This year, for the third year in a row, the Mediterranean diet has been named the best diet overall in the established US News & World Reportannual rankings. Here, Dietetics student David Gray, tells us just how beneficial this diet can be to our health and wellbeing.

No need to tell you that the Mediterranean diet originates from countries that border the Mediterranean Sea: Spain, France, Italy, Greece, Croatia and Cyprus, for example. Places we think of as havens of sunshine, good food and wine, terrific holiday destinations from the often grey, drizzly days of UK summer.

The Mediterranean diet, however, varies from country to country. Nevertheless, it has similarities, which make it ‘Mediterranean’. These similarities include the regular consumption of olive oil as the main source of fat and an emphasis on plant foods such as fruit, vegetables, wholegrain cereals, seeds, beans and legumes. Fish and seafood are also important to this diet, (consumed at least twice a week), with a moderate poultry and dairy intake, low red meat and sweet consumption, as well as a low to moderate alcohol intake mostly from red wine.¹

WHAT ARE THE BENEFITS OF THE MEDITERRANEAN DIET?

There have been many studies over the years looking at the health benefits of the Mediterranean diet and adherence to the diet has been consistently associated with lower all-cause mortality.² More specifically, the diet has been positively associated with reducing and even preventing the development of cardiovascular disease (CVD), diabetes, obesity, some cancers and even cognitive decline.³

1) CVD

CVD is a general term for conditions that affect the heart or blood vessels, such as heart disease, stroke, and atherosclerosis. It is one of the main causes of death and disability. Many factors can contribute towards developing CVD. These include high blood pressure, high cholesterol, being overweight or obese, diabetes, and being physically inactive.⁴ An increased adherence to the Mediterranean diet has consistently shown beneficial effects in relation to CVD,⁵ and is ranked as the most likely dietary model to provide protection against coronary heart disease in a systematic review.⁵

A 2006 randomised trial found that when the Mediterranean diet is supplemented with olive oil or nuts, it has a greater beneficial effect on the risk of CVD compared with a low-fat diet. This study, which ran over three months, included 772 participants between the ages of 55 to 80, at high risk of CVD. The participants in the Mediterranean diet group had decreased systolic and diastolic blood pressure, blood glucose levels and increased HDL cholesterol levels compared with the low-fat group. All these factors contributed towards a reduced risk in CVD.⁶

2) FIBRE

The Mediterranean diet provides us with fibre, from foods such as wholegrains, legumes, beans, and seeds, and which has been shown to have a significant cholesterol-lowering effect. Furthermore, a randomised trial that included 200 overweight or obese patients found that the groups who had fibre whilst consuming an energy-restricted diet, tended to have greater weight loss, satiety after eating and significant reduction in LDL-cholesterol.⁷

3) OMEGA-3

Omega-3 polyunsaturated fatty acids are found in the Mediterranean diet from sources like oily fish, nuts and seeds and plant oils such as olive oil. Omega-3 fatty acids have been strongly associated with a reduced risk of sudden death in men without CVD,⁸ and have potential anti-inflammatory properties, suggesting potential use in inflammatory diseases.⁹

WHAT MAKES UP THE MEDITERRANEAN DIET?

The Mediterranean diet pyramid shows how often you should include different types of food into meals and how often we should be eating them.

• Foods that every meal should be based around include fruits, vegetables, wholegrains, olive oil, beans, nuts, legumes, seeds, herbs and spices.
• Fish and seafood should be consumed at least twice a week and can include oily fish like sardines, trout, mackerel, pilchards, herring and other fish like tuna, both canned and fresh, cod, haddock, tilapia and pollock. Other seafood can include prawns, mussels, scallops, squid, oysters and crab.¹⁰
• Moderate daily to weekly portions of poultry, such as chicken and turkey, eggs, cheese and yoghurt, are recommended.
• At the very top of the pyramid, which should only be eaten occasionally, are red meat and sweets.
• Outside of the pyramid there is water, which should be the fluid of choice to be consumed adequately during the day, and wine, which is recommended to be drunk in moderation.

NON-DIETARY ASPECTS

The Mediterranean diet is made up of heart-healthy nutritious food, which benefits many aspects of our health. There is a non-dietary aspect however, that makes the Mediterranean diet highly recommended above many other diets, and that’s the social and physical activity aspect. The foundation of the Mediterranean diet’s pyramid is built on two things: being physically active and social eating, i.e. eating meals with other people.

