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What's so special about the Mediterranean Diet?

We’ve teamed up with Dr Jenna Macchiochi – a Hove-based immunologist, lecturer, fitness instructor and keen home cook – to bring you a series of articles explaining the benefits of including more fresh fish and shellfish in your diet and the science behind it. In this third guest blog, Jenna explains the ‘Mediterranean Diet’ and why it's so good for you...


You may have heard about the ‘Mediterranean Diet’ and conjure up holiday eating in Italy or Greece - or perhaps thought it's just another diet scam. The Mediterranean Diet term emerged from early 1960s health data which linked a lowered risk of heart disease, neurodegenerative diseases and cancer to the traditional eating pattern observed in Greece and Southern Italy. It’s not the only healthful eating pattern out there, but with thousands of research papers supporting its health benefits, the Mediterranean Diet is perhaps the best studied healthful global diet pattern.


A note on diet patterns


Although many of us often seek out the latest so-called 'superfoods', or focus on individual nutrients, diet patterns examine the effects of overall diet. This makes more sense as we eat food not nutrients - and nutritional quality of any given diet must be taken in context of everything that is eaten. Dietary patterns represent a broader picture of food and nutrient consumption, and may be more predictive of how healthful a diet is. When it comes to Mediterranean eating, it is the combination of these foods that appear protective against disease.


What is the Mediterranean Diet?


Typically Mediterranean-style eating includes minimally processed foods that make up nutrient-dense, fibre-focused meals. It's rich in fresh fruits, vegetables, legumes and wholegrains, and uses spices for flavour (reducing the need for salt) with moderate protein and quality fats (1). As much as it's about what to include in your diet, it's also about what to exclude: sugar, sweetened beverages and highly-processed foods are all off the Mediterranean menu.


Plant-focused, not plant based


Whilst it's rich in plants, it's not plant-based. Animal foods like dairy, poultry and eggs are eaten in small quantities, with the preferred protein source being from fish and seafood - one of the key ingredients to the overall healthfulness of this diet pattern. Fish and seafood are a fantastic source of high-quality protein which means they contain all the essential amino acids (building blocks of protein) that our body needs. Marine sources of protein are generally rich in nutrients while being lower in calories than other protein sources like red meat. The protein content of fish makes it highly satiating, helping you stay fuller for longer. So, although not a weight-loss diet, eating fish and seafood as part of a Mediterranean-style dietary pattern is generally associated with lower risk of becoming overweight and obese, and may positively affect body composition.


Good fats from fish and a healthy heart (and brain)


Healthy fats are a mainstay of the Mediterranean diet. One interesting finding of this eating pattern is that it dispels the myth that people with or at risk for heart disease must eat a low-fat diet. Although Mediterranean eating is higher in total fat intake than some diets, it's the quality and type of fat that matters. Low in saturated fat - a specific type of fat that is known to be bad for our health - Mediterranean eating is rich in unsaturated fats. These include monounsaturated fats like olive oil, nuts and avocados, plus polyunsaturated fats predominantly from fish and seafood.


The PREDIMED study - a clinical trial including thousands of people with diabetes or other risk factors for heart disease - found that a Mediterranean diet without any fat and calorie restrictions reduced the rates of death from stroke by roughly 30% (2).


Another study found that people who followed a Mediterranean-type eating pattern including quality protein and fats from fish and seafood were 46% more likely to age healthfully, without declines in mental health and cognition with age (3).


And the health benefits don’t stop there! Evidence suggests that there may be some protective effect from replacing red meat with fish on risk of colorectal cancer (4). There is some evidence that eating fish during pregnancy may be associated with a lower risk of atopic conditions in the offspring, particularly for eczema (5).


Where to start with Mediterranean-style eating


If the idea of overhauling your entire way of shopping and eating seems daunting, then start small. Choose a few aspects and work on making them a habit.


Firstly, replace meat and poultry with fish. In particular aim for 2-3 portions of oily fish like salmon, sardines and mackerel each week. Increasing intakes on a population level can put greater strain on fish stocks: the concern that current fishing practices are unsustainable has led to the development of considerable work to ensure that fish stocks are not depleted. Using a local fish and shellfish delivery service like Nutritious Fish brings peace-of-mind that fish has been sustainably sourced within the UK, plus you benefit from plenty of inspiration for cooking fish and seafood in new ways.


Secondly, swap to olive oil for cooking and salad dressings. You might have heard that we shouldn't cook with olive oil but this is slightly misguided. It's true that some oils can be damaged by cooking, but olive oil with its plentiful polyphenols and antioxidants protects this oil making it perfect for home cooking.


Thirdly, give your meals a plant slant. We can all work on increasing our intake of fruits and veggies, but what about including more wholegrains, nuts and seeds, beans and pulses in your diet? Diversity is the key: switch up your shopping and challenge yourself to include more plant-based foods in your diet.


Finally remember ‘Gioie della Tavola’ (The joys of the table) - whilst we often want to focus on food and nutrition, eating Mediterranean-style also has cultural aspects that are good for our health. Taking pleasure in the cooking process, taking time to eat and digest food properly, sharing meals with family and friends and enjoying an occasional glass of wine.


Photography: Emma Croman


References:


(1) Willett WC, Sacks F, Trichopoulou A, Drescher G, Ferro-Luzzi A, Helsing E, Trichopoulos D. Mediterranean diet pyramid: a cultural model for healthy eating. AJCN. 1995 Jun 1;61(6):1402S-6S.


(2) Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM. Primary prevention of cardiovascular disease with a mediterranean diet supplemented with extra-virgin olive oil or nuts. New England Journal of Medicine. 2018 Jun 13. [Note: reference updated in June 2018 due to retraction and republication]


(3) Samieri C, Sun Q, Townsend MK, Chiuve SE, Okereke OI, Willett WC, Stampfer M, Grodstein F. The Association Between Dietary Patterns at Midlife and Health in Aging: An Observational Study. Annals of internal medicine. 2013 Nov 5;159(9):584-91.


(4) Jedrychowski W, Maugeri U, Pac A, Sochacka-Tatara E, Galas A. Protective effect of fish consumption on colorectal cancer risk. Hospital-based case-control study in Eastern Europe. Ann Nutr Metab. 2008;53(3-4):295‐302. doi:10.1159/000195770


(5) Zhang GQ, Liu B, Li J, et al. Fish intake during pregnancy or infancy and allergic outcomes in children: A systematic review and meta-analysis. Pediatr Allergy Immunol. 2017;28(2):152‐161. doi:10.1111/pai.12648

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