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How to Stay Healthy with a Mediterranean Diet

Following a Mediterranean diet with lots of veggies, fruit and fish can help reduce the risk of heart disease, diabetes and breast cancer.
How to Stay Healthy with a Mediterranean Diet
Caprese. Caprese salad. Italian salad. Mediterranean salad. Italian cuisine. Mediterranean cuisine. Tomato mozzarella basil leaves black olives and olive oil. Recipe – Ingredients

Would you like to be able to improve your health by what you put on your plate? Health professionals and patients alike may doubt that diet can be as powerful as pills. When it comes to important benefits such as preventing heart attacks and strokes, reducing the risk of diabetes or delaying dementia, doctors like medication. Strong evidence now shows, however, that a traditional Mediterranean diet rivals medications when it comes to these important health conditions. Women who eat the Mediterranean way may also reduce their chance of a breast cancer diagnosis.

Following a Mediterranean Diet for the Sake of Your Heart:

A study from Spain (CORDIOPREV) compared a modified Mediterranean diet to a low-fat diet for heart health  (PLOS One, Sept 9, 2020). Over 800 patients who had had a heart attack participated, randomly assigned to the diets.

The Mediterranean diet group consumed at least four tablespoons of olive oil daily. They were also supposed to eat at least two servings of vegetables, one serving of salad and three or more servings of fresh fruit daily. On a weekly basis, this group of volunteers tried to eat at least three servings of legumes, three or more handfuls of nuts and seeds and three or more servings of seafood. According to the protocol,  they cooked with sofrito at least twice a week. This is a sauce made of tomato, garlic, onion, aromatic herbs and olive oil. These participants cut back on red meat and avoided sugar, chips, sugared beverages and commercial baked goods.

The volunteers randomized to the low-fat diet followed American Heart Association guidelines. These minimize the amount of oil used in cooking and salad dressing and substitute low-fat for full-fat dairy products. In addition, these participants limited meat consumption to no more than once a week. They also swapped out oily fish like tuna for lean fish like cod. The investigators urged them to forego nuts and seeds as well as commercial baked goods. 

Mediterranean Patterns Boost Blood Vessel Function:

The CORDIOPREV results demonstrated that the Mediterranean diet produced more flexible blood vessels within a year. There was also a drastic reduction in damage to the endothelium or lining of blood vessels. Stiffer blood vessels increase the likelihood of cardiovascular events.

Studying the Mediterranean Diet:

Earlier, Spanish scientists had made an impressive contribution when they published the first results of their PREDIMED study (New England Journal of Medicine, June 21, 2018).  PREDIMED stands for Prevención con Dieta Mediterranea, which means about what you might guess.

This randomized, controlled trial included almost 7,500 people who did not have heart disease at the start of the study but were at high risk for it. (They were overweight or had diabetes or high blood pressure.) The investigators assigned them randomly to follow a Mediterranean diet with additional extra-virgin olive oil; a Mediterranean diet with additional nuts; or a prudent low-fat diet of the type usually recommended by the American Heart Association.

Sticking with the Mediterranean Style of Eating for a Healthy Heart:

The researchers had no trouble getting the Spanish study subjects to stick with the Mediterranean diet plans. The investigators supplied the extra olive oil and nuts, which made following the diet even easier. The volunteers gravitated toward a diet rich in vegetables, fruit and fish, with little milk, meat or sweets. People had more difficulty following a really low-fat diet.

Still, the differences were significant. After less than five years, people in the Mediterranean diet groups had suffered approximately 30 percent fewer heart attacks, strokes and deaths due to cardiovascular causes than those in the low-fat diet control group. That compares quite well to the use of statins. These cholesterol-lowering drugs reduce the possibility of such an event by about 25 percent (JAMA Cardiology, June 1, 2016). (This is relative risk in both cases; absolute risk reduction is much lower.)

Vegetables and EVOO to Prevent Breast Cancer:

Q. Is it true that a Mediterranean diet with lots of extra virgin olive oil can be protective against breast cancer? If so, how do you get more olive oil in your diet besides using it in salad dressing? I do grill salmon with it, but that’s not all that often.

A. Evidence from the PREDIMED trial suggests that a Mediterranean diet supplemented with extra-virgin olive oil (EVOO) can help reduce the risk of breast cancer (JAMA Internal Medicine, Nov. 2015). In this study, the women who were randomized to consume 4 tablespoons of EVOO daily were less likely to be diagnosed with invasive breast cancer. Over nearly five years, the rates were 1.1 per 1000 woman-years for those on the EVOO-enriched high-vegetable plan and 2.9 per 1000 woman-years for those in the control group on the “low-fat” diet. 

