Mediterranean Diet

The Mediterranean diet is a plant-based dietary pattern that emphasizes whole grains, fruits, vegetables, legumes, nuts, and olive oil, while limiting red meat, processed foods, and saturated fats.

The Mediterranean diet is a dietary pattern based on the traditional food choices and habits of countries bordering the Mediterranean Sea, including Italy, Greece, Spain, and Portugal. The Mediterranean diet is rich in vitamins, minerals, fiber, and healthy fats, and has been associated with numerous health benefits, including reduced risk of cardiovascular disease, diabetes, and certain types of cancer.

This dietary pattern is characterized by high consumption of fruits, vegetables, whole grains, legumes, nuts, and olive oil, moderate consumption of fish, poultry, and dairy products, and low consumption of red meat, processed foods, and sweets. Ancel Keys was an American physiologist and researcher who made significant contributions to the study of nutrition and heart disease. He is best known for his pioneering work on the relationship between dietary fat intake and cardiovascular disease. In the 1950s, Keys conducted a series of landmark studies, including the Seven Countries Study, which examined the dietary habits and health outcomes of thousands of people from around the world.

The study demonstrated a clear association between high dietary fat intake and increased risk of heart disease. Keys was also a prominent advocate of the Mediterranean diet, which he believed to be a healthier and more sustainable way of eating than the typical American diet of his time. He helped to popularize the diet in the United States and other Western countries, and it has since become widely recognized as a healthy and effective way of eating.

Motivated to dig for answers, Keys began the first multi-country epidemiological study to look for a causal relationship between low-density lipoprotein (LDL) cholesterol[1] and coronary heart disease[2] in 1958. This five-year study enrolled nearly 12,000 men aged 40 to 59 in Finland, Greece, Italy, Japan, the Netherlands, the United States, and Yugoslavia.

The study found that the men who consumed a Mediterranean-style diet had lower rates of heart disease and mortality than those who consumed a diet high in saturated fat. This study helped to establish the link between diet and heart disease and contributed to the development of dietary recommendations aimed at reducing the risk of heart disease.

However, Keys’ cholesterol hypothesis has also been subject to criticism, with some researchers arguing that the link between cholesterol and heart disease is more complex than initially thought. Nevertheless, his research has had a significant impact on the study of nutrition and heart disease.

The Mediterranean diet is based on the traditional dietary patterns of countries bordering the Mediterranean Sea, and it reflects the food choices and habits of people who lived in these regions many years ago. Historically, the Mediterranean diet was a reflection of the food that was readily available and affordable to people, including whole grains, legumes, vegetables, fruits, nuts, and olive oil.

The Oldways Diet online site can help pharmacists and pharmacy technicians analyze a patient’s diet. The Oldways Diet is an organization that promotes traditional diets, including the Mediterranean diet, and offers resources and tools to help people adopt and follow these diets. Their website includes information on the principles of the Mediterranean diet, as well as resources such as meal plans, recipes, and shopping guides.

They also offer a free online diet analysis tool called the Mediterranean Diet Score, which can help individuals assess their adherence to the Mediterranean diet and identify areas for improvement.

Pharmacists and pharmacy technicians can refer patients to these resources to help them make healthier dietary choices and improve their overall health. The Aging and Adherence to the Mediterranean Diet study was published in the Journal of the Academy of Nutrition and Dietetics in 2019 and investigated the association between adherence to the Mediterranean diet and medication adherence among older adults in the United States.

The study found that older adults who reported higher adherence to the Mediterranean diet were more likely to report higher adherence to their medications, and also had better overall health status, compared to those who reported lower adherence to the Mediterranean diet. The study suggests that promoting adherence to the Mediterranean diet may be a useful strategy for improving medication adherence and overall health among older adults.

PREDIMED (Prevención con Dieta Mediterránea) was a randomized clinical trial conducted in Spain from 2003 to 2011, involving more than 7,000 participants at high risk for cardiovascular disease. The trial aimed to assess the effects of a Mediterranean diet supplemented with either extra-virgin olive oil or nuts, compared to a control diet, on the primary endpoint of major cardiovascular events, such as myocardial infarction, stroke, or death from cardiovascular causes.

The trial also assessed the effects of the Mediterranean diet on secondary endpoints, such as cognitive function and cancer. The results of the trial showed that the Mediterranean diet reduced the incidence of major cardiovascular events by approximately 30% compared to the control diet, and had other positive effects on health.

The center of Florence contains numerous landmarks and monuments, including the Florence Cathedral, the Palazzo Vecchio, and the Uffizi Gallery, which are considered masterpieces of Renaissance art and architecture. The designation of UNESCO Cultural Heritage recognizes places and monuments that have significant cultural or historical importance to humanity and are considered to be of outstanding universal value.

