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Is the Mediterranean Diet the Best Choice for Health?

The key to health is captured by embracing a Mediterranean lifestyle, starting with real food, enjoyed with others, and moving more.

With David l. Katz, MD, MPH, Marion Nestle, PhD, MPH, and Laia Cortes, PhD

The Mediterranean diet is more of an approach to eating than a specific diet plan. There is a secret ingredient to the Mediterranean diet: think lifestyle. This will make more sense if you consider that there are some 20 countries with a coastline on the Mediterranean Sea. As different as these countries may be, it is the similarities that have been captured in the Mediterranean concept of a diet.

The appeal, and indeed the science, supports a Mediterranean-style of eating. Here’s why. Diabetes, heart disease, inflammation, metabolic syndrome, and obesity are all chronic conditions that can be reversed or perhaps avoided by practicing a so-called Mediterranean lifestyle.1  In addition, adopting a Mediterranean inspired way of eating can lessen the risk of developing some forms of cancer, including breast cancer. 

Mediterranean diet is about enjoying food, life, and being active, which promotes health.To be healthy means: eating real food, quality over quantity, being active, and enjoying the company of others.

What Is the So-Called Mediterranean Diet? 

Think whole foods as they grow on the farm. Move your body more, much more. Make time to relax—get enough sleep and lessen the stresses we all face. The good news is, there is no best diet, no rulebook, no one and only way. Maybe you are getting into the rhythm—the Mediterranean lifestyle allows you to properly meet the full physiological needs of your body. If it seems so simple, that’s because in many ways it is, if you are willing to embrace it.

Think—Vegetables, fruits, beans and lentils, nuts and seeds, whole grains. This is the list of priority foods that David L. Katz, MD, MPH, founding director of the Yale-Griffin Prevention Research Center at Yale University in New Haven, and president of the True Health Initiative, repeats each time he is asked about the Mediterranean diet.

What more does Dr. Katz, a leading nutritionist, physician, professor, and researcher have to say about the Mediterranean diet? 

“We know enough about diet and lifestyle to say yes these can reverse or prevent almost all of the chronic diseases that plague modern society, and yes diet and lifestyle can absolutely add life to your years and years to your life,” Dr. Katz says.

Yet, 45% of Americans are still suffering from at least one chronic illness.2 So if the solution is that straightforward, how is it that the rates of all those related chronic diseases are not declining?  We’ve chosen the industrialization of food over farm fresh produce.

Industrialization of Food: Processing, Bleaching, Salting, Added Sweeteners

“We live in a toxic environment, and in our effort to get a grip, we seem to have chosen solutions that worsen our circumstances, [rather than improve our health],” Dr. Katz tells EndocrineWeb. This toxicity permeates our surroundings, from the sugar pumped into our yogurt and bread, bleached and milled to remove the fiber, and the animals pumped with chemicals, so they’ll grow bigger and faster. Add to that, the fact the most of us live in places far from where our foods are grown. To top it off, we live in a culture that encourages and rewards stress, confusing that with success.

We’ve also become a nation that moves from one diet to another. Our comfort seems rooted in sidestepping good instincts and deferring to someone else’s diet rules. But most likely that hasn’t served you well. Time to embrace another way. 

By choosing and implementing a lifestyle that focuses on whole foods, movement, social connections, proper rest, relaxation, and enjoyment, you have all the elements needed to preserve or improve your health.

Think Quality and Pleasure, Not Quantity and Haste

You’ve likely heard this before but it bears repeating. Consider the usual portion sizes on your plate—our portions have been increasing steadily since the 1970’s. For example, a serving of cooked pasta exceeds federal guidelines by 480%— a portion of pasta should be closer to 1 cup but tops 3 cups), and steak portions should be 2.5 ounces but is often 6 ounces at home and typically weighing in at 12 ounces at a good restaurant.3

As portion sizes increase, so have the rates of chronic illness; not to mention our waistlines. Add to that, the hard sell of a new diet book seemingly every week, and we are simply setting ourselves up to fail. If it feels impossible to know what and how to eat to improve your health, have no fear. Dr. Katz says it is quite possible for you to embrace a way of living that will come to seem very logical. 

