The Mediterranean Diet: Is it Really the World's Healthiest Diet? -

Kaitlin Little

Embraced by medical professionals and dietitians across the globe, the Mediterranean diet has been hailed as one of the healthiest ways to eat in the world. The diet draws upon the traditional foods and cooking styles of countries bordering the Mediterranean Sea, such as Greece and Southern Italy.

During the mid-20th century, these countries had low rates of chronic disease and a longer average life expectancy compared to Western populations. Since access to healthcare was limited, researchers believed that their diet was the key to their exceptional health.

What is the Mediterranean Diet?

More than 18 countries border the Mediterranean Sea, each with their own natural resources and eating patterns. Hence, there are many different ways to follow the Mediterranean diet. However, generally speaking, the diet emphasizes fruits, vegetables, fish, whole grains, and healthy fats, while limiting dairy foods, poultry, and red meat. You can even have a liberal splash of olive oil and a glass of red wine!

Although, it’s not just about eating fresh, wholesome foods—daily exercise and sharing meals together are vital aspects of the Mediterranean diet too.

Foods to eat:

Eat every day: fruits, vegetables, nuts, seeds, legumes, whole grains, herbs, spices and healthy fats, such as extra virgin olive oil.
Eat twice a week: Fish and seafood.
Eat in moderation: Eggs, poultry, yogurt, and cheese.
Eat rarely: Red meat (no more than twice a month).

Foods to avoid:

Salt: Flavor foods with herbs and spices instead of salt.
Butter and Margarine: Replace with healthy fats such as olive oil and canola oil.
Processed sugar: Replace cakes, pastries, candy, and chocolate bars with fresh fruit.
Refined grains: Replace white bread, white pasta, and white rice with wholemeal, multi-grain varieties.
Processed meats: Choose fish as the preferred animal protein, avoiding sausages, hot dogs and cured meats

What to drink:

Water: Choose water as your main daily beverage, aiming for at least 2 liters per day.
Wine: Consume an optional wine with meals, around one glass a day.
Coffee and tea: Allow caffeinated drinks but avoid added sugar.

Also, avoid beverages with added sugar or artificial sweetener, including:

Soda and diet soda
Fruit juice
Sports drinks
Flavored water

Health Benefits of the Mediterranean Diet

Studies over the past several decades have consistently shown that the Mediterranean diet promotes longevity and is highly protective against the development of chronic diseases. [1]

Helps Prevent Cardiovascular Disease

It’s not called the “Heart Healthy” diet for nothing. A large study of almost 26,000 American women found that those who followed the Mediterranean diet for 12 years had a 28% lower risk of developing cardiovascular disease, such as a heart attack or stroke. [2] The diet improves known cardiovascular risk factors, including weight, blood pressure, cholesterol, markers of inflammation, and blood glucose. [3]

Furthermore, the Mediterranean diet has proven superior to the traditional low-fat diet in the prevention of cardiovascular disease. A ground-breaking 2018 study published in the New England Journal of Medicine assessed the connection between the Mediterranean diet and cardiovascular health in over 7,000 high-risk Spanish individuals. Participants followed an unrestricted Mediterranean diet, supplemented with extra virgin olive oil and mixed nuts for nearly 5 years. Researchers found that those who adhered to the Mediterranean diet had a 30% lower incidence of heart attack, stroke, and cardiovascular-related death compared to those on a calorie-controlled low-fat diet. [4]

Interestingly, a typical Mediterranean diet contains up to 42% of total caloric intake from fat, which is much higher than the 20-35% advised by national guidelines. [5] However, the diet contains just 7-8% saturated fat, which is well aligned with recommendations by the American Heart Association.

In fact, one of the main reasons the Mediterranean diet is believed to confer protection against cardiovascular disease is the diet’s fat profile. It has a high percentage of healthy monounsaturated and polyunsaturated fats (such as those from oily fish, nuts, and olive oil) compared to unhealthy saturated and trans fat (such as those from processed meats, fried foods, and baked goods). This fat profile can help lower LDL “bad” cholesterol and increase HDL “good” cholesterol. LDL cholesterol can contribute to the narrowing of arteries, a significant risk factor for heart attack and stroke. [6]

But there’s even more! Certain polyunsaturated fatty acids, like alpha linoleic acid, and plant proteins called polyphenols are also thought to reduce cardiovascular risk by lowering systemic inflammation. [7]

Decreases Risk of Type 2 Diabetes

Adopting a Mediterranean diet can also help prevent the development of type 2 diabetes. Two large long-term studies both recently reported that a greater adherence to the Mediterranean diet substantially lowers risk of type 2 diabetes by 35% to 83%. [8]

Furthermore, in 2009 researchers found that a Mediterranean type diet can not only prevent diabetes, but also help diabetics manage their blood glucose (sugar) levels. People with diabetes who followed a Mediterranean eating plan had lower HbA(1c) levels in their blood two hours after consuming a meal, which indicates greater blood glucose control. [9]

One of the main reasons for this improvement is that foods on the Mediterranean diet typically have a low glycemic index. Glycemic Index (GI) indicates how much a food is expected to raise blood sugar. Eating low GI foods stabilizes blood glucose levels and reduces stress placed on the pancreas to produce insulin.

