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New Mediterranean Pyramid Favors Fish
6/8/2009
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Update of science-based eating plan reflects the conclusions reached by leading nutrition researchers
by Craig Weatherby


The folks behind the Mediterranean Diet Pyramid just revised the popular, science-based eating plan to recommend more fish, herbs, and spices.

The changes reflect recent research that’s helped explain exactly why the sunny coastal region’s healthiest diets reduce rates of disease and lengthen life spans (To compare the old and new pyramids, see “Fish, herbs, and spices...”, below).

In truth, what we now call the “Mediterranean” diet actually describes an idealized version of the diet enjoyed by Aegean islanders until American-style foods started to invade their shores in the 1970s.

This proven-healthful version of the Mediterranean diet is rich in green vegetables, fruits, nuts, beans, fish, and olive oil, and has been linked to longer life, less heart disease, and protection against some cancers.

The authors of a recent, exhaustive, evidence review conclude that of all the various diets associated with better heart health, only the Mediterranean diet has been clinically proven to reduce risk of coronary heart disease (Mente A et al. 2009).

The benefits of the idealized, Aegean-style Mediterranean diet are believed to flow from its abundance of fiber, antioxidant polyphenol compounds, vitamins, minerals, and omega-3 fats (from fish, grass-fed poultry, and green plants).

The original Mediterranean diet pyramid was developed in 1993 by Oldways, a non-profit organization that promotes eating patterns proven healthful in scientific studies.

Fish, herbs, and spices receive new emphasis
Over the last several years, reams of new research have bolstered claims made for the health benefits of the Mediterranean diet, and the insights provided by these studies prompted Oldways to revise their pyramid.

The re-design of the pyramid draws on the conclusions of leading nutrition and health experts who convened for a three-day conference in November of 2008, sponsored by Oldways.

As a result of the conference consensus, Oldways made two major changes to its Mediterranean diet pyramid:
  1. More frequent enjoyment of fish. Instead of just once a week, the pyramid now recommends consuming fish and shellfish at least two times a week, thanks to mounting scientific evidence for the importance of omega-3 fish fats to brain, heart, and developmental health.
  2. The addition of herbs and spices. Oldways added herbs and spices to the pyramid to reflect increased evidence of their health-promoting characteristics—which flow largely from their unequalled antioxidant content—and the role they play in increasing the palatability of foods.
In addition, Oldways’ Mediterranean diet now groups all recommended plant foodsfruits, vegetables, grains, nuts, legumes, seeds, olives and olive oilat the base of the pyramid, to indicate that they should be the basis of most meals.

The new Mediterranean Diet Pyramid, described
The parts of the Mediterranean region that enjoy the lowest recorded rates of chronic diseases and the highest adult life expectancy
largely, the Aegean islandsshow a pattern like the one described in the Oldways list below.

As Oldways describes it, the Mediterranean dietary pattern emphasizes a higher intake of vegetables, legumes, fruits, nuts, whole grains, cheese or yogurt, fish, and [more] monounsaturated [fatty acids] relative to saturated fatty acids.”

The healthfulness of this pattern and its individual components is supported by a large, persuasive body of epidemiological and clinical evidence.

The amounts given are approximate, since healthful Aegean diets vary considerably within the basic pattern, but deliver equivalent decreases in disease and increases in longevity.

According to Oldways, the healthiest Mediterranean eating patterns reflect the following priorities. We edited their list version of the pyramid for brevity and clarity (Oldways 2009):
  • An abundance of whole plant foods, including fruits and vegetables, potatoes, whole grains and breads, beans, nuts, and seeds.
  • Minimally processed, seasonally fresh, locally grown foods.
  • Two servings of fish* per week, at least, alternating with poultry; grass fed poultry is better than grain fed, but hard to find.
  • Olive oil replaces other fats and oils, including butter and margarine. Extra virgin olive oil is highest in health-promoting fats, phytonutrients, and other important micronutrients.
  • Total fat ranges from less than 25 percent to over 35 percent of calories, with saturated fat no more than 7 to 8 percent of calories.
  • Two servings of of fish per week.
  • Daily consumption of low to moderate amounts of cheese and yogurt (low-fat and non-fat versions may be preferable); eat from zero to four eggs per week (including those used in cooking and baking).
  • Fresh fruit as the typical daily dessert; sweets with a significant amount of sugar (often as honey) and saturated fat consumed not more than a few times per week.
  • Red meat a few times per month (recent research suggests that consumption should be limited to a maximum of 12 to 16 ounces [340 to 450 grams] per month; lean versions may be preferable).
  • Regular physical activity sufficient to ensure healthy weight, fitness and well-being.
  • Moderate consumption of wine, normally with meals; about one to two glasses per day for men and one glass per day for women (wine should be considered optional and avoided when consumption would put the individual or others at risk).
Notes from the 2008 Oldways conference one new Mediterranean diet research offers these additional points on the role of fish in the Mediterranean diet:

“Tuna, herring, sardines, salmon and bream are rich in essential heart-healthy omega-3 fatty acids... fish and shellfish are not typically battered and fried in Mediterranean countries, as they are in many other countries, including the U.S.”

We would add that several studies show that battered fish do not reduce stroke risk like non-fried fish do.

This is probably because deep-frying fat is very high in omega-6 fats, which can be pro-inflammatory and compete with the anti-inflammatory, stroke-fighting omega-3 fats in fish.

And a 2006 clinical study found that eating a Mediterranean diet resulted in a better balance between blood levels of omega-3 fats and the omega-6 fats, and improved several risk factors for cardiovascular disease. (Ambring A et al. 2006)

Being unable to resist a cheap crack, we've said it before and probably will again: “Eat like a Cretan.”

And don't forget the fish!


Sources
  • Mente A, de Koning L, Shannon HS, Anand SS. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease.
  • Oldways. Updating Mediterranean Diet Pyramid. Accessed online June 1, 2009 at http://www.oldwayspt.org/med_pyramid.html
  • Oldways. 2008 Mediterranean Diet Pyramid. Accessed online June 1, 2009 at http://www.oldwayspt.org/pdf/other_downloads/Mediterranean%20Diet%20Pyramid%20Text.pdf
  • Ambring A, Johansson M, Axelsen M, Gan L, Strandvik B, Friberg P. Mediterranean-inspired diet lowers the ratio of serum phospholipid n-6 to n-3 fatty acids, the number of leukocytes and platelets, and vascular endothelial growth factor in healthy subjects. Am J Clin Nutr. 2006 Mar;83(3):575-81.

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