Diagnosis
The Mediterranean Diet – Can It Help You Live Longer?
By Matthew Constantin, PhD
Eating is one of life’s great pleasures. One can savor this joy totally if the food not only looks, smells and tastes good, but also promotes good health. Having spent most of my life in the Mediterranean area, I have experienced first hand the health benefits of the Mediterranean Diet (MD). The MD has grown in popularity over the last 20 years thanks to its role in lowering the rates of cardiovascular disease, increasing longevity of human life, and reducing the chances of cancer and some age-associated ailments.
The MD is a nutritional model based on the traditional diets of the countries located in the Mediterranean basin, mainly southern Italy, Greece, Portugal, Spain, Turkey and Cyprus. This is the place where the modern civilization was born, and with it the Mediterranean culinary culture.
It was in the late sixties, when The World Health Organization sponsored one of the first studies on the health benefits of the MD [1]. It examined the dietary habits of people living in Greece, Italy, Yugoslavia, Holland, Finland, the USA and Japan. The study found that people who lived in Greece, and specifically in the island if Crete, had exceptionally low death rates from heart disease. Cretans follow the traditional MD.
The Mediterranean Diet Extends Life
Several studies have examined the relationship between longevity and the Mediterranean Diet (MD). A recent study by Faustino Perez-Lopez (University of Zaragoza, Spain), which reviewed all the existing literature on the health benefits of the MD, points out that “individuals who adhere to the principles of the traditional MD tend to have a longer life span” [2].
Studies on the “longevity” effect of the MD have been conducted in several countries. Elderly European people who adhered to the MD presented a 23% reduction in mortality rate [3]. In Spain, a high intake of fresh fruit, root and fruiting vegetables was associated with a reduced mortality rate [4]. In Italy, the “olive oil and salad” pattern, which included high consumption of olive oil, raw vegetables, soups and poultry, was associated with decreased overall mortality [5]. In Australia, people of Mediterranean descent (Mediterranean-born immigrants) had a lower cardiovascular disease and heart-related mortality [6]. In America, among 566,000 people, those who reported eating foods closest to the MD were about 20% less likely to have died of heart disease, cancer or any other cause in a 10-year period, according to the 1995 study of the US National Institute Health [7].
The Mediterranean Diet Both Prevents and Heals METS
Metabolic syndrome (METS) is a combination of medical disorders that increase the risk of developing cardiovascular disease and diabetes. You know you have METS if you have 3 or more of the following 5 risk determinants:
1. Abdominal obesity
2. Increased level of serum triglycerides
3. Decreased level of HDL-C (good cholesterol)
4. High fasting glucose level, and
5. Increased blood pressure.
Some studies have estimated that the prevalence of METS may be as high as 25% of the general population.
A Spanish study found that adherence to the MD lowered significantly the incidence of METS [8]. The ATTICA study in Greece found that an increased consumption of fish, cereals, vegetables, legumes, and fruits was associated with decreased levels of biological and clinical markers linked to the METS, whereas an increased intake of alcohol and meat was associated with an increase in these markers [9].
A study published in the peer-reviewed journal Diabetes Care, shows that some drugs used to treat the METS, like rosiglitazone, produce changes in endothelial cells (the cells that line the interior surface of your blood vessels) that are similar to those observed in individuals under the MD [10]. This by itself demonstrates not only the METS-protective nature of the MD but also its healing effect.
The Mediterranean Diet Lowers Hypertension
Proper nutrition can help hypertensive people reduce their blood pressure remarkably. Eating fruits and vegetables and reducing the amount of fat and cholesterol has been shown to reduce blood pressure. It also helps with weight loss, which by itself can lower blood pressure.
Studies have found an inverse association between the degree of adherence to the MD and the systolic and diastolic blood pressure. The higher the adherence to the MD the lower the blood pressure [11]. Intake of olive oil, fruit and leafy vegetables significantly lowered blood pressure, while the consumption of processed meat, potatoes and alcohol was positively related to blood pressure.
The Mediterranean Diet Decreases Cardiovascular Disease Risk
Cardiovascular disease (CVD) is determined by environmental and genetic factors. However, an appropriate diet and healthy lifestyle can greatly control the risk of CVD.
