How to Follow the Mediterranean Diet and Enjoy Its Health Benefits

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For years now, the Mediterranean diet has right­fully been pub­licly cel­e­brated for its phys­i­cal and men­tal health ben­e­fits, but what exactly is it, and how does it work?

In sim­ple terms, the Mediterranean diet refers to the tra­di­tional diet of olive-grow­ing regions before the intro­duc­tion of fast food, large quan­ti­ties of red meats and other harm­ful habits that arose from the glob­al­iza­tion of the decades fol­low­ing World War II.

Mediterranean coun­tries are his­tor­i­cally among the health­i­est coun­tries in the world, record­ing rel­a­tively low rates of car­dio­vas­cu­lar dis­eases and can­cer, as well as longer life expectancy.

The Spain-based Mediterranean Diet Foundation, one of the most influ­en­tial orga­ni­za­tions ded­i­cated to research­ing and pro­mot­ing the Mediterranean diet, defines the diet as a way of life. In the foundation’s view, lifestyle and val­ues form a vital part that can not be sep­a­rated from the whole.

This is reflected in its Mediterranean diet pyra­mid. Unlike more famil­iar food pyra­mids, the base is built from a com­bi­na­tion of exer­cise, rest, social­iz­ing and cook­ing on the phys­i­cal front, and a com­mit­ment to sus­tain­able, local, sea­sonal, and eco-friendly food choices on the value front.

As the pres­i­dent of the foun­da­tion, Francisco Martinez Arroyo, explains, ​“the Mediterranean diet is not just food, but a way of under­stand­ing the envi­ron­ment, of relat­ing to each other, of enjoy­ing local and sea­sonal con­sump­tion, and con­tin­u­ing to trans­mit our his­tory and cul­tural her­itage.”

The next foun­da­tional level of the pyra­mid is sim­ply water, either on its own or in the form of herbal infu­sions. As with most vari­a­tions of the Mediterranean diet, the con­sump­tion of both car­bon­ated and caf­feinated drinks is actively dis­cour­aged. The European Union-funded MedDiet project rec­om­mends drink­ing at least 1.5 to two liters of water every day.

Next in the pyra­mid come those foods that should be used to put together every main meal. All vari­a­tions on the Mediterranean diet pri­or­i­tize veg­eta­bles here, with two or more serv­ings per meal, and at least one being raw.

Choosing a vari­ety of dif­fer­ent col­ors and tex­tures increases the diver­sity of antiox­i­dants and vit­a­min and min­eral com­bi­na­tions. This is a tech­nique that insti­tu­tions such as the American Institute for Cancer Research, the American Heart Association, and the United States Department of Agriculture Food and Nutrition Service have referred to as ​“eat­ing the rain­bow.”

After veg­eta­bles come fruit and cere­als. Although all cere­als pro­vide nec­es­sary car­bo­hy­drates, whole grains are prefer­able because they retain many valu­able nutri­ents and sig­nif­i­cantly more fiber. Studies in India, for exam­ple, have sug­gested that recent large increases in type 2 dia­betes in the coun­try are due in part to refined grains tak­ing the place of more tra­di­tional unprocessed forms.

Also at this level is olive oil. Olive oil, par­tic­u­larly extra vir­gin olive oil (EVOO,) is per­haps the most well-known com­po­nent of the Mediterranean diet. The total amount of lipids (fats and oils) in these types of diets is often off-putting to peo­ple used to fol­low­ing North American or Northern European nutri­tional guides.

The lipids from olive oil are monoun­sat­u­rated, how­ever. The dis­cov­ery that monoun­sat­u­rated fat could be ben­e­fi­cial came from the famous Seven Countries Study of the 1960s.

It revealed that peo­ple in Greece and other parts of the Mediterranean enjoyed a low rate of heart dis­ease despite a high-fat diet. The main fat in their diet, though, was not the sat­u­rated ani­mal fat com­mon in coun­tries with higher rates of heart dis­ease, but olive oil. EVOO addi­tion­ally con­tains higher con­cen­tra­tions of var­i­ous com­pounds such as polyphe­nols.

At the every­day level of the pyra­mid come olives, nuts and seeds, pri­mar­ily for snack­ing or as side dishes, which intro­duce extra sources of pro­teins, vit­a­mins, min­er­als and fiber; and twice-daily serv­ings of low-fat dairy prod­ucts.

While an excess of sat­u­rated fat has been asso­ci­ated with increased heart dis­ease, small amounts are nec­es­sary as part of a bal­anced diet. In most forms of the Mediterranean diet, these are pro­vided by a mod­er­ate intake of dairy prod­ucts, which also pro­vide vital sources of cal­cium.

Also at the every­day level are herbs, spices, onion and gar­lic. Not only do these add vari­ety and enjoy­ment to both cook­ing and eat­ing, but many have also been shown to have pos­i­tive effects on the immune sys­tem, as well as inher­ent anti-bac­te­r­ial, anti-viral and anti-fun­gal prop­er­ties.

Finally, there are those foods that add addi­tional sources of both plant and ani­mal pro­teins through­out the week. Fish, seafood, legumes (beans, pulses, etc.,) eggs, and white meat are the most impor­tant part of this group.

A very small quan­tity of red and processed meat can be ben­e­fi­cial but should be kept to a min­i­mum. This is also the case for pota­toes, gen­er­ally used as an ingre­di­ent in cer­tain tra­di­tional recipes. Foods and drinks con­tain­ing refined sug­ars are regarded as items saved for spe­cial occa­sions, and not for reg­u­lar con­sump­tion.

Both the Mediterranean Diet Foundation and the MedDiet project rec­om­mend mod­er­ate por­tion sizes for all meals of the day, although this is much less impor­tant than over­all diet qual­ity accord­ing to Dariush Mozaffarian, a car­di­ol­o­gist and dean at Tufts University’s school of nutri­tion sci­ence and pol­icy.

He points out that ​“sub­op­ti­mal diet qual­ity is now the lead­ing mod­i­fi­able cause of death and dis­abil­ity in the world. In con­trast to the erro­neous notions that diet quan­tity – how much a per­son eats – or iso­lated sin­gle nutri­ents are most impor­tant, the most rel­e­vant char­ac­ter­is­tics of health­ful diets are the over­all pat­terns of foods con­sumed.”

In his view, the Mediterranean diet is one of the best ways to increase people’s over­all diet qual­ity, say­ing, ​“tri­als con­sis­tently demon­strate sig­nif­i­cant ben­e­fi­cial effects of Mediterranean-type diets and their com­po­nents on car­diometa­bolic risk fac­tors and dis­ease end­points.”

“Mediterranean diets also improve glycemic con­trol and reduce the inci­dence of type 2 dia­betes,” Mozaffarian con­cluded. ​“The key com­po­nents of Mediterranean diets are also ben­e­fi­cial for weight loss in obese patients and for pre­vent­ing long-term weight gain in non-obese pop­u­la­tions.”

Following the Mediterranean diet, in whole or in part, is remark­ably sim­ple com­pared to the raft of health ben­e­fits that it can bring.

• Mediterranean Diet Foundation
• BMC Medicine
• MedDiet Project