The Nordic Diet: The Non-Mediterranean Mediterranean Diet?

Does eating a “Mediterranean diet” mean eating only Italian, Greek, Spanish and other Mediterranean dishes? What’s the difference between Mediterranean cuisine and the Mediterranean diet?

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Recently published studies about a healthy Nordic Diet provide a good framework from which to look at this question. Let’s get past the tendency to talk about ANOTHER diet, and instead look for the bottom line of a predominantly plant-based diet can help you focus on key steps to support YOUR good health.

What is a Healthy Nordic Diet?

The Nordic Diet–representing eating patterns in Denmark, Sweden, Finland, Norway and Iceland – has been examined in several studies published over the last few months.

The traditional Nordic diet tends to be low in legumes (dried beans and peas) and most vegetables; and high in animal foods, sweets, potatoes and foods relatively processed and refined. Since this runs counter to what research links to lower risk of major chronic health problems, Scandinavian researchers and health experts considered what to do.  Are there any redeeming qualities in the traditional diet that could be encouraged, rather than call for a wholesale change in food choices?

One result is a Healthy Nordic Food Index, which awards points for above-average consumption of traditional Scandinavian foods that seem likely to promote health:

• Fish
• Cabbage and other commonly eaten cruciferous vegetables (broccoli, cauliflower, kale and Brussels sprouts)
• Root vegetables (mainly carrots)
• Whole grain rye bread
•  Oatmeal
• Apples and pears

Another choice compatible with traditional Nordic eating patterns involves the many berries that grow there.  Although berry consumption is not reflected in the Healthy Nordic Food Index, the fiber, vitamin C and many natural antioxidant flavonoid compounds berries contain are likely to add protective health benefits, too.

Nordic Diet: Links to Mortality & Cancer Risk

The Diet, Cancer and Health Study, involving more than 50,000 Danish men and women ages 50 to 64 followed for about 12 years, awarded one point each for above average consumption of these six healthy foods. Each one-point increase in score was linked with four percent lower mortality. Altogether, after adjusting for other influences, compared to those with lowest overall scores, people with highest scores showed 25-36 percent lower mortality rates. This was “statistically significant” in men, but although a visible trend, could not be clearly attributed to more than chance among women.

In separate analysis from that same group of Danish men and women, those scoring highest on the Healthy Nordic Food Index score also showed a 31-33 percent lower risk of colorectal cancer.  However, the high scorers were more likely than low scorers to have other healthy habits, too, like smoking less and being more likely to participate in sports.

They also tended to have smaller waists.  All these factors link with lower colorectal cancer risk, so researchers adjusted statistically for them and for calorie consumption. The results: although the link of Nordic score to colorectal cancer risk in women was essentially unchanged, the link in men was starkly reduced. More research is needed to understand what this means.

Among these Danish men and women, consumption of whole grain rye bread, cabbage family vegetables and root vegetables showed some independent links to lower overall mortality, the overall eating pattern was much more important to mortality and colorectal cancer risk than any single food.

Nordic Diet & Heart Health 

Swedish researchers used traditional Nordic food choices, but shifted proportions to create the predominantly plant-based diet now linked with long-term health. Compared to the typical eating pattern documented in national Swedish dietary surveys, here’s what changed:

♦ More vegetables and fruits – the focus was on traditional choices like blueberries, lingonberries, apples, pears, prunes, cabbage, cauliflower, Brussels sprouts, broccoli, fennel, spinach, kohlrabi, viper’s grass, onions, leek, kale, turnips, carrots, and beets.  The goal amounted to about six servings daily, a 25 percent increase compared to the average Swedish diet.  However, people were able to eat whatever amounts they wanted, and average intake soared to about 8 to 11 servings a day, which included only about one serving of (usually boiled) potatoes.

♦ Legumes went from typical Swedish occasional use to about one serving daily, including brown beans, yellow and green peas, chickpeas, kidney bean and lentils.

♦ Whole-grain rye and wheat bread and other whole grains – such as barley, oats, muesli and whole grain pasta – remained relatively high. The main change was the focus on these whole grains that included substituting them for another traditional choice, white rice.

♦ Fish consumption, already relatively high compared to U.S. intake at about 12 ounces per week, targeted three to five servings a week, resulting in average intake of about18 ounces per week. This included a variety of white fish as well as traditional choices rich in omega-3 fat such as herring, salmon and mackerel.

