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Updated 06 March 2013

Go the Mediterranean route

Eat wholegrains, fruit, vegetables, fish, legumes, olive oil and nuts, and you could live to a ripe old age. DietDoc takes a look at the many benefits of the Mediterranean Diet.

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As a descendant of Mediterranean ancestors, I've always enjoyed eating Mediterranean food and am convinced that this type of diet has a highly positive influence on health and longevity.

Research into the positive effects of the Mediterranean Diet (MD) has continued unabated since the 1970s, when scientists first recognised that this diet can play an important role in preventing a variety of so-called "diseases of lifestyle".

The MD traditionally includes the following foods:

  • Pasta made from durum wheat (low-GI), bread, rice, couscous, polenta (yellow, unsifted maize meal), and other wholegrains and potatoes
  • Fresh vegetables in large quantities, which contain protective antioxidants such as beta-carotene, vitamin C and phytonutrients
  • Fresh fruit in moderate quantities that also provide the above-mentioned protective nutrients
  • Legumes (dry, canned or cooked peas, beans, chickpeas, lentils) rich in dietary fibre, vitamins and minerals
  • Plenty of fish, which is rich in omega-3 fatty acids, and only small quantities of lean meat and eggs
  • Milk and dairy products, especially fermented milk products such as plain yoghurt, and cheese like Parmesan and Ricotta
  • Plenty of monounsaturated fatty acids in the form of olive oil, olives and nuts
  • Red wine, which contains antioxidants (polyphenols) to protect the heart
  • Plenty of allium-containing foods such as fresh garlic, onions, shallots and leeks

The benefits of the MD are regarded as so important that the Oldways Organisation (2008) has included the MD Pyramid on its website to promote better health worldwide.

Why is this diet so important?
The Oldways Organisation points out that research findings from the Mediterranean region have indicated that people living around the Mediterranean Sea have the “lowest recorded rates of chronic diseases and the highest adult life expectancy”compared to the rest of Europe and other western countries (Oldways, 2008).

A recent edition of the Arbor Clinical Nutrition Updates (Arbor, 2009) has once again focused our attention on the MD and its beneficial effects on one of the most common diseases of lifestyle, namely diabetes.

The Mediterranean Diet and diabetes
The Arbor team reviewed new research results from Spain and concluded that this diet has “a beneficial effect on glucose handling and diabetes prevention”. In one of the Spanish studies, those subjects who adhered strictly to a MD for four years were five times less likely to develop diabetes than individuals who didn't stick to the diet.

In another study, 63 patients with metabolic syndrome (already suffering from pre-diabetes/insulin resistance and pre-hypertension) followed a MD for six months. The researchers found that glucose tolerance and blood pressure improved significantly with the MD, and in comparison to measurements at the start of the study, the waist circumference measurements decreased after six months. The latter improvement indicates that abdominal obesity, one of the most dangerous aspects of the metabolic syndrome, can be reversed.

The third study produced similar results, with a shift in fat distribution from the abdomen to other areas of the body, and improved insulin sensitivity (Arbor, 2009).

Finally, a large study with 1224 older, experimental subjects who either followed a low-fat diet (the control diet) or a MD using virgin olive oil (1 litre a week) or a MD with nuts (30g per day of almonds, walnuts and hazelnuts) for one year, demonstrated that the individuals who ate the MD plus nuts were more likely to change from having metabolic syndrome to not having metabolic syndrome.

This change was also linked to significant lowering of abdominal obesity, high blood pressure and high triglyceride levels in the blood (Arbor, 2009).

The Mediterranean Diet and heart disease
The MD is also linked to a pronounced decrease in heart disease.

Results obtained with the Nurses’ Health Study in the USA showed that women who adhered to the MD had a 30% reduction in the risk of developing heart disease over a period of 20 years, compared to subjects who followed a traditional western diet that was high in saturated fat (Arbor, 2009).

Why is the Mediterranean Diet so protective?
Scientists are still trying to pinpoint what aspects of the MD contribute to its health effects.

At the moment, the experts agree that certain characteristics of the MD, such as the high vegetable and fruit intake, the greater use of wholegrains, the emphasis on monounsaturated fats in the form of olive oil, olives and nuts, regular fish intake and drinking moderate quantities of wine with meals, seem to confer special benefits.

The researchers also point out that the above-mentioned eating pattern would automatically result in a lower intake of energy and saturated fat, while boosting intakes of monounsaturated fats and omega-3 fatty acids, dietary fibre and antioxidants (including polyphenols from wine and lycopene from tomatoes) (Arbor, 2009).

All these dietary changes are beneficial to health and longevity.

Take-home message
Although we're not yet sure which aspects of the MD confer the greatest benefit, we do know that the MD is healthy and protects us against many diseases of lifestyle.

In fact, an expert review by Walter Willett stated that the Mediterranean Diet, “together with regular physical activity and abstinence from smoking, can prevent 90% of type 2 diabetes, along with more than 80% of coronary heart disease and 70% of stroke”. This is indeed a worthwhile goal to pursue.

Start making changes to your diet to make it more Mediterranean.

Eat wholegrains, lots of vegetables, including garlic, onions and olives, and fruit, replace all your oils with olive or canola oil and buy olive oil-based margarine, eat fish more often than meat and when you eat meat or eggs, eat only lean meat once or twice a week, have plenty of legumes and fat-free yoghurt, and drink moderate quantities of wine with meals.

For an example of the Mediterranean Diet Pyramid, visit the Oldways’ site at http://www.oldwayspt.org/med_pyramid.html.

  - (June 2009)

References:
(Arbor (2009). Mediterranean diet & diabetes. Arbor Clinical Updates, Issue 307, May 2009, 1-4; Oldways (2008) Mediterranean Diet Pyramid, http//www.oldwayspt.org/ med_pyramid.html.)


Any questions? Ask DietDoc

Dr Ingrid van Heerden is a registered dietician and holds a doctoral degree in Nutrition and Biochemistry. She believes that "we are what we eat" and offers free nutrition and weight loss advice via her DietDoc service on Health24.com.

 
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