Leah:
Hello and welcome to the Ideal Nutrition Podcast. I’m Leah Higl and I’m here with my co-host Aidan Muir. And today we’ll be discussing our thoughts on the Mediterranean diet. So this is a pretty popular dietary approach. It is commonly linked with a bunch of health benefits. And that includes things like weight loss, weight management, but also things like heart health and an overall reduction in chronic disease risk. So it’s something that is quite popular and does have quite a lot of research behind it. So that’s what we’ll be going through today.
Aidan:
So talking about what the Mediterranean diet is, it is based on the traditional foods that people used to eat in countries bordering the Mediterranean Sea. And that includes places like France, Spain, Greece and Italy. It typically encourages fruits, vegetables, whole grains, legumes, nuts, seeds and healthy fats. Meat is included but less frequently and in comparatively small amounts. They include quite a lot of plant-based meals, so those meals just don’t have any meat. And fish is also consumed more frequently than it is in countries like Australia and stuff like that. But it’s still not like a huge, huge portion of their diet.
And they limit a lot of foods like processed foods, added sugar, refined grains. Those things are limited on this type of diet and alcohol, is something everybody talks about with Mediterranean diet, but it’s included, but it’s only in smaller amounts and it’s only alongside meals. Like we’re talking like a glass of wine alongside meals and stuff like that. Whereas other people might hear that and interpret it as being a lot more than that.
Leah:
Yeah. It’s not like a bottle of wine or dinner every night or anything crazy. But let’s start with things that we like about this approach. I think there’s like a lot of general positive themes, especially when you compare the Mediterranean diet to like the standard, like quote on quote, Western diet. There’s a lot of things that generally are improved if you were to make a switch. And that includes the fact that this diet is high in micronutrients. So you’re eating a lot of very nutrient-dense foods. It’s high in fibre, particularly because it is a lot of plant-based foods included, mostly minimally processed foods. So that’s always a good thing when your diet is mainly whole food based. There’s a lot of variety, again, particularly on that plant-based spectrum.
There is an emphasis on healthy fats, so things like nuts, seeds, and oily fish. Overall, it is a fairly anti-inflammatory style diet because of all these things and being rich in antioxidants. And it often is linked with stuff beyond just diet as well. So there’s like a social aspect to the Mediterranean-style dietary approach. So we know that like there is more to eating than just nutrition. is that kind of social and cultural aspect. And what I do like about it is it’s less focused on restriction and excluding things and more like look at all these awesome things you can include for health.
Aidan:
Going through some interesting research on the topic, the first one we’re gonna start off with is cardiovascular disease. So something that I personally have found very interesting is that the Mediterranean diet, in those who don’t lose weight, like they’re eating enough calories to maintain their body weight, which I think is a good control for these kind of dietary quality kind of things, it gives us interesting research. For those who don’t change their body weight, on average, their cholesterol doesn’t decrease, right?
But that’s a little bit of a red herring because there is a reduction in risk in cardiovascular disease still. It’s not huge, like it’s like a 10 to 20% kind of reduction in cardiovascular disease on average if they’re under those circumstances. But I remember reading quite a lot of studies on the Mediterranean diet and noticing that cholesterol didn’t decrease when body weight wasn’t reduced. And I originally interpreted that quite strongly as, well, reducing body weight is something that’s probably pretty important for reducing cholesterol because we have these studies where people dramatically improve their dietary quality like they reduce a lot of junk food and stuff like that and they increase their healthy fats and all these other things and cholesterol doesn’t change.
But I’ve kind of switched my perspective a little bit over the last few years of being like, yes, I do think getting lean is important in a lot of cases still, but we still see reductions in cardiovascular disease, which is the outcome we care about even if it’s not changing cholesterol that much.
Leah:
Another thing that we could look at when looking at the Mediterranean diet is its effect on depression and anxiety. So general like mental health outcomes, which is quite interesting. So there has been a link, like looking at the research, there is a link with positive outcomes for mental health, namely in regards to depression and anxiety above most other things and following this kind of dietary approach. One of the best randomised control trials that we do have on this would be the SMILES trial, which we’ve mentioned a fair few times in this podcast before.
It is an interesting one because participants were encouraged to follow a modified Mediterranean diet. I have an infographic in front of me, which I’m going to try to briefly summarise, but we will put in the show notes, which is located on the website anyway, if you wanted to have a look. But overall, this kind of diet was like, okay, let’s on a daily basis get in five to eight serves of whole grains, three serves of fruit, six serves of veg, two to three serves of dairy, 60 mLs specifically of olive oil.
Aidan:
Huge. That’s 500 calories.
Leah:
That’s 500 calories. So that’s something we’ll go over for sure in terms of like why that may not be the best approach for everybody, but this was something that was included in this protocol. And then one serve of nuts daily. So again, like more kind of higher calorie, high-fat options.
