The Mediterranean Diet
This week we were joined by the incredibly knowledgeable Jaebien AKA Mr Cogfit!
He joined us from stateside to give us his nutrition expertise and own experience of the Mediterranean diet. If you want to listen to our full discussion on this diet the listen down below. For a written summary continue!
So, What Is It?
The Mediterranean diet is the healthy living habits of those from countries bordering the Mediterranean sea. So, we are referring to places like France, Italy, Greece & Spain. What makes this diet interesting is there is no one template as it varies wildly from region to region. Things like culture, religion, ethical stance and economical positions make this variance more prevalent.
Variety aside if you were to google this diet it would normally highlight that the diet is high in fruit, veg, beans, legumes, nuts, cereals, whole grains, fish and a lot of unsaturated fat. (Olive oil normally appears) Usually, intake of meat and dairy is low however this really does depend and is not always the case. Essentially this is a pretty flexible diet.
A claim that every diet likes to make. "We are superior for weight loss". Is this diet superior? Not inherently no. No diet is really superior. As we've established in numerous blogs, numerous podcasts it comes down to energy in vs energy out and what really makes a diet superior is its ability to be sustainable long term. Could you stick it out on this diet? I think the main thing going for it is its flexible nature. There are no real strict guidelines and let's be honest the food looks and tastes fantastic especially with how much variety is on offer. This alone could potentially make it great for weight loss because you can stick with it long term and we know that fat loss and keeping it off requires long term adherence.
We have loads of data showing a high intake of unsaturated fat (this diet) over saturated fat can reduce the risk of coronary heart disease and low LDL "bad cholesterol" As I said we have a lot of data so let's look at a few.
There are now several scientific studies that relate this traditional dietary pattern with the incidence of coronary heart disease, various types of cancer, and other diseases. The past years have several observational and clinical studies suggested the mechanisms by which this traditional diet may affect coronary risk. This review underlines the importance of the Mediterranean dietary patterns in the prevention of coronary heart disease.
Dontas AS, Zerefos NS, Panagiotakos DB, Vlachou C, Valis DA. Mediterranean diet and the prevention of coronary heart disease in the elderly. Clin Interv Aging. 2007;2(1):109-15. doi: 10.2147/ciia.2007.2.1.109. Erratum in: Clin Interv Aging. 2008;3(2):397. Vlachou, Cleo [added]. PMID: 18044083; PMCID: PMC2684076.
The associations between dietary saturated fat and risk of coronary heart disease (CHD) remain controversial, but few studies have compared saturated with unsaturated fats and sources of carbohydrates in relation to CHD risk.
This study sought to investigate associations of saturated fats as compared with unsaturated fats and different sources of carbohydrates in relation to CHD risk.
We followed 84,628 women (Nurses’ Health Study, 1980 to 2010), and 42,908 men (Health Professionals Follow-up Study, 1986 to 2010) who were free of diabetes, cardiovascular disease, and cancer at baseline. Diet was assessed by semiquantitative food frequency questionnaire every 4 years.
Our findings indicate that unsaturated fats, especially PUFAs, and/or high-quality carbohydrates should replace dietary saturated fats to reduce CHD risk.
Li Y, Hruby A, Bernstein AM, Ley SH, Wang DD, Chiuve SE, Sampson L, Rexrode KM, Rimm EB, Willett WC, Hu FB. Saturated Fats Compared With Unsaturated Fats and Sources of Carbohydrates in Relation to Risk of Coronary Heart Disease: A Prospective Cohort Study. J Am Coll Cardiol. 2015 Oct 6;66(14):1538-1548. doi: 10.1016/j.jacc.2015.07.055. PMID: 26429077; PMCID: PMC4593072.
Dietary recommendations to decrease the risk of cardiovascular disease (CVD) have focused on reducing intake of saturated fatty acids (SFA) for more than 50 years. While the 2015-2020 Dietary Guidelines for Americans advise substituting both monounsaturated and polyunsaturated fatty acids for SFA, evidence supports other nutrient substitutions that will also reduce CVD risk. For example, replacing SFA with whole grains, but not refined carbohydrates, reduces CVD risk. Replacing SFA with protein, especially plant protein, may also reduce CVD risk. While dairy fat (milk, cheese) is associated with a slightly lower CVD risk compared to meat, dairy fat results in a significantly greater CVD risk relative to unsaturated fatty acids. As research continues, we will refine our understanding of dietary patterns associated with lower CVD risk.
Briggs MA, Petersen KS, Kris-Etherton PM. Saturated Fatty Acids and Cardiovascular Disease: Replacements for Saturated Fat to Reduce Cardiovascular Risk. Healthcare (Basel). 2017 Jun 21;5(2):29. doi: 10.3390/healthcare5020029. PMID: 28635680; PMCID: PMC5492032.
Background: Olive oil polyphenols have shown protective effects on cardiovascular risk factors. Their consumption decreased oxidative stress biomarkers and improved some features of the lipid profile. However, their effects on LDL concentrations in plasma and LDL atherogenicity have not yet been elucidated.
