprise the next time you reach for it. Wash it in hot water and use a stiff brush—not a scouring pad—if there’s any stuck-on food that needs to be removed. You can also use coarse salt as a safe abrasive. Rinse and dry it completely with a soft towel. Then rub in a few drops of olive oil and use a clean paper towel to buff it dry. 

While I love skillet brownies, avoid using the same cast iron skillet for sweet and savory dishes, especially fish—have one dedicated for each.

For Your Best Health

The Benefits of a Good Work-Life Balance 

Work-life balance may not guarantee success, but without it, failure is almost inevitable, according to J. Gerald Suarez, PhD, and other experts from the University of Maryland’s Robert H. Smith School of Business.

Finding the right balance between work demands and a satisfying personal life may seem overwhelming, but it helps to think of balance as those elements that contribute to your stability and steadiness. “It’s in the process of mindful reflection and discovery that we find inspiration to execute our decisions and bring our priorities to life,” says Dr. Suarez, professor of practice in systems thinking and design. 

Successful work-life balance is about moving forward steadily, he suggests. Think of the tightrope walkers who set the goal of making it to the other end, focusing on their next steps and compartmentalizing all other potential distractions—they recognize that there are no shortcuts. You can work to identify the small and achievable steps that will bring consistency of action each day, week, and month, he explains, adding that unexpected events, conflicts, crises, requests, and scheduling shifts will challenge that consistency and require mindful choices to maintain your course. “Is it possible to balance a conflict between an important work presentation that can contribute to a promotion or attending the first recital of our kids? By the time we find ourselves in this predicament, we can only justify our decision,” said Dr. Suarez. “But no matter the choice we make, there will be a residual emotional effect and an impact on ourselves and others.”

Here are Dr. Suarez’s tips for achieving a better work-life balance:

Be honest with yourself. Be genuine and articulate what truly matters most to you. Share your intent with your loved ones and heighten their awareness regarding your priorities and the context behind them.

Keep a calendar. Schedule and honor personal activities and time with friends and family much like you do with important work-related events. It’s easy to embrace the “always on” attitude at work and neglect the relationships and experiences that bring stability to our lives.

Set the right tone. For supervisors, be an example to others in the workplace by modeling adequate behaviors for work-life balance. Sending emails in the middle of the night or during weekends may signal there are no demarcations or boundaries.

Create safeguards. Empower and develop team members at work to become an extension of your leadership. If they feel trusted, empowered, and capable, they will amplify your presence and create pockets of freedom in your schedule. Developing your team will allow you to mitigate the discomfort of taking time off, booking your next vacation, or having a moment to unplug.

Fitness Flash

Beyond Diet and Exercise to Protect Heart Health

A new study from researchers at The Ohio State University analyzed data from over 20,000 U.S. adults and linked a healthier diet and increased exercise to weight loss that reduces heart disease risk. But even people who lost weight still fell short on the American Heart Association’s “Life’s Essential 8,” the 8-part checklist promoting heart disease risk reduction by meeting goals for body weight, blood pressure, cholesterol, blood sugar, smoking, physical activity, diet, and sleep. This means that weight loss alone isn’t enough for optimal heart health. The researchers found that, overall, Americans have an average score of 60 out of 100 on the eight measures, suggesting there is plenty of room for improvement even among those whose diet and exercise behaviors helped move the needle on some metrics. 

 “Clinically significant weight loss results in improvements in some health indices,” says senior study author Colleen Spees, PhD, MEd, RDN, associate professor of medical dietetics in the School of Health and Rehabilitation Sciences at Ohio State. “People should feel hopeful in knowing that losing just 5% of their body weight is meaningful in terms of clinical improvements.” Adults with weight loss reported higher diet quality, more moderate and vigorous physical activity, and lower LDL cholesterol than the group without clinically significant weight loss. Yet as a group, they also had a higher average BMI and HbA1c blood sugar measure and fewer hours of sleep, things that bring down their composite Life’s Essential 8 score.

Among adults who did not have success at weight loss, many reported skipping meals or using prescription diet pills, following low-carb and liquid diets, taking laxatives or vomiting, and smoking—all of which are not winning weight-loss strategies. “We saw that people are still gravitating to non-evidence-based approaches for weight loss, which are not sustainable. What is sustainable is changing behaviors and eating patterns,” Dr. Spees says.

“We have a lot of work to do as a country,” she adds. “Even though there were significant differences on several parameters between the groups, the fact remains that, as a whole, adults in this country are not adopting the Life’s Essential 8 behaviors that are directly correlated with heart health…We absolutely need to be moving toward prevention of disease versus waiting until people are diagnosed with a disease. This becomes quite overwhelming, and individuals may feel it’s too late at that point,” she said.

One idea to consider, she suggests, would be prescriptions for regular visits with registered dietitians trained in behavior change, complete with insurance reimbursement, similar to physical therapy. “We have fantastic research, we have incredible educators,” she says. “What we don’t have is policy that promotes optimal health across the lifespan, from pregnancy through older adulthood.”

The study, “Differences in Adherence to American Heart Association’s Life’s Essential 8, Diet Quality, and Weight Loss Strategies Between Those With and Without Recent Clinically Significant Weight Loss in a Nationally Representative Sample of US Adults,” was published in the Journal of the American Heart Association.

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