Mediterranean Diet: Good for your mind and body

By Dale Mayo, March 23, 2023

In the 1940s, Ancel Keys and several colleagues launched the Seven Countries Study (SCS), which looked at variations in coronary heart disease risk related to diet and culture in the US, Finland, Netherlands, Italy, Greece, former Yugoslavia, and Japan.  The led to the recognition of the health benefits of the eating patterns found in Italy and Greece, hence the name “Mediterranean Diet.”[i]  The word Diet is a little bit of a misnomer, as the Mediterranean Diet describes the types of foods eaten (cereals, legumes, fruit, vegetables, fish, and wine) but does not specify the intake of calories. Some foods that are not on the list are eaten in Mediterranean countries, but in much smaller amounts than in other countries in the SCS (e.g., beef, meat, dairy, eggs, and sweets).

While we’ve known for that people who follow a Mediterranean Diet have lower incidence of heart disease, recent studies show that there are further health benefits:  not only is it is good for staving off dementia and diabetes, it’s especially good for women. 

https://upload.wikimedia.org/wikipedia/commons/4/44/Why_Diet.pdf

What it is

The Cleveland Clinic website provides a good summary of the Mediterranean diet: 

While some eating styles focus on weight loss (many using unproven, unsafe methods), others focus on specific elements of your health. And time and again, research shows that when it comes to heart health and overall well-being, one eating style reigns supreme: The Mediterranean diet.

• Fish: Three servings per week (one serving = 3 to 4 ounces).
• Extra-virgin olive oil: At least 1 tablespoon per day, but no more than 4 tablespoons per day.
• Fruit: Three servings of fruit per day (one serving = 1/2 to 1 cup).
• Vegetables: Three-plus servings per day (one serving = 1/2 cup cooked or 1 cup raw).
• Legumes: Three servings per week (one serving = 1/2 cup).
• Nuts: At least three servings per week (one serving = 1/4 cup or 2 tablespoons nut butter).
• Whole grains and starchy vegetables: Three to six servings per day (one serving = 1/2 cup cooked vegetables, one slice of bread or 1-ounce dry cereal).

The Mediterranean Diet isn’t a plan you pay for and follow for a time-limited period; rather, it describes a lifestyle. In cities and villages around the Mediterranean Sea, people don’t think of what they’re buying as food for a diet, it’s just food. They tend to walk and ride bicycles and visit with one another in the village square. Activity, social contact, and good food are all part of the lifestyle.[ii]

https://onlinelibrary.wiley.com/doi/full/10.1111/joim.13333

Promote a healthy heart

Heart disease is the leading cause of death globally.  The Mediterranean diet helps prevent coronary and cardiovascular disease in middle-aged and elderly men and women.  An on-going seven-year study shows that for people who already have heart disease, it prevents future heart problems better than a low-fat diet.[iii]  Coronary heart disease is the number one killer of women in the US and kills more than twice as many women as breast cancer in the United Kingdom. According to a recent study, women who follow a Mediterranean diet have 24% lower risk of cardiovascular disease.[iv] Cardiologists often recommend the Mediterranean diet for its heart health benefits as well as its overall health benefits. Fish and other seafood, staples of the Mediterranean Diet, are a good source of lean protein and an excellent source of omega-3 fatty acids which are good for heart health.

Lower risk of dementia

According to a new study, people who follow a Mediterranean or MIND (Mediterranean-DASH Intervention for Neurogenerative Delay) diet may have fewer signs of Alzheimer’s disease in their brain tissue.[v]  The study concludes that the Mediterranean Diet may be a protective factor against memory decline and that longitudinal and dietary intervention studies should be undertaken.[vi]  In a review of the effect of the Mediterranean Diet on cognitive impairment (that your cognition will be worse in 10 years compared to your peers) and cognitive decline (that your cognition will be worse in 10 years than it is now), a Harvard health website states that fish is the single most important dietary factor in lowering the risk of cognitive impairment and that it also lowers the risk of cognitive decline.

