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The Mediterranean Diet and Good Health

mediterranean foods In the 1950s, researchers found that the adult life expectancy for people living in the Mediterranean regions (Crete, part of Greece, Southern Italy, and other countries bordering the Mediterranean Sea) were among the highest in the world. They also found that rates of coronary heart disease, certain cancers, and some other diet-related chronic diseases in this region were among the lowest in the world.
The health of the Mediterranean people did not appear to be due to existing medical services, which were limited at that time. However, the researchers found that the Mediterranean people had something in common that might be contributing to their good health—their dietary patterns. These dietary patterns share characteristics that have been associated with low rates of chronic diseases and long life expectancies in many studies conducted throughout the world.

What Is the Mediterranean Diet?

There is no one typical Mediterranean diet. Many countries border the Mediterranean Sea and variations in the Mediterranean diet exist between these countries. However, according to the American Heart Association, traditional Mediterranean diets have the following characteristics in common:
  • An abundance of plant foods:
    • Fruits
    • Vegetables
    • Breads and cereals
    • Potatoes
    • Beans, nuts, and seeds
  • Olive oil used as a common monounsaturated fat source
  • Low-to-moderate amounts of fish and poultry
  • Small amounts of red meat
  • Low-to-moderate amounts of dairy products (mostly cheese and yogurt)
  • Low-to-moderate amounts of eggs (zero to four times per week)
  • Low-to-moderate amounts of wine (one to two glasses of wine per day), normally consumed with meals

Comparison With the American Diet

The American diet is characterized by:
  • Animal products daily, as main source of protein
  • White starches, predominantly
  • Moderate to low in fruits and vegetables
  • High in saturated and trans fats
Unlike the typical American diet, the traditional Mediterranean diet is high in fiber and low in saturated fat. However, the Mediterranean diet is not necessarily low in total fat. But, the types of fats emphasized in the Mediterranean diet are "healthy" monounsaturated fats, like those found in olive oil, which do not raise cholesterol levels.

Mediterranean Diet Pyramid

The traditional Mediterranean diet has been illustrated in a Mediterranean diet pyramid developed by researchers at Harvard and Oldways, a nonprofit education organization that promotes alternatives to unhealthy eating styles of industrialized countries. The pyramid is arranged in the following way:
  • Along the base is daily physical activity, as well as a reminder to eat meals with friends and family.
  • The next layer is food that should be eaten daily. These include fruits, vegetables, whole grains, olive oil, beans, nuts, legumes and seeds, and herbs and spices.
  • The layer above that features fish and seafood. Eat these more often (at least two times per week).
  • The second layer from the top includes poultry and eggs. Eat these every two days or once per week. Cheese and yogurt is also in this layer, which should be eaten daily to weekly.
  • The final layer has meats and sweets, which should be eaten less often.
Alongside the pyramid, water and wine are featured. Stay hydrated throughout the day with water, and drink wine in moderation (two drinks per day for men, and one drink per day for women).

Health Benefits

There has been a lot of research on the potential health benefits of following the Mediterranean diet. According to studies, this diet may offer these benefits:
  • Reduce the rate of death in people who have had a heart attack
  • Reduce the rate of heart attack and stroke in people who have heart disease
  • Aid in weight loss
  • Lower the risk of developing cancer
  • Lower HbA1c levels (a measurement of how well the body uses blood sugar) in people with diabetes
  • Reduce pain in rheumatoid arthritis
  • Lower the risk of developing type 2 diabetes
  • Reduce the risk of metabolic syndrome—The term "metabolic syndrome" refers to a group of risk factors for cardiovascular disease. These risk factors include obesity, low amounts of "good" (HDL) cholesterol, high triglycerides, high blood pressure, and prediabetes.
It is important to remember, though, that other factors can affect these benefits. For example, people who follow the Mediterranean diet may have a lower risk of cancer because of other lifestyle factors or their environment.

