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All about the Mediterranean diet

Here at Elevated, the eating plan that is probably closest to our hearts – quite literally given its affect on cardiovascular function – is the Mediterranean diet.

The traditional Mediterranean diet refers to the dietary pattern in the Mediterranean olive grove areas at the beginning of the 1960s, during the post-World War II recovery period but before these areas were influenced by fast-food culture.

It’s traditionally characterised by high consumption of fruits, vegetables, legumes, cereals, fish and olive oil, low consumption of milk and meat and moderate intake of alcohol (1).

Some of you will love the latter, which is perfect as a key facet of the Mediterranean diet is not only what you eat but how you eat it. Traditionally, those communities excelled in taking time to sit and enjoy a meal with family and friends as a social, communal event, rather than the means to an end that food has become for many of us as we cram a sandwich into our mouths while staring at a computer screen.

The Mediterranean diet is also one of the most studied by scientists over the years, proving beneficial at combatting many of the illnesses and diseases seen today, from the aforementioned heart health, to type-II diabetes and even some cancers.

It’s one of the reasons too why two of the World’s famed Blue Zones, where people have the longest life expectancy, are in the Mediterranean: Ikaria in Greece and Sardinia in Italy.

What does it consist of?

There is no one right way to follow the Mediterranean diet, as there are many countries around the Mediterranean Sea and people in different areas may have eaten different foods – but here are some general guidelines that largely match our thoughts on healthy eating here t Elevated.

What to eat

  • Most of the time: Vegetables, fruits, nuts, seeds, legumes, potatoes, whole grains, breads, herbs, spices, fish, seafood and extra virgin olive oil.
  • In moderation: Poultry, eggs, cheese and yogurt.
  • Eat rarely: Red meat.

Foods to avoid

  • Added sugar: Pop/soda, sweets/candies, ice cream and table sugar
  • Refined grains: White bread, pasta made with refined wheat, white rice
  • Trans fats: Found in margarine and various processed foods.
  • Refined oils: Soybean oil, canola oil, cottonseed oil and others.
  • Processed meat: Processed sausages, hot dogs, hams
  • Highly processed foods: Anything labeled “low-fat” or “diet” or which looks like it was made in a factory.

Give me some examples please

  • Vegetables: Tomatoes, broccoli, kale, spinach, onions, cauliflower, carrots, Brussels sprouts, cucumbers, aubergine, courgettes
  • Fruits: Apples, bananas, oranges, pears, strawberries, grapes, dates, figs, melons, peaches
  • Nuts and seeds: Almonds, walnuts, macadamia nuts, hazelnuts, cashews, sunflower seeds, pumpkin seeds
  • Legumes: Beans, peas, lentils, pulses, peanuts, chickpeas
  • Tubers: Potatoes, sweet potatoes, turnips, yams
  • Whole grains: Whole oats, brown rice, rye, barley, corn, buckwheat, whole wheat, whole-grain bread and pasta
  • Fish and seafood: Salmon, sardines, trout, tuna, mackerel, shrimp, oysters, clams, crab, mussels
  • Poultry: Chicken, duck, turkey
  • Eggs: Chicken, quail and duck eggs
  • Dairy: Cheese, yogurt, Greek yogurt
  • Herbs and spices: Garlic, basil, mint, rosemary, sage, nutmeg, cinnamon, pepper
  • Healthy Fats: Extra virgin olive oil, olives, avocadoes and avocado oil.

Scientists are so enamoured with the Mediterranean diet that they use a Mediterranean Diet Score to assess how close people get to it. Want to find out if you’re a Greek God of eating? Take our quiz below.

The Mediterranean diet and recent health studies

Unless stated, all the following studies refer to systematic reviews, considered the highest form of evidence as they assess all the previous studies on a subject and try and draw conclusions.

The MD and gut health

In a study published this year, scientists looked at the composition of the microbiota (your gut bacteria) and the production of short-chain fatty acids (SCFAs) which takes place in the gut and are essential for sending signals on the gut-brain axis. They concluded that “the Mediterranean diet could play a valuable role in ensuring our health through direct interaction with our microbiota”. (2)

The MD and weight loss, type 2 diabetes and metabolic syndrome

In another study in 2016, researchers tried to assess the Mediterranean diet and other eating plans for long-term weight loss. Long-term weight loss is a tricky subject for researchers as it’s hard to follow people’s habits outside of a lab environment. As such, they could only gather information from five other studies. They found that over 12 months, a Mediterranean diet showed greater weight loss for participants compared to others on a low-fat diet and similar weight loss to those on a low-carbohydrate diet and the American Diabetes Association diet. (3)

Managing blood sugar balance is key to combatting Type 2 diabetes. In 2015 a study concluded that: “The Mediterranean diet was associated with better glycaemic control and cardiovascular risk factors than control diets, including a lower fat diet, suggesting that it is suitable for the overall management of type 2 diabetes. (4)

High adherence to the Mediterranean diet has also been associated with a lower prevalence of metabolic syndrome – the medical term for a combination of diabetes, high blood pressure (hypertension) and obesity. A 2021 study analysed 58 other research projects and found employing a Mediterranean diet had positive effects on waist circumference, levels of triglycerides and HDL cholesterol. (5)

The MD and blood pressure

Earlier this year, a paper was published in Clinical Nutrition. The authors by researchers looked at 35 scientific trials with a total of almost 14,000 participants and found that adoption of the Mediterranean diet “was accompanied by a relatively small, but yet significant BP reduction.” (6)

