Did the Retracted Mediterranean Study Cancel Its Benefits?
- January 20, 2021
Not only is the Mediterranean diet a tasty way to eat, drink and live, but it’s also a realistic and sustainable way to reduce disease-causing inflammation and to lose weight, too (or to maintain a healthy weight). In fact, in January 2019 when U.S. News evaluated 41 of the most popular diets they identified the Mediterranean Diet as being the “#1 Best Overall Diet.”
The Mediterranean diet has long been one of the healthiest diets known to man. The history and tradition of the Mediterranean diet come from the historic eating and social patterns of the regions around southern Italy, Greece, Turkey and Spain.
Therefore, the Mediterranean diet is really not even a “diet” in the way we usually think of them, more like a life-long way of eating and living. For thousands of years people living along the Mediterranean coast have indulged in a high-fiber diet of fruits and vegetables, also including quality fats and proteins in moderation, and sometimes a glass of locally made wine to complete a meal, too.
Meanwhile, this eatin pattern has gotten a reputation for disease prevention, mood-enhancement, and even “enjoyable” weight manageable. That’s right, studies show the same diet that can help you shed excess weight, and keep it off too, can also reduce your risk for depression, cardiovascular disease and more.
Starting in Italy thousands of years ago and spreading to Greece, Spain and other areas around the Mediterranean, this diet is now successful all over the world for promoting health and longevity. While it’s always existed, even before books and studies were dedicated to it, the diet really began to take hold around the world in the 1990s, when a Harvard University doctor showcased it as a diet useful for improving heart health, losing weight and clearing up other health issues.
Is the Mediterranean Diet Still Good for You?
In 2013, a landmark study of more than 7,000 people in Spain was published. The study’s subjects were split into three groups: those receiving advice about following a Mediterranean diet and getting extra-virgin olive oil delivered to their home; receiving advice about following the Mediterranean diet and getting nuts delivered to their home; and, in the control group, receiving advice about following a low-fat diet.
The study found that those people eating a Mediterranean diet that was supplemented with the olive oil deliveries were 30 percent less likely to die of heart attack, disease, stroke or death from cardiovascular causes than those eating a low-fat diet. (1) In fact, the study finished earlier than planned, because the results were drastic enough that it was considered unethical to continue conducting it. For those of us who advocate eating a Mediterranean diet, this study was a welcome validation.
But in June 2018, the authors took the rare step of retracting the original study in the New England Journal of Medicine based on flaws in how the original study was conducted. It turns out that about 15 percent of the people in the study weren’t actually placed in a particular group randomly — people with a family member also participating were placed in the same group; one clinic assigned everyone to the same group; and another study site didn’t properly use the randomization table.
The study’s authors have said that after excluding the non-randomized people from the study and reexamining the data, the results still hold true. But because the study wasn’t truly random, it can no longer claim that the health benefits are directly caused by the Mediterranean diet and olive oil.
Instead, a revised version of the study was released on June 13, 2018. (2a) This updated study made statistical adjustments to the data, accounting for the fact that it wasn’t 100 percent random. The language is softer, too — instead of saying that the Mediterranean diet was the direct cause of the reduced rate of cardiovascular diseases and death, it simply says that people following the diet had fewer instances of it.
So is the Mediterranean diet still healthy? Absolutely. While this one study may have been flawed, it doesn’t change the fact that fresh fruits, veggies, lean proteins, whole grains, fish and healthy fats like olive oil (along with the occasional glass of wine!) are all foods that are proven to be good for you on their own. Together, they comprise a diet that can be terrific for your health — study or no study.
And as Allan S. Brett, MD, Editor-in-Chief of NEJM Journal Watch says, “After reanalysis of the data, the original results are essentially unchanged.” (2b)
What Are the Health Benefits?
Considered by many nutrition experts to be one of the most heart-healthy ways of eating there is, the base of the Mediterranean diet is loaded with anti-inflammatory foods and built upon plant-based foods and healthy fats.
Based on much research, this particular diet can protect against the development of heart disease, metabolic complications, depression, cancer, type-2 diabetes, obesity, dementia, Alzheimer’s and Parkinson’s. The best part is, even with all of these benefits, it still provides the opportunity for people to “eat, drink and be merry.”
