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A Pesco-Mediterranean diet with intermittent fasting: an ideal diet for health and longevity

Last Updated on August 4, 2021 by Max


Diet is one of the pillars determining a person’s health and heart health, in particular. For the last three years, 25 leading American experts have ranked the Pesco-Mediterranean diet as the #1 among 35 other diets for overall health in terms of nutrition, safety, easiness to follow, effectiveness for weight loss, protecting against cardiovascular disease, and diabetes. American Dietary Guidelines and American College of Cardiology/American Heart Association endorsed the traditional Mediterranean diet as the best diet for human health and longevity. 

How did the Pesco-Mediterranean diet deserve such accolades? 

The Pesco-Mediterranean diet

– Reduces the incidence of myocardial infarction by 29% and stroke – by 42%;

– Reduces the risk of myocardial infarction recurrence by 73%;

– Lowers the risk of mortality from coronary artery disease by 34%;

– Lowers risks for metabolic syndrome, diabetes, cognitive decline, Alzheimer’s disease, depression, overall cancer mortality, and breast and colorectal cancers;

– Improves quality of life and longevity.

The Pesco-Mediterranean diet involves eating plant foods (fruits, vegetables, legumes, seeds, tree nuts, and whole grains), fish/seafood as the principal source of high-quality animal protein, and olive oil as the major fat source, modest amounts of fermented dairy products (yogurt and soft cheese) and eggs, as well as some alcohol consumption (ideally red wine with the evening meal), but few red and processed types of meat.

Is the Mediterranean diet a decent diet to follow?

Tens of different diets may have been approved for certain health conditions, nevertheless, have various limitations to recommend them as fully satisfying human needs in nutrition on one hand and keep up his health for his life on the other hand. 

We humans have evolved as omnivorous creatures as shown by the anatomy and physiology of our digestive system. Therefore, any artificial restrictions on food sources may have negative health outcomes. The so-called Western diet based predominantly on meat and animal products is rapidly spreading all over the world. The prevalence of concomitant diseases of this diet such as cardiovascular disease (CVD), diabetes, gastrointestinal cancers, and obesity are also rocketing. As an alternative to the Western diet and to cut the risk of CVD and cancer, various types of vegetarian diets have been adapted. However, diets excluding animal-based food can result in some nutrient deficiencies such as vitamin B12, high-quality proteins, iron, zinc, omega 3 fatty acids (u3FA), vitamin D, and calcium. Studies suggest that strict veganism raises the risk for bone fractures and loss of muscle tissues.

Is the Mediterranean diet the only decent diet to follow, to make sure you have a nutritious diet and good health? Yes, it is. Many epidemiological studies and randomized clinical trials show that the Mediterranean diet is related to lower risks for all-cause and CVD mortality, coronary heart disease, metabolic syndrome, diabetes, cognitive decline, Alzheimer’s disease, depression, overall cancer mortality, and breast and colorectal cancers. 

So, most naturally, without the use of drugs and surgery, the Mediterranean diet can cut the dire outcomes of the quiet pandemic of our time –the food revolution

Over the past three years, we all have witnessed a terrible viral pandemic that has claimed millions of lives. Although it is still raging in some countries, effective vaccines have already been created that can stop the further spread of the pandemic. We have seen scientists, governments, and ordinary people mobilize to confront the pandemic.

One can make an analogy between the COVID-19 vaccine and the Pesco-Mediterranean diet; this diet is indeed a life-saving vaccine that can prevent millions of premature deaths, improve the quality of life, and release so much creative energy. So, we can exclaim “Eureka” and advertise it wherever we can. Unfortunately, this is not happening. Do your part to protect your family, loved ones, and friends, help to spread the word about the best eating style in the world in your circles. 

Scientific evidence backing the Pesco-Mediterranean diet.

Seafood is the key part of the Pesco-Mediterranean diet. The Dietary Guidelines for Americans recommend including at least two fish/seafood meals a week, totaling at least 8 to 10 oz/week ((Millen al. 2015).

In a Greece study of 22,043 participants, (Trichopoulou A. et al. (2003)) a higher level of adherence to the Mediterranean diet correlated with a 25% decrease in total mortality and a 33% of cut in death due to CHD.

The PREDIMED was a randomized clinical trial conducted in Spain on elderly people at high risk but with no CVD at enrollment. The study tested three diets: 

  • a Mediterranean diet + extra-virgin olive oil (EVOO), 
  • a Mediterranean diet + mixed nuts (walnuts, almonds, and hazelnuts), 
  • and a low-fat diet (Estruch R et. al. 2018). 

