- Sep 10, 2019
Over the past few decades the Mediterranean diet has grown considerably popular among Americans who seek to treat various health complications or improve overall health through their diets. This is an area of interest to our business clients who are looking to support better well-being through sustainable behavior change, so we wanted to share some information related to the topic.
The Mediterranean diet is based on the diets of Mediterranean countries whose nutritional adherence to select food groups has historically proven to lower the risk of health conditions like heart attacks, strokes, obesity and poor cognitive function later in life. The diet’s widespread appeal is a testament to the success of its health outcomes for brain health, diabetes, hypertension and weight management – among other serious health conditions.
This blog covers the many benefits of the Mediterranean diet in relation to a variety of health conditions, as well as how to successfully implement this impactful and disease-preventing nutritional regimen for optimal treatment and health outcomes.
The Importance of Diet Adherence
As you may be aware, diets are not temporary or quick fix solutions for serious health diseases or conditions but rather life-long shifts in eating habits and nutritional intake that ultimately lead to improved health. In our mainstream society, however, diets are often misconstrued as fads that can help people lose weight for an upcoming event. Regardless of the distinction, people continuously struggle to implement life-long diets, are miss-educated about their individual dietary best practices and require coaching support to stay true to a realistic, personalized nutritional regimen.
Apart from yielding quantifiable and positive health outcomes, the Mediterranean diet is appealing to many because it allows for the consumption of some appetizing options – like dairy and red wine – whereas other diets are more stringent. This creates a potential for higher diet-adherence which would then make the Mediterranean diet more attractive to prescribing physicians and their patients alike.
According to a recent news article, Dr. Lindsay Malone of Cleveland Clinic says that the, “cornerstone of the Mediterranean diet is focusing on the quality of what we’re eating, rather than just the quantity.” This focus on quality of calories versus quantity further encourages diet-adherence because it does not require calorie-counting or calorie limits in the way that other diets require, further supporting the idea that the Mediterranean diet is a feasible lifestyle change. Instead of calorie-counting, the Mediterranean diet recommends substituting unhealthy options with healthy ones. A few examples are listed below:
Fish and poultry vs. red meat
Olive oil vs. vegetable oil / butter
Fruits vs. sugary treats
Additionally, Dr. Malone expressed that “when people eat the Mediterranean diet, they have this nice foundation of good, nutrient-dense foods that are providing vitamins, minerals, phytonutrients, and that’s why we see it again and again, having a positive impact on things like cognitive functioning, heart health, blood sugar balance, and weight management.” Having a foundation of good nutritional intake can significantly influence the success and failure of disease management.
Brain Health and Mediterranean Diet
The Mediterranean diet is beneficial for brain development because it includes a healthy variety of nutrients that are good for different parts of the body. Dr. Malone conveys this point of view, saying that “the Mediterranean diet is likely helpful for brain function because it relies on vegetables, fruits, beans, nuts, seeds and whole grains.” According to a recent study based on the Mediterranean diet-adherence of more than 2,600 adults in their thirties whose brain and cognitive functions were then observed 25-30 years after initiating the lifestyle change, “those who closely followed the Mediterranean diet were 46 percent less likely to have poor brain function at midlife than those who ate other diets.” As encouraging as these results may be, diet-adherence and exercise are key to the success or failure of any diet. Though the Mediterranean diet encourages daily exercise, both diet-adherence and daily exercise are difficult to maintain for most individuals. Despite the proven and clear benefits of the Mediterranean diet, many patients struggle with diet-adherence and exercise if the threat of disease is not imminently present or if the health benefits are not immediate. Yet the dangers of poor eating habits and sedentary lifestyles are always present and real. The good news is that, conversely, the health benefits of diets (like healthy brain function) are also present and real even if said health benefits do take a little longer to materialize.
In addition to the positive cognitive function outcomes later in life, the Mediterranean diet might also help prevent serious brain health issues like Alzheimer’s. According to a Mayo Clinic article, the Mediterranean diet could help “reduce the risk of mild cognitive impairment (MCI) — a transitional stage between the cognitive decline of normal aging and the more-serious memory problems caused by dementia or Alzheimer's disease.” It’s important to note that current evidence supporting the claim that the Mediterranean diet reduces the risk of Alzheimer’s is limited for lack of additional evidence and potential confounding factors.
Another study as reported by the Mayo Clinic “looked at whether following a Mediterranean diet, the Dietary Approaches to Stop Hypertension (DASH) diet designed to treat high blood pressure or a hybrid diet that combined aspects of both diets known as the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet could reduce the risk of Alzheimer's disease.” The results showed that all three diets lowered the risk of Alzheimer's disease. However, not all diets are recommended for the same conditions and or treatment plan. A diabetic may be recommended the DASH diet to meet a specific goal or a certain health metric.
On the other hand, perhaps the Mediterranean diet is recommended for someone who happens to be lactose intolerant and would therefore require a dairy free diet, i.e. the DASH diet. Whatever the unique circumstances are, treating and managing a disease through an individually customized diet is a crucial aspect of a successful treatment plan - perhaps the most important aspect. Therefore, it is paramount that patients adhere to diets recommended by their physicians for optimal health outcomes relative to the patients’ specific condition and treatment plan.
To read more about how the DASH diet can be an effective heart-healthy approach to lowering risk of developing heart failure by almost half, click here to read a recent and related APH blog.