It's recommended to get at least 150 minutes of moderate intensity exercise per week, which could be made up from anything like brisk walking, swimming, or going for a bike ride. Moderate intensity exercise has been shown to increase performance in working memory and cognitive flexibility.¹¹ If you’re a more serious sporty person, 75 minutes of vigorous intensity by playing a sport such as football or tennis, going for a run, is ideal. Even activities such as dancing, gardening, climbing stairs and housework all count as physical activity. High-intensity exercise has been shown to improve cognitive information processing speed.¹¹

The aim is to minimise sedentary time during the day. Just being physically active can help to improve sleep, manage stress, maintain a healthy weight, and even reduce the risk of Type 2 diabetes by 40%, cardiovascular disease by 35%, joint and back pain by 25%, depression by 30%, and even cancers such as colon and breast cancer by 20%.

Mealtimes shared between family and friends have been shown to be good for your mental health, as a structured routine helps us be more attentive to what we are eating, and a social environment for meals provides feelings of contentment and security.¹² Sharing mealtimes can also help to lower the risk of depression, obesity, eating disorders, and can help improve self-esteem.¹³

IN SUMMARY

To sum up, the Mediterranean diet is more of a lifestyle than just the food you consume. It is made up of a variety of nutritious foods that contain a wide variety of nutrients. It doesn’t exclude food groups and gives you a guide of the type and amount of the food you should be consuming. As the Mediterranean diet combines healthy food, socialising and physical activity, it benefits both our physical health and our mental health.

I don’t doubt that this diet will remain at the top spot for the best overall diet for a few years to come!

David Gray
Student Dietitian, Coventry University

David is a second-year student dietitian.
He is interested in many areas of dietetics,
particularly freelance dietetics.

References

1      Lăcătușu CM, Grigorescu E-D, Floria M, Onofriescu A and Mihai BM (2019). The Mediterranean Diet: from an Environment-Driven Food Culture to an Emerging Medical Prescription. International Journal of Environmental Research and Public Health 16 (6), 942

2      Martínez-González MÁ. and Sánchez-Villegas A (2003). Review: The emerging role of Mediterranean diets in cardiovascular epidemiology: Monounsaturated fats, olive oil, red wine, or the whole pattern? European Journal of Epidemiology 19 (1), 9-13

3      Widmer R, Flammer A, Lerman L and Lerman A (2014). The Mediterranean Diet, its Components, and Cardiovascular Disease. Author manuscripts Journal of Medicine 128 (3), 229-238

4      NHS (2018). Cardiovascular disease [online] available from <https://www.nhs.uk/conditions/cardiovascular-disease/#:~:text=Home-,Cardiovascular%20disease,increased%20risk%20of%20blood%20clots.>

5      Mente A, de Koning L, Shannon HS and Anand SS (2009). A Systematic Review of the Evidence Supporting a Causal Link Between Dietary Factors and Coronary Heart Disease. Archives of Internal Medicine 169 (7), 659-669

6      Estruch R (2006). Effects of a Mediterranean-Style Diet on Cardiovascular Risk Factors. Annals of Internal Medicine 145 (1), 1-11

7      Salas-Salvadó J, Farrés X, Luque X, Narejos S, Borrell M and Basora J (2007) Effect of two doses of a mixture of soluble fibres on body weight and metabolic variables in overweight or obese patients: a randomised trial. British Journal of Nutrition 99 (06), 1380-1387

8      Saremi A and Arora R (2009). The Utility of Omega-3 Fatty Acids in Cardiovascular Disease. American Journal of Therapeutics 16 (5), 421-436

9      Yan Y, Jiang W, Spinetti T, Tardivel A, Castillo R, Bourquin C and Zhou R (2013). Omega-3 Fatty Acids Prevent Inflammation and Metabolic Disorder through Inhibition of NLRP3 Inflammasome Activation. Immunity 38 (6), 1154-1163

10   NHS (2018). Fish and shellfish [online], available from <https://www.nhs.uk/live-well/eat-well/fish-and-shellfish-nutrition/>

11   Chang YK and Etnier JL (2009). Exploring the Dose-Response Relationship between Resistance Exercise Intensity and Cognitive Function. Journal of Sport and Exercise Psychology 31 (5), 640-656

12   Mental Health Foundation (nd). Mealtimes and mental health [online], available from <https://www.mentalhealth.org.uk/a-to-z/m/mealtimes-and-mental-health>

13   The Family Dinner Project (nd). Benefits of family dinners [online], available from <https://thefamilydinnerproject.org/about-us/benefits-of-family-dinners/>