During the 4.8-year study, the first and the second groups showed significant cuts of 29% for myocardial infarction, stroke, and death from these conditions and 42% for stroke. 

The Lyon Diet Heart study was another randomized clinical trial that tested, if a Mediterranean diet may prevent recurrences after a first myocardial infarction (MI). 605 survivors of a first MI were randomly distributed into either a control or a Mediterranean group. An impressive 73% reduction in the risk of new MI was observed in the Mediterranean diet group. 

An analysis of 5 dietary studies of coronary artery disease (CAD) mortality among vegetarians and meat-eaters found:  Compared with nonvegetarians CAD mortality was 

  • 34% lower in the Pesco-Mediterranean diet group 
  • 34% lower in lacto-ovo-vegetarians, 
  • 26% lower in vegans, 
  • and 20% lower in occasional meat-eaters (Key TJ et. al. 1999).

Adventist Health Study 2 (a 6-year study involving 73,308 individuals in North America) reported a reduced rate of all-cause mortality in vegetarians compared with nonvegetarians. However, pesco-vegetarians had the lowest risks compared with vegans, lacto-ovo vegetarians, and semivegetarians. 

In the Oxford study, which included 48,188 participants with 18 years of follow-up, the rate of CAD was much lower among vegetarians and pescatarians compared with meat-eaters (Tong TYN et al. 2019). The study observed an interesting fact that vegetarians, but not pescatarians, had significantly higher rates of hemorrhagic strokes and total strokes compared with meat-eaters. 

The components of the Pesco-Mediterranean diet.

Fish and seafood.

The Pesco-Mediterranean eating style is primarily a plant-rich diet, but fish and seafood provide the preferable animal food sources. Due to fish and seafood, the Pesco-Mediterranean diet is rich in u-3FA, zinc, iodine, selenium, B vitamins, calcium, and magnesium. Moreover, fish and seafood give high-quality protein, which is important for the building and sustaining of muscle and bone tissues.

Recent reviews including more than 130 000 individuals, showed that fish/seafood eating during pregnancy was connected with benefits to brain development in offsprings that became significant at 4 oz/week and increased from there. There were no adverse effects even when the amount of fish/seafood consumption exceeded 100 oz/week (Hibbeln JR et al. 2019).

When choosing fish, it is prudent to pick low-mercury fish, such as salmon, sardines, trout, herring, and anchovies. All of them are high in u-3FA, and scallops, shrimp, lobster, oysters, and clams, which are also low in mercury. Upon cooking, use lower temperatures until flesh is opaque; avoid charring or burning fish/seafood, which can cause carcinogenic compounds.

Extra virgin olive oil (EVOO).

EVOO is unrefined oil obtained by cold pressing olives, and in this sense is equal to pure olive juice. EVOO keeps highly bioactive polyphenols, which are deemed to hold cardioprotective benefits, such as reduced low-density lipoprotein cholesterol (bad cholesterol) and increased high-density lipoprotein cholesterol (good cholesterol), and lower diabetes risk.  

The presence of polyphenols in the oil is felt by a tingling or burning sensation in the back of the throat a few seconds following after swallowing olive oil. 

Along with vinegar, plentiful use of EVOO for dressing salads and vegetable dishes is encouraged. It is also recommended for simmering minced tomatoes, garlic, onions, and aromatic herbs as a sauce to use on vegetables, pasta, rice, fish, or legumes.

Dairy products and eggs.

Dairy products and eggs are also included in the Pesco- Mediterranean diet as important sources of high-quality protein, minerals, probiotics, and vitamin D. Preference is given to fermented dairy products such as yogurt, kefir, and soft cheeses; butter and hard cheese are not recommended, as they are rich in saturated fats and salt.

Eggs as a superfood include high-quality nutrients in the most bioavailable form: all essential amino acids, vitamins: A, D, B2, B12, niacin, minerals: selenium, iodine, phosphorus, zinc, and carotenoids: lutein, zeaxanthin. While some recent research suggests that egg consumption is not associated with blood cholesterol levels, it should be borne in mind that each yolk contains about 184 mg of cholesterol. The Pesco-Mediterranean diet recommends no more than 5 yolks a week and egg whites can be consumed without limit.

Tree nuts.

Tree nuts include almonds, Brazil nuts, cashews, hazelnuts, pistachios, macadamias, pecans, pine nuts, and walnuts. Nuts are nutrient-dense foods rich in unsaturated fats, fiber, protein, polyphenols, phytosterols, tocopherols, and minerals. Randomized clinical trials have shown that diets enriched with nuts improve insulin sensitivity, lipoprotein profile, and lower inflammation. 

