May is international Mediterranean diet month. And it’s worth reexamining this regimen in light of a paper recently published in JAMA. Through observational cohort studies and a secondary prevention trial, an inverse association was noted between adherence to the Mediterranean diet and cardiovascular risk. Among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts was found to reduce the incidence of major cardiovascular events.
Many of your patients who are looking for a healthier eating plan, whether for weight loss or for overall health, have explored the Mediterranean diet. Below is a primer on this regimen so that you can address your patients’ questions and concerns, and help them adopt this program, or one like it, to improve their overall health.
We know that healthy diets should include plenty of fruits, vegetables, and whole grains. However, the Mediterranean diet is not a conventional diet in that it incorporates a mix of traditional cooking styles, eating habits, and lifestyle behaviors of people living in countries bordering the Mediterranean Sea, including Italy, Greece, Spain, France, and the Middle East. For millennia, people in this region have enjoyed their traditional foods, leisurely dining, and regular physical activity without considering the healthful properties of their lifestyles.
It has been long known that incorporating the Mediterranean diet is associated with a lowered risk of heart disease. Studies have shown that a Mediterranean-type diet is advantageous for many cardiovascular risk factors, including total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, blood pressure, and blood sugar levels. One of the reasons cited for these benefits is the low levels of saturated fat and high levels of monounsaturated fat and dietary fiber inherent in this diet. In addition, the health effects of the Mediterranean diet’s most famous component, olive oil, have also been praised. A 10-year study published in JAMA found that adherence to a Mediterranean diet, including its healthful lifestyle, was associated with lowering early death rates by more than 50%.
In addition to regular physical activity, the Mediterranean diet emphasizes:
- Basing meals on primarily plant-based foods, such as fresh fruits and vegetables, whole grains, legumes, and nuts (no candied, honey-roasted, or heavily salted nuts)
- Replacing butter with olive oil (preferably, extra virgin) and canola oil
- Flavoring foods with herbs and spices rather than salt
- Consuming red meat no more than a few times a month
- Eating fish and poultry at least twice a week
- Enjoying dairy foods in moderation; primarily cheese and Greek yogurt
- Drinking red wine in moderation (optional)
Regarding wine, the health effects of alcohol have long been debated, and some doctors are reluctant to encourage any alcohol consumption because of the possible consequences of excessive drinking. However, some research studies have found that moderate consumption of alcohol has been associated with a reduced risk of heart disease. The Mediterranean diet typically includes a moderate amount of wine, limiting consumption to no more than 1 glass daily for women (or men over age 65), and no more than 2 glasses daily for men under age 65. More than this may increase the risk of health problems, including certain types of cancer. If a patient is unable to limit their alcohol intake to the amounts noted above, if they have a personal or family history of alcohol abuse, or if they currently have heart or liver disease, advise them to avoid drinking wine or any other alcohol.
There are additional warnings to be heeded if a patient decides to switch to a Mediterranean-type diet:
- Because of the high intake of fats, there is a risk for weight gain
- The reduced consumption of dairy products can lead to reduced iron levels and possible calcium loss
- Patients with latex allergies may also be cross-allergic to chickpeas or other foods from the Leguminosae family, which are common in the Mediterranean diet
There are plenty of recipes, meal plans, and lists of specific foods associated with Mediterranean-type diets that can be easily found online. Here are some easy and delicious dishes to get your patients started…
- Estruch R, Ros E, Salas-Salvadó J. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368:1279-1290. http://www.nejm.org/doi/full/10.1056/NEJMoa1200303.
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