Discover the many benefits of the Mediterranean diet, a healthy eating pattern that can help you lose weight, lower your blood pressure and cholesterol levels and reduce your chances of heart disease and cancer.
What is the Mediterranean diet?
The Mediterranean diet was first described in the medical literature in the early 1960s by Ancel Keys. He observed that people who ate their traditional foods who lived in countries like Greece, Southern Italy, and Crete had longer life expectancies and lower rates of chronic disease.
Although Keys focused on low levels of saturated fats (Martínez-González 2004) and initial research focused on the vitamin and minerals content of the traditional Mediterranean diet, more recent research shows it is the variety of real whole foods that has immense health benefits.
The Mediterranean diet varies culturally from country to country around the Mediterranean depending on cultural food preference. It is a type of eating that is whole food plant based. In general it is a dietary pattern that consists of high intake of:
- fresh fruits
- vegetables – including leafy green vegetables
- whole grains,
- nuts and pulses/legumes,
- fatty fish
- olives and extra virgin olive oil
- moderate intakes of fish and other meat, dairy products and red wine,
- low intakes of eggs and refined sweets desserts (Davies 2015).
Mediterranean diet food pyramids are a useful visual representation of the Mediterranean diet. One of the first Mediterranean diet pyramid was first visualized in 1993 by Oldways.
This Mediterranean diet food pyramid depicts how proportionally much more whole plant-foods are eaten daily and much less meats and sweets than in a standard western diet.
At the base of the Mediterranean diet pyramid, there is emphasis on other lifestyle factors that improve health such as physical activities and eating as a social activity with friends and loved ones.
A review of studies on the Mediterranean diet shows that the Mediterranean Diet contained between 3-9 servings of vegetables, 0.5-2 servings of fruit, 1-13 serves of cereals and 1.5-8 serves of olive oil (Davies 2015).
The Mediterranean diet is high in fiber and plant protein due to it’s plentiful and diverse whole plant food content.
Mediterranean Diet and Flavonoid Content
Bioactive compounds are a class of metabolic by-products that are produced by plants, such as polyphenols and flavonoids, which confer health benefits such as anti-inflammatory effects, protecting cells from oxidative damage that can lead to a many chronic diseases and cancers (Zamora-Ros 2010).
These bioactive metabolites are found in foods such as red wine, olive oil, coffee, tea, nuts, fruit, vegetables, herb, and spices are foods found in abundance in the Mediterranean diet. A series of observational studies (Zamora-Ros 2010) and a prospective cohort study of over 40,000 individuals. and the PREDIMED interventional study (Tressera-Rimbau 2014) found that on average, those eating a Mediterranean Dietary pattern consumed approximately 350mg of bioactive plant-based antioxidants per day.
Mediterranean diet for the heart health
The changing diet of the Western world towards more industrialized and processed foods has resulted in an increase in heart attacks and cardiac death.
The Lyon Diet Heart Study was a randomized controlled trial aimed at testing whether a Mediterranean style diet may reduce the rate of heart disease. The researchers compared the Mediterranean diet to a ‘prudent Western-type diet’ – the American Heart Association recommendation that Americans consume a low-fat diet (less than 300mg cholesterol daily, 30-35 calories from fat, less than 10% of calories from saturated fat and less than 10 % from polyunsaturated fat).
Over the 5 year follow-up period it was shown that a Mediterranean diet had significant reduced risks of the following conditions compared with the low-fat diet:
- Cardiac death and non-fatal heart attack
- Unstable angina, stroke, heart failure, pulmonary embolism and deep vein thrombosis
- Hospital admissions as complications of heart disease
The Mediterranean Diet for Brain Health
Eating a Mediterranean Diet May Reduce Women’s Risk for Stroke
The heart and brain health benefits of a Mediterranean diet was the focus of a study conducted in 2009 (Fung et al 2009). In this cohort study, researchers followed 75,000 women aged 38 to 63 years of age over a period of 20 years.
They found those that high adherence to a Mediterranean style diet were 29% less likely to develop cardiovascular disease and stroke than those that are less adherent. At the time the researcher acknowledged their limitations, that further studies are needed to replicate their findings and to see whether the same could be said for men.
Since then a critical review (Martínez-González, 2019) of 45 reports, including 4 randomized controlled trails and 32 large-scale independent observational cohort studies concluded that there is a strong, plausible, and a consistent body of evidence that the Mediterranean diet has significant health benefits for heart health.
It’s clear that eating a healthy diet is important for reducing your risk for stroke and other chronic diseases.
