Unlock the Secrets of the Mediterranean Diet for Ultimate Health and Longevity!

The Mediterranean diet has long been celebrated as a pathway to better health, drawing attention for its emphasis on fresh, whole foods and its association with reduced risk of various diseases. But what exactly is the Mediterranean diet, and why is it so beneficial? This article delves into the core principles of this dietary approach, exploring its historical roots, key components, and the latest scientific evidence supporting its positive impact on health.

The Origins of the Mediterranean Diet

The Mediterranean diet owes its fame to US physiologist Ancel Keys and his wife Margaret, a chemist turned nutritionist. In the 1940s, Ancel became one of the first to argue that saturated fats - mostly found in animal products like meat and dairy - are a major cause of heart disease because they lead to a build-up of cholesterol in the blood. Building on this, the couple travelled the world to study the diets people ate in different regions. The result was the Seven Countries Study, which began in 1956 and compared diet and health in parts of the US, Japan, Finland, the Netherlands, Italy, Greece and what was then Yugoslavia. During their work, Ancel and Margaret noticed something else. In one of their study areas - southern Italy - there were a surprisingly large number of centenarians. The pair became convinced that details of the local diet, which was high in unsaturated fat, were the key to this longevity. Ancel and Margaret began singing its praises, later even relocating to southern Italy to feel its benefits themselves. The fact that both of them went on to live long lives - Ancel died in 2004 at the age of 100; Margaret followed two years later, aged 97 - just seemed to add further credence to their message.

Defining the Mediterranean Diet

Despite its widespread recognition, defining the Mediterranean diet precisely can be tricky. Nutritionists don’t always agree on the exact form it should take. One of the most widely used definitions of what it should include is the Mediterranean Diet Score (MDS). This was developed in the 1990s by Antonia Trichopoulou, then at the National School of Public Health in Athens, Greece. According to the MDS, a fully Mediterranean diet is one containing lots of vegetables, legumes, fruits and nuts, cereals and a moderately high amount of fish. Other changes to the standard definition of the diet have accumulated over the years as researchers have continued to refine their understanding of the optimal form it should take for a prolonged healthy life.

Core Components of the Mediterranean Diet

The Mediterranean diet is characterized by a high intake of:

Vegetables: A cornerstone of the diet, with an emphasis on variety and abundance. Aim to add an extra serving of vegetables to both lunch and dinner, aiming for three to four servings a day. You don’t need to be eating Mediterranean vegetables like peppers and aubergines.
Fruits: Fresh fruit is preferred, aiming for three servings a day. Poached or fresh fruit is best.
Legumes: Such as beans, lentils, and chickpeas, consumed at least three servings a week.
Nuts: A good source of healthy fats and nutrients.
Cereals: Whole grains are favored, such as whole-grain bread or other whole grains. Select dense, chewy, country-style loaves without added sugar or butter.
Olive Oil: Especially extra-virgin olive oil, used as the primary source of fat. The Mediterranean diet is far more effective if it includes extra-virgin olive oil.
Fish: Eaten in moderately high amounts, aiming for two to three servings a week.
Dairy: Dairy is considered neutral now.
Wine: Often consumed in moderation, typically with meals. The amount of alcohol recommended has gone down too.

The diet also emphasizes limiting the consumption of red meat, sugary beverages, and high-fat, high-sugar desserts. Choose lean poultry in moderate, 3- to 4-ounce portions. Save red meat for occasional consumption or use meat as a condiment, accompanied by lots of vegetables, as in stews, stir-fries, and soups.

Health Benefits of the Mediterranean Diet

Evidence has been mounting for over 50 years that the Mediterranean diet really can improve your health in many ways. The benefits seem to extend beyond cardiovascular disease. A 2020 review concluded that people who follow the diet are 20 per cent less likely to develop type 2 diabetes than those who don’t.

Cardiovascular Health

The best evidence is for cardiovascular disease. There is also evidence that the diet reduces the risk of developing cardiovascular disease in the first place. A 2020 review by Cochrane, a UK charity that examines evidence on health issues, looked at 22 randomised controlled trials investigating this issue and found “moderate quality evidence” that the diet reduced cardiovascular risk factors.

Diabetes Prevention

Eating a Mediterranean-style diet with fewer calories, adding moderate physical activity, and receiving professional guidance for weight management can lower the risk of developing type 2 diabetes by 31%. The Mediterranean diet acts synergistically to improve insulin sensitivity and reduce inflammation. With PREDIMED-Plus, we demonstrate that combining calorie control and physical activity enhances these benefits.

