Originally printed in the July 2018 issue of Produce Business.

By Kelly Toups

Read Jim Prevor’s Commentary below

While fad diets come and go, the Mediterranean Diet represents an eating pattern that stretches back centuries in time, to the Greek island of Crete and surrounding communities along the Mediterranean Sea such as those in Italy, Spain, and Turkey. Plant foods, like fruits, vegetables, whole grains, herbs, beans and olive oil make up the base of the Mediterranean Diet Pyramid, and meals are accented with moderate amounts of seafood, red wine, artisan cheese and yogurt.

Chefs appreciate the Mediterranean cuisine for its emphasis on bold flavors and seasonality. But nutrition researchers are enamored with it as well, and for good reason. The Mediterranean Diet is backed by more than five decades of epidemiological and clinical research and is recommended in the Dietary Guidelines for Americans.

For decades, scientists have observed that people who follow a Mediterranean style diet tend to live longer lives with lower rates of chronic disease. Newer research, including randomized clinical trials (the “gold standard” of nutrition science) supports these findings and sheds light as well. In fact, the Mediterranean Diet recently was crowned the No. 1 best diet by U.S. News and World Report (tied with the DASH diet). New studies on the Mediterranean Diet are published almost weekly, so here are a few health benefits that current researchers are particularly interested in.

Cancer

The Mediterranean Diet has long been known for its links with heart health, but the Mediterranean Diet also can be an important part of a cancer-protective strategy. In a 2018 Journal of Urology study of 754 men with prostate cancer, and 1,277 controls without prostate cancer, those most closely following a Mediterranean Diet were 34 percent less likely to have an aggressive form of prostate cancer than those not following a Mediterranean Diet. Similarly, a 2017 BMC Medical Genetics study of more than 3,000 people found those closely following a Mediterranean Diet were independently linked with significantly lower risk of colorectal cancer, and a 2014 clinical trial of more than 4,200 women, published in the Journal of American Medicine Association’s Internal Medicine, found that a Mediterranean Diet may lower breast cancer risk by more than 50 percent compared with a low-fat diet.

For decades, scientists have observed that people who follow a Mediterranean style diet tend to live longer lives with lower rates of chronic disease.

Aging

A Mediterranean Diet can also help seniors age comfortably. In a study of 1,630 seniors (ages 60 and over) in Spain, published in The Journals of Gerontology, those most closely following a Mediterranean Diet were 33 percent less likely to have problems with agility, 31 percent less likely to have problems with mobility and 40 percent less likely to have decreased overall physical function. Similarly, in a study of 351 older Spanish adults (ages 60 and over), published in The Journal of Nutrition, Health and Aging just this year, participants who most closely followed a Mediterranean Diet had significantly better health-related quality of life and better mental function. Among men, those most closely following a Mediterranean Diet were more likely to have healthy blood sugar and cholesterol levels, as well as improved physical function. Among women, those most closely following a Mediterranean Diet were more likely to have better life satisfaction.

In a study of 476 elderly adults in Rome, published in The Journal of Nutrition, Health and Aging in January 2018, those not following a Mediterranean Diet were more likely to need multiple medications and have high blood pressure, unhealthy cholesterol levels and diabetes. The authors concluded following a Mediterranean Diet “might potentially delay the onset of age-related health deterioration and reduce the need of multiple medications.”

Obesity and related weight problems concern many countries around the world. But here again, the Mediterranean Diet holds promise. In a 2018 crossover study published in Circulation, researchers randomly assigned 118 overweight adults who normally eat meat to either a lower calorie Mediterranean Diet or a lower calorie vegetarian diet for three months each, with a two-week washout period in between. Participants lost about four pounds during each diet, and both diets were also effective at decreasing body fat. Given that both Mediterranean and vegetarian diets heavily feature nutrient-dense foods such as produce, legumes, and whole grains, it’s not surprising to find both these diets can be an effective path to weight loss.

Though the term ‘diet’ suggests otherwise, the Mediterranean approach to eating is a cuisine worth savoring. The healthiest way to prepare fruits and vegetables is the way that actually gets you to eat them, a lesson that Italian nonnas, Greek giagiádes and Spanish abuelas take in stride. Spanakopita, with its indulgent, golden phyllo exterior, is stuffed with enough spinach to make Popeye proud. And it’s hard not to take a second bite of your eggplant, when it’s mingling with ripe tomatoes, aged vinegar and briny olives, in the Sicilian dish caponata.

You don’t have to live in the Mediterranean to reap the benefits of the Mediterranean Diet. Stock your kitchen with lots of veggies and olive oil, pour yourself a glass of wine, then roll up your sleeves and get cooking.