Objective: Our objective was to assess whether the consumption of olive oil polyphenols could decrease LDL concentrations [measured as apolipoprotein B-100 (apo B-100) concentrations and the total number of LDL particles] and atherogenicity (the number of small LDL particles and LDL oxidizability) in humans.
Conclusion: The consumption of olive oil polyphenols decreased plasma LDL concentrations and LDL atherogenicity in healthy young men. This trial was registered at www.controlled-trials.com as ISRCTN09220811.
Hernáez Á, Remaley AT, Farràs M, Fernández-Castillejo S, Subirana I, Schröder H, Fernández-Mampel M, Muñoz-Aguayo D, Sampson M, Solà R, Farré M, de la Torre R, López-Sabater MC, Nyyssönen K, Zunft HJ, Covas MI, Fitó M. Olive Oil Polyphenols Decrease LDL Concentrations and LDL Atherogenicity in Men in a Randomized Controlled Trial. J Nutr. 2015 Aug;145(8):1692-7. doi: 10.3945/jn.115.211557. Epub 2015 Jul 1. PMID: 26136585; PMCID: PMC4516770.
I won't apologise for the bombardment of scientific data as I really wanted to highlight that I'm not talking nonsense and there is an abundance of data out there saying we should reduce intake of saturated fat and replace with things like unsaturated fat, whole grains and possibly/ideally plant-based protein. There are those out there that say LDL (bad cholesterol) is actually fine (I'm looking at the carnivores) however we also have data to suggest that LDL causes ASCVD (Atherosclerotic Cardiovascular Disease)
Consistent evidence from numerous and multiple different types of clinical and genetic studies unequivocally establishes that LDL causes ASCVD.
Ference BA, Ginsberg HN, Graham I, Ray KK, Packard CJ, Bruckert E, Hegele RA, Krauss RM, Raal FJ, Schunkert H, Watts GF, Borén J, Fazio S, Horton JD, Masana L, Nicholls SJ, Nordestgaard BG, van de Sluis B, Taskinen MR, Tokgözoglu L, Landmesser U, Laufs U, Wiklund O, Stock JK, Chapman MJ, Catapano AL. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2017 Aug 21;38(32):2459-2472. doi: 10.1093/eurheartj/ehx144. PMID: 28444290; PMCID: PMC5837225.
While we are not saying the Mediterranean diet will cure alzheimers we are seeing some promising data. Data that leads to hope in what can only be described as a horrid saddening condition.
For example this diet is naturally high in omega 3s and this could possibly help with things like alzhemiers
Objective: Previous research in Alzheimer's disease (AD) has focused on individual dietary components. There is converging evidence that composite dietary patterns such as the Mediterranean diet (MeDi) is related to lower risk for cardiovascular disease, several forms of cancer, and overall mortality. We sought to investigate the association between MeDi and risk for AD.
Methods: A total of 2,258 community-based nondemented individuals in New York were prospectively evaluated every 1.5 years. Adherence to the MeDi (zero- to nine-point scale with higher scores indicating higher adherence) was the main predictor in models that were adjusted for cohort, age, sex, ethnicity, education, apolipoprotein E genotype, caloric intake, smoking, medical comorbidity index, and body mass index.
Results: There were 262 incident AD cases during the course of 4 (+/-3.0; range, 0.2-13.9) years of follow-up. Higher adherence to the MeDi was associated with lower risk for AD (hazard ratio, 0.91; 95% confidence interval, 0.83-0.98; p=0.015). Compared with subjects in the lowest MeDi tertile, subjects in the middle MeDi tertile had a hazard ratio of 0.85 (95% confidence interval, 0.63-1.16) and those at the highest tertile had a hazard ratio of 0.60 (95% confidence interval, 0.42-0.87) for AD (p for trend=0.007).
Interpretation: We conclude that higher adherence to the MeDi is associated with a reduction in risk for AD.
Scarmeas N, Stern Y, Tang MX, Mayeux R, Luchsinger JA. Mediterranean diet and risk for Alzheimer's disease. Ann Neurol. 2006 Jun;59(6):912-21. doi: 10.1002/ana.20854. PMID: 16622828; PMCID: PMC3024594.
Looking closer at this data it could infact be due to higher intakes of omega 3. Let's look at some more.
This review has highlighted the lack of consistent evidence for the potential of nutraceuticals and pharmacotherapies to delay the progression of AD. Evidence for a single nutrient therapy is inconsistent. Therefore, it appears that the overall quality and composition of the diet also contribute to protection against AD and dementia. The strongest evidence in support of nutrition preventing cognitive decline in AD is for long chain omega-3 fatty acids. Primarily, this is because long chain omega-3 has shown promising potential to ameliorate low grade inflammation in the early stages of this neurodegenerative disease.
