Mediterranean Diet – A Heart Healthy Diet

Cretans from the Greek island of Crete and other Greeks live longer than many other populations in the world. They are 20% less likely to die of coronary artery heart disease than the people living in North America. Along with populations of southern Italy, they also enjoy a significant decrease in the incidence of chronic diseases. This health bonanza has been attributed primarily to their diet. In 2002, Curtis and O’Keefe in the Postgraduate Journal, suggested that the Mediterranean Diet could be the new ‘Gold Standard’ for heart disease prevention. (Curtis B, O’Keefe J. Understanding the Mediterranean Diet: Could This Be the New “Gold Standard” for Heart Disease Prevention? Postgraduate Medicine. 2002; 112(2):35-8.). These populations have an unique dietary tradition – they regularly use liberal amounts of olive oil, nuts, grains, beans, fruits and vegetables in their food. They also eat fish regularly and indulge in moderate amount of wine drinking. Their diet is limited in red meat, refined grains, sugars and processed food items. The effects include an improvement in lipid profile, reduction in blood pressure, decrease in insulin resistance and induces favorable changes in the markers of inflammation – leading to decreased heart disease.

As mentioned above,adherence to the Mediterranean diet also protects against several chronic diseases. (Gjonça A, Bobak M. Albanian Paradox, Another Example of Protective Effect of Mediterranean Lifestyle? Lancet. 1997;350:1815-7.) Two major benefits are:

Decrease in the risk of developing diabetes mellitus: M Á Martínez-González and associates followed13 380 Spanish university graduates without diabetes at baseline followed them for a median of 4.4 years. They found that those who adhered to the Mediterranean diet had a lower risk of developing diabetes. (M Á Martínez-González, C de la Fuente-Arrillaga, J M Nunez-Cordoba et al. Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. BMJ 2008;336:1348-1351). The benefits accrued from decreases in insulin resistance and increases in insulin sensitivity. Mediterranean diet is also inversely associated with the metabolic syndrome – a key risk factor associated with the development of diabetes.

Decrease in cancer: In 2004 Trichopoulou noted that one reason for the increase in longevity in people following the Mediterranean diet was a reduction in the incidence of cancer. (Trichopoulou A, Critselis E. Mediterranean diet and longevity. European Journal of Cancer Prevention. 2004;13(5):453-6.). A recent report has again verified these findings (Benetou V, Trichopoulou A, Orfanos P. Conformity to traditional Mediterranean diet and cancer incidence: the Greek EPIC cohort. British Journal of Cancer. 2008;99:191-5.). The cancer risk can be cut by almost 12% by just adding a few elements of the Mediterranean diet to the western diet – reducing red meat intake and increasing the intake of peas, beans, lentils and olive oil. Scientists reached this conclusion after monitoring the detailed dietary records of over 26,000 Greek men and women, over a period of eight years.

Other benefits noted and well documented in clinical studies include improvement in Alzhiemer’s disease, Parkinsons disease, rheumatoid arthritis, depression and body weight. This was recently confirmed again in a study by Sofi and associates and published in the British Medical Journal of 12 September, 2008.

It stands to logic that the reduction in chronic diseases, especially heart ailments, diabetes and cancer should lead to an increased longevity. And the data has supported this:

Increase in life span: Knoops and associates studied 1,507 healthy men and 832 healthy women aged 70-90 years in 11 European countries (including Italy, Finland, and the Netherlands) between 1988 and 2000. They found that maintaining a Mediterranean diet and a healthy lifestyle resulted in a more than 50% lower risk of death for people 70-90 years old. ( Knoops K, de Groot L, Kromhout D, et al: Mediterranean Diet, Lifestyle Factors, and 10-year Mortality in Elderly European Men and Women. The HALE Project. JAMA 292:1433-1439, 2004.) Recent data from a study from Northern Europe shows that this diet also reduces mortality in younger people. (Lagiou P, Trichopoulos D, Sandin S, et al. Mediterranean dietary pattern and mortality among young women: a cohort study in Sweden. British Journal of Nutrition. 2006;96(2):384-92.) The reduction appears to be due to several factors, including reductions in cancer and cardiovascular deaths.

To summarize, healthy ‘Mediterranean’ food advice is:

Eat less red meat.

Consume less milk and dairy products like cream and cheese.

Eat more fish, especially cold water fish.

Switch to olive oil.

Eat more grains, seed and nuts.

Avoid refined grains and processed foods.

Eat more fruits and vegetables and legumes.

And drink alcohol moderately, especially red wine with meals.

Remember what researcher W.C. Willet, said “Together with regular physical activity and not smoking, our analyses suggest that over 80% of coronary heart disease, 70% of stroke, and 90% of type 2 diabetes can be avoided by healthy food choices that are consistent with the traditional Mediterranean Diet.” (Willett WC. The Mediterranean diet: science and practice. Public Health Nutrition. 2006;9(1A):105-10.).