If you were fortunate enough to visit a Mediterranean country, such as the Catalan region of Spain, you would find tables set with platters of fish and rice, bowls of soup, and a variety of dishes that include: vegetables, fruits, whole grains, beans, lentils, nuts, and seeds. Sound familiar!

Yet, the experience goes well beyond what’s on the table. The people gathered around those tables are animated in conversation, often with a glass of wine in hand. They linger for hours, eating slowly, and savoring every bit. Compare that to the 11 minutes on average spent by a typical American to eat a meal or to the commonly consumed two-minute breakfast on the go, while driving to work or pushing the kids out the door to catch the school bus.

Time to slow down. Consider adopting a different approach, one that Dr. Katz says is based on six basic principles of a healthy lifestyle: Feet, fork, fingers, sleep, stress, and love.4

  • Lead with your feet so you are making movement an essential part of every day.
  • The fork reminds us that food should nourish us, not punish us; and must be handled with care (meaning raising it less often, and only as needed).
  • Fingers are meant to bring your flavors (not to hold cigarettes or other toxic substances).
  • Sleep is essential for a healthy mind and body, yet one in three adults still aren’t getting enough.5
  • Work to reduce or alleviate whatever causes your level of stress to rise. Simply put, strive for more joy.
  • Love is the basis of social connections and support, which is an essential ingredient for our wellbeing. 

Not quite there yet? It may require you to sit quietly and take stock.

Conjure Up That "Mediterranean" Vacation Feeling For Just a Bit Longer

Go back to that spot in Spain (or France, or wherever you like), and linger at those diners. What you might see is that the glass of wine lasts throughout the meal, the bread is shared among many and meant to be eaten in tiny bites that hold the olive oil, and another important detail: the plates are smaller. So yes, you can eat bread and meat and have dessert, just not too much. The trouble with our way is that we have a tendency to overdo everything. But we don’t realize it.

Take stress. Try this…shut your eyes and breathe in slowly, deeply, and hold for a second, then let your breath out even more slowly. What do you notice? You are more relaxed. That’s all it takes. Now commit to doing it regularly and often and the other principles will likely follow.

Dr. Marion Nestle, PhD, MPH, the Paulette Goddard Professor of Nutrition, Food Studies, and Public Health Emeritus at New York University and author of author of the forthcoming book, Unsavory Truth: How food companies skew the science of what we eat (available in October 2018), says it plainly: “What's called the Mediterranean diet is just a version that follows sensible principles of healthy diets: eat plenty of plant foods (fruit, vegetables, beans, grains), balance calories, and don’t eat too much junk food. Really, it’s that simple.“

If it sounds like Dr. Nestle is proposing the same principles as Dr. Katz, it should come as no surprise, as most health professionals embrace this concept of a Mediterranean approach to living as a guide to a healthier end.  “Putting these concepts into practice is another matter,” she tells EndocrineWeb.

Admittedly, it's easier said than done for a myriad of reasons. While this approach may seem overly simplistic, it could be that you’ve been surrounded by a constant barrage of popular diets: vegan, paleo, DASH, keto, raw, Atkins, Clean Eating, vegetarian, Whole 30. While the list goes on and on, these prescribed diets fail because most people stick with them for only a short time.

The biggest barrier to sustained weight loss with these highly touted, trending diets is the strict rules that can't be maintained for the foreseeable future; they are too rigid and drastically different from how you eat now or even want to eat ever. Whereas the Mediterranean approach has lasting power is driven by its underlying philosophy:  Eat real food, makes you feel good, so you want to stick with it for the long haul. Keep life simple. Move daily. Enjoy.

This is the basis for Dr. Katz’s True Health Initiative, a forum for top health practitioners and organizations committed to promoting, “lifestyle as medicine.” Thus, growing support for a scientifically sound way to utilize the 6 principles, mentioned earlier—Forks, Feet, Fingers, Sleep, Stress, Love—as the basis to healthy living. 

