Over the last several decades, the benefits of the Mediterranean diet have been extremely influential. In fact, the Mediterranean diet is one of the primary models behind the development of modern nutritional guidelines from authorities like the World Health Organization, the Mayo Clinic, and the American Heart Association. These government and health experts follow the lead of the Mediterranean diet in the emphasis they place on eating fresh fruits, lots of vegetables, whole grains and legumes, fish, and monounsaturated fats in place of the red meats, animal-fats, and refined and processed foods that have come to characterize our modern eating habits.
But the Mediterranean diet itself has some distinctive elements that are not always fully addressed. These elements make it well worth another look at what the Mediterranean diet is and what scientific research has to tell us about its potential impact on our health and well-being.
Health Benefits of the Mediterranean Diet
Recently, a research team from the University of Zaragoza in Spain led by Dr. Faustino R. Pérez-López undertook a comprehensive review of the clinical and experimental research literature documenting how the Mediterranean diet correlates with a variety of major health concerns, including hypertension, cardiovascular disease, obesity, the metabolic syndrome, cancer, life expectancy, bone health, and rheumatoid arthritis. In every one of these areas, research from the Mediterranean region and around the world has found significant evidence of health benefits from adhering to some version of a Mediterranean diet.
- Hypertension. The benefits of a diet high in fruits, grains, legumes and vegetables for treating high blood pressure are widely recognized. The Mediterranean diet however adds some additional gains through its generous use of virgin olive oil, which studies have demonstrated contributes to improved systolic and diastolic blood pressure [Psaltopoulou 2004].
- Cardiovascular health. The Mediterranean diet’s emphasis on virgin olive oil and nuts has been shown to be more effective than a low-fat diet in reducing the risk of cardiovascular disease by lowing blood glucose, harmful cholesterol and systolic blood pressure [Estruch 2006]. Elderly people with a history of heart attacks who adhered closely to a Mediterranean diet had significantly better survival rates as well [Trichopoulou 2005].
- Weight control. Despite concerns that the relatively high level of calories from fat in the MD would contribute to increased weight, researchers studying a population of men and women in Spain found that the risk of obesity was lower for both genders the more closely they followed a Mediterranean diet [Schroder 2004]. Other studies confirmed that “high MD adherence was associated with a lower likelihood of gaining weight” [Mendez 2006].
- Metabolic Syndrome. Given the previous factors, it is not surprising that people who eat a Mediterranean diet have been found to have significantly lower risk of developing metabolic syndrome, a condition diagnosed in people who exhibit three of the following characteristics: excessive abdominal fat, high triglycerides, low HDL cholesterol, high fasting blood sugar levels, and high blood pressure [Tortosa 2007]. Individuals with metabolic syndrome are at particular risk for cardiovascular problems and diabetes. The MD very closely matches the dietary recommendations for reducing the chances of developing metabolic syndrome: increased omega-3 fatty acids, reduced saturated and trans-fats, and increased fruit, vegetable, nuts, and whole and unrefined grains [Giugliano 2006].
- Anti-cancer benefits. Many elements of the Mediterranean diet are associated with reduced cancer risks—olive oil, fish, fruit, whole grains, vegetables and lycopene-rich tomatoes in particular. Studies have confirmed lower cancer mortality rates in general among people whose diet closely matches the MD model [Mitrou 2007, Benetou 2008, Lagiou 2006, La Vecchia 2006]. Benefits have also been found in connection with many individual types of cancer (breast, ovarian, endometrial, colorectal, and digestive tract).
- Increased longevity. After a thorough review of the available research, Dr. Perez-Lopez and his team summarize their findings dramatically with the conclusion that “People on a MD had more than a 20% lower chance of dying over a 10-year period than those not on such a diet” regardless of their age, weight or gender [Knoops 2004].
Lower rates of osteoporosis in Mediterranean countries and of rheumatoid arthritis among people who consume larger quantities of olive oil and fish suggest that these ailments too are positively affected by elements typical of the Mediterranean diet. [Prynne 2006, Linos 1999]
Diet and Lifestyle Elements of the Mediterranean Diet
Given how much of the Mediterranean diet is practically boilerplate now for nutritional guidelines and recommendations—such as the importance of fruits, vegetables, and whole grains—it’s worthwhile emphasizing here some of the distinctive elements that have remained somewhat less familiar and accepted: i.e., the prominent role of fats (MUFA and PUFA) from olive oil, fish and nuts, of tomatoes and of red wine.
- Fats (olive oil, fish oil, and nuts). Surprisingly, as much as 25 to 35 percent of the calories in a Mediterranean diet come from fat, but that fat is almost exclusively unsaturated. Virgin olive oil is the model monounsaturated fat (MUFA), while fish is particularly high in polyunsaturated fat (PUFA). Both are rich in antioxidants that protect the heart, lower cholesterol, and reduce vascular inflammation. The fatty acids (omega-3) of fish may also have beneficial effects on the brain. Nuts again are a rich source of both MUFAs and PUFAs and have been linked to better cholesterol ratios and lower risk of cardiovascular disease and metabolic syndrome.