The EPIC (European Prospective Investigation into Cancer and Nutrition) study examined the effect of adherence to the MD on survival among elderly people with previous myocardial infarction. A dietitian interviewed each participant to obtain a 14-point score measuring the degree of adherence to MD. It was shown that increased adherence by 2 units on the study scale was associated with 18% lower mortality rate [12].
The Mediterranean Diet Fights Obesity
It is disturbing how the occurrence of obesity is rapidly increasing in industrialized, reaching 30–50% among the general population. However, an answer to fight obesity lies in the adherence to the MD, which was found to be inversely associated with BMI (Body Mass Index, a measure of obesity) in a cross-sectional survey that was conducted in the northeast of Spain. The risk of being obese decreased in both men and women when the people increasingly adhered to the traditional MD [13].
As we age, the chance of gaining weight increases. Can the MD help us avoid that? A study, which included 17,238 women and 10,589 men aged 29-65, found that those who followed the MD had a lower likelihood of gaining weight in a 3-year period than those who did not [14].
The Mediterranean Diet Reduces The Risk Of Cancer
The MD is rich in tomatoes, vegetables, fish, fruits, and olive oil, all of which provide important nutrients that may contribute to lowering the risk of cancer. Lycopene, a major antioxidant in tomatoes, has been shown to have anti-carcinogenic activity. Fish consumption correlates with reduced risk of cancer [15]. High intake of fruit and vegetables appears to reduce the risk of cancer, while the consumption of wholegrain foods lowers the risk of malignant tumors at all sites except thyroid [16]. Consumption of olive oil appears to reduce the incidence of colorectal cancers, and cancers of breast and respiratory tract.
Conclusion
People who adhere to the principles of the traditional Mediterranean Diet (MD) tend to have a longer life span. Whether this is the effect of the anti-inflammatory and cholesterol-regulating effects of olive oil, the anti-oxidant properties of fruits and vegetables, the brain- and heart-protective omega-3 fatty acids in fish, the powerful polyphenols in red wine, or the siesta (afternoon nap), the sunlight exposure, the lower stress, the strong family links and outdoor activities, we don’t know. It is probably the combination of all these features of the MD.
What we do know, though, is that people who follow the MD have 20% lower chance of dying over a 10-year period than those who don’t follow such a diet. And this is independent of their age, body weight and gender [3].
References
1. Keys A, Aravanis C, Black burn HW, et al. Epidemiological studies related to coronary heart disease: characteristics of menaged 40–59 in seven countries. Acta Med Sc and Suppl 1966; 460:1–392.
2. Faustino R. Pérez-Lópeza, Peter Chedraui, Javier Haya, José L. Cuadros. Effects of the Mediterranean diet on longevity and age-related morbid conditions. Maturitas 2009;64; 67–79.
3. Knoops KT, de Groot LC, Kromhout D, et al. Mediterranean diet, lifestyle factors, and10-year mortality in elderly European men and women: the HALE project. JAMA 2004; 292: 1433–9.
4. Agudo A, Cabrera L, Amiano P, et al. Fruit and vegetable intakes, dietary antioxidant nutrients, and total mortality in Spanish adults: findings from the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain). Am J Clin Nutr 2007; 85: 1634–42.
5. Masala G, Ceroti M, Pala V, et al. A dietary pattern rich in olive oil and raw vegetables is associated with lower mortality in Italian elderly subjects. Br J Nutr 2007; 98: 406–15.
6. Harriss LR, English DR, Powles J, et al. Dietary patterns and cardiovascular mortality in the Melbourne Collaborative Cohort Study. Am J Clin Nutr 2007; 86: 221–9.
7. Mitrou PN, Kipnis V, Thiébaut AC, et al. Mediterranean dietary pattern and prediction of all-cause mortality in a US population: results from the NIH- AARP Diet and Health Study. Arch Intern Med 2007; 167: 2461–8.
8. Tortosa A, Bes-Rastrollo M, Sanchez-Villegas A, Basterra-Gortari FJ, Nunez-Cordoba JM, Martinez-Gonzalez MA. Mediterranean diet inversely associated with the incidence of metabolic syndrome: the SUN prospective cohort. Diabetes Care 2007; 30: 2957–9.
