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Mediterranean Diet Secrets

October 12, 2009 Written by JP    [Font too small?]

In life and in medicine we tend to categorize as a way of simplifying things. But every so often we learn something new about a medical technique that genuinely surprises us. Take the Mediterranean diet for instance. Doctors and patients throughout the world associate this way of eating with cardiovascular benefits. It’s the “heart healthy” diet. This view is both accurate and incomplete.

The term “Mediterranean diet” conjures up images of exquisite Greek and Italian cuisine that focuses on fresh fish, fruits, lean meats, nuts, red wine and vegetables. The cardio-protective benefits of such a menu plan is very well established in the scientific literature. Multiple studies have been published this year alone that attest to this fact. The traditional diet of the Mediterranean region is: a) rich in monounsaturated fats (fish, nuts and olive oil); b) contains large quantities of dietary fiber (40-60 grams a day) and; c) is an abundant source of food based antioxidants (from fruits, vegetables and red wine). (1,2,3,4,5,6)

What isn’t so well known is that the reach of this eating program extends far beyond the prevention of heart attacks and stroke. There are three important areas of health care with which the Mediterranean diet can specifically help. Here’s a brief overview of what the latest studies tell us:

  • Blood Sugar Disorders – A 4 year trial, just published, examined the effects of a low-carbohydrate Mediterranean-style diet vs. a low fat diet in a group of 215 overweight type 2 diabetics. At the start of the experiment none of the participants required drug therapy to manage blood sugar. By the end of the study, 44% of those on the Med diet and 70% on the low fat diet were undergoing “antihyperglycemic drug therapy”. The researchers also noted that those following the Mediterranean eating plan lost more weight and demonstrated better cardiovascular health than the low fat group. Other trials indicate that adding more nuts and tea to a typical Med diet can further enhance the health of those with diabetes and “prediabetes”. (7,8,9)
  • Depression – A new study presented in the Archives of General Psychiatry determined that long term adherence to “Mediterranean dietary pattern” can significantly decrease the likelihood of depression. This conclusion is based on an examination of over 10,000 men and women who were followed over a 4 year period. Food frequency questionnaires, medical records and physician diagnosis were used to evaluate the connection between diet and mood changes over time. Those who stuck to the diet the most consistently demonstrated the lowest risk for depressive symptoms. Not surprisingly, they were also less likely to be on antidepressant medication. Supportive research has found that higher levels of fish and olive oil intake may afford additional psychological benefits to those already on a Med diet. (10,11,12)
  • Health Parameters While on a Very Low Carb Med. Diet

    Parameters Week 0 Week 12 % of Change
    Weight (kg) 108.62 94.48 13.02
    Body Mass Index (kg/m2) 36.46 31.76 12.89
    Total Cholesterol (mg/dl) 208.24 186.62 10.38
    LDL Cholesterol (mg/dl) 114.52 105.95 7.48
    HDL Cholesterol (mg/dl) 50.10 54.57 8.19
    Triglycerides (mg/dl) 218.67 113.90 47.91
    Blood Sugar (mg/dl) 109.81 93.33 15.01
    Systolic Blood Pressure (mm Hg) 125.71 109.05 13.25
    Diastolic Blood Pressure (mm Hg) 84.52 75.24 10.98
    Source: Nutr J. 2008; 7: 30.(link)
  • Memory Decline – The August issue of the Journal of the American Medical Association (JAMA) found a correlation between “higher adherence to a Mediterranean diet” and slower cognitive decline. A separate study in the Archives of Neurology estimates a 28% reduced risk of “mild cognitive impairment” for those classified as strict followers of this manner of eating. A dramatic 48% decline in Alzheimer’s disease incidence was also reported in this group of over 1,400 study volunteers. Other research presented in JAMA suggests that combining regular physical exercise with a Med diet may further protect against age related cognitive decline. (13,14,15)

All of these individual findings are very promising. But the big picture is even more encouraging when we look at it from afar. Elevated blood sugar (diabetes and metabolic syndrome) and depression have been linked to higher rates of dementia. These two conditions have also been associated with poor cardiovascular health. This, in turn, brings us full circle. It also provides a rationale for why the Med diet is good for the heart, both directly and indirectly. (16,17,18,19,20)

In health care and in life, good decisions tend to have far reaching consequences. It’s similar to the concept of “paying it forward” – if you show kindness to one individual, that person is likely to do the same for someone else. This process then continues forth and ultimately leads to a better community and society at large. A similar reaction occurs within the body. When we do something positive for the cardiovascular system, it’s likely to affect other, seemingly unrelated systems – such as the brain (depression) and pancreas (diabetes). This is a common result of many holistic therapies and the primary reason why I encourage their use.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!


