The Mediterranean diet is a modern nutritional recommendation inspired by the traditional dietary patterns of some of the countries of
the Mediterranean Basin. The Mediterranean diet is a "heart-healthy" diet combining elements of Mediterranean style cooking. The
Mediterranean diet incorporates the basics of healthy eating — plus a touch of flavorful olive oil and perhaps a glass of red wine —
among other components characterizing the traditional cooking style of countries bordering the Mediterranean Sea.
The most commonly-understood version of the Mediterranean diet was presented by Dr. Walter Willett of Harvard University's School of Public
Health in the mid-1990s. Based on "food patterns typical of Crete, much of the rest of Greece, and southern Italy in the early 1960s",
this diet, in addition to "regular physical activity," emphasizes "abundant plant foods, fresh fruit as the typical daily dessert, olive
oil as the principal source of fat, dairy products (principally cheese and yogurt), and fish and poultry consumed in low to moderate
amounts, zero to four eggs consumed weekly, red meat consumed in low amounts, and wine consumed in low to moderate amounts". Total fat
in this diet is 25% to 35% of calories, with saturated fat at 8% or less of calories. The diet is often cited as beneficial for
being low in saturated fat and high in monounsaturated fat and dietary fiber.
Although it was first publicized in 1945 by the American doctor Ancel Keys stationed in Salerno, Italy, the Mediterranean diet failed
to gain widespread recognition until the 1990s. It is based on what from the point of view of mainstream nutrition is considered a paradox:
that although the people living in Mediterranean countries tend to consume relatively high amounts of fat, they have far lower rates of
cardiovascular disease than in countries like the United States, where similar levels of fat consumption are found. A parallel phenomenon
is known as the French Paradox.
One of the main explanations is thought to be the large amount of olive oil used in the Mediterranean diet. Unlike the high amount of
animal fats typical to the American diet, olive oil lowers cholesterol levels in the blood.[5] It is also known to lower blood sugar
levels and blood pressure. Research indicates olive oil prevents peptic ulcers and is effective in treatment of peptic ulcer disease,
and may be a factor in preventing cancer. In addition, the consumption of red wine is considered a possible factor, as it contains
flavonoids with powerful antioxidant properties.
The principal aspects of this diet include high olive oil consumption, high consumption of legumes, high consumption of unrefined cereals,
high consumption of fruits, high consumption of vegetables, moderate consumption of dairy products (mostly as cheese and yogurt),
moderate to high consumption of fish, low consumption of meat and meat products, and moderate wine consumption.
Michael Pollan suggests the explanation is not any particular nutrient, but the combination of nutrients found in unprocessed food.
Dietary factors may be only part of the reason for the health benefits enjoyed by these cultures. Genetics, lifestyle (notably
heavy physical labor), and environment may also be involved.
This diet is not typical of all Mediterranean cuisine. In central Italy, for instance, lard and butter are commonly used in cooking,
and olive oil is reserved for dressing salads and cooked vegetables. In North Africa, wine was traditionally not consumed by Muslims.
In both North Africa and the Levant, along with olive oil, sheep's tail fat and rendered butter (samna) are traditional staple fats.
Medical research:
The Seven Countries Study found that Cretan men had exceptionally low death rates from heart disease, despite moderate to high intake of
fat. The Cretan diet is similar to other traditional Mediterranean diets: consisting mostly of olive oil, bread, abundant fruit and
vegetables, fish, and a moderate amount of dairy foods and wine.
The Lyon Diet Heart Study set out to mimic the Cretan diet, but adopted a pragmatic approach. Realizing that some of the people in the
study (all of whom had survived a first heart attack) would be reluctant to move from butter to olive oil, they used a margarine
based on rapeseed (canola) oil. The dietary change also included 20% increases in vitamin C rich fruit and bread and decreases in
processed and red meat. On this diet, mortality from all causes was reduced by 70%. This study was so successful that the ethics
committee decided to stop the study prematurely so that the results of the study could be made available to the public immediately.
According to a study published in the British Medical Journal (May 29, 2008), the traditional Mediterranean diet provides substantial
protection against type 2 diabetes. The study involved over 13 000 graduates from the University of Navarra in Spain with no
history of diabetes, who were recruited between December 1999 and November 2007, and whose dietary habits and health were subsequently
tracked. Participants initially completed a 136-item food frequency questionnaire designed to measure the entire diet. The
questionnaire also included questions on the use of fats and oils, cooking methods and dietary supplements. Every two years
participants were sent follow-up questionnaires on diet, lifestyle, risk factors, and medical conditions. New cases of diabetes
were confirmed through medical reports. During the follow-up period (median 4.4 years) the researchers from the University of
Navarra found that participants who stuck closely to the diet had a lower risk of diabetes. A high adherence to the diet was
associated with an 83% relative reduction in the risk of developing diabetes.
A study published in The New England Journal of Medicine (July 17, 2008) examined the effects of the three diets: Low-carb,
Low-fat, and Mediterranean. The study involved 322 participants and lasted for the a duration of 2 years. The low-carb and
Mediterranean diet resulted in the highest weight-loss, 12 lbs and 10 lbs, respectively. Low-fat diet resulted in a loss of 7 lbs.
Benefits of the Mediterranean diet:
The Mediterranean diet is thought to reduce your risk of heart disease. In fact, a 2007 study conducted in the United States found that both men and women who consumed a Mediterranean diet lowered their risk of death from both heart disease and cancer.
