Why Aren't You Still Following the Mediterranean Diet?

We know that the Mediterranean diet is not just a list of dishes that will help you lose weight and look good by the start of beach season. The Mediterranean diet is a lifestyle that, day by day, for many years, will fill your life with health and energy.

Sounds good but in order to change our lifestyle, we need something more than just beautiful slogans and pictures. We need facts. 

Of course, there are many people who make serious decisions based on emotions. They are capable of drastically changing their (and not only their) lives, being impressed by vivid images drawn by their imagination. Even more, some people make decisions based on images drawn by the imagination of others.

No one says it's bad. It's easier and more efficient in terms of saving time and mental energy. This way of making decisions is ideal for choosing toilet paper or the color of a new car. But when it comes to a choice that will determine the quality of your life for the remaining years, it's still worth spending a few hours and a couple of hundred kilocalories. 

So for people who want to take control of their lives, we have prepared this review of some research on the influence of the Mediterranean diet on our health and well-being.  

The Mediterranean Diet and Reducing the Risk of Cancer, Cardiovascular and Neurodegenerative Diseases

In 2021, a large study published in the New England Journal of Medicine found that people who followed the Mediterranean diet supplemented with extra virgin olive oil or nuts had a lower risk of heart attack, stroke, and cardiovascular death compared to those on a low-fat diet. 

The PREDIMED study, published in the New England Journal of Medicine, investigated the effects of the Mediterranean diet on cardiovascular outcomes. The study involved over 7,000 participants at high risk for cardiovascular disease who were assigned to three different dietary interventions: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control group following a low-fat diet.

The results of the study showed that both Mediterranean diet groups experienced a significant reduction in the risk of major cardiovascular events. These events included heart attack, stroke, and cardiovascular death. The Mediterranean diet supplemented with extra-virgin olive oil was associated with a 30% relative risk reduction, while the group supplemented with nuts had a 28% relative risk reduction when compared to the control group on a low-fat diet.

These findings suggested that adherence to the Mediterranean diet, enriched with either extra virgin olive oil (real farm olive oil, not supermarket garbage!) or nuts, could provide protection against cardiovascular diseases. The study highlighted the potential benefits of a dietary pattern rich in fruits, vegetables, whole grains, legumes, fish, and healthy fats, such as olive oil and nuts, in promoting cardiovascular health.  

Another study published in the Journal of the American College of Cardiology in 2020 found that adherence to the Mediterranean diet was associated with a lower risk of heart disease, stroke, and cardiovascular death in women. 

The study involved over 25,000 women with an average age of 55 years who participated in the Women's Health Study. The participants were followed for an average of 12 years, during which their adherence to a Mediterranean diet was assessed using a scoring system. The researchers analyzed the association between adherence to the Mediterranean diet and the incidence of cardiovascular disease, stroke, and cardiovascular death.

The findings of the study indicated that higher adherence to the Mediterranean diet was associated with a significantly lower risk of developing cardiovascular disease, stroke, and cardiovascular death in women. The women who followed the Mediterranean diet most closely had a 25% lower risk of developing cardiovascular disease, a 23% lower risk of experiencing a stroke, and a 28% lower risk of cardiovascular death, compared to those with lower adherence to the diet.

A 2018 study published in the Lancet Public Health found that following the Mediterranean diet was associated with a lower risk of death from all causes, including heart disease, cancer, and neurodegenerative diseases. 

The study involved a large cohort of over 23,000 participants from the Greek EPIC (European Prospective Investigation into Cancer and Nutrition) cohort. The participants' adherence to the Mediterranean diet was assessed using a scoring system that evaluated their consumption of various components of the diet, including fruits, vegetables, legumes, nuts, whole grains, fish, dairy products, meat, and dry red wine.

The findings of the study revealed that higher adherence to the Mediterranean diet was associated with a lower risk of death from all causes. Specifically, participants with the highest adherence to the diet had a 25% lower risk of death from any cause compared to those with the lowest adherence. Furthermore, a higher adherence to the Mediterranean diet was specifically linked to a reduced risk of death from heart disease, cancer, and neurodegenerative diseases.

It's important to note that this was an observational study, and while it identified an association, it cannot establish a cause-and-effect relationship. 

Nevertheless, the study adds to the existing body of evidence supporting the potential benefits of the Mediterranean diet for overall health and longevity. 

The Mediterranean Diet and Depression

A 2019 study published in the British Medical Journal found that following the Mediterranean diet was associated with a lower risk of depression. 

The study explored the relationship between the Mediterranean diet and the risk of depression. The researchers conducted a meta-analysis, which is a statistical analysis that combines data from multiple studies, to evaluate the association. 

The findings of the study suggested that individuals who had a high consumption of fruits, vegetables, whole grains, legumes, nuts, and olive oil and moderate consumption of fish, poultry, and dairy products had a lower likelihood of developing depression compared to those who did not adhere to the Mediterranean diet. 

