By Nurse Mark
The Mediterranean diet has been touted as being heart healthy and promoting longevity. But is it really all it’s cracked up to be? The answer, both yes and no, is more complicated than you might think.
Though it was first publicized in 1945 by Dr. Ancel Keys the Mediterranean diet failed to gain widespread recognition until the 1990s when it’s concepts were popularized in a book titled “Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating” by by Dr Walter Willett of Harvard University’s School of Public Health.
The diet (with the word diet used in the classical sense – meaning “way of life“) was based on the eating and activity patterns of the people of Crete, Greece, and Southern Italy in the late 1950′s and early 1960′s.
The basics of The Mediterranean diet are generally accepted to be:
- regular vigorous physical activity
- abundant plant foods – locally grown and minimally processed
- fresh fruit as the typical daily dessert
- olive oil as the principal source of fat
- dairy products such as cheese and yogurt in moderation
- fish and poultry consumed in low to moderate amounts
- up to four eggs a week
- red meat consumed in low amounts
- red wine consumed in low to moderate amounts
Total fat in the Mediterranean diet is 25% to 35% of calories, with saturated fat at 8% or less of calories. The primary source of fats is olive oil.
The Yes and the No of it
The first thing to remember about the Mediterranean diet it that it is NOT intended to be a weight-loss diet. It is a healthy way of life and yes, with modifications and restricted food intake and increased physical exercise it could be used as a reasonably healthy weight loss diet. But no, it is not primarily a “weight loss diet.”
So, is it an anti-inflammatory diet as it has been claimed by some to be? Maybe.
The Mediterranean diet relies heavily on olive oil as a source of fat. Olive oil is said to have facilitated the consumption of large amounts of vegetables and legumes (relatively “low density” foods, nutritionally) by enhancing both their taste and energy density (adding calories to otherwise low-calorie foods).
Olive oil is high in oleic acid which is considered to be an anti-inflammatory fatty acid. It is also a source of the important antioxidant Vitamin E.
On the other hand, the Mediterranean diet also made use of a variety of carbohydrates, and depending on the region these could include couscous in North Africa, pasta, polenta, potatoes, and rice in southern Europe, bulgur, rice, chickpeas and other beans in the eastern Mediterranean regions. Dr. Willett, in his paper “Mediterranean diet pyramid: A cultural model for healthy eating” stresses that while bread “was a fundamental component of virtually all meals” it was “eaten without butter or margarine.” He goes on to state that “Butter was rare in the Mediterranean region in 1960, and margarine unknown until quite recently. [as of 1993]“
Carbohydrates (such as bread, pasta, potatoes, rice, etc.) have been shown to cause increased inflammatory markers (cytokines).
Well then, is the Mediterranean diet really “heart healthy”? Once again, the answer is a qualified “Maybe.”
Dr. Willett writes that “In adult Greek men in 1960, for example, premature mortality from coronary heart disease was 90% lower than that for men in the United States, and the life expectancy of Greek men was the highest in the world reported at that time.”
He also reported however that “Mediterranean populations in the early 1960′s were highly [physically] active, and the groups observed in Crete and other areas of Greece were leaner than their western counterparts.”
In an apparent paradox for cardiovascular health (at least by conventional western standards) the Mediterranean diet is high in salt with foods such as olives, salt-cured cheeses, anchovies, capers, salted fish roe, and salads dressed with olive oil all containing significant amounts of salt. Western medicine today would consider such salt intake would virtually guarantee the development of hypertension (high blood pressure).
The Mediterranean diet features lots of fresh fruit, right? Not really…
Dr. Willett writes that “fresh fruit [was] the typical daily dessert” – not that it was consumed in large amounts or with each meal. Further, he reports that “sweets, containing concentrated sugars or honey were consumed [only] a few times per week.”
Grapes, olives, figs, almonds, dates, and carobs have been cultivated in the Mediterranean region since early times, while other fruits and nuts such as mandarins, loquats, persimmons, pomegranates, pistachios, and cactus pear are historically more recent.
All would be expected to provide important anti inflammatory bioflavonoids to the diet.