May Protect Against Cancer

Several long-term prospective studies show that the Mediterranean diet can reduce the risk of cancer, including colorectal, breast, prostate, liver, and head and neck cancers. [10]

In a recent analysis of 26,000 Greek men and women from the European Prospective Investigation into Cancer and Nutrition, researchers found that adherence to the Mediterranean diet over eight years conferred a 12% reduction in the overall incidence of cancer. [11]

Another prospective study conducted by the National Institutes of Health further elucidated this connection by analyzing the effects of dietary patterns on all-cause mortality on almost 380,000 men and women in the United States. According to the results, the Mediterranean diet was, yet again, associated with a 12% reduction in cancer mortality and a 20% decrease in all-cause mortality. [1]

The protective effects of the Mediterranean diet against cancer may be mediated by a reduction in oxidative stress and chronic inflammation. Due to a high intake of colorful fruits and vegetables, nuts, seeds, and even a glass of red wine, the diet delivers a rich dose of antioxidants. Antioxidants play a significant role in reducing and preventing cell damage caused by an accumulation of free radicals. Free radicals are unpaired molecules that can wreak havoc throughout the body by attaching to healthy cells in a process known as oxidative stress.

Helps Preserve Memory and Cognitive Function

Eating the Mediterranean way may help prevent age-related cognitive decline and ward off diseases that affect memory, including Alzheimer’s disease and other types of dementia. In one study, researchers found that the Mediterranean diet combined with physical activity was associated with a 40% decline in Alzheimer’s disease risk. [16]

Eating an abundance of antioxidant-rich foods is thought to protect brain cells by preventing oxidative stress. Healthy fats in the Mediterranean diet may also improve blood flow to the brain by helping to maintain healthy blood vessels.

The Mediterranean Diet and Weight Loss

It is well established that the Mediterranean diet reduces the risk of chronic disease and promotes longevity, but does the Mediterranean diet facilitate weight loss despite its high fat content? The short answer is yes.

A 2018 systematic review recently assessed the effectiveness of the Mediterranean diet for long-term weight management in overweight and obese individuals. Researchers identified five clinical trials with a total of nearly 1,000 participants and reported that the Mediterranean diet resulted in a 50% greater weight loss than traditional low fat diets after 12 months ( 9-22 lbs vs. 6-11 lbs). However, weight loss was similar to other high-fat diets, such as the Atkins diet. [12]

The Mediterranean diet has also been compared to the vegetarian diet. In one study, researchers found that both diets reduced total body weight by about 4 pounds and improved body composition by reducing fat mass equally. [13]

How Does the Mediterranean Diet help Weight Loss?

While the Mediterranean diet isn’t usually recommended for weight loss, studies show that it is more effective than traditional low fat diets. When followed properly, the Mediterranean diet may:

Increase Satiety

Eating an abundance of plant-based foods and dietary fiber makes you feel full. It has been suggested that these foods promote feelings of fullness due to prolonged chewing, slow stomach emptying, and the enhanced release of hunger-suppression hormones, like leptin. [14] Plus, fruits and vegetables have high water content, which also contributes to satiety and a lower calorie intake.

Promote Fat Burning

The Mediterranean diet has a favorable fat profile for weight loss. The high percentage of monounsaturated fats compared to saturated fats has been shown to increase fat oxidation within the body. Greater fat oxidation means increased fat burning and less fat storage, which in terms of weight loss is highly beneficial. [15]

Reduce Sugar Cravings

The Mediterranean diet is rich in low glycemic index (GI) carbohydrates including whole-grain bread, legumes, lentils, and fiber-rich fruits and vegetables. These foods raise blood glucose levels slowly and provide a sustained energy source without extreme sugar peaks or energy slumps. By limiting high GI foods, such as refined white bread, processed baked goods, and sugary breakfast cereals, a Mediterranean meal plan can improve blood glucose regulation and reduce your cravings making it easier to avoid overeating.

Increase the Consumption of Nutritious, Naturally Lite foods

The habitual use of olive oil in salads, vegetables, legumes, and fish dishes enhances the palatability of these foods. Consequently, you can increase your consumption of nutrient dense foods that are high in dietary fiber and low in energy density.

It Is Also Safe and Sustainable

The Mediterranean diet is well tolerated by most people because it encourages a diverse array of tasty foods. In fact, various studies show reasonably high adherence rates compared to other more restrictive diets. The Mediterranean diet also has a long history of safe use without adverse effects, as demonstrated by prospective decade long studies on Italian and Greek populations.

Potential Drawbacks of the Mediterranean diet

While the Mediterranean diet is one of the healthiest ways to eat, it does have some pitfalls.

Risk of Overeating

The Mediterranean diet does not state exact serving sizes but rather describes macronutrient distribution, which can be confusing for some people. For example, the diet uses words like “low” and “moderate” intake, which can be interpreted differently. This could lead to a surplus of calories, especially if you’re accustomed to following rigid serving sizes.

Daily Wine

When following the Mediterranean diet, one to two glasses of wine (moderate consumption) are encouraged. This may not be advisable for people with a history of alcohol abuse. Alcohol also has the potential to interact with certain medications and can lead to weight gain when consumed in excess.

Expensive

Depending on the season and availability of local produce, the diet can get pricey. Consuming fresh fish at least twice a week, a handful of nuts every day, and bundles of fresh produce with every meal can quickly add up.

Is the Mediterranean Diet for you?

Although you might have imagined eating loads of pizza, pasta, and gyros on the Mediterranean diet, I hope you can now see that the region’s present day practices don’t reflect their traditional way of eating.

Strong research supports the Mediterranean diet as a heart-healthy way of eating to promote longevity and help protect against chronic disease. The diet may also facilitate healthy weight loss, especially when used in conjunction with calorie restriction and exercise. So perhaps, the rumors are true—the Mediterranean diet may indeed be the world’s healthiest diet!

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