Today we hear a lot about the Mediterranean diet. UNESCO, the cultural arm of the United Nations, has proclaimed the Mediterranean diet one of civilization’s great treasures. But which Mediterranean diet? There are sixteen countries that border the Mediterranean Sea. I’ve been to most of them for extended periods of time, and I can tell you that there is no single Mediterranean diet.
What is eaten in Spain is very different from that eaten in Italy, and what is consumed in Italy is distinct from the diet in Greece, not to mention the other 13 countries in the region. If you ask most Americans for their definition of the Mediterranean diet, the response is usually eating pasta (and pizza), drinking red wine, using a little olive oil, drinking espresso, and adding some parmesan cheese to their meals. But that American version doesn’t look anything like the real Mediterranean diet. If you eat that way—and think you’re cutting your risk of heart disease and helping your body shed fat—it’s time to rethink.
THE REAL MEDITERRANEAN MIRACLE
There is no definitive caloric composition that makes up “the Mediterranean diet.” The best that researchers can do is to estimate adherence to food groups they think should be in the Mediterranean diet. A good guess is that about 60% of the calories in the Mediterranean diet are consumed as carbohydrates, 15% as protein, and about 35% as fat, which would make the Mediterranean diet close in macronutrient composition to the current American diet.
Let me say that again: When it comes to carbs, protein, and fat, the Mediterranean diet is almost identical to what the average American eats.
So why is it seemingly so much healthier? One word: polyphenols. The distinguishing feature of the diets in virtually every region that borders the Mediterranean Sea is not pasta but vegetables and fruits. We finally have enough scientific sophistication to realize that it’s the high levels of polyphenols—micronutrients that act as powerful anti-inflammatory agents—that make the Mediterranean diet unique. If you look at the Mediterranean food groups carefully, they usually fall into two broad categories: those rich in polyphenols (fruits, vegetables, wine) eaten in large quantities and those, such as red meat, chicken, and eggs, that are not great sources of polyphenols—and are eaten less frequently.
Furthermore, it is implicit that the fat in the Mediterranean diet is generally rich in monounsaturated fats (from olive oil and nuts), moderate in omega-3 fats (coming from fish), and low in omega-6 and saturated fats (from corn oil and red meat). Foods rich in polyphenols, monounsaturated fats, and omega-3 fatty acids and low in omega-6 and saturated fats may well explain why, despite having a similar ratio of carbohydrates, protein, and fat to the current American diet, the Mediterranean diet is so much more effective at preventing disease and promoting longevity.
Most of the research around the Mediterranean diet comes from epidemiological studies, which observe large groups of individuals to determine whether those more closely adhering to a dietary ingredient regimen have any improved health outcomes over those who are not. Better adherence to a Mediterranean diet (meaning probably eating more polyphenols) appears to reduce the incidence of diabetes and heart disease. Just as important, adherence to the Mediterranean diet also appears to preserve the mind and slow the rate of aging. Since diabetes, heart disease, and dementia are caused by cellular inflammation, this would strongly suggest that a Mediterranean diet really is an anti-inflammatory diet. However, remember that these benefits only come from a lifetime of eating a Mediterranean diet, reinforcing the ancient Greek origins of the word diet, which means “way of life.”
The American Heart Association, for one, recommends that we avoid fat when possible, especially saturated and trans fats, and if we do eat fat, that we try to focus on polyunsaturated fats like corn oil. Are there any intervention studies that suggest that the Mediterranean diet has health benefits compared with a control diet, such as the one recommended by the AHA?
Actually, there are. The results of the first of such studies, the Lyon Diet Heart Study, didn’t make the American Heart Association very happy. Started in 1988, this study split more than 600 French patients who had recently suffered a heart attack into two groups. One group followed the AHA diet guidelines, consisting of a low-saturated-fat, low-cholesterol diet, but the fat they did consume was relatively rich in omega-6 fatty acids (beloved by the AHA because they are shown to lower blood cholesterol). The other group followed an experimental diet similar to the Mediterranean diet, which included more fish, vegetables, and fruits and was low in omega-6 fatty acids.
The researchers wanted their subjects to use olive oil. But because the French tend to prefer butter over olive oil, the researchers gave the subjects free margarine low in omega-6 fatty acids, but enriched with omega-3 fats and lots of trans fatty acids to hold it together. Trans fats! It was almost as though the Med diet subjects were set up to fail. They planned to follow the patients in both groups for the next five years, but the study was stopped after three and half years. Was it ended because those getting the experimental Mediterranean diet were dying like flies because of the trans fats in their diet? No, just the opposite. They were doing dramatically better (especially in terms of mortality) than the subjects following the American Heart Association recommendations.
How much better? They had 70% fewer deaths overall and a complete elimination of sudden cardiac arrest (the primary reason you die from a heart attack). When researchers looked for clinical markers to explain these remarkable differences in mortality, they found the blood cholesterol levels were the same in the two groups, as were the blood sugar and blood pressure levels.The only thing they found that was different was that those following the experimental Mediterranean diet had a 30% lower AA:EPA ratio in their blood. The AA (arachidonic acid):EPA (eicosapentaenoic acid) ratio is an indication of the levels of cellular inflammation in your body.
High levels of cellular inflammation do not mean you have a disease state, but it does indicate that you are not as well as you could be. This suggested that the mortality differences may be a result of reductions in cellular inflammation—and not the usual suspects, like elevated cholesterol and blood pressure That study is old news, but even today, the AHA stubbornly sticks to its “reduce fat and cholesterol” stance, despite consistent evidence against it. In one recently published intervention study, researchers split the subjects into three separate groups. One group was given free nuts, including walnuts and almonds. The second group was given free extra virgin olive oil. The third was told to change their current diet to a low-fat diet.
Not surprisingly, the groups that got the free food eagerly consumed it. Since the free food consisted of items that increased their adherence to the Mediterranean way of eating, it was not surprising that their Mediterranean diet adherence scoresalso increased. At the end of the study, those subjects getting either free nuts or free olive oil (foods rich in polyphenols) had fewer heart attacks. The media screamed this proved the Mediterranean diet prevents heart disease, when it really proved that people who eat free food rich in polyphenols seem to have fewer heart attacks. It also proved that it’s very difficult to change a person’s dietary habit if they don’t get free food.
MAKING THE MEDITERRANEAN DIET BETTER
There have been other more controlled intervention studies that have indicated when you dramatically reduce the levels of carbohydrates in the Mediterranean diet (usually around 60% total calories) and simultaneously increase the protein content from about 15% of total calories to about 30%, there are significant improvements in blood sugar control and satiety. This would suggest that there is a lot of potential improvement in what is considered to be the Mediterranean diet. The logical question might be this: Can the benefits of the Mediterranean diet (decreased chronic disease, increased longevity, and decreased dementia) be taken to a still higher level using the Zone blueprint of balancing protein, carbs, and fat in addition to providing the missing Holy Grail of weight loss at the same time? Absolutely.