Back to Basics: Head to the Kitchen to Prepare Your Meals

Maybe you didn’t grow up with the kitchen as your home base for meals. You are not likely to pass a fruit stand on your way to work every day, and perhaps you only have a thirty-minute break to eat lunch. It can feel impossible to be healthy in a culture that runs on Dunkin’ and  Happy Meals but as Dr. Katz reminds us, “We are the culture.” Our decisions matter.

Dr. Nestle offers another way to get to the same place, “We’ve already seen changes that resulted from voting with your fork: more organics, more locally grown food, and better supply chains.”  While you may feel overwhelmed, you do have the possibility to change your health and move toward a better environment.

Insights from Mediterranean Natives

Barcelona-based nutritionist, Laia Cortes, PhD, takes the Mediterranean lifestyle to a more personal level, describing it as one in which “we grow up with food, smelling and touching the fruits and vegetables. For us, there is great pleasure in eating this way. We don’t think, ‘Oh I must go on a diet and have only salad,’ instead we simply enjoy the salad.” She says, “You must take pleasure in the food.” She also describes a pattern of eating that flips the timing to match our body’s needs.

“Eat more of your food earlier in the day and less at night. You want to give the body energy when it needs it, not when you are winding down and can’t use it,” says Dr. Cortes, who adds,  “There is a Spanish proverb, ‘have breakfast like a king, lunch like a prince, and dinner like a beggar.’”  

Esther Fernandez, who owns Embolic, a health-focused restaurant in the Mediterranean town of Cadaqués, likes to feature three basic dishes.

  • A salad of lettuce, avocado, tomato, olive oil, and salmon or tuna. “Or use anchovies or sardines instead. Which fish doesn’t matter so much; it's more important that you eat what you like,” she tells EndocrineWeb.
  • Hummus made by mashing chickpeas with tahini, olive oil, garlic, lemon, cumin. “Of course, you can add whatever spices you like,” Ester says. The hummus comes with a bread homemade from a variety of grains and seeds. There is no corn syrup or preservatives added.
  • Mango “ice cream” is a dessert made by freezing sliced mango, then blending it until creamy but without any added sugar, salt, or dairy.  Or preservatives.

Best of all, each dish has a time commitment of under 20 minutes to prepare and serve;  and no dish has exact measurements. That' is so the flavors will reflect your preferences, your mood, and your desires. As Dr. Katz says, “Calories count, but you don’t need to count them.”

There are two major themes to Esther’s cooking instructions olive oil and pleasure. As you likely know, a primary ingredient to all Mediterranean cooking is olive oil be it Italian, Greek,  or Spanish olives. Beyond its robust flavor, it confers a multiplicity of health benefits including improving blood cholesterol, anti-inflammatory properties, and helping to lower blood pressure and type 2 diabetes.6,7

There is one crucial caveat. The compounds in olive oil known as polyphenols that are responsible for these health benefits are mostly absent from the processed oils sitting on your grocery store shelf. When choosing an olive oil, buy cold-pressed, extra virgin olive oil, says Dr. Nestle. Pouring commercially processed olive oil on your salad is just soaking lettuce in extra fat.

“High-quality olive oils packaged in dark bottles can maintain their quality for six months to a year, so buy them in sizes that you know you will use,” she says, and while good olive oil may cost a bit more than the more common vegetable oils, you’ll be saving money on other ingredients because you'll be eating more rice, and beans, and smaller portions of fish and meat.

Is the Mediterranean diet an effective way to improve your health and prevent chronic diseases including diabetes and heart disease?  A resounding “Yes”, say both Dr. Katz and Dr. Nestle, as is any diet that focuses on vegetables, fruits, whole grains, beans, lentils, nuts, and seeds. And, this return to unprocessed, chemical-free foods will support a healthier weight and reduce the risk of many cancers and other disorders.

Getting the final word, Dr. Katz says, “science is a collection of studies, and yes, we do know what we know about diet and exercise; it all comes down to—Eat, move, enjoy.“

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