Can the Mediterranean diet and physical exercise improve the quality of life for cancer patients?

In a recent review published in the Nutrients Journal, researchers reviewed existing literature on the benefits of