If there’s one so-called diet that is widely acclaimed for its health benefits, it’s the Mediterranean diet. In fact, U.S. News & World Report ranked the Mediterranean diet No. 1 on its 2019 41 Best Diets Overall list, citing a “host of health benefits, including weight loss, heart and brain health, cancer prevention, and diabetes prevention and control.” (1)
More of an eating pattern than a calorie-restricted diet, the Mediterranean regimen emphasizes eating lots of vegetables, fruits, nuts, legumes, seeds, and fish, with liberal use of olive oil, a moderate amount of dairy foods, and a low amount of red meat — a way of eating common in Mediterranean countries such as Spain, Italy, and Greece, noted an article published in June 2018 the journal Current Atherosclerosis Reports. (2)
Followers avoid processed foods that are high in sugar, refined carbohydrates, and unhealthy fats (think: chips, cookies, cake, white bread, white rice, and the like). But they do drink a little red wine socially during meals. The Mediterranean pattern focuses on enjoying food and drink with loved ones, along with being physically active, and always keeping moderation in mind. Notably, though, there’s no counting — be it calories, fat grams, or glycemic load — by which to gauge that moderation. (2)
“I look at it as a Mediterranean lifestyle. It’s not so much what they eat, which is beneficial and anti-inflammatory; it’s in how they eat it,” says Robert E. Graham, MD, MPH, an integrative medicine physician at Physio Logic in Brooklyn, New York. “They eat it with gusto, flavor. They eat it with family members.”
Regardless, you can’t really say there’s one uniform Mediterranean lifestyle or eating pattern, because its followers don’t live in the same place. That complicates the effort to assess the potential health benefits of the diet. “Did you live in Italy? Did you live in Greece? Did you live in Spain? So then, when you do research studies, the diet might be a little different in each,” says Jo Ann Carson, PhD, a clinical nutrition professor at UT Southwestern Medical Center in Dallas who is a past Nutrition Committee chair for the American Heart Association.
Dr. Carson adds that eating and drinking in moderation may be harder for those living on this side of the Atlantic to adopt — particularly because the Mediterranean diet does not set calorie intake guidelines. “I get concerned that someone from the United States will try to add ¼ cup of olive oil to their diet, but they’re not going to cut out some of the sweets … and then they’re going to be getting too many calories,” she says.
With those caveats in mind, here is a look at eight of the touted health benefits of the Mediterranean diet — and the science behind them.
1. The Mediterranean Diet May Help Reduce Your Risk for Heart Disease
Numerous studies suggest the Mediterranean diet is good for your ticker, noted a meta-analysis published in November 2015 in the journal Critical Reviews in Food Science and Nutrition. (3)
Perhaps the most convincing evidence comes from a randomized clinical trial published in April 2013 in the New England Journal of Medicine, known as the PREDIMED study. (4) For about five years, authors followed 7,000 women and men in Spain who had type 2 diabetes or a high risk for cardiovascular disease. Those who ate a calorie-unrestricted Mediterranean diet with extra-virgin olive oil or nuts had a 30 percent lower risk of heart events. Researchers didn’t advise participants on exercise.
The study authors reanalyzed the data at a later point to address a widely criticized flaw in the randomization protocol, and reported similar results in June 2018 in the New England Journal of Medicine. (5)
“That is probably the biggest scientific evidence to say that a Mediterranean diet is healthful, in terms of reducing the risk of cardiovascular disease,” Carson says.
2. Eating a Mediterranean Diet May Reduce Women’s Risk for Stroke
We already know from the PREDIMED study that eating in a Mediterranean fashion can help lower the risk of cardiovascular disease in some people. Well, the diet may also help reduce stroke risk in women, though researchers didn’t observe the same results in men, according to a cohort study published in September 2018 in the journal Stroke. (6)
Researchers looked at a predominantly white group of 23,232 men and women ages 40 to 77 who lived in the United Kingdom. The more closely a woman followed a Mediterranean diet, the lower her risk of having a stroke. However, researchers didn’t see statistically significant results in men. Most notably, in women who were at high risk of having a stroke, following the diet reduced their chances of this health event by 20 percent.