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Posted in Food and Drink, Mental Health, Nutrition

18 Comments & Updates to “Mediterranean Diet Secrets”

  1. bluthochdruck Says:

    healthy food is always one of the best way to come out from any problem. I am always stick to healthy food. Thank you very much for giving a healthy article to us. I will follow it whenever I need it.

  2. Anonymous Says:

    Grains in the Mediterranean region are typically whole grain and usually contain very few unhealthy trans fats, and bread is an important part of the diet there. However, throughout the Mediterranean region, bread is eaten without butter or margarines, which contain saturated or trans fats.

  3. JP Says:

    Thanks, bluthochdruck.

    I hope it will help to keep you healthy!

    Be well!


  4. JP Says:

    Thank you, Anonymous.

    The exclusion of hydrogenated fats is definitely a plus. I agree that whole grains are better than heavily processed grains. However, the lower-carb versions of the Med diet (that I mentioned) contain little or no grains as a part of their daily menu.

    Be well!


  5. Ang Says:

    This Med diet has always confused me because I couldn’t find anyone in the Mediterreanean that eats like they suggest you should. I found that everyone out there ate as much pasta and white flour products in general as Americans do. They were just as heavy too. And this Okinawa study that’s been researched too…I’ve been to Okinawa. They’re so chubby and no one eats like that! Where are they finding these populations that still live on traditional diets? I don’t see them!

  6. JP Says:

    Good day, Ang.

    I suspect your observation has to do with the issue of eating a “traditional diet”. Many people, regardless of geographical location, have adopted modern habits at the dining table. This generally includes the inclusion of many refined foods – like white bread and pasta.

    However, there are still pockets of people (mainly in rural areas) that maintain many of the local, time-tested eating patterns. These are often the groups that are selected for study. But please keep in mind that some of these trials aren’t population studies at all. They’re scientifically controlled experiments – such as the Spanish Ketogenic Med Diet Study (linked underneath the table). That variety of research further strengthens the epidemiological evidence that supports the use of a Med diet.

    Be well!


  7. Paul Fanton Says:

    Hi JP,

    This article is very encouraging for the adoption of the Low carb Mediterranean diet,for so many reasons.
    I will go to your reference material to zero in on these choices!
    Thank you for the great lead and clarifications.
    I hope many people will follow your valuable guidance.

    Paul (75+)

  8. JP Says:

    Many thanks, Paul! 🙂

    I think most people would greatly benefit from eating a Mediterranean-like diet. A Med diet that’s lower in carbohydrates is likely to be an even better choice, in my opinion.

    Please make sure to check out the Spanish study (linked underneath the table). It’s very promising!


    Be well!


  9. haarausfall Says:

    I am totally agree with you that Healthy diet is very good for health as well as it will help to reduce BP also. healthy food is always one of the best way to come out from any problem. I am always stick to healthy food. Thank you very much for sharing your knowledge about healthy food. I will follow it as soon as possible.

  10. JP Says:

    Thank you, haarausfall. 🙂

    Be well!


  11. Noah Curtiss Says:

    When I read these type of studies I always look at how they define low-fat diet. I’d hardly consider 30% of the calories from fat low fat.

  12. JP Says:


    I agree that definitions are indeed important. However, if you look closely at the data you’ll see that they define the “low fat diet” as being under 30% (<30%). I wish I had the exact figures. The full text of the study is only available for purchase.


    Be well!


  13. JP Says:

    Update 05/12/15:


    JAMA Intern Med. 2015 May 11.

    Mediterranean Diet and Age-Related Cognitive Decline: A Randomized Clinical Trial.