Cognitive Function

People with multiple sclerosis who adhere to the Mediterranean diet are less likely to have issues with cognition. After adjusting for age, sex, race, socioeconomic status, sleep, exercise and other health-related factors, the researchers found that adherence to the Mediterranean diet was associated with a lower risk of cognitive impairment.

Other Potential Benefits

While some of these purported benefits may disappear as more rigorous studies are conducted, Martínez-González is confident that the diet is still worth adopting. There is growing evidence that its health benefits are partly explained by additional components that are lost if it is further processed to produce “refined” olive oil. These include a host of plant chemicals, one notable kind being polyphenols. The June review concluded that polyphenols were probably responsible for extra-virgin olive oil’s benefits. Personal genetics may play a role too, given evidence that specific nutrients in olive oil and other components of the Mediterranean diet may influence the activity of genes linked to things like inflammation.

Read also: Delicious Mediterranean Recipes

Factors Influencing the Diet's Effectiveness

The benefits were only seen in highly educated people and those with high household incomes. One possibility is that the details of what people eat really matter, says Bonaccio. “We ask people, for example, how many fruits you eat per day,” she says. But studies don’t ask about the type of fruit, how it was grown or the form it took. The quality of the food, she suggests, may play a role. This would fit the data: people from lower-income households may have little choice but to buy and eat cheaper frozen or processed foods, which may not be as nutritious as fresh foods.

The Importance of Lifestyle

It is possible that some of the reported benefits of the diet aren’t due to the food itself, but to the associated lifestyle. Bonaccio points out that the Mediterranean villagers studied by Ancel and Margaret Keys - and later by Trichopoulou - didn’t just eat a specific diet, “they also had a specific way of living”. For instance, they resided in the countryside and their work was often outdoors and physical. Other studies show such factors make a difference: research published in March 2023 found that walking just an extra 500 steps a day reduces the risk of cardiovascular disease in older adults. It is probably also significant that the Mediterranean villagers studied in the 20th century prepared their own food and often ate leisurely meals in social groups - which some research suggests boosts general happiness and life satisfaction, both of which are also linked to better health.

Adapting the Mediterranean Diet to Your Life

You don’t need to be eating Mediterranean vegetables like peppers and aubergines. Some components, like extra-virgin olive oil, would appear non-negotiable, however: Hoffman stresses its importance.

Practical Tips for Incorporating the Mediterranean Diet

Here are some small changes you can make. Pick one change every week and incorporate it gradually.

Switch from whatever fats you use now to extra virgin olive oil. Start by using olive oil in cooking, and then try some new salad dressings with olive oil as the base.
Eat nuts and olives.
Add whole-grain bread or other whole grains to the meal. Select dense, chewy, country-style loaves without added sugar or butter.
Begin or end each meal with a salad.
Add more and different vegetables to the menu. Add an extra serving of vegetables to both lunch and dinner, aiming for three to four servings a day.
Eat at least three servings a week of legumes.
Eat less meat. Choose lean poultry in moderate, 3- to 4-ounce portions. Save red meat for occasional consumption or use meat as a condiment, accompanied by lots of vegetables, as in stews, stir-fries, and soups.
Eat more fish, aiming for two to three servings a week.
Substitute wine in moderation for other alcoholic beverages.
Cut out sugary beverages.
Eat less high-fat, high-sugar desserts. Poached or fresh fruit is best. Aim for three servings of fresh fruit a day.
Seek out the best quality food available.
Finally, try to have dinner as a family as often as possible.

Beyond Food: Embracing the Mediterranean Lifestyle

Unless we can find the time to prepare our own meals and savour them with friends, we may never feel the full effects of the Mediterranean diet. But carve out those extra hours each day for such dining, while also remaining active, and it might be possible for all of us to experience the health benefits that so impressed Ancel and Margaret on their visits to southern Italy in the 1950s.

Challenges and Considerations

Some researchers aren’t convinced it is for everyone. They think that, as we have learned more about what is going on, it has become increasingly unclear whether the diet can be made to work beyond the Mediterranean itself. For instance, Bonaccio says we now know that each world region is characterised by distinctive features, like climate and microbes, that alter the local optimal diet.

Socioeconomic Factors

Martínez-González wants to see taxes introduced on ultra-processed fare like sodas and fast food, and for the revenues to be used to subsidise healthier options. The improvements to public health that better-quality diets should bring would cut the costs of medical care. However, even for those who can afford to purchase high-quality foods, there is one potentially vital component of the diet that can’t be found on supermarket shelves.

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