Mediterranean Diet and Lifestyle

It is well known that the Mediterranean area is home to a large percentage of people who are not only surviving to but thriving into their 80s and beyond. According to a review article, “Islands in the Mediterranean basin share particular habits and traditions and greater life expectancy than other European regions.”1 Dan Buettner, author of The Blue Zones: Lessons for Living Longer From the People Who’ve Lived the Longest (National Geographic), studied geographical areas of people living into their 80s and older. He identified that people on the Greek island of Ikaria were 3 times more likely to reach age 90 years than those in the United States and have about 20% less cancer, half the rate of cardiovascular disease, and almost no dementia.2 Besides Ikaria, many people living on the other islands of the Mediterranean Sea hold the secrets to healthy and happy aging. Some of the characteristics of these areas where people live longer and are physically active into their 100s include “family coherence, avoidance of smoking, plant-based diet, moderate and daily physical activity, and social engagement, where people of all ages are socially active and integrated into the community.”3

Research on the dietary and lifestyle characteristics associated with longevity and healthy and happy aging mirrors my observations when performing an ethnographic study of people on the Greek island of Crete who were alive in the 1950s (age range of participants, 65-107 years). In a 1986 assessment of 15-year death rates, Keys et al found that “compared to American men, men from Crete had half the cancer death rate, one-twentieth of the mortality rate attributed to coronary artery disease, and the lowest all cause mortality rates”4(7) in their epidemiological research study of 11 579 men aged 40 to 59 years from 7 countries. In 1991, thirty-one years after the beginning of the study by Keys et al, the Social Health Sector of the University of Crete undertook a medical checkup of the study cohort and found that approximately 50% of the participants from Crete were still alive, in contrast to the other 6 participating countries, where there was not a single survivor, even in the other cohort from Greece.5

Factors that correlate with healthy and happy aging and with longevity are a Mediterranean diet with traditional foods and beverages, social and family support, and lifestyle characteristics that include afternoon naps, physical activity, and stress management with a positive outlook on life. Notably, most people who are surviving and thriving into their 80s and beyond in the Mediterranean area did not have access to conventional medical care until recently and relied on traditional and folk medicine, such as herbal medicine, for health and wellness during most of their life. Traditional herbal teas that are widely consumed by people in the Mediterranean basin are high in antioxidants and may contribute to health and longevity.

The free radical scavenging effect of foods and beverages in the Mediterranean diet may account for their benefits in health and longevity. The mechanism by which aging occurs is theorized to be due to oxidative damage that occurs throughout our life. Aging and the diseases associated with aging occur when some of the damages are not entirely repaired and are accumulated over time. Oxidative damage to DNA seems to be a key step in this process, and it depends (among other factors) on the antioxidant composition of biological membranes and body fluids, which in turn may be directly modified through diet.6 There are a variety of antioxidant, anti-inflammatory, and nutrient-rich foods in a traditional Mediterranean diet.

Ethnographic Case Study

One of the people I interviewed in Crete was my great-aunt Argyro. She passed away in September 2011 at the age of 107 years. She grew up and lived most of her life in a town on Crete called Lakkoi, until she moved in with her son and his family in the town of Hania, Crete. Lakkoi is a mountainous region in western Crete, 450 m high, below the White Mountains and in between Chania and the plateau of the mountainous region of Omalos. She had 2 children, a son and a daughter, who were born with the help of a midwife at home in her village. Argyro never took any pharmaceutical medication, and her only health concerns were a history of benign squamous cell carcinoma on her skin and a hip fracture. Despite the history of skin cancer, she was virtually free of wrinkles when I interviewed her at age 104 years, which she attributed to her olive oil consumption. She was physically active up until 2005, when she fell and broke her hip. After then, she remained bedridden; however, her son and daughter-in-law stated that “she had physical therapy and was able to get up, but was afraid to get out of bed and walk since the fall.” I conducted my interview at her bedside. She was a sociable, proud, and confident woman, who would listen to church liturgies and music every day. She sang me a traditional Cretan song and told me a funny personal story to make me laugh about how she had made a woman faint in church because she looked so beautiful with her blond hair and blue eyes in the brown dress she had made.

Argyro’s diet for most of her life was characteristic of the Mediterranean diet, with an abundance of plant-based foods and “meat eaten once a week, if we were lucky.” Other common main meals included boiled potatoes and wild greens with beans, bean soups, and olive oil with dark bread. While in Lakkoi, she had her own chickens that produced eggs and meat and a large garden with vegetables and ornamental flowers and olive and orange trees. Like most people in Crete, she also foraged and ate an abundance of wild edible greens, such as wild chicory and purslane. To procure the wild greens, she would walk barefoot from her town in Lakkoi to the mountains of Omalos, which is approximately 9 km. The typical food carried when traveling by foot included olives, dark bread, and local Gruyère cheese. There were usually orange, fig, and chestnut trees on the road to enjoy foraging from along the way. She said that her secret to longevity was drinking a small glass of olive oil every day. Like most villagers at that time, her family produced their own olive oil from their olive trees, as well as homemade red wine and moonshine.

Another common daily dietary ritual of the elderly in Crete that Argyro continued until the end of her life was eating plain (Greek) yogurt every night. The 1908 Nobel Prize–winning Russian scientist Ilya Ilyich Metchnikoff in his 1907 book7 attributed the longevity of the Bulgarian population to eating cultured milk products. Greek yogurt is traditionally prepared from sheep’s or goat’s milk and is strained to give it a thicker consistency. Because of the way it is prepared, Greek yogurt is higher in protein and probiotics and is lower in sugar, sodium, calcium, and carbohydrates. Many traditional Mediterranean dishes include yogurt in their preparation.