    Importance: Oxidative stress and vascular impairment are believed to partly mediate age-related cognitive decline, a strong risk factor for development of dementia. Epidemiologic studies suggest that a Mediterranean diet, an antioxidant-rich cardioprotective dietary pattern, delays cognitive decline, but clinical trial evidence is lacking.

    Objective: To investigate whether a Mediterranean diet supplemented with antioxidant-rich foods influences cognitive function compared with a control diet.

    Design, Setting, and Participants: Parallel-group randomized clinical trial of 447 cognitively healthy volunteers from Barcelona, Spain (233 women [52.1%]; mean age, 66.9 years), at high cardiovascular risk were enrolled into the Prevención con Dieta Mediterránea nutrition intervention trial from October 1, 2003, through December 31, 2009. All patients underwent neuropsychological assessment at inclusion and were offered retesting at the end of the study.

    Interventions: Participants were randomly assigned to a Mediterranean diet supplemented with extravirgin olive oil (1 L/wk), a Mediterranean diet supplemented with mixed nuts (30 g/d), or a control diet (advice to reduce dietary fat).

    Main Outcomes and Measures: Rates of cognitive change over time based on a neuropsychological test battery: Mini-Mental State Examination, Rey Auditory Verbal Learning Test (RAVLT), Animals Semantic Fluency, Digit Span subtest from the Wechsler Adult Intelligence Scale, Verbal Paired Associates from the Wechsler Memory Scale, and the Color Trail Test. We used mean z scores of change in each test to construct 3 cognitive composites: memory, frontal (attention and executive function), and global.

    Results: Follow-up cognitive tests were available in 334 participants after intervention (median, 4.1 years). In multivariate analyses adjusted for confounders, participants allocated to a Mediterranean diet plus olive oil scored better on the RAVLT (P = .049) and Color Trail Test part 2 (P = .04) compared with controls; no between-group differences were observed for the other cognitive tests. Similarly adjusted cognitive composites (mean z scores with 95% CIs) for changes above baseline of the memory composite were 0.04 (-0.09 to 0.18) for the Mediterranean diet plus olive oil, 0.09 (-0.05 to 0.23; P = .04 vs controls) for the Mediterranean diet plus nuts, and -0.17 (-0.32 to -0.01) for the control diet. Respective changes from baseline of the frontal cognition composite were 0.23 (0.03 to 0.43; P = .003 vs controls), 0.03 (-0.25 to 0.31), and -0.33 (-0.57 to -0.09). Changes from baseline of the global cognition composite were 0.05 (-0.11 to 0.21; P = .005 vs controls) for the Mediterranean diet plus olive oil, -0.05 (-0.27 to 0.18) for the Mediterranean diet plus nuts, and -0.38 (-0.57 to -0.18) for the control diet. All cognitive composites significantly (P < .05) decreased from baseline in controls. Conclusions and Relevance: In an older population, a Mediterranean diet supplemented with olive oil or nuts is associated with improved cognitive function. Be well! JP

  14. JP Says:

    Updated 08/28/15:


    J Gerontol A Biol Sci Med Sci. 2015 Aug 22.

    Patterns of Alcohol Consumption and Risk of Frailty in Community-dwelling Older Adults.

    BACKGROUND: Consumption of moderate-to-heavy amounts of alcohol has been associated with lower risk of cardiovascular disease and diabetes. Although both diseases are main causes of the frailty syndrome, no previous study has assessed the association between alcohol-drinking patterns and risk of frailty in older adults.

    METHODS: A prospective cohort study of 2,086 community-dwelling individuals aged 60 and older, recruited in 2008-2010, and followed through 2012, was carried out. Drinking patterns were self-reported at baseline. Moderate drinking was defined as alcohol intake less than 40g/day for men and less than 24g/day for women. A Mediterranean drinking pattern was defined as moderate alcohol intake, with wine preference (≥80% of alcohol proceeds from wine) and drinking only with meals. Study participants were followed through 2012 to ascertain incident frailty, defined as ≥2 of the following 4 Fried criteria: exhaustion, muscle weakness, low physical activity, and slow walking speed. Analyses were performed with logistic regression and adjusted for the main confounders.