- Tomatoes. Tomatoes—especially cooked tomatoes—are one of the most prominent and healthful of the fruits and vegetables featured in the Mediterranean diet, primarily because of the antioxidant properties of the lycopene they contain, which has been shown effective in treating hypertension and cardiovascular ailments and in decreasing the risk of cancer.
- Red Wine. Wine is of course also a plant-based food, and contains many beneficial antioxidant compounds, particularly the polyphenol resveratrol contained in the skin of red grapes. Resveratrol may inhibit tumor growth and development, and may even have some age-retardant properties.
The Mediterranean diet as it was originally defined and studied is actually much more than a list of foods. It is (or was) part and parcel of a very particular region, climate, culture and way of life.
The temperate climate of the Mediterranean region fostered a very different lifestyle than is found in northern Europe, for instance. Much more of work, social and family life can be conducted out of doors. Sunshine itself is a health-giving anti-depressant for many people and contributes to higher levels of cardioprotective vitamin D. The heat common to the Mediterranean climate contributed to the custom of siestas, which may also yield heart benefits. The climate is obviously conducive to certain agricultural crops—the olive orchards most notably—and to the predominance of a plant-based diet. Finally, the fact that the economy of the area was fairly depressed for many years may actually have protected people from adopting the overly rich and processed diet of modern developed countries quite so quickly.
The Future of the Mediterranean Diet
Many of these lifestyle factors are disappearing—though not the heat and the sunshine of course. Economic development and industrialization are changing the way Mediterranean people eat and live and bringing them more into line with many of the less-healthy characteristics of the modern Westernized diet.
On the other hand, all of the primary elements of the Mediterranean diet are now available in markets throughout the developed world. It may take more conscious effort in our far-flung locations, but the benefits of the Mediterranean diet can now be extended far beyond its geographical birthplace and contribute to better health and longer lives for people everywhere.
References
Benetou V, Trichopoulou A, Orfanos P, et al. Conformity to traditional Mediterranean diet and cancer incidence: the Greek EPIC cohort. Br J Cancer 2008;99:191–5.
Estruch R, Martinez-Gonzalez MA, Corell D, et al. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med 2006;145:1-11.
Pérez-López, FR, Chedraui, P, Haya, J, Cuadros, J. Effects of the Mediterranean diet on longevity and age-related morbid conditions. Maturitas 2009;64:67–79.
Giugliano D, Ceriello A, Esposito K. The effects of diet on inflammation: emphasis on the metabolic syndrome. J Am Coll Cardiol 2006;48:677-85.
Knoops KT, de Groot LC, Kromhout D, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA 2004;292:1433–9.
Lagiou P, Trichopoulos D, Sandin S, et al. Mediterranean dietary pattern and mortality among young women: a cohor study in Sweden. Br J Nutr 2006;96:384-92.
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Linos A, Kaklamani VG, Kaklamani E, et al. Dietary factors in relation to rheumatoid arthritis: a role for olive oil and cooked vegetables? Am J Clin Nutr 1999;70:1077-82.
Mendez MA, Popkin BM, Jakszyn P, et al. Adherence to a Mediterranean diet is associated with reduced 3-year incidence of obesity. J Nutr 2006;136:2934–8.
Mitrou PN, Kipnis V, Thiébaut AC, et al. Mediterranean dietary pattern and prediction of all-cause mortality in a US population: results from the NIH-AARP Diet and Health Study. Arch Intern Med 2007;167:2461–8.
Prynne CJ, Mishra GD, O’Connell MA, et al. Fruit and vegetable intakes and bone mineral status: a cross sectional study in five age and sex cohorts. Am J Clin Nutr 2006;83:1420-8.
Psaltopoulou T, Naska A, Orfanos P, Trichopoulos D, Mountokalakis T, Trichopoulou A. Olive oil, the Mediterranean diet, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study. Am J Clin Nutr 2004;80:1012–8.
Schröder H, Marrugat J, Vila J, Covas MI, Elosua R. Adherence to the traditional Mediterranean diet is inversely associated with body mass index and obesity in a Spanish population. J Nutr 2004; 134: 3355–61.
Tortosa A, Bes-Rastrollo M, Sanchez-Villegas A, Basterra-Gortari FJ, Nunez-Cordoba JM, Martinez-Gonzalez MA. Mediterranean diet inversely associated with the incidence of metabolic syndrome: the SUN prospective cohort. Diabetes Care 2007; 30: 2957–9.
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About the author
A native of Greece, Matt Papa’s knowledge of the Mediterranean diet was gained firsthand. Now a postdoctoral research fellow in biochemistry and molecular biophysics at Washington University School of Medicine in St Louis, MO, Matt writes articles about the health benefits of traditional diets and reviews on best diets to lose weight in his spare time. He also posts information about gastric bypass support tools and offers a coupon for Medifast.