9. Panagiotakos DB, Pitsavos C, Skoumas Y, Stefanadis C. The association between food patterns and the metabolic syndrome using principal components analysis: the ATTICA study. J Am Diet Assoc 2007;107:979–87.
10. Esposito K, Ciotola M, Carleo D, et al. Effect of rosiglitazone on endothelial function and inflammatory markers in patients with the metabolic syndrome. Diabetes Care 2006; 29: 1071–6.
11. Psaltopoulou T, Naska A, Orfanos P, Trichopoulos D, Mountokalakis T, Trichopoulou A. Olive oil, the Mediterranean diet, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study. Am J Clin Nutr 2004;80: 1012–8.
12. Sánchez-Taínta A, Estruch R, Bulló M, et al. Adherence to a Mediterranean type diet and reduced prevalence of clustered cardiovascular risk factors in a cohort of 3,204 high-risk patients. Eur J Cardiovasc Prev Rehabil 2008;15:589–93.
13. Schröder H, Marrugat J, Vila J, Covas MI, Elosua R. Adherence to the traditional Mediterranean diet is inversely associated with body mass index and obesity in a Spanish population. J Nutr 2004;134: 3355–61.
14. Mendez MA, Popkin BM, Jakszyn P, et al. Adherence to a Mediterranean diet is associated with reduced 3-year incidence of obesity. J Nutr 2006; 136: 2934–8.
15. Tang FY, Cho HJ, Pai MH, Chen YH. Concomitant supplementation of lycopene and eicosapentaenoic acid inhibits the proliferation of human colon cancer cells. J Nutr Biochem 2009;20: 426–34.
16. Chatenoud L, Tavani A, La Vecchia C, et al. Whole grain food intake and cancer risk. Int J Cancer 1998;77: 24–8.
By Matthew Constantin, PhD
Eating is one of life’s great pleasures. One can savor this joy totally if the food not only looks, smells and tastes good, but also promotes good health. Having spent most of my life in the Mediterranean area, I have experienced first hand the health benefits of the Mediterranean Diet (MD). The MD has grown in popularity over the last 20 years thanks to its role in lowering the rates of cardiovascular disease, increasing longevity of human life, and reducing the chances of cancer and some age-associated ailments.
The MD is a nutritional model based on the traditional diets of the countries located in the Mediterranean basin, mainly southern Italy, Greece, Portugal, Spain, Turkey and Cyprus. This is the place where the modern civilization was born, and with it the Mediterranean culinary culture.
It was in the late sixties, when The World Health Organization sponsored one of the first studies on the health benefits of the MD [1]. It examined the dietary habits of people living in Greece, Italy, Yugoslavia, Holland, Finland, the USA and Japan. The study found that people who lived in Greece, and specifically in the island if Crete, had exceptionally low death rates from heart disease. Cretans follow the traditional MD.
The Mediterranean Diet Extends Life
Several studies have examined the relationship between longevity and the Mediterranean Diet (MD). A recent study by Faustino Perez-Lopez (University of Zaragoza, Spain), which reviewed all the existing literature on the health benefits of the MD, points out that “individuals who adhere to the principles of the traditional MD tend to have a longer life span” [2].
Studies on the “longevity” effect of the MD have been conducted in several countries. Elderly European people who adhered to the MD presented a 23% reduction in mortality rate [3]. In Spain, a high intake of fresh fruit, root and fruiting vegetables was associated with a reduced mortality rate [4]. In Italy, the “olive oil and salad” pattern, which included high consumption of olive oil, raw vegetables, soups and poultry, was associated with decreased overall mortality [5]. In Australia, people of Mediterranean descent (Mediterranean-born immigrants) had a lower cardiovascular disease and heart-related mortality [6]. In America, among 566,000 people, those who reported eating foods closest to the MD were about 20% less likely to have died of heart disease, cancer or any other cause in a 10-year period, according to the 1995 study of the US National Institute Health [7].
