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June 13, 2022

Sicilian Secret

The Mediterranean Diet

The Mediterranean Diet is a traditional way of eating used in countries of the Mediterranean basin like Italy and Sicily, Spain, France, and Greece.

Dan Buetner in his book, “Blue Zones”, has identified 5 places on the planet that people live long and free of chronic disease. Two of these places are in Italy and Greece and the remainder adhere to a diet that is plant rich and very similar to the Mediterranean Diet:

There are numerous studies that have scientifically shown that the Mediterranean Diet can prevent heart disease, diabetes cancer, dementia, infertility, and cancer.


Foods to Eat

Here are some foods that you can enjoy as part of the Mediterranean diet:

Fruits: apples, oranges, strawberries, kiwi, melon, blueberries, pears, peaches, apricots

Vegetables: spinach, arugula, broccoli, cauliflower, onions, zucchini, asparagus, kale, potatoes

Legumes: chickpeas, lentils, beans, peanuts

Whole Grains: quinoa, couscous, millet, oats, brown rice, buckwheat, whole grain pasta, farro

Nuts & Seeds: almonds, pistachios, walnuts, chia seeds, flax seeds, hazelnuts, macadamia nuts, sunflower seeds

Poultry: chicken, turkey, goose, duck

Seafood: salmon, tuna, trout, mackerel, anchovies, sardines, mussels

Eggs: egg yolks and egg whites

Dairy: cheese, yogurt, milk

Healthy Fats: olive oil, avocados, olives, avocado oil

Herbs & Spices: basil, oregano, thyme, rosemary, pepper, turmeric, garlic, cinnamon, coriander

Beverages: water, coffee, tea, red wine (1–2 glasses per day)


Foods to Avoid

Here are some foods that you should limit or avoid as part of the Mediterranean diet:

Processed Meats: bacon, salami, sausage, hot dogs

Refined Grains: white bread, crackers, biscuits, white pasta, flour tortillas, white rice

Sugar-Sweetened Beverages: juice, soda, energy drinks, sports drinks

Refined Oils: vegetable oil, soybean oil, canola oil, corn oil, safflower oil

Processed Foods: fast food, chips, convenience meals, microwave popcorn, pretzels

Added Sugar: table sugar, ice cream, candies, cookies, baked goods, ice cream


The Lyon Diet Heart Study:

This was one of the first studies to prospectively study the effects of the Mediterranean Diet on the risk of developing heart disease.  This study randomized 605 people into a Mediterranean style Diet or a typical Western style Diet (The American Heart Association low fat diet), and they were followed for 4 years. This study resulted in a 72% risk reduction in the people in the Mediterranean Diet group for heart attacks and death due to heart attacks. Of note is that all these participants were at high risk because they all had a previous history of a heart attack prior to enrolling in the study.


This study of 7,447 people which took place over 5 years, showed that a Mediterranean Diet rich in olive oil and nuts reduced the combined risk of heart attacks, stroke, and death by about 30%.

Of interest, this study took place in Spain, a country where most people already adhere to a basic Mediterranean Diet.

This study also showed a 6.7% reduction in metabolic syndrome, which is combination of conditions such as elevated blood pressure, high fasting blood sugar, fat around the waist, high cholesterol, and high triglycerides. Metabolic syndrome significantly increases one’s risk of heart disease, stroke, and Type 2 diabetes.

For atherosclerosis to occur there must be a cascade of events that is initiated by inflamed or oxidized LDL (bad) cholesterol that enters the cell of the artery wall. The Predimed Trial also showed that these oxidized LDL particles were significantly reduced with the Mediterranean Diet.

Endothelial Function:

The endothelium are cells that line the inside of artery walls. The proper function of the endothelium is fundamental for good vascular health, and the dysfunction of the endothelium most likely precedes the development of atherosclerosis and the consequences such as heart attacks, stroke, and death. Arteries are not just plumbing tubes, they are active organs that constantly dilate and contract, and the endothelium is what helps make arteries more flexible and healthier. In addition, the endothelium is important to promote or prevent clotting, immunity, and helps prevent platelets from adhering to the artery wall, which is usually the initial event that occurs before a heart attack.

In a study published in the Journal of the American Medical Association (JAMA) a Mediterranean Diet resulted in improved endothelial function, weight loss, reduced inflammatory markers and improved insulin resistance and reduced rates of Diabetes.


This is serious and chronic disease and refers to a clustering of diseases that affect how your body utilizes blood sugar (Glucose). Glucose is fundamental to life because it is the energy source for or cells and is the main fuel for our brains. The common finding in all the diseases in the diabetes family is elevated blood sugar. Type 1 Diabetes is not preventable or reversible and usually starts in childhood.