Mediterranean Diet and Cognitive Decline and Alzheimer’s Disease
Alzheimer’s Disease is the most common form of dementia, where brain cells slowly die overtime. At first symptoms start off very mild by being forgetful, acting confused and problems with tasks such as paying bills. As the dementia gets worse, episodes of anger or aggression to days where your loved one is unable to reason, eat, bathe themselves, or do every-day tasks.
Sadly, there are not any good cures, but that has not stopped the worldwide medical community from research into understanding the risk and future treatments that can give those that are affected by Alzheimer’s disease a fighting chance.
Observational studies have indicated that eating a Mediterranean style diet is associated with brain health in the following ways:
- Better cognitive performance (McGrattan et al, 2019)
- Slower rates of cognitive decline (McGrattan et al, 2019)
- Reduced risk of cognitive impairment and Alzheimer’s Disease (Lourida et al , 2013)
Some higher quality randomized control studies have also indicated modest benefits for brain health and function. For instance, the PREDIMED-NAVARRA study found adherence to a Mediterranean Diet over over a period of 4-6 years demonstrated higher cognitive function in global cognition, memory and executive function.
The NU-AGE Study reported no benefit of the Mediterranean Duet cognitive function after 1 year in older European adults. However participants with the greatest Mediterranean Diet adherence demonstrated improved global cognition and episodic memory compared to those with low adherence.
Ongoing research into the effects of the Mediterranean diet for the prevention of Alzheimer disease will give us information about the use of a whole food plant based (WFPB) diet for brain health.
The Mediterranean Diet For Depression
Depression is a common mental health condition that is influenced by eating patterns. Current evidence suggests that there is a beneficial effect between the Mediterranean diet and depression.
A prospective cohort study of over 15,000 people showed that greater adherence to a Mediterranean style diet, in particular, abundant use of fruit and vegetables, nuts, and avoidance of fast and fried foods was associated with a reduced risk of developing depression (Ujué Fresán 2018).
Similarly a meta-analysis of 9 cross-sectional studies have found that the Mediterranean diet is linked to lower rates of depression than a standard diet (Fateme Shafiei 2019).
The Mediterranean diet is rich in polyphenols, a substance with anti-depressant properties. A meta-analysis looking at the associations between polyphenols – found abundantly in tea, coffee, citrus, nuts, soy, grapes, legumes, and spices, showed that an association between higher polyphenol consumption and reduced depression risk, as well as evidence suggesting polyphenols can effectively alleviate depressive symptoms (Bayes 2020).
The Mediterranean Diet, Weight Loss and Maintenance
The Mediterranean diet is a diet that focuses on whole plant-based foods and healthy fats. The diet has been shown to be helpful for weight loss and maintenance.
The focus on whole foods makes the Mediterranean diet a sustainable and healthy option to consider when looking for a nourishing dietary pattern to improve lean body composition.
A review of Mediterranean diet compared with other dietary eating patterns such as low-fat, low-carb and the American Heart Association diet (Mancini 2016) found that weight loss was comparable between people who maintained any of these dietary patterns. On average, regardless of which dietary pattern was used, weight loss over 12 months was approximately 9 lbs or 4.1 kg.
Eating a Mediterranean Diet to Prevent and Manage Type 2 Diabetes
Type II diabetes (T2DM) is one of the leading causes of mortality and is a significant burden to healthcare (Arias 2003). The increasing incidence of diabetes worldwide has been highly linked to westernized dietary patterns – heavy in processed, sugar and oil-added foods, and physical inactivity.
The Mediterranean diet is a great way to improve management of type 2 diabetes. A systematic review showed that greater adherence to the Mediterranean diet resulted in:
- lower HBA1C
- lower blood sugar levels 2 hrs after eating
- reduced insulin resistance
A prospective study showed that those who consumed a Mediterranean style diet with olive oil had a 40% reduced risk of developing diabetes compared with a standard low-fat diet (Salas-Salvadó 2014). This suggests eating a Mediterranean diet rich in plant foods can help prevent the development of type 2 diabetes in addition to improving blood glucose in those who have diabetes.
The Mediterranean Diet: Rheumatoid arthritis
People with rheumatoid often experience pain, inflammation, and a general feeling of tiredness. The Mediterranean diet has been shown to have some health benefits for those living with the rheumatoid arthritis.
The Mediterranean diet has a rich content of anti-inflammatory antioxidants from foods like fruit, vegetables, whole grains, legumes, fish, and olive oil. These foods may help relieve symptoms of RA by reducing inflammation in the body. Additionally, the healthy omega-3 fatty acids found in the Mediterranean diet can help improve joint health and reduce pain.