Tips for Mediterranean Eating

How can you eat more authentically Mediterranean? Here are some tips from the Oldways website:
  • Include an abundance of food from plant sources such as fruits, vegetables, potatoes, whole grains, seeds, and nuts.
  • Choose a variety of minimally processed foods, preferably those that are seasonally and locally grown.
  • Use olive oil as the principal fat in your diet, replacing other fats and oils.
  • Eat low-to-moderate daily amounts of cheese and yogurt (preferably low-fat and non-fat versions).
  • Eat fish and poultry at least twice per week.
  • Have fresh fruit as your typical daily dessert.
  • Eat red meat only a few times per month. When eating red meat, choose lean cuts and smaller portions. Avoid sausage, bacon, and other meats that are high in fat.

Lifestyle Changes

Research suggests that the Mediterranean diet is a healthful and pleasing alternative to the American diet. However, will the diet alone significantly reduce your risk of heart disease and increase your longevity? Researchers point out that the low incidence of heart disease and low death rate in the Mediterranean countries may be due, in part, to other lifestyle factors, such as more physical activity and extended social support systems.

RESOURCES

The American Heart Association http://www.heart.org/

Oldways http://www.oldwayspt.org/

CANADIAN RESOURCES

Canadian Digestive Health Foundation http://www.cdhf.ca/

Dietitians of Canada http://www.dietitians.ca/

References

Albert CM, Oh K, et al. Dietary alpha-linolenic acid intake and risk of sudden cardiac death and coronary heart disease. Circulation. 2005;112:3232-3238.

de Lorgeril M, Salen P. The Mediterranean-style diet for the prevention of cardiovascular diseases. Public Health Nutr. 2006;9(1A):118-123.

de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and rate of cardiovascular complications after myocardial infarction. Circulation. 1999;99:779-785.

de Lorgeril M, Salen P. The Mediterranean diet in secondary prevention of coronary heart disease. Clin Invest Med. 2006;29:154-158.

Depression. World Health Organization website. Available at http://www.who.int/mental%5Fhealth/management/depression/definition/en/. Accessed July 2, 2012.

Mediterranean diet. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated February 1, 2012. Accessed July 2, 2012.

Mayo Clinic. Mediterranean diet: Choose this heart healthy diet option. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/mediterranean-diet/CL00011/NSECTIONGROUP=2. Updated June 19, 2010. Accessed July 2, 2012.

McManus K, Antinoro L, Sacks F. A randomized controlled trial of a moderate-fat, low-energy diet compared with a low-fat, low-energy diet for weight loss in overweight adults. Int J of Obesity. 2001;25:1503-1511.

Mediterranean diet. American Heart Association website. Available at http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/Mediterranean-Diet%5FUCM%5F306004%5FArticle.jsp. Updated January 20, 2012. Accessed July 2, 2012.

Mediterranean diet pyramid. Oldways website. Available at http://www.oldwayspt.org/resources/heritage-pyramids/mediterranean-diet-pyramid. Accessed July 2, 2012.

7/22/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Shai I, Schwarzfuchs D, Henkin Y, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359:229-241.

1/13/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Salas-Salvadó J, Fernández-Ballart J, Ros E, et al. Effect of a Mediterranean diet supplemented with nuts on metabolic syndrome status: one-year results of the PREDIMED randomized trial. Arch Intern Med. 2008;168:2449-2458.

10/9/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Sánchez-Villegas A, Delgado-Rodríguez M, Alonso A, et al. Association of the Mediterranean dietary pattern with the incidence of depression. Arch Gen Psychiatry. 2009;66:1090.

1/31/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Salas-Salvadó J, Bulló M, Babio N, Martínez-González MÁ, et al. Reduction in the incidence of type 2 diabetes with the Mediterranean diet: results of the PREDIMED-Reus nutrition intervention randomized trial. Diabetes Care. 2011;34(1):14-19.

7/22/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Kastorini CM, Milionis HJ, Esposito K, Giugliano D, Goudevenos JA, Panagiotakos DB. The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol. 2011;57(11):1299-1313.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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