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The Mediterranean Diet: Is It the Most Healthful Eating Plan Known to Man?

Antonio Todde would probably have lived his life in total obscurity had someone not found his birth certificate. It proved that the shepherd from Sardinia, at age 111, was the oldest man in the world. When told of his distinction, the curmudgeonly Todde responded by asking, ‘You have come all this way to tell me that I’m the oldest man? Who says so?’

When scientists examined the possible reasons for Todde’s longevity, several factors emerged. Genetics undoubtedly played a role: One of Todde’s sisters was 100 years old, and his father had lived to 90. His mother might have made it past 100 had she not eaten a piece of poisoned cheese at age 99. Sardinia, the island off Italy where Todde spent his entire life, was known for its unusual abundance of centenarians. Was it the simple, relatively stress-free life that enabled Sardinians to live so long?

Perhaps. On the other hand, a scientific project designed to identify the secrets behind Sardinian longevity found that most of the older people on the island also had a deficiency of an enzyme called glucose 6PD, which can cause a disease marked by rapid destruction of red blood cells should a person with the deficiency eat (of all things) fava beans. Somehow, the enzyme deficiency interacted with other genes to confer long life. Antonio Todde had a far simpler explanation: ‘You take one day after the other; you just go on. Just love your brother and drink a glass of good wine.’

Todde’s diet, as it turned out, was in keeping with current theories about the interaction between what you eat and how long you live. He didn’t take in too many calories, basing his diet on pasta and soup. He did have some pork or lamb each day in moderate amounts, always including a glass and a half of red wine. His diet was a version of what’s known as the Mediterranean diet.

The Mediterranean diet is named for the eating style prevalent in European countries abutting the Mediterranean Sea, especially Greece, Italy, the south of France and Crete. It has some of the best features of the Zone diet, as well as the Paleolithic, or Stone Age, diet, both of which have been discussed in detail in past issues of IRON MAN. What the diets have in common are natural elements that empower the human body to maintain health, energy and longevity.

What Is the Mediterranean Diet?

Like the Paleolithic diet, the Mediterranean diet has been around for thousands of years. It’s big on high fiber intake, mainly from fruits and vegetables, and moderate intake of whole grains. It boasts a moderate fat content, averaging between 30 and 35 percent of total daily calorie intake, precisely the same as the Zone diet. Also like the Zone diet, it emphasizes decreased saturated-fat intake and a higher intake of monounsaturated fat, mainly in the form of extravirgin olive oil. It features lowfat, high-protein sources, such as chicken and fish, with a moderate intake of red meats. The high-fiber fruits and vegetables are rich sources of natural antioxidants that research shows offer potent protection against the two major killers, cardiovascular disease and cancer.

Rigorous research has confirmed the protective effects of the Mediterranean diet against cardiovascular disease. The Lyons Diet Heart Study featured 605 people who had previously suffered a heart attack. After four years on a Mediterranean diet rich in alpha-linoleic acid, an omega-3 fat source and monounsaturated fat, the patients showed a 55 percent reduction in the risk of death, with 50 percent to 70 percent less risk of recurrent cardiovascular events than other patients not on the Mediterranean diet. The benefits couldn’t be explained by changes in blood fats, such as cholesterol. The GISSI-Prevenzione trial showed that those who went on a Mediterranean diet had more favorable survival rates after four years. Analysis of the diet showed that its active components included fish, fruit, vegetables and olive oil.

The Fat Connection

The so-called good fats, such as omega-3 fats derived from fish and the monounsaturated fat in olive oil, are primary components of the Mediterranean diet. Omega-3 fats are known to have various cardiovascular-protective effects, such as lowered triglycerides, or fat, in the blood and reduction of heart-rhythm disturbances. Trans fats, which have been structurally manipulated to increase the shelf life of (mostly processed) foods, are notably missing from the Mediterranean diet. Trans fats may decrease the oxidation that promotes spoilage and rancidity, but they’re the worst type of fat to eat. They’ve been linked to both cardiovascular disease and cancer. They’re even worse than the much maligned saturated fats: While both forms of fat increase low-density-lipoprotein cholesterol, or LDL, which is associated with cardiovascular disease, trans fats also lower protective high-density-lipoprotein cholesterol, or HDL.

Nuts are integral to the Mediterranean diet. As noted in recent IRON MAN features on nuts, they’re not the demonic food that so many people believe they are. Sure, they’re high in fat, but always the more beneficial monounsaturated and polyunsaturated fats’never the saturated form. Nuts are also rich in other protective nutritional elements, such as fiber, vitamin E, folic acid, potassium and magnesium. ALL A Little Vino’and Other Beneficial Features

A happy feature of the natural Mediterranean diet is that it permits a regular intake of moderate amounts of alcohol, mainly red wine. Red wine is rich in antioxidants called polyphenols, which exert potent protective effects and, with the alcohol itself, increase HDL. One study found that men who drink five or six alcoholic beverages a week had a 20 percent lower risk of mortality than nonimbibers.

The Mediterranean diet’s chief benefit seems to be that it contributes to a significant reduction in tissue inflammation.1 That’s because research has confirmed that out-of-control inflammation is at the core of most serious forms of disease, including cardiovascular disease, cancer and Alzheimer’s. A study published last year examined 1,514 men, aged 18 to 87, and 1,528 women, aged 18 to 89, from the Attica area of Greece who had regularly adhered to a Mediterranean diet. Comparing them with subjects who had not followed the diet, the researchers found that those who followed the Mediterranean plan showed an average of 20 percent less C-reactive protein, a major marker of overall inflammation in the body. They also had 17 percent lower levels of interleukin-6, an inflammatory cytokine, or protein, linked to high cortisol levels, and had lower levels of other inflammatory blood markers, such as homocysteine and fibrinogen.

