Is the Mediterranean Diet the Best Diet on the Planet?
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The Mediterranean Diet has been rated as the healthiest diet on the planet three years in a row, and as the meals are simple to prepare and truly delicious, it has also been ranked as the easiest diet to follow long term
The diet itself is based upon the eating habits of people living around the Mediterranean Sea: Spain, France, Italy, Greece, and Turkey, as well as middle eastern and northern African countries.
What these cuisines have in common is the consumption of fresh, seasonal, whole foods featuring vegetables, fruits, beans, nuts, herbs and spices; the predominate use of extra-virgin olive oil instead of butter, margarine, or vegetable oils; moderate amounts of seafood and poultry; and the moderate consumption of red wine. What the Mediterranean diet specifically has avoided is processed foods, sugar, sweeteners, and artificial flavors. Red meats are rarely on the menu or are used sparingly to flavor a dish.
Overall, a Mediterranean eating plan is extremely versatile. You can follow a vegetarian version very easily. You can skip breakfast and include partial intermittent fasting and benefit from ketosis several mornings per week. And as I’ll expand upon shortly, you can also limit the glycemic load (sugar-load) to enhance blood sugar control and weight loss.
For 2020, The US News and World Report rated the Mediterranean diet as:
- The best diet overall
- The best diabetes diet
- The best diet for healthy eating
- The best plant-based diet
- The easiest diet to follow
It won similar awards in 2018 and 2019. These honors should not be too surprising, as Mediterranean countries have some of the longest life spans on the planet and they have lower rates of heart disease, diabetes, memory loss, cancer, and obesity than nearly all other western countries. The people of Spain, who follow the Mediterranean diet perhaps the closest, have the longest lifespan and the best health of any country in the Western world, and are anticipated to surpass Japan for longest lived country on the planet by 2030.
Considering all these benefits, I felt compelled to write a book, The Mediterranean Method, to help promote this eating plan and to make it simple to follow. The research included reading nearly 1,000 scientific journal articles, plus, my wife Nicole and I bought a sailboat in Europe with the goal to evaluate the food, lifestyle, and health habits of people living on the Mediterranean Sea. We spent 10 months sailing from Spain to Turkey during the spring and summers of 2018 and 2019. We followed the coastline along Spain, France, Corsica, western Italy, across to Greece and through the Cyclade Islands, and on to Turkey. We visited small ports, food markets, mom and pop family run restaurants, and searched for regional recipes that were easy to prepare, delicious, and healthy. What was amazing was how inexpensive and delicious the food was. And how opinionated locals were about how to prepare a dish within each region. Whether one worked in a food market, at a gas station, or drove a taxi, everyone cared about what ingredients went into local dishes and how they were prepared.
Let’s look more closely at the top three health benefits from following a Mediterranean Diet:
- Better Weight Control
- Reverse and Prevent Heart Disease
- Improve Cognitive Function and Prevent Memory Loss
Better Weight Control
In 2016, Dr. Joseph Mancini and his colleagues evaluated five randomized weight-loss trials with more than 1,000 subjects on various dietary regimens including low-fat, low-carb, and Mediterranean. These subjects were followed for at least 12 months, a meaningful length of time given most people lose weight in the short term and regain it later. The research found that the Mediterranean Diet was more effective than the low-fat diet, and equally as effective as a low-carb diet over the long-term. What’s more, they concluded that those following the Mediterranean Diet not only lost weight, but they had the best improvements in lipid and metabolic profile. The typical weight loss ranged from 10 to 22 pounds lost throughout the 12-months.
Preventing Heart Disease
Heart disease remains the #1 killer for men and women, even though studies have shown we can prevent 90 percent of heart disease with the right lifestyle changes–our biggest challenge is finding a diet and lifestyle that people are willing to follow long-term.
In 2003, the Greek EPIC trial showed that the closer subjects followed a Mediterranean eating plan, the lower their rate of cardiovascular events. Subsequent studies have shown that the closer people living outside the Mediterranean follow this same diet, the less heart disease and longer life they enjoy.
Then in 2018, the large-scale landmark PREDIMED study with over 7,000 subjects published in The New England Journal of Medicine affirmed the cardiovascular-fighting reputation of the Mediterranean Diet; those who followed a Mediterranean diet and added extra nuts or olive oil had 30% fewer events than those following a low-fat diet.