Kelly Toups, MLA, RD, LDN, is the director of nutrition at Oldways, a nonprofit organization with a mission to bring traditional foods, foodways and lifestyles — ones that are good for people and good for the planet — to people around the world. Kelly holds a Bachelor of Science in nutrition from the University of Texas, where she completed her dietetic internship, and also holds a Master of Science in Gastronomy from Boston University, with a concentration in food policy. She joined Oldways in 2014.

Founded in 1990, Oldways is best known for creating educational tools that promote the Mediterranean Diet Pyramid, the certification and consumption of whole grains and cheeses, for introducing olive oil into the mainstream American diet, and for promoting worldwide cultural heritage awareness through culinary tours.

Mediterranean Lifestyle Might Resonate More Than Diet

By Jim Prevor

Understanding nutrition, as Winston Churchill said in another context, is like a riddle, wrapped in a mystery, inside an enigma. There are so many variables, and most of the studies are, to be polite, imperfect. Just recently, the famous PREDIMED (Primary Prevention of Cardiovascular Disease with a Mediterranean diet) study was retracted and, although the researchers reanalyzed and published a new paper with similar claims, they felt the need to soften the claims.

Originally, the conclusion was that the Mediterranean diet “reduced the incidence of cardiovascular events,” but in the new paper they wrote that “the incidence was lower.” In other words, the original paper made a claim for causation; the new version simply for association. That is all the difference in the world.

Yet even this weaker claim has many skeptics. The New York Times quoted an important researcher: “Nothing they have done in this reanalyzed paper makes me more confident,” said Dr. Barnett Kramer, director of the division of cancer prevention at the National Cancer Institute.

Indeed, the whole process by which such an import research paper, published in the prestigious New England Journal of Medicine, was both published and retracted led many to doubt the whole field. The Washington Post published this claim: “Sad day for credibility of major medical journals and nutritional science,” tweeted Sekar Kathiresan, a physician, scientist, human geneticist and director of the Center for Genomic Medicine at Massachusetts General Hospital.

It is very hard to do Gold Standard nutrition research. It may be true that people who follow the Mediterranean diet are healthier than those who don’t. But it is equally possible that those who follow the Mediterranean diet are more conscientious about health and also go to the doctor more frequently, meditate, exercise, don’t smoke, etc.

Generally, those studies that actually assign people to diets on a randomized basis are too short to be of much use. It may well be that people participating in a study can lose four pounds over 90 days. But no diet is optimal if people won’t follow it. Nothing was stopping people from going on the Mediterranean diet before the study, so what evidence do we have that people will stay on it permanently post-study?

If we hold open the idea of eating fresh and delicious as keys to a joyful life, we might just get people interested in living the lives they dream of.

Of course, even if we accept the science, it is not clear that the claims will induce much behavioral change. Part of the problem is that the actual impact is rather small. U.S. Decennial Life Tables provide data that indicate that if cancer was cured – if nobody ever again died of cancer – the increase in life expectancy in the U.S. would be a little more than three years.

So, if strictly following the Mediterranean diet would reduce the incidence of cancer by one-third (a claim for which we have almost no evidence), life expectancy would increase by a bit over one year.

Is there the slightest reason to believe that publication of these figures would lead all the steakhouses in America to close – bereft of customers?

Which brings us to the dilemma: Even if these health claims are true, what is the industry, what is the government, what is anybody supposed to do with this information?

We have for decades had various initiatives to inform people as to the health benefits of produce. But research indicates most people already believe that eating more fruits and vegetables is healthy.

Sure, some individual products have benefitted by selling their healthy attributes. But evidence that any of these health-focused programs have actually led to overall increased consumption of fruits and vegetables is sorely lacking. But there may be some way to tie in that goes beyond some kind of nannyish finger-wagging about what is good for you.

Can’t we romanticize by focusing not on the diet but the Mediterranean lifestyle?

Sure, we can show beautiful fruits and vegetables, but how about beautiful women and buff guys jumping off yachts and dining in the whitewashed Greek Isles with music and wine.

One shot is bathing suits, the next tuxedos and gowns jumping out of a Ferrari in Monte Carlo to go to the casino.

Marketing the life of which the Mediterranean diet is an integral part.

If we focus on trying to get people to eat a diet they have already chosen not to eat because it is good for them in a vague way, we will fail.

But if we hold open the idea of eating fresh and delicious as keys to a joyful life, we might just get people interested in living the lives they dream of – and of eating a Mediterranean diet.