Also, the study titled "A Pesco-Mediterranean Diet With Intermittent Fasting" was published in the Journal of the American College of Cardiology in 2020. 

The authors of the study are James H. O'Keefe, Noel Torres-Acosta, Evan L. O'Keefe, Ibrahim M. Saeed, Carl J. Lavie, Sarah E. Smith, and Emilio Ros. The study aims to review the cumulative evidence regarding diet and health, with a focus on the cardiovascular benefits of a Pesco-Mediterranean diet.

The study argues that as opportunistic omnivores, humans are adapted to obtain calories and nutrients from both plant and animal sources. However, excessive consumption of processed meats high in saturated fats and additives can lead to adverse health effects. On the other hand, strict veganism may result in nutritional deficiencies. The authors propose a compromise in the form of a Pesco-Mediterranean diet, which emphasizes a plant-rich diet supplemented with fish and seafood as the main sources of animal food.

The foundation of the Pesco-Mediterranean diet consists of vegetables, fruits, nuts, seeds, legumes, whole grains, and extra-virgin olive oil, along with fish/seafood and fermented dairy products. The recommended beverages include water, coffee, and tea. The authors also suggest time-restricted eating, involving intermittent fasting for 12 to 16 hours daily. 

The study incorporates data from landmark clinical trials on the Mediterranean diet and recommendations from recent guidelines to support the hypothesis that a Pesco-Mediterranean diet is ideal for optimizing cardiovascular health. The Mediterranean diet has been associated with various health benefits, and the inclusion of fish and seafood as primary animal food sources may further enhance its cardioprotective effects. 

The Mediterranean Diet and Its Benefits on Health and Mental Health

In 2020 Clinical Practice & Epidemiology in Mental Health Journal published the results of the study "Mediterranean Diet and its Benefits on Health and Mental Health: A Literature Review". 

The study was authored by Antonio Ventriglio, Federica Sancassiani, Maria Paola Contu, Mariateresa Latorre, Melanie Di Slavatore, Michele Fornaro, and Dinesh Bhugra. It was published on July 30, 2020, and has the PubMed Central ID (PMCID) of PMC7536728 and the PubMed ID (PMID) of 33029192. 

The study includes a review of the existing scientific literature on the Mediterranean diet and its potential benefits for both physical and mental health. Literature reviews generally summarize and analyze the findings of multiple studies to provide an overview of the current knowledge on a specific topic.

The study explored the association between adherence to the Mediterranean diet and its potential positive effects on various aspects of health, including mental health. The Mediterranean diet is known for its emphasis on whole foods, fruits, vegetables, whole grains, legumes, nuts, olive oil, moderate consumption of fish and poultry, and limited intake of red meat and processed foods. This dietary pattern has been linked to several health benefits, including cardiovascular health and potential mental health benefits.

Here are the key points of the review: 

1. The Mediterranean Diet was initially described by Ancel Keys as a dietary pattern prevalent in Greece and southern Italy in the 1960s, characterized by low quantities of fat oils and high levels of vegetable oils. 

2. Various organizations and guidelines, such as the Greek Dietary Guidelines, the Mediterranean Diet Foundation, and Oldway's Preservation and Trust, have proposed different versions of the Mediterranean Diet Pyramids, highlighting the consumption of olive oil, vegetables, fish, legumes, cereals, fruits, and moderate wine intake during meals.

3. From a nutritional perspective, the Mediterranean diet is low in saturated fats and animal proteins, while being rich in antioxidants, fibers, monounsaturated fats, omega-3 fatty acids, phytosterols, and probiotics, which may contribute to its health benefits.

4. The Seven Countries' study conducted in the late 1950s compared food consumption patterns and health outcomes in different countries, confirming that the Mediterranean diet was adopted in Greece and Italy, while other regions had different dietary patterns.

5. The PREDIMED (PREvención con DIeta MEDiterránea) study, a large multicenter study launched in 2013, aimed to assess the long-term effects of the Mediterranean diet on cardiovascular disease and other clinical conditions. It found associations between the Mediterranean diet with olive oil or nuts and improvements in various markers of cardiovascular health.

6. A subsequent study called PREDIMED-Plus evaluated the combined impact of lifestyle interventions, including an energy-restricted Mediterranean diet, polyphenol intake, and physical activity, on the prevention of cardiovascular disease and metabolic syndrome.

7. the Mediterranean diet has shown potential benefits for improving the quality of life, cognitive functioning, and physical activity levels in individuals.

8. The PREDI-DEP study has been launched to investigate whether the Mediterranean diet supplemented with extra virgin olive oil or nuts can prevent the risk of relapse in individuals with unipolar depression.

9. Adopting a healthy dietary regimen and engaging in physical exercise is generally recommended for individuals with mental illnesses to improve their overall well-being, reduce mortality related to physical comorbidities and unhealthy lifestyles, and enhance the outcome of illness.