And then on a weekly basis, it just suggested that three to four serves of lean red meat. So that’s less than what probably most Australians consume. Legumes, three to four serves, definitely more than what most Australians consume. At least two serves of fish, two to three serves of poultry, up to six eggs a week. And then like extras in terms of like discretionary foods, less than three serves per week. So, far, far less than what most Australians would be consuming.
Aidan:
And for context, they defined extras as 600 kilojoules worth of junk food or whatever you’d call it. So three serves is 1800 kilojoules per week coming from that. To convert that to calories, it’d be like 150 calories is like 600 kilojoules. So 450 calories per week on extras.
Leah:
Which is very, very little.
Aidan:
Very little. For context as well, they were consuming above 20 per week. As the baseline.
Leah:
Yes, that’s a huge difference in overall dietary quality. And then from an alcohol perspective, there was just a general guideline on no more than two standard drinks per day, which like two standard drinks per day is still like a fair bit of alcohol, which I found was interesting, but not everyone had up to that. Like that was just like a maximum. But so that was the diet, the modified diet in general, which followed obviously that Mediterranean approach.
And the dietary intervention group had a much greater reduction in their depressive symptoms over the three month period that they followed that diet compared to those who were just having like the social support from their intervention and not the dietary change. At the end of the trial, a third of those in the dietary support group met criteria for remission of major depression. So that’s like pretty huge. Like a third of the people who were following this diet went into remission for major depressive disorder. I think that’s just wild to me.
Aidan:
Yeah. And like something I’ve spoken about before, like in the last podcast we were talking about probiotics is like this study, this one was the first trial on this. It’s like whenever we got the first trial, it’s like, how do we know if we couldn’t make this better? Like how do we know that we couldn’t tweak a few things and get better results? The fact that it was a third is insane.
Leah:
Absolutely insane. And that was compared to, I think it was, yeah, 8% of those in the social support group went into remission. So you’re thinking like a third compared to less than 10 % in the people that didn’t have the dietary change.
Aidan:
Yeah, and even with that 8% as well like that, that social support group, would wager would have outperformed people who hadn’t done anything. Yeah, they were just trying to replicate the fact that the people in the intervention group were seeing a dietitian a few times over 12 weeks. It’s like maybe just the social interactions gonna help. yeah, they’re trying to control for that.
Leah:
Yeah, which is a definitely an awesome point. And then since then, there have been other randomized controlled trials on Mediterranean style approaches, and mental health, particularly looking at depression, covering like a lot of different populations. And honestly, it all looks pretty positive.
Aidan:
Yeah, and from memory, I think the SMILES trial was either all women or mostly women. And like they’ve recreated this type of approach in men. It’s shown similar results. It looks super promising.
Leah:
Yeah, so definitely some positive stuff happening there.
Aidan:
Yeah, I think that’s one of the biggest areas of the Mediterranean diet that kind of really shines. And just as another thing on the, this was one of the first things I looked at from the cholesterol standpoint, because with that diet, they intentionally put it in a position where people wouldn’t be losing weight. Like they did tell them to do all those serves and stuff like that, but they told them to eat ad libitum. So if they didn’t reach those targets, they could stop before they got there or whatever. But the intention was that they didn’t lose weight and they didn’t lose weight at the end of the study.
So it worked out with their intention, which is good because that could be a variable in depression as well, of course. But from the cholesterol standpoint, that was another example of where their cholesterol didn’t change at all, which I found really interesting because they didn’t get down to the three extras because this was like, this was a real-world study. They didn’t have to follow the just tried to follow the diet. They didn’t get down to three extras per week but there was a massive reduction that was reported. So it was a huge improvement in the actual dietary quality in practice.
Another area that I find super interesting is just the general link with longevity. One of the most famous examples of this is these areas called the blue zones, which mostly happen to be Mediterranean areas as well. These areas are defined as areas where people are three times more likely than Australians to live to a hundred years old. And most of my following diets that include a lot of the themes from the Mediterranean diet, they’re more plant-based diets, they often have healthy fats, they often have a lower average calorie intake than the average person around the rest of the world and stuff like that.
But we obviously don’t just put it down to just diet. Like if we’re looking at the Blue Zones and people who follow the traditional Mediterranean-style diet in like a historical kind of sense, often they’re more active. They’re not necessarily going to the gym and doing formal exercise, but they’re more active, they’re doing more walking, more kind of gardening, those kind of just informal activities. And the social thing is huge. A lot of these areas, they eat pretty much every meal around other people. They stop what they’re doing. They’re often not working through it and stuff like that. And they have a lot of other things in their life that kind of link with longevity beyond just diet. But I think it’s an interesting perspective too.
