By Rachel Johnson, Ph.D, M.P.H., R.D., "The World's Healthiest Diet?,"September/October 2008
A few years ago I was invited to lecture in Italy. My husband, Mark, always ready for an adventure, tagged along. After my work was done, we visited the Cinque Terre, five tiny villages perched high upon rugged hills overlooking the Mediterranean. We hiked the scenic trail into the coastal town of Riomaggiore. Weary from our walk we settled into a small café for a 2 ½-hour lunch: a small plate of pasta with pesto, fresh fish drizzled with olive oil and a platter of grilled artichokes and peppers, along with a carafe of the house red. With plenty of exercise, delicious food in reasonable portions and a relaxed pace, I experienced the Mediterranean lifestyle in its home base—and felt wonderful.
The Mediterranean Diet has been officially recognized by Oldways, a nonprofit food-issues think tank in Boston, as one of the world’s healthiest. Based on the age-old dietary traditions of Crete, Greece and southern Italy, this “diet,” or eating pattern, is abundant in fruits, vegetables and olive oil, sparing with meat and anointed daily with red wine.
Studies support this way of eating. The New England Journal of Medicine published a study that showed that following a Mediterranean-style, reduced-calorie diet was just as effective as a low-carbohydrate diet. The study tracked 322 Israelis over a two-year period and found the Mediterranean eating pattern helped people lose more weight than a conventional low-fat diet and helped people with diabetes better control their blood glucose levels.
Another study by Spanish researchers reports that people who adhered most closely to Mediterranean Diet principles reduced their risk of developing type 2 diabetes by as much as 83 percent, compared with those who didn’t. We also know the diet reduces inflammation, a risk factor for heartattack and stroke, and may even ward off depression and lower the risk of developing Alzheimer’s disease.
But while studies continue to support this eating pattern, the traditional lifestyle on the shores of the Mediterranean is regrettably losing ground. Inactivity is increasing and obesity is on the rise. Longer work hours leave less time to shop and cook, while a shift toward more sedentary lifestyles means more sitting in front of the computer screen than working in the fields.
Recognizing this, here are four tenets of the Mediterranean Diet for people with 21st-century lives.
1. Stock your pantry and cook at home. Do your best to cook more and use whole, unprocessed ingredients so you can control portion sizes, salt and calories. “We can’t ask people to make everything from scratch,” says Oldways dietitian Nicki Heverling, M.S., R.D. Instead, she suggests stocking your pantry and freezer with Mediterranean-inspired staples like canned tomatoes, olives, whole-wheat pasta and frozen vegetables.
2. Get most of your protein from beans and fish. Swap out some of your meat and get your protein from beans, nuts and other plants. By displacing meat, you’ll lower your saturated-fat intake while adding healthful nutrients, like fiber and antioxidant-rich flavonols. Heverling recommends starting with a few small changes: aim to make a plant-based dinner, like meatless chili once or twice a week. Or make the focus of the meal whole grains and vegetables and think of meat as a flavoring; for example, use a little diced pancetta in a tomato sauce for pasta.
3. Make olive oil your staple fat. Give heart-healthy olive oil as well as other plant-based oils like canola and walnut oil star billing over saturated-fat-laden, LDL-cholesterol-raising butter, lard or shortening—even in baking. Or do as the Greeks do and sauté your vegetable dishes in olive oil (ladera, or “oily” style) to highlight their flavor. Learn to appreciate extra-virgin olive oils with plenty of flavor, advises Antonia Trichopoulou, M.D., from the University of Athens School of Medicine: “Look for a yellow or green olive oil with a rich smell and taste.” Pale, odorless oils are fine for baking and frying and are still high in heart-healthy monounsaturated fats, she adds, “but they are lacking in the more than 200 microcomponents that have beneficial effects on health.” Microcomponents like oleocanthal, for example, which is a potent anti-inflammatory found in extra-virgin olive oils.
4. Enjoy a glass of wine with meals. Enjoy wine in moderation during meals, never drinking alone outside of the meal and never in excess. Drinking wine increases HDL (good) cholesterol, may help regulate blood sugar and can even help you digest your food and absorb its nutrients. Wines, especially reds, also deliver a dose of heart-healthy resveratrol. Take Trichopoulou’s advice and use wine “to enjoy life, not to forget life!”
Can the Mediterranean Diet endure today? I think ancient food traditions will never truly go away; they’ve already survived for millennia. But just the thought of traditional ways under siege is enough to scare some countries into safeguarding their food heritage: Italy, Spain, Greece and Morocco recently launched an international campaign to win United Nations recognition by adding the Mediterranean Diet to its World Heritage List, and give it protected status just like historic sites.
In the meantime, I’m working on putting Dr. Trichopoulou’s advice into practice in my everyday life. Olive oil for dipping has become a staple on our dinner table and we regularly enjoy meatless meals along with our nightly glass of red wine. Mark and I are happily returning to Italy this fall with a plan to enjoy the old ways as much as we can. Salute!
Rachel K. Johnson, EatingWell’s senior nutrition advisor, is Professor of Nutrition at the University of Vermont.