♦ Meat (including traditional beef, pork, reindeer and sausage) and poultry were still included, but decreased by about a third. This included keeping red meat within the limit of 18 ounces per week recommended by the American Institute for Cancer Research for lower cancer risk.

♦ Saturated fat consumption was reduced, although added fat actually increased somewhat. Beyond the decrease in meat consumption, this also relates to a shift from butter to vegetable oil spreads and canola oil, and a switch to low-fat milk and cheese selections.

♦ Sweets, including bakery and ice cream, decreased nearly 25 percent by saving them for weekend use only.

A randomized controlled trial involving Swedish men and women who had mildly elevated blood cholesterol compared the effects of usual Swedish eating habits to this healthy Nordic diet.  On the Nordic diet, although food was chosen and prepared for them, people were allowed to eat as much as they wanted. After six weeks, here’s what happened:

• Systolic blood pressure dropped 6 percent
• Insulin levels and a measure of insulin resistance both dropped 9 percent
• LDL (“bad”) cholesterol dropped 21 percent
• Weight dropped 4 percent

This drop in insulin resistance not only means that, if continued, people would be at less risk of developing type 2 diabetes; research is now suggesting it could mean lower risk of some cancers. Although the diet also lead to a drop in HDL (“good”) cholesterol, LDL dropped much more and the ratio of LDL to HDL suggests this is overall very positive for heart health.  This study did not show the expected Mediterranean diet-related drop in a marker of inflammation, which is important to heart and overall health; but it was reduced in another study of a healthy Nordic diet.

Weight loss seemed to be the major reason for the drop in blood pressure and insulin resistance. Researchers suggest that the drop of about 500 calories a day that led to it, despite people being allowed to eat as much as they wanted, might relate to the filling effect of the increase of already-high fiber consumption all the way to an average of 48 grams a day. (That’s about five times the typical fiber consumption in the U.S.)  This could also reflect the decrease in calories consumed when tempting sweet desserts are not available each and every day.

What’s this got to do with a Mediterranean diet?

Don’t get distracted in the differences of flavor – dill and horseradish versus basil and oregano – or specific vegetables – cabbage, beets and kale versus rapini, artichokes and tomatoes – between the  Nordic and Mediterranean diets.

Although the choice of added fat varies between Nordic and Mediterranean diets, they both emphasize reducing red and processed meat and other sources of saturated fat.  And both emphasize a predominantly plant-based diet that puts vegetables, fruits, whole grains and beans at the center of our plates.

My take on the bottom line: There are differences among plant-based diets like vegan diets, and the DASH, Portfolio, Mediterranean and Nordic diets that may give one or more even greater health benefits.  Or perhaps different eating patterns could be a better health-wise match for people based on genetic or other health differences. But when it comes down to it, among these and other healthy eating patterns, the one that benefits you most is the one you actually follow.  Maybe it’s none of these, but a synthesis of bits of each that match your tastes.  Over and over, some form of a predominantly plant-based eating pattern is showing up in studies linked to lower risk of cancer, heart disease and type 2 diabetes.  Let these new studies on the Nordic diet remind you to find a pattern that works for you, and start making the necessary changes.

Let’s talk: How are you putting together a predominantly plant-based diet that fits your lifestyle and food preferences?

Check previous Smart Bytes™ posts for more detailed discussion of the DASH and Portfolio diets and the Mediterranean diet.

References

Slimani N,  et al. Diversity of dietary patterns observed in the European Prospective Investigation into Cancer and Nutrition (EPIC) project. Public Health Nutr. 2002 Dec;5(6B):1311-28.

Olsen A, et al. Healthy aspects of the Nordic diet are related to lower total mortality. Nutr. 2011 Apr 1;141(4):639-44.

Kyrø C, et al. Adherence to a healthy Nordic food index is associated with a lower incidence of colorectal cancer in women: The Diet, Cancer and Health cohort study. Br J Nutr. 2012 Jul 3:1-8. [Epub ahead of print]

Adamsson V, et al.  What is a healthy Nordic diet? Foods and nutrients in the NORDIET study. Food Nutr Res. 2012;56. doi: 10.3402/fnr.v56i0.18189.

Adamsson V, et al. Effects of a healthy Nordic diet on cardiovascular risk factors in hypercholesterolaemic subjects: a randomized controlled trial (NORDIET).  J Intern Med. 2011 Feb;269(2):150-9.

Sofi F, et al. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr. 2010 Nov;92(5):1189-96.