The Mediterranean Diet For Autoimmune Disease
Dec 31, 2022
The Mediterranean diet is one of the most studied diets and it’s excellent for general inflammation management, heart health and hormonal health. In fact, it's one of my core diets I recommend for clients who are just getting started on nutritional changes or want an easy-to-follow plan for chronic pain, digestion, energy and gradual weight loss.
For those with an autoimmune, type 2 diabetes or metabolic disorders (high blood sugar, cholesterol and blood pressure), the traditional Mediterranean diet absolutely needs modifications. And in fact, I find it to be more of a maintenance diet after they have done some initial work with me to help restore their gut health/microbiome and identified their unique food sensitivities
You will learn why later on. In the meantime, let’s look at what the Mediterranean Diet is all about.
The Mediterranean Diet vs Anti-Inflammatory Diet
From where I sit, they are basically one in the same.
The Mediterranean Diet is based on the traditional foods of people living around the Mediterranean Sea – Spain, France, Italy, Malta, Croatia, Slovenia and Greece. It's a nod to my heritage (thanks Dad) and the diet we loosely followed while growing up. I can confirm ... it's a delicious way to eat.
In the mid-20th century, researchers noted that people in Spain, Greece, and Italy lived longer and healthier than Americans. And they had lower levels of heart disease, North America’s number one killer. And the research keeps coming in.
Eating a Mediterranean Diet is linked with:
- Less obesity and overweight (it's better than low-fat diets)
- Better blood sugar control (for diabetes)
- Lower risk of heart disease and stroke (and blood markers like cholesterol and triglycerides)
- Reduced risk of Parkinson's and Alzheimer's diseases
- Fewer cancers (breast & colorectal)
- Less premature death
Recent research even links the Mediterranean diet to better gut health. Gut health is associated with mental health, autoimmune, allergies and chronic inflammation. Why the connection? Well, the Mediterranean diet is high in fruit, vegetables and fibre, key food groups for friendly gut microbes. It’s also low in processed foods and sugar … key foods for unfriendly gut microbes.
Many people who start eating a Mediterranean diet can stick with it long-term. In fact, many live it life-long. It is easy to follow and easy to stick to. It also doesn’t restrict foods. Nope. It embraces them.
How is this even possible? Read on …
What to foods to include on a Mediterranean Diet
Whole foods comprise the bulk of the Mediterranean Diet. Foods like:
- Fruits and vegetables
- Nuts and seeds
- Legumes
- Whole grains
- Fish and seafood
- Extra virgin olive oil
- Herbs and spices
These foods are full of vitamins, minerals, antioxidants, healthy fats, and fibre. It’s important to underline that whole grains refers to grains in their WHOLE form, not refined. Think kasha, quinoa and brown rice, not multi-grain Wonder Bread.
The go-to beverage for the Mediterranean Diet is water. Coffee and tea are also regularly consumed (without the addition of lots of cream and/or sugar). And yes, you can enjoy red wine (about 1 glass per day)! Yay!
Additional foods and drinks that are eaten in moderation include:
- Poultry
- Eggs
- Cheese and yogurt
- Red meat, unfermented dairy (e.g., milk), butter, and salt
What foods to avoid on a Mediterranean Diet
There are many foods and drinks that are not part of the Mediterranean diet. Not surprisingly, this includes many highly processed and unhealthy foods like:
- Packaged desserts
- Processed meats (with the exception of some cured meats like prosciutto)
- Sauces and gravies
- Sugar-sweetened beverage, coffees
- Refined grains and oils (including hydrogenated oils)
- Too much salt
- Added sugars
An Anti-Inflammatory Lifestyle On The Mediterranean Diet
The Mediterranean Diet Mindset also incorporates a different lifestyle. Depending on where you live, walking is the primary mode of transportation as cars can not fit through the streets of the smaller villages and certain city neighborhoods. You park on the outside of town and walk to the centre, often uphill as in the case of the Mediterranean coastline.
This doesn't happen in North America where we have to make a decision to park and walk further from our destination.
Having lived on the Mediterranean coast line, I can also say that HOW the Europeans eat and time of day is very different from North America. Breakfast is often higher in healthy fats or proteins, lunch is the main event when it comes to meal time and dinner is often a simple soup or light meal, unless it is a special occasion. This allows the body time to use up the food it’s being given and allows the body to fast properly overnight.
The notion of farm-to-table is alive and well in Europe. People buy what’s in season and they shop for fresh more often as kitchen storage is typically tight. Fridges are smaller than what we have in a North American kitchen and it’s considered a luxury to have a secondary small cube freezer.
Meals are also social and eaten with others. You connect, discuss and eat slowly. Even lunchtime is celebrated and “eating at your desk” at work is not a customary habit. You eat with co-workers. Other countries are starting to get on board with this process. In fact, Canada recently changed it’s food guidelines to include a section on the importance of mindful eating:
- The importance of preparing food from scratch
- Connecting with others
- Slowly chewing food
- Music
When you are rushed or stressed, you do not digest well. Your gut is often referred to as your second brain (also known as the enteric nervous system, housing more neurotransmitters than your spinal column!). Slow down for the benefit of your body and nerves.
Pros and Cons of the Mediterranean Diet For Autoimmune
This diet is particularly rich in Omega 3 and 9 (healthy fats) which helps balance the Omega 6 : Omega 3 ratio. I'll explain below and if you want more in-depth info, you can read this article I wrote called, Why Omega 3s Are So Important For Autoimmune And Inflammation.
