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Can you tell me more about the Mediterranean diet?

Thanks to the best-selling paperback, "The Mediterranean Diet" by Cloutier and Adamson many people have heard the term "Mediterranean diet" but don't know what's involved with this eating plan. We'd like to tell you a little bit more about food traditions along the Mediterranean Sea than is presented in this best-selling diet book. And we'd like give you a more research-based perspective on the idea of a "Mediterranean Diet." Our reasons here are simple: from a research perspective, the Mediterranean diet is strongly associated with a decreased risk of heart disease, diabetes, certain cancers, and even overall risk of death when compared with other diets. In addition, the rich health benefits provided by this diet approach are being confirmed by research on similar diets (like the DASH diet) that are plant-based and focus on vegetable intake and outstanding food quality.

What Are the Mediterranean Food Traditions?

Many countries border along the Mediterranean Sea, and many different food traditions are represented in these countries. The Mediterranean countries include France, Spain, Italy, Greece, and Portugal along the north; Turkey, Syria, Lebanon, and Israel on the east; and the African countries of Egypt, Libya, Algeria, Morocco, and Tunisia on the south. Cuisines on the eastern border of the Mediterranean are usually referred to as Middle Eastern cuisines. Cuisines along the southern border are usually referred to as North African cuisines. This classification system leaves the countries of Italy, Greece, Spain, Portugal, and (southern) France as the food traditions usually referred to as "Mediterranean" cuisines.

Olive Oil

If you've purchased olive oil in the grocery store, you may have noticed that virtually all of it comes from one of three countries: Italy, Spain, or Greece. Over 75% of all olive oil worldwide comes from the three Mediterranean countries. Olive trees are native to this area of the world, and it would be impossible to follow a Mediterranean diet tradition without including olives and their oil.

Mediterranean diets have been especially interesting to researchers in relationship to heart disease. Given the total amount of fat in many Mediterranean foods (including olives and nuts), it might seem logical to expect a higher incidence of heart disease in Mediterranean countries than actually occurs. One reason for the lower-than-expected rates of heart disease is olive oil (and olives). Olives are very high in monounsaturated fat, a type of fat that often escapes damage by free radicals and is therefore more heart healthy. Oleic acid accounts for most of the monounsaturated fat in olives, and diets containing significant amounts of this fatty acid have also been shown to help lower LDL cholesterol and homocysteine levels in the body. Both of these changes are considered protective of the heart and circulation.

Olives also contain some unique phytonutrients called phenols. Oleuropein is the best studied of these phenols. This phenolic substance in olives has been found to help lower blood fats, prevent interruption of blood flow, and function as an antioxidant that helps protect the blood vessels.

Mediterranean Climate, Vegetables, and Fruits

The climate around the Mediterranean Sea is often referred to as "dry summer subtropical." Just like this name suggests, the summer months in this region of the world are very dry. However, year-round temperatures average 39°-56°F (4°-13°C) in the coolest months and 66°-88°F (19°-31°C) in the warmest months, with plenty of rainfall during the late fall and early winter season. This climate is ideal for a wide variety of fresh, locally grown vegetables including an abundance of tomatoes and peppers. Figs and pomegranates are also unique fruits widely available in this region. The Mediterranean climate leaves populations in this part of the world with an especially rich vegetable-and-fruit platform for building a delicious and optimally nourishing food plan.

Fish

All of the Mediterranean countries share an active stretch of coastline along the Mediterranean Sea. For this reason, fish are a staple part of the Mediterranean diet. Bass, blue whiting, striped mullet, skate, shark, shad, sturgeon, and tuna are all common to this region. Many of the fish contribute to the much better-than-average intake of omega-3 fatty acids in the Mediterranean diet. The omega-3 fatty acids are not only helpful in prevention of heart disease, but also in support of most organ systems in the body.

Red Wine

Italy, Spain, and France are countries famous worldwide for their production of red wine. Regular consumption of red wine would be considered part of most Mediterranean diets, and like olive oil, red wine supplies civilizations along the Mediterranean with ample supplies of several unique phytonutrients. Resveratrol is one of the best-studied polyphenols in red wine. This substance has been shown to improve blood flow to the brain and to help keep heart muscle flexible. Tannin and saponin glycosides are other substances in red wine that are clearly heart-protective due to their total cholesterol-lowering and HDL cholesterol-increasing effects. The saponins in red wine also help prevent unwanted clumping together of red cells in the blood.

