The Merits of the Mediterranean Diet

Finally, an eating style that is easy to follow, is heart-protective and tastes good, too!

With obesity rates escalating and activity rates declining, it’s no wonder that 1 in 5 Americans has at least one form of cardiovascular disease, such as high blood pressure, heart attack or stroke (American Heart Asso­ciation 2003). Is it possible to reduce the risk of getting one of these crippling conditions by making simple changes to our diets?

The research says yes, but the challenge lies in persuadingpeople to change their fast-food lifestyles and their overreliance on processed foods. Faced with the prospect of making dietary changes, the majority of Americans still want to eat food that tastes good. What many don’t know is that they can if they follow the classic Mediterranean diet.

Mapping Out the Mediterranean Diet

The Mediterranean diet is not a new concept in nutrition, nor is it one of the latest fad diets (Haber 1997). Quite the opposite, since the benefits of this diet have been extolled since the Renaissance. The Mediterranean diet and variations on it are the traditional eating styles indigenous to certain regions of France, Italy, Spain, Portugal, Crete, Greece, North Africa (especially Morocco and Tunisia), the Balkan region and the Middle East.

Following the Mediterranean diet allows people to eat healthy meals and still enjoy delicious foods. The flavors and textures inherent in these foods are spectacular on their own, alleviating the need for heavy sauces, salty condiments or unnecessary processing.

What your clients may not know is how to get started on this diet or how to include Mediterranean foods easily into their current food plans. This article will describe the heart-healthy food groups that are staples in the Mediterranean diet and provide practical strategies on how to eat more of these foods on a regular basis.

What the Science Says

One reason why the Mediterranean diet continues to garner interest is its apparent ability to decrease coronary heart disease significantly. Scientific studies have indicated that the following two main components of the Mediterranean diet contribute to its heart-health benefits:

• low intake of cholesterol, saturated fat and trans fatty acids
• high intake of foods rich in protective antioxidants and phytochemicals, such as flavonoids, polyphenols and carotenoids

Researchers have also identified alpha-linolenic acid, an omega-3 fatty acid found in plant sources, as a significant heart-protective element in this diet. The landmark Lyon Diet Heart Study catapulted what has come to be called “The French Paradox” into the international limelight (Simini 2000). The dramatic results of this study showed a 70 percent reduction in overall deaths and cardiovascular events in French subjects who adhered to a Mediterranean diet, with the protective effect occurring within just 2 months of starting the diet!

Scientists were baffled that the traditional French diet of calorie-laden meals accompanied by copious amounts of wine could confer any health benefit at all, let alone one so dramatic. In fact, the results seemed to fly in the face of all government recommendations advising Americans to adhere to low-fat, low-carbohydrate eating plans for optimal health. And yet, other studies conducted before and since, such as Ancel Keys’s Seven Countries Study, have attested to the pro­tective health benefits derived from eating a traditional Medi­terranean diet (Keys 1995; Willet et al. 1995).

Elements of the Mediterranean Diet

Dietary habits vary among the residents of different Mediter­ranean countries, sometimes even within a certain coun­try. For example, diets change in nature from northern to southern Italy, with northern dwellers consum­ing more meat and dairy products. How­ever, one consis­tent element of the Medi­ter­ranean diet is that it is closely tied to areas of olive oil cultivation within the Mediter­ranean region.

Mainly vegetarian, the Mediterranean diet consists largely of these heart-healthy components:

• a daily abundance of fruits, vegetables, whole grains, beans and nuts
• several servings of fish per week
• less frequent consumption of red meat (a few times per month)
• olive oil as the principle fat
• moderate consumption of wine with meals

Whole Grains

Whole grains are integral to the Mediter­ranean diet. A whole grain is defined as the entire edible part of any grain, including the bran, endo­sperm and germ. Whole grains are minimally processed and take longer than white flour to be diges­ted into the bloodstream.

Whole grains are superior to processed grains in part because of the way the human body digests carbohydrates. When any carbohydrate is ingested, the body releases insulin to transport the glucose (the storage form of carbohydrate) from the bloodstream to the cells. If a large amount of processed carbohydrate (e.g., a huge bowl of white-flour pasta) is ingested, the body can overreact and produce too much insulin, lowering blood glucose levels too far. This signals the brain to get more glucose and revs up the body’s hunger mechanism, which can ultimately lead to overeating and weight gain.

Packed with antioxidants, phytochemicals, vitamins, minerals, protein, folate and fiber, whole grains have been linked to a reduced risk of heart disease and lower incidences of diabetes and cancer (Salmeron et al. 1997; Jacobs et al. 1998; Liu et al. 2000).

Fruits and Vegetables

While most Americans consider vegetables a side course to meat entrées, people living in the Mediterranean regions often build their entire meals around fresh fruits and vegetables. At best, Americans struggle to get four daily servings of fruits and vegetables, missing the government’s five-a-day target for this important food group (Krebs-Smith et al. 1995).

