Chapter 2
IN THIS CHAPTER
Taking a close look at the powerful nutrients found in simple foods and functional foods
Toasting to the health benefits of red wine
Highlighting heart health research
Looking and feeling your best with anti-aging tips
Dealing with diabetes and cancer through a Mediterranean diet
The Mediterranean diet has long been touted for providing health benefits, such as reducing coronary artery disease and decreasing the risk of some cancers. Including fresh vegetables and fruits, legumes, and healthy fats into your diet can help improve your health in many ways. And in addition to the health benefits, you’re eating foods with full flavor. Thinking of bland or boring Greek or Italian food isn’t easy.
This chapter highlights why this diet is full of health benefits (focusing on heart disease, cancer, diabetes, and anti-aging) by looking at some of the main nutrients found in Mediterranean eating.
A plant-based diet such as the Mediterranean diet offers a plethora of nutrients that can help your body stay healthy. These plant foods are loaded with vitamins, minerals, antioxidants, phytochemicals, and healthy fats. The following sections highlight some of these key nutrients found in the foods associated with the Mediterranean coast.
Antioxidants are a key component of many plant foods that help slow down the process of oxidation (when your body’s cells burn oxygen). This slowing decreases the amount of free radicals, or unstable molecules, that cause damage to your cells, tissues, and DNA. Antioxidants are a crucial part of your diet because you can’t avoid oxidation all together. Consider the many contaminants, such as car exhaust, sunlight, unhealthy foods, and air pollution, that you’re exposed to during a typical day. These types of exposures can cause free radicals to gain speed in your body, damaging everything in their path and leaving you at greater risk of chronic conditions like heart disease and cancer.
Think about slicing an apple. Before you know it, the exposed flesh turns from white to brown. This browning occurs because of oxidation. But adding orange juice or lemon juice to the apple right after you slice it keeps it whiter longer because the antioxidant vitamin C in the juice protects the flesh.
Eating a diet high in antioxidants such as vitamin C, vitamin E, and beta-carotene means better protection for your body and overall health (no, the benefits of antioxidants aren’t just for apples). The ATTICA study in the September 2005 issue of the American Journal of Clinical Nutrition measured the total antioxidant capacity of men and women in Greece. It found that the participants who followed a traditional Mediterranean diet had an 11 percent higher antioxidant capacity than those who didn’t adhere to a traditional diet. The findings also showed that the participants who followed the traditional diet the most had 19 percent lower oxidized LDL (bad cholesterol) concentrations showing a benefit in reducing heart disease.
TABLE 2-1 Antioxidant-Rich Foods
Antioxidant |
Foods |
Vitamin C |
Asparagus |
Broccoli |
|
Cantaloupe |
|
Cauliflower |
|
Grapefruit |
|
Green and red bell peppers |
|
Guava |
|
Lemons |
|
Oranges |
|
Pineapple |
|
Strawberries |
|
Spinach, kale, and collard greens |
|
Tangerines |
|
Tomatoes |
|
Vitamin E |
Mustard greens, Swiss chard, spinach, and turnip and collard greens |
Almonds |
|
Peanuts |
|
Sunflower seeds |
|
Beta carotene |
Broccoli |
Cantaloupe |
|
Carrots |
|
Cilantro |
|
Kale, spinach, and turnip and collard greens |
|
Romaine lettuce |
Besides vitamins and minerals, plants also contain phytochemicals. Don’t be scared by the big word. Phytochemicals are simply healthy chemicals that offer your body healthful benefits. As we say repeatedly throughout this book, a plant-based diet high in fruits, vegetables, and legumes can provide you with an increased amount and variety of phytochemicals, helping to promote heart health and working to prevent certain cancers.
Research in this area is relatively new and is uncovering a whole side of previously unknown health benefits. To date, certain phytochemicals have been shown to work as antioxidants (see the previous section), contain anti-inflammatory properties, and promote heart health.
TABLE 2-2 Potential Health Benefits of Foods by Color
Color |
Health Benefits |
Foods |
Blue/purple |
A lower risk of some cancers; improved memory; and healthy aging |
Blueberries, eggplants, purple grapes, and plums |
Green |
A lower risk of some cancers; healthy vision; and strong bones and teeth |
Broccoli, green peppers, honeydew melon, kiwi, salad greens, and spinach |
Red |
A lower risk of heart disease and of some cancers, and improved memory function |
Pink watermelon, red bell peppers, and strawberries |
White |
A lower risk of heart disease and of some cancers |
Bananas, garlic, and onions |
Yellow/orange |
A lower risk of heart disease and of some cancers; healthy vision; and a stronger immune system |
Carrots, oranges, yellow and orange bell peppers, and yellow watermelon |
Your body gets vitamin D, otherwise known as the sunshine vitamin, both from food sources and from exposure to sunlight. You want to make sure you get the appropriate amount of vitamin D; people in the Mediterranean may be healthier because they have strong levels of the vitamin.
