Submitted by Geoffrey Ankeney, MD, Family Practice Physician, Kaiser Permanente Olympia Medical Center
Have you ever heard of a “Battle of the Bands” concert? It’s usually a fun show where band after band performs in the same venue, with a winner among them declared usually based largely on crowd response.
Turns out there’s been something similar going on with diets. And the winner is almost always – drumroll, please, Nigel – the Mediterranean Diet.
The name of the diet is a bit of a misnomer, by the way. Know anyone who’s ever spent any time in ‘Mediterranea?’ Me neither. The diet is a reference to some commonalities among many of the countries that line the Mediterranean Sea. Most commonly, this means Italy, Spain, Portugal, Morocco, Greece, Cyprus, and Croatia.
Notably, this list excludes France, which is of course on the Med. And it includes Portugal, which is not on the med. It also leaves off Egypt, Libya, Israel, Palestine and Lebanon– all places with amazing food.
So really it’s better then to describe what makes the Mediterranean diet distinctive: it has to do with the composition of the diet, rather than the location in the world where it came from.
Fundamentally, we’re talking about a diet with olive oil as the principle source of fat, lots of vegetables especially leafy green ones, fresh fruits (dessert, in many Med cultures), and whole grain cereals, nuts, and legumes. Additionally, the typical Med diet is moderate in seafood, poultry, and dairy products, especially cheese and yogurt. Red wine is common in this diet and a big part of many cultures around the Mediterranean basin, but not consumed excessively. Notably, foods like eggs, red meat, processed meats, and sweets are very rare.
There’s no fountain of youth, of course, but there is good evidence that the Mediterranean diet leads to real health benefits.
Take heart disease. In a meta-analysis in 2013, the Med Diet was compared to vegan, vegetarian, low-carb (Atkins), high-fiber and high-protein (roughly speaking, a Keto diet) and found to improve risk factors for cardiovascular disease and diabetes. Alternately, there was minimal evidence that vegetarian and vegan diets kept pace.
The presumed reason for this is the diet’s emphasis on monounsaturated fats (good, we think) and fiber while de-emphasizing saturated fats. The “active ingredient” here is the olive oil. It contains notably oleic acid which is currently thought to be a great source of energy without the many side-effects of many other types of fatty acids. This is an area of avid clinical research. And a 2014 meta-analysis concluded that an elevated consumption of olive oil is associated with reduced risk of all-cause mortality, cardiovascular events, and stroke.
Additional studies have found promising evidence that a Med diet improves blood sugar control in diabetes and reduces risk of developing some cancers. One study found that strict adherence to the diet lowered the chance of dying from cancer by 6%.
According to a systematic study in 2016 and two similar reviews in 2013, the Med diet was found to improve cognitive function. One found the diet lowered the risk of developing Alzheimer’s, the others found that cognitive function decline was slowed by the diet in people who already had the disease.
Perhaps not surprisingly, in the 2019 edition of U.S. News and World Report Best Diets, the Mediterranean Diet was ranked #1, claiming, “With its emphasis on fruits, vegetables, olive oil, fish and other healthy fare, the Mediterranean diet is eminently sensible.”
But life in “Mediterranea” isn’t just about fats, proteins and carbohydrates. Perhaps one of the best precepts of the Med diet is the way it is usually practiced. In most of the countries mentioned, meal time is slow, peaceful and highly family-oriented. Most of the food is fresh because it came from Grandpa’s tomato garden, or the wine was made from the grapes in the family’s small backyard vineyard.
All told, yes, the Mediterranean diet likely contains a better balance of nutrients and emphasizes calories that are better for our bodies. But the bigger picture is one of joy around the family table. If we’re going to pick up anything up from our friends collected around the sparkling blue waters of the Mediterranean Sea, this is it.