    RESULTS: After a mean follow-up of 3.3 (SD = 0.6) years, 292 participants with incident frailty were identified. Compared with nondrinkers, the odds ratio and its 95% confidence interval of frailty was 0.90 (0.65-1.25) for moderate drinkers. The corresponding results were 0.74 (0.48-1.16) for wine versus other beverage preference and 0.53 (0.31-0.92) for drinking only with meals versus only outside meals. Finally, compared with nondrinkers, the odds ratio (95% confidence interval) of frailty was 0.68 (0.47-0.99) for those adhering to the Mediterranean drinking pattern.

    CONCLUSIONS: Certain drinking patterns, in particular drinking only with meals and the Mediterranean drinking pattern, are associated with a lower risk of frailty in older adults.

    Be well!


  15. JP Says:

    Updated 06/11/16:


    Lancet Diabetes Endocrinol. 2016 Jun 6.

    Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial.

    BACKGROUND: Because of the high density of fat, high-fat diets are perceived as likely to lead to increased bodyweight, hence health-care providers are reluctant to recommend them to overweight or obese individuals. We assessed the long-term effects of ad libitum, high-fat, high-vegetable-fat Mediterranean diets on bodyweight and waist circumference in older people at risk of cardiovascular disease, most of whom were overweight or obese.

    METHODS: PREDIMED was a 5 year parallel-group, multicentre, randomised, controlled clinical trial done in primary care centres affiliated to 11 hospitals in Spain. 7447 asymptomatic men (aged 55-80 years) and women (aged 60-80 years) who had type 2 diabetes or three or more cardiovascular risk factors were randomly assigned (1:1:1) with a computer-generated number sequence to one of three interventions: Mediterranean diet supplemented with extra-virgin olive oil (n=2543); Mediterranean diet supplemented with nuts (n=2454); or a control diet (advice to reduce dietary fat; n=2450). Energy restriction was not advised, nor was physical activity promoted. In this analysis of the trial, we measured bodyweight and waist circumference at baseline and yearly for 5 years in the intention-to-treat population. The PREDIMED trial is registered with ISRCTN.com, number ISRCTN35739639.

    FINDINGS: After a median 4·8 years (IQR 2·8-5·8) of follow-up, participants in all three groups had marginally reduced bodyweight and increased waist circumference. The adjusted difference in 5 year changes in bodyweight in the Mediterranean diet with olive oil group was -0·43 kg (95% CI -0·86 to -0·01; p=0·044) and in the nut group was -0·08 kg (-0·50 to 0·35; p=0·730), compared with the control group. The adjusted difference in 5 year changes in waist circumference was -0·55 cm (-1·16 to -0·06; p=0·048) in the Mediterranean diet with olive oil group and -0·94 cm (-1·60 to -0·27; p=0·006) in the nut group, compared with the control group.

    INTERPRETATION: A long-term intervention with an unrestricted-calorie, high-vegetable-fat Mediterranean diet was associated with decreases in bodyweight and less gain in central adiposity compared with a control diet. These results lend support to advice not restricting intake of healthy fats for bodyweight maintenance.

    Be well!


  16. JP Says:

    Updated 09/13/16:


    Int J Food Sci Nutr. 2016 Sep 12:1-15.

    Short-term benefits of an unrestricted-calorie traditional Mediterranean diet, modified with a reduced consumption of carbohydrates at evening, in overweight-obese patients.

    The Mediterranean diet (MeD) is believed to promote health; nevertheless, changes in the nutritional patterns in the Mediterranean area (increased intake of refined carbohydrates/saturated fats; reduced fibers intake; main calorie load shifted to dinner) led to reduced MeD benefits in recent decades. We retrospectively investigated the effects of a MeD with a low intake of refined carbohydrates in the evening (“MeDLowC”) on body weight (BW) and metabolic profile of overweight/obese subjects. According to their adherence to MeDLowC, subjects were classified into 44 (41%) individuals with “excellent” adherence and 63 (59%) with “poor” adherence. Nutritional counseling induced an improvement in BW, glucose metabolism and liver transaminases in both groups, with an increased magnitude of these effects in the “Excellent” adherence group. “Excellent” adherence to MeDLowC improved insulin sensitivity and lipid metabolism. In conclusion, MeD with a restriction of carbohydrates in the evening significantly ameliorates obesity and associated metabolic complications.

