A Pesco-Mediterranean Diet With Intermittent Fasting
Open accessAbstract
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.
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A high rate of long-living people and low incidence of cardiovascular disease in Mediterranean countries suggests the importance of a Mediterranean diet.
“Notably, a high rate of long-living people and the low incidence of cardiovascular disease in many Mediterranean countries suggests the importance of a diet rich in fruits, vegetables, whole grains, legumes, fish high in omega-3 fatty acids, and extra virgin olive oil188.”
From SARS-CoV-2, COVID-19 and the aging immune system (2021) · cites this paper as [188]
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Horne, B. D., Anderson, J. L., May, H. T., Le, V. T., Bair, T. L., Bennett, S. T., Knowlton, K. U., & Muhlestein, J. B. (2023) · International Journal of Cardiology Cardiovascular Risk and Prevention · doi:10.1016/j.ijcrp.2023.200209 · Cited by 6 · see citing works
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Boada, V. L., Manzanares‐Céspedes, M. C., López‐López, J., Ventura, A. P., & Giovannoni, M. L. (2025) · European Journal Of Dental Education · doi:10.1111/eje.70071 · Cited by 2 · see citing works
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Pitha, J. V. (2025) · International Angiology · doi:10.23736/s0392-9590.25.05442-2 · Cited by 1 · see citing works
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Yang, F., Liu, C., Liu, X., Pan, X.-D., Li, X.-Y., Tian, L., Sun, J.-H., Yang, S.-J., Zhao, R., An, N., et al. (2021) · Research Square · doi:10.21203/rs.3.rs-214009/v1 · Cited by 1 · see citing works
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Whiteson, H. Z., Whiteson, J., & Frishman, W. H. (2026) · Cardiology in Review · doi:10.1097/crd.0000000000001238
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- Authors
- O’Keefe, J. H., Torres-Acosta, N., O’Keefe, E. L., Saeed, I. M., Lavie, C. J., Smith, S. E., & Ros, E.
- Affiliations
- Saint Luke's Hospital (US)
- University of Missouri–Kansas City (US)
- Tulane Medical Center (US)
- Inova Fairfax Hospital (US)
- The University of Queensland (AU)
- Instituto de Salud Carlos III (ES)
- Corresponding author
- O’Keefe, James H.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2020-09
- Volume
- 76
- Issue
- 12
- Pages
- 1484-1493
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W3085507151
- Cited by
- 45
- References
- 53
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 2 · 2023: 9 · 2022: 8 · 2021: 18 · 2020: 1
- FWCI
- 1.50
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- University of Missouri
- Danone
- University of Missouri-Kansas City
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición
- Instituto de Salud Carlos III
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Physiology › Dietary Effects on Health
- Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
- Keywords
- Mediterranean diet, intermittent fasting, time-restricted eating, cardiovascular health, fish and seafood consumption, plant-based diet, extra virgin olive oil, fermented dairy products, dietary guidelines
- MeSH terms
- Olive Oil, Cardiovascular Diseases, Fasting, Humans, Fabaceae, Nuts, Seafood, Diet, Mediterranean
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