Key components of the Mediterranean diet include:
- Eating a generous amount of fruits and vegetables
- Consuming healthy fats such as olive oil and canola oil
- Eating small portions of nuts
- Drinking red wine, in moderation, for some
- Consuming very little red meat
- Eating fish on a regular basis
Fruits, vegetables and grains:
The Mediterranean diet traditionally includes fruits, vegetables, pasta and rice. For example, residents of Greece eat very little red meat and average nine servings a day of antioxidant-rich fruits and vegetables. The Mediterranean diet has been associated with a lower level of oxidized low-density lipoprotein (LDL) cholesterol — the "bad" cholesterol that's more likely to build up deposits in your arteries.
Grains in the Mediterranean region are typically whole grain and usually contain very few unhealthy trans fats, and bread is an important part of the diet there. However, throughout the Mediterranean region, bread is eaten without butter or margarines, which contain saturated or trans fats.
Healthy fats:
The focus of the Mediterranean diet isn't to limit total fat consumption, but to make wise choices about the types of fat you eat.
The Mediterranean diet is similar to the American Heart Association's Step I diet, but it contains less cholesterol and has more fats. However, the fats are healthy — including monounsaturated fats, such as olive oil, and polyunsaturated fats, which contain the beneficial linolenic acid (a type of omega-3 fatty acid). These fat sources include canola oil and nuts, particularly walnuts. Fish — another source of omega-3 fatty acids — is eaten on a regular basis in the Mediterranean diet. Omega-3 fatty acids lower triglycerides and may improve the health of your blood vessels. The Mediterranean diet discourages saturated fats and hydrogenated oils (trans-fatty acids), both of which contribute to heart disease.
Choosing oils and fats:
Olive oil. All types of olive oil provide monounsaturated fat — a type of fat that can help reduce LDL cholesterol levels when used in place of saturated or trans fats. "Extra-virgin" and "virgin" olive oils are the least processed forms, meaning they contain the highest levels of the protective plant compounds that provide antioxidant effects.
Nuts. Nuts may be high in fat (80 percent of their calories come from fat), but tree nuts, including walnuts, pecans, almonds and hazel nuts, are low in saturated fat. Walnuts also contain omega-3 fatty acids. Nuts are high in calories, so they should not be eaten in large amounts — generally no more than a handful a day. For the best nutrition, avoid honey-roasted or heavily salted nuts.
Wine:
The health effects of alcohol have been debated for many years, and some doctors are reluctant to encourage alcohol consumption because of the health consequences of excessive drinking. However, light intake of alcohol has been associated with a reduced risk of heart disease in some research studies.
Red wine has an aspirin-like effect, reducing the blood's ability to clot, and also contains antioxidants. The Mediterranean diet typically includes some red wine, but this should be consumed only in moderation. This means no more than 5 ounces (148 milliliters) of wine daily for women (or men over age 65), and no more than 10 ounces (296 milliliters) of wine daily for men under age 65. Any more than this increases the risk of health problems, including increased risk of certain types of cancer.
If you're unable to limit your alcohol intake to the amounts defined above, if you have a personal or family history of alcohol abuse, or if you have heart or liver disease, refrain from drinking wine or any other alcohol. Also keep in mind that red wine may trigger migraines in some people.
Putting it all together:
Adopting a Mediterranean diet is easy if you're a smart shopper. Choose plenty of fresh fruits and vegetables, limit your intake of red meat, and eat fish at least once a week. Though avoid fish that's fried or laden with butter or heavy sauces. Use healthy fats, such as olive oil and canola oil, when cooking — but only in moderation because of their high calorie content. Consider nuts as a snack or an addition to a salad. Finally, reduce or eliminate saturated fat and trans fats (also known as hydrogenated or partially hydrogenated oils) from your diet.
Read food labels to see what you're really buying and putting into your body. Here are some specific steps you can take:
Eat natural peanut butter, rather than the kind with hydrogenated fat added.
Use butter sparingly. "Low fat" or "cholesterol-free" on the label doesn't mean a product is necessarily good for you. Many of these items are made with trans fats.
Eat a variety of whole fruits and vegetables every day. Ultimately, strive for seven to 10 servings a day. Keep baby carrots, apples and bananas on hand for quick, satisfying snacks. Fruit salads are a wonderful way to eat a variety of healthy — and tasty — fruit.
Use canola or olive oil in cooking. Try olive oil for salad dressing and as a healthy replacement for butter or margarine. After cooking pasta, add a touch of olive oil, some garlic and green onions for flavoring. Dip bread in flavored olive oil or lightly spread it on whole-grain bread for a tasty alternative to butter.
Substitute fish and poultry for red meat. Avoid sausage, bacon and other high-fat meats.
Limit higher fat dairy products such as whole or 2 percent milk, cheese and ice cream. Switch to skim milk, fat-free yogurt and low-fat cheese.
Eat fish once or twice a week. Water-packed tuna, salmon, trout, mackerel and herring are healthy choices. Grilled fish tastes good and requires little cleanup. Avoid fried fish, unless it's sauteed in a small amount of olive oil.
Keep walnuts, almonds, pecans and Brazil nuts on hand for a quick snack.
If it's OK with your doctor, go ahead and have a glass of red wine at dinner with your pasta or fish. If you don't drink alcohol, you don't need to start. Drinking purple grape juice may be a healthy alternative to wine.
Once you experience the delicious and healthy choices the Mediterranean diet has to offer, it just might become your favorite diet.
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