Hypertension and The Mediterranean Diet
As aforementioned, the Mediterranean diet is a lifestyle and life-long commitment that reduces the risk of many preventable diseases and health conditions. It was not designed to reduce the risk of hypertension, or any specific disease for that matter, in the way the DASH diet was. The Mediterranean diet is simply a collective adoption of the traditional foods and diets of Mediterranean countries.
Furthermore, The Mediterranean diet unlike many other diets can help manage multiple existing conditions because, as noted, it contains a foundation of nutrients that are good for several bodily functions.
While it is true that the DASH (Dietary Approaches to Stop Hypertension) diet prescribes to a nutritional regimen specifically designed to help patients manage hypertension, that does not necessarily make it the most effective diet for treating or managing a diabetic who also suffers from some other chronic condition(s). For this reason, it’s important to establish the purpose or goal of a diet with the individual’s unique health circumstances in mind. Different diets serve different purposes and beyond that, some diets serve the same purpose but have varying results dependent on the individual. It is critical that the patient’s specific condition be addressed by the diet regimen and to do so, it is equally important to know as much information about the patient’s health condition(s) before subscribing to or recommending any diet.
For example, the American Diabetes Association (ADA) recommends diabetics lower their “A1C < 7%, controlling blood pressure to < 130/80 mmHg, and controlling LDL cholesterol to < 100 mg/dl (< 70 mg/dl for those with diagnosed cardiovascular disease [CVD]) to reduce the risk of microvascular and cardiovascular complications.” This example provides specific metrics or goals that a diabetic could accomplish within a given timeframe if they adhere to a proper diet. Certainly there is room for overlap of nutrients that can help manage A1C levels between the Mediterranean diet and other diets, like the DASH diet, but according to the American Diabetes Association, “although there is some overlap in the recommendations, nutrition guidelines can be complex and confusing to people with diabetes who are often working to manage their diabetes in combination with other health risks.” The problem therefore is not finding a diet that can improve outcomes for a diabetic but rather navigating the complex and confusing guidelines of custom dieting
This confusion often stems from limited health literacy, or the ability to consume health care information and data interpretation to accurately make the optimal health decisions for the disease and circumstance. For diabetics who rely on a diet as a foundational source of nutrients, the ADA explains that, “nutrition recommendations often require an individual to have advanced skills, such as label reading or data interpretation (e.g., calculation of carbohydrate intake, and, for those using insulin, correction factors or insulin-to-carbohydrate ratios).” This illustrates a need for diet coaching and guidance for a population of patients and individuals who may not currently have any.
Exacerbating the complexity and confusion are the various iterations of diets and or diet combinations. For example, the previously mentioned hybrid diet that combines facets of both the DASH and the Mediterranean diet into one. According to the Mayo Clinic, this hybrid diet is referred to as the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet. The MIND diet is associated with a reduced level of risk for the development of Alzheimer’s. Additionally, and according to the US National Library of Medicine National Institutes of Health, there is a low-carbohydrate version of the Mediterranean diet known as the Mediterranean/LC diet that reduces Hepatic Fat Content (HFC) more effectively than Low-fat diet. High levels of hepatic fat can be dangerous for liver health and could further lead to complications with metabolic syndrome, type 2 diabetes and coronary heart disease.
Perhaps expecting advanced health literacy from patients is unfair to the patient and sets them up for failure. The Mediterranean diet mitigates the effects of poor health literacy nicely because it does not rely on a stringent regimen and simultaneously provides important nutrients for every part of the body – improving overall health. In fact, for diabetics, the Mediterranean diet addresses three important factors in one diet alone; blood glucose, blood pressure and cholesterol management can all be addressed through proper Mediterranean diet adherence and treatment. The ADA reports that “In terms of diabetes prevention, an 83% lower risk of diabetes has been found among those who closely adhered to a Mediterranean diet. Furthermore, adherence to a Mediterranean diet, even without calorie restriction, seems to be effective in preventing diabetes among those at high cardiovascular risk.”
The success of the Mediterranean diet for treating diabetes should not, however, dissuade diabetics, pre-diabetic or any patient from researching multiple options to find their personal, optimal diet. For example, the DASH diet can also be effective for helping to manage diabetes and furthermore has proven to reduce the risk of developing heart failure by almost half. Additionally, some comorbidities or unique circumstances prevent patients from adhering to the Mediterranean diet. What patients truly need is not improved health literacy, but better diet coaching and diet-adherence support.
Implementing the Mediterranean Diet
While it is true that implementing the Mediterranean diet is a difficult and life-long commitment, the health benefits are too good to ignore. Below are a few conditions, per wellandgood.com, that severely impact quality of life but can be prevented or better managed through adherence to the Mediterranean diet:
Diabetes: Type 2; Blood sugar
Hypertension: Heart attack; Stroke; Cholesterol and blood pressure
Brain health: Cognitive health; MCI and Alzheimer’s
Cancer: Colon cancer; Breast cancer and gastric cancer
The initial step to implement a successful Mediterranean diet regimen begins with a revamped grocery list. It is important to re think the below food groups on a grocery list, described in greater detail on Olivetomato.com:
Meat and Poultry
Fish and Seafood
Grains and Breads
Fats and Nuts
Herbs and Spices
A grocery list is a great place to start to help take the next step. Below are some great meal options and recipes shared on mayoclinic.com:
Mediterranean-style grilled salmon
Vegetable and garlic calzone
Roasted red pepper with feta salad
Baked apples with cherries and almonds