Fruits and vegetables contain numerous compounds—many still being discovered—that contribute positively to the biological activity of the human body (Brown et al. 1999; Aldoori et al. 2002; John et al. 2002; Key et al. 2002). For example, these important foods provide fiber, which delays the absorption of carbohydrates and fats, helping stabilize blood sugar levels. The vitamins and minerals plentiful in plant foods show promise in the fight against cancer, heart disease, stroke, high blood pressure, diabetes and osteoporosis.

How to Add More Fruits and Veggies to Your Diet:

• Instead of reaching for the usual iceberg lettuce, Red Delicious apples or navel oranges, opt for a variety of different fruits and vegetables (especially ones that have deep color). ‰
• When fresh produce is not available, use canned or frozen fruits and vegetables.
• Add fruit to smoothies, cereal and yogurt.
• Mix veggies into stir-fry dishes and salads.
• Grate carrots and zucchini into pasta sauces to thicken; add puréed or cooked fruits and vegetables to baked goods or soups, stews and chili.

Legumes and Nuts

One hallmark of the Mediterranean diet is the low amount of red meat consumed. With less protein coming from animal sources, alternative sources of protein are important. Two protein sources integral to the Mediterranean diet are legumes and nuts. Best of all, legumes provide needed protein without adding any cholesterol to the diet—and only a minimal amount of saturated fat.

Legumes, such as beans, are heart protective and provide a host of nutrients, such as folate, fiber, iron and potassium, each offering a unique health benefit (Bazzano et al. 2001; Hernandez-Diaz et al. 2002). For example, too little folate has been linked to high homocysteine blood levels, a risk factor for heart disease. The soluble fiber in beans helps remove cholesterol from the body. Iron is vital for oxygen transport and red blood cell formation, whereas potassium helps maintain fluid and electrolyte balance, as well as cell integrity.

Nuts have long been negatively considered diet busters owing to their high caloric and fat content. However, nuts are also nutrient dense and have heart-protective properties (Hu et al. 1998). Re­searchers have found that adding nuts to the diet can increase satiety, which decreases food cravings. Nuts also boost intake of the omega-3 fatty acid alpha-linolenic acid, monounsaturated fats, vitamin E, folic acid, potas­sium and fiber.

Olive Oil

Olive oil is the principal fat in the Medi­terranean diet, replacing butter, margarine and other fats and oils. Olive oil is rich in mono­unsaturated fat, the type that lowers LDL (bad) cholesterol levels and protects HDL (good) cholesterol levels. Research suggests that olive oil contributes to better control of high triglyceride levels and may reduce the risk of breast and colorectal cancers (Owen et al. 2000). Additionally, olive oil may help people with inflammatory and autoimmune diseases, such as rheumatoid arthritis (Alarcon de la Lastra et al. 2001).

Although olive oil is a staple in the Mediterranean diet, it is 100 percent fat and has virtually the same caloric content as butter. (In fact, olive oil is often referred to as “Italian butter” and replaces butter on many restaurant tables in Mediterranean countries.) Using olive oil in small amounts is perfectly acceptable, but caution clients to limit their intake in order to manage calories and fat.

How to Add More Olive Oil to Your Diet:

• Skip the store-bought salad dressings; instead, mix extra-virgin olive oil with your favorite vinegar.
• Use olive oil (except strongly flavored extra-virgin varieties) in place of other fats when baking.
• Remember to use olive oil sparingly.

Fish

An important source of protein in the Mediter­ran­ean diet, fish also contains omega-3 fatty acids—essential fatty acids that must be obtained from food because the body can’t make them on its own. These fatty acids are important for cellular growth and contribute to hormone production. There is strong evidence linking omega-3 fatty acids to the prevention and treatment of heart disease (Albert et al. 1998; Carroll et al. 2002). Omega-3 fatty acids may also have a positive effect on autoimmune conditions, such as lupus and rheumatoid arthritis (Ernst et al. 1994).

The Mediterranean Diet Food Pyramid recommends eating fish several days each week. However, make sure you and your clients choose fatty varieties of fish, such as mackerel, lake trout, herring, sardines, tuna or salmon.

How to Add More Fish to Your Diet:

• Discover new varieties of fish by frequenting restaurants or markets that specialize in this cuisine.
• Try different preparation methods, such as grilling or poaching, when cooking fish at home.
• Add canned fish, like tuna and salmon, to salads, pastas and sandwiches.

Red Wine

One of the most curious aspects of the Mediterranean diet is the role that wine—especially red wine—plays in heart health. Although the current body of research is not conclusive, the polyphenolic compounds found in red wine have been linked to vascular relaxation, reduced inflammation and prevention of clot formation (Burns et al. 2001; daLuz et al. 2001; Muka­mal et al. 2003).

Although wine is a daily component of the Mediterranean diet, the consistent message conveyed by most medical experts is to consume wine in moderate amounts. This translates to one or two drinks a day for men, and no more than one drink a day for women. And if you don’t drink alcohol, don’t feel you have to start just because it may be heart protective!

Recipes for Good Health

The recipes on page 59 make good use of components of the Mediterranean diet. These are just two easy and delicious examples of how to include more of these healthful ingredients in your daily diet—without traveling all the way to the Mediterranean region! u

Cathy Leman, RD, LD, is an ACE-certified personal trainer and owner of NutriFit, a nutrition counseling/consulting and in-home personal training business specializing in nutrition and fitness for women of all ages. Based in Glen Ellyn, Illinois, she can be reached at nutri fit@sbcglobal.net.