Another study looked at all the elements of the Mediterranean diet related to heart attacks and concluded that one of its major benefits was high fiber intake.2 In fact, those who ate the most fiber while on the diet were a whopping 86 percent less likely to suffer a major heart attack. ‘Our data suggest that a substantial part of the postulated benefits of the Mediterranean diet on coronary risk might be attributed to a high intake of fiber and fruit,’ wrote the primary author of the study.

The Big Benefits of Using Olive Oil

Still, the food element most linked to the protective effect of the Mediterranean diet is virgin olive oil, a monounsaturated fat with phenol compounds. One study found that taking in a minimum of 25 milliliters a day of virgin olive oil would lead to reduced oxidation of the dreaded cardiovascular-disease-prone LDL.

Monounsaturated fat, the kind found in olive oil, is less subject to oxidation than other food oils and has a neutral effect on blood lipids, meaning that it doesn’t lower HDL in the blood. As Zone author Barry Sears notes, monounsaturated fats don’t adversely affect the synthesis of fat-based chemicals in the body collectively known as eicosanoids. That means monounsaturated fat protects against both cardiovascular disease and cancer. One scientist has estimated that up to 25 percent of the incidence of colorectal cancer, 15 percent of breast cancer and 10 percent of the incidence of prostate, pancreatic and endometrial cancers would be prevented if people adopted the Mediterranean diet eating style.

Monounsaturated fat exists in foods that don’t pack olive oil’s punch. Many scientists think that what sets virgin olive oil apart is its unique blend of antioxidant phenol compounds, such as oleuropein and hydroxytyrosol, which promote decreased oxidation of LDL in the blood. Olive oil also helps lower blood pressure, and it contains squalene, a substance that guards against various cancers, including skin cancer. Like prescription statin drugs, squalene inhibits the liver enzyme that synthesizes cholesterol from saturated fat and prevents the proliferation of smooth muscle within arterial walls, which narrows blood vessels and promotes heart attacks and strokes.

You’ve seen lots of olive oils on supermarket shelves, but extravirgin oil is what you want. Other types don’t have the phenols. You also need to be realistic about what olive oil can do for you. A recent meta-analysis of previously published studies explained that the amount of olive oil used in the typical Mediterranean diet is too small to provide significant antioxidant benefits,3 which underscores the fact that no single element of the Mediterranean diet works magic. Rather, the protective nutrients work in a synergistic fashion.

But Can It Work for Bodybuilders?

From a bodybuilding perspective, the Mediterranean diet can be used year-round. Prior to a contest, you would simply need to reduce calories. In actual practice those who follow the diet year-round would likely have low bodyfat levels, making any type of stringent precontest diet superfluous.

The generous intake of natural, unprocessed foods means that your food supplement budget would also be considerably reduced. You would need to include nutrients not found in abundance in natural foods, such as vitamin E. Adding a high-quality protein supplement would also be an excellent idea, since such products contain almost no carbs.

Following a Mediterranean diet may not allow you to live to 112, as it did for Antonio Todde, unless you also share his genes, but it will assure you of maximal health, help you avoid most degenerative diseases and permit you to develop a body rich in muscle and very low in fat. Mediterranean Diet Eating Tips So how do you eat a Mediterranean diet? The following are general guidelines:

1) Eat a wide variety of fruits and vegetables while avoiding fruit juices, which are mostly processed junk. Aim for seven to 10 servings of fruit and veggies daily, focusing on low-glycemic-index fruits and cruciferous veggies, such as broccoli and brussels sprouts. Avoid veggies prepared with butter or cream sauces.

2) Eat high-fiber breads, cereals or pasta. Stick with brown rice, avoid white bread, biscuits, breadsticks and other refined carbs. Avoid any food containing high-fructose corn syrup, a highly refined carb that easily converts into bodyfat.

3) Eat protein sources low in saturated fat. That includes lean cuts of red meat, skinless chicken and nonfat dairy. Forget about bacon, sausage and all types of processed meat, which are linked to prostate and colon cancers.

4) Make sure that you eat fatty fish containing omega-3 fats, such as salmon, trout, herring, water-packed tuna and mackerel. If you hate fish, take an omega-3 fish oil supplement.

5) Eat healthful oils, including extravirgin olive oil, canola oil and flaxseed oil. Avoid excessive intake of inflammation-promoting omega-6 oils, such as corn, sunflower, safflower, soybean and peanut oils.

6) Eat peas, beans and nuts. They’re all good fiber sources. Don’t eat salted nuts, stale or rancid nuts or honey-coated nuts.

7) Limit alcohol. If you choose to imbibe, have no more than one five-ounce glass of wine, a 12-ounce beer or 1.5 ounces of hard liquor a day.

8) Avoid trans fats. That includes margarine, fried foods, chips, crackers, baked goods, doughnuts (unless you’re a cop) and any food that contains partially hydrogenated vegetable oil.


1 Chrysohoou, C., et al. (2004). Adherence to the Mediterranean diet attenuates inflammation and coagulation processes in healthy adults: the Attica study. J Amer Coll Cardio. 44:152-158.
2 Martinez-Gonzalez, M., et al. (2002). Role of fiber and fruit in the Mediterranean diet to protect against myocardial infarction: a case-control study in Spain. Eur J Clin Nutr. 56:715-722.
3 Vissers, M.N., et al. (2004). Bioavailability and antioxidant effects of olive oil phenols in humans: a review. Eur J Clin Nutr. 58:955-965. IM

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