The Mediterranean Diet, aka MedDiet, doesn’t feel like a diet. That’s because the much-lauded MedDiet is more of a lifestyle than a deprivation or elimination diet.
The MedDiet focuses on eating lots of fruits, vegetables, whole grains, nuts and seeds, 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. Staying with an eating plan is easier when you aren’t feeling deprived.
Why does it work?
While numerous studies have looked 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 promising results for managing 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.
The European Alliance of Associations for Rheumatology Annual Conference, EULAR 2022, included studies that explored the relationship between the Mediterranean Diet and disease activity in patients with Rheumatoid Arthritis and Sjogren's.
One study identified that improving the overall diet quality significantly improved pain, physical function, and quality of life in patients with rheumatoid arthritis, the adherence to MedDiet may further improve physical activity levels. This small study did not assess inflammatory biomarkers; however, participants had higher rates of adherence to the MedDiet because of continuous follow-up by a Registered Dietitian for 12 weeks.
Another study aimed to explore the dietary habits of 105 patients living with primary Sjogren's Syndrome and their relationship with metabolic and inflammatory indicators. Patients who adhered to the MedDiet, consumed more fish and whole grains and less red meats had a lower disease activity. Interestingly, participants with higher intakes of red meat expressed higher self-reported pain levels.
What does the MedDiet look like?
As its name suggests, the MedDiet looks like the typical diet in the Mediterranean basin, for example, Greece, France, Italy, and Morocco.
The MedDiet includes daily consumption of fruits, vegetables, whole grains, pulses, healthy fats, herbs, and spices. There is moderate consumption of fish and seafood, dairy (mostly yogurt and 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.
8 simple ways to switch over to a MedDiet
Make small swaps using your traditional or comfort 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 (EVOO) into my day-to-day cooking with my comfort foods. Now, I only cook with EVOO.
1. Don't fear whole grains
An easy way to start is switching from refined grains such as white rice or bleached flour products to whole grains such as brown rice, whole grain bread, quinoa or barley.
If you avoid gluten for personal or medical reasons, you still can eat whole grains such as certified gluten-free oats, buckwheat (surprisingly, gluten-free despite the name!), quinoa, amaranth, corn, and rice.
2. Add fruits and vegetables to your meals and snacks
Increase the amount of fruit and vegetables you consume daily by including them in each meal or snack. Aim for two servings of veggies and three servings of fruit a day.
3. Include plant-based sources of protein and fats
Look to plant-based sources for your protein, such as beans, lentils, chickpeas, soy, and peas. Add more healthy fats like extra-virgin olive oil, avocadoes and nuts as they provide the anti-inflammatory support that may help you manage swelling and pain. Flaxseeds and chia seeds are excellent sources of plant-based Omega 3 fats.
4. Include fish and shellfish (If tolerated)
Eat fish and shellfish twice weekly to ensure you get the omega-3 fats necessary to reduce inflammation and heart disease risk.
5. Moderate amounts of poultry, eggs, and dairy
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 more vegetables to your plate.
6. Enjoy fermented dairy products
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 my blog post "Do Not Ignore Nutrition in Autoimmune Rheumatic Disease."
7. Less red meats and sweets are best
Enjoy red meat and dessert less frequently. You don’t need to eliminate these foods from your diet. Listen to your body and assess how your body responds to eating red meats and refined sugars.
8. Water and red wine
While most 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.
The MedDiet 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 it is right for you.
My favourite beginner's guide to the Mediterranean Diet way of eating is "Make Every Day Mediterranean: An Oldways 4-Week Meal Plan"
Thanks to Cheryl Anderson, RD2B, who originally assisted with the research and writing for the post On Trend: The Mediterranean Diet "The Anti-Diet". This year, I am updating the blog post to include recent evidence on MedDiet and inflammatory arthritis.
Are you ready to Survive Summer with Sjögren's? Check out this signature program for Sjogren's warriors to elevate their Anti-inflammatory Lifestyle with the Arthritis Dietitian, a fellow Sjogie!