With so many diets out there, each with its own list of benefits for reducing the impacts of inflammatory diseases, it can be overwhelming and frustrating. Over the next few months, I will be taking a closer look at these diets and helping you understand what works, what doesn’t and what might be right for you.
Since May is International Mediterranean Diet Month, I thought, what better way to start off this series than with the #1 doctor recommended diet! The Mediterranean Diet, aka MedDiet, really doesn’t feel like a diet at all. That’s because the much-lauded MedDiet is more of a lifestyle than a deprivation or elimination diet. It focuses on eating lots of fruits, vegetables, whole grains and healthy fats, with moderate consumption of plain fermented dairy products (yogurt, cheese), fish, and lean proteins, and enjoying red meat and refined sugars with less frequency. One of the best features of this diet is the high adherence rate. It is easier to stick with an eating plan when you aren’t feeling deprived.
Why does it work?
While there have been numerous studies that look at the benefits of the MedDiet for the management (and even prevention) of many chronic diseases such as cardiovascular diseases, diabetes and cancer; arthritis sufferers often ask me if the MedDiet will help manage their symptoms. More robust research is needed; however, recent studies (1,2,3, 4) show that there are promising results for the management of inflammatory diseases by those following the MedDiet. The higher intake of anti-inflammatory and antioxidative foods promoted by the MedDiet may help to decrease swelling, stiffness, disease activity, and lessen the joint damage caused by Rheumatoid Arthritis and Psoriatic Arthritis. More quality and long-term studies are needed to determine the effects of MedDiet on other types of inflammatory arthritis.
As you probably know, the joint pain and swelling that comes with inflammatory arthritis are caused by an immune system that produces antibodies that attack your joints causing the inflammation, pain and swelling. Dietary changes are often suggested to help with managing the symptoms of inflammatory diseases because there are a number of foods that have natural anti-inflammatory properties such as omega-3 fats, antioxidants, and fibre that can also help to alter your gut flora to positively impact your overall health and reduce inflammation.
It works by increasing the consumption of healthy fats such as olive oil, omega-3s from fish and plant sources (i.e. flax seeds, chia seeds) and lowering the consumption of saturated fats, such as those found in meat, dairy and tropical plant oils (coconut and palm oils). Extra-virgin olive oil has a main role in this diet because it is high in monounsaturated fats, which helps lower LDL cholesterol and is used for cell development, and it has a high antioxidant content that helps to reduce inflammation.
Other health benefits are associated with the increase in fibre intake, vitamins and minerals due to the consumption of more fruits, vegetables and whole grains, and lower consumption of processed foods and red meat. All of this contributes to the healthier gut microbiome I mentioned earlier, which is emerging as an area of interest for researchers who are studying the benefits it may have on the immune system and inflammation. When there is an imbalance in the gut microbiome, inflammation can occur.
What does the MedDiet look like?
Like its name suggests, the MedDiet looks like the typical diet found in the Mediterranean basin (ie Greece, France, Italy and Morocco for example). It includes daily consumption patterns that are high in fruits, vegetables, whole grains, pulses, healthy fats, and herbs and spices. There is moderate consumption of fish and seafood, dairy (mostly yogurt, cheese), eggs and poultry, and minimum consumption of refined sugars and red meats. Most meals are prepared from fresh ingredients and little processed food is used.
An excellent visual reference to guide you in eating a Mediterranean Diet is The Oldways Mediterranean Diet Pyramid shown below.
How can you make the change to the MedDiet?
An easy way to start is to make the switch from refined grains such as white rice or bleached flour products to whole grains such as brown rice, wholegrain breads, quinoa or barley. If you are gluten-free, stick to wheat-free options such as oats, buckwheat (surprisingly, gluten-free despite the name!), quinoa, amaranth, corn and rice. Increase the amount of fruit and vegetables you consume each day by including them in each meal or snack. Look to plant-based sources for your protein and healthy fats. Extra-virgin olive oil, avocadoes and nuts can provide the anti-inflammatory support that may help you manage swelling and pain. Eat fish and shellfish twice a week to ensure you are getting the omega-3 fats that are necessary for reducing inflammation and the risk of heart disease. Decrease your consumption of poultry, eggs and dairy. You can still enjoy these favourite foods, but instead of a larger helping, try cutting back on your serving by adding a bit more vegetables to your plate. Enjoy plain fermented dairy products such as yogurt and cheese. It's a delicious way to increase probiotics in your diet and promote a healthy gut microbiome. See also my blog post "Do Not Ignore Nutrition in Autoimmune Rheumatic Disease". Enjoy red meat and dessert less frequently. You don’t need to eliminate these foods entirely from your diet, but they should be considered treats and only enjoyed from time to time rather than daily. While the majority of your fluid consumption should be from water, the MedDiet recognizes the benefit of low-moderate consumption of red wine. If you are a teetotaler, you can still gain the same benefits from eating purple grapes or the occasional glass of concord grape juice. As you can see on the MedDiet Pyramid, fruits, vegetables, whole grains and plant-based proteins make up the largest section! So, keep enjoying your favourite foods, just alter your intake to align with the pyramid.
Make small swaps using your traditional foods. I am Colombian, olive oil is not part of my heritage and did not find the taste that appealing either. We are used to cooking with sunflower and palm oil. I learned to slowly introduce extra virgin olive oil into my day-to-day cooking with my comfort foods:
The MedDiet really is an “anti-diet” diet because it provides numerous health benefits, without the restrictions and deprivation usually associated with dieting. For exciting recipes and advice on making the switch please check out The Oldways Nonprofit Nutrition Organization. As always, discuss any dietary changes you wish to make with your healthcare provider to ensure that it is right for you.
Special thanks to Cheryl Anderson, 3rd-year nutrition student at Ryerson University who assisted with the research and writing for this post.