The Mediterranean diet (Η Μεσογειακή διατροφή)

I rarely get my food cooked for me, and it is a real treat when I even get it served to my table. It's just the same with my writing. I write everything I post on my blog myself, but today, I'm going to present something to you that has been written especially for my blog by someone else. Coming from a Greek background, I can personally attest to the many health benefits of the Mediterranean diet. So can other Greeks, especially those who work in the health sector, where nutrition and holistic health are part of their work, so it only makes sense that I should introduce them in my blog. Matt Papa has been working as a post-doctoral fellow at the Department of Biochemistry and Molecular Biology in the School of Medicine in Washington University (St Louis, Missouri) since he got his Ph. D. from Patras University in Greece. Thankfully, his hard work has paid off as he was awarded two research grants from the American Heart Association to study the role of coagulation factors in cardiovascular diseases. Part of the results of this ongoing work have already been published in peer-reviewed journals. Here is what he has to say about the Mediterranean diet. He validates his claims with references that can be traced to scientific studies.

Over the last twenty years, more and more people around the world have adopted the Mediterranean Diet (MD) into their lifestyle. The MD’s association with longevity is supported by extended clinical research. Several studies have demonstrated that those who adhere to the principles of the MD are likely to experience a lower risk of cardiovascular disease, stroke and cancer, and feel a lower impact of menopause and age-related cognitive decline.

The MD is a nutritional model that is based on the dietary values of those living in the Mediterranean basin, namely Southern Italy, Greece, Cyprus, Spain, Portugal and Turkey. Back in 1966, the World Health Organization led a thirty-year study that noted the health and nutrition of 13,000 participants aged 40-59 [1]. The study concluded that Cretan men (people who live in the Greek island of Crete) had particularly low risk rates associated with heart disease and a longer life expectancy.* This stimulated interest around the world in the MD.

The MD is not really a diet in the sense that it is not a weight loss plan. It is a nutritional model, a summary of the patterns of food and drink as observed around the Mediterranean basin. The MD itself is about eating healthy food in moderation. Main meals are made up primarily of whole grains and minimally processed foods, like couscous, pasta and legumes, fresh seasonal vegetables and moderate amounts of fish, poultry and eggs. Plenty of fresh fruit is also consumed along with a moderate amount of nuts. Low amounts of dairy, comprising of cheese and yogurt, are also included. Sweets including pastries, ice cream and cookies are eaten at infrequent intervals and red meat less often. Red wine is often consumed with meals, but usually not more than one or two glasses a day.

LONGEVITY: There is no one feature of the MD that will help you live longer. Instead, there are several beneficial components that work together to promote health and vitality. Across the board, many studies have shown that those who adhere to the MD experience longevity. One of the largest scale studies into the health benefits of the MD was the European Perspective Investigation into Cancer and Nutrition (EPIC), which assessed a population sample across nine countries in relation to health and the MD. This study found that those who follow the diet live longer than those who don’t [2]. In America, the MD has been shown to have a similar effect on longevity. In 1995 the US National Institute of Health-AARP surveyed 3.5 million people across America on their dietary habits and followed their progress. Those who followed the MD were 20% less likely to have died from heart disease or cancer over a period of 10 years [3].

CORONARY DISEASE: What do they all have in common? Well, all of them are the biggest killers in America today. While genetics play a role in all of the diseases listed above, environmental factors, such as diet, have a huge impact on your risk factor for developing these illnesses. The MD lowers the risk factor for all of these diseases. Cardiovascular diseases are the number one killer in America today. In 2006, over 80,000,000 people suffered a form of cardiovascular disease including heart attack, stroke, hypertension or heart disease [4]. It has been observed that a low fat diet that consists of unprocessed foods dramatically reduces the risk of cardiovascular disease. Interestingly, studies have shown that the MD reduces this risk even further. The EPIC study assessed the effect of adherence to the MD (through a 10-unit scale) on survival among people 60 years old or older who had suffered myocardial infarction. Those who increased their adherence to the MD by 2 units showed an 18% lower overall mortality rate than those who did not [5].