Study authors don’t know the reason for the difference, but they hypothesize that different types of strokes in men and women may play a role. A good next step toward understanding the reasons behind the differences would be a clinical trial, Carson says.
3. A Mediterranean Diet May Prevent Cognitive Decline and Alzheimer’s Disease
As a heart-healthy diet, the Mediterranean eating pattern may also help to reduce a decline in your memory and thinking skills with age. “The brain is a very hungry organ. To supply all of those nutrients and oxygen [that it needs], you have to have a rich blood supply. So, people who are having any problems with their vascular health — their blood vessels — are really at increased risk for developing problems with their brain, and then that frequently will present itself as cognitive decline,” says Keith Fargo, PhD, director of scientific programs and outreach for the Alzheimer’s Association.
A July 2016 review published in the journal Frontiers in Nutrition looked at the effect of the Mediterranean diet on cognitive function and concluded “there is encouraging evidence that a higher adherence to a Mediterranean diet is associated with improving cognition, slowing cognitive decline, or reducing the conversion to Alzheimer’s disease.” (7)
What’s more, a small study funded by the National Institute on Aging and published in May 2018 in the journal Neurology looked at brain scans for 70 people who had no signs of dementia at the outset, and scored them for how closely their eating patterns hewed to the Mediterranean pattern. (8) Those who scored low tended to have more beta-amyloid deposits (protein plaques in the brain associated with Alzheimer’s disease) and lower energy use in the brain at the end of the study. At least two years later, these individuals also showed a greater increase of deposits and reduction of energy use — potentially signaling an increased risk for Alzheimer’s — than those who more closely followed the Mediterranean diet.
All that said, more research is needed before recommending this eating approach to lower Alzheimer’s risk. The authors called for additional research in a larger participant group and for a longer study period.
For now, Dr. Fargo identifies the Mediterranean diet as one way of eating that can help stave off cognitive decline. But he does not necessarily recommend it over other well-studied diets, such as the MIND diet (MIND stands for Mediterranean–DASH Diet Intervention for Neurodegenerative Delay), which is a hybrid of the Mediterranean pattern and the blood-pressure lowering DASH diet, noted an article published in September 2015 in the journal Alzheimer’s and Dementia. (9) “What the Alzheimer’s Association recommends is a heart-healthy pattern of eating,” he says.
He also urges caution in drawing conclusions about the current body of research into how diets affect the development of Alzheimer’s disease, saying that the exact mechanisms at play are still unclear.
4. The Mediterranean Diet May Help With Weight Loss and Maintenance
Likely due to its focus on whole, fresh foods, the Mediterranean diet may help you lose weight in a safe and sustainable way, but if you’re looking for fast results, you may be better off with a different diet plan. As mentioned, in its 2019 rankings, U.S. News & World Report rated the Mediterranean diet as No. 1 in its Best Diets Overall category, yet the diet tied with several other plans for the 17th position among the website’s Best Weight Loss Diets. (1)
Over a five-year period, eating a calorie-unrestricted Mediterranean diet high in unsaturated vegetable fat led to slightly more weight loss and added less to participants’ waist circumferences than a low-fat diet, according to an analysis of the Spanish PREDIMED trial data that was published in August 2016 in the journal The Lancet: Diabetes and Endocrinology. (10) Particularly, people who added extra-virgin olive oil to their diets lost the most weight — 0.88 kilograms (kg), or 1.9 pounds (lbs) on average. Those who added nuts lost 0.4 kg on average (0.88 lbs), and those in the control group who ate a low-fat diet lost 0.6 kg (1.3 lbs).
Once you add calorie restriction, the Mediterranean diet may show more dramatic results, though not necessarily beating out another popular diet approach. In a two-year randomized, clinical trial, 322 moderately obese middle-aged participants in Israel, who were mostly men, followed one of three diets: a calorie-restricted low-fat diet, a calorie-restricted Mediterranean diet, and a calorie-unrestricted low-carb diet. (11)
Among the Mediterranean diet followers, women ate a maximum of 1,500 calories per day, while men’s calorie count was restricted to 1,800 calories per day, with the goal of having no more than 35 percent of their calories from fat. The calorie restrictions were the same for those on the low-fat diet. The mean weight loss was 4.4 kg (9.7 lbs) for the Mediterranean-diet group, 2.9 kg (6.4 lbs) for the low-fat group, and 4.7 kg (10.3 lbs) for the low-carbohydrate group.
