The Mediterranean Diet Health Benefits Revisited


Three red tomatoes lycopene mediterranean diet prevents cancerPhotograph courtesy of epSos.de

A recent study evaluated six different clinical trials involving 2650 overweight and obese patients around the world.  The Mediterranean Diet was found to be more effective in reducing weight, body mass index, blood pressure, fasting sugar and total cholesterol than a low fat diet.  

The Mediterranean Diet is known as a moderate fat diet, because a higher percentage of calories comes from fat than in a standard heart healthy diet where less than 30% of calories are from fat. However, the secret of the Mediterranean diet is not the percentage of fat but the type of fat consumed. Olive, canola, sunflower, safflower, soybean and peanut oil commonly eaten in the Mediterranean regions are all mono and poly unsaturated oils, which are healthier than saturated and trans (partially hydrogenated vegetable oils). Monounsaturated fatty acids (commonly abbreviated MUFA) are healthier than saturated fats, which are found in animal fat products such as butter and tropical oils.  Avocados are another source of MUFA.

Nuts, another integral food consumed in Mediterranean countries, provide heart-healthy omega 3 fatty acids.

Fish, a leaner protein than red meat, is a major component of the Mediterranean Diet.  Fatty fish like salmon, halibut, herring, black cod and sardines have high levels of omega 3 fatty acids, which support healthy memory and aging, and prevent heart disease. Interestingly, omega 3 fatty acids modestly increase LDL ( bad cholesterol), but they are beneficial in preventing heart disease and stroke because they prevent platelet stickiness and help lower blood triglyceride levels. Omega 3 fatty acids also reduce the risk of sudden death by preventing heart dangerous types of heart rhythm abnormalities.Mykonos Crete Mediterranean Diet Madelaine Bulkes Made B

Photograph Courtesy of Madelaine Bulkes

The Standard American Diet or SAD (pun intended) has large amounts of red meat, fried foods, processed grains, cured meats, and sugary sweets and beverages.  In contrast, the Mediterranean Diet is plant-based, with up to 10 servings of fruits and vegetables daily. 

Whole grains are another important feature of the Mediterranean Diet. Bread is eaten plain or dipped in olive oil.  Avoid butter, which has saturated fat, and margerine, which contains trans fat made by partially hydrogenating vegetable oils. Whole grains take longer to digest so they prevent sharp increases in blood sugar after meals. 

Americans more commonly eat processed grains, which have the outer covering of the grain removed.  Remember that whole wheat bread is not made of whole grain; instead it is made out of processed wheat flour (but still has more fiber than white bread). Whole grains have more fiber and are healthier for the colon than processed grains. A high fiber diet can reduce the risk of diverticulosis and colon cancer.  It takes more calories to digest whole grains than to digest processed grains.  A diet high in fiber can also lower blood  cholesterol levels. The Mediterranean Diet have high amounts of soluble (beans, legumes, cracked wheat)  and insoluble (fruits, vegetables, oat bran) fiber.

Substitute a whole wheat version of your favorite pasta, and remember to cook it al dente (not soft) in order to prevent increases in blood sugar after eating.

red wine mediterranean diet mark phillips Timba LimberRed wine in moderation is acceptable in the Mediterranean Diet. However, if more than 5 ounces per day in women or 10 ounces a day in men is consumed, the benefits of the red wine are lost.  Women at risk for breast cancer or breast cancer

Photograph courtesy of Mark Phillips/Timba Limber

recurrence should consider restricting alcohol intake since this factor has been associated with breast cancer occurrence.  It is believed that the benefits of red wine to the heart are through the antioxidant action of the phytonutrient resveratrol, which is found in the skins of grapes. So the same benefits of wine can be achieved by eating red grapes or drinking pure red grape juice. 

Dr. Ancel Keyes and his colleagues (including Dr. Paul Dudley White, who later served as President Eisenhower’s heart doctor) developed the Seven Countries Study after World War II to evaluate the health of almost thirteen thousand middle-aged men in the United States, Greece, Italy, the Netherlands, Finland, Yugoslavia and Japan.  They discovered that people who ate a diet high in vegetables, fruits, legumes (beans, lentils), fish and whole grains were the healthiest. The healthiest men were the residents of Crete, who lived longer and had less heart disease than Americans in the post World War II era.  Dr. Keyes and his  associates hypothesized that it was the Mediterranean diet that the Cretans ate which contributed to their longevity and good health. The residents of Crete ate up to 10 servings of fruits and vegetables daily!

Studies have shown that the Mediterranean Diet decreases the risk of heart attack, stroke, Parkinson’s disease, Alzheimer’s disease and death from all causes. Although there have not been any prospective randomized, double blind, placebo controlled trials (the gold standard for evidence based medicine) comparing the Mediterranean diet to the standard American diet or weight loss programs, a number of studies have shown that people who follow the Mediterranean diet are leaner than people who follow other diets.

