The Mediterranean Diet and Good Health
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) was 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 didn't appear to be due to existing medical services, which were limited at that time. But 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:
- Breads and cereals
- Beans, nuts, and seeds
- Olive oil as the main source of fat
- Moderate amounts of fish and poultry
- Small amounts of red meat
- 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
- Fresh fruit as the typical daily dessert and low consumption of sweets (often honey, no more than several times a week)
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. The total fat ranges from less than 25%-35% and sometimes greater; this is dependent on the amount of olive oil a person uses. Olive oil is rich in monounsaturated fats, which are considered healthful fats. Many foods emphasized in the Mediterranean diet are also emphasized in the USDA’s food guide pyramid.
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 unhealthful eating styles of industrialized countries. The pyramid is arranged in the following way:
- Along the base is daily physical activity
The next four layers are foods that should be eaten daily:
- Bread, pasta, rice, couscous, polenta, and other whole grains and potatoes
- Fruits, vegetables, beans, other legumes, and nuts
- Olive oil
- Cheese and yogurt
The next four layers are foods that should be eaten weekly:
- Last—and least—is meat, which fills the space at the top of the pyramid and is recommended only on a monthly basis
Alongside the pyramid is wine, which should be consumed in moderation.
Diet Associated With Significant Health Benefits
Increasing scientific evidence suggests positive health effects of diets high in whole grains, fruit, vegetables, and legumes, as well as fish, nuts, and low-fat dairy products. Such diets should emphasize vegetable oils that are low in saturated fats and partially hydrogenated oils (which contain heart-damaging trans fats). According to the International Task Force for Prevention of Coronary Heart Disease, the traditional Mediterranean diet, whose primary source of fat is olive oil, encompasses these dietary characteristics.
In their 2000 Consensus Statement, Dietary Fat, The Mediterranean Diet and Lifelong Good Health , the International Task Force for Prevention of Coronary Heart Disease states that elements of the Mediterranean diet may reduce the risk of the following conditions:
Atherosclerosis and Coronary Heart Disease
Reduced consumption of saturated fatty acids and substitution of saturated fats with monounsaturated fatty acids and oils, plus increased consumption of vegetables, fruit, and whole grains may reduce the risk of atherosclerosis and coronary heart disease by:
- Improving blood lipid profile (lowering LDL or “bad” cholesterol and triglycerides, and increasing or maintaining HDL or “good” cholesterol)
- Reducing the risk of plaque formation in the arteries
- Improving insulin resistance
The Mediterranean diet is also rich in antioxidants (vitamin E and vitamin C , carotenoids, and other compounds found in vegetables, fruits, nuts, grains, legumes, virgin olive oil, and wine) that may play a role in the prevention of cardiovascular disease.
In the Lyon Heart Study, published in Circulation: Journal of the American Heart Association , researchers found that people who ate a Mediterranean diet after having their first heart attack were 50%-70% less likely to suffer a second heart attack than those on a "Western" diet. The same authors, writing seven years later stress the potential importance of adding omega-3 fatty acids, even in low amounts. These could be obtained from fatty fish sources (salmon, sardines, and others), from certain margarines, or from supplements. Good evidence supports the benefits of omega-3 intake, though not as an addition to the Mediterranean diet. Fish, however, is a major source of protein (and omega-3s) for many people living in proximity to the Mediterranean sea.
Recent studies suggest that alpha-linoleic acid (ALA, one of the major constituents of a Mediterranean diet), rather than reducing all heart disease risks, may specifically lower the risk of sudden cardiac death. If confirmed further, these findings may add even more strength to these dietary recommendations and/or may argue for ALA supplementation.
Although not a low-fat diet, the Mediterranean diet may contribute to the prevention and treatment of obesity , provided that calories are controlled. According to a study published in the International Journal of Obesity, the Mediterranean diet was found to be more effective in helping people to lose weight and sustain weight loss than a strict low-fat diet. The researchers found that people could more easily adhere to the Mediterranean diet because it allowed for a greater variety of foods and was more appetizing than a strict, bland, low-fat diet.
Other studies suggest that consumption of monounsaturated fats, olive oil, fish oil, antioxidants, and other fat compounds in the Mediterranean diet may help reduce the risk of certain cancers, such as breast cancer and colon cancer .
Research suggests that a diet high in whole grains, vegetables, fruit, and fiber, which also emphasizes monounsaturated fats, may help improve blood lipid and glucose profiles. This may lead to better control of diabetes and decreased risk for complications such as heart disease.
If You Want to Eat Like an Egyptian…or a Sicilian…or a Libyan…
How can you eat more authentically Mediterranean? Here are some tips from the Oldways Preservation and Exchange:
- 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 principle fat in your diet, replacing other fats and oils such as butter and margarine.
- Total daily fat should range from less than 25% to over 35% of daily calories, with saturated fat no more than 7% to 8% of daily calories.
- Eat low to moderate amounts of cheese and yogurt (preferably low fat and non-fat versions).
- Consume low to moderate amounts of fish and poultry and from zero to four eggs per week.
- Have fresh fruit as your typical daily dessert and limit desserts with significant amounts of sugar and saturated fat to a few times a week.
- Eat red meat only a few times per month.
- If you choose to drink alcohol, moderate consumption of wine is recommended (about 1-2 glasses per day for men and 1 glass per day for women).
Exercise Is Essential, Too
Research suggests that the Mediterranean diet is a healthful and pleasing alternative to the American diet. But 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. Relaxing in the sun on the Amalfi Coast probably doesn’t hurt either!
Canadian Digestive Health Foundation
Dietitians of Canada
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International Task Force for Prevention of Coronary Heart Disease Website. 2000 consensus statement: dietary fat, the Mediterranean diet and lifelong good health. Available at http://www.chd-taskforce.com/2000consensusstatement/index_e.htm . Accessed December 20, 2002.
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.
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Mediterranean diet. American Heart Association website. Available at http://www.americanheart.org/presenter.jhtml?identifier=4644 . Accessed December 19, 2002.
Mediterranean diet pyramid. Oldways website. Available at http://www.oldwayspt.org . Accessed December 23, 2002.
*¹7/22/2008 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.
Last reviewed June 2008 by Dianne Scheinberg MS, RD, LDN
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