Despite many studies have examined the relationship between heart health and the Mediterranean diet, those looking at the effects on rheumatoid arthritis are very few. However a systematic review of the 4 studies (Forsyth 2017) showed use of the Mediterranean diet as an intervention for rheumatoid arthritis had the following benefits:
- reduced experience of pain
- reduced rheumatoid arthritis activity
Overall, despite the low number of studies, the research indicates a positive benefit for consuming a Mediterranean diet abundant in plant-foods and fish and extra-virgin olive oil.
The Mediterranean Diet and Cancer
The Mediterranean diet is rich in combination of foods rich mainly in antioxidants and anti-inflammatory nutrients. Antioxidants protect against cancer by stopping or slowing oxidative damage and reducing inflammation. Antioxidants found in the Mediterranean diet include
- vitamin C,
- vitamin E,
Additionally the Mediterranean eating helps with cancer prevention by:
- modulating cancer mediators -hormones and growth factors
- changing the gut microbiota – promoting production of beneficial bacterial metabolites.
A recent study published in the journal Nutrients (Mentella 2019) suggests that the Mediterranean diet significantly reduces the risk of a large variety of cancers including:
- breast cancer,
- colorectal cancer
- prostate cancer
- gastric cancer
- bladder cancer
- cervical and endometrial cancers
- head and neck cancer
- gallbladder and pancreas cancer
- lung cancer
Increasing the variety and amount of plant foods will increase your exposure to beneficial nutrients and a beneficial microbiome for cancer prevention.
The Mediterranean diet and the gut microbiome
The gut microbiome is essential to human health. When the gut microbiome balance is disrupted, gut dysbiosis is the result. A healthy gut microbiota is not only important for gut health, but also for the prevention of chronic illnesses. gut dysbiosis influences many chronic illnesses including
- heart disease,
- autoimmune diseases.
The Mediterranean diet contains abundant and diverse plant-foods contains ample prebiotics and colonic foods to feed health-promoting bacterial growth. It also promotes diversity of health promoting bacteria.
A recent study found that following a Mediterranean diet will increase the good bacteria in your microbiome by 7 percent. The microbiome is the community of microorganisms that live in your body. Eat a Mediterranean diet to maintain gut eubiosis (balanced bacteria in the gut) and to reduce your risk of chronic disease. It’s good for your gut!
How to start: Mediterranean diet quick start tips
In order to ease into sustainable lifestyle changes use these 9 tips to start the Mediterranean diet:
- Focus on real, whole foods. These include fruits, vegetables, legumes, wholegrains nuts and seeds.
- Start by gradually replacing unhealthy foods with healthier ones. This will help make the transition easier and more sustainable in the long run.
- Incorporate fruit and vegetables into every meal. Increasing fruit and vegetable consumption provides an abundance of phyto-nutrients, but they also provide fiber, which is essential for a healthy digestive system.
- Choose whole grains over refined grains whenever possible. Refined grains have been stripped of their nutrients and can actually cause weight gain when eaten in excess. An example includes steel cut oats instead of quick oats in your oatmeal.
- Opt for lean proteins like chicken or fish instead of red meat whenever possible. Red meat has been linked to an increased risk of heart disease, cancer and other chronic health conditions.
- Avoid processed foods as much as possible. Processed foods are often high in unhealthy fats, sugar, and salt and can lead to weight gain and other health problems if eaten too frequently.
- Drink plenty of water throughout the day to stay hydrated and help keep your body functioning at its best
- Try meat-free Monday to try and increase the plant-protein in your diet such as beans, lentils, chickpeas etc.
- Experiment with herbs and spices: not only do they make food more flavorsome, but they also have beneficial anti-inflammatory effects.
Foods to Avoid
When following the Mediterranean diet, you should limit processed foods such as:
- Fast food such as burgers, fries, shakes, doughnuts
- Convenience meals such as microwave dinners
- Microwave popcorn
- Granola/Muesli bars
- breakfast cereals
- Limit red meat to a few times per month.
These industrialized, processed foods are high in added fat and refined sugar which promotes high blood sugars, gut dysbiosis and chronic inflammation in the body.
In addition to being unhealthy, highly processed foods are also often expensive. So by avoiding them, you’ll not only improve your health but also save money!
Choose water, green tea, and coffee in moderation.
Eating is more than simply fuel for the body. It is nourishing. It can be an important way to connect socially to those we love and care about. Eating a whole food plant based diet such as the Mediterranean diet is kind for your body and for our planet.
By Dr Tane Brunt. Last updated: 21/5/2022
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