Mediterranean diet

Written by: 
Dr Sarah Brewer

What are the benefits of the Mediterranean-style diet and what do you eat to follow it? This page explains.

The Mediterranean diet is a traditional way of eating among people living in areas around the Mediterranean Sea - particularly in Greece, Crete and southern Italy.

The diet combines relatively large amounts of vegetables, fruit, olive oil, fish, garlic, wholegrains, beans, nuts, seeds, bread and potatoes with a relatively low intake of red meat and a moderate consumption of red wine.

Overall, the diet provides a total fatOne of the three main food constituents (with carbohydrate and protein), and the main form in which energy is stored in the body. content of 25 - 35 per cent, with an unusually low intake of saturated fatOne of the three main food constituents (with carbohydrate and protein), and the main form in which energy is stored in the body. that accounts for 8 per cent or less of energy intake.1

Several health benefits are associated with the Mediterranean diet. Research suggests that the diet may:

Individuals can adopt simple changes to their diet if they want to follow a Mediterranean-style eating pattern.

Health benefits of the Mediterranean diet

Medical researchers began to investigate the Mediterranean diet when they noted that people living in the areas around the Mediterranean Sea had low risks of developing heart disease, cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. and other diet-related illnesses. These people also had one the highest adult life expectancies in the world.1

Studies indicate that following a traditional Mediterranean diet, taking regular exercise and not smoking can prevent more than 80 per cent of new cases of heart disease, 70 per cent of stroke and 90 per cent of type 2 diabetes.2 The diet may also be associated with a slower onset of cognitive decline, but not of dementiaDecline in mental capacity, brain functioning and memory that affects day-to-day living..3

In addition, researchers discovered that following a Mediterranean-style diet reduces the activity of genes involved in hardening and furring up of arteries (atherosclerosisDisease leading to fatty deposits in the inner walls of the arteries, which reduce and may eventually obstruct blood flow.). The diet has the effect of:

  • Limiting production of inflammatory chemicals
  • Reducing formation of foam cells (scavenger cells overladen with oxidised LDL-cholesterolSubstance that carries cholesterol around the bloodstream, a form of so-called 'bad cholesterol'., which get trapped in arteryA blood vessel that carries blood away from the heart. Apart from the pulmonary artery and umbilical artery, all arteries carry oxygenated blood. walls)
  • Reducing formation of abnormal bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. clots (thrombosis).4

Read more on atherosclerosis and cholesterol.

Mediterranean diet and longevity

Populations following a Mediterranean way of eating tend to live longer than populations following other types of diet.
When researchers looked at the results of a number of studies investigating high bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. pressure, cardiovascular disease, obesityExcess accumulation of fat in the body. and cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., they found that individuals who reported eating foods consistent with the Mediterranean diet were 10 - 20 per cent less likely to die from heart disease, cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. or any other cause over the course of the study.5

Mediterranean diet and heart disease

In the 1994 Lyon Diet Heart Study performed by several French medical research bodies, people who were asked to follow a Mediterranean-style diet after having had a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. were significantly less likely to have a second heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. than those following a 'prudent Western-type diet'.6

In fact, the protective effects were so striking - a 70 per cent reduction in all causes of death - that the study was terminated after 27 months (rather than the planned 5 years) because it was thought unethical not to advise those in the control group to also follow a Mediterranean way of eating.7

The benefits produced by following a Mediterranean-style diet do not seem to be related to a significant cholesterolA substance present in many tissues and an important constituent of cell membranes although high concentrations of a certain type of cholesterol in the blood are unhealthy.-lowering effect - other mechanisms are involved.

  • One of the most likely beneficial factors is the high intake of omega-3 fatty acids
  • A high intake of dietary antioxidants and monounsaturated fatOne of the three main food constituents (with carbohydrate and protein), and the main form in which energy is stored in the body. also plays a role.

Read more on omega-6 and omega-3 fatty acids, cholesterol and fats in your diet.

Mediterranean diet and type 2 diabetes

The Mediterranean diet is associated with a lower risk of developing type 2 diabetes.

Researchers therefore tested whether or not this way of eating was of benefit to people who already had diabetes, but had not yet needed glucoseA simple sugar that is an important source of energy in the body.-lowering medication.

A total of 215 overweight people with newly diagnosed type 2 diabetes were advised to follow either a low-fatOne of the three main food constituents (with carbohydrate and protein), and the main form in which energy is stored in the body., calorie-restricted diet, or a relatively low-carbohydrate, Mediterranean-style diet containing less than 50 per cent of calories from carbohydrate.

After four years, 70 per cent of those in the low-fatOne of the three main food constituents (with carbohydrate and protein), and the main form in which energy is stored in the body. group had needed to start glucoseA simple sugar that is an important source of energy in the body.-lowering medication, compared with only 44 per cent of those following a Mediterranean-style diet.

Those assigned to the Mediterranean-style diet also lost more weight and showed greater improvement in risk factors for heart disease than those on the low-fatOne of the three main food constituents (with carbohydrate and protein), and the main form in which energy is stored in the body. diet.8

How to follow a Mediterranean diet

It is relatively easy to start obtaining the health benefits of the Mediterranean diet:9

  • Eat more fruit and make sure you have fruit every day
  • Eat more vegetables, beans and potatoes
  • Eat more fish
  • Eat more nuts and seeds
  • Choose wholegrain bread and wholegrain cereals
  • Use olive oil rather than other cooking or dressing oils
  • Eat low to moderate amounts of dairy products and poultry
  • Eat less red meat, butter and cream
  • Eat eggs four times a week or less
  • Consume wine in low to moderate amounts.

At the same time, cut back on other types of food, especially biscuits, cakes, sweets and puddings, which can readily be replaced with fruit.

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References

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References: 
  1. Willett WC, Sacks F, Trichopoulou A et al. Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr 1995;61:1402S - 1406S
  2. Willett WC. The Mediterranean diet: science and practice. Public Health Nutr 2006;9(1A):105-10
  3. Feart C, Samieri C, Rondeau V  et al. Adherence to a Mediterranean diet, cognitive decline and risk of dementiaDecline in mental capacity, brain functioning and memory that affects day-to-day living. JAMA 2009; 302(6):638-48
  4. Llorente-Cortes V, Estruch R, Mena MP et al. effect of Mediterranean diet on the expression of pro-atherogenic genes in a population at high cardiovascular risk. Atherosclerosis 2009;Epub ahead of print. Link
  5. Perez-Lopez FR, Chedraui P, Haya J et al. effects of the Mediterranean diet on longevity and age-related morbid conditions. Maturitas 2009; Epub ahead of print. Link
  6. de Lorgeril M, Salen P, Martin J-L et al. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarctionDeath of an area of heart muscle due to poor blood supply.: final report of the Lyon Diet Heart Study. Circulation. 1999;99:779-785
  7. Leaf A. Dietary prevention of coronaryRelating to the arteries supplying the heart itself. heart disease: The Lyon Diet Heart Study. Circulation 1999;99:733-735
  8. Esposito K, Maiorino MIMyocardial infarction. Death of a segment of heart muscle, which follows interruption of its blood supply., Ciotola M et al. Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: a randomised trial. Ann Intern Med 2009;151(1):306-14
  9. 'Lyon Diet Heart Study'. American Heart Association. Link