Improving on the Mediterranean Diet

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What are the four problematic nutritional aspects of even plant-based Mediterranean diets?

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The traditional Mediterranean diet can be considered as a mainly, but not exclusively, plant-based diet, and certainly not a whole food plant-based diet, as olive oil and wine can be considered essentially fruit juices. Even if one is eating a vegiterranean diet, an entirely plant-based version, there are a number of potentially problematic nutritional aspects that are rarely talked about. For example, lots of white bread, white pasta, not a lot of whole grains. Alcohol can be a problem, the caloric density with all that oil can be high, as well as the salt intake. Let’s go over these one by one.

In this anatomy of the health effects of the Mediterranean diet, the single most important component was the high consumption of plant foods. In contrast, high cereal consumption, meaning high grain consumption, did not appear to help.

This may be because most grains modern Mediterranean dieters eat are refined, like white bread, whereas the traditional Mediterranean diet was characterized by unprocessed cereals—in other words, whole grains. And while whole grains have been associated with a lower risk of diabetes, heart disease, and cancer, refined grains may increase the risk of diabetes, obesity, heart disease, and other chronic diseases. For example, in the PREDIMED study, those who ate the most white bread–but not whole grain bread–gained significant weight.

Alcohol may also be a problem. As a plant-centered diet, no surprise, adherence to a Mediterranean diet is associated with lower cancer risk, but not with lower breast cancer risk. With all the fruits, veggies, nuts, seeds, and beans and low saturated fat, you’d assume there would be a lower breast cancer risk, but alcohol is a known breast cancer risk factor–even in moderate amounts. But if you create a special adapted version of the Mediterranean diet score that excludes alcohol, the diet does indeed appear to reduce breast cancer risk.

The wonderful grape phytonutrients in red wine can improve our arterial function such that if you drink de-alcoholized red wine, red wine with the alcohol removed, you get a significant boost in endothelial function–the ability of our arteries to relax and dilate normally, increasing blood flow. But if you drink the same red wine with the alcohol added back in, it abolishes the beneficial effect; it counteracts the benefit of the grape phytonutrients. So better just to eat grapes.

Similarly, there are components of extra virgin olive oil—the antioxidant phytonutrients–that may help endothelial function, but when consumed as oil, even extra virgin olive oil, it may impair arterial function. So even if white bread dipped in olive oil is the very symbol of the Mediterranean diet, we can modernize it by removing oils and refined grains.

Another important, albeit frequently ignored, issue in the modern Mediterranean diet is sodium intake. Despite evidence linking salt intake to high blood pressure, heart disease, and strokes, dietary salt intake in the U.S. is on the rise. Right now we get about seven to ten grams a day, mostly from processed foods. If we were to decrease that just by three grams, which is about 1,000 mg of sodium, half a teaspoon of table salt, every year we could save tens of thousands of people from having a heart attack, prevent tens of thousands of strokes, and tens of thousands of deaths. There is a common misconception that only certain people should reduce their salt intake, and that for the vast majority of the population, salt reduction is unnecessary. But in reality, the opposite is true.

But there is much we can learn from the traditional Mediterranean diet. A defining characteristic of the Mediterranean diet is an abundance of plant foods, and one thing that seems to have fallen by the wayside. No real main Mediterranean meal is replete without lots of greens, a key part of not only a good Mediterranean diet, but of any good diet.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Image thanks to Pedro Vezini via Flickr.

The traditional Mediterranean diet can be considered as a mainly, but not exclusively, plant-based diet, and certainly not a whole food plant-based diet, as olive oil and wine can be considered essentially fruit juices. Even if one is eating a vegiterranean diet, an entirely plant-based version, there are a number of potentially problematic nutritional aspects that are rarely talked about. For example, lots of white bread, white pasta, not a lot of whole grains. Alcohol can be a problem, the caloric density with all that oil can be high, as well as the salt intake. Let’s go over these one by one.

