Wednesday, July 08, 2009

In Search Of The Mediterranean Diet

I'll be honest. I don't know what the "Mediterranean Diet" (MD) is. I know there's some olive oil in there, fresh fruit, wine (red?), vegetables, and a few bean dishes. But I couldn't come up with a weekly menu easily. What does it exclude? Do people who live in the Mediterranean region eat shredded wheat cereal? Soymilk? eggsbaconchipsandbeans? Blueberry muffins? Spaghetti and meatballs? Pumpkin pie? How much?

I imagine there's a lot of variability, with so many countries and cultures bordering the Mediterranean Sea, from Spain and Morocco, through France, Italy, Turkey, Israel, Egypt, and the rest of Northern Africa. Oh, and the Greek island Crete (I know Mediterranean Kiwi will say something if I don't). The benefits of the MD, if real (maybe it's the geographical location) probably depend on a combination of dietary factors, rather than any particular nutritional component.

This recent study in the British Medical Journal supports the existence of a dietary pattern, or at least it didn't refute it, "The results of our study do not refute the possibility of synergistic effects among foods and nutrients in the Mediterranean diet."

It investigated the relative importance of individual components of the MD:
Anatomy Of Health Effects Of Mediterranean Diet: Greek EPIC Prospective Cohort Study, BMJ, June 2009

  • Participants were 23,349 men and women in the Greek segment of the 10-country-wide European Prospective Investigation into Cancer and nutrition (EPIC)
  • Mean follow-up: 8.5 years
  • Individuals were scored on "the nine widely accepted components of the Mediterranean diet:"
    • High intake of vegetables
    • High intake of fruits and nuts
    • High intake of legumes
    • High intake of fish and seafood
    • High intake of cereals
    • Low intake of meat and meat products
    • Low intake of dairy products
    • High ratio of monounsaturated to saturated lipids
    • Moderate intake of ethanol
(So, here is an outline of an MD - description and quantification was detailed in this and cited studies.)

"Controlling for potential confounders, higher adherence to a Mediterranean diet was associated with a statistically significant reduction in total mortality."
The contributions of the individual components of the MD to this association (reduced mortality) were:
  • 23.5% from moderate ethanol consumption
  • 16.6% from a low consumption of meat and meat products
  • 16.2% from a high vegetable consumption
  • 11.2% from a high fruit and nut consumption
  • 10.6% from a high monounsaturated to saturated fat ratio (indicates high olive oil consumption)
  • 9.7% from a high legume consumption

  • High cereal consumption had minimal beneficial effect. (6.1%)
  • Low dairy consumption had minimal beneficial effect. (4.5%)
  • High seafood consumption had a non-significant increase in mortality. (The authors state that their Greek population had too low a seafood intake for this finding to be meaningful, and that, although the positive association was unexpected, it was "probably owing to chance.")

In as much as foods consumed in Greece may reflect the Mediterranean diet, this investigation adds to accumulating evidence that a certain dietary pattern (i.e. high in fruits and vegetables while low in meat) rather than a certain dietary component, is responsible for longevity.

The study went further though by assigning relative importance to components of that successful dietary pattern - with the top three contributors being, in order of benefit:
  1. Moderate alcohol intake
  2. Low consumption of meat
  3. High consumption of vegetables
How you would describe the Mediterranean Diet? What foods would you say it includes? Excludes?
Photo of a traditional Greek salad I found on Havabite Eatery. Mediterranean Kiwi, can you vouch for its authenticity? (What are those shiny green roll-ups?)


Unknown said...

pita like bread or flat bread ( no butter or eggs in them ) roasted on fire
dry fruits, dates ( even raw ) and figs
lots of tahini, tabbouleh, things made out of wheat bulgur
sea food from the sea nearby ?
olive oil - the bestest quality - raw - i think
grilled meat ( the quality of meat itself - all of it is kosher/halal . i am not sure both are the same, but they do have a specific way of butchering the animals) and grilled vegetables
great bean salads

Anonymous said...

dolmathes/stuffed vine leaves

Bix said...

My god, Anrosh. Come cook for me.

So, you would say the MD has a lot of grilled food?

Bix said...

Thanks, michael. Stuffed ... with rice? (I'll say this, the MD does seem to involve more cooking than a typical American diet.)