Leah:
So I think like the next kind of question after talking about like here are all these like awesome positives of this diet. Well, why don’t we use it with everybody? Because I know like not everyone that walks into my clinic or like sees me, I’m going to go, let’s use the Mediterranean style approach. There’s one obvious reason for that. There’s one super obvious reason for me. And that’s literally because I’d say 90% of my clients are plant-based. So I’m not going to then tell them to eat fish and poultry and red meat and stuff. But in saying that, I still think there’s a lot of overlap in that regard because I still encourage my clients to eat a lot of nuts and seeds and a variety of plant-based foods and legumes and like all these great things.
But, you know, I’m not gonna follow the strict approach for those clients. But outside of that, there are other contexts where the Mediterranean-style diet in its kind of whole form may not be the best approach. Things that come to mind for me would be, okay, like athletes, we both work with a lot of athletes and usually, their protein requirements are quite high and the Mediterranean diet approach, whilst it’s like it’s got a decent amount of protein in it, it’s probably not quite high enough.
Aidan:
It wouldn’t be the optimal level.
Leah:
Athletic recommendations for that. Secondary to that would be it’s not necessarily like low in calories. So there is a large focus on those like healthy, higher fat foods like that olive oil being a huge one. But nuts, seeds, oily fish, et cetera. So if someone comes to me for a fat loss phase, I’m not gonna use the whole Mediterranean style approach likely because it’s probably going to exceed the amount of calories that would be optimal for a fat loss phase. So it’s not really gonna fit there. And I think, just generally, dietary interventions are all about the context and the goals at which what you’re going for.
So the Mediterranean diet is not always going to align with that even though I feel like I generally use principles from it mostly always.
Aidan:
Yeah, so I agree with a lot of that. My additional thoughts on that starting with the biggest overlapping one with the protein intake as well.When you also link that in with a fat loss phase as well, protein as a percentage of total calories gets higher. And if you already have a large allotment to carbohydrates and fat, obviously you can’t have it as a as a high percentage. So that’s one thing. The other thing, I really rate the benefits of extra virgin olive I promote it a lot. There’s a lot of clients who I see who might use spray olive oil and stuff like that to try and get like three grams or less or something like that. So it’s not adding a lot of calories.
With those people I kind of encourage just like using a bit more like still like because there’s so many benefits and I wonder like using that that research on depression and anxiety and stuff like that. It’s like is it a Mediterranean diet or is it olive oil? I don’t even answer that question. Is it a combination of both of these things? I don’t know. But there’s enough research linking extra virgin olive oil with huge benefits in a whole wide range of things.
I’m like, if we were going to have X amount of fat per day, maybe we allocate some of that to extra virgin olive oil. with that kind of 60 mL amount, with an average of 500 calories, it’s just like it’s too much for what most people I work with want to be achieving. If somebody had maintenance calories of 1800 calories, for example, and they wanted to go into a deficit, I obviously can’t give them 500 calories of olive oil. If somebody wants to have protein as a high percentage of the intake, I obviously can’t give them 500 calories of extra virgin olive oil. Even with all these benefits, I’m like, I think food variety is a really important thing. Let’s allocate it to a wide variety of things.
But then, taking the next step, we know that the Mediterranean diet is not associated with weight gain, even though people are including large amounts of olive oil and all these other healthy fats and stuff like that. And a lot of people point to that aspect, which I do agree with, but I think something that’s often overlooked is what’s missing from their diets. Although it’s an inclusive style diet and everything like that, what is missing? Like they have a low intake of processed foods. They have a low intake of what we would call hyper-palatable foods. They have a low intake of sugar and everything like that.
It’s very tricky living in Western society to try and include some of these things and then also add a bunch of calories elsewhere. It’s kind of like their diet works because they’re not having those things, and your calories have to come from somewhere. So they can add that kind of thing in. It’s hard to do, hard to take features of the Mediterranean diet and keep things of the standard Western diet in as well without overshooting your calorie target.
Another thing that is underrated, it’s pretty time and energy intensive to transfer over to Mediterranean diet. That SMILES trial we talked about. They gave them a food hamper to start off with.
Leah:
Oh did they?
Aidan:
They gave them a food hamper. So though it was real world, it’s like this was to get them started. They gave them quite a lot of food to start off with so that they wouldn’t have to go zero to 100 with learning around the Mediterranean diet. They did have to do a lot of shopping, cooking, everything like that, but they had a bit of a head start. If I had somebody walk into my office and I tried to get them to switch straight away, very, very hard to do. And the final thing that I think we probably can both agree on is in a lot of cases, we can get either a similar outcome or better outcome without fully transitioning over. So it’s just kind of like we take the positive lessons from it, but then adapt it to the individual situation too.
Leah:
100%. So this has been episode 84 of the Ideal Nutrition podcast. As always, if you could leave a reading and review, that’s always appreciated. But other than that, thanks for tuning in.