Ever wonder why people from the Mediterranean region seem so happy and full of life? It’s tempting to attribute their good health and positive moods to one single factor alone — like their diet, for example — but the truth is that it’s a combination of their lifestyle factors and their unprocessed diets that has promoted their longevity and low rates of disease for centuries.
According to the Harvard School of Public Health,”Together with regular physical activity and not smoking, our analyses suggests that over 80 percent of coronary heart disease, 70 percent of stroke, and 90 percent of type 2 diabetes can be avoided by healthy food choices that are consistent with the traditional Mediterranean diet.” (3)
What Foods Are Included?
The Mediterranean way of eating promotes foods including:
- fresh fruits and vegetables (especially leafy greens like spinach and kale and non-starchy veggies like eggplant, cauliflower, artichokes, tomatoes and fennel)
- olive oil
- nuts and seeds (like almonds and sesame seeds used to make tahini)
- legumes and beans (especially lentils and chickpeas used to make hummus)
- herbs and spices (like oregano, rosemary and parsley)
- whole grains
- eating wild-caught fish and seafood at least twice a week
- high quality pasture-raised poultry, eggs, cheese, goat milk, and probiotic-rich kefir or yogurt consumed in moderation
- red meat consumed on special occasions or about once weekly
- plenty of fresh water and some coffee or tea
- oftentimes a daily glass of red wine
The Importance of Olive Oil
Nearly every nutritional researcher attributes at least some of the legendary health benefits of the Mediterranean diet to the copious amounts of olive oil included in almost every meal. Olives themselves are an ancient food, and olive trees have been growing around the Mediterranean region since about 3,000 B.C.
Olive oil joins foods containing omega-3 fats, like salmon and walnuts, for example, as an elite category of healthy fatty acids. Olive oil has a ton of research backing its health benefits — in fact, it’s so backed by research that the FDA even permits labels on olive oil bottles containing a specific health claim (to date this is only allowed on olive oil, omega-3 fats and walnuts). That claim?
Limited and not conclusive scientific evidence suggests that eating about 2 tablespoons (23 grams) of olive oil daily may reduce the risk of coronary heart disease due to the monounsaturated fat in olive oil. To achieve this possible benefit, olive oil is to replace a similar amount of saturated fat and not increase the total number of calories you eat in a day. (4)
So what is it about olive oil that makes it so good for you?
To start, olive oil is very high in compounds called phenols, which are potent antioxidants capable of lowering inflammation and fighting free radical damage. Olive oil is mainly made up of monounsaturated fatty acids, the most important of which is called oleic acid. Oleic acid is known to be extremely heart-healthy in numerous ways, especially when compared to many other refined vegetable oils, trans-fats or hydrogenated fats.
Olive oil even has a step up in terms of heart health benefits compared to most grain-based carbohydrates — for example, high monounsaturated fat diets lower LDL cholesterol, raise HDL cholesterol and lower triglycerides better than carb-heavy diets do, according to some some studies. (5)
How much olive oil should you consume daily? While recommendations differ depending on your specific calorie needs and diet, anywhere from one to four tablespoons seems to be beneficial. Estimates show that those in the Mediterranean region probably consume between three to four tablespoons a day, and this is the amount that some health practitioners recommend to their heart disease patients.
Just remember that all olive oil is not created equally. Unfortunately, most commercial manufacturers that are trying to ride the health hype on olive oil have rushed to the market with all kinds of fake olive oils, which are imitations and inferior products. The problem is these oils aren’t always harvested or processed properly, which can kill many of their delicate nutrients and turn some of their fatty acids rancid or toxic.
Here’s what really makes a big difference: Look for labels that indicate your oil is “extra-virgin” and ideally cold-pressed. Olive oil is almost unique among oils in that you can consume it in its crude form without any processing needed (for example, you could literally press olives and enjoy their natural oils).
While it’s delicate and not necessarily the best oil for cooking, cold-pressed or expeller-pressed oil hasn’t been refined so it holds all of its natural vitamins, essential fatty acids, antioxidants and other nutrients better. While unrefined oil is separated without high heat, hot water, solvents and left unfiltered, on the flip side some oils are heated to a high degree, which reduces their benefits.