Encouraging studies to explore the benefits of healthy food selection and lifestyle choices for the general population is emphasized in the narrative review.

The 27 selected articles were analyzed and divided into different groups based on the aims of the studies and the population involved. These groups included healthy or young subjects, post-menopausal women, elderly subjects, pregnant women, depressive disorder patients, type-2 diabetes mellitus patients, cardiovascular disease patients, cancer patients, and metabolic syndrome patients.

The studies involved a total of 16,584 participants, with 7,447 participants from the PREDIMED-Trial reports. The age of the participants varied across the studies, with high heterogeneity in age reported for studies involving healthy subjects. The studies also collected data on the participants' Body Mass Index (BMI), and four studies found a significant improvement in BMI as a result of following the Mediterranean diet.

The studies had different designs, including RCTs, parallel-group designs, and crossover RCT designs. The duration of the studies ranged from 2 weeks to 5 years, depending on the aim, design, and study population.

The report summarized the findings of the selected studies for different populations. For healthy subjects, the studies reported various outcomes such as the reduction of cardiovascular risk factors, changes in vascular biomarkers, no significant changes in physical activity or quality of life, and no short-term benefits for children with obesity.

In the elderly population, the impact of the Mediterranean diet on inflammatory indexes, bone mineral density, and biomarkers of bone and collagen degradation was investigated. The results showed no significant changes in bone mineral density but suggested a potential reduction in femoral neck bone mineral density in individuals with osteoporosis.

For pregnant and post-menopausal women, the Mediterranean diet was found to have positive effects on stress markers and a reduced incidence of gestational diabetes mellitus. 

The report also highlighted the effectiveness of the Mediterranean diet in reducing cardiovascular risk factors, such as blood pressure, cholesterol levels, and triglycerides. Other reported benefits included a reduction in major cardiovascular events, metabolic syndrome, obesity, and complications of diabetes.

In conclusion, the selected studies supported the effectiveness of the Mediterranean diet in promoting health and well-being, particularly in relation to cardiovascular health. However, the specific outcomes varied depending on the population studied and the study design.

The main challenges in studying the role of the Mediterranean Diet in health and mental health are related to accurately assessing individuals' exposure to dietary patterns, dealing with the heterogeneity of populations involved, and comparing clinical and non-clinical conditions that could benefit from dietary interventions. 

The Mediterranean diet has been confirmed to have a role in improving metabolic and cardiovascular parameters, reducing the incidence of major cardiovascular events by approximately 30%. the Mediterranean diet also shows benefits in improving metabolic balance in patients with type 2 diabetes mellitus. The improvement of biochemical markers has been documented for metabolic disorders and patients at risk of specific cancer diseases. Dietary regimens based on polyphenols, fibers, extra-virgin olive oil, or nuts may greatly reduce oxidative biochemical processes related to metabolic, cardiovascular, and cancer pathophysiology.

The role of the Mediterranean diet in the prevention of the development of mental disorders has become a recent research focus over the past decade. Although the efficacy of dietary programs in managing metabolic issues among patients with severe mental illness is well-known and described, there is limited data available on the effects of the Mediterranean diet on specific psychopathological issues. Two recent clinical trials on the Mediterranean diet and mental health showed positive findings regarding the improvement of depressive symptoms and remission rates under a healthy diet regimen. Additionally, a literature review based on 37 studies in 2020 confirmed an association between polyphenol consumption and depression risk, as well as a reduction in the severity of depressive symptoms. Moreover, adherence to the Mediterranean diet is a key factor in promoting improved outcomes in depressive patients, as suggested by an observational study that reported an inverse association between adherence to the Mediterranean diet and the severity of symptoms, as well as poor depressive outcomes among patients with comorbid overweight or metabolic syndrome.

This review suggests the need for further studies to determine the role of the Mediterranean Diet, specific nutrients, and dietary programs in the outcomes of physical diseases and mental disorders. These studies may also provide additional evidence on the pathophysiology and treatment of illnesses within the framework of gene-environment interactions. Specifically, focused experimental protocols should address the efficacy of diet as an adjunctive treatment for mental disorders, as well as for the management of comorbid cardiovascular and metabolic issues.

Overall, these studies suggest that the Mediterranean diet is a healthy and sustainable dietary pattern that can reduce the risk of chronic diseases and promote overall health and well-being. 

It's important to note that medical research is constantly evolving, and new studies are published regularly. There may have been additional studies since the last update that have further explored the relationship between the Mediterranean diet and cardiovascular health. We recommend consulting the latest scientific literature or seeking advice from a healthcare professional for the most up-to-date information on this topic. 

So why aren't you still following the Mediterranean diet? 

Because reading research is just the first step to making a decision. Now you should tell your doctor about your intentions, pass the necessary examination and get professional advice. And then, welcome to the Mediterranean diet!