Mediterranean Diet: Anti Inflammatory Foods Behind Health Benefits

With Mary Yannakoulia PhD, and Teresa T. Fung, ScD, RDN

We all want to age gracefully, especially as the risk of chronic diseases becomes a greater threat. Yet, achieving the basics of sufficient sleep, a healthy diet, enough physical activity, social interaction, and reducing stress, which are necessary elements to achieving good health longer, remain elusive for many.1,2

Sleeping soundly, for example, remains important as you age, yet tends to become more difficult to achieve. Fortunately, how you eat can improve how well you sleep in your older years.3

A Mediterranean inspired salad delivers an anti inflammatory boost.Anti inflammatory foods like those found in a Mediterranean diet offer best chance of long-term health. Photo: 123RF

Benefits of Sleep Quality Can Be Improved with Diet

While attention to sleep typically focuses on the number of hours in slumber, a team of researchers from  Athens, Greece, make a compelling argument for adhering to a Mediterranean diet to improve sleep quality; and in doing so, they make a distinction between sleep quality and sleep quantity.3

In this longitudinal study,3 published in the journal, Geriatrics & Gerontology International, the researchers evaluated the sleep duration and quality of 1639 adults who were 65 years of age and older based on self-reported questionnaires as was their adherence to a Mediterranean diet.  

 The investigators found that study participants who followed a Mediterranean diet demonstrated a noticeable improvement in sleep quality, particularly among those 65 to 75 years old.3

 “Adherence to this healthy dietary pattern was negatively associated with the following components: trouble falling asleep and sleep disturbance, and positively with sleep adequacy,” says senior author, Mary Yannakoulia PhD, assistant professor in the Department of Nutrition and Dietetics at Harokopio University in Athens, Greece.

“Interestingly, we also reported that following the Mediterranean diet was not significantly related to sleep duration (number of hours asleep),” she says. In fact, sleep quality is viewed as a more complete index, making it the most important sleep measure associated with dietary choices, whereas sleep duration appears less sensitive and not significantly associated with diet."

Dr. Yannakoulia and her team believe that many aspects of this particular anti inflammatory eating pattern may play a role in improved sleep quality.3  

Mediterranean Diet Promotes Sound Sleep

“Poor sleep quality has been linked to high levels of markers of inflammation and oxidation. Anti-inflammatory factors, as well as antioxidative properties, have been extensively attributed to the Mediterranean dietary pattern,”4-6 says Dr. Yannakoulia.

This may make more sense if you consider the apps that track sleep; you may fall asleep at midnight and wake up at seven, but if your sleep is constantly disturbed, the quantity does not matter because the quality is so poor.

Since inflammation may contribute to sleep disturbances, they postulated that by following an anti inflammatory diet—an approach to eating that features fruits, vegetables, nuts, fish, olive oil and whole grains; otherwise known as a Mediterranean diet—the level of inflammation is likely to decrease.  

 “Vascular pathways may also explain the connections between a Mediterranean diet and sleep quality. Also, some foods characterizing the Mediterranean dietary pattern, such as olives, some kinds of fish, and seasonal fruits, are good sources of melatonin, a neurohormone that modulates circadian rhythms and is involved, among others factors, in the sleep-wake cycle by promoting sleep and subsequently enhancing sleep quality,” Dr. Yannakoulia tells EndocrineWeb.

Avoiding Inflammation Key to Reducing Chronic Diseases

 It is worth noting that anti inflammatory foods such as those that comprise the Mediterranean diet extend beyond sleep to a reduced risk of dying, including from heart disease, some cancers, and diabetes,6 as highlighted in another recently published study.

Swedish researchers report that eating anti-inflammatory foods such as fruits and vegetables, tea and coffee, monounsaturated fats (eg, olive and canola oils) nuts and avoiding pro-inflammatory foods—red meat, processed meats, chips and soda—reduces risk of death from any causes by 18%, cardiovascular disease by 20%, and 13% for cancer.6 Most important, they report a dose-response, meaning the closer you stick to an anti-inflammatory diet, the greater the health benefits.6

Further evidence of the value in adopting a diet built around anti inflammatory, Mediterranean type foods comes from an analysis of recent studies in which the authors examined the link between various diets and the potential for disease,5 which was published in the British Medical Journal. The conclusion from this literature review,5 was that dietary patterns, and not individual foods, are most closely linked to disease prevention.

Overall Dietary Pattern Matters Most 

 After all, “we don't eat food in isolation. Culturally, some foods are consumed together (eg, burgers and French fries, cheese and crackers) and if we eat more of one thing, often we eat less of something else,” says Teresa T. Fung, ScD, RDN, adjunct professor of nutrition at Harvard University, TH Chan School of Public Health, who was not involved in either of these new studies.       