In this anatomy of the health effects of the Mediterranean diet, the single most important component was the high consumption of plant foods. In contrast, high cereal consumption, meaning high grain consumption, did not appear to help.

This may be because most grains modern Mediterranean dieters eat are refined, like white bread, whereas the traditional Mediterranean diet was characterized by unprocessed cereals—in other words, whole grains. And while whole grains have been associated with a lower risk of diabetes, heart disease, and cancer, refined grains may increase the risk of diabetes, obesity, heart disease, and other chronic diseases. For example, in the PREDIMED study, those who ate the most white bread–but not whole grain bread–gained significant weight.

Alcohol may also be a problem. As a plant-centered diet, no surprise, adherence to a Mediterranean diet is associated with lower cancer risk, but not with lower breast cancer risk. With all the fruits, veggies, nuts, seeds, and beans and low saturated fat, you’d assume there would be a lower breast cancer risk, but alcohol is a known breast cancer risk factor–even in moderate amounts. But if you create a special adapted version of the Mediterranean diet score that excludes alcohol, the diet does indeed appear to reduce breast cancer risk.

The wonderful grape phytonutrients in red wine can improve our arterial function such that if you drink de-alcoholized red wine, red wine with the alcohol removed, you get a significant boost in endothelial function–the ability of our arteries to relax and dilate normally, increasing blood flow. But if you drink the same red wine with the alcohol added back in, it abolishes the beneficial effect; it counteracts the benefit of the grape phytonutrients. So better just to eat grapes.

Similarly, there are components of extra virgin olive oil—the antioxidant phytonutrients–that may help endothelial function, but when consumed as oil, even extra virgin olive oil, it may impair arterial function. So even if white bread dipped in olive oil is the very symbol of the Mediterranean diet, we can modernize it by removing oils and refined grains.

Another important, albeit frequently ignored, issue in the modern Mediterranean diet is sodium intake. Despite evidence linking salt intake to high blood pressure, heart disease, and strokes, dietary salt intake in the U.S. is on the rise. Right now we get about seven to ten grams a day, mostly from processed foods. If we were to decrease that just by three grams, which is about 1,000 mg of sodium, half a teaspoon of table salt, every year we could save tens of thousands of people from having a heart attack, prevent tens of thousands of strokes, and tens of thousands of deaths. There is a common misconception that only certain people should reduce their salt intake, and that for the vast majority of the population, salt reduction is unnecessary. But in reality, the opposite is true.

But there is much we can learn from the traditional Mediterranean diet. A defining characteristic of the Mediterranean diet is an abundance of plant foods, and one thing that seems to have fallen by the wayside. No real main Mediterranean meal is replete without lots of greens, a key part of not only a good Mediterranean diet, but of any good diet.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Image thanks to Pedro Vezini via Flickr.

Doctor's Note

This is the final video in a six-part video series on the Mediterranean diet. Here are the first five in case you missed them:

  1. Why Was Heart Disease Rare in the Mediterranean?
  2. The Mediterranean Diet or a Whole Food Plant-Based Diet?
  3. PREDIMED: Does Eating Nuts Prevent Strokes?
  4. Which Parts of the Mediterranean Diet Extended Life?
  5. Do Flexitarians Live Longer?

I was happy to have an opportunity to plug Julieanna’s new book. Learn more about her work at http://plantbaseddietitian.com/

I touch more on whole grains in How Many Meet the Simple Seven? and Whole Grains May Work As Well As Drugs.

More on breast cancer and alcohol in Breast Cancer and Alcohol: How Much Is Safe? and Breast Cancer Risk: Red Wine v. White Wine

I’ve touched on olive oil in the other videos in this Mediterranean diet series, but also have an older video Extra Virgin Olive Oil vs. Nuts.

More on sodium in Dietary Guidelines: With a Grain of Big Salt and Can Diet Protect Against Kidney Cancer? But what if without salt everything tastes like cardboard? Not to worry! See Changing Our Taste Buds.

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