The scientific community has been buzzing in the last ten years about the health benefits of vitamin D. Research shows this vitamin can help
One theory suggests that the people of the Mediterranean coast are healthier because they’re exposed to more sunlight — specifically, the ultraviolet B rays that are responsible for producing vitamin D — because of their location near the equator and because they’re outside more often walking, gardening, working, or enjoying family and friends.
In addition to the sun, you can get vitamin D from a few foods, such as fish, fortified cereals, and fortified milk. Food sources are limited, so you mostly need to depend on sun exposure to get the proper amounts.
Researchers agree that people’s vitamin D levels need to increase, although the level of increase is still up for debate. In 2010, the Institute of Medicine released a report recommending the following daily intake of vitamin D:
The Mediterranean diet is lower in omega-6 polyunsaturated fats (or fatty acids) and saturated fats than most people’s diets are; it’s also higher in healthy fats, such as monounsaturated fats and omega-3 polyunsaturated fats. (For reference, you find monounsaturated fats in foods such as olive oil, avocadoes, and certain nuts. Polyunsaturated fatty acids are in corn, safflower, soybean, sesame, and sunflower oils and seafood. Saturated fatty acids appear in animal-based foods such as meat, poultry, butter, and dairy products, as well as in coconut and palm oils.) The higher percentage of monounsaturated fats found in the Mediterranean diet is associated with
Omega-3 fatty acids are one of the big contributors to the health benefits of the Mediterranean diet, and many people don’t get enough of them. Research shows that omega-3s help reduce inflammation, which is specifically important for those with inflammatory diseases such as arthritis, cardiovascular disease, or inflammatory bowel disease. These fats are also shown to be helpful for weight management, immune system function, behavioral issues such as attention deficit (hyperactivity) disorder, mood disorders such as depression, and prevention of Alzheimer’s disease.
Omega-6 fatty acids occur abundantly in the diet through sources such as grains, nuts, and legumes as well as sunflower, safflower, sesame, and corn oils. Omega-6 fats lower cholesterol, help keep the blood from clotting, and support skin health. Both omega-3 and omega-6 fats are considered essential, which means your body doesn’t make them and needs to get them from your diet.
The big trouble begins when omega-3s aren’t balanced appropriately with omega-6s. A diet too high in omega-6 fatty acids and too low in omega-3 fatty acids can promote conditions of chronic inflammation, including atherosclerosis, arthritis, and inflammatory bowel disease. Preliminary research also shows a possible connection to obesity, depression, dyslexia, and hyperactivity. This out-of-balance fat intake is very common in the American diet (with a ratio of 15 to 20 omega-6s to 1 omega-3) and less common in a Mediterranean style diet. Experts say to shoot for balance with a ratio closer to 1 part omega-6 and 1 to 2 parts omega-3.
“Eat more fiber.” You’ve probably seen this message in advertisements and the media. You can get all the fiber you need by eating the Mediterranean way, focusing on fruits, vegetables, whole grains, and legumes.
Fiber is what you may call the “roughage” found in plants. Your body doesn’t digest fiber like it does nutrients; fiber goes through your gastrointestinal tract intact. This process has a bigger impact on health than you may think; its very important roles include the following:
Functional foods are foods that provide a function other than basic nutrition, offering either specific health benefits or disease prevention. Often, these foods are high in phytochemicals, antioxidants, or good bacteria that can decrease your risk of disease.
You don’t need to get caught up in buying expensive packaged foods that promise you a cure-all; just focus on eating common Mediterranean cuisine. Easy! The following sections highlight some of the more common functional foods included in Mediterranean eating.
