February 25, 2015

Association Between Mediterranean Diet and Increased Telomere Length

Study further demonstrates potential longevity and health benefits of this diet
Many studies have suggested that protection of telomeres leads to longevity. In a study using data from Nurses’ Health, researchers found that participants maintaining a Mediterranean diet had healthier, longer telomeres than those who did not follow that diet—yet more evidence that adherence to a Mediterranean diet leads to longer, healthier lives.


Crous-Bou M, Fung TT, Prescott J, et al. Mediterranean diet and telomere length in Nurses’ Health Study: population based cohort study. BMJ. 2014 Dec 2;349:g6674.


Population-based cohort study


Participants were 4,676 disease-free women from nested case-control studies within the Nurses’ Health Study, an ongoing prospective cohort of 121,700 nurses who enrolled in 1976 with a subset of 32,825 women who provided blood samples between 1989 and 1990.

Outcomes Measures

The association between self-reported Mediterranean diet data and relative telomere lengths in peripheral blood leukocytes as measured by quantitative real time polymerase chain reaction

Key Findings

Longer telomeres were associated with greater adherence to the Mediterranean diet. After adjusting for potential confounders (eg, physical activity, smoking, body mass index), mean telomere length z scores were ‒0.038 (standard error: 0.035) for the lowest Mediterranean diet scores and 0.072 (0.030) for the highest group (P=.004).

Practice Implications

Since Hermann Muller first discovered them in 1938, telomeres have fascinated researchers. The protective caps on the end of chromosomes, telomeres protect the physical integrity of the chromosomes. Accelerated shortening of telomeres has been linked to inflammation, chronic illness, and decreased life expectancy.1,2 Telomerase is an enzyme that preserves the telomere by maintaining its length. Research demonstrates that modifiable factors such as diet can affect telomere attrition and telomerase activity.3 This latest study further emphasizes that the Mediterranean diet is a contributing factor in preserving telomere length.
Recommending a Mediterranean diet in concert with lifestyle habits such as regular exercise and stress management appears to be sound foundational advice that we can give to patients to help encourage optimal longevity.
A key question most patients ask is, “What is the best diet?” While all practitioners individualize their advice and have favorite recommendations, it’s hard to argue against a whole-foods Mediterranean-style diet as the foundation upon which individualization can be overlaid. With its emphasis on whole, unprocessed foods, fruits, vegetables, nuts, and healthy fats, the Mediterranean diet posesses important antioxidant, antiinflammatory, and telomere-protecting factors. In addition to this latest trial, other studies have demonstrated that components of the Mediterranean diet can positively influence telomere length and stability. In 2012, Marcon et al showed that a high vegetable diet, specifically one high in carotenoids, was associated with longer telomeres.4 Also in 2012, Boccardi et al observed both longer telomeres (P=.003) and higher telomerase activity (P=.013) in elderly subjects who had the highest adherence to the Mediterranean diet.5
Regardless of—or perhaps in part due to—telomere status, the Mediterranean diet is associated with significant reductions in overall mortality and disease-specific mortality from cardiovascular disease and cancer.6 In 2013, Estruch et al published the largest prospective randomized controlled trial examining the effects of the Mediterranean diet on cardiovascular disease. Known as the PREDIMED (short for PREvención con DIeta MEDiterránea or Prevention with Mediterranean Diet) trial, the researchers found that the Mediterranean diet supplemented with extra virgin olive oil or nuts was associated with a 30% reduction in heart attack risk.7 [Click here for more information about PREDIMED.] Babio et al published a secondary analysis of the PREDIMED trial and found that individuals who adhered to the Mediterranean diet also had significant decreases in both central obesity and high fasting glucose (P=.02).
It’s important to note that diet is just 1 epigenetic factor associated with longer telomeres. In 2008, Ornish et al demonstrated that a healthy diet combined with moderate aerobic exercise, stress management, and specific nutrient supplementation increased telomerase activity by nearly 30% during a 3-month period.9 In 2012, Sun et al’s cross sectional analysis of 5,682 women in the Nurses’ Health Study demonstrated that women who did not smoke, maintained a healthy body weight, exercised regularly, had moderate alcohol intake, and ate a healthy Mediterranean-style diet had a 31.2% increase in telomere length.3
This latest study adds to the growing evidence clearly indicating that we can biochemically and epigentically influence how our genes behave in an impactful way. Recommending a Mediterranean diet in concert with lifestyle habits such as regular exercise and stress management appears to be sound foundational advice that we can give to patients to help encourage optimal longevity.
Editor’s note: To read a peer-reviewed article on telomeres and optimal health by Lise Alschuler, ND, FABNO, click here.

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  1. Blasco MA. Telomeres and human disease: ageing, cancer and beyond. Nat Rev Genet. 2005;6(8):611-622.
  2. Haycock PC, Heydon EE, Kaptoge S, et al. Leucocyte telomere length and risk of cardiovascular disase: systemic review and meta-analysis. BMJ. 2014 Jul 8;349:g4227.
  3. Sun Q, Shi L, Prescott J, et al. Healthy lifestyle and leukocyte telomere length in U. S. women. PLoS One. 2012;7(5):e38374.
  4. Marcon F, Siniscalchi E, Crebelli R, et al. Diet-related telomere shortening and chromosome stability. Mutagenesis. 2012;27(1):49-57.
  5. Boccardi V, Esposito A, Rizzo MR, Marfella R, Barbieri M, Paolisso G. Mediterranean diet, telomere maintenance and health status among elderly. PLoS One. 2013;8(4):e62781. 
  6. Sofi F, Cesari F, Abbate R, Gensini GF, Casini A. Adherance to Mediterranean diet and health status: meta-analysis. BMJ. 2008 Sep 11;337:a1344.
  7. Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368(14):1279-1290.
  8. Babio N, Toledo E, Estruch R, et al. Mediterranean diets and metabolic syndrome status in the PREDIMED randomized trial. CMAJ. 2014;186(17):E649-E657. Epub 2014 Oct 14. 
  9. Ornish D, Lin J, Daubenmier J, et al. Increased telomerase activity and comprehensive lifestyle changes: a pilot study. Lancet Oncol. 2008;9(11):1048-1057.