And about that wine…
Yes, the Mediterranean diet does feature the regular, daily, moderate consumption of wine. Specifically, red wine, taken with meals. Moderate is defines as one glass daily for women and two glasses daily for men. This level of intake resulted in decreased coronary risk but Dr. Willett goes on to caution that such alcohol intake for women may result in an increase in the risk of breast cancer.
Red wine is well-known to contain a number of significant and important antioxidants and resveratrol and may also have served as a digestive aid to promote more complete digestion and assimilation of nutrients. We could assume that the red wine consumed was locally made from locally grown grapes, without preservatives and sulfites.
So, what’s the bottom line?
I cringe whenever I hear someone tell me that they are “on the Mediterranean diet” because it allows them to eat “lots of pasta and couscous and hummus on pita and bread dipped in olive oil” and drink lots of wine – though they often qualify that by saying they’ll choose white wine “because it has fewer calories.”
Feeling pious because they are eating copious salads and fruits and low-fat foods, these people invariably have simply modified their traditional western diet to include parts of what they believe might be Mediterranean cuisine (the parts that appeal to them, like pasta, bread, hummus, rice..) and they end up with a “diet” that is neither particularly healthy nor very nutritious.
Here is what the Mediterranean diet really means:
- Mediterranean people in 1960 were highly physically active. As Willett writes: “Work in the field or kitchen resulted in a lifestyle that included regular physical activity and was associated with low rates of obesity.” These were not people for whom “exercise” meant 18 holes of golf once a week or a pilates gym membership or walking the dog twice a day – “exercise” was simply how they lived and they had little option but to be physically active.
- Mediterranean food portions in 1960 were described repeatedly in Dr. Willetts paper as “moderate.” We might surmise that these portion sizes are what we would now describe as “small” since our western tendency is to “supersize” our food portions.
- Processed foods, convenience foods, concentrated sugars, additives, preservatives, soft drinks and “snack foods” were virtually unheard of by the Mediterranean people of 1960 and their healthy status and longevity reflected that.
- Dietary intakes of pro-inflammatory carbohydrates (breads, pastas, starches) were in minimally processed “moderate” portions and were balanced with the consumption of a relatively anti-inflammatory fat, olive oil.
- The Mediterranean diet is in no way a vegetarian diet – red meat, poultry, fish, dairy, eggs and other foods from animal sources formed a significant part if the diet.
- Meals were taken with family and friends and were a social gathering where the enjoyment of the company of others and of the flavors, textures, and aromas of the foods were more important than the serving sizes. Conversation, laughter, and storytelling at the meal table would have provided considerable distraction from the process of eating, slowing the meal and promoting early satiety with smaller portions.
So, the bottom line. Is the Mediterranean diet really all it’s cracked up to be?
For someone willing to adopt the Mediterranean diet as the lifestyle that it really is – that is, a highly physically active lifestyle of daily labor, meals of predominantly locally-grown and minimally processed foods, avoidance of processed foods, convenience foods, concentrated sugars, additives, preservatives, soft drinks and “snack foods”, and replacement of butter and processed oils and fats with minimally processed olive oil the answer is a resounding “yes” – the Mediterranean diet as a “lifestyle” is indeed healthy.
For someone who simply wants to “cherry pick” the attractive parts of Mediterranean cuisine such as pasta, rice, hummus, baklava, and sweet breads and then add them to a junk food filled western diet of sodas, processed foods, concentrated carbohydrates, and trans-fatty fast food while continuing to live a sedentary lifestyle the answer is “no” – it is simply a self-deluding recipe for health disaster.
Do you need some help deciding which diet plan is best for you? Consider a Brief Phone Consultation with Dr. Myatt.
Mediterranean diet pyramid: A cultural model for healthy eating http://www.ajcn.org/content/61/6/1402S.full.pdf+html
Comparison of Low Fat and Low Carbohydrate Diets on Circulating Fatty Acid Composition and Markers of Inflammation http://www.springerlink.com/content/r1x1143pl42737u8/
C. Leclercq and A. Ferro-Luzzi (Mar 1991). “Total and domestic consumption of salt and their determinants in three regions of Italy”.European Journal of Clinical Nutrition 45 (3): 151–9.
Fruit and nut cultivation of the Mediterranean region: http://www.hort.purdue.edu/newcrop/proceedings1996/v3-416.html
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