The Mediterranean diet has long been touted as the best eating plan to follow for the prevention of obesity, diabetes, heart disease, and even certain types of cancer.
The staples of the Mediterranean diet include whole grains, healthy monounsaturated fats like olive oil, fresh fruits and vegetables, nuts, seeds, legumes, seafood and red wine. Occasionally, dairy products (mainly yogurt and cheese) and poultry are consumed, but red meat, processed foods and foods high in sugar and salt are either eaten minimally or avoided altogether.
For all the already-proven health benefits, not many studies have examined the link between eating a Mediterranean diet and the prevention of osteoporosis. Researchers hypothesized that the antioxidant, anti-inflammatory and alkalinizing properties of this particular diet could have a bone-sparing effect.
To test their hypothesis, they recruited 200 women aged 18–65. Because menopause is one of the biggest risk factors and predictors of osteoporosis, they divided the women into two groups: The first group consisted of 100 premenopausal women, and the second group had 100 postmenopausal women who had ceased menstruating at least 12 months prior to the start of the study.
The preliminary data researchers obtained included weight, height, physical activity, smoking habits, body mass index, waist circumference and bone mineral density (BMD), which was measured using dual-energy X-ray absorptiometry (DEXA). Trained interviewers also collected information about each participant’s eating habits using a food frequency questionnaire that included 97 food items. Participants had to answer if they had eaten each item during the last year, the number of times it was consumed per week, and the amount they consumed each time.
Researchers measured adherence to the Mediterranean diet using a scoring system that evaluated compliance. For the beneficial components of the diet (fruits, vegetables, whole grains, healthy fats, etc.), women whose consumption was below the median were assigned a value of 0, while women whose consumption was at or above median were assigned a value of 1. The same scoring system was used for detrimental foods (meat, dairy products, etc.). The women who drank between 5–25 g per day of wine received a value of 1. Overall, if participants met all the characteristics of the Mediterranean diet, they received the highest score of 9, reflecting maximum adherence. Conversely, no adherence at all to the Mediterranean diet received a score of 0.
After analyzing their data, researchers concluded that following a traditional Mediterranean diet was, in fact, associated with higher BMD in both pre- and postmenopausal women. In particular, fruit and vegetable consumption was significantly related to BMD in both groups of women. In addition, in the premenopausal group, monounsaturated fat intake was positively associated with BMD, while nuts were significantly associated with BMD in the postmenopausal group.
Researchers believe one of the reasons the Mediterranean diet has such a positive effect on bones has to do with dietary acid load. This diet excludes processed foods and foods high in sugar, both of which have an acidic effect on the body. On the other hand, most fruits and vegetables (with the exception of citrus) are alkaline in nature, so consuming them in great quantities helps contribute to an alkaline body composition. The more alkaline your body’s pH, the less likely your body will “steal” alkaline minerals like calcium and magnesium from your bones to reduce the acidity in the rest of your body.
In addition, fruits and veggies have high levels of bone-friendly nutrients like calcium, vitamins C and K, and phytoestrogens.
How to Go Mediterranean
The easiest way to start eating a Mediterranean diet is by ditching the vegetable and canola oils and start using olive oil in your cooking, as well as in salads and for marinades.
Next, cut out unhealthy snack foods like chips and cookies and opt for cut up vegetables or a piece of fruit. Also, switch out two red meat-based dinners per week for cold-water fish like salmon, tuna, mackerel, halibut or trout — and use olive oil and fresh spices as your marinade.
Try to drink less milk every day, and if you do consume dairy, opt for Greek yogurt or cheese. And if you want to indulge in some alcohol on an occasional basis, choose heart-healthy and bone-friendly red wine over beer or hard liquor.
Finally, do your best to eliminate as much sugar and processed food from your diet as possible. This may be a challenge at first, but your overall quality of life and now, bone health, will improve in the process, so it’s well worth the effort.
 Rivas A et al. Mediterranean diet and bone mineral density in two age groups of women. Int J Food Sci Nutr. 2012 Sep 5. [Epub ahead of print.]