9 Benefits of the Mediterranean Diet
1. Low in Processed Foods and Sugar
The diet primarily consists of foods and ingredients that are very close to nature, including olive oil, legumes like peas and beans, fruits, vegetables, unrefined cereal products, and small portions of animal products (that are always “organic” and locally produced). In contrast to the typical American diet, it’s very low in sugar and practically free of all GMOs or artificial ingredients like high fructose corn syrup, preservatives and flavor enhancers. For something sweet, people in the Mediterranean enjoy fruit or small quantities of homemade desserts made with natural sweeteners like honey.
Beyond plant foods, another major staple of the diet is locally caught fish and a moderate consumption of cow, goat or sheep cheeses and yogurts that are included as a way to receive healthy fats and cholesterol. Fish like sardines and anchovies are a central part of the diet, which usually is traditionally lower in meat products than many Western diets today.
While most people in the Mediterranean aren’t vegetarians, the diet promotes only a small consumption on meats and heavier meals — instead going for the lighter and healthier fish options across the board. This can be beneficial for those looking to lose weight and improve things such as their cholesterol, heart health and omega-3 fatty acid intake.
2. Helps You Lose Weight in a Healthy Way
If you’re looking to lose weight without being hungry and maintain that weight in a realistic way that can last a lifetime, this might be the plan for you. The diet is both sustainable and worthwhile, and has been undertaken by many people all around the world with great success related to weight loss and more, as it works to help manage weight and reduce fat intake naturally and easily due to eating many nutrient-dense foods.
There’s room for interpretation in the Mediterranean diet, whether you prefer to eat lower carb, lower protein or somewhere in between. The diet focuses on consumption of healthy fats while keeping carbohydrates relatively low and improving a person’s intake of high-quality protein foods. If you refer protein over legumes and grains, you have the option to lose weight in a healthy, no-deprivation-kind-of-way with a high amount of seafood and quality dairy products (that simultaneously provide other benefits like omega-3s and often probiotics).
Fish, dairy products and grass-fed/free-range meats contain healthy fatty acids that the body needs, working to help you feel full, manage weight gain, control blood sugar, and improve your mood and energy levels. But if you’re more of a plant-based eater, legumes and whole grains (especially if they’re soaked and sprouted) also make good, filling choices.
3. Improves Heart Health
Research shows that greater adherence to the traditional Mediterranean diet, including plenty of monounsaturated fats and omega-3 foods, is associated with a significant reduction in all-cause mortality, especially heart disease. A striking protective effect of a Mediterranean diet rich in alpha-linolenic acid (ALA) from olive oil has been shown in many studies, with some finding that a Mediterranean-style diet can decrease the risk of cardiac death by 30 percent and sudden cardiac death by 45 percent. (6)
Research from the Warwick Medical School also shows that when high blood pressure is compared between people eating more sunflower oil and those consuming more extra-virgin olive oil, the olive oil decreases blood pressure by significantly higher amounts. (7)
Olive oil is also beneficial for lowering hypertension because it makes nitric oxide more bioavailable, which makes it better able to keep arteries dilated and clear. Another protective element is that it helps combat the disease-promoting effects of oxidation and improves endothelial function. Keep in mind that low cholesterol levels are worse than high sometimes, but people in the Mediterranean don’t usually struggle to maintain healthy cholesterol levels either since they obtain plenty of healthy fats.
4. Helps Fight Cancer
According to the European Journal of Cancer Prevention,
The biological mechanisms for cancer prevention associated with the Mediterranean diet have been related to the favorable effect of a balanced ratio of omega-6 and omega-3 essential fatty acids and high amounts of fiber, antioxidants and polyphenols found in fruit, vegetables, olive oil and wine. (8)
A plant based diet, one that includes lots of fruits and vegetables, is the cornerstone of the Mediterranean diet, which can help fight cancer in nearly every way — providing antioxidants, protecting DNA from damage, stopping cell mutation, lowering inflammation and delaying tumor growth. Many studies point to the fact that olive oil might also be a natural cancer treatment and decrease the risk of colon and bowel cancers. It might have a protective effect on the development of cancer cells due to lowered inflammation and reduced oxidative stress, plus its tendency to promote balanced blood sugar and a healthier weight.
