- A new study suggests a Mediterranean diet is associated with lower stroke risk in women.
- Women with the highest Mediterranean diet adherence had an 18% lower risk of total stroke.
- The protective effect was particularly strong for hemorrhagic stroke, with a 25% risk reduction.
The Mediterranean diet has long been celebrated for its heart-healthy benefits, but new research suggests it may be even more powerful than we thought when it comes to protecting your brain. While past studies have linked this eating pattern to better cardiovascular health and longevity, most haven’t specifically examined how it affects different types of stroke—particularly hemorrhagic strokes, which occur when a blood vessel in the brain ruptures.
Stroke is a leading cause of death and disability, and women face unique risks. Women have a higher lifetime incidence of stroke than men, partly due to the sharp increase in stroke risk after menopause. Women also have higher rates of stroke risk factors like hypertension and atrial fibrillation. That’s why understanding dietary strategies for stroke prevention in women is so important.
While research has shown that the Mediterranean diet can reduce overall stroke risk, there’s been limited data on how it affects stroke subtypes specifically. Some scientists even wondered whether the diet’s lower saturated fat content might not protect against hemorrhagic stroke, since some evidence suggests saturated fat intake may lower hemorrhagic stroke risk.
To answer these questions, researchers analyzed data from more than 105,000 women followed for more than two decades, and their findings were recently published in the journal Neurology Open Access.
How Was This Study Conducted?
This was a large prospective cohort study—meaning researchers followed participants forward in time to see what health outcomes developed. The study included 105,614 California women who were public school teachers and administrators, with an average age of about 52 years at the start.
Participants completed detailed food questionnaires at the beginning of the study in 1995-1996, reporting on their typical diet over the past year. Researchers used these responses to calculate a Mediterranean diet score ranging from 0 to 9, with higher scores indicating better adherence. The score was based on consumption of nine food groups: vegetables, fruits, legumes, cereals, fish, olive oil, moderate alcohol and lower amounts of meat and dairy.
The researchers then tracked participants through 2020 using California hospital records and death records to identify stroke events. During the average 20.5-year follow-up period, there were 4,083 stroke events total, including 3,358 ischemic strokes (caused by blocked blood vessels) and 725 hemorrhagic strokes (caused by ruptured blood vessels).
The analysis adjusted for numerous factors that could influence stroke risk, including age, race/ethnicity, socioeconomic status, smoking, body mass index, physical activity, total calorie intake and medical conditions like hypertension, diabetes, and heart disease.
What Did the Study Find?
The results showed that women who followed the Mediterranean diet most closely had significantly lower stroke risk across the board. Those with the highest Mediterranean diet scores (6-9 out of 9) had an 18% lower risk of total stroke compared to women with the lowest scores (0-2).
When researchers looked at stroke subtypes separately, they found protection for both types. For ischemic stroke, women with the highest diet scores had a 16% lower risk. But the most striking finding was for hemorrhagic stroke: Women with the highest Mediterranean diet adherence had a 25% lower risk compared to those with the lowest adherence.
This hemorrhagic stroke finding is particularly noteworthy because this study included far more hemorrhagic stroke cases (725) than previous research, giving it greater statistical power to detect an association. The protective effect remained significant even after accounting for vascular risk factors like hypertension and diabetes, suggesting the diet offers benefits beyond just managing these conditions.
There are some important limitations to keep in mind. The study relied on self-reported dietary information from a single point in time, which can be subject to recall errors. Participants’ eating habits may have changed over the 20-year follow-up period. The study population was predominantly white and highly educated, so results may not apply equally to all groups. Additionally, olive oil consumption was very low in this population at baseline in 1995, so other Mediterranean diet components like vegetables, fruits and whole grains likely drove much of the protective effect.
How Does This Apply to Real Life?
If you’re looking to reduce your stroke risk, adopting a Mediterranean-style eating pattern is one of the most well-researched dietary approaches you can take. The good news is that you don’t need to follow it perfectly to see benefits—even moderate adherence showed protective effects in this study.
Here are some practical ways to incorporate more Mediterranean diet principles into your daily routine:
- Load up on plants. Make vegetables and fruits the foundation of your meals, aiming for a variety of colors throughout the day.
- Choose whole grains. Swap refined grains for whole grain bread, brown rice, quinoa and whole wheat pasta.
- Add more legumes. Include beans, lentils, and chickpeas in soups, salads and main dishes several times per week.
- Enjoy fish regularly. Aim for at least two servings of fatty fish like salmon, sardines, or mackerel each week.
- Use olive oil. Make it your primary cooking fat and use it as part of your go-to vinaigrettes and marinades.
- Limit red meat. Save beef, pork and lamb for occasional meals rather than daily consumption.
- Snack on nuts and seeds. A handful of almonds, walnuts or sunflower seeds makes a satisfying, nutrient-dense snack.
The key is making gradual, sustainable changes rather than overhauling your entire diet overnight. Start by adding one or two Mediterranean-style meals to your week and build from there.
Our Expert Take
A new study published in Neurology Open Access suggests that following a Mediterranean diet is associated with lower stroke risk in women, with particularly strong protection against hemorrhagic stroke. Women with the highest adherence to this eating pattern had an 18% lower risk of total stroke and a 25% lower risk of hemorrhagic stroke over a 20-year period. While more research is needed to understand exactly how the Mediterranean diet protects against stroke, the evidence continues to mount that this plant-forward, whole-foods eating pattern is one of the best choices for long-term brain and heart health.