Prevent obesity and diabetes

People with obesity are at increased risk for a variety of related disorders including hypertension, dyslipidemia, type 2 diabetes mellitus, cardiovascular disease, and several cancers.[vii] According to a review of studies of the Mediterranean Diet and obesity related disorders, the negative effects of obesity can be partly reversed by substantial weight loss that can be achieved with Mediterranean Diet, especially when low-calorie and in combination with adequate physical activity.[viii] American portion sizes tend to be larger than those of other countries, which means that some portion control may be advised.

The Mediterranean Diet is comparable with pharmacological interventions in terms of reducing the risk of obesity and cardiovascular and metabolic events.[ix]

Other benefits

The Mediterranean Diet has been studied for its value in preventing and managing a wide variety of ailments and serious illnesses. There continues to be high interest in following a Mediterranean Diet approach management of such conditions:

• Preventing pre-eclampsia in pregnancy. Following a Mediterranean-style diet may also significantly lower the odds of developing the potentially serious pregnancy complication pre-eclampsia. Researchers surveyed more than 8,500 women about their eating patterns during pregnancy. Compared with women eating the fewest Mediterranean-style foods, those in the group eating the highest amount showed a 28% lower risk for pre-eclampsia. [x]
• Reducing hot flashes during menopause. Consumption of a fruit or Mediterranean-style diet decreased the risk of reporting hot flashes compared to a high-fat and high-sugar diet.[xi]
• Healthy aging. In a study following more than 10,000 women ages 57-61, researchers found that those who followed a Mediterranean eating (and lifestyle) pattern were most likely to live to 70 or older healthily (without chronic disease or decline in mental health, cognition and physical functioning).[xii]
• Improving mood. A review of research literature states that two clinical trials about the Mediterranean Diet and mental health showed improvement of depressive symptoms and remission rates under a healthy diet regimen.[xiii]

"wild salmon grilled on a cedar plank" by woodleywonderworks is licensed under CC BY 2.0

Seafood in the Mediterranean Diet

The Mediterranean Diet is suggested by physicians as a healthy alternative to a typical American diet that includes fast food, highly processed carbohydrates and meats, and more than the recommended amount of salt and sugar.  In addition, many trusted medical organizations recommend that we eat seafood at least twice a week. Seafood is easy to fit into any diet, but it is a hallmark of the Mediterranean Diet.  Fish is a low-fat, high quality protein loaded with omega-3 fatty acids, vitamins (B2 and D), minerals (iron, zinc, iodine, magnesium, and potassium), other nutrients (choline), calcium, and phosphorous. Seafood is good for everyone – adults, children, and pregnant women. The Federal Drug Administration and Environmental Protection Agency have developed a chart that shows dozens of healthy and safe options and includes information about the nutritional value of fish.[xiv] 

[i]   https://www.sevencountriesstudy.com/tag/mediterranean-diet/

[ii]   Robertson, D. (2023). ’It’s about more than just food’: Mediterranean diet is a part of a whole way of life. The Guardian. March 19, 2023. https://www.theguardian.com/food/2023/mar/19/its-about-more-than-just-food-mediterranean-diet-is-part-of-a-whole-way-of-life

[iii]   Corliss, J. (2022). Preventing heart attacks:  Mediterranean vs. low-fat diet. Harvard Heart Letter.  August 1, 2022. https://www.health.harvard.edu/heart-health/preventing-repeat-heart-attacks-mediterranean-vs-low-fat-diet

[iv]   Francis, E. (2023). Mediterranean diet can cut heart disease risk in women by 24 percent, report says. The Washington Post. March 15, 2023. https://www.washingtonpost.com/wellness/2023/03/15/mediterranean-diet-heart-disease-women-study/

