Author + information
- Received March 20, 2020
- Revision received June 25, 2020
- Accepted July 20, 2020
- Published online September 14, 2020.
- James H. O’Keefe, MDa,b,∗ (, )@MidAmericaHeart,
- Noel Torres-Acosta, MDa,
- Evan L. O’Keefe, MDc,
- Ibrahim M. Saeed, MDa,b,
- Carl J. Lavie, MDd,
- Sarah E. Smith, PhDa,b and
- Emilio Ros, MD, PhDe
- aUniversity of Missouri–Kansas City, Kansas City, Missouri
- bSaint Luke’s Mid America Heart Institute, Kansas City, Missouri
- cTulane Medical Center, New Orleans, Louisiana
- dUniversity of Queensland School of Medicine, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, New Orleans, Louisiana
- eLipid Clinic, Endocrinology and Nutrition Service, Institut d'Investigacions Biomediques August Pi Sunyer, Hospital Clinic, University of Barcelona, and CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- ↵∗Address for correspondence:
Dr. James H. O’Keefe, University of Missouri-Kansas City, 4321 Washington Street, Suite 2400, Kansas City, Missouri 64111.
• Although humans as omnivores can subsist on myriad foods, the ideal diet for health remains a dilemma.
• A Pesco-Mediterranean diet of plants, nuts, EVOO, and seafood has strong cardioprotective evidence.
• A daily time-restricted eating window of 8 to 12 h is a central component of this diet.
• This diet is hypothetical and needs prospective and randomized studies to document its efficacy.
As opportunistic omnivores, humans are evolutionarily adapted to obtain calories and nutrients from both plant and animal food sources. Today, many people overconsume animal products, often-processed meats high in saturated fats and chemical additives. Alternatively, strict veganism can cause nutritional deficiencies and predispose to osteopenia, sarcopenia, and anemia. A logical compromise is a plant-rich diet with fish/seafood as principal sources of animal food. This paper reviews cumulative evidence regarding diet and health, incorporating data from landmark clinical trials of the Mediterranean diet and recommendations from recent authoritative guidelines, to support the hypothesis that a Pesco-Mediterranean diet is ideal for optimizing cardiovascular health. The foundation of this diet is vegetables, fruits, nuts, seeds, legumes, whole grains, and extra-virgin olive oil with fish/seafood and fermented dairy products. Beverages of choice are water, coffee, and tea. Time-restricted eating is recommended, whereby intermittent fasting is done for 12 to 16 h each day.
Dr. O’Keefe has a major ownership interest in CardioTabs, a supplement company that sells some products containing omega-3 fatty acids. Dr. Ros has received research funding through his institution from the California Walnut Commission (CWC); was a paid member of the CWC Health Research Advisory Group; has served as a nonpaid member of the CWC Scientific Advisory Council; and has received honoraria for presentations and funds for travel from the CWC and Danone. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received March 20, 2020.
- Revision received June 25, 2020.
- Accepted July 20, 2020.
- 2020 The Authors
- Central Illustration
- Traditional Mediterranean Diet: Gold Standard for Cardiovascular Health
- Seafood as Key Component of the Mediterranean Diet
- Health Benefits of Mediterranean, Vegetarian, and Pesco-Vegetarian Diets
- Fish and Seafood in the Diet
- Other Key Components of the Mediterranean Diet: EVOO, Nuts, and Legumes
- Intermittent Fasting/Time-Restricted Eating