The Mediterranean Diet is specifically known to correct heart disease, high blood pressure and high cholesterol. It is also used in cancer recovery. It is not a prescribed regimen of foods, but rather a way of eating based on the local foods of indigenous cultures that live around the Mediterranean Sea. People from this region tend to live longer, and have less chronic disease and obesity than the rest of Europe and North America. To understand why, scientists looked at the foods and lifestyle of the region.
It is estimated that over 600 million people have high blood pressure. Heart disease is still one of the leading causes of death in the United States, and dietary interventions are first line therapies for prevention and treatment. The Mediterranean Diet, so called because it mimics classic eating patterns and ingredients from countries like Spain, Italy and Greece, has proven itself time and again as an effective therapy for hypertension and cardiovascular disease. A quick search of Medscape will show you that other conditions like Type 2 Diabetes, Weight loss, Alzheimer’s disease, Metabolic Syndrome, and Cancer are also being improved by adherence to this style of eating.
What It Entails
The Mediterranean Diet is modeled after a traditional European “local” diet. Think small servings of homemade pasta or polenta, with fresh local herbs and vegetables like rosemary, basil, tomato, fennel, mushrooms and onions sautéed in liberal amounts of extra virgin olive oil. Add some white beans or fresh local cheese and handfuls of fresh arugula. Small fish like sardines and anchovies are added to meals regularly or served as a snack with walnuts, flatbread and cut up raw vegetables like cucumbers, cabbage, carrots, and broccoli. Fish is a regular staple, always cooked with olive oil and often marinated with lemon and fresh herbs. A couple times a week you may have free range eggs or chicken, again with liberal amounts of greens, cooked vegetables, beans and fresh herbs. And steak or lamb is eaten a couple times a month. Red wine is served with dinner most nights, and small amounts of homemade dessert like tiramisu or gelato a couple times a month.
A triangle is an easy way to depict the major food groups for the Mediterranean diet.
Grains and Pastas
Grains and pastas are important for feeling full, serotonin production, daily fiber and vitamins and minerals. They are also essential for T3 thyroid hormon
e production. Grains are commonly used in their whole form for optimal nutrition although some homemade pasta and bread are implemented. Suggested Mediterranean grains include barley, buckwheat, bulgur, couscous, farro, millet, polenta, rice, and wheat berries. Whole grain salads and porridges are great ways to have a daily grain in your menu. Portion sizes are conservative, with emphasis on the vegetable and olive oil.
Vegetables
Vegetables are an important staple in the eating patterns of all countries bordering on the Mediterranean, providing essential plant nutrients, vitamins, minerals and fiber. Cook with virgin olive oil, and drizzle whole pressed plant oils on raw vegetables. These plant nutrients and plant oils are the foundation of the Mediterranean diet benefits as they provide essential omega fats daily.
Commonly used vegetables include: artichokes, arugula, beets, broccoli, Brussel sprouts, cabbage, carrots, celery, celeriac, cucumber, dandelion greens, eggplant, fennel, greens of all kinds including collard, kale, Swiss chard and more, leeks, lemons, lettuce, mache, mushrooms, okra, onions, peas, peppers, potato, pumpkin, radish, rutabaga, scallion, spinach, turnips, yams and zucchini.
Whole Fresh Fruit
Whole fresh fruit provides important nutrients with juicy sweetness. Include apples, apricots, avocado, cherries, clementines, dates, figs, grapefruit, pomegranate, strawberries and tomatoes. Avoid juices, jams, and jellies as these are high in sugar without the antioxidants and fiber of whole fruit. One-two glasses of wine are included as a daily beverage with meals; for people who abstain from alcohol, 100% purple grape juice can be used instead as a source of antioxidants and resveratrol.
Raw Nuts and Seeds
Raw nuts and seeds are another key to the healthful oils that improve cardiovascular health. One study added only walnuts to a standard diet and exhibited cardiac disease improvement just from the omega 3 fats naturally contained in these nuts. Twenty raw almonds daily have also been suggested as a natural way to lower blood pressure. All raw nuts and seeds and raw nut butters except peanuts contain beneficial oils and add richness and flavor to vegetable based dishes. Once you “dry roast” or roast the nuts and seeds, the beneficial oils are lost or made into inflammatory trans-fats. If you prefer the taste, buy raw nuts and toast them yourself in a cast iron pan or a low heat oven for 10-20 minutes. You can add spices, soy sauce or honey before toasting for additional delicious taste!