BLOOD PRESSURE: Following the MD can also reduce hypertension (high blood pressure). Nutrition is recognized as a contributing factor to hypertension. Increasing fruit and vegetables to the diet and cutting out salty snacks, and foods high in saturated fat, will make drastic changes to those who suffer from hypertension. It has been noted that the MD, in particular the frequent use of olive oil, substantially reduced the levels of blood pressure in Greek males [6]. In the EPIC cohort it was noted that eating plenty of fresh vegetables and olive oil correlated with low blood pressure.

METABOLIC SYBDROME (METS): METS is diagnosed in a person that displays 3 out of 5 characteristics associated with a high risk factor for cardiovascular disease. These are an increased waist circumference, elevated triglycerides, reduced HDL (good cholesterol), hypertension and elevated fasting glucose levels. It is estimated that 50,000,000 Americans are currently suffering from the metabolic syndrome. Studies have demonstrated that the MD reduces the METS across a population. The ATTICA study reported that a diet, like the MD, which includes a good amount of Omega-3 fatty acids, low amounts of trans and saturated fats and high amounts of grains, legumes, fruits and vegetables, drastically reduces the clinical and biological markers linked to the METS [7].

CANCER: Many of the foods that make up the MD are known to have anti-carcinogenic properties. Tomatoes, which are used quite a lot in Greek, Italian and Spanish cooking, contain lycopene, a powerful antioxidant, which has shown to reduce the risk of some cancers [8]. Also, the presence of fish in the diet shows a correlation with lowered incidences of cancer. The presence of wholegrain foods reduces the risk of developing malignant tumors in the body. A high intake of fruit and vegetables is also associated with a lowered risk of many cancers occurring.

WEIGHT LOSS: An estimated 30-50% of the population in the United States is regarded as obese and more so as overweight. With the high risk factors of diabetes, hypertension and cardiovascular disease associated with being overweight, working towards a healthy BMI (Body Mass Index) is more important than ever. Making the MD a part of your life can help you lower and control your weight. An antidote to many of the fad diets that have gained popularity in recent years, the MD is a healthy and sustainable way to achieve good health and lose weight at the same time. In Spain, those who followed the Mediterranean Diet were more likely to have a healthy BMI. The same study found that women who combined the MD diet with a light exercise program lost significant weight over a four-month period [9].

BONE METABOLISM: Across the Mediterranean there is a lower incidence of osteoporosis than in other parts of the world. This is considered to be in part due to dietary habits. A diet high in fruits and grains is thought to improve bone metabolism. Research has shown that an increase in fruit consumption prevents calcium loss from bones [10].

MEMORY: Foods that are rich in antioxidants have proven to be beneficial to the central nervous system, helping neuron function throughout the body. Specifically, the MD helps prevent Alzheimer’s disease, and even helps lessen the severity of the condition for those who already suffer from this ailment [11].

Perhaps the most celebrated and well-documented aspect of the Mediterranean diet is the olive oil, which comes from the tree Olea europea. For centuries, olive oil has been an important part of the Mediterranean lifestyle. In Roman times, many people considered eating animal meat the act of barbarian nomads, and instead got their protein and fat requirements from fish and olive oil. Olive oil is a natural juice with hundreds of micro-components of biological significance. It contains high amounts of antioxidants and mono-unsaturated fatty acids, which are known to decrease cholesterol levels as well as discourage inflammation and protect from cardiovascular disease.

Over 1/5 of the weight of our brain is made up of fatty acids, 20% of them being omega-3 DHA. Consumption of fish has been linked to brain and cardiovascular health. It has been suggested that a high intake of the unsaturated fatty acids contained in fish, as opposed to consumption of saturated fats, can improve cognitive performance. The omega-3 fatty acids, contained in sardines and anchovies, have anti-inflammatory and vasodilatory properties.

Fruit and vegetable intake is also important. The antioxidant content of fresh fruits and vegetables has been shown to protect against heart disease and cancer. Specifically, the lycopene in tomatoes, which are a big part of the MD, has shown to ameliorate hypertension and cardiovascular disease, protect the skin from the harmful UV rays and lower the risk of many chronic diseases.