Adventist Health Study (G.E. Fraser et al. 1992), for the first time, linked nut eating to a reduced risk of coronary heart disease. 

A randomized clinical trial by J. Sabaté et al. (1993) showed that a diet enriched with walnuts lowered blood cholesterol compared with a healthy control diet.

Nut consumption is correlated with reduced mortality rates from both CVD and CAD, as well as decreased risks of diabetes. 1 daily serving of mixed nuts resulted in a 28% reduction in CVD risk.

Reasonable consumption of nuts does not promote weight gain.


Legumes also play a central role in the traditional Mediterranean diet. Legumes are an invaluable source of fiber, vegetable protein, folate, polyphenols, and magnesium. Legumes eating can reduce the risk of incident and fatal CVD and CAD, as well as improvements in blood glucose, cholesterol, blood pressure, and body weight. 

Whole grains.

An indispensable part of the Mediterranean diet is whole grains, such as barley, whole oats, rye, corn, buckwheat, brown rice, and quinoa. 

Homemade pizza and pasta, or mixed rice dishes are authentic and healthy Mediterranean foods. Pasta despite being a refined carbohydrate, has a low glycemic index. According to a recent study, pasta may even help decrease body weight (Chiavaroli L, et al. 2018). 

Concerning white rice, like pasta, is usually cooked with a sauce including EVOO, tomatoes, other vegetables, and aromatic herbs, thereby adding beneficial nutrients and bio-actives to these starchy but nutritive foods that are likely to further lower their glycemic index. 

The primary beverage of the Mediterranean diet is unsweetened water. Tea and coffee are noncaloric and rich in antioxidants, particularly polyphenols, and are associated with improved CVD issues. 

For alcohol lovers, the Pesco-Mediterranean diet recommends dry red wine no more a single glass (#6 oz or 170 ml) for women and 1 or 2 glasses/day for men (6 to 12 oz or no more than 340ml) consumed with meals.

Servings shown in the table below, are for a person of average weight and height. Obviously, they cannot be the same for a person weighing 70 kg and 120 kg. or a person employed in intensive physical labor and an office worker. The portions are always easy to adjust for yourself, proportionally changing the constituent parts.

Pesco-Mediterranean Diet
Recommended foodsAmount of food
Fish/seafood3 or more times a week, 100g/ 3.5 oz – 1 serving
Vegetables3 or more servings a day, 225g/8 oz a day
Fresh fruits2 or more servings a day, 300g/11 oz a day
Legumes3 or more servings a week, 150g/ 5.3 oz – 1 serving
Whole grains3 or fewer servings a week, 120g/ 4.4 oz – 1 serving
Tree nuts1 or more servings a day, 30g/1 oz – 1 serving
EVOO4 or more tablespoons/day
Sofrito* 2 or more servings/week
Foods allowed with caution
Lean fresh red meatno more than 1 time (112g/4 oz) a week
White meatno more than 2 times a week, 112g -1 serving
Eggs5 yolks/week
Dry red wine6 oz/day for women
12 oz/day for men
Soft cheeses, Dark chocolate
Foods that should be avoided
Processed meats (e.g., bacon,
sausage, hot dogs, ham, deli meats, cold cuts).
Most refined carbohydrates such as products made
with added sugars and/or white flour (e.g.,
commercial bakery goods, cookies, cakes, pies,
candy, mashed potatoes, rolls, tortillas, and chips)
SweetsSoda drinks and sweetened fruit juices
Butter and margarineArtificially sweetened beverages and foods
Sofrito- a sauce made with tomato and onion, typically including garlic and aromatic herbs slowly simmered in olive oil.

Intermittent fasting – an integral part of the Pesco-Mediterranean diet.

Intermittent fasting is the practice of eating where the entire daily food intake is restricted to a specific time frame, usually 6 to 12 hours.

This is a daily eating culture for a lifetime, rather than a course with specific duration and it is not compatible with routinely eating 3 large meals plus snacks every day. 

Intermittent fasting reduces intra-abdominal fat, the most dangerous adipose tissue for prostate health.  Evidence is growing that eating in 6 hours and fasting for 18 hours can switch cellular metabolism from glucose-based to ketone-based energy, with increased stress resistance and longevity, reduced inflammation, and a decreased rate of illnesses, including cancer, diabetes, CVD, neurodegenerative diseases, and obesity (de Cabo R ey al. 2019).

