For about 300,000 years Homo sapiens have been eating anything that looks edible. Plants, grains, fruits, as well as parts of any creature that walks, flies, swims or crawls travel down the esophagus. One would think that with all this experience we would have figured out what foods are good for health. But here we are, 300,000 years later, talking about low-carb diets, ketogenic diets, carnivores, low-fat diets, vegan diets, flexible diets, intermittent fasting diets and more. While all of these have their adherents, the most interest generated by the scientific community is in favor of the “Mediterranean diet”. There is a problem here though. There are twenty-one countries around the Mediterranean and each has its own way of eating. The Spanish don’t eat the same as the Lebanese, and the French baguette is not the same as the Greek pita. So, what is the “Mediterranean diet” that experts so strongly advocate? And why?
Life expectancy around the Mediterranean is generally a few years longer than in North America, although this often applies to southern European countries such as Spain, Italy and Greece. These countries have lower rates of heart disease and obesity, and the population is more metabolically healthy, meaning they have optimal levels of five markers, such as waist circumference, fasting glucose, triglycerides, HDL cholesterol, and blood pressure without the need for medication. Food is obviously a factor, but people around the Mediterranean also walk more, have more social connections and generally have access to quality health care.
Assuming that diet is a factor, the question arises as to what Mediterranean people actually eat. In general, they eat lots of vegetables, fruits, whole grains, legumes, nuts, seeds, and fish. They eat little red meat, moderate amounts of dairy (mostly yogurt), poultry, and eggs. Their main oil is olive oil. But the secret to their diet may not be what they eat. Maybe it’s something they don’t eat. They don’t eat ultra-processed foods or refined carbohydrates, they stay away from processed meats, and they don’t drink sugary drinks. This dietary pattern lowers LDL cholesterol and blood pressure, lowers inflammatory markers, and leads to insulin sensitivity and higher satiety, which means fewer calories.
However, debunking any benefits of the Mediterranean diet may actually require more than observational studies. We need appropriate, randomized interventional studies such as the “PRIDEUM” trial conducted in Spain between 2003 and 2011, which randomly divided 7,500 adults at high risk for heart disease into three groups. One group followed a Mediterranean diet supplemented with olive oil, another group ate a Mediterranean diet supplemented with nuts, and a third group ate a low-fat control diet. After 5 years, the Mediterranean groups had 30% fewer cardiovascular events, meaning heart attack, stroke or cardiovascular death. Impressive!
What about cancer? There are no dramatic differences, but some cancers, such as colon and breast, have a slightly lower incidence in Mediterranean countries than in North America. This may be due to the increased fiber and antioxidants from vegetables. There is another type of health that is worth considering when it comes to the Mediterranean diet, and that is mental health.
We can get a glimpse of this from a study that looked at following a “MIND” diet that is believed to be beneficial for the brain. Brain combines the Mediterranean diet and the “DASH” (Dietary Approaches to Prevent Hypertension) diet. Researchers followed 1,600 adults over the age of 60 who filled out food frequency questionnaires and underwent MRI scans every four years. Their diets were evaluated based on a “mind scoring system” that awards points based on the number of servings of “brain-healthy” foods over a week and subtracts points for servings of “brain-unhealthy” foods. Healthy foods include leafy greens, other vegetables, dairy, nuts, olive oil, whole grains, fish, poultry, beans, legumes, and wine. Unhealthy foods are meat and meat products, butter and margarine, cheese, pastries and sweets, fast and fried foods.
To calculate adherence to the MIND diet, add 1 point for brain-healthy foods or unhealthy foods according to the table below. You receive 0.5 points for moderate consumption of each group and 0.5 points for low consumption of healthy foods or high consumption of unhealthy foods according to the table below. For example, if you eat 6 or more servings of green leafy vegetables per week, give yourself 1 point. If you only eat 3 servings, you get half a point. If you eat less than 4 servings of red meat per week, you get one point. There are 15 categories so the maximum number of points will be 15.
Participants who got closer to MIND had less brain shrinkage and less loss of gray matter, which is vital for memory and cognition. Unfortunately, the researchers did not conduct memory tests to see if less brain shrinkage was associated with better memory. Brain shrinkage and gray matter loss have also been linked to Alzheimer’s disease, and even moderate adherence to MIND has been shown to reduce Alzheimer’s risk by nearly 35%, while high adherence can reduce it by up to 50%.
I think this scoring system will also work to assess the risk of heart disease, cancer and diabetes. The only quibble I would have is giving one point for one glass of wine a day. I do not believe there is evidence to justify this. I would rather suggest adding a point not to consume alcohol. Do the math in each situation and if you come up with a score higher than 9, you have a perfect diet. However, remember that it’s the whole lifestyle that matters, so anyone who thinks they’ll live longer by tossing olive oil on their salad or eating yogurt instead of ice cream for lunch is wrong.
@JoeSchwarcz
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