The MD and chronic inflammation

Chronic low-grade inflammation in the body is constantly being linked with a range of diseases as well as mental health disorders. Earlier this year, researchers writing in the journal Nutrients looked at 53 other studies and found that: “A good quality diet, high in vegetable and fruit intake, wholegrains, fibre and healthy fats ameliorates low-grade inflammation, and therefore represents a promising therapeutic approach, as well as an important element for disease prevention in both children and adolescents.” (7)

The MD and cancer

Some studies have found links between the Mediterranean diet and cancer. One in 2017 looked at three components of the diet, olive oil polyphenols, red wine resveratrol, and tomato lycopene, and their potential effect on colorectal cancer and found “an association of these components with a reduction in cancer initiation and progression.” (8) Another looked at ovarian and endometrial cancer and while it found no association between diet quality and risk of ovarian cancer, that the Mediterranean diet “might be associated with lower the risk of endometrial cancer.” (9)

The MD and age-related cognitive decline

The Mediterranean diet may also help with age-related memory. A 2021 study published in Ageing Research Reviews found that: “high adherence to a Mediterranean diet reduced the risk of global cognitive decline in non-demented older adults.” However, no significant associations between the diet, the incidence of mobility problems and dementia were found. (10)

The MD and Inflammatory Bowel Disease

Diet is one of the most critical factors for inflammatory bowel disease such as Crohn’s disease and ulcerative colitis. Researchers looked at 14 studies and concluded that  “These results implied that a high score on the Mediterranean diet was negatively associated with risk and progression of IBD. However, a diet with high inflammatory potential could increase risk and aggravate disease activity in IBD. (11)

References

  1. Stefler D, Malyutina S, Kubinova R, et al. Mediterranean diet score and total and cardiovascular mortality in Eastern Europe: the HAPIEE study. Eur J Nutr [Internet]. 2017 Feb 1 [cited 2021 Jul 31];56(1):421. Available from: /pmc/articles/PMC5290049/
  2. Gibiino G, De Siena M, Sbrancia M, et al. Dietary habits and gut microbiota in healthy adults: Focusing on the right diet. a systematic review [Internet]. Vol. 22, International Journal of Molecular Sciences. Int J Mol Sci; 2021 [cited 2021 Jul 31]. p. 6728. Available from: https://pubmed.ncbi.nlm.nih.gov/34201611/
  3. Mancini JG, Filion KB, Atallah R, Eisenberg MJ. Systematic Review of the Mediterranean Diet for Long-Term Weight Loss. Am J Med [Internet]. 2016 Apr 1 [cited 2021 Jul 31];129(4):407-415.e4. Available from: https://pubmed.ncbi.nlm.nih.gov/26721635/
  4. Esposito K, Maiorino MI, Bellastella G, Chiodini P, Panagiotakos D, Giugliano D. A journey into a Mediterranean diet and type 2 diabetes: A systematic review with meta-analyses [Internet]. Vol. 5, BMJ Open. BMJ Open; 2015 [cited 2021 Jul 31]. Available from: https://pubmed.ncbi.nlm.nih.gov/26260349/
  5. Bakaloudi DR, Chrysoula L, Kotzakioulafi E, Theodoridis X, Chourdakis M. Impact of the level of adherence to mediterranean diet on the parameters of metabolic syndrome: A systematic review and meta-analysis of observational studies [Internet]. Vol. 13, Nutrients. Nutrients; 2021 [cited 2021 Jul 31]. Available from: https://pubmed.ncbi.nlm.nih.gov/33946280/
  6. Filippou CD, Thomopoulos CG, Kouremeti MM, et al. Mediterranean diet and blood pressure reduction in adults with and without hypertension: A systematic review and meta-analysis of randomized controlled trials. Clin Nutr [Internet]. 2021 May 1 [cited 2021 Jul 31];40(5):3191–200. Available from: https://pubmed.ncbi.nlm.nih.gov/33581952/
  7. Bujtor M, Turner AI, Torres SJ, Esteban-Gonzalo L, Pariante CM, Borsini A. Associations of dietary intake on biological markers of inflammation in children and adolescents: A systematic review. Nutrients [Internet]. 2021 Feb 1 [cited 2021 Jul 31];13(2):1–29. Available from: https://pubmed.ncbi.nlm.nih.gov/33503979/
  8. Farinetti A, Zurlo V, Manenti A, Coppi F, Mattioli AV. Mediterranean diet and colorectal cancer: A systematic review [Internet]. Vols. 43–44, Nutrition. Nutrition; 2017 [cited 2021 Jul 31]. p. 83–8. Available from: https://pubmed.ncbi.nlm.nih.gov/28935150/
  9. Zhang YH, Li Z, Tan MZ. Association Between Diet Quality and Risk of Ovarian and Endometrial Cancers: A Systematic Review of Epidemiological Studies. Front Oncol [Internet]. 2021 May 18 [cited 2021 Jul 31];11. Available from: https://pubmed.ncbi.nlm.nih.gov/34084748/
  10. Coelho-Júnior HJ, Trichopoulou A, Panza F. Cross-sectional and longitudinal associations between adherence to Mediterranean diet with physical performance and cognitive function in older adults: A systematic review and meta-analysis. Ageing Res Rev [Internet]. 2021 Sep [cited 2021 Jul 31];70:101395. Available from: https://pubmed.ncbi.nlm.nih.gov/34153553/
  11. Z T, X Z, M Z, et al. Index-Based Dietary Patterns and Inflammatory Bowel Disease: A Systematic Review of Observational Studies. Adv Nutr [Internet]. 2021 Jun 22 [cited 2021 Jul 31]; Available from: https://pubmed.ncbi.nlm.nih.gov/34157069/
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