The food of the Mediterranean diet is but a small portion of what makes it unique. There are many important lifestyle factors associated with the diet that likely play just as important a role in the health and wellness benefits of the diet as the food itself. The combined effect of these habits appears to be a lowered risk of heart disease and all-cause mortality, a lower average body mass index, and, more subjectively, reduced stress levels and a greater sense of life satisfaction.
The main lifestyle factors that are important to a Mediterranean diet lifestyle are physical activity, abstention from tobacco use, low to moderate alcohol usage, longer meal times, and a strong sense of community. I’m sure living close to beautiful beaches doesn’t hurt, either. Beach proximity aside, we will be carrying these factors over to the Ketogenic Mediterranean lifestyle, so let’s use this opportunity to get better acquainted with each one.
PHYSICAL ACTIVITY. Walking, leisure sports, and manual labor around the house are common aspects of life in many parts of the Mediterranean, and, subsequently, residents of that region do not struggle to meet the recommended daily amount of physical activity. Exercise can certainly be about performance and pushing your limits, but for our purposes it is more about baseline wellness. You can pick any metric, from mental well-being to lung capacity to bone strength, and it will be positively correlated with regular physical activity. Of course, correlation is not good enough. In this case, however, there are many well-described physiological mechanisms responsible for these benefits. I will offer some prescriptions for ways to incorporate more physical activity into your daily routine in the next section and point you to some great resources if you are interested in understanding these mechanisms.
TOBACCO USE. In this day and age, there are very few people left that deny the many negative health consequences of tobacco product usage. In spite of this apparent understanding, the use of tobacco products is still more widespread than it should be in the United States. If you are a smoker or use smokeless tobacco products (like chewing tobacco, known as dip), cessation of these products is the single best lifestyle change that you can make to reduce your risk of early death or debility. The recent rise in using e-cigarettes as a smoking alternative, or “vaping,” certainly seems like an improvement, but early research indicates that it does not come without risks of its own. Total cessation is the best policy.
MODERATE ALCOHOL USE. Moderate alcohol use means no more than one to two servings daily, and in the traditional Mediterranean diet, alcohol means red wine. This is likely a good example of correlation but not causation. There is no evidence that I am aware of indicating that there is anything uniquely beneficial to red wine itself. While it is included in traditional Mediterranean diets and traditional Mediterranean diets seem to be protective against a whole host of negative health outcomes, it has only been assumed that red wine is in some way protective. It has been theorized that the antioxidant content of the flavonoids in the skins of the grapes may be a factor. My theory is that a good glass of red wine is divine and when it is enjoyed with friends or family, it is even better. The improved mood and life quality experienced while enjoying that glass of wine likely lowers stress levels, which in turn lowers inflammation. Lowered inflammation is absolutely protective against disease.
Regardless of the mechanisms at play, if you enjoy red wine you should feel free to continue enjoying it while pursuing a Mediterranean diet. However, this is one of those situations in which you can have too much of a good thing. One to two glasses is associated with good health, but any more than that results in diminishing returns. Additionally, one five-ounce serving of red wine contains four grams of carbohydrates, so you’ll want to enjoy it in moderation for sure.
LONGER MEAL TIMES. People enjoying the Mediterranean lifestyle do a better job of remembering that meals are not only a time to nourish the body, but can also be a fantastic way to take a brief repose from the stress of the day and nourish the mind. Because it takes at least 20 minutes for your brain to register the chemical signals your body manufactures to indicate that you are full, enjoying your meals more slowly also allows for better portion control. If you slow down while eating, you give yourself time to relish your meal and listen to the cues from your body that tell you when you're full. This ties into the concept of “mindful eating,” which I will discuss in greater detail in the next section. For now, we’ll just say there is no place in the Mediterranean diet for standing in front of your fridge stuffing cold falafel in your mouth before running off to do errands.
COMMUNITY. It is difficult to overstate the incredible and far-reaching effects that a strong sense of community can have on your health. Multiple studies have noted a correlation between having a place in a community and having higher life satisfaction scores, increased happiness ratings, and more positive health outcomes.
Maslow’s hierarchy of needs, the famous theory of human motivation, organizes human needs into a pyramid with physiological needs like food and water at the bottom and the idea of “self-actualization,” or the realization of one’s talents, at the top. But just below this need to use our talents is the need for esteem, or a sense of belonging. In other words, we think of a sense of community as a basic human need. That goes a long way toward explaining why the strong sense of community associated with the Mediterranean lifestyle would lower stress and be correlated with better health.
We will focus on this aspect in the following section. In a society that has been told for the last 40 years that fat is bad, eating a diet that is 70 to 80 percent fat can be understandably isolating. Thankfully, there are ways to mitigate this isolation by finding a community and enjoying the wonderful feeling of sharing a meal with loved ones.
The Mediterranean Diet is So Much More
The Mediterranean diet as we know it was manufactured by the Harvard School of Public Health and Oldways, the food and nutritional education organization. It represents an intentional effort on the part of the public health community to take their observations of populations that tend to be very healthy and make them accessible to a broader audience. Thankfully, the subsequent popularity of the diet has prompted food manufacturers and importers to widen the variety of foods that are readily available, making it easier than ever to follow a Mediterranean diet.
While the eating pattern has been the most heavily studied aspect of this lifestyle, I still feel that it is inappropriate to refer to it only as a “diet” because of the lifestyle aspects that are a necessary component. Thankfully, none of these lifestyle changes are outside our reach. They can all be implemented relatively easily with the right guidance. Regular physical activity, cessation of tobacco use, the inclusion of (or restriction to) a moderate amount of alcohol, more mindful eating, and a sense of community are all beneficial habits regardless of the diet you are pursuing.
It is time to take the Mediterranean lifestyle to the next level and incorporate the principles of the ketogenic diet. Carbohydrate restriction and inclusion of the right kind of fats, combined with the whole-foods and flavor-rich approach of Mediterranean cuisine, will yield amazing health benefits without any sense of sacrifice. It is high time we explore what these two amazing dietary plans can be when combined.