Beans and Legumes
Beans and legumes are great source of protein and fiber and have a rich creamy texture. Cook with cannellini beans, chickpeas, fava beans, and green beans. Kidney beans, lentils, and split peas are also common ingredients in Mediterranean meals. Legumes provide a protein rich flavor note and nutritional support; in moderate amounts they are less likely to cause digestive upset. How to make nice bean based recipes: Think brothy bowls of rich soup, light summer salads with olive oil and beans, or a Spanish fabada with pork and sausage. Use a digestive enzyme if needed to improve digestion and reduce side effects.
Fish and Seafood
Fish and seafood are prominent in this way of eating as it is based around sea cultures. Fish and shellfish are incorporated almost daily, providing high amounts of omega three fats essential for heart health. Little fish like sardines, anchovies and mackerels are cheap and abundant and very high in omega 3 oils. Next time you are at a grocery store, pick up a tin of boneless, skinless sardines. Try eating them with crackers and sour cream, or top a nicoise-style salad with them (potatoes, olives and arugula.) They are quite delicious! Bigger fish like tuna, salmon and sea bass are featured regularly, as well as all shellfish, octopus and eel varieties. Fish and seafood are rarely battered and fried. They are often grilled, baked, steamed or pan-fried with olive oil.
Eggs and Dairy
Eggs and dairy are also part of this way of life, but in modest amounts, For example, cheese and yogurt may be eaten daily as tzatziki yogurt dip, manchego cheese in arugula salad, romano or feta to complement dishes; you do not see the consumption of large amount of industrialized cheese like a Domino’s pizza.
Red meat is enjoyed every couple weeks as are cured meats like salami, carpaccio or prosciutto – used sparingly on homemade pizzas with a cheese like ricotta, or served as antipasti with olives and vegetables.
Homemade desserts are eaten every couple of weeks as well.
As you can see, there is great diversity in this way of eating. There are no “bad” foods and “good” foods, but the intake of vegetables, fish, healthy oils and high fiber grains is much higher than the intake of dairy, sugar, chicken and red meat. The vegetarian and pescatarian style of eating results in high vitamin C, E and selenium, high levels of glutathione, balanced omega 6 and 3 oils, high fiber, and abundant antioxidants from fruits and vegetables including resveratrol from red wine and polyphenols from olive oil. These are the basic foundations of a heart healthy diet that any nutritionist or integrative doctor will recommend!
Longevity Lifestyle
There is more than just food to the Mediterranean success though. Lifestyle is almost equally as important as the style of eating for the longevity and happiness that contributes to this regions wellness. Meals are enjoyed in a social atmosphere, contributing to slower eating and improved digestion. Naps in the form of “siestas” are built into the regions lifestyle, allowing valuable down time and relaxation as well as sleep! Movement, in the form of daily walking and gardening, is an inherent part of an active lifestyle that also improves cardiovascular fitness. And finally, there is a strong sense of community, often centered around religion, which fulfills the esoteric or spiritual needs at an individual level. In fact, anthropologists and scientists have discovered what they call Blue Zones in areas around the Mediterranean where people are exceptionally healthy and regularly live over 100 years due to a constellation of diet, lifestyle and positive attitudes. Read some Blue Zone recipes here.
Implementing Changes
The biggest hurdle to changing your nutrition is what you put in your grocery cart. As long as you have frozen meat and industrial cheese in your cupboards, that is what you and your family will eat. Start by purchasing a good quality olive oil in glass or metal (not plastic), vegetables, raw nuts, and whole grains, and planning simple meals. Beans are easily added into an American diet in the form of hummus, black bean dips, tacos, hearty soups and homemade chili. They are also a delicious, satisfying, high fiber and high protein addition to salads. (plus 3 bean salad!) Scope out your local Italian grocery store like Micucci’s in Portland, and go to the farmers market and fish market for fresh local inspiration. Classic Italian or Greek recipes can provide inspiration; however, this is inherently a simple style of eating. Some convenience may be lost as you cook a minestrone style soup, but the preparation time can be made up by the abundance of delicious, easy leftovers. Enjoy your preparation time with music and a glass of red wine and have your kids help – community + relaxed eating environments are two of the secrets to happiness!
