Among the many fad diets that plague us, one of the most enduring also happens to be a balanced, science-backed diet. The Mediterranean diet, so called because of the cuisine associated with countries bordering the sea, promotes the consumption of foods high in fat, low in carbohydrates and minimally processed.
The diet is characterized by whole grains, abundant fruits and vegetables, olive oil as the main cooking fat, and protein mainly from fish and legumes. But part of the diet’s success may come from a certain X-factor, something that cannot be quantified or tested in a clinical setting.
Where does the Mediterranean diet come from?
The Mediterranean diet can be said to have been around since humans lived and ate around the Mediterranean Sea. When and how it became a popular diet in the rest of the world is another story.
In 1958, the American physiologist Ancel Keys launched the study of the seven countries. Keys aimed to find a relationship between diet and the prevalence of coronary heart disease in seven countries with contrasting lifestyles and diets: Greece, Italy, Spain, South Africa, Japan and Finland. A crucial link he pursued was how dietary fat affects blood cholesterol levels. He found that participants from Japan, Greece and Italy had the lowest incidence of not only coronary heart disease, but also all-cause mortality. Curiously, the Japanese participants had a low fat diet, while the Mediterranean groups (Greece and Italy) had a higher fat one. In particular, the diet was effective in older people who did not smoke, exercised regularly, and drank alcohol moderately.
From the 1960s, what we now call the Mediterranean diet took off.
What makes the Mediterranean diet healthy?
Although the term “healthy” is relative, the mainstays of this diet come from its emphasis on fresh fruits and vegetables, legumes, nuts and seeds, fatty fish, moderate alcohol intake and avoidance of ultra-processed foods and sugars. The diet is high in monosaturated fats, what most people call “healthy” fats, high in fiber, and it’s low on the glycemic index.
In May 2022, an article published in The American Journal of Clinical Nutrition directly compared the keto and Mediterranean diets. In this study, 40 participants with prediabetes or type 2 diabetes spent 12 weeks on the Mediterranean diet and another 12 on the keto diet. One of the study’s authors, Christopher Gardner, a nutrition researcher at Stanford University, notes that during both diets, participants lost significant amounts of weight, had better control of their glucose and had lower triglycerides (a value that reflects the fat content in the blood), although the keto portion contains even lower triglycerides. On the other hand, keto seemed to raise LDL cholesterol.
It was the sequel that he found interesting. Twelve weeks after the two trial diets ended, Gardner and his team checked the participants’ eating habits. Most were following a more Mediterranean diet, which he says is because the keto diet is more restrictive.
Is there more to the Mediterranean diet than food?
As interesting as this comparison is, Gardner thinks there is something missing in the discussion of why the Mediterranean diet works, and it has nothing to do with food.
Gardner points to a publication called Nutrition Action Healthletter by the Center for Science and the Public Interests. He recalls that about 20 years ago, when fad diets were all the rage, the cover story of Healthletter featured the diet.
“They said, ‘The Mediterranean isn’t just a diet – it’s a way of life,'” he says. Reverseevoked Western European behaviors – walking for hours every day, eating a huge lunch, taking a three-hour nap, meeting friends late at night for a light dinner and a glass of red wine.
The idea is that in addition to the food you eat, it’s how you eat and live. This image of the Mediterranean diet is about enjoying not just food, but life itself. There is no need to restrict or prohibit certain foods, and eating is a joyful, communal practice. The glowing health benefits stem from the diet itself, as well as living a highly connected, low-stress life.
However, Gardner notes, it’s hard to quantify things like joy. As such, it is difficult to test multiple factors associated with life satisfaction the way one follows multiple macros in a diet.
But there’s some support that there’s more to a healthy diet than the food itself. This notion comes from what are now called blue zones, or communities around the world where people live the longest and healthiest lives. Gardner recalls data that blue zone centenarians had two big things in common: a relaxed, physically active lifestyle — and beans. High in protein and fiber and low in fat, beans seem to make sense, and it can be easy to follow. Even physical activity is easy to track. But relative levels of relaxation and life satisfaction can be difficult to measure because they impact diet.
“I can’t really randomly assign you to be at peace with yourself and nature,” Gardner says.
Why is he still there?
According to Gardner, the key to this diet’s endurance is simple: “It tastes good.”
There is no need to sacrifice carbohydrates or fats. It’s flexible and inclusive, as Gardner notes, because the Mediterranean diet can encompass Greek, French, Italian, Turkish and Middle Eastern foods.
As recently as 2018, nutrition researchers are further digging into the science behind the Mediterranean diet. In 2013, the PREDIMED study (Prevención con Dieta Mediterránea), studying the effects of the Mediterranean diet on more than 7,400 people, was published. They found an inverse relationship between diet and cardiovascular disease risk, as Keys had done, and compared them to a group assigned a low-fat diet.
In 2018, the researchers amended their study after PREDIMED was withdrawn, although Gardner still considers the original article legitimate and influential. Moreover, the re-edited document came to the same conclusions.
Although it may still be a fad diet, the benefits of the Mediterranean diet lie in its non-restrictive nature and the value that it is not only possible to live a healthy life while enjoying food, but that it is, in fact, integral.
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