The Mediterranean Diet Both Prevents and Heals METS
Metabolic syndrome (METS) is a combination of medical disorders that increase the risk of developing cardiovascular disease and diabetes. You know you have METS if you have 3 or more of the following 5 risk determinants:
1. Abdominal obesity
2. Increased level of serum triglycerides
3. Decreased level of HDL-C (good cholesterol)
4. High fasting glucose level, and
5. Increased blood pressure.
Some studies have estimated that the prevalence of METS may be as high as 25% of the general population.
A Spanish study found that adherence to the MD lowered significantly the incidence of METS [8]. The ATTICA study in Greece found that an increased consumption of fish, cereals, vegetables, legumes, and fruits was associated with decreased levels of biological and clinical markers linked to the METS, whereas an increased intake of alcohol and meat was associated with an increase in these markers [9].
A study published in the peer-reviewed journal Diabetes Care, shows that some drugs used to treat the METS, like rosiglitazone, produce changes in endothelial cells (the cells that line the interior surface of your blood vessels) that are similar to those observed in individuals under the MD [10]. This by itself demonstrates not only the METS-protective nature of the MD but also its healing effect.
The Mediterranean Diet Lowers Hypertension
Proper nutrition can help hypertensive people reduce their blood pressure remarkably. Eating fruits and vegetables and reducing the amount of fat and cholesterol has been shown to reduce blood pressure. It also helps with weight loss, which by itself can lower blood pressure.
Studies have found an inverse association between the degree of adherence to the MD and the systolic and diastolic blood pressure. The higher the adherence to the MD the lower the blood pressure [11]. Intake of olive oil, fruit and leafy vegetables significantly lowered blood pressure, while the consumption of processed meat, potatoes and alcohol was positively related to blood pressure.
The Mediterranean Diet Decreases Cardiovascular Disease Risk
Cardiovascular disease (CVD) is determined by environmental and genetic factors. However, an appropriate diet and healthy lifestyle can greatly control the risk of CVD.
The EPIC (European Prospective Investigation into Cancer and Nutrition) study examined the effect of adherence to the MD on survival among elderly people with previous myocardial infarction. A dietitian interviewed each participant to obtain a 14-point score measuring the degree of adherence to MD. It was shown that increased adherence by 2 units on the study scale was associated with 18% lower mortality rate [12].
The Mediterranean Diet Fights Obesity
It is disturbing how the occurrence of obesity is rapidly increasing in industrialized, reaching 30–50% among the general population. However, an answer to fight obesity lies in the adherence to the MD, which was found to be inversely associated with BMI (Body Mass Index, a measure of obesity) in a cross-sectional survey that was conducted in the northeast of Spain. The risk of being obese decreased in both men and women when the people increasingly adhered to the traditional MD [13].
As we age, the chance of gaining weight increases. Can the MD help us avoid that? A study, which included 17,238 women and 10,589 men aged 29-65, found that those who followed the MD had a lower likelihood of gaining weight in a 3-year period than those who did not [14].
The Mediterranean Diet Reduces The Risk Of Cancer
The MD is rich in tomatoes, vegetables, fish, fruits, and olive oil, all of which provide important nutrients that may contribute to lowering the risk of cancer. Lycopene, a major antioxidant in tomatoes, has been shown to have anti-carcinogenic activity. Fish consumption correlates with reduced risk of cancer [15]. High intake of fruit and vegetables appears to reduce the risk of cancer, while the consumption of wholegrain foods lowers the risk of malignant tumors at all sites except thyroid [16]. Consumption of olive oil appears to reduce the incidence of colorectal cancers, and cancers of breast and respiratory tract.
Conclusion
People who adhere to the principles of the traditional Mediterranean Diet (MD) tend to have a longer life span. Whether this is the effect of the anti-inflammatory and cholesterol-regulating effects of olive oil, the anti-oxidant properties of fruits and vegetables, the brain- and heart-protective omega-3 fatty acids in fish, the powerful polyphenols in red wine, or the siesta (afternoon nap), the sunlight exposure, the lower stress, the strong family links and outdoor activities, we don’t know. It is probably the combination of all these features of the MD.