The Rich and Authentic Taste of Real Food

Devotion to taste is one final topic that's impossible to avoid when describing the Mediterranean diet. Culture traditions in this region of the world prize the deliciousness of food in a way that is almost legendary. One of the reasons that fast food, processed food, and hydrogenated oils play a smaller role in this region than in the United States is because of their reverence of the taste of fresh food. To inhabitants of the Mediterranean, there is just nothing like the spectacular taste of fresh, regionally-grown foods seasoned and prepared with the utmost of care. Everything else falls short. The simplicity of good taste is a key factor in the healthiness of the Mediterranean diet. It's also one reason why there is so much overlap between this way of eating and the Healthiest Way of Eating we recommend based on the World's Healthiest Foods.

Proven Health and Nutrition Benefits

The simple, good tastes from fresh, regionally grown foods as represented by the Mediterranean diet would not be nearly so interesting to researchers if were not for the amazing health and nutrition benefits offered by this diet. With respect to weight management, risk of cardiovascular disease, type 2 diabetes, several types of cancer, arthritis, and other chronic diseases, no single dietary approach has more research-based benefits than the Mediterranean diet. And when it comes to nutrient intake, the more closely a person eats in accordance with a Mediterranean diet, the better that person's nutrient intake becomes.

The Mediterranean diet is especially interesting in terms of obesity prevention and weight management. Studies have documented a tendency toward less obesity (as measured by lower body mass index, or BMI, and also by lower waist circumference) among individuals who follow a Mediterranean diet. At the same time, individuals who follow a Mediterranean diet tend to have higher calorie intakes. That combination doesn't make immediate sense, because we ordinarily expect weight and excess body fat to go up if calories go up. However, individuals who follow a Mediterranean diet also have a tendency to increase their physical activity level, and they are able to consume an unexpected large volume of food because a Mediterranean diet emphasizes foods (like vegetables) that give us large volumes in exchange for a relatively small number of calories.

References:

Aguilera CM, Ramirez-Tortosa MC, Mesa MD, et al. "." Nutr Hosp; 2001;16(3):78-91.

Al-Azzawie HF, Alhamdani MS. Hypoglycemic and Antioxidant Effect of Oleuropein in Alloxan-Diabetic Rabbits. Life Sci. 2006;78(12):1371-7.

Allman-Farinelli MA, Gomes K, Favaloro EJ, et al. A Diet Rich in High-Oleic-Acid Sunflower Oil Favorably Alters Low-Density Lipoprotein Cholesterol, Triglycerides, and Factor VII Coagulant Activity. J Am Diet Assoc. 2005;105(7):1071-9.

Andreadou I, Iliodromitis EK, Mikros E, et al. The Olive Constituent Oleuropein Exhibits Anti-Ischemic, Antioxidative, and Hypolipidemic Effects in Anesthetized Rabbits. J Nutr. 2006;136(8):2213-9.

Baro L, Fonolla J, Pena JL, et al. N-3 Fatty Acids Plus Oleic Acid and Vitamin Supplemented Milk Consumption Reduces Total and LDL Cholesterol, Homocysteine and Levels of Endothelial Adhesion Molecules in Healthy Humans. Clin Nutr. 2003;22(2):175-82.

Bond R, Lloyd DH. A Double-Blind Comparison of Olive Oil and a Combination of Evening Primrose Oil and Fish Oil in the Management of Canine Atopy. Vet Rec. 1992;131(24):558-60.

Martinez-Dominguez E, de la Puerta R, Ruiz-Gutierrez V. Protective Effects Upon Experimental Inflammation Models of a Polyphenol-Supplemented Virgin Olive Oil Diet. Inflamm Res. 2001;50(2):102-6.

Miura D, Miura Y, Yagasaki K. Hypolipidemic action of dietary resveratrol, a phytoalexin in grapes and red wine, in hepatoma-bearing rats. Life Sci. 2003;73(11): 1393-400.

Miyagi Y, Miwa K, Inoue H. Inhibition of human low-density lipoprotein oxidation by flavonoids in red wine and grape juice. Am J Cardiol. 1997;80(12):1627-31.

Olson ER, Naugle JE, Zhang X, et al. Inhibition of cardiac fibroblast proliferation and myofibroblast differentiation by resveratrol. Am J Physiol Heart Circ Physiol. 2004 Oct 21; .

Roche HM. Olive Oil, High-Oleic Acid Sunflower Oil and CHD. Br J Nutr. 2001;85(1):3-4.

Romaguera D, Norat T, Mouw T et al. Adherence to the Mediterranean diet is associated with lower abdominal adiposity in European men and women. J Nutr. 2009 Sep;139(9):1728-37.

Rumawas ME, Dwyer JT, Mckeown NM et al. The Development of the Mediterranean-Style Dietary Pattern Score and Its Application to the American Diet in the Framingham Offspring Cohort. J Nutr 2009: Vol. 139, No. 6, 1150-1156.

Visioli F, Romani A, Mulinacci N, et al. Antioxidant and Other Biological Activities of Olive Mill Waste Waters. J Agric Food Chem. 1999;47(8):3397-401.

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