A note on olive oil. Americans spend about 700 million dollars on olive oil per year. Low grade olive oil is rampant, and many cheap versions are cut with soybean oil or other inferior vegetable oils. Products branded as Extra Virgin Olive Oil (EVOO) are often not extra virgin (first press) and often not 100% olive. Choosing organic olive oil is a higher price, but ensures the quality and manufacturing guaranteed by organic standards. There are no regulations in place for non-organic oils at the moment. Using liberal amounts of soybean oil or other low grade, low quality oils, especially when stored in plastic, will NOT have the same beneficial properties like polyphenol antioxidants that real olive oil has.
Consider shopping at an olive oil specialty store that lets you taste before you buy ~ Le Roux offers this option plus delicious balsamic vinegars to pair it with! Buying olive oil in larger amounts, like the metal cans sold at Italian grocery stores, often allows for improved quality and a lower volume price. Transfer some of the oil into a smaller table-friendly vessel for cooking and dressing raw greens!
For more information see this New Yorker Article: Olive Oils Dark Side.
References
Kokkinos, Peter, Panagiotakos, Demosthenes B. Polychronopoulos, Evangelos. “Dietary influences in Blood Pressure: The Effect of the Mediterranean Diet on the Prevalence of Hypertension.” Medscape Multispecialty n.d. http://www.medscape.com/viewarticle/502409_5 Accessed July 8, 2015
Stetka, Bret S. “Beans, Greens, and the Best Foods for the Brain.” Medscape Psychiatry. July 7, 2015 http://www.medscape.com/viewarticle/847304_5 Accessed July 30 2015
Toledo E1, Hu FB, Estruch R, Buil-Cosiales P, Corella D, Salas-Salvadó J, Covas MI, Arós F, Gómez-Gracia E, Fiol M, Lapetra J, Serra-Majem L, Pinto X, Lamuela-Raventós RM, Saez G, Bulló M, Ruiz-Gutiérrez V, Ros E, Sorli JV, Martinez-Gonzalez MA.” Effect of the Mediterranean diet on blood pressure in the PREDIMED trial: results from a randomized controlled trial.” BMC Med. 2013 Sep 19; 11:207. doi: 10.1186/1741-7015-11-207. http://www.ncbi.nlm.nih.gov/pubmed/24050803 Accessed July 8 2015
Bautista RN, Marita; Engler PhD, RN, MS, Marguerite. “The Mediterranean Diet: Is It Cardioprotective?” Prog Cardiovasc Nurs. 2005;20(2):70-76. http://www.medscape.com/viewarticle/504600_2 Accessed July 8 2015
Black, Henry MD, Sasson, Lisa MS RD. “Mediterranean Diet: Not Only Great Food but Great Lifestyle” Medscape Cardiology. October 5, 2011. http://www.medscape.com/viewarticle/750564#vp_2 Accessed July 8 2015.
Nainggolan, Lisa. “Indo-Mediterranean Diet Better than Low-Fat for CAD” Heartwire for Medscape November 7, 2002. http://www.medscape.com/viewarticle/785895#vp_2 Accessed July 9, 2015
“Traditional Mediterranean Diet” Oldways, Health Through Tradition. 2015 Oldways Preservation Trust.http://oldwayspt.org/resources/heritage-pyramids/mediterranean-diet-pyramid/traditional-med-diet Accessed July 8 2015
“Bean Cuisine from Mediterranean Masters” The World Bean Kitchen: Passport to Flavor. Culinary Institute of America. 2013 http://www.ciaprochef.com/northarvest/mediterranean.html Accessed July 9 2015.
Carroll, Linda, Whitman, Jake. “Wine, Beans and family: Sardinia’s secrets to living to 100.” Today Health and Wellness. April 7, 2015. http://www.today.com/health/live-100-sardinias-secrets-longevity-blue-zones-2D80590693 Accessed July 15, 2015
About the Author
Coastal Pharmacy & Wellness Staff
