What Is the Mediterranean Diet?

WHAT IS THE MEDITERRANEAN DIET?The Mediterranean diet has been well accepted as a healthy diet and lifestyle (1–4). In his Seven Countries Study, Ancel Keys, Ph.D., a physiologist from the United States, was the first to describe the Mediterranean diet and lifestyle among those who lived around the Mediterranean Sea. Mediterranean diets are high in bioactive compounds (e.g., carotenoids and polyphenols) due to the high consumption of fruits, vegetables, whole grains, legumes, and nuts (5). They all contribute to a high antioxidant intake, leading to lower systemic inflammation (6). In addition to a high intake of fruits, vegetables, and grains, individuals who consume the Mediterranean diet consume about 20% of their energy from protein, with most of the protein derived from fish, with a small percentage from meat (1). As mentioned in the first sentence above, the Mediterranean diet is not just a diet but a lifestyle, where physical activity is part of a person’s day (e.g., harvesting olives, walking to the market, etc.). Although the Mediterranean diet has been shown to help with weight loss (7), there has been a relative paucity of research conducted on the Mediterranean diet and athletic performance. THE MEDITERRANEAN DIET AND ATHLETIC PERFORMANCE Cobo-Cuenca et al. (8) determined adherence to the Mediterranean diet using the Mediterranean Diet Adherence Screener (MEDAS). In this cross-sectional study, they evaluated adherence to the Mediterranean diet with body composition, handgrip strength, standing long jump, and cardiorespiratory fitness measures in 310 first-year Spanish university students.Only 24% of students had good adherence to the Mediterranean diet based on the MEDAS. Those who adhered to the Mediterranean diet had significantly greater hand grip strength (P = 0.005) and cardiorespiratory fitness (P = 0.017) compared with those who had medium and low adherence to the Mediterranean diet. They reported that consuming >2 vegetables per day (P < 0.001), consuming ≥3 fruits per day (P < 0.001), using olive oil (P = 0.021), and consuming <3 commercial sweets/week (P < 0.001) were all associated with high adherence to the Mediterranean diet. Baker et al. (9) evaluated if consuming the Mediterranean diet for a short term would improve endurance exercise performance compared with the typical Western diet. Seven recreationally active women and four men, 28 ± 3 years of age, with a body mass index of 24.6 ± 3.2 kg/m2, were randomly assigned to either the Mediterranean diet or the Western diet (each person received each of the diets in random order). They were on each diet for 4 days. There was a 9- to 16-day washout period between the two diets. Endurance exercise performance was evaluated with a 5-km treadmill time trial. Anaerobic exercise performance was assessed using the Wingate cycle test, a vertical jump test, and hand grip dynamometry. The participants ran a significantly faster 5-km when they consumed the Mediterranean diet compared with the Western diet (27.09 ± 3.55 vs. 28.59 ± 3.21, respectively; *P = 0.030). There were no significant differences in heart rate (P = 0.0941) or ratings of perceived exertion (P = 0.356) between trials. In addition, there were no significant differences observed between the diet conditions for peak and mean power from the Wingate test (P > 0.05), the vertical jump test (P = 0.19), and the handgrip strength test (P = 0.69). These results demonstrate that consumption of the Mediterranean diet can be advantageous for exercise performance in the short term. More research is required to determine whether long-term consumption of the Mediterranean diet provides greater benefits and if it will benefit anaerobic exercise as well as muscle strength and power (9). More research is required to determine whether long-term consumption of the Mediterranean diet provides greater benefits and if it will benefit anaerobic exercise as well as muscle strength and power (9). Galan-Lopez et al. (10) evaluated the association between adherence to the Mediterranean diet with physical fitness factors and body composition in 917 adolescents, 13 to 16 years of age. They incorporated the Adherence to the Mediterranean Diet (KIDMED) questionnaire to evaluate adherence to the Mediterranean diet. They included the ALPHA-Fitness Test to assess physical fitness and body composition. They reported that those who had higher adherence to the Mediterranean diet had significantly greater cardiovascular endurance compared with those who did not have good adherence. WAYS TO INCLUDE THE MEDITERRANEAN DIET INTO DAILY MEALS How can individuals incorporate the Mediterranean diet into their meals? Some ideas include consuming a variety of fruits and vegetables, by making smoothies or making fruit skewers. Use vegetables as a “container” (e.g., stuffed peppers with vegetables, rice). Include dates in the diet, which also may help to replace added sugars. Use the peels of fruits and vegetables (e.g., orange skins for flavor, or bake potato skins with olive oil and garlic). Consume one meatless meal a week. Increase whole grains by using whole grain bread or whole grain rice. Increase consumption of fish, including sardines, if possible. Small changes to the diet can lead to large gains in health and exercise performance. SUMMARY The Mediterranean diet has been a diet and lifestyle based in Mediterranean countries for years. It has been well established to help prevent chronic diseases and also can be effective with weight loss. With respect to exercise performance, it has been shown that consuming the Mediterranean diet can enhance performance. Recommending that athletes consume, or at least try to incorporate, the Mediterranean diet into their meals could lead to better performance and overall health.