Wine, in particular red wine, is healthy for the heart. This fact has been well publicized over the last decade. It is noteworthy that studies into the benefits of wine have all reflected that intake should be in moderation. Once you increase your consumption past two glasses a day you start to lose the benefits.

Nuts are also an important part of the MD as another source of unsaturated fat. In a recent study, it was found that those who met the criteria for the METS helped alleviate symptoms by consuming roughly 30g of mixed nuts per day.

Sweet made from grape must

It remains unknown how the traditional MD increases life expectancy. Is it the antioxidants in the fresh fruits and vegetables? The polyphenols in the red wine? The healthy fats in fish, olive oil and nuts? The siesta (afternoon nap), which has been inversely associated with coronary mortality, or the exposure to sunlight? It is probably a combination of all these.

CONCLUSION: One of the most important studies on the “longevity” effect of the MD was conducted in 2004 by Dr Knoops and his group. They published the results of the HALE (Healthy Aging: a Longitudinal study in Europe) project. People who followed the MD had at least a 20% lower chance of dying over a 10-year period than those who were not on such a diet. And this was independent of their age, gender or body weight [12].

REFERENCES:
1. Keys A, Aravanis C, Blackburn HW, et al. Epidemiological studies related to coronary heart disease: characteristics of men aged 40–59 in seven countries. Acta Med Scand Suppl 1966; 460: 1–392.
2. Trichopoulou A, Orfanos P, Norat T, et al. Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ 2005; 330: 991.
3. Mitrou PN, Kipnis V, Thiébaut AC, et al. Mediterranean dietary pattern and prediction of all-cause mortality in a US population: results from the NIHAARP Diet and Health Study. Arch Intern Med 2007; 167: 2461–8.
4. American Heart Association
5. Trichopoulou A, Bamia C, Norat T, et al. Modified Mediterranean diet and survival after myocardial infarction: the EPIC-Elderly study. Eur J Epidemiol 2007; 22: 871–81.
6. Psaltopoulou T, Naska A, Orfanos P, Trichopoulos D, Mountokalakis T, Trichopoulou A. Olive oil, the Mediterranean diet, and arterial blood pressure: the Greek European Prospective Investigation
7. Panagiotakos DB, Pitsavos C, Skoumas Y, Stefanadis C. The association between food patterns and the metabolic syndrome using principal components analysis: the ATTICA study. J Am Diet Assoc 2007; 107: 979–87.
8. Unlu NZ, Bohn T, Francis DM, Nagaraja HN, Clinton SK, Schwartz SJ. Lycopene from heat-induced cis-isomer-rich tomato sauce is more bioavailable than from all-trans-rich tomato sauce in human subjects. Br J Nutr 2007; 98: 140–6.
9. Schröder H, Marrugat J, Vila J, Covas MI, Elosua R. Adherence to the traditional Mediterranean diet is inversely associated with body mass index and obesity in a Spanish population. J Nutr 2004; 134: 3355–61.
10. Prynne CJ, Mishra GD, O’Connell MA, et al. Fruit and vegetable intakes and bone mineral status: a cross sectional study in five age and sex cohorts. Am J Clin Nutr 2006; 83: 1420–8.
11. Scarmeas N, Luchsinger JA, Mayeux R, Stern Y. Mediterranean diet and Alzheimer disease mortality. Neurology 2007; 69: 1084–93.
12. Knoops KT, de Groot LC, Kromhout D, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA 2004; 292: 1433–9.

About the Author: Matt Papa, PhD, is a research fellow at Washington University School of Medicine in St. Louis, MO. Matt believes in sustaining a healthy lifestyle though nutrition and exercise. Born and raised in Greece, he has enjoyed the Mediterranean Diet his whole life, and also seen the benefits it provides first-hand. In his free time, Matthew develops his website where he provides information on best rated weight loss programs and offers a coupon for the Medifast diet. He also publishes articles on various weight loss procedures such as the intragastric balloon procedure in Texas.

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