Diet Corner – Mediterranean Diet with Intermittent Fasting

Studies have shown that a pesco-Mediterranean diet and intermittent fasting are both excellent disease improvement tools. Combined, they offer a powerful weight loss option too.

Heart disease is the leading killer of men and women in the United States and in many countries around the world. However, heart disease is also one of the most preventable and treatable diseases that we face. Indeed, dozens of accessible tests can predict future heart disease. Many are so simple that they are scheduled for an average patient’s annual physical exam. If a patient does have a higher risk for heart disease, the first line of defense is improving their diet. Unfortunately, modern-day dieting has turned into following extreme or fad diets that deprive us of many of the foods we want the most. However, taking an approach of moderation and eating healthful but delicious foods not only improves outcomes but also makes it easier for us to follow these diets long term.

Before we delve into Dr. Robine’s favorite dietary plan, it is worth understanding that a combination of what we eat and how we eat it really has made the difference between a generation ago, when obesity was not a great concern, and today, where it represents one of the most serious societal issues that we face. Simply by removing the worst offending foods and eating normal portions, we can take significant steps toward improved health. However, for those already suffering from excess weight and obesity, there is a great option in the form of a pesco-Mediterranean diet with intermittent fasting.

What Is a Pesco Mediterranean Diet?

You have undoubtedly heard about the Mediterranean diet, touted as one of the most effective dietary plans. However, it’s not a “diet” for those living in the Mediterranean – it’s a way of life. The concept is that plant foods high in good fats such as olive oil, various nuts, and other healthy products of the earth like legumes, whole grains and seeds are the basis of a healthy diet. Dairy is somewhat limited, and moderate alcohol consumption (red wine) is encouraged at evening meals. Red meat is very much a luxury, not an everyday meal, with lean and healthy animal protein provided by fish.  The result? This diet may be one of the reasons behind the exceptional longevity and low cardiovascular disease rates traditionally documented in the area.

Contrast this to what we have grown accustomed to in the United States and many other places in the Western world, where farming has been overrun by large, faceless conglomerates. As a result of the growing need for food and ever-larger portions, most of us consume highly processed meats from animals that themselves eat unnatural foods and live in stressful environments. The result has been a staggering increase in excess weight and obesity alongside a much higher rate of cardiovascular disease, despite our best efforts to treat and prevent it.

You might say that eliminating animal products is the best way to go. However, we know that many important proteins and vitamins are introduced through animal products. Here enters fish. Many fish, especially Mediterranean whitefish, offer a myriad of vitamins and minerals, protein, and exceptional taste while also being very healthy and filling.

What Is Intermittent Fasting?

Intermittent fasting is a pattern of eating that typically involves fasting for about 16 hours a day, followed by eating normally for the other 8 hours. For example, you may eat from 9 am to 5 pm or 10 am to 6 pm, but you would not eat late at night or early in the morning. Other options for fasting might include calorie restriction for two days each week or not eating for 24 hours twice a week. You can discuss which intermittent fasting cycle is best for you with a nutritionist, your primary care physician, or your cardiologist here at Nevada Cardiology.

Much like the Mediterranean diet explained above, we have found that many of our ancestors fasted both out of necessity, in the early human days, and later for religious reasons. However, today, with the abundance of food at our disposal, fasting has largely gone by the wayside. Fasting starts some very beneficial changes in the body. First, fasting allows the body to burn more stored body fat. Second, it improves insulin sensitivity. Third, it repairs our bodies on a cellular level and even improves the functions of our genes.

Of course, these benefits are not easily seen and certainly not obvious over the short term. As such, the most tangible and visible benefit of intermittent fasting is its biggest draw – weight loss. By rebalancing insulin secretion and improving human growth hormone levels, many of our patients have seen significant increases in their metabolic rate and weight loss as a result.

The Results

According to a review study in the journal of the American College of cardiology (, all-cause mortality was lowest in pesco-vegetarians, which would include those following the pesco-Mediterranean diet, even when compared to vegans. We saw an even greater proportional improvement in ischemic heart disease mortality.

Based on this review of both the pesco-Mediterranean diet and of the benefits of intermittent fasting, the authors have proposed this dual dietary plan as ideal for continued heart health and improvement in patients who are currently at risk of cardiovascular disease.

Nevada Cardiology’s Take

As cardiologists, we have been at the frontline of the fight against heart disease, and sadly, we have not seen exceptional improvements in cardiovascular health despite the proliferation of new diet and exercise programs costing hundreds, if not thousands, of dollars a year. What we have noticed is that while some patients may lose a significant amount of weight in the short term, it is the long-term weight loss that does not stick. One reason for this is simply that following an extreme or fad diet requires a degree of dedication that most cannot muster. Eliminating all of your favorite foods all of the time simply cannot be sustained. However, the pesco-Mediterranean diet with intermittent fasting is more of a mind shift than anything. The food you will be consuming is, truthfully, delicious, and you have a plethora of options to choose from. Further, intermittent fasting is not exceptionally difficult and simply requires a bit of discipline each day. As such, this dietary plan is preferred by Dr. Robine and is something he is both passionate about and discusses with any patient who wants to change their lifestyle in a positive, heart-healthy way.