The Mediterranean Diet, renowned for its plant-centric approach, healthy fats, and moderate protein intake, merits a comprehensive examination to unravel its potential as an “ideal” diet.

While it has been continuously adopted for the past 2,000 years in the Mediterranean basin, the modern appreciation for the Mediterranean Diet gained momentum in the mid-20th century.

The Seven Countries Study, initiated by Ancel Keys, played a crucial role in highlighting the positive health outcomes associated with a Mediterranean-style eating.

The study linked the diet to low saturated fats and cholesterol levels, and to a consequent reduction in the rates of cardiovascular diseases and other chronic conditions.

What are the key components of the Mediterranean diet?

Olive oil: Rich in monounsaturated fats, olive oil is a staple in the Mediterranean Diet, offering cardiovascular benefits and anti-inflammatory properties.

Tomatoes: Abundant in antioxidants like lycopene, tomatoes contribute to reducing oxidative stress, potentially lowering the risk of chronic diseases, especially high blood pressure and consequent stroke.

Fish: Moderate fish consumption provides essential omega-3 fatty acids, promoting heart and brain health.

Fruits and vegetables: A cornerstone of the Mediterranean Diet, consuming an average of 8 servings of fruits and vegetables daily, including cruciferous vegetables like cabbage, provides a rich source of vitamins, minerals, and antioxidants.

Nuts and seeds: Rich in healthy fats, fibres, and various nutrients, nuts and seeds contribute to heart health and longevity, and may aid in weight management.

Legumes: Like lentils, chickpeas and beans provide a plant-based protein source, abundant fibres, and a whole range of micronutrients. In studies targeting the Blue Zone diet [see below], beans have been directly implicated in prolonging population’s life span.

Herbs and spices: The likes of basil, oregano and parley. As an example, parsley holds an uncommon combination of nutrients that makes it a powerful superfood. It has flavonoids with antioxidant properties, and myristicin and eugenol, which have anticancer benefits.

Cheeses and yoghurt: While milk intake traditionally stops at a very young age in the Mediterranean diet, the moderate and regular consumption of cheeses and yoghurt confers a steady supply of proteins, calcium, vitamins and probiotics essential for gut health.

Red meat limitation: The Mediterranean Diet emphasises limited red meat intake, opting for leaner protein sources to reduce the risk of heart ailments and certain cancers.

Controlled carbohydrates: Instead of refine sugars, the diet encourages the consumption of complex carbohydrates, such as whole grains. This promotes stable insulin and blood sugar levels.

No processed foods or preservatives: This helps to maintain the nutritional integrity and simplicity of the diet.

What is the impact of the Mediterranean diet on cardiovascular health?

Several studies have supported the cardiovascular benefits of the Mediterranean diet. One notable trial is the Predimed study (Prevención con Dieta Mediterránea), a large-scale randomised controlled trial conducted in Spain.

It demonstrated that individuals following a Mediterranean diet rooted in extra virgin olive oil and mixed nuts had a 30 per cent less incidence of major cardiovascular events, like heart attacks and strokes, compared to those on a low-fat control diet.

What is the impact of the Mediterranean diet on longevity?

Adherence to the Mediterranean Diet is linked to increased longevity, supported by research suggesting a reduced risk of age-related diseases.

The European Prospective Investigation into Cancer and Nutrition study analysed data from a large cohort of 450,000 persons across multiple European countries.

The study found that greater adherence to a Mediterranean Diet was associated with a reduced overall mortality risk, of 10 per cent in men and 14 per cent in women, particularly due to lower death from heart diseases and cancer.

A 2014 study conducted by researchers at the Harvard T.H. Chan School of Public Health found that higher adherence to the Mediterranean Diet was associated with longer telomeres, which are protective structures at the ends of chromosomes.

Longer telomeres are often considered a marker of biological ageing and have been associated with increased longevity.

A large prospective cohort study conducted in the United States, known as the NIH-AARP Diet and Health Study, found that greater adherence to a Mediterranean-style diet was associated with a lower mortality risk. The study included a diverse population, in ways of age, geography, and ethnicity, strengthening the generalizability of the findings.

Are the Mediterranean diet and Blue Zone diet the same?

The two Blue Zones, Ikaria in Greece and Sardinia in Italy, are located in the Mediterranean basin. Both the Mediterranean Diet and Blue Zone diet share commonalities, emphasising plant-based foods, healthy fats, and moderate protein intake.

However, the Blue Zone diet has more restrictions on meat and calories, and more emphasis on beans.

In conclusion

Supported by a robust body of scientific literature, the Mediterranean Diet emerges as a potentially perfect dietary model, intricately weaving together diverse elements of optimal nutrition, prime health, and added longevity.

The parallels with Blue Zone diet further underscore the potential of this holistic eating lifestyle.

It is worth adding that despite societal and temporal changes, the core principles of the Mediterranean Diet have persisted through the millennia while adapting to contemporary circumstances.

The diet's flexibility and inclusivity allow for the integration of new nutritional knowledge without compromising its fundamental tenets.

• Joe Yammine, MD, is a consultant cardiologist at the Bermuda Hospitals Board. The information here is not intended as medical advice or as a substitute for professional medical opinion. Always seek the advice of your physician