In a separate Spanish study, more than 10,000 alumnae of the University of Navarra responded to repeated questionnaires about health, diet and lifestyle (Public Health Nutrition, Feb. 24, 2020). During a decade of follow-up, the women who most closely adhered to a Mediterranean dietary pattern had about one-third the average risk of a breast cancer diagnosis before menopause.

You can use olive oil in marinades, over pasta and substitute it for butter on bread. We sauté vegetables with olive oil and of course use it on all our salads. Read on for more information about how to follow a Mediterranean-style eating plan.

Can You Help Your Brain by Eating Like a Spaniard or an Italian?

Heart disease is not the only chronic health problem that might be forestalled with a tasty menu full of vegetables, fruits, fish, legumes, nuts and olive oil. PREDIMED data also demonstrate that those on an olive oil based Mediterranean diet are less likely to develop dementia or cognitive problems (Journal of Neurology, Neurosurgery and Psychiatry, Dec., 2013).  Perhaps that is because those in the Mediterranean diet groups were less likely to suffer a stroke (Diabetes Care, Aug., 2013) A stroke results from damage to the circulatory system in the brain. Such damage can also lead to cognitive decline.

Counteracting Genetic Susceptibility:

Eating Mediterranean-style was able to blunt the impact of genetic variants that put some people at greater risk for diabetes and for stroke. One study shows that people with diabetes are only about half as likely to develop diabetic retinopathy if they follow a Mediterranean diet with at least two servings a week of fish and seafood (JAMA Ophthalmology, Oct. 1, 2016).  This complication of diabetes is one of the leading causes of blindness among working age people. (You can learn more about protecting your vision from our interview with Dr. Peter McDonnell, director of the Wilmer Eye Institute at Johns Hopkins Medical Center.)

How to Eat Mediterranean-Style:

So how can you get these benefits for yourself? A meta-analysis of studies on Mediterranean-type diets used seven criteria (Annals of Internal Medicine, July 19, 2016):

  • Most of the fat in the diet is monounsaturated, from olive oil or nuts.
  • The basis of the diet is vegetables and fruits.
  • The diet provides plenty of beans, peas and lentils.
  • Breads or cereal products in the diet are whole grain, mostly.
  • Dairy products are limited.
  • Meat is rare, but fish appears on the menu more often.
  • Wine, especially red wine, is permitted in moderation.

The meta-analysis shows that people following a Mediterranean diet based on these principles are less likely to suffer heart attacks, strokes, diabetes, breast cancer and colorectal cancer. That seems to us like a lot of benefit to be gained from eating delicious food with friends.

If you’d like more guidance on how to follow this healthful way of eating, you’ll find it in our book, The People’s Pharmacy Quick & Handy Home Remedies.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
Citations
  • Yubero-Serrano EM et al, "Mediterranean diet and endothelial function in patients with coronary heart disease: An analysis of the CORDIOPREV randomized controlled trial." PLOS One, Sept 9, 2020. https://doi.org/10.1371/journal.pmed.1003282
  • Estruch R et al, "Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts." New England Journal of Medicine, June 21 2018. DOI: 10.1056/NEJMoa1800389
  • Karmali KN et al, "Drugs for primary prevention of atherosclerotic cardiovascular disease: An overview of systematic reviews." JAMA Cardiology, June 1, 2016. DOI: 10.1001/jamacardio.2016.0218
  • Toledo E et al, "Mediterranean diet and invasive breast cancer risk among women at high cardiovascular risk in the PREDIMED Trial: A randomized clinical trial." JAMA Internal Medicine, Nov. 2015
  • Gardeazabal I et al, "Mediterranean dietary pattern is associated with lower incidence of premenopausal breast cancer in the Seguimiento Universidad de Navarra (SUN) Project." Public Health Nutrition, Feb. 24, 2020. DOI: 10.1017/S1368980019003835
  • Martínez-Lapiscina EH et al, "Mediterranean diet improves cognition: The PREDIMED-NAVARRA randomised trial." Journal of Neurology, Neurosurgery and Psychiatry, Dec., 2013. DOI: 10.1136/jnnp-2012-304792
  • Corella D et al, "Mediterranean diet reduces the adverse effect of the TCF7L2-rs7903146 polymorphism on cardiovascular risk factors and stroke incidence." Diabetes Care, Aug., 2013. https://doi.org/10.2337/dc13-0955
  • Sala-Vila A et al, " Dietary marine ω-3 fatty acids and incident sight-threatening retinopathy in middle-aged and older individuals with type 2 diabetes: Prospective investigation from the PREDIMED Trial." JAMA Ophthalmology, Oct. 1, 2016. DOI: 10.1001/jamaophthalmol.2016.2906
  • Bloomfield HE et al, "Effects on health outcomes of a Mediterranean diet with no restriction on fat intake: A systematic review and meta-analysis." Annals of Internal Medicine, July 19, 2016. https://doi.org/10.7326/M16-0361
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