Cruciferous vegetables (shaped like a cross when cut)  such as broccoli, cauliflower, kale, cabbage and Brussels sprouts have antioxidants which prevent several kinds of cancer including breast and prostate.  Tomatoes have lycopene, an  antioxidant similar to vitamin A, which  reduces the risk of cancers such as breast and prostate. Cooking tomatoes or cooking with olive oil, such as in tomato sauce, increases the lycopene content.

The low sodium Mediterranean diet combined with the high potassium content of fruits and vegetables such as various greens, legumes, potatoes and squash helps lower blood pressure.  Spinach, almonds, lentils, broccoli, pumpkin and sunflower seeds are good sources of magnesium, another element essential to maintain good blood pressure.

The high fiber content of fruits, vegetables and whole grains stabilizes blood sugar and prevents diabetes.  Another benefit of fiber in the diet is that it keeps maintains a feeling of fullness, decreasing the temptation for eating unhealthy snacks when ravished! Mono unsaturated fats from foods such as avocados, olive oil and nuts increase the body’s ability to use insulin, which also decreases the risk of diabetes. 

Although nuts have healthy omega 3 fatty acids, they are composed of fat, so no more than a handful a day is recommended. Avoid salted or honey roasted nuts. Almonds, walnuts, hazelnuts, pine nuts, cashews and pistachios can be eaten as part of the Mediterranean diet.

Lean protein in the form of chicken and other poultry and fish (healthy portion  is checkbook cover size) are important components of the Mediterranean diet, and are consumed weekly. Red meat and pork is rarely eaten, no more than a few times a month, and in small portions (about the size of a deck of cards). Food is prepared simply, using fresh ingredients, without  sauces or gravies. Rosemary, garlic, thyme, basil and parsley are herbs commonly used in Mediterranean cuisine, and have been shown to have beneficial health effects.

Studies show that garlic decreases blood pressure and reduces risk of cardiovascular disease. Remember to allow cut garlic to sit out for at least 5 minutes before cooking, in order to retain its health benefits.

In the Mediterranean region, sweets are consumed infrequently (no more than twice weekly), and are usually made of natural sugars such as honey.  Aiming for a 75 calorie dessert is ideal. Sorbets, fruit and dark chocolate are the best dessert choices.

Low fat Greek yogurt, feta cheese, sardines, beans, Brussels sprouts, broccoli, spinach and kale are good sources of calcium.

Lentils, spinach, almonds, and poultry are good sources of iron. Eating citrus fruit or peppers provides vitamin C, which helps the absorption of iron in a meal. Lentils and beans are also good sources of potassium, magnesium, folic acid and soluble fiber. Soak beans and change the soaking water several times in order to decrease the gas producing substances in beans. Remember that beans are not a complete protein, meaning they lack some essential amino acids that the body must get through the diet; adding lean poultry and eggs provides these essential amino acids.  Egg yolks should be eaten no more than once a week due to the saturated fat content, but there is no limit to the amount of egg whites that can be consumed.

At least 30 minutes daily exercise or movement is a recommended part of the Mediterranean diet.

Finally, a very important component of the Mediterranean lifestyle is sharing food with friends and family. Enjoy the Mediterranean lifestyle, have a zest for life and improve health all at the same time!

Allain J. Nordmann, Katja Suter-Zimmerman, Heiner C. Bucher, Iris Shai, Katherine R. Tuttle, Ramon Estruch, Matthias Briel. Meta-Analysis Comparing Mediterranean to Low-Fat Diets for Modification of Cardiovascular Risk Factors. The American Journal of Medicine Volume 124, Issue 9, Pages 841-851.e2, September 2011.

Last updated on January 18, 2012 by Dr. Vee  Photograph courtesy of epSos.de

red raspberries frozen antioxidants

Top 12 Must-Have Items for a Senior’s Medicine Cabinet


1.  Advanced Directives–Also known as a Living Will.  Includes your determination of your Healthcare Surrogate, or who you want to make medical decisions for you. 

If you have a “DNR” form that specifies that you do not want paramedics to resuscitate you in the event your heart stops beating or lungs stop breathing, this should be prominently placed near the entrance of your home or attached to your refrigerator.

2.  List of your medications, including specific doses.  Include medication allergies, including any allergy to latex.

According to a survey by AARP and the National Institutes of Health (NIH), two-thirds of people aged 50 and older use some form of complementary and alternative medicine (CAM). Less than one-third of those who use CAM talk with their doctors about it. Remember that supplements are not evaluated by the Food and Drug Administration.

The term Medicine Cabinet is used in the title of this article to emphasize the fact that supplements should be treated like other medicines. Share with your doctor any supplements you may be taking to find out any side effects or interactions with other medicines you may be taking.