Both Bifidobacterium and Lactobacillus[3] have been shown to have beneficial effects on the microbiome[4]. They stimulate the growth of other beneficial species: Both Bifidobacterium and Lactobacillus can also stimulate the growth of other beneficial species in the gut.

The food group that provides the most amount of microbes to our bodies is fruits and vegetables. These foods are rich in fiber and other nutrients that support the growth and diversity of beneficial microbes in the gut. In addition, fruits and vegetables often have a complex surface structure that can harbor a diverse array of microorganisms. On the other hand, processed foods and those high in fat and sugar have been shown to have a negative impact on the gut microbiome, reducing microbial diversity and promoting the growth of harmful bacteria. Meats and grains can also contribute to the microbiome, but in smaller amounts compared to fruits and vegetables.

The human microbiome has been shown to play a significant role in a wide range of health conditions, and research in this area is ongoing. Based on current scientific evidence, some disease states that may benefit from microbiome-based interventions include:

  • Kidney disease: Studies suggest that alterations in the gut microbiome may contribute to the development and progression of kidney disease. Modulating the microbiome through diet or probiotic therapy may have a protective effect on the kidneys.
  • Diabetes: The gut microbiome has been implicated in the development of insulin resistance and type 2 diabetes. Manipulating the microbiome through dietary interventions or fecal microbial transplantation may improve glucose control and metabolic health.
  • Asthma: Emerging evidence suggests that the composition of the gut microbiome may influence the development and severity of asthma. Interventions aimed at modulating the microbiome, such as probiotics or prebiotics, may help to reduce inflammation and improve lung function.
  • Crohn’s disease: The gut microbiome has been implicated in the development and progression of Crohn’s disease. Fecal microbial transplantation has shown promise in the treatment of this condition.

Overall, the Mediterranean diet is considered to be a healthy and sustainable way of eating that can provide a wide range of health benefits. It emphasizes whole, unprocessed foods, and a balanced intake of macronutrients, which can help promote overall health and well-being.

  1. Low-density lipoprotein (LDL) cholesterol is often referred to as “bad” cholesterol because high levels of LDL cholesterol in the blood can increase the risk of developing heart disease and stroke. LDL cholesterol is a type of lipoprotein that carries cholesterol from the liver to the cells of the body. When there is too much LDL cholesterol in the blood, it can build up in the walls of arteries, forming plaques that can narrow the arteries and restrict blood flow. Over time, these plaques can rupture and cause a heart attack or stroke. A healthy lifestyle, including regular physical activity, maintaining a healthy weight, and a diet low in saturated and trans fats, can help lower LDL cholesterol levels and reduce the risk of heart disease. [Back]
  2. Coronary heart disease (CHD) is a condition that occurs when the arteries that supply blood to the heart become narrowed or blocked by a buildup of plaque. This can reduce blood flow to the heart and cause chest pain (angina), shortness of breath, and in some cases, heart attack. CHD is the leading cause of death worldwide and is often caused by a combination of genetic, environmental, and lifestyle factors, such as smoking, high blood pressure, high cholesterol levels, diabetes, and physical inactivity. Treatment for CHD typically includes lifestyle changes, such as regular physical activity and a healthy diet, as well as medications, such as aspirin, beta-blockers, and statins, to reduce the risk of heart attack and stroke. [Back]
  3. Bifidobacterium and Lactobacillus are two types of beneficial bacteria commonly found in the human gut microbiome. Bifidobacterium are known to produce lactic and acetic acids, which can help maintain a healthy pH level in the gut and prevent the growth of harmful bacteria. They also play a role in modulating the immune system and may help improve gut barrier function. Lactobacillus, on the other hand, are known for their ability to produce lactic acid, which can help lower the pH in the gut and inhibit the growth of harmful bacteria. They may also have anti-inflammatory properties and help regulate the immune system. Both Bifidobacterium and Lactobacillus have been studied for their potential health benefits, including improving digestive health, preventing and treating infections, and reducing inflammation in the gut. [Back]
  4. The human microbiome is a complex community of microorganisms, including bacteria, viruses, fungi, and other microbes, that live on and inside the human body. These microbes play an important role in maintaining human health by aiding in digestion, synthesizing essential vitamins and nutrients, and supporting the immune system. Alterations in the composition or function of the microbiome have been linked to a variety of health conditions, including obesity, autoimmune diseases, and even mental health disorders. Factors such as diet, medications, and lifestyle can influence the diversity and composition of the microbiome. Understanding the microbiome and its relationship to health is a rapidly growing area of research, with potential implications for the prevention and treatment of a wide range of diseases. [Back]

