The Mediterranean Diet
A healthy Mediterranean eating style has begun to take on a new meaning in the past few years, as an increasing number of patients have been following the Mediterranean Diet (MD) for weight control. For the sixth consecutive year in a row, this dietary pattern was #1 in the U.S. News and World Reports "Best Diets Overall" ranking.64 Extensive nutrition research consistently confirms an undeniable association between the MD, weight control and a whole host of other health benefits, including preventing chronic disease.
The MD is a nutrient-rich eating style based on the traditional and cultural foods eaten in the countries surrounding the Mediterranean Sea. The diet emphasizes enjoying meals with others, physical activity and intuitive eating. Individuals consume core whole foods every day, including vegetables, fruits, legumes, beans, nuts, seeds, avocados, olives, herbs, spices and whole grains. Traditional Mediterranean whole grains include bulgur, barley, farro and brown, black or red rice. Fish is eaten at least twice per week and poultry, eggs, dairy and wine are consumed in moderation. SSB, red meat, highly processed meats, refined grains, ultra-processed snacks and fast foods are rarely consumed. This makes the MD a dietary pattern that is environmentally sustainable, high in fiber, vitamins, minerals and phytochemicals and low in animal protein, saturated fat and added sugars. The MD pyramid can be seen in Figure 2.65
Figure 2: Healthy Mediterranean-Style Eating Pattern
Accruing evidence has linked the MD to reducing obesity and promoting weight control and maintenance. A systematic review of controlled clinical trials and prospective studies published in 2019 concluded that a high level of evidence exists to support that the MD lifestyle reduces obesity.66 A 2-year dietary intervention study of 322 moderately obese Israeli individuals was published in the New England Journal of Medicine. The individuals who followed the MD lost weight and had a significant decrease in waist circumference and blood pressure. Beneficial metabolic effects were also seen, as the diabetic participants in the MD group had decreased fasting plasma glucose levels.67 Additionally, the MD has been consistently associated with lower rates of cardiovascular disease, obesity, neurodegenerative disease, cancer, depression, respiratory disease, fragility fractures and total mortality in prospective observational studies and trials in diverse populations.68,69
It has been reported through systematic reviews and meta-analysis studies that obesity is positively associated with an increased risk of oral chronic inflammatory diseases including periodontitis.70,71 While further research is needed to better establish how these factors work together, studies have indicated positive results regarding the MD diet, weight control and oral health. More specifically, an intervention study found a beneficial change in the salivary microbiome in obese and overweight adults after following the MD for 8 weeks. These adults had a significant decrease in the pathogenic bacteria associated with periodontal disease: Porphyromonas gingivalis, Prevotella intermedia, and Treponema denticola compared to the control group who did not change their eating habits.72 A cross-sectional study of 6,209 participants of the Hamburg City Health Study identified a significant association between higher adherence to the MD and reduced risk for developing periodontal disease.73 In addition, a recent RCT published in the Journal of Clinical Periodontology looked at the effect of the MD on gingivitis and reported dramatic findings. After just 6 weeks following the MD, there was a significant reduction in gingivitis, periodontal inflammatory parameters and whole-body anthropometric parameters.74
The bottom line: The Mediterranean-Style diet, a popular diet trend that emphasizes whole grains, fruits, vegetables, nuts, seeds, olives, avocados and legumes, fosters a healthy weight and a healthy oral cavity.