Prediabetes, Type 2 Diabetes, and gestational diabetes, however, are both preventable and reversible.

Diabetes is a major risk factor for heart attacks, stroke, nerve damage (neuropathy), kidney damage, blindness (diabetic retinopathy), amputations, infections of the skin, deafness, depression, and Alzheimer’s disease. Type 2 Diabetes has become an epidemic in Western countries and may be the basis for other epidemics such as heart disease. Approximately 4 million people per year die globally from Diabetes and its complications. The life expectancy of a person with diabetes can be shortened by 10 years.

There is consistent and compelling evidence that a Mediterranean Diet can both prevent and reverse Type 2 Diabetes.

In another study published in Diabetologia, 10,000 healthy volunteers were followed, and those who ate a MD style diet with more fruits and vegetables had a significantly reduced risk of developing DM2.

This was a review if 5 separate studies and found that the Mediterranean Diet was as effective as a low carb diet for weight loss. On average the Med Diet resulted in 22-pound weight loss over 1 year – a very healthful rate of weight loss.

This study showed that over a 5-year period in 32,000 people, the Mediterranean Diet (MD) was associated with weight loss and reduced belly fat.


The Mediterranean Diet (MD) has been shown in several studies to reduce inflammatory markers and to reduce the adhesion of cells to the endothelium via down regulation of certain inflammatory molecules.


Substances in vegetables and the Mediterranean Diet (MD) have been shown to delay the aging process by reducing oxidative stress, improve cell longevity and stem cell senescence.


Due to high content of factors in the Mediterranean Diet (MD) that are anti-cancer, such as polyphenols, antioxidants, and anti-inflammatory factors in olive oil, fresh fruits and vegetables and other components of the MD. The Mediterranean Diet is a sustainable diet that is inherently anti-cancer.

Studies have shown that a Mediterranean Diet is associated with a reduced risk of:

  • Prostate cancer
  • Breast Cancer
  • Colorectal cancer


Bone Health:

There is also evidence that a Mediterranean Diet rich in vegetables also improves bone health.


De Lorgeril M, et alMediterranean Diet, Traditional Risk Factors, and the Rate of Cardiovascular Complications After Myocardial Infarction: Final Report of the Lyon Diet Heart Study. Trusted Source[13] Circulation, 1999.

Estruch R, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra Virgin Olive Oil or Nuts. The New England Journal of Medicine, 2018.

Salas-Salvado J, et alEffect of a Mediterranean Diet Supplemented with Nuts on Metabolic Syndrome Status Trusted Source. JAMA Internal Medicine, 2008.

Montserrat F, et alEffect of a Traditional Mediterranean Diet on Lipoprotein Oxidation Trusted Source. JAMA Internal Medicine, 2007.

Esposito K, et al. Effect of a Mediterranean-Style Diet on Endothelial Dysfunction and Markers of Vascular Inflammation in the Metabolic Syndrome Trusted Source. The Journal of the American Medical Association, 2004.

Nutrients. 2020 Aug; 12(8): 2236. Mediterranean Diet Effects on Type 2 Diabetes Prevention, Disease Progression, and Related Mechanisms. A Review

Wang F, Baden MY, Guasch-Ferré M, et al. Plasma metabolite profiles related to plant-based diets and the risk of type 2 diabetes. Diabetologia. Published online April 8, 2022. doi:10.1007/s00125-022-05692-8

Weight Loss Am J Med . 2016 Apr;129(4):407-415.e4. doi: 10.1016/j.amjmed.2015.11.028. Epub 2015 Dec 22. Systematic Review of the Mediterranean Diet for Long-Term Weight Loss

Nutr Diabetes. 2018; 8: 22. Published online 2018 Apr 25. doi: 10.1038/s41387-018-0023-3 PMCID: PMC5916888PMID: 29695712 Adherence to a Mediterranean diet and long-term changes in weight and waist circumference in the EPIC-Italy cohort

Biomedicines. 2020 Jul; 8(7): 201. Published online 2020 Jul 8. doi: 10.3390/biomedicines8070201 PMCID: PMC7400632PMID: 32650619 Mediterranean Diet as a Tool to Combat Inflammation and Chronic Diseases. An Overview

Molecules. 2022 Apr 2;27(7):2316. doi: 10.3390/molecules27072316. Vegetables and Their Bioactive Compounds as Anti-Aging Drugs

Cancer and Mediterranean Diet: A Review
Nutrients. 2019 Sep: 11(9): 2059

Cao JJ, Roemmich JN, Sheng X, Jahns L. Increasing vegetable intake decreases urinary acidity and bone resorption marker in overweight and obese adults: an 8-week randomized controlled trial. J Nutr. 2021;151(11):3413-3420. doi: 10.1093/jn/nxab255


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