The Mediterranean diet: A recipe for long life and good health

No matter where they live in our vast and wonderful planet, people are people. But if all humans share a common biologic backbone, the peoples of the earth display a remarkable diversity of cultural norms. Language, religion, family structure, governance, music, dance, sports, and clothing are all subject to amazing cultural differences. And the human diet is every bit as diverse as the other cultural traditions. All people eat to live, but the foods they choose depend on complex interactions between climate, geography, national resources, religion, and tradition. Each culture has its signature dishes; for example, Asians are noted for rice, noodles, and soy; Italians for pasta and bread; Germans for meat and potatoes; the French for wine and cheese; and the Latinos for corn, beans, and rice. As migration, travel, and the global economy shrink our world, dietary diversity has diminished. But before variety becomes an exception, we should consider adopting the best nutritional traditions from other cultures, not just for the occasional pleasure of ethnic dining but as a healthful pattern for everyday life. And one of the best patterns is the traditional Mediterranean diet.

A Mediterranean eating pattern was first identified more than 50 years ago as part of a study of health and habits in seven countries — Greece, Finland, Italy, Japan, the Netherlands, the United States, and Yugoslavia. One of its most intriguing findings was that people living in Crete, other parts of Greece, and Southern Italy lived longer and had the lowest rates of heart disease in spite of a high-fat diet and limited medical care.

What Is It?

Although the Mediterranean Basin occupies only a small fraction of the earth, there is considerable dietary diversity within the region. When nutritionists speak of the traditional Mediterranean diet, though, they refer to a centuries-old dietary pattern that has flourished in Crete, various rural regions in the rest of Greece, and parts of Southern Italy and France. And that pattern has 10 characteristic features:

1) An abundance of vegetables, fruits, beans, nuts, seeds, and other plant foods.

2) An abundance of unrefined grains, such as whole grain cereals and bread.

3) Olive oil as the major source of fat.

4) Fish in moderate to high amounts.

5) Fruit as the typical dessert, with sweets containing honey or sugar consumed several times a week in low to moderate amounts.

6) Yogurt, cheese, and other dairy products consumed daily in low to moderate amounts.

7) Four or fewer eggs consumed per week.

8) Poultry consumed in moderate to large amounts and red meat in low amounts.

9) A reliance on locally grown, fresh, minimally processed foods.

10) Alcohol consumed in moderate amounts, usually as wine with meals.

Although the farmers of Crete did not analyze the nutrients in their diets, modern scientists have run the numbers. The traditional Mediterranean diet is high in complex carbohydrates and fiber but low in simple sugars, moderate in unsaturated fat, moderate in proteins, and moderate in alcohol. It’s also tasty, but does it work? Yes, it does, if we base it on the many research studies done previously in Europe.

Studies In Greece And Europe

And here are some recent studies that further prove the beneficial effects of the Mediterranean diet:

• A study of 22,043 adults in Greece found that people who adhered to the traditional Mediterranean diet enjoyed a lower mortality rate than those who did not. Compared to people with the least traditional diets, people with the best diets were 33 percent less likely to die of heart disease and 24 percent less likely to die of any cause during the 44 months of the study. And benefit depended on the overall Mediterranean dietary pattern rather than any individual nutrients; olive oil won’t help unless you include the other good stuff in your diet.

• A study of 74,607 men and women, aged 60 or older, in nine European countries found that following the principles of the Mediterranean diet was associated with increased survival and longevity. Protection was consistent in Mediterranean as well as in non-Mediterranean countries.

• A study of 2,339 people between the ages of 70 and 90 in 11 European countries linked the Mediterranean diet to a 23-percent reduction in the overall mortality rate. And when exercise, moderate alcohol use, and avoidance of tobacco were added to the diet, the death rate was reduced by more than 50 percent.

• A study of 1,302 Greek patients with heart disease found that greater adherence to the traditional Mediterranean diet was associated with a lower death rate during nearly four years of observation.

• A study of 1,926 Greek adults found that people who followed a Mediterranean diet enjoyed a 27-percent decrease in the likelihood of acute coronary artery syndrome.

• A study of 11,323 Italian heart attack survivors found that patients who succeeded in adopting a Mediterranean diet were only half as likely to die during 6.5 years of observation as patients who did not succeed in improving their diets.

More Support From U.S. Studies

There was more encouraging news a little more than a year ago, when the Archives of Internal Medicine issue of December 10/24, 2007, published results from an American study. In a long-term investigation of 400,000 men and women, the results confirmed the beneficial effects of the Mediterranean diet. Those whose eating patterns closely matched the Mediterranean diet were about 20 percent less likely to have died of heart disease, cancer, or any cause, over a five-year follow-up period.

In addition, a Mediterranean-type diet seems to be as good for treating heart disease as it is for preventing it. In the Heart Institute of Spokane Diet Intervention and Evaluation Trial (THIS-DIET), heart attack survivors following this type of diet were less likely than their counterparts on a more typical American diet to have died or suffered a second heart attack, a stroke, or an episode of unstable angina over a two-year period. The study was published in the June 1, 2008 issue of the American Journal of Cardiology.

Are you trying to lose weight? A Mediterranean diet trumps a low-fat diet. Results of a two-year head-to-head comparison study, published in the July 17, 2008 issue of the New England Journal of Medicine showed that the Mediterranean diet yielded greater weight loss and was better at easing low-grade inflammation, a process linked to heart disease. Among the volunteers with diabetes, the Mediterranean diet yielded better fasting blood sugar and insulin levels.

How It Works

The Mediterranean diet works because it has lots of the things that can protect you from heart disease, diabetes, and other chronic illnesses; the list includes dietary fiber, vitamin-rich fruits and vegetables, and fish, as well as the moderate amounts of alcohol that also appear to protect the heart. At the same time, it shuns items that are harmful, including saturated fat from animal sources, trans fat from partially hydrogenated vegetable oils, salty processed foods, and rapidly absorbed simple carbohydrates. The net results include lower levels of LDL (“bad”) cholesterol, higher levels of HDL (“good”) cholesterol, lower levels of blood sugar and insulin, and lower blood pressure readings.

In addition, a randomized clinical trial of 180 patients with the metabolic syndrome, a major precursor of cardiovascular disease, found that the Mediterranean diet reduced body weight, improved arterial function, and lowered levels of C-reactive protein and other markers of vascular inflammation. Researchers have also demonstrated that the Mediterranean diet produces similar risk factor improvements even in healthy adults.

Postscript

When doctors prescribe the Mediterranean diet, they are advising the traditional diet present in Crete and certain other rural areas in Southern Greece, Italy or France. But with globalization, the traditional dietary pattern is eroding. In the Mediterranean, as in much of the world, the Western preference for processed foods that are high in fat, salt, sugar, and calories but low in fiber, is taking hold. Olive oil and wine are still in vogue, but exercise is not. Over the past 30 years, the Greek waistline has expanded drastically; the prevalence of obesity is now as high or higher than any area of the world except certain Pacific islands. Diabetes is also rampant, and an epidemic of heart disease may just be a heartbeat away.

So, here’s the take-home advice: When in Greece, do as the Greeks used to do!