By Joseph E. Scherger, MD, MPH

Core Faculty, Eisenhower Health Family Medicine Residency Program, Eisenhower Health Center, La Quinta, CA; Clinical Professor, Keck School of Medicine, University of Southern California, Los Angeles

Dr. Scherger reports no financial relationships relevant to this field of study.

SYNOPSIS: Italian seniors who ate a high-quality Mediterranean diet exhibited better cognitive function than those who did not.

SOURCE: De Amicis R, et al. Mediterranean diet and cognitive status in free-living elderly: A cross-sectional study in Northern Italy. J Am Coll Nutr 2018;37:494-500.

A group of Italian investigators from Milan, Pavia, and Brescia, Italy, performed a cross-sectional study that included 279 seniors ≥ 65 years of age. The authors specifically studied subjects’ diet and cognitive function. The Mediterranean diet was assessed using a 14-item questionnaire. Cognitive function was assessed with the Mini-Mental State Examination (MMSE). In sum, 30.1% of subjects met the criteria for a healthy Mediterranean diet. The authors suspected mild cognitive decline or observed signs of such in 13.6% of subjects. Adherence to the Mediterranean diet was associated with a lower risk of cognitive impairment (odds ratio [OR], 0.39). The authors also observed this effect when subjects consumed more than three glasses of wine per week (OR, 0.37). Researchers did not observe any association for other food groups.


These findings are consistent with the work of other researchers who found that adhering to a Mediterranean diet is one of the factors that may lead to better cognitive function.1-3 However, what constitutes a proper and healthy Mediterranean diet is confusing and may mean different things to physicians and the public. Listing the 14 items from the Mediterranean diet questionnaire is instructive:

  • Using olive oil as the primary cooking fat;
  • More than four tablespoons of olive oil daily;
  • More than two servings of vegetables daily;
  • Three or more daily servings of fruit;
  • Less than one daily serving of red or processed meat;
  • Less than one daily serving of butter, cream, or margarine;
  • Less than one sugar-sweetened beverage per day;
  • Three or more glasses of wine per week;
  • Three or more servings of legumes per week;
  • Three or more servings of fish/seafood per week;
  • Fewer than three commercial and confectionary sweets per week;
  • One or more servings of nuts per week;
  • More white meat than red meat;
  • Using soffritto, a mixture of slowly cooked carrots, onions, and celery that is used as a base to add flavor to sauces, soups, and stews. Sometimes, carrots, onions, and celery are called the “holy trinity” in Italian cuisine.4

Importantly, pasta is not mentioned as part of a healthy Mediterranean diet. With its emphasis on olive oil, vegetables (including avocado), nuts, and seafood, the Mediterranean diet includes healthy fats and protein as its main macronutrients and is low carbohydrate. Carbohydrates are obtained only from whole foods such as fruit. A healthy Mediterranean diet has stood the test of time as possibly the healthiest way to eat.5,6 It should be standard medical advice for anyone not adhering to a whole food, plant-based diet.


  1. Bredesen DE. The End of Alzheimer’s: The First Program to Prevent and Reverse Cognitive Decline. New York: Avery (Penguin House); 2017
  2. Bredesen DE, et al. Reversal of cognitive decline in Alzheimer’s disease. Aging (Albany NY) 2016;8:1250-1258.
  3. Bredesen DE. Reversal of cognitive decline: A novel therapeutic program. Aging (Albany NY) 2014;6:707-717.
  4. Tasting Table. All About That Base. July 5, 2016. Available at: Accessed Dec. 6, 2018.
  5. Mayo Clinic. Mediterranean diet: A heart-healthy eating plan. Nov. 3, 2017. Available at: Accessed Dec. 6, 2018.
  6. Godman H. Adopt a Mediterranean diet now for better health later. Harvard Health Blog, Nov. 6, 2013. Available at: Accessed Dec. 6, 2018.