5. Prevents or Treats Diabetes
Evidence suggests that the Mediterranean diet serves as an anti-inflammatory dietary pattern, which could help fight diseases related to chronic inflammation, including metabolic syndrome and type 2 diabetes. (9) One reason the Mediterranean diet might be so beneficial for preventing diabetes is because it controls excess insulin, a hormone that controls blood sugar levels, makes us gain weight and keeps the weight packed on despite us dieting.
By regulating blood sugar levels with a balance of whole foods — containing healthy fatty acids, quality sources of protein and some carbohydrates that are low in sugar — the body burns fat more efficiently and has more energy too. A low-sugar diet with plenty of fresh produce and fats is part of a natural diabetic diet plan.
According to the American Heart Association, the Mediterranean diet is higher in fat than the standard American diet, yet lower in saturated fat. It’s usually roughly a ratio of 40 percent complex carbohydrates, 30 percent to 40 percent healthy fats and 20 percent to 30 percent quality protein foods. Because this balance is somewhat ideal in terms of keeping weight gain and hunger under control, it’s a good way for the body to remain in hormonal homeostasis, so someone’s insulin levels are normalized. As a byproduct, it also means someone’s mood is more likely to stay positive and relaxed, energy levels up, and physical activity easier.
The Mediterranean diet is low in sugar, since the only sugar present usually comes from fruit, wine and the occasional locally made dessert. When it comes to drinks, many people drink plenty of fresh water, some coffee and red wine, too. But soda and sweetened drinks aren’t nearly as popular as they are in the U.S.
While some Mediterranean diets do include a good deal of carbohydrates — in the form of pasta or bread, for example — being active and otherwise consuming very low levels of sugar means that insulin resistance remains rare in these countries. The Mediterranean style of eating helps prevent peaks and valleys in blood sugar levels, which zaps energy and takes a toll on your mood. All of these various factors contribute to this diet’s diabetes prevention capabilities.
Most people in the Mediterranean eat a balanced breakfast within one to two hours of waking up, which starts their day right by balancing blood sugar when it’s at its lowest. They then typically eat three meals a day that are filling, with plenty of fiber and healthy fats. Many people choose to have their biggest meal mid-day as opposed to at night, which gives them the opportunity to use that food for energy while they’re still active.
You can see how this differs from the standard American diet, which often results in many people skipping breakfast, snacking throughout the day on energy-zapping foods high in carbs and sugar, and eating a lot at nighttime while they’re sedentary.
6. Protects Cognitive Health and Can Improve Your Mood
Eating the Mediterranean way might be a natural Parkinson’s disease treatment, a great way to preserve your memory, and a step in the right direction for naturally treating Alzheimer’s disease and dementia. Cognitive disorders can occur when the brain isn’t getting a sufficient amount of dopamine, an important chemical necessary for proper body movements, mood regulation and thought processing.
Healthy fats like olive oil and nuts, plus plenty of anti-inflammatory veggies and fruits, are known to fight age-related cognitive decline. These help counter the harmful effects of exposure to toxicity, free radicals, inflammation-causing poor diets or food allergies, which can all contribute to impaired brain function. This is one reason why adherence to the Mediterranean diet is linked with lower rates of Alzheimer’s. (10)
Probiotic foods like yogurt and kefir also help build a healthy gut, which we now know is tied to cognitive function, memory and mood disorders.
7. Might Help You Live Longer!
A diet high in fresh plant foods and healthy fats seems to be the winning combination for longevity. Monounsaturated fat, the type found in olive oil and some nuts, is the main fat source in the Mediterranean diet. Over and over, studies show that monounsaturated fat is associated with lower levels of heart disease, cancer, depression, cognitive decline and Alzheimer’s disease, inflammatory diseases and more. These are currently the leading causes of death in developed nations — especially heart disease.
In the famous Lyon Diet Heart Study, people who had heart attacks between 1988 and 1992 were either counseled to follow the standard post-heart attack diet advice, which reduces saturated fat greatly, or told to follow a Mediterranean style. After about four years, follow-up results showed that people on the Mediterranean diet experienced 70 percent less heart disease — which is about three times the reduction in risk achieved by most cholesterol-lowering prescription station drugs! The people on the Mediterranean diet also amazingly experienced a 45 percent lower risk of all-cause death than the group on the standard low-fat diet. (11)
These results were true even though there wasn’t much of a change in cholesterol levels, which tells you that heart disease is about more than just cholesterol. The results of the Lyon Study were so impressive and groundbreaking that the study had to be stopped early for ethical reasons, so all participants could follow the higher-fat Mediterranean-style diet and reap its longevity-promoting payoffs.