Sidebar: References

Alarcon de la Lastra, C., et al. 2001. Mediterranean diet and health: biological importance of olive oil. Current Pharmaceutical Design, 7 (10), 933-50.
Albert, C.M., et al. 1998. Fish consumption and risk of sudden cardiac death. Journal of the American Medical Association, 279 (1), 65-6.
Aldoori, W., et al. 2002. Preventing diverticular disease: Review of recent evidence on high-fiber diets. Canadian Family Physician, 48, 1632-7.
American Heart Association. Cardiovascular disease statistics. www.americanheart.org; retrieved March 4, 2003.
Bazzano, L.A., et al. 2001. Legume consumption and risk of coronary heart disease in U.S. men and women: NHANES I Epidemiologic Follow-up Study. Archives of Internal Medicine, 161 (21), 2573-8.
Brown, L., et al. 1999. A prospective study of carotenoid intake and risk of cataract extraction in U.S. men. American Journal of Clinical Nutrition, 70 (4), 517-24.
Burns, J., et al. 2001. Alcohol consumption and mortality: Is wine different from other alcoholic beverages? Nutrition, Metabolism and Cardiovascular Diseases, 11 (4), 249-58.
Carroll, D.N., et al. 2002. Evidence for the cardioprotective effects of Omega-3 fatty acids. Annals of Pharmacotheraphy, 36 (12), 1950-6.
daLuz, P.L., et al. 2001. Alcohol and atherosclerosis. Anais da Acadamia Brasileira de Ciencias, 73 (1), 51-5.
Ernst, E., et al. 1994. Fish oils and rheumatoid arthritis. Ugeskrift for Laeger, 156 (23), 3490-5.
Haber, B. 1997. The Mediterranean diet: A view from history. American Journal of Clinical Nutrition, 66 (Supplement), 1053S-7S.
Hernandez-Diaz, S., et al. 2002. Dietary folate and the risk of nonfatal myocardial infarction. Epidemiology, 13 (6), 700-6.
Hu, F.B., et al. 1998. Frequent nut consumption and risk of coronary heart disease in women: Prospective cohort study. British Medical Journal, 317 (7169), 1341-5.
Jacobs, D.R., et al. 1998. Whole-grain intake and cancer: An expanded review and meta-analysis. Nutrition and Cancer, 30 (2), 85-96.
John, J.H., et al. 2002. Effects of fruit and vegetable consumption on plasma antioxidant concentrations and blood pressure: A randomized controlled trial. The Lancet, 359 (9322), 1969-74.
Key, T.J., et al. 2002. The effect of diet on risk of cancer. The Lancet, 360 (9336), 861-8.
Keys, A. 1995. Mediterranean diet and public health: personal reflections. American Journal of Clinical Nutrition, 61 (Supplement), 1321S-3S.
Krebs-Smith, S.M., et al. 1995. U.S. adults’ fruit and vegetable intakes, 1989 to 1991: A revised baseline for the Healthy People 2000 Objective. American Journal of Public Health, 85 (12), 1623-9.
Liu, S., et al. 2000. A prospective study of dietary glycemic load, carbohydrate intake and risk of coronary heart disease in U.S. women. American Journal of Clinical Nutrition, 71 (6), 1455-61.
Mukamal, K.J., et al. 2003. Roles of drinking pattern and type of alcohol consumed in coronary heart disease in men. New England Journal of Medicine, 9 (348), 109-18.
Oldways Preservation and Exchange Trust. 1999-2000. The Mediterranean Diet Food Pyramid. www.oldwayspt.org/index.html.
Owen, R.W., et al. 2000. Olive-oil consumption and health: The possible role of antioxidants. The Lancet, 1, 107-12.
Salmeron, J., et al. 1997. Dietary fiber, glycemic load and risk of non-insulin-dependent diabetes mellitus in women. Journal of the American Medical Association, 277 (6), 472-7.
Simini, B. 2000. Serge Renaud: From French Paradox to Cretan miracle. The Lancet, 355 (9197), 48.
Willet, W.C., et al. 1995. Mediterranean Diet Food Pyramid: A cultural model for healthy eating. American Journal of Clinical Nutrition, 61 (Supplement), 1402S-6S.

Cathy Leman, RD, LD

IDEA Author/Presenter

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Cathy Leman is a registered dietitian, NSCA-certified personal trainer, and the owner of NutriFit... moreCathy Leman is a registered dietitian, NSCA-certified personal trainer, and the owner of NutriFit, a nutrition therapy practice and personal fitness training studio in Glen Ellyn, IL. Cathy specializes in nutrition therapy for eating disorders, weight management, sports nutrition, and general nutrition for health. Cathy loves strength-based yoga, weight training, and has recently rekindled her adoration for running. Cathy conducts worksite nutrition education at Chicago area businesses and shares her passion for nutrition and fitness as a freelance author and in-demand speaker. less