Data published from my own clinic has shown that in patients who follow a low-glycemic version of a Mediterranean diet, the average person shrinks their artery plaque load over time (measured with carotid ultrasound testing), and amazingly, hundreds of our patients had more than a 10% regression in their arterial plaque load over an average of 2-3 years.
Enhancing Cognition and Preventing Memory Loss
The most expensive disease in the U.S. and most western countries is dementia; recent estimates are that the total bill to treat it exceeds $278 billion per year. More startling is that the rates of memory loss and Alzheimer’s disease are predicted to double over the next 15 years.
Yet, just as we can prevent most cases or heart disease, there is now growing evidence that we can also prevent dementia and cognitive decline with the right lifestyle changes. PREDIMED researchers tracked the impact on cognition of the dietary interventions over 6.5 years on over 500 participants and controlled for multiple lifestyle and health factors. Those randomized to a low-fat diet had lower overall cognitive scores and more progression to dementia than those in the Mediterranean diet group.
Many other studies have also shown cognitive improvement and/or reduced cognitive impairment with following a Mediterranean diet, including the FINGER trial, Three-City study in France, the Chicago Health and Aging Project (CHAP), and in a group of more than 1,200 Puerto Rican adults living in the U.S.
Data published from my own clinic confirmed that the closer a person follows these dietary recommendations, the better their brain processing speed and cognitive scores, results which have continued over 12 years of follow up.
Myths Regarding a Mediterranean Diet
Despite the many health benefits of this eating plan, and the delicious food it provides, there are several misunderstandings that threaten to eliminate these benefits. Let’s clarify several right now, dealing with the top six myths.
MYTH #1. YOU CAN EAT ALL THE HEALTHY FOOD YOU WANT
There’s no need to put a hard limit on daily servings of vegetables (you won’t overdo it because you’ll naturally fill up on fiber), but it is possible, for instance, to overeat walnuts or almond butter, or use too much olive oil, particularly if you’re dipping pieces of bread into it.
MYTH #2. EATING MEDITERRANEAN MEANS EATING PASTA, BREAD AND PIZZA
You can easily overdo the portion size, even with whole grains. When you see grains and cereals on the Mediterranean diet, this doesn’t mean a giant platter of pasta, unlimited bread (even if it’s organic and whole grain), or bowls of rice (even if it’s brown rice). It’s important to control your portions of grains and cereals, and as you’ll read in a moment, of all the food components listed in the Mediterranean diet, whole grains provide the least health benefit.
Further, when you grind a grain into flour, such as bread, that processed grain has a much higher glycemic load (sugar load) than the same amount of whole grain. If we want healthy blood sugar control, we all need to limit or avoid even whole grain products that are processed into flour—such as bread, crackers, cake, and pancakes.
MYTH #3. EATING SEAFOOD ON OCCASION WILL BENEFIT YOUR HEART
Eating fish merely a few times a month won’t yield the disease-fighting benefits of the Mediterranean diet, particularly for the heart and brain. Because of the benefits from consuming long chain omega-3 fats that are found only in seafood, aim to eat seafood at least twice a week–preferably three to five times per week. Seafood includes fish, shellfish, and seaweed.
If you are vegetarian, or avoid fish and shellfish for other reasons, plan to either eat seaweed several times per week, as in a cup portion of seaweed salad, or take a seaweed DHA supplement daily.
MYTH #4. ALL CHEESES (AND YOGURTS) ARE CREATED EQUAL
Treating pasteurized cheese as a go-to food–compared, for example, with raw, probiotic-rich and vitamin K2-loaded camembert–is a mistake. The same goes for yogurt and kefir. Many of my patients are shocked when I explain that fruit-flavored yogurt has more sugar than ice cream. As with so many components of the Mediterranean diet, when choosing your foods, simple and unsweetened is best.
If you avoid dairy products, you still need some source of probiotic food source, which can easily be obtained by using coconut yogurt sources, and other pickled foods, such as sauerkraut, olives, capers, and Asian foods such as miso and kombucha.
MYTH #5. YOU CAN SKIP THE BEANS
Don’t miss out on this fiber-packed superfood that is one of the best foods for controlling blood sugar, and it’s the #1 all-time top food for blocking disease-causing oxidation. They are also loaded with fiber, protein, B vitamins, and calcium. In Mediterranean cuisine, beans are the healthy foundation for countless meals and are used often as a side dish as well.