8. Helps You De-stress and Relax
Another influencing factor is that this diet encourages people to spend time in nature, get good sleep and come together to bond over a home-cooked healthy meal, which are great ways to relieve stress and, therefore, help prevent inflammation. Generally, people in these regions make sure to spend a lot of time outdoors in nature; eating food surrounded by family and friends (rather than alone or on-the-go); and put aside time to laugh, dance, garden and practice hobbies.
We all know that chronic stress can kill your quality your life along with your weight and health. Those who practice the diet have the luxury of leisurely dining at a slow pace, eating local delicious foods almost every day and engaging in regular physical activity too — other important factors that help maintain a happy mood.
In addition, the history of the Mediterranean diet includes a love for and fascination with wine — especially red wine, which is considered beneficial and protective in moderation. For instance, red wine may help fight obesity, among other benefits. This smart choice of a healthy way of life leads to longer lives free of chronic complications and diseases related to stress, such as those caused by hormonal imbalances, fatigue, inflammation and weight gain.
9. Can Help Fight Depression
A 2018 study published in the journal Molecular Psychiatry found evidence that healthy dietary choices, those in line with eating the Mediterranean diet, can help reduce the risk for depression. (12) Researchers involved in the study investigated the mental-health effects of adherence to a range of diets — including the Mediterranean diet, the Healthy Eating Index (HEI), the Dietary Approaches to Stop Hypertension diet (DASH diet), and the Dietary Inflammatory Index. They found that the risk of depression was reduced the most when people followed a traditional Mediterranean diet and overall ate a variety of anti-inflammatory foods.
What is it about anti-inflammatory foods that helps boost your mood and mental health? Inflammation is frequently named as the root cause of many mood and psychiatric conditions, including schizophrenia, obsessive compulsive disorder, depression, anxiety, fatigue, and social withdrawal. The same lifestyle habits that tend to activate inflammation— such as a poor diet, chronic stress and sleep deprivation — also tend to produce brain states that contribute to mental illness. (13) A nutrient-dense diet seems to help directly protect parts of the brain, while other dietary/lifestyle changes like getting good sleep, having a mindful approach to meals, planning meals ahead of time, and limiting stress can also lead to a calmer mindset. (14)
Related: Top 12 Cancer-Fighting Foods
Healthy Mediterranean Diet Recipes
Ready to get started eating in the same way as those living in the region? Here are some simple Mediterranean diet recipes for including more vegetables, fish, legumes, fruit, herbs and quality proteins in your diet:
This Zucchini Noodles with Marinara Sauce Recipe is a great raw recipe full of flavor, fiber and vitamin C! Try this raw recipe for dinner tonight.
Total Time: 20 minutes
- 2–4 large tomatoes, seeded and chopped
- 1 red bell pepper
- 1 cup sun-dried tomatoes
- 1 teaspoon honey
- 1/4 cup extra virgin olive oil
- 2 cloves garlic, crushed
- 3/4 teaspoon sea salt
- pinch of cayenne pepper
- 2 tablespoons minced fresh basil
- 2 tablespoons minced fresh oregano
- 6 medium green zucchini (peeling optional)
- Put all ingredients (except olive oil and zucchini) in food processor and blend to chunky or smooth. Pour into bowl and mix in olive oil.
- Transform zucchini into noodles using a spiral slicer.
- Toss noodles with enough marinara sauce to coat well and serve immediately.
You can also try making some of these:
- Fennel Apple Soup Recipe — This fennel apple soup recipe is delicious and nutritious. With only six ingredients, it’s easy to make but still full of good flavor.
- Basic Hummus Recipe — This hummus recipe is the perfect thing to pair with vegetables. It makes for a great snack and is packed full of good fiber. It’s also easy and fast to make!
- Goat Cheese and Artichoke Dip Recipe — My Goat Cheese and Artichoke Dip Recipe just might convince you to sneak more artichokes into your diet. Perfect as a game-day dip or a mid-day snack.
Related: Mediterranean Diet Meal Plan