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Eat like a Mediterranean — but how?

Here's what the research says — and doesn't say — about the Mediterranean diet.

November 21, 2011|By Karen Ravn, Special to the Los Angeles Times
  • The Mediterranean diet gets most of its fat from olive oil, and most of the fat in olive oil is monounsaturated. A high ratio of monounsaturated to saturated fat is considered an intrinsic element of the traditional Mediterranean diet -- and evidence shows that it's good for people's health.
The Mediterranean diet gets most of its fat from olive oil, and most of the… (Al Seib / Los Angeles Times )

Americans tend to like their fats saturated, their grains processed, their protein grown on legs and their sugar added anywhere their sweet tooth decides it would like some. As for fiber, they're all for it — in, say, their French fries or the pickles on their burger.

In a related development, nutrition experts tend to be bummed out by the typical American diet. In fact, many wish we'd trade it in for a diet that's pretty much the opposite, namely, the Mediterranean diet, which favors monounsaturated fat, whole (unprocessed) grains, protein with roots in the ground, sugar in its natural habitat only and fiber, well, fiber just about everywhere.

One of its champions, Dr. Dimitrios Trichopoulos of Harvard University, calls the Mediterranean way of eating "possibly the best ever."

Trichopoulos can point to hundreds of scientific studies — as well as a long-running natural experiment among Mediterranean people themselves — linking the diet to a decrease in mortality rates (meaning deaths per thousand per year) and, more specifically, to reduced rates of heart disease, Alzheimer's disease, cancer, diabetes and other serious health problems.

Probably no diet in the world has been studied more thoroughly or associated with more positive outcomes. But questions remain. Scientists still can't say for sure how the diet does everything it seems to do — or if some parts of it do more than others. (For example, is the red meat you don't eat more important than the olive oil you do?) And if you're looking for precise rules on exactly how much to eat of exactly what foods, you won't find them here — because they don't exist.

Not to worry, though. What follows are the basic principles underlying the Mediterranean diet, and evidence suggests that following these basic principles can do you a world of good.

Why scientists got interested in the Mediterranean diet in the first place

Around the middle of the 20th century, scientists noticed that people living in Mediterranean areas had longer, healthier lives than people in many other parts of the world — even though smoking rates were high and healthcare wasn't that great in some of those countries. Some of the first hard evidence supporting this observation came from the so-called Seven Countries Study, published in 1970: It found that Greece — as exemplified by the island of Crete — had lower rates of cardiovascular disease and cancer than the other six countries in the study: the United States, Finland, the Netherlands, Italy, the former Yugoslavia and Japan.

For example, before World War II, mortality rates from heart disease and cancer were almost three times as high in the United States as in Crete. (In southern Italy, where the diet was similar to Crete's, rates were lower too.)

Though it seemed these differences might well be due, at least in part, to differences in diet, there was no firm proof: Genetics, socioeconomics and other non-diet lifestyle factors could all come into play. But now, after decades of research, scientists are more convinced that a Mediterranean diet confers multiple health benefits.

In a 2010 article in the American Journal of Clinical Nutrition, for example, researchers analyzed the results from 19 studies with more than 2 million total participants. They found that adherence to the Mediterranean diet was associated with lower overall mortality rates, as well as reduced rates of (and death from) many serious health problems, including heart disease, stroke, Alzheimer's disease and cancer.

Another analysis, published in 2011 in the Journal of the American College of Cardiology, pooled the results of 50 studies (including 35 clinical trials) with more than a half-million total participants. It found that consumers of the Mediterranean diet were less likely than others to develop high blood pressure, high insulin levels, too much fat around the waist and unhealthful cholesterol levels, or all of these clustered together (a condition known as metabolic syndrome).

The Mediterranean diet has been around, if not forever, at least for a very long time. "It developed naturally and spontaneously in the olive-growing areas of the Mediterranean basin," Trichopoulos says. People liked it and thrived on it, but then, under the influence of globalization, they gradually abandoned it.

That was a step in a very wrong direction, in the opinion of health and nutrition experts. So when they talk about the virtues of the Mediterranean diet, they're not referring to how Mediterraneans eat now but how they used to eat, up until about 50 years ago.

So what is the Mediterranean diet?

"The term 'the Mediterranean diet' is a misnomer," says Dr. Artemis Simopoulos, president of the Center for Genetics, Nutrition and Health, a nonprofit educational organization in Washington, D.C. "There are many Mediterranean diets."

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