The most prevalent form of intermittent eating involves a 16:8 fasting to eating ratio and includes 2 rather than 3 meals a day. So, despite you have two not restricted calories meals, the overall amount of consumed food during a day is reduced by 15 to 60 percent which may help to stabilize your body weight. If you do not have any contraindications or preferences, the easiest way is to deny breakfast. After a 12-hs overnight fast, in the morning, the body starts using fats from adipose cells to burn as metabolic fuel instead of glucose. This improves insulin sensitivity. Fasting does appear to lower blood pressure and resting heart rate and enhance cardiovascular health even in nonobese people.


Today we are proud to live in a free country where everyone is free to choose their lifestyle, including the style of eating. Just think, do we voluntarily choose to eat the food that causes so much trouble: one in two men and one in three women is diagnosed with cancer, cardiovascular diseases kill 655,000 Americans every year, and a third of the population is obese. It is estimated that one-third of all cancer deaths in the United States could be prevented through dietary change.
We must show everywhere that there is another choice and the results of comparative studies of different diets should not be published only in scientific journals, but also intelligibly reach the general public at every step. Then consciousness will change and after it the need to eat wholesome healthy food, which gives joy and longevity.

The Pesco- Mediterranean diet with daily fasting for 16 hs and accent on eating fish and seafood as the principal sources of animal protein is proposed as an ideal diet for health and longevity.

The post was based on the findings published in the Journal of the American College of Cardiology in 2020 (James H. O’Keefe et al. 2020). 



  • Millen B, Lichtenstein AH, Abrams S, et al. Dietary Guidelines for Americans 2015-2020. Eighth Edition. U.S. Department of Health and Human Services. Washington, DC: U.S. Department of Health and Human Services, U.S. Department of Agriculture, 2015.
  • Estruch R, Ros E, Salas-Salvado J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extravirgin olive oil or nuts. N Engl J Med 2018;378:e34.
  • Key TJ, Fraser GE, Thorogood M, et al. Mortality in vegetarians and nonvegetarians: detailed findings from a collaborative analysis of 5 prospective studies. Am J Clin Nutr 1999;70:516S–24S.
  • Tong TYN, Appleby PN, Bradbury KE, et al. Risks of ischaemic heart disease and stroke in meat eaters, fish eaters, and vegetarians over 18 years of follow-up: results from the prospective EPICOxford study. BMJ 2019;366:l4897.
  • Hibbeln JR, Spiller P, Brenna JT, et al. Relationships between seafood consumption during pregnancy and childhood and neurocognitive development: Two systematic reviews. Prostaglandins Leukot Essent Fatty Acids 2019;151:14–36.
  • G.E. Fraser, J. Sabaté, W.L. Beeson, et al. A possible protective effect of nut consumption on risk of coronary heart disease. The Adventist Health Study. Arch Intern Med, 152 (1992), pp. 1416-1424.
  • J. Sabaté, G.E. Fraser, K. Burke, et al. Effects of walnuts on serum lipid levels and blood pressure in normal men. N Engl J Med, 328 (1993), pp. 603-607.
  • Chiavaroli L, Kendall CWC, Braunstein CR, et al. Effect of pasta in the context of lowglycaemic index dietary patterns on body weight and markers of adiposity: a systematic review and meta-analysis of randomised controlled trials in adults. BMJ Open 2018;8:e019438.
  • de Cabo R, Mattson MP. Effects of intermittent fasting on health, aging, and disease. N Engl J Med 2019;381:2541–51.
  • James H. O’Keefe et al. A Pesco-Mediterranean Diet With Intermittent Fasting. Journal of the American College of Cardiology. Vol. 7 6, No. 12, 2020.
  • Trichopoulou A. et al. (2003). Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 2003 Jun 26; 348(26):2599-608.
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2 thoughts to “A Pesco-Mediterranean diet with intermittent fasting: an ideal diet for health and longevity”

  1. Hi I have done some intermediate fasting before, but I never thought to just use fish and not to include meat. This could be my final step to use more weight and to become healthy again. Do you eat any kind of fish or do you also pick out specific species? thanks!

    1. Hi Lizzy

      Thanks for the comment. When it comes to fish in the Mediterranean diet, fish and seafood are the main sources of high-quality animal protein, and meat plays a secondary role. But as you may have noticed, the Mediterranean diet does not ban meat, limiting its consumption to 1 serving per week for red meat and 2-3 servings for white meat. I prefer wild-caught salmon four times a week and seafood 2-3 times a week. And my diet usually includes 3-4 servings of white meat a week too.

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