The traditional Mediterranean diet comprises foods eaten by people living in olive growing regions of the Mediterranean before the 1960s, notably Crete, the Greek mainland, Spain and Southern Italy. This diet is a feature of the lifestyle of poor people, their climate and hardship at a time before the globalisation of American dietary trends, which introduced the regular consumption of red meat, factory fats, convenience foods and refined sugar. The Mediterranean diet has been associated with a reduced risk of developing cancer, heart disease, Parkinson’s disease, Alzheimer’s disease, and diabetes.^1,2

The Mediterranean diet is largely vegetarian and during the months of religious fasting is actually almost vegan. It is abundant in vegetables, fruits, whole-grain cereals, nuts and legumes. It is therefore rich in protective phytonutrients such as flavonoids, phytosterols, phenols and terpenes. Meat is consumed in modest amounts as fish, pork and chicken, while dairy is also eaten sparingly in the form of cheese and yoghurt. These dairy products are usually derived from sheep’s or goat’s milk. Wine and coffee are drunk in moderation, the wine usually accompanying the meal.

The high oil content of the diet, around 30% in Italy and 40% Greece, is derived from olive oil, nuts and fatty fish.³ The oleic acid in olive oil contains polyphenols which have antioxidant, anti-inflammatory and antiatherogenic properties, which raises protective HDL and lower total cholesterol.⁴ Nuts and fish contain beneficial omega-3 fatty acids as well as other fats, vitamins and minerals.

Consuming fat mostly in the form of olive oil means that the diet contains a relatively low amount of saturated fat and animal-derived cholesterol, a fact which lead Dr Ancel Keys to promote it in the 1950s as preventative of heart disease and stroke. In the Seven Countries Study (US, Finland, The Netherlands, Italy, Yugoslavia, Greece, Japan) Keys identified high cholesterol, high blood pressure, smoking and a lack of exercise as risk factors for the development of coronary heart disease. A risk factor, however, is not the same as a cause, and elevated blood cholesterol has long since been dismissed as a cause in heart disease.⁵

Unfortunately Dr Keys’ study excluded data from several important countries, notably France and Mexico, which was available at the time. These countries had diets with high levels of saturated fat, but statistics showing low rates of coronary heart disease, contradicting the central tenet of what became known as the ‘Lipid hypothesis.’ The low rate of heart disease amongst the French is usually attributed to a high consumption of antioxidant-rich fruit and vegetables, moderate wine consumption and the protective effects of foods such as cheese and yoghurt.⁶

Red wine alone contains the protective phytonutrients myricetin, kaempferol, quercetin, catechin, epicatechin, proanthocyanidins, anthocyanins, phenolic acids and resveratrol. Just one of these nutrients, resveratrol, has antioxidant, anti-inflammatory and anticancer properties.⁷

At the time, Professor John Yudkin presented an alternative hypothesis which implicated the high consumption of processed sugar in the US as being the cause of heart disease, something the Mediterranean people ate little of traditionally.⁸ As it turns out, these two opposing theories actually represent two pieces of a much larger, more complex puzzle as we know it today.

Unfortunately, the limited state of knowledge in the 1950s concerning cholesterol, fats, sugar and hormone signalling led to the broad scale recommendation, still in place today, to avoid saturated fats and cholesterol. Subsequently, patients in clinics everywhere have been advised for decades to replace most dietary fats with omega-6 dominant vegetable oils to reduce the risk of heart disease. Low-fats diets have also completely failed to curb obesity.⁹

As it turns out, this dietary change was sponsored by lobbyists of the powerful sugar, margarine and low-fat food industry who directly influence research funding and health policy.¹⁰ The tragedy lies in the pharmaceutical industry fix such as statins and metformin, for this very profitable degenerative diseases epidemic.¹¹

Keys and Yudkin have long been overtaken by research that has added further dimensions to an understanding of the aetiology of heart disease which includes inflammation, oxidative stress, the role of additives and pesticides, and the danger of subsisting on industrial foods. Put simply, a diet high in processed carbohydrates and factory fats, where sugary carbonated drinks routinely replace water, increases insulin resistance and oxidative stress leading to obesity and diabetes. In addition, this diet creates nutrient deficiencies, causes the oxidation of cholesterol and promotes plaque formation in arteries, as well as other degenerative tissue changes of the kind observed in cancer.

A high consumption of red meat, refined grain and dairy foods adds to the inflammatory and acidifying effect of this modern urban diet, which is devoid of the crucial compensatory phytonutrients present in traditional diets which prevent accelerated aging. By comparison, traditional diets containing natural organic ingredients, build enduring health and raise vitality.

It should be said that the Mediterranean diet of the last 10,000 years, which corresponds to the domestication of animals and grain-based agriculture, best suits the genetics of blood type A. This blood type has a tolerance for carbohydrates and grains and manages well on much less animal protein than type O which evolved as a hunter-gather (Paleo). Type A is content as a vegetarian, while types B and AB are natural omnivores. Nevertheless, while type A is tolerant of carbohydrates and grains, no blood group is suited to the ultra-processed carbohydrates, polished grains and chemical additives of our advanced industrial age.¹²

The regular consumption of herbal teas along with plenty of clean water are also healthy features of the diet. Furthermore, a high level of physical activity and time spent out in the fresh air and sunshine promote well-being and longevity.

References

1.         Sofi F, Abbate R, Gensini GF, Casini A. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr 2010;92:1189–96.

2.         García-Fernández E, Rico-Cabanas L, Rosgaard N, Estruch R, Bach-Faig A. Mediterranean diet and cardiodiabesity: a review. Nutrients 2014;6:3474–500.

3.         Trichopoulou A, Martínez-González MA, Tong TY, et al. Definitions and potential health benefits of the Mediterranean diet: views from experts around the world. BMC Med 2014;12:112.

4.         Casas R, Sacanella E, Estruch R. The immune protective effect of the Mediterranean diet against chronic low-grade inflammatory diseases. Endocr Metab Immune Disord Drug Targets 2014;14:245–54.

5.         Ravnskov U. The Cholesterol Myths: Exposing The Fallacy That Saturated Fat And Cholesterol Cause Heart Disease. Washington, DC: New Trends; 2000.

6.         Durán Agüero S, Torres García J, Sanhueza Catalán J. Consumption Of Cheese And Milk And Chronic Diseases. Nutr Hosp 2015;32:61–8.

7.         Catalgol B, Batirel S, Taga Y, Ozer NK. Resveratrol: French paradox revisited. Front Pharmacol 2012;3:141.

8.         Yudkin J. Pure, White and Deadly: How Sugar is Killing Us and What We Can Do to Stop It. London: Penguin Books; 2012.

9.         Lustig RH. Fat Chance: The bitter truth about sugar. London: Fourth Estate; 2013.

10.       Kearns CE, Schmidt LA, Glantz SA. Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents. JAMA Intern Med 2016;176:1680–5.

11.       Goldacre B. Bad Pharma: How Drug Companies Mislead Doctors And Harm Patients. London: Fourth Estate; 2012.

12.       D’Adamo P. Live Right For Your Type. Penguin Books; 2002.