TABLE 2-3 Functional Foods
Food |
Benefits |
Extra-virgin olive oil |
Extra-virgin olive oil contains high levels of monounsaturated fats and is a good source of phytochemicals, including polyphenolic compounds, squalene, and alpha-tocopherol. Health benefits include cardiovascular health, cancer prevention/protection, and immune boosting. |
Lemons (zest and juice) |
Citrus bioflavonoids benefit both cholesterol and triglycerides. Lemon is also dense source of vitamin C and has anti-inflammatory properties. |
Tomatoes and tomato products |
Lycopene in tomato products benefits prostate health. Tomato is also a good source of vitamins A and C and carotenoids. |
Grapes and grape products (such as red wine) |
Phytochemicals in grapes, including polyphenols and resveratrol, are noteworthy for heart health and brain protection. |
Nuts |
Nuts are dense in monounsaturated fats and vitamin E; they also provide anti-inflammatory benefits and cardiovascular protection. |
Yogurt |
Yogurt is a fermented food providing healthy bacteria to your gut, plus healthy fats. |
Garlic |
Garlic contains allicin, a phytochemical to help regulate blood pressure. |
Fresh herbs (parsley, basil, oregano, rosemary, and so on) |
Herbs are antioxidant and vitamin dense, plus they contain heart-protective phytosterols. Some herbs are often used medicinally. |
Olives |
Olives are fermented foods providing healthy bacteria to the gut, along with heart-healthy omega-3 fatty acids. |
Fatty fish |
Fish are rich in omega-3 fatty acids and help reduce triglycerides and inflammation. |
Leafy greens |
Greens contain phytochemicals such as carotenoids, sulforaphanes, apigenin, and lutein/zeaxanthin. They’re cancer protective, immune boosting, vision protective, and heart healthy. |
Eggs |
Eggs are rich in vitamin D, lecithin, choline, and lutein/zeaxanthin. Benefits include vision health, brain health, hormone regulation, and bone health. |
As you read this book, you have trillions of little creatures working hard inside your body to keep you healthy. These creatures, better known as your gut bacteria, are what scientists call your second brain.
Your gut bacteria change and shift depending on what you eat. Emerging research shows that a microbe balance more heavily populated with good bacteria can improve your immune system, help keep your mood in check, improve digestion, and even help you manage your weight more effectively. When the balance is off and you’re not supporting the good bacteria, it can affect your body in a negative way. Chronic gas, bloating, and indigestion are signs that your gut bacteria may be out of whack. On a bigger scale, your bacteria may indicate your risk of chronic disease. Your gut bacteria have many important roles, such as building vitamins during digestion and signaling your immune system. Research is beginning to show people with chronic diseases like diabetes may have a different mix of bacteria than healthy individuals. This is a new and exciting field that needs more exploration, but for now it’s wise to feed and expand your good bacteria.
Fermented food is full of healthy bacteria sometimes called probiotics and is quite popular in Mediterranean cooking. Fermentation is the process where the sugars and starches from fruits and vegetables are converted to lactic acid, which in return preserves food without refrigeration or canning. The most common fermented foods in Mediterranean meals are yogurt, cheese, wine, sourdough bread, and brined foods like olives, capers, artichokes, and peppers. Whether you snack on some peppers or have a slice of sourdough toast in the morning, you’ll be making your gut happy and healthy.
You’d be hard pressed to find a Mediterranean cookbook that doesn’t offer recipes using nuts and seeds. A traditional Mediterranean diet was a poor person’s cuisine, so people ate what they could readily grow, including many varieties of tree nuts.
Nuts are made up of fat and protein, making them a perfect snack or meal component to help you feel full and satisfied. As a functional food, many nuts contain omega-3 fatty acids and/or monounsaturated fatty acids shown to help with heart health and decreasing inflammation. Nuts are also a great source of vitamin E, an antioxidant shown to protect the artery walls from forming plaque. According to a 2016 systemic review posted in the British Journal of Nutrition, higher nut consumption is associated with a decreased risk of coronary artery disease and mortality.
Nuts are also high in magnesium, a nutrient many people are lacking in the typical American diet. Mild magnesium deficiency is difficult to diagnose but may be more common than you think. Symptoms include insomnia, muscle cramps, headaches, and nausea.
Drinking more red wine, like many people on the Mediterranean coast do, may be one reason you’re excited about switching to a Mediterranean diet. Red wine has certain properties that research has shown are beneficial for heart health. If you drink alcohol in moderation, add a little red wine in place of other alcoholic beverages. (If you’re not a fan of red wine, drinking grape juice made from Concord grapes and eating purple grapes also provide similar heart-health benefits.)
The cardio protection red wine provides is attributed to the antioxidants from flavonoids found in the skin of the grapes. The flavonoids reduce your risk of heart disease by lowering bad cholesterol, increasing good cholesterol, and reducing blood clotting. A specific flavonoid called reservatol may have additional benefits, including inhibiting tumor development in certain cancers, but that research is still in early stages.
The Mediterranean diet is most noticed in the scientific community for its effect on heart health. Heart disease is the number one cause of death in the United States, even though a few lifestyle changes make it easily preventable. Genetics still play a strong role, of course, but making small changes to your diet and exercising make a big difference.
