The Mediterranean diet has long been considered one of the healthiest eating patterns for the heart, but new research suggests an even more plant-forward version of it may offer additional benefits, particularly for people with a common genetic variant linked to heart disease risk.
The study compared three groups following different dietary advice: a standard healthy diet, a traditional low-calorie Mediterranean diet, and a “Green Mediterranean” diet, or Green-MED, that emphasizes an even greater proportion of plant-based, polyphenol-rich foods. Distinctively, the Green-MED group also drank a daily shake containing mankai, an aquatic plant related to duckweed that is unusually rich in folate, plant protein, fiber, and essential amino acids.
Researchers found that participants on the Green-MED plan had significantly higher blood folate levels than those on the traditional Mediterranean diet or standard healthy-eating guidelines. Those higher folate levels were, in turn, associated with improved insulin sensitivity, reduced inflammation, lower visceral and liver fat, and healthier blood lipid profiles.
The results were especially notable for people carrying a common gene variant associated with impaired folate metabolism — a variant linked to elevated homocysteine levels and higher risk of hypertension, heart disease, fatty liver disease, osteoporosis, and certain age-related neurological conditions. Participants with this higher-risk genetic profile who closely followed the Green-MED diet saw lower cardiovascular risk scores than those who didn’t, and researchers observed increased activity in alternative folate-processing genes, including MTHFD2 and DHFR — suggesting the diet may help the body compensate for a genetic disadvantage it can’t otherwise change.
“While genetic makeup cannot be altered, targeted dietary interventions may reduce some inherited health risks,” the researchers noted. The findings add to a broader body of evidence — including a separate 20-year study of more than 3,000 Greek adults published this summer, which linked plant-based Mediterranean-style eating patterns to substantially lower cardiovascular disease risk — reinforcing that how “green” a Mediterranean diet is may matter as much as following the pattern in general.