Thomas J, Thomas CJ, Radcliffe J, Itsiopoulos C. Omega-3 Fatty Acids in Early Prevention of Inflammatory Neurodegenerative Disease: A Focus on Alzheimer's Disease. Biomed Res Int. 2015;2015:172801. doi: 10.1155/2015/172801. Epub 2015 Aug 2. PMID: 26301243; PMCID: PMC4537710.
Futhermore if the diet is adhered to in a controlled and "healthy" manner it does naturally lower things like blood pressure and levels of LDL (bad cholesterol) which data suggests do help with cognitive decline. However more factors come into play such as if you follow this diet 100% making all the right choices but drink alcohol and smoke in excess you are not really doing yourself any favours in terms of cognitive decline.
We've established on numerous occasions that cancer is incredibly complex and that whatever some of these diets tell you there is no one diet that is going to cure cancer! (Looking mainly at you Alkaline diet!) However is there data to suggest that the med diet can help with cancer?
In conclusion, the present update of our systematic review and meta-analyses provided additional important evidence for a beneficial effect of high adherence to MedD with respect to primary prevention overall cancer risk and specific types of cancer, especially colorectal cancer. These observed beneficial effects are mainly driven by higher intakes of fruits, vegetables, and whole grains. Moreover, we report for the first time a small decrease in breast cancer risk (6%) with the pooling seven cohort studies. To further elucidate the relationship between Mediterranean dietary patterns and cancer types, future studies should adopt a precise definition of a MedD.
Schwingshackl L, Schwedhelm C, Galbete C, Hoffmann G. Adherence to Mediterranean Diet and Risk of Cancer: An Updated Systematic Review and Meta-Analysis. Nutrients. 2017 Sep 26;9(10):1063. doi: 10.3390/nu9101063. PMID: 28954418; PMCID: PMC5691680.
This data makes a link we've discussed before and that is a higher intake of fruits, vegetables and whole grains shows beneficial effects. This is something we spoke about in regards to high levels of fibre in the diet when counteracting the carninvore diet (especially in colorectal cancer) An important point to note is it's statement of needing a precise definition of a med diet in future studies. As mentioned at the start of this post the diet can vary wildly depending on numerous factors and can infact be quite flexible so it's hard to pin point an exact dietry formula. Cancer is so complex and we are still working hard as a society to try and combat at it but anything that can help is always welcomed provided it's backed with solid data and not providing false hope!
An incredibly important part of any diet is the socioeconomic factors. When looking at this diet in it's traditional sense it offers some fantastic benefits. As Tom described on the podcast when eating with friends from such culture that it was almost an event every single meal taking at least an hour on each occasion. That's the key. In a UK/US setting in most cases we aren't really mindful of eating and literally get straight in and straight out where we should be using meal times to spend time with loved ones. "Hows your day been?" "Any plans for tomorrow" A time to reflect and catch up.
So not only can this diet offer some healthy food choices but if followed in it's social traditional sense it could promote more mindful eating and an overall better family life.
Big question is is it affordable?
Fish is expensive right?
When people think of this diet they think fish fish fish and yes there can be and when you go to a shop and look at fresh fish it can be quite expensive. Why not opt for canned fish? There is nothing wrong with it as much as the protentious organic fresh food zealots will tell you. For one you can buy it in bulk and store it for a long time which is fantastic if you can't get out the shops very often or simply don't have the refrigdation/freezer space. You'll see the whole mercury argument which comes down to the dose. You'd have to be consuming a lot of this stuff for an impact. Moderation is key with all foods. Also we'd recommend opting for the canned fish in water because water and oil don't mix well the good fatty acids are locked into the fish and don't drain out! They will also contain less sodium.
Lots of fruit and veg?
We are mainly focusing on vegetables here because it can be quite daunting for a parent to have to store and prepare fresh vegetables on a daily basis. They tend to perish quite quickly and sometimes require a bit of time to prepare. What if I told you you could simply buy a a bag of frozen mixed vegetables? Once again the fresh zealots will tell you oh no it must be fresh. Well if we actually look at it frozen veg is frozen fresh so could be even more fresh than the non frozen. You can also store it for longer meaning less trips the shop. Preperation is super easy as well as it normally requires a blast in the microwave or a few minutes on the hob in boiling water. So if you need more veg in your diet don't think it needs to be fresh it can be cheap wholesome frozen veg!
Couple more top tips!
Avoid anything with "Mediterranean Diet" labelled all over it. This will simply be a marketing ploy to overinflate the price. As I said before there is no one template and can be adjusted for your situation.
Opt for seasonal fruit and vegetables. If going fresh looking for whats in season will normally lead to a more reasonable price! Save those pennies by going seasonal.
If you need any more help/ideas for this diet then I'd highly recommend getting in touch with our friend Jaebien as he has great exposure to this way of living and can offer some fantastic insight.
Final Point. Are you or anyone you know on this diet? We'd love to hear your experiences and stories from a health/social point of view. Get in touch below or drop us an email. Secondly we'd love to know if this podcast/article have perhaps given you the idea of giving it a go. If so please let us know and keep us updated on how you're getting on!