The first research focused on the Mediterranean diet started with a scientist named Ancel Keys and the Seven Countries Study. This study found that southern Europe had far fewer coronary deaths than northern Europe and the United States did, even when factoring in age, smoking, blood pressure, and physical activity. These results made researchers look more closely at the differences in dietary habits. This study is still important today because more people in the Mediterranean regions studied no longer eat in their traditional way, and those regions show higher occurrences of heart disease.
Recent research continues to show a correlation between a traditional Mediterranean diet and lower incidence of heart disease. According to a 2011 review of several studies covering 535,000 people that was published in the Journal of the American College of Cardiology, a traditional Mediterranean diet is associated with lower blood pressure, blood sugar, and triglyceride levels.
Another study published in the New England Journal of Medicine in 2013 observed more than 7,400 individuals who were already at high risk of heart disease. The participants were assigned a Mediterranean diet with olive oil, a Mediterranean diet supplemented with nuts, or a traditional Westernized lowfat diet. After following the participants for five years, the study found the folks following either Mediterranean style diet had a 30 percent reduction in cardiac events. This study highlights that a lowfat diet isn’t necessarily the answer for reducing cardiac events; the type of fats eaten, primarily nuts and olive oil, are more important.
Many more studies have shown the heart health protection of a diet high in fruits, vegetables, legumes, wine, and seafood, which support the idea that the Mediterranean diet is a healthy lifestyle. We’re sure you’ll continue to see more and more research on this topic in the future.
Another area research on the Mediterranean diet has focused on is the diet’s effects on preventing and managing cancer. Specific staples of the diet have been shown to provide cancer-preventing and cancer-fighting benefits:
In addition to these ingredient-specific studies, the diet as a whole has some promising research. A 2008 study review published in the British Medical Journal showed that following a traditional Mediterranean diet reduced the risk of dying from cancer by 9 percent. That same year, the American Journal of Clinical Nutrition published a study that showed that among post menopausal women, those who followed a traditional Mediterranean diet were 22 percent less likely to develop breast cancer. The EPIC study has also published papers on the association between the Mediterranean diet and cancer risk. (Head to the nearby sidebar “Taking in the evidence with the EPIC cohort study” for more on the EPIC study.) A 2011 study published in the British Journal of Nutrition found that those who adhered more closely to a Mediterranean diet had a decreased rate of cancer. Although more research is needed in this area, you can enjoy a Mediterranean diet and know that you’re helping increase your odds against cancer.
The foods in a Mediterranean diet make perfect sense for a person with type 2 diabetes because the food choices lean toward being low-glycemic. The glycemic index is a measurement given to carbohydrate-containing foods that shows how quickly they turn into blood sugar. High-glycemic foods create a quick, high blood sugar spike, while low-glycemic foods offer a slow blood sugar rise. A diet that provides this slow rise in blood sugar is best for diabetics, who can’t manage a large influx of sugar normally. Most vegetables, fruits, whole grains, and legumes (hallmarks of the Mediterranean diet) provide a much slower blood sugar response compared to white bread, white pasta, or sugary snacks. A 2009 study from the Second University of Naples in Italy published in the Annals of Internal Medicine, found that diabetics who followed a Mediterranean diet instead of a lowfat diet had better glycemic control and were less likely to need diabetes medication.
The portion sizes in the Mediterranean diet can also make a significant difference for a diabetic. Starchy foods such as the whole grains found in cereals and breads can also make blood sugar rise if a person consumes too much of them, but the portion sizes associated with a Mediterranean pattern of eating are much lower and help keep total carbohydrate intake during the meal in check.
But the benefits don’t stop at those who already have diabetes; this diet pattern may help you reduce your risk of getting the disease. A 2015 meta analysis published in Public Health Nutrition showed that those who more closely follow a Mediterranean diet pattern had a 19 percent decrease in the risk of developing type 2 diabetes. The SUN cohort study from the University of Navarro, Spain, which involved more than 13,000 participants with no history of diabetes, showed that those participants who followed a Mediterranean style diet were less likely to develop type 2 diabetes. What’s more interesting about this study is that participants who had high risk factors for type 2 diabetes (including older age, family history of diabetes, and a history of smoking) and followed the diet pattern strictly had an 83 percent relative reduction for developing the disease.
A Mediterranean lifestyle can also help you feel and look your best. A diet high in nutrients, moderate activity, and lots of laughter with friends lets you enjoy the benefits of health! Here are some of the ways you can age gracefully with a Mediterranean lifestyle.