Fine-Tuning the Mediterranean Diet

Note: This article is not meant as a substitute for proper medical advice. Please consult with your medical practitioner before using any type of remedy, herbal or otherwise.

By Robert Luby, MD

From a scientific point of view, the Mediterranean Diet (MD) is the most-studied of any dietary plan. Research has shown that adherence to the MD may reduce the risk of cardiovascular mortality (death from heart disease), the incidence of cancer and cancer mortality, and the risk of Parkinson's and Alzheimer's diseases. All told this leads to lower overall mortality, or stated positively, a longer life expectancy.

What is the MD? When approached strictly from the point of view of foods consumed, the MD emphasizes plant-based foods over animal-based foods, healthy fats and oils, lean sources of protein, and plentiful herbs and spices. The MD emphasizes “plant-based foods”; however, it should be noted that a healthy balance of vegetables, fruits, grains, nuts, and seeds is the ideal. Of these components, vegetables are the most important to eat in abundance. Yet not all vegetables are equally healthy. In general, it is best to consume more “above-ground” than “below-ground” vegetables. The main benefit of this approach is the consumption of more fiber and micronutrient content. This would include foods which are stalks, stems, leaves and flowers (but not seeds). Cruciferous vegetables receive a special nod of approval here, as they have been shown to improve detoxification processes and lower the risk of cancer. Root vegetables and other “below-ground” vegetables tend to provide a higher starch-to-fiber ratio, and therefore are usually less nutrient dense.

Fruits are certainly good sources of nutrients, but also contain relatively high amounts of simple carbohydrates. Whole fruits are preferable to fruit juices, but it would be unwise to consume fruits at the expense of vegetables. Further enhancement of the benefits of fruits and vegetables may be attained by choosing organic and locally grown items.

Grain-based foods deserve special attention. In general, it is best to choose whole grains over processed grains, whole grain products over flour-based products, and whole grain flours over refined flours.  For some individuals, intolerance of gluten will necessitate avoidance of wheat, spelt, kamut, rye, barley and perhaps oats (if processed in sites which also handle gluten-containing grains). While grains provide important nutrients, they also contain plenty of starch/carbohydrate.  It remains important to emphasize vegetable calories over grain calories. In other words, when adopting the MD, do not become a “starch-etarian”.

Nuts and seeds are good sources of fat and protein. Many of the fats derived from nuts/seeds are “healthy fats” (not saturated), and therefore are preferable to the saturated fats in animal products. However, nuts and seeds contain “antinutrients” which may limit their benefits unless special measures are used in preparation. The soaking and/or sprouting process for nuts and seeds is recommended to neutralize these “anitnutrients” and liberate the full spectrum of beneficial nutrients.

Oils can be divided into three categories: omega-3,-6 and -9. In general, omega-6 oils are derived from cereals, grains and vegetable oils, and if over-consumed tend to promote inflammation in the body – an undesirable effect. In general most Americans consume an excess of omega-6. The MD emphasizes omega-3 and -9 oils. Omega-3 is most abundant in fish, marine oils and other marine foods. Omega-6 is most plentiful in nuts, seeds, olives and avocadoes. 

Fats are also separated into categories of saturated, mono-unsaturated and poly-unsaturated. Long chain saturated fats (think animal products) are the most detrimental to human health if over-consumed. While not classically considered a staple of the MD, the beneficial medium-chain saturated fat in coconut oil is an excellent choice for human health. The mono-unsaturated olive oil is the oil most highly emphasized in the MD, and may be used liberally. In order to maximize the benefits of any oil, it is important to reduce the risk of rancidity. To achieve this, it is important to store the oil properly, and if used for cooking, to maintain temperatures below that which would induce rancidity.

With regards to animal-based protein sources, fish and poultry are preferrable over red meat sources. There are several reasons for this. Fish and poultry have lower amounts of saturated fat. Fish are also the highest source of  beneficial omega-3 fats. However, it is not only the type of animal, but the way in which the animal was raised, which determines its overall nutritional value. For example, grass-fed red meat may be preferable to grain-fed poultry, and is certainly preferable to grain-fed red meat. This is because dietary grain results in an animal laden with omega-6 fats which, when consumed, promote inflammation. Grass-fed animals offer meat with ahigher content of omega-3 fats which are anti-inflammatory.

Toxins are another consideration when choosing animal protein sources. It is best to avoid marine species high in mercury and other toxins. Pastured, free-range, organically fed animals tend to have lower toxin levels than confined, non-pastured, and non-organically fed animals. Discerning consumers will also want to avoid meat sources which have been treated with antibiotics and hormones.

Herbs and spices are probably the most under-emphasized aspect of the MD. In general, the higher the ratio of herbs and spices to salt, the healthier the diet. Herbs and spices contain many nutrients which are antioxidants and have anti-inflammatory effects. Research has shown that they protect against cancer, heart disease and other chronic medical conditions. Of all the Mediterranean spices, rosemary is arguably the most beneficial. In contrast, salt, while undeniably delicious, lacks these health benefits, has scant nutrient value, and may be harmful for many individuals. A notable caveat to this generalization is that sea salts and mineral salts can be beneficial due to higher mineral content and lack of bleaching, anti-caking agents, and other detrimental aspects of conventionally-processed table salt. Potassium chloride is also considered a healthier alternative to conventional sodium chloride table salt.

When viewed more broadly, the Mediterranean Diet is not merely a dietary plan, but an approach to eating and a healthy lifestyle. For example, the “Mediterranean Lifestyle” encourages plenty of outdoor physical activity. Healthy eating behaviors promoted in this lifestyle include sitting down to eat, ensuring a calm and quiet eating environment, eating slowly, and eating with friends/family. All of these factors improve stress levels, food digestion, and nutrient assimilation.  If your goal is long-term health, consider not merely choosing the foods emphasized in the Mediterranean Diet, but adopt the “Mediterranean Lifestyle” as well.