There was no such thing as organic standards in Crete before the 1950s because pesticides only became available in Greece (and the rest of the world) after World War II. Therefore, all of Argyro’s food was produced without pesticides and from water gathered from the well or mountain water. The Mediterranean diet in the 1900s was also influenced by the lack of refrigeration at that time, which necessitated the use of olive oil, animal fat, honey, salt, sugar, or smoking techniques as natural preservatives. Foods with synthetic preservatives, hydrogenated fats, or artificial flavors and colors were not available in Greece until recently.

Argyro’s physical activity levels before she was bedridden were characteristic of people in Crete until cars became more accessible in the 1950s. Her main mode of transportation for most of her life was walking, on a daily basis. She would also periodically walk to Hania from Lakkoi, a distance of approximately 12 km, to visit relatives.

The Mediterranean Diet

The HALE (Healthy Ageing: a Longitudinal Study in Europe) project7 studied 1507 healthy men and 832 healthy women, aged 70 to 90 years, in 11 European countries between 1988 and 2000. Among these individuals, the study found that a Mediterranean diet (including moderate alcohol consumption) and a healthful lifestyle (physical activity, without smoking) was associated with a more than 50% lower rate of all-cause and cause-specific mortality. Furthermore, not following the Mediterranean diet “was associated with a population attributable risk of 60% of all deaths, 64% of deaths from coronary heart disease, 61% from cardiovascular diseases, and 60% from cancer.”8(p1433)

The basic characteristics of a Mediterranean diet include eating legumes, vegetables, whole grains, fish, and fruit as most of the diet and eating organic dairy products and free-range meat in moderation. A study9 among centenarians in the Mediterranean area showed that most were consuming olive oil (82% of them), dairy products, and vegetables daily; poultry, fish, and legumes 2 or 3 times a week; and red meat rarely. Only 6% were using fats of animal origin on a daily basis.

The Mediterranean diet includes moderate consumption of alcohol, mostly in the form of local or homemade red wine that is consumed with meals. The nutritional profiles and quality of the foods and beverages consumed contribute to their health benefits on health and longevity. The diet increases longevity and prevents disease by excluding inflammatory and toxic foods with artificial ingredients, refined sugars, high amounts of saturated fats, and pesticides, which contribute to aging and genetic degradation. The Mediterranean diet is high in fresh seasonal fruits and vegetables, which are anti-inflammatory and protect against free radical damage. Some specific components of the Mediterranean diet that were mentioned by great-aunt Argyro and contribute to its health benefits include virgin olive oil, legumes, wine and grapes, yogurt, foods high in polyunsaturated fatty acids, and wild edible greens (see table with complete article at ndnr.com).

Mediterranean Lifestyle

Happy aging is called eugeria in Greek. It involves social support, physical activity, afternoon naps, and stress management with a positive attitude.20

Social Support

The family network is culturally important in Greece, where most aging parents or relatives live with their family and continue to partake in social activities, including those of their church community, throughout their life. A study found that “[o]nly 2% of centenarians in Greece lived in an institution, most lived with family members. 25% had an active social life.”9(p514-516)

Physical Activity

Many of the people I interviewed in Crete who were in their 70s or older were remaining physically active by walking many kilometers a day to get groceries, see friends, and go on excursions. Furthermore, most of them have home gardens and forage for wild edible greens. Staying physically active is necessary to reduce diseases, such as diabetes and osteoporosis, as we age and to maintain activities of daily living and social options.

The Mediterranean diet and environment support the ability to stay physically active by preventing osteoporosis, maintaining strong muscles and bones, and managing pain. The Mediterranean diet is high in the nutrients important for maintenance of physical activity, such as omega-3 fatty acids, vitamin K, B vitamins, and magnesium. The climate of the Mediterranean basin also provides optimal amounts of vitamin D from sunshine, which has been found to be protective against osteoporosis, heart disease, and cancer and aids in immune system functions.

Afternoon Naps

As we get older, our sleep cycles change, and we sleep less during the night, go to bed earlier, and need to nap more to have enough energy to enjoy the day.21 In the Mediterranean area, an afternoon nap is a daily ritual for most people between 3 and 5 pm. The afternoon nap is a practical way for people in hot climates to escape the doldrums of the hottest time of the day, but it has other health benefits. In a population cohort study22 in Greece comprising 23 681 individuals followed up for 6.32 years, those who napped occasionally had a 12% lower risk of coronary mortality, and those who napped regularly had a 37% lower risk. A 4-week study23 among the elderly found that taking a short nap after lunch and exercising in the evening improved nighttime sleep and had secondary benefits on mental health.

Happiness and Stress Reduction

Stress is not only bad for our health but also affects our quality of life and our ability to be happy.

Nutrients in the Mediterranean diet that contribute to a good mood or happy aging (eugeria) include omega-3 fatty acids and B vitamins. A study24 in The Journal of Nutrition, Health & Aging among elderly Italian women found that women with depression who received daily supplements containing 2.5 g of omega-3s experienced significant reductions in their symptoms. In addition, researchers from the University of Pavia (Italy) also report that omega-3 supplements providing a daily EPA dose of 1.67 g and a daily DHA dose of 0.83 g reported these same benefits.24