Further Reading

  • Oldways
  • Bach, A., Serra-Majem, L., Carrasco, J. L., Roman, B., Ngo, J., Bertomeu, I., & Obrador, B. (2013). The use of indexes evaluating the adherence to the Mediterranean diet in epidemiological studies: a review. Public health nutrition, 16(3), 440-449.
  • Estruch, R., Ros, E., Salas-Salvadó, J., Covas, M. I., Corella, D., Arós, F., … & PREDIMED Study Investigators. (2013). Primary prevention of cardiovascular disease with a Mediterranean diet. New England Journal of Medicine, 368(14), 1279-1290.
  • Martínez-Lapiscina, E. H., Clavero, P., Toledo, E., Estruch, R., Salas-Salvadó, J., San Julián, B., … & Martínez-González, M. A. (2013). Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomised trial. Journal of Neurology, Neurosurgery & Psychiatry, 84(12), 1318-1325.
  • Panagiotakos, D. B., Pitsavos, C., Arvaniti, F., Stefanadis, C., & Adherence to the Mediterranean Diet and Inflammation Markers in the Attica Study. (2018). Annals of Nutrition and Metabolism, 73(3), 210-216.
  • Valls-Pedret, C., Sala-Vila, A., Serra-Mir, M., Corella, D., de la Torre, R., Martínez-González, M. Á., … & Ros, E. (2015). Mediterranean diet and age-related cognitive decline: a randomized clinical trial. JAMA internal medicine, 175(7), 1094-1103
  • Keys, A. (1953). Atherosclerosis: A problem in newer public health. Journal of Mount Sinai Hospital, 20(2), 118-139.
  • Keys, A. (1970). Coronary heart disease in seven countries. Circulation, 41(4 Suppl), I1-211.
  • Keys, A. (1975). Mediterranean diet and public health: Personal reflections. The American Journal of Clinical Nutrition, 22(5), 585-588.
  • Blackburn, H., & Keys, A. (1960). The disease of coronary heart disease: Its study and treatment. Bulletin of the World Health Organization, 23(5), 663-681
  • Turroni F, Ventura M, Buttó LF, Duranti S, O’Toole PW, van Sinderen D. Molecular dialogue between the human gut microbiota and the host: a Lactobacillus and Bifidobacterium perspective. Cell Mol Life Sci. 2014 Apr;71(9):183–203. doi: 10.1007/s00018-013-1318-0. Epub 2013 Sep 18. PMID: 24045841.
  • Plaza-Díaz J, Ruiz-Ojeda FJ, Vilchez-Padial LM, Gil A. Evidence of the Anti-Inflammatory Effects of Probiotics and Synbiotics in Intestinal Chronic Diseases. Nutrients. 2017 Aug 2;9(8):555. doi: 10.3390/nu9080555. PMID: 28767086; PMCID: PMC5579645
  • Sofi F, Dinu M, Pagliai G, et al. Low-Calorie Vegetarian versus Mediterranean Diets for Reducing Body Weight and Improving Cardiovascular Risk Profile: CARDIVEG Study (Cardiovascular Prevention With Vegetarian Diet). Circulation. 2018;137(11):1103-1113.
  • Schwingshackl L, Missbach B, Konig J, Hoffmann G. Adherence to a Mediterranean diet and risk of diabetes: a systematic review and meta-analysis. Public Health Nutr. 2015;18(7):1292-1299.
  • Feart C, Samieri C, Rondeau V, et al. Adherence to a Mediterranean diet, cognitive decline, and risk of dementia. JAMA. 2009;302(6):638-648.
  • Buckland G, Agudo A, Lujan L, et al. Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study. Am J Clin Nutr. 2010;91(2):381-390.
  • World Health Organization. Cardiovascular diseases (CVDs). Accessed May 5, 2023.
  • American Heart Association. Coronary Artery Disease. Accessed May 5, 2023.
  • National Heart, Lung, and Blood Institute. Coronary Heart Disease. Accessed May 5, 2023.
  • Gilbert JA, Blaser MJ, Caporaso JG, et al. Current understanding of the human microbiome. Nat Med. 2018;24(4):392-400.
  • Ursell LK, Metcalf JL, Parfrey LW, Knight R. Defining the human microbiome. Nutr Rev. 2012;70 Suppl 1:S38-44.
  • O’Hara AM, Shanahan F. The gut flora as a forgotten organ. EMBO Rep. 2006;7(7):688-693.
  • Lloyd-Price J, Abu-Ali G, Huttenhower C. The healthy human microbiome. Genome Med. 2016;8(1):51.

Author: Doyle

I was born in Atlanta, moved to Alpharetta at 4, lived there for 53 years and moved to Decatur in 2016. I've worked at such places as Richway, North Fulton Medical Center, Management Science America (Computer Tech/Project Manager) and Stacy's Compounding Pharmacy (Pharmacy Tech).

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