    Be well!


  17. JP Says:

    Updated 09/30/16:


    Am J Clin Nutr. 2016 Sep 28.

    Adherence to the Mediterranean diet is associated with better quality of life: data from the Osteoarthritis Initiative.

    BACKGROUND: The Mediterranean diet has positively influenced various medical conditions, but only a paucity of studies has considered the relation between the Mediterranean diet and quality of life (QOL) among people living in North America.

    OBJECTIVE: We investigated whether a higher adherence to the Mediterranean diet (aMED) was associated with better QOL and decreased pain, stiffness, disability, and depression in a large cohort of North Americans from the Osteoarthritis Initiative.

    DESIGN: aMED was evaluated through a validated Mediterranean diet score categorized into quintiles. Outcomes of interest were QOL [assessed with the 12-Item Short-Form Health Outcome Survey (SF-12)]; disability, pain, and stiffness [assessed in both knees with the Western Ontario and McMaster Universities Arthritis Index (WOMAC)]; and depressive symptoms [assessed with the Center for Epidemiologic Studies Depression Scale (CES-D)].

    RESULTS: Of the 4470 participants (2605 women; mean age: 61.3 y), those with a higher aMED had significantly more favorable scores on all outcomes investigated (P < 0.0001 for all comparisons). After adjustment for potential confounders in linear regression analyses, a higher aMED was significantly associated with a higher SF-12 physical composite scale value (β: 0.10; 95% CI: 0.05, 0.15; P < 0.0001), lower WOMAC scores (except for stiffness), and lower CES-D scores (β: -0.05; 95% CI: -0.09, -0.01; P = 0.01). An adjusted logistic regression analysis, taking as reference those in the 2 highest quintiles of the aMED score, confirmed these findings. CONCLUSION: Higher aMED is associated with better QOL and decreased pain, disability, and depressive symptoms. Be well! JP

  18. JP Says:

    Updated 12/09/17:


    Acta Diabetol. 2017 Dec 7.

    Intensive dietary intervention promoting the Mediterranean diet in people with high cardiometabolic risk: a non-randomized study.

    AIMS: Mediterranean diet (MD) is acknowledged to exert a number of beneficial health effects. We assessed the efficacy and the durability of a 3-month intensive dietary intervention aimed at implementing the MD on body weight and cardiometabolic risk factors in subjects at high risk.

    METHODS: One hundred and sixteen subjects participated in the study (71 assigned to the intensive intervention and 45 to the conventional intervention). The intensive intervention consisted of 12 weekly group educational meetings and a free-of-charge supply of meals prepared according to the MD model. The conventional intervention consisted of an individual education session along with monthly reinforcements of nutritional messages by the general practitioner. All participants were followed up for 9 months.

    RESULTS: The two groups had similar pre-intervention characteristics. After the intervention, mean body weight decreased significantly in both groups (p < 0.001). However, the intervention group lost more weight (6.8 ± 4.0 vs. 0.7 ± 1.3, p < 0.0001) and showed a greater reduction in plasma glucose, triglycerides, blood pressure and an increase in HDL cholesterol than the control group (p < 0.01-p < 0.002). In the subgroup of participants with type 2 diabetes, there was a significant reduction in HbA1c level following the intensive (p < 0.0001) but not the conventional intervention. At follow-up, weight loss still persisted in the intervention group (p < 0.0001), while it was lost in the control group. Both interventions significantly reduced blood pressure in the long term (p < 0.001). A significant reduction in daily total energy intake was observed in both groups with a greater reduction in saturated fat and a higher increase in fibre intake in the intervention than in the control group (p < 0.009 and p < 0.001, respectively). CONCLUSIONS: A 3-month intensive dietary intervention inspired to the traditional MD produced greater and more durable weight loss and improvement in cardiometabolic risk profile than the conventional intervention. Be well! JP

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