3.  First Aid Kit with topical antibiotic, alcohol pads, gauze pads, paper tape, Ace wrap and bandages.

4.   I call Vitamin D the Superstar Supplement–studies suggest it may reduce the risk of high blood pressure, diabetes and certain cancers.   Vitamin D helps the absorption of calcium in the stomach.  Many more people are vitamin D deficient than previously known.  Vitamin D is important for healthy bones.  It helps the absorption of calcium in the stomach.

5.  Calcium is important to prevent osteoporosis or thinning of the bones.  Calcium supplements typically contain vitamin D as well. 

6.   Continuing this discussion about healthy bones, the combination of glucosamine and chondroitin were shown to improve the pain of moderate to severe arthritis, but was no better than placebo in mild arthritis in the GAIT study  funded by the National Center for Complementary and Alternative Medicine.

7.  Healthy joints may also benefit with omega-3 fatty acids, more commonly known as “fish oil.”  Studies show that omega-3 fatty acids may help patients with an inflammatory arthritis called rheumatoid arthritis. 

Omega 3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have also been found to improve memory. 

Fish oil is best known for helping increase the good cholesterol in the body and lowering  bad cholesterol and triglycerides (fats).  The best way to get omega 3 fatty acids is to eat fatty fish such as  salmon, sardines, tuna or mackerel twice a week. 

A landmark study conducted in Italy showed that omega 3 fatty acid supplementation after a heart attack helped reduce the risk of recurrent heart attacks.    The American Heart Association recommends 500 mg of omega 3 fatty acids daily for healthy people and 1 gm of omega 3 fatty acids for people who have known coronary artery disease. Check with your doctor before taking omega 3 fatty acids because they may increase the risk of bleeding.

8.   Cholesterol levels can also be improved by eating fiber in the diet.  The best sources of fiber are whole grains such as barley, oat bran or quinoa.   Fiber also helps prevent diverticulosis (small pouches inside the large intestine).   The more fat in the diet, the more diverticula that form.  They can become inflamed and infected and may even require surgical removal of part of the colon.    Some patients with irritable bowel syndrome or constipation benefit with fiber supplements in their diet. It is very important to drink lots of water when taking fiber supplements–approximately 64 ounces a day. 

9.    Probiotics are supplements that also help maintain good colon health.  Probiotics are microorganisms which replenish the good bacteria that normally live in our colon or large intestine.  Probiotics are especially helpful when you have a stomach virus or have to take antibiotics.

10.  A study carried out by Harvard Medical School researchers showed that regular use of aspirin after developing colorectal cancer decreased the risk of death from colon cancer.  The most common use for aspirin, though, is to prevent heart attack and stroke.  The U. S. Preventive Services Task Force (USPSTF) encourages men aged 45-79 to consider taking low dose aspirin to prevent heart attack. Women ages 55-79 should consider aspirin therapy to prevent stroke.

Like other blood thinners, aspirin should not be used by patients who have had bleeding ulcers, patients over the age of 80 (except under a doctor’s supervision), patients with bleeding strokes or people at high risk for falls.  Always consult your doctor before starting aspirin.

11.  Lutein is an antioxidant supplement which has been shown to  help slow down or prevent vision loss in patients with age related macular degeneration.   The macula is the part of the back of the eye called the retina which is involved in central vision.  

Age related macular degeneration leads to loss of central vision, sparing the peripheral vision. The macula is the part of the retina that is also most sensitive to blue light the part of the visible light spectrum that, along with ultraviolet light, can damage your eyes.  Sunglasses also prevent  penetration of blue and ultraviolet light to the macula.

12.  Sunblock SPF at least 15 should be used daily to exposed skin.  Broad spectrum sunblock prevents ultraviolet A and ultraviolet B rays.  UVA rays cause premature aging of the skin.  UVB rays can cause sunburns.  

Exposure to both types of ultraviolet rays can lead to the development of skin cancer, including melanoma, a very serious type of skin cancer.   Look for agents that contain titanium and zinc oxide. Most people do not use as much sunblock as needed to protect the skin.   One ounce, enough to fill a shot glass, is  needed to protect each of the exposed parts of the body. 

Sunblock should be rubbed into the skin, especially on the face, ears, arms and hands, 15-30 minutes before sun exposure.  It must be re-applied frequently, every two hours, even the water-resistant kind.   

The American Academy of Dermatology recommends daily use of sunblock to exposed areas of the body, not just on days you are out in the sun.   On cloudy days, up to 80% of the sun’s rays are still present to cause sun damage. This article is for informational purposes only and should not substitute for medical advice from your healthcare provider.

The author is not providing personal medical opinion, diagnosis or course of treatment. Do not delay or substitute this information for medical treatment.

Last updated May 1, 2010 by Dr. Vee