To arrive at this understanding, the authors analyzed the following diets and eating patterns:

  • Healthy Eating Index: Assessing how closely a person’s diet meets the current Dietary Guidelines for Americans.7,8
  • Alternative Healthy Eating Index: Developed by Harvard nutrition experts to more closely reflect foods that predict the risk of chronic diseases including diabetes, cardiovascular disease and heart failure.9
  • Dietary approaches to stop hypertension (DASH) diet: An eating plan designed to lower blood pressure and to avoid the need for medication.10
  • Mediterranean diet. As discussed in a full-length article at EndocrineWeb, this is a way of eating that is folded into a lifestyle approach rather than a simple food plan.
  • Paleo diet: Introduced by Loren Cordain, PhD, this eating plan is modeled after a pre-industrialized hunter-gatherer lifestyle with a focus doubling the protein content and limiting carbohydrates.11

Of all these popular dietary approaches, the Mediterranean diet is the only eating plan that has been demonstrated to lower risk of chronic diseases in both observational and randomized trials.4-6

The researchers concluded that adopting a Mediterranean diet most closely delivers an eating plan that reduces chronic disease risk among the most popular diets by delivering on the anti inflammatory foods known to improve health for the long-term.

Avoiding Inflammation Promises Optimal Health

The anti-inflammatory effects of the Mediterranean diet may be one of its greatest benefits, based on a longitudinal study,6 appearing in the Journal of Internal Medicine. The results of this trial reinforce the message that an anti-inflammatory diet is associated with a decreased risk of dying from any cause, dying from cardiovascular disease, and dying from cancer.6

Perhaps these outcomes support the impact that improved sleep cycles have in adults who appear to have decreased levels of inflammation. The study,6 followed men and women who adhered to an anti-inflammatory diet consisting of fruits and vegetables, tea, coffee, whole grain bread, breakfast cereal, low-fat cheese, olive oil and canola oil, nuts, chocolate, and moderate amounts of red wine and beer over 16 years.

There is an interesting parallel in studies looking at an anti-inflammatory diet and those assessing a Mediterranean diet. While the Mediterranean diet may include small amounts of red meat which is considered a pro-inflammatory food, most other aspects of these foods are anti-inflammatory so the net effect is still healthful; and offers further support for the importance of food patterns or specific foods. 

No Matter Your Age, a Meditteranean Diet Is Beneficial 

“The best approach to sounder sleep and better health is by striking a balance between the foods you chose to eat and the foods you avoid,” Dr. Yannakoulia says. In effect, if you want to improve your sleep and decrease your risk of chronic diseases into the foreseeable future, commit to a healthy eating pattern—one that builds meals around anti inflammatory foods and steers clear of fried, fast, and processed foods.

Dr. Fung stresses that while the anti-inflammatory aspects of a Mediterranean eating pattern are important, these foods have other benefits, too. In addition to the anti-inflammatory and anti-oxidative effects, the Mediterranean diet can increase adiponectin,12 a hormone responsible for regulating glucose-levels and facilitating fatty-acid breakdown, which is important for healthy sleep cycles as well as for reducing the risks of diabetes, obesity, heart disease, and potentially even arthritis and osteoporosis.

If you are stuck in a cycle of poor sleep, poor eating, little exercise, and high stress, a good place to start may be adjusting your diet.3 Without good quality sleep, your body is apt to produce more of a hormone called ghrelin, which sends a signal to the brain that you need to eat, now.  At the same time, sleep-deprivation decreases leptin, the hormone responsible for alerting the brain to slow eating down.

Conversely, too little leptin tells the brain that you need more food.  When you adopt an eating approach that is closely aligned with the Mediterranean diet, chances are you will sleep more soundly, get your digestive hormones in check, and most importantly, lower your overall risk of chronic diseases that would otherwise likely worsen with age.

Moving Toward a Plant-based Approach is Key to Long-Term Health

Probably the most important point to remember, Dr. Fung tells EndocrineWeb, is that while the Mediterranean diet reflects a healthy approach to eating, the more important goal is for you to find the precise food plan that works best for you; one you can stick with (more or less) day in and day out.

Although you don’t need to adhere formally to a Mediterranean diet, Dr. Fung recommends trying to move toward a more plant-based eating plan that features: “fruits, vegetables, whole grains, plant proteins (eg, beans, seeds, and nuts) and fish.” 

A final thought: While eating patterns can foster lifelong health, there are some foods that are needed by everyone. For example, getting some green leafy vegetables every day is important; selecting the type of greens (eg, kale, spinach, Swiss chard, Watercress, Romaine, Boston, Bibb, etc) is up to you.

She also stresses the importance of gut microbes, suggesting that you include low-fat, unsweetened yogurt in your diet regularly.  [Tip: add fresh or frozen fruit and nuts for a tasty and powerful anti-inflammatory boost.] 

What about supplements? Dr. Fung responds, “High-quality research has consistently shown that [nutritional] supplements have little benefit in a well-nourished population.” In other words, get the nutrients you need from the foods you eat.

Sleep along with a healthy diet, regular exercise, and making an effort to keep stress low, are components that are essential for a healthy life at any age, and the best way forward if you are committed to aging gracefully. 

While the Sleep in Aging study focused on an older population,3 the findings suggest that the Mediterranean diet would have just as beneficial an effect on sleep patterns in younger adults, says Dr. Yannakoulia.

A final recommendation—Begin by adding anti inflammatory foods to your daily repertoire before you focus on eliminating foods. As Dr. Fung says, “because you eat foods in combinations (as meals), when you increase your intake of healthful foods, the usual trend is that the intake of unhealthy foods will very likely  decrease quite naturally.” 

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