[v]  Moniuszko, S. (2023). Mediterranean, MIND diets linked to fewer Alzheimer’s signs in brain, study finds. CBS News. March 9, 2023. https://www.cbsnews.com/news/mediterranean-mind-diets-linked-fewer-alzheimer-signs-study/

[vi]   Ballarini T, Melo van Lent D, Brunner J, Schröder A, Wolfsgruber S, Altenstein S, Brosseron F, Buerger K, Dechent P, Dobisch L, Duzel E, Ertl-Wagner B, Fliessbach K, Freiesleben SD, Frommann I, Glanz W, Hauser D, Haynes JD, Heneka MT, Janowitz D, Kilimann I, Laske C, Maier F, Metzger CD, Munk M, Perneczky R, Peters O, Priller J, Ramirez A, Rauchmann B, Roy N, Scheffler K, Schneider A, Spottke A, Spruth EJ, Teipel SJ, Vukovich R, Wiltfang J, Jessen F, Wagner M; DELCODE study group. Mediterranean Diet, Alzheimer Disease Biomarkers and Brain Atrophy in Old Age. Neurology. 2021 May 5;96(24):e2920–32. doi: www.doi.org/10.1212/WNL.0000000000012067.

[vii]   Muscogiuri G, Verde L, Sulu C, Katsiki N, Hassapidou M, Frias-Toral E, Cucalón G, Pazderska A, Yumuk VD, Colao A, Barrea L. (2022). Mediterranean Diet and Obesity-related Disorders: What is the Evidence? Curr Obes Rep. 2022 Dec;11(4):287-304. www.doi.org/10.1007/s13679-022-00481-1

[viii]   Muscogiuri G, Verde L, Sulu C, Katsiki N, Hassapidou M, Frias-Toral E, Cucalón G, Pazderska A, Yumuk VD, Colao A, Barrea L. (2022). Mediterranean Diet and Obesity-related Disorders: What is the Evidence? Curr Obes Rep. 2022 Dec;11(4):287-304. www.doi.org/10.1007/s13679-022-00481-1

[ix]   Barrea, L., Pugliese, G., Laudisio, D., Colao, A., Savastano, S. & Muscogiuri, G. (2021). Mediterranean diet as medical prescription in menopausal women with obesity: a practical guide for nutritionists, Critical Reviews in Food Science and Nutrition, 61:7, 1201-1211, https://www.tandfonline.com/doi/full/10.1080/10408398.2020.1755220

[x]  Salamon, M. (2022). Mediterranean diet may help ward off a dangerous pregnancy complication. Harvard Women’s Health Watch. August 1, 2022.  https://www.health.harvard.edu/womens-health/mediterranean-diet-may-help-ward-off-a-dangerous-pregnancy-complication

[xi]   Herber-Gast GC, Mishra GD. (2013). Fruit, Mediterranean-style, and high-fat and -sugar diets are associated with the risk of night sweats and hot flushes in midlife: results from a prospective cohort study. Am J Clin Nutr. 2013 May;97(5):1092-9. www.doi.org/10.3945/ajcn.112.049965

[xii]  Samieri C, Sun Q, Townsend MK, Chiuve SE, Okereke OI, Willett WC, Stampfer M, Grodstein F. (2013). The association between dietary patterns at midlife and health in aging: an observational study. Ann Intern Med. 2013 Nov 5;159(9):584-91. www.doi.org/10.7326/0003-4819-159-9-201311050-00004

[xiii]   Ventriglio A, Sancassiani F, Contu MP, Latorre M, Di Slavatore M, Fornaro M, Bhugra D. (2020). Mediterranean Diet and its benefits on health and mental health: a literature review. Clin Pract Epidemiol Ment Health. 2020 Jul 30;16(Suppl-1):156-164. www.doi.org/10.2174/1745017902016010156

[xiv]   https://www.fda.gov/food/consumers/advice-about-eating-fish; https://www.fda.gov/media/102331/download