What we do know, though, is that people who follow the MD have 20% lower chance of dying over a 10-year period than those who don’t follow such a diet. And this is independent of their age, body weight and gender [3].
References
1. Keys A, Aravanis C, Black burn HW, et al. Epidemiological studies related to coronary heart disease: characteristics of menaged 40–59 in seven countries. Acta Med Sc and Suppl 1966; 460:1–392.
2. Faustino R. Pérez-Lópeza, Peter Chedraui, Javier Haya, José L. Cuadros. Effects of the Mediterranean diet on longevity and age-related morbid conditions. Maturitas 2009;64; 67–79.
3. Knoops KT, de Groot LC, Kromhout D, et al. Mediterranean diet, lifestyle factors, and10-year mortality in elderly European men and women: the HALE project. JAMA 2004; 292: 1433–9.
4. Agudo A, Cabrera L, Amiano P, et al. Fruit and vegetable intakes, dietary antioxidant nutrients, and total mortality in Spanish adults: findings from the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain). Am J Clin Nutr 2007; 85: 1634–42.
5. Masala G, Ceroti M, Pala V, et al. A dietary pattern rich in olive oil and raw vegetables is associated with lower mortality in Italian elderly subjects. Br J Nutr 2007; 98: 406–15.
6. Harriss LR, English DR, Powles J, et al. Dietary patterns and cardiovascular mortality in the Melbourne Collaborative Cohort Study. Am J Clin Nutr 2007; 86: 221–9.
7. Mitrou PN, Kipnis V, Thiébaut AC, et al. Mediterranean dietary pattern and prediction of all-cause mortality in a US population: results from the NIH- AARP Diet and Health Study. Arch Intern Med 2007; 167: 2461–8.
8. Tortosa A, Bes-Rastrollo M, Sanchez-Villegas A, Basterra-Gortari FJ, Nunez-Cordoba JM, Martinez-Gonzalez MA. Mediterranean diet inversely associated with the incidence of metabolic syndrome: the SUN prospective cohort. Diabetes Care 2007; 30: 2957–9.
9. Panagiotakos DB, Pitsavos C, Skoumas Y, Stefanadis C. The association between food patterns and the metabolic syndrome using principal components analysis: the ATTICA study. J Am Diet Assoc 2007;107:979–87.
10. Esposito K, Ciotola M, Carleo D, et al. Effect of rosiglitazone on endothelial function and inflammatory markers in patients with the metabolic syndrome. Diabetes Care 2006; 29: 1071–6.
11. Psaltopoulou T, Naska A, Orfanos P, Trichopoulos D, Mountokalakis T, Trichopoulou A. Olive oil, the Mediterranean diet, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study. Am J Clin Nutr 2004;80: 1012–8.
12. Sánchez-Taínta A, Estruch R, Bulló M, et al. Adherence to a Mediterranean type diet and reduced prevalence of clustered cardiovascular risk factors in a cohort of 3,204 high-risk patients. Eur J Cardiovasc Prev Rehabil 2008;15:589–93.
13. Schröder H, Marrugat J, Vila J, Covas MI, Elosua R. Adherence to the traditional Mediterranean diet is inversely associated with body mass index and obesity in a Spanish population. J Nutr 2004;134: 3355–61.
14. Mendez MA, Popkin BM, Jakszyn P, et al. Adherence to a Mediterranean diet is associated with reduced 3-year incidence of obesity. J Nutr 2006; 136: 2934–8.
15. Tang FY, Cho HJ, Pai MH, Chen YH. Concomitant supplementation of lycopene and eicosapentaenoic acid inhibits the proliferation of human colon cancer cells. J Nutr Biochem 2009;20: 426–34.
16. Chatenoud L, Tavani A, La Vecchia C, et al. Whole grain food intake and cancer risk. Int J Cancer 1998;77: 24–8.
Matthew Constantin, PhD, is a biologist and research assistant at Washington University School of Medicine in St Louis, MO. His Greek descent allowed him to experience the Mediterranean diet from its original source. Matthew owns Weight Loss Triumph, where he publishes information from credible sources on best weight loss programs and gives away coupons for Medifast, a medically designed diet.