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Women who closely followed a Mediterranean diet lived much longer than those who did not, according to a new study that followed more than 25,000 women for 25 years.
“For women interested in longevity, our study shows that following a Mediterranean dietary pattern could result in about one quarter reduction in risk of death over more than 25 years with benefit for both cancer and cardiovascular mortality, the top causes of death,” senior study author Dr. Samia Mora, a cardiologist at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School in Boston, said in an email.
The Mediterranean diet features simple, plant-based cooking, with much of each meal focused on fruits and vegetables, whole grains, beans and seeds, with a few nuts and a heavy emphasis on extra-virgin olive oil. Fats other than olive oil, such as butter, are consumed rarely, if at all, and sugar and refined foods should be avoided.
Red meat is used sparingly, usually only to flavor a dish. Eating healthy, oily fish, which are packed with omega-3 fatty acids, is encouraged, while eggs, dairy and poultry are eaten in much smaller portions than in the traditional Western diet.
“In this study, adherence to the Mediterranean diet was a proxy for diet quality. Those who adhered most closely were eating more legumes, more vegetables, more fruits, less meat, and less processed meats,” said Dr. David Katz, a specialist in preventive and lifestyle medicine who founded the nonprofit True Health Initiative, a global coalition of experts dedicated to evidence-based lifestyle medicine.
While the study was observational and thus could not show a direct cause and effect, “the finding is entirely consistent with many other studies of the now famously healthful Mediterranean diet,” said Katz, who was not involved in the research.
“We may be comfortable inferring that a high quality diet did, indeed, ‘cause’ a lower risk of death,” Katz said in an email.
Why studying women is important
The Mediterranean diet has a long list of scientific kudos: The Mediterranean style of eating may reduce the risk for breast cancer, dementia, depression, diabetes, high cholesterol and memory loss. Adherence to the diet can also lead to stronger bones, a healthier heart and longer life. It’s also good for healthy weight loss.
In all that data, however, are few details on the specific ways the Mediterranean diet may affect women, especially long-term. That’s important, experts say, because women are not little men.
A woman’s brain works differently on a molecular level than a man’s brain. The size of a woman’s heart may differ from a man’s, and women have completely different symptoms for a heart attack than men. Women metabolize alcohol and medications differently than men. And then there’s the obvious difference of menarche and menopause, which creates an entire class of health risks specific to women.
Every bite counts
In the new study, published Friday in the journal JAMA Network Open, researchers asked 25,315 healthy women participating in the Women’s Health Study about their diet and collected blood and other biomarkers between 1993 and 1996. Those women were reevaluated between 2018 and 2023.
Not only did closely following the Mediterranean diet cut the risk of early death by 23%, it lessened the risk of dying from cancer by 17% and dying from cardiovascular disease by 20%, the study found.
“There was a graded stepwise increase in benefit — the more committed the more benefit,” said lead author Shafqat Ahmad, an associate professor of molecular epidemiology at Uppsala University in Sweden, in an email.
Each increase in adherence to the Mediterranean diet was associated with a 6% lower risk of all-cause mortality and a 5% reduced risk of dying from either heart disease or cancer, Ahmad said.
“What might be worth noting is that the adherence measure ‘corrects’ for distortions of the Mediterranean diet,” Katz said. “In the US, simply adding olive oil to French fries might result in someone claiming to be ‘on’ the Mediterranean diet.”
However, the study corrects for distortions by looking at all the “key features of a ‘true’ Mediterranean diet, and thus precludes that kind of misrepresentation,” Katz said.
Want to start the Mediterranean diet?
It’s not hard to incorporate a Mediterranean style of eating into your life, experts say. Start by adding more veggies and legumes to each meal and use all kinds and colors to get the broadest range of nutrients, phytochemicals and fiber. Cook, roast or garnish them with herbs and a bit of extra-virgin olive oil.
Add whole grains and fruit to every meal, but use nuts and seeds as a garnish or small snack because of their higher calorie and fat content.
Cut way back on the use of red meat. Instead turn to fish and other seafood, which are often consumed at least twice a week. Get as much protein as you can from beans and other legumes. Start with one bean-based meal a week, then add two and build your nonmeat meals from there.
Mix in cheese and yogurt daily to weekly in moderate portions. Chicken, pork and eggs are OK on occasion. Keep sweets for special occasions and satisfy your sweet tooth with fresh and frozen fruit.
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