Expert Doctors: One Mediterranean Diet Treat May Be Causing Health Problems
A Harvard doctor suggests one in four deaths among young adults can be attributed to this indulgence. Here's how to enjoy it a little safer, if it's appropriate for you.
The Mediterranean diet is generally considered to be the gold standard diet of our time. It incorporates the healthiest eating principles from countries bordering the Mediterranean Sea, where populations have demonstrated extraordinary longevity rates.
The Mediterranean diet primarily consists of fruits; vegetables; whole grains; minimal dairy; oils made of omega-3 fats, like olive oil; lean meats, such as fish and poultry; a little high-quality chocolate; and, of course, a small amount of wine—preferably red, say some cardiovascular clinicians.
However, in recent years, the idea that consuming moderate amounts of alcohol is heart-protective and may extend life has been challenged. For example, in January 2023 the World Health Organization (WHO) stated that there is no safe level of alcohol consumption. The WHO classified alcohol as a carcinogen with effects akin to asbestos and tobacco, and linked it directly to at least seven types of cancer.
Miguel A. Martínez-Gonzalez, PhD, an adjunct professor of nutrition at the Harvard T.H. Chan School of Public Health and a leading researcher of PREDIMED-PLUS (a large study of the effects of the Mediterranean diet), spoke to these concerns at a conference in late 2023, suggesting that wine should be removed from the Mediterranean diet in many cases. Dr. Martinez-Gonzalez authored a paper in The American Journal of Clinical Nutrition, which was published at the end of December 2023 in an uncorrected proof. This paper reviewed the existing evidence on alcohol consumption, age, and the Mediterranean diet.
As a result of his research, Dr. Martinez-Gonzalez suggested that individuals under 35 years of age should not be encouraged to consume alcohol. That recommendation is due to the data suggesting one in every four deaths of that age group is caused by alcohol-related accidents, as well as rising rates in cancer—specifically breast cancer, Dr. Martinez-Gonzales noted (though colon cancer among this demographic has been rising, too). He said those over age 40 should drink alcohol cautiously.
The reality is that alcohol consumption has been linked to hundreds of diseases and conditions and, for adults ages 20 to 34 years, is the leading cause of mortality, connected with 25% of all deaths among this age group. However, the risk of death due to alcohol-related injuries generally decreases as a person ages past young adulthood. For people aged 35 through 49, alcohol was involved in about 17% of deaths, 9% for those aged 50 to 64, and less than 1% for those over 70.
Martínez-Gonzalez concluded that age and the risk of dying from alcohol abuse must be considered when evaluating the role of red wine in the Mediterranean diet. If someone is at risk of dying prematurely due to alcohol-related incidents, the cardiovascular benefits of moderate red wine consumption may be irrelevant. Additionally, the risk of cancer should be taken into account. Martínez-Gonzalez stated, “Admittedly, for teenagers and young adults, the healthiest choice regarding alcohol intake is total abstention.” He also stressed that nobody should be encouraged to start drinking solely for potential preventive effects.
Some subsets of people do appear to benefit from moderate alcohol consumption though, particularly red wine. In fact, in some diet studies, wine has been a key factor contributing to the heart’s protective effect, and removing it could potentially reduce the diet’s effectiveness. “With the available evidence, it can be concluded that between 12% and 24% of the protection afforded by the Mediterranean diet against total mortality is lost when red wine consumption is removed from its definition,” Martínez-Gonzalez says.
Martínez-Gonzalez acknowledges the need for potential adjustments to the message, perhaps with age-specific warnings. Removing wine from the diet prematurely could have serious consequences. The diet with the moderate alcohol message seems to offer benefits such as weight loss, improved management of chronic diseases, and increased longevity for a significant population. This decision should not be made without further study. Martínez-Gonzalez emphasized, “A sufficiently large trial comprehensively assessing the clinical effects of alcohol is long overdue.”
How to drink wine as safely as possible on the Mediterranean diet
Martínez-Gonzalez also highlights that many people may not be correctly following the Mediterranean diet. It’s not a license to consume wine freely every day. When it comes to moderate drinking, several guidelines should be followed to minimize negative effects and maximize positive ones:
- Alcohol intake should be moderate and spread out over a week, rather than concentrated on specific days or weekends. Consuming several glasses of wine in one or two days a week does not align with adhering to the diet.
- Binge drinking should always be avoided.
- All alcohol consumption should be with meals.
- Wine is preferred, with red wine being the best option, while hard liquor should be avoided.
Martínez-Gonzalez stated, “Closer adherence to this drinking pattern was consistently associated with lower all-cause mortality.”