Mediterranean Diet, Cortisol and Inflammation

When I wrote The Adaptation Diet, the focus of the book was on controlling cortisol, the main stress hormone through diet. By lowering cortisol, the risk for many chronic diseases, including diabetes, heart disease and cancer can be reduced. The secret to lower cortisol is reducing inflammation. My research led me to use the Mediterranean diet as the best long term diet to control cortisol. Since the book was first published in 2010, a slew of studies have been done that proves this dietary approach is the one most people should adopt.    

A 2014 study of over 7000 people who were placed on a Mediterranean diet made headlines around the world. The study reported in the New England Journal of Medicine, found that people with high risk for heart disease, smokers, overweight people, diabetics and those with other risk factors, who were placed on a Mediterranean diet had over a 30% lower incidence of heart disease than those people on a control diet, either low fat or the usual modern diet of with high amounts of red meat, sodas and baked goods. Those with the lower heart disease rate ate 4 tablespoons of olive oil per day, or a handful of nuts such as walnuts, almonds or hazelnuts. In addition they consumed fish at least three times per week, legumes three times a week and drank seven glasses of red wine a week.

In addition, when the researchers looked at a subgroup of people in this study that had cognitive dysfunction, those on the Mediterranean diet had significant improvement in memory and focus. This prospective study was the first to show that foods that are anti-inflammatory such as nuts and olive oil, rich in omega 3 and omega 9 oils, cold water fish rich in omega 3 oils, as well as large amounts of antioxidant rich plant based foods is good for your heart, brain and blood sugar. And going back to the core idea of The Adaptation Diet, another study showed that the Mediterranean diet lowers cortisol levels and leads to less activation of the hypothalamic-pituitary-adrenal axis compared to a control diet.  

In a study done at the University of Navarra in Spain, 41 obese subjects were placed on a low calorie Mediterranean style diet and followed for 8 weeks. Those who adhered most closely to the diet not only had the greatest weight loss, but also had a marked reduction in blood levels of inflammation including CRP, complement C3 and TNF alpha. The conclusion of the researchers was that this type of diet, not only helps with weight loss but also can markedly reduce inflammation and improve.

The Mediterranean diet, rich in fruit and vegetables and high in monounsaturated fats, reduces features of the metabolic syndrome, including high blood pressure, insulin resistance, truncal obesity (fat around the waistline), high triglycerides and blood sugar, and low HDL cholesterol. It is a major risk factor for heart disease and diabetes. Some recent studies, including one done by Balbio in Spain, have demonstrated a 25 percent net reduction in the prevalence of metabolic syndrome following lifestyle changes mainly based on nutritional recommendations.

The bottom line is that there is greater evidence than ever before that the Mediterranean diet can control inflammation, the underlying process in nearly all chronic disease. Controlling cortisol through diet is the natural outcome of a plant based and healthy fat diet, especially one rich in olive oil as the main fat, cold-water fish, legumes, vegetable and fresh fruits. The diet used in this groundbreaking study is almost identical to the maintenance diet I present in The Adaptation Diet. Making dietary choices based on a traditional Mediterranean diet used for many generations of people with lower incidence of cancer, heart disease, obesity and diabetes seems to be an obvious choice we can all make. The payoff is greater adaptation, lower cortisol levels, less inflammation and a smaller waistline.

The Mediterranean Diet has the following characteristics:

  • Low-glycemic-index carbohydrates such as whole grains, fruits, and vegetable in large amounts, more than 50% of every meal is vegetables or fruit

  • Minimal snacking between meals and no fast foods

  • Moderate consumption of red wine (5 ounces per day)

  • Olive oil as the principal fat, with significant amounts of fish, nuts, and seeds and a balanced omega 6 to 3 ratio

  • Significant intake of fish, especially salmon and small fish like sardines rich in EPA-DHA fatty acids

  • Little saturated fats from butter, cream, full-fat dairy, or red meats

  • Protein primarily as beans and lentils with moderate amounts of fish and poultry

  • Dairy consumed as low-fat yogurt, kefir, or cheese

  • Fat consumption is 25–35 percent of calories, with saturated fat less than 8 percent

  • Desserts are fresh fruits

  • Use of local produce, fish, and poultry with minimal importation from distant sources

  • Slow food approach, eating leisurely meals in a social setting with family and friends

These are some of the principles included in The Adaptation Diet, and what I recommend to my patients every day.