5. Eating a Mediterranean Diet May Help Stave Off and Manage Type 2 Diabetes
For type 2 diabetes management and possible prevention, a Mediterranean diet may be the way to go.
Using participants from the PREDIMED study, researchers randomized a subgroup of 418 people ages 55 to 80 without diabetes and followed up with them after four years to see if they had developed the disease. The results were published in the journal Diabetes Care. (12) Those participants who followed the Mediterranean diet, whether supplementing with olive oil or nuts, had a 52 percent lower risk for type 2 diabetes during the four year follow-up, and they didn’t necessarily lose weight or exercise more.
Furthermore, a meta-analysis of 20 randomized clinical trials published in January 2013 in the American Journal of Clinical Nutrition found that the Mediterranean diet improved blood sugar control more than low-carbohydrate, low-glycemic index, and high-protein diets, in those managing type 2 diabetes. (13) This finding suggests that a Mediterranean diet may be an effective way to help ward off type 2 diabetes–related health complications.
6. People With Rheumatoid Arthritis May Benefit From the Mediterranean Diet
Rheumatoid arthritis (RA) is an autoimmune disease in which the body’s immune system mistakenly attacks the joints, creating pain and swelling in and around them. (14) Certain properties of the Mediterranean diet, including its richness in anti-inflammatory omega-3 fatty acids, may help relieve RA symptoms.
According to the National Institutes of Health’s Office of Dietary Supplements, research thus far suggests that long-chain omega-3 fatty acids (found in fatty fish) may be helpful in relieving RA symptoms on top of medication, though more research is needed. (15,16)
7. Are Foods in the Mediterranean Diet Protective Against Cancer?
Indeed, a Mediterranean diet meal plan may help prevent certain types of cancer.
A meta-analysis and review of 83 studies published in October 2017 in the journal Nutrients suggested the Mediterranean diet may help reduce the risk of cancers such as breast cancer and colorectal cancer, and help prevent cancer-related death. (17) “These observed beneficial effects are mainly driven by higher intakes of fruits, vegetables, and whole grains,” the authors wrote.
A separate study, published in October 2015 in the journal JAMA Internal Medicine and based on PREDIMED data, found that women who ate a Mediterranean diet supplemented with extra-virgin olive oil had a 62 percent lower risk of breast cancer than those in the control group that ate a low-fat diet. (18)
8. Eating Foods in a Mediterranean Diet May Help Ease Depression
The Mediterranean way of eating is linked to lower incidence of depression, according to an analysis of 41 observational studies published in September 2018 in the journal Molecular Psychiatry. (19) Analysis of pooled data from four longitudinal studies revealed that the diet was associated with a 33 percent reduced risk of depression, compared with following a “pro-inflammatory diet” (richer in processed meats, sugar, and trans fats) that is more typical of a standard American diet.
While the study didn’t reveal why a Mediterranean diet lowered depression risk, the study authors wrote that their results may be a launching point to develop and study diet-based interventions for depression.
The Importance of Moderation When Following a Mediterranean Diet
It’s clear that there’s plenty evidence that a Mediterranean way of eating can be healthful, but Carson cautions that it’s important to watch your portions and avoid unhealthy foods if you want to reap all of the benefits. Keep in mind that the USDA’s recommended daily calorie intake ranges from 1,600 to 3,200 for an adult, depending on age, gender, and level of physical activity. (20)
“Whether you’re thinking of diabetes or cancer or heart disease, we want people to be at a healthy weight and not to be gaining weight unnecessarily. As you’re following the Mediterranean pattern, make sure that you’re doing it in a way that helps you to control calories, which is very doable,” she says.
MEDICALLY REVIEWED BY: KELLY KENNEDY, RD
* This article is a repost which originally appeared on everydayhealth.com.