To help manage inflammation, you should ideally maintain a 3:1 ratio of Omega 6 : Omega 3s in your diet. Omega 6 is found in plants and Omega 3 is primarily found in seafood. Due to the amount of processed foods that North Americans eat (fried foods, crackers, chips, cookies, snacks and treats that use plant oils) vs the amount of fish and seafood we eat (none in many households), the Omega 6 to 3 ratio has swung dramatically out of balance and many consume a ratio closer to 10:1. This puts your body into an inflammatory state.
An easy way to swing the balance is to simply incorporate more fish and seafood into your diet. In fact, the autoimmune protocol recommends 5 – 6 meals a week to help increase intake of Omega 3s and selenium.
Worried about mercury? Research shows that the amount of selenium found in fish naturally binds to mercury for it to be removed from the system, and the leftover selenium can support the overall immune system. If you’re still worried, purchase smaller fish … they will contain less mercury overall.
If you dislike making or eating fish, a fish oil supplement may be an option for you.
I also think that there is a very good argument to include grass-fed beef in the Mediterranean Diet. Historically, not a lot of beef was included and that’s because people lived seaside on rocky terrains with limited pastures to raise cattle. The cows they did have were grass fed and used for dairy. This makes a difference in the quality of what they were eating.
Today, our beef is mostly grain fed (feed loaded with genetically modified soy and corn, and the chemicals that come along with that). As a result of the feed, grain-fed beef also tends to be higher in saturated fat (typically known as “the bad fat”), whereas research shows that grass-fed beef has a better Omega 6:3 ratio, and it is higher in Vitamins A and E, important antioxidants.
Grass-fed beef is also a good source of iron and B12, micronutrients that those with autoimmune are typically low in that we need for immune regulation, the formation of red blood cells for energy and a long list of other metabolic reactions in the body.
In my opinion, the disadvantages of the Mediterranean diet seem to center most around the nuances for autoimmunity and food sensitivities. This is based on my observations with clients and also the application of the research studies.
The Mediterranean Diet is high in many known food triggers that can contribute to discomfort for those with IBD or arthritic/rheumatic conditions: legumes, nuts/seeds, grains and nightshades. These foods contain compounds known as lectins (prolamins and agglutins), saponins, phytic acid and digestive enzyme inhibitors. For some – especially those with a hyper immune system – these compounds cause additional inflammation.
Nightshades in particular can be troubling and I have yet to have a client with a rheumatic condition, IBD or Hashimoto’s who does well with all nightshades when we tested them with an elimination diet (i.e., okay with strained tomatoes, but not green peppers).
Another disadvantage is that the Mediterranean Diet includes wheat and whole grains, and when you live in North America, the assumption is that any grain in any quantity will do. Not so. The whole grains in Europe don’t include genetically modified farming practices or the spraying of certain chemicals, which we use here, in abundance. And despite the vision we have of Europeans with their baguettes and fresh bread, they eat far less than North Americans. What they do eat is also preservative free, made with natural, whole ingredients, which is why it hardens or goes bad in 2 days.
With all of this in mind …
I have found that most of my autoimmune clients - whether they be men or women or have RA, Fibro, MCTD, inflammatory arthritis, Crohn’s, Colitis, Hashimoto’s…
Most of my clients feel the best, fastest results when they follow the Autoimmune Protocol or a modified Paleo approach which is why we offer both a modified Mediterranean and the Autoimmune Paleo Protocol inside The Integrative Autoimmune Network. In many cases, members do a hybrid of these, depending on their food sensitivities.
We are able to get their joint, muscle and digestive symptoms quickly under control and I have had clients reverse their lab results (blood sugar, thyroid, GI inflammation, CRP/ESR) with these two approaches within six months.
Recent research into RA also supports that the Mediterranean Diet needs to be modified for this population, and that gluten and red meat eliminated. My experience is that this is person specific.
The Mediterranean Diet is also one of the key diets recommended for blood sugar control, cholesterol and blood pressure. Yet, when pitted against a Paleo, Paleo outperforms. In fact, studies show people have a more significant drop in blood glucose while following a Paleo approach for only 12 weeks, while lipid profiles improve and blood pressure decreases.
From here, the Mediterranean Diet becomes a MAINTENANCE diet - customized to your body and lifestyle.
Conclusion
The Mediterranean Diet is a very healthy way of eating. It is a whole food diet based mainly on plant and seafood (fruits, vegetables, nuts, seeds, legumes, whole grains, fish, olive oil, and herbs and spices).
The Mediterranean Diet is high in vitamins, minerals, antioxidants, healthy fats, and fibre; all of which are health-boosting from your head to your heart… and the rest of your body. The majority of research on the Mediterranean Diet focuses on heart health.
Don't forget that health involves more than just food. The Mediterranean lifestyle also incorporates regular exercise, eating with people whom you care about, and overall enjoyment of life.
If you have an autoimmune disease, it's helpful to consider modifications for your condition and goals. The Mediterranean Diet includes quite a few food triggers for gut inflammation and may not be the best fix for your overall short term health goals (getting symptoms under control quickly). A more therapeutic approach like a modified Paleo or AIP may be better suited for the short term.
References:
https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
https://medlineplus.gov/ency/patientinstructions/000110.htm
https://www.healthline.com/nutrition/mediterranean-diet-meal-plan
https://www.healthline.com/nutrition/5-studies-on-the-mediterranean-diet#section3
https://www.medscape.com/viewarticle/866254
https://www.healthline.com/nutrition/optimize-omega-6-omega-3-ratio
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846864/