However, 10% of people appear to be lectin intolerant–they develop major gastrointestinal symptoms when they consume beans. The process of soaking (so called sprouting) appears to help, but if you have a lectin intolerance, just like any food intolerance, then avoid beans.
MYTH #6. YOU CAN USE EXTRA-VIRGIN OLIVE OIL FOR ALL YOUR COOKING NEEDS
Don’t use extra-virgin olive oil for high-heat cooking, or even medium-high heat. Once it reaches 400ºF–its smoke point, the maximum temperature it can reach before it breaks down and becomes a damaged fat–extra-virgin olive oil starts losing nutritional value, not to mention its complex and delicate flavors. For medium-high heat cooking, use avocado and/or almond oil) instead.
Save flavorful extra-virgin olive oil for drizzling over foods, making dressings, and for low or medium heat cooking.
Adapting the Mediterranean Diet to the 21st Century
Despite all these clear health benefits, there are some limitations related to the Mediterranean diet that should be applied to living in the 21st century.
First, the original Mediterranean diet was followed by farmers, fisherman, and herders–men and women who were physically active for 6 to 10 hours per day. Very few can achieve this much movement today. We therefore need to modify an eating plan with a lower glycemic load to match our activity level.
Second, studies that have evaluated the Mediterranean diet have also assessed what components of the traditional eating plan had the most and least health benefit. Results from the EPIC trial showed that consuming vegetables, fruit, beans, nuts, and olive oil provided the greatest benefit, and eating whole grains provided the least–likely related to their glycemic load.
A more recent study, The EPIC Greek Cohort study, published in 2012, analyzed adherence to a Mediterranean Diet, and glycemic load intake. It concluded that those who adhered to a Mediterranean Diet and had the lowest glycemic load intake had the best health benefits of all. And if the subjects were overweight, the benefits of following a low-glycemic load version of a Mediterranean Diet were even greater.
This low-glycemic version has the added advantage of appealing to many people who have already shifted towards a low-carb and/or Paleo eating plan, and switching from a low-carb to a Mediterranean diet will usually increase their nutrient dramatically.
Though there are many proven benefits to following a low-glycemic version of a Mediterranean diet, the health benefits of the Mediterranean lifestyle are not solely limited to food intake. Mediterranean people are more active than we are in the U.S., they spend more time walking and cycling to work and for daily shopping, and they spend more time outdoors and with nature.
How they eat is important as well. They enjoy long, leisurely meals typically with friends and family, which fosters close social connections, which is likely related to the fact that they have lower rates of anxiety and depression than are found in the U.S.
Let me share my version of the food and lifestyle pyramid of a low-glycemic Mediterranean diet, adapted from my book, The Mediterranean Method.
The pyramid’s foundation is the lifestyle, which features activity, social interaction, cooking, and mindful-leisurely eating.
Foods and beverages that are consumed daily include vegetables, fruits, beans, nuts, olive oil, herbs and spices, yogurt, dark chocolate, and water, with moderate intake of red wine and coffee or tea. Seafood, poultry, eggs, and other probiotic-rich dairy products are on the menu several times a week, although a vegetarian or vegan version without animal protein is very feasible. Whole grains are also an option, although served in small portions (and gluten free as needed).
Unlike many diets that are popular today, notice that almost no real foods are completely banned–for a special occasion, you can still enjoy special treats that fit the affair–the key is that you limit them to a special event, and that you eat real, unprocessed food.
The Mediterranean Diet is not just a short-term eating plan. It has been followed for centuries, generation after generation, tested in numerous long-term clinical studies, and been found to be the best diet on the planet for long term adherence and for healthy eating. The food is delicious, generally simple and easy to prepare, and the ingredients can be found at your local grocery store. This is an eating plan that truly combines proven health benefits with delicious food–no other diet can embrace the saying as well–To Your Health & Bon Appétit!
Steven Masley MD, FAHA, FACN, CNS is a physician, nutritionist, author, and a trained chef. He is a fellow with the American Heart Association and the American College of Nutrition, plus he is an Affiliate Clinical Associate Professor at the University of South Florida. He has written seven books and his latest is The Mediterranean Method. You can follow him on his blog (at www.DrMasley.com) and/or see his posts on Facebook (@StevenMasley)
MedDiet interventions improve endothelial function in adults, suggesting that the protective effects of the MedDiet are evident at early stages of the atherosclerotic process with important implications for the early prevention of CVD. This study has the PROSPERO registration number: CRD42018106188.