For how we live.
A six-month randomised trial found liver-fat improvement tracked weight loss and lower ultra-processed food intake, not whether people were assigned a Mediterranean or low-carbohydrate pattern.
Observational studies robustly link the diet to lower mortality. The best randomised trial measured fewer heart attacks and strokes, and the strongest review finds the evidence for a survival benefit weak.
A Mediterranean diet rich in extra-virgin olive oil cut cardiovascular events in a Spanish trial, and US cohorts link over half a tablespoon a day to less heart disease — the biggest signal in what it replaces.
People who eat nuts have lower rates of heart disease and early death in large cohorts, and a Mediterranean diet with nuts cut cardiovascular events in one trial. Most of the evidence is observational.
Spain's PREDIMED trial is the strongest randomised evidence that a dietary pattern lowers cardiovascular events. In 2018 its authors withdrew it over flawed randomisation and reissued corrected results.
A diet built to protect the brain looked powerful when researchers watched who chose to eat it. When they assigned it in a three-year trial, both groups improved by almost exactly the same amount.
The trial was designed to test non-inferiority against traditional dietary advice. It found superiority instead, with 62% versus 42% achieving a clinical response over six weeks.
A Spanish trial in 4,746 adults compared an energy-reduced Mediterranean diet plus exercise against the same diet eaten freely. Over six years the absolute gap was 12.0% versus 9.5%.