Maria Verivaki said...

the mediterranean diet is based on a diet of beans, fruit, greens and fish, with hardly any sweets and just once-a-week meat servings.

it was defintely the main dietary pattern in the past, but there is no way any young/modern/active/educated person practices this kind of diet any more - mamas have stopped cooking like this, and it is often referred to as grandmama's cuisine, a sign that it is not as commonly eaten as it used to be

sadly, we are experiencing the negative effects of the introduction of globalised diet trends in the mediterranean and there is very little we can do to stop these trends from taking over where the mediterranean diet left off

i like to believe we are still practicing it at home, but we are defintely eating more ice cream now in the summer than it would ever have allowed...

Bix said...

I enjoy your perspective, Mediterranean kiwi.

So, once-a-week meat. Wow. I can't imagine that going over here. Even if people aren't grabbing a fast-food burger, they're cooking meat at home. We just had a holiday here, our Independence Day. There were brochures and inserts in the newspapers, in the mail, commercials on TV ... all promoting the purchase and consumption of meat ... hot dogs, hamburgers, steaks, grilled chicken, fried chicken, pork chops, pork tenderloin, page after page of meat. Well, I guess grocery stores won't make much money selling buy-one-get-one-free heads of cauliflower.

Perovskia said...

Meditteranean Kiwi... would you say that area has started to adapt a Western-style diet? There's a book I'm reading, which I'll review on my blog (sorry Bix, had to plug :)) and it says the Western diet is world-wide now. Countries that never had 'our' problems (health), are greatly increasing.

Bix... You're right. I can't believe how much meat is thrown at us during the holidays. It's crazy. Oh, and I noticed as you laid out in bullet-form the components of the MD, by those standards, it seems what the North American diet's new 'pyramid' is trying to convey. But we're *still* doing something wrong. We're not getting any healthier!

I've said it before and I'll say it again; I've tried the MD and loved it. I *never* felt better. Increased olive oil consumption, more veggies, less meat and NO sweets (or very, very rare). Dairy? Well, I still had it with my cereal in the morning, but that's usually it.

Maria Verivaki said...

here's a rough menu plan that i follow in the winter:

in the summer, we eat a lot of vegetables which we grow ourselves.

i do try to keep a lot of the so-called bad food into my family;'s intake, and i cant say its not working, but the truth is that once my kids are able to service themselves, their mother's med diet will be history

Perovskia said...

Sorry, got thinking..

Meditteranean Kiwiw.. has your (or your areas) consumption of refined grains (white flour, white sugar, etc) increased? I know it's killing us, but I wonder if it's having the same effect there.

Bix said...

White flour. That's a great question.

Perovskia said...

Yeah, it's brought up a lot in the book (In Defense of Food, Michael Pollan).

Maria Verivaki said...

greece is definitely eating a westernised diet now - greeks are more global than they think.

a recent study came out the other day claiming that cretan children eat more hanburger-style fast food than they eat dakos (

the average greek nay scorn soymilk and never have eaten blueberry muffins, but they overdose on souvlaki ( and drink whisky and nescafe instead of raki ( and greek coffee ( we are very wesernised without realising it

Steve Parker, M.D. said...

Here are the characteristcs of the traditional, healthy Mediterranean diet:

It maximizes natural whole foods and minimizes highly processed ones.
Small amounts of red meat.
Less than four eggs per week.
Low to moderate amounts of poultry and fish.
Daily fresh fruit.
Seasonal locally grown foods with minimal processing.
Concentrated sugars only a few times per week.
Wine in low to moderate amounts, and usually taken at mealtimes.
Milk products (mainly cheese and yogurt) in low to moderate amounts.
Olive oil as the predominant fat.
Abundance of foods from plants: vegetables, fruits, beans, potatoes, nuts, seeds, breads and other whole grain products.
Naturally low in saturated fat, trans fats, and cholesterol.
Naturally high in fiber, phytonutrients, vitamins (e.g., folate), antioxidants, and minerals (especially when compared with concentrated, refined starches and sugars in a modern Western diet).
Naturally high in monounsaturated and polyunsaturated fats, particularly as a replacement for saturated fats.

Is that specific enough?


George Peterson said...

greens, beans, and seafood.

Alison Clancy said...

Hi! My name is Alison and I work for Oldways, a non-profit in Boston and the creators of the Mediterranean Diet Pyramid. If you have any questions at all about the Mediterranean Diet, please visit our website at or our food blog at Hope this helps!

- Alison Clancy

Unknown said...

everybody thinks that grass is greener on the other side.

bix, i am an easy cook. i grew up eating the above things ( minus tabbouleh and tahini - and of course sesame is plenty in india.

so i am no where mediterranean, if that is what you are thinking :)

i am the queen of one pot cooking -from scratch of course almost all the time ( until and unless i am hungry and the blood sugar is getting low -- i hit the bakery 2 blocks down where i get hot-hot breads. white or brown ( no exaggeration) from a bakery that is run by lebanese, palestian. i love cakes - but i have made a rule - " you make and you eat" - when that becomes the principle one eats less.

the problem i see in american grocery stores is "EVERYTHING" is READY made. No sweat. If one decide that he wants to eat a biscotti or a tabouleh, it is available in the store.

Nothing is more convenient than American grocery stores. I have a scottish friend who has an american wife. The problem is this country has almost no culture of cooking ( may be i am wrong ) and They cook for only 2 days of the week and it is NOT seasonal (this was new for me when i first came).
the other days it is take out and "ready made" from stores. so when kids grow up - they just do what they see. that has happened with some of my relatives who grew up here, even where moms cooked. and the food is really cheap. no economics at all.

of course i am one of the type who do not make an elaborate meal everyday and cooks the least, and includes a lot of variety ( that is my bad point )

actually there is a store on 41st and 9th in manhattan - run by a guy from greece. he has been here practically all his life and also has a greek restaurant on 10th avenue. while talking to him he told me that most of the food is cooked in Clay vessels. I have to agree with him, because my mom used to make fish in clay vessels and my grandparents cooked all their meals in clay vessels. the taste of the food is very different - very tasty. the first time i cooked fish in a vessel - one of those t-fal types, i could feel the difference. i was wondering what was i eating -

another friend who has married a turkish woman, told me that the food in turkey was "real food" :)
turks also eat a lot of yogurt as you know there you go... i rambled .. i love food , but i have to conquer myself before the food conquers me - that is my fight! growing up things were rationed and so i had no problems! it was kept on the plate and no second servings - it was pure economics!

i do not mean any offence to any american reading this. so please do not take offence - every country has its own culture - some good, some bad, some excellent. so please do not throw fire on me.

i love your blog, because this is one place i can talk what good food is all about, without being a chef and without designer receipes and breaking the wallet !

on another note, did u read that somewhere in australia, that they have banned bottled water --- we an become organic, sustainable, green , earth friendly if we want - nothing is impossible

Unknown said...

6th line - 2 days of the year. Please note i am NOT a puritan.

Bix said...

Steve Parker ... That is one fine list!

Bix said...

"You make and you eat."
Yep. New banner.

Bix said...

Anrosh, the experience you bring from living in India (or Med. kiwi in Greece, or ...) is invaluable. A lesson for me. I love hearing your stories.

The point you make here (and you made before) about cooking keeps coming up. Cooking. Pollan & others said it too. We have to cook more. We have to teach our youth to cook. We have to make time to cook. We have to reestablish the value of cooking in society. Cooking - not knowing how to assemble 17 esoteric ingredients into a bit of sculpture-for-the-plate - but how to boil beans.

Perovskia said...

Highly agreed.

virginia said...

and, a how to:

yum, but my favorite is stuffed cabbage leaves (not greek).

Maria Verivaki said...

i think anrosh summed it up really well - people have to cook more

at the moment, we are eating a lot of zucchini - we grow a lot, so we eat a lot. i also freeze the dishes we eat on a daily basis, for use in the winter. these are our ready-made foods: we made them, not bought them ready

my pet hate in recipe blogs is when i see non-seasonal, non-local ingredients being used. it's just too easy these days to cook anything anytime anywhere.

Bix said...

BTW, here's what constitutes "moderate ethanol consumption" in this particular group:

"there were no men who drank more than seven glasses of wine a day and no women who drank more than two glasses of wine a day so that no study subject could be considered a heavy drinker."

7 glasses of wine is moderate?

Angela and Melinda said...

Perhaps the wine is watered, but even so, 7 glasses for men seems a lot. There are some wonderful links you folks have provided here in the comments--thanks!