For Mediterranean Diet’s Health Benefits, Is it About the Food — or the Lifestyle?

The Mediterranean diet has been prescribed by doctors for decades to help treat heart disease. But a new film is questioning whether it’s the diet itself, or the healthy lifestyle of people in the region, that brings on the major health benefits. (Photo: Getty Images)

A new documentary extolling the virtues of the Mediterranean diet makes an interesting argument: The beloved diet isn’t just about food.

The Pioppi Protocol follows British cardiologist Aseem Malhotra, MD, as he explores the Italian town of Pioppi, where Ancel Keys, the first scientist to champion the Mediterranean diet, lived for decades.

After spending time in Pioppi, which has incredibly low rates of heart disease and an average life expectancy of about 90 years, Malhotra says the benefits of the Mediterranean diet may have been oversimplified. He argues in the film that the diet and lifestyle factors — long, slow meals with friends, lots of moderate exercise, and a relatively stress-free existence — as are the reason for lower instances of heart disease in the Mediterranean. Not, as we here in America extoll, simply a diet alone.

But research has shown that the Mediterranean diet, which features the use of olive oil, nuts, beans, fish, fresh fruits and vegetables, and moderate amounts of wine, can have a big impact on its own on a person’s heart health.

A study of nearly 7,500 people published in the New England Journal of Medicine in 2013 found that people with a high risk of heart disease who ate a Mediterranean diet supplemented with extra-virgin olive oil or nuts had a 30 percent lower risk of heart attack, stroke, and death from heart disease than those who didn’t. The study stopped after five years because the results were so clear that it was considered unethical to continue.

Another study that followed 2,500 Greek adults found that adults who closely followed a Mediterranean diet were 47 percent less likely to develop heart disease over 10 years than those who didn’t follow the diet.

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Malhotra tells Yahoo Health that, while important, diet alone won’t give people all of the heart health benefits that residents of Pioppi enjoy. “Diet is most important but what’s key is modern interpretation is incorrect and has contributed to the obesity epidemic,” he says. “Our film will aim to explain how this happened and correct it.”

The film points out that people in Pioppi savor their food, turn mealtimes into social occasions, and spend a lot of time outside. They also frequently walk and ride bikes, and seem to have low levels of chronic stress.

“There is a synergy of factors that interact to help people lead healthy lives,” says Malhotra.

But Nicole Weinberg, MD, a cardiologist at Providence Saint John’s Health Center in Santa Monica, Calif., tells Yahoo Health that the diet alone has its perks. “The Mediterranean diet as a standalone does have merit,” she says. “It has been shown that, even if you put the diet with a crazy lifestyle, you can have some benefit.”

Weinberg calls the lifestyle aspects of the diet that Malhotra advocates the “cherry on top,” adding, “there is some aspect to having low stress and good healthy exercise to lower your risk of heart disease.”

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Sharonne Hayes, MD, a cardiologist and professor of medicine at the Mayo Clinic, tells Yahoo Health that Malhotra is on to something. “When you think about the Mediterranean ‘diet,’ it is a lifestyle,” she says. “To be fair, the Mediterranean diet alone has been shown to reduce cardiovascular disease, but when added to the lifestyle…that’s sort of the secret sauce.”

Hayes acknowledges that it’s difficult for people in many parts of the U.S. to bike or walk outside during the winter, but says there’s still benefit in trying to incorporate exercise into all aspects of your life — even when it’s freezing out.

“If you have a piece of fitness equipment, move it up from your basement to your living room so you can work out while watching TV,” she says. “Even 15 minutes of walking on the treadmill while watching the nightly news will make a difference.”

Hayes also stresses that portion control is important, even on the Mediterranean diet. People in Pioppi “don’t eat American quantities of food,” she says, which can diminish the benefits of following the diet.

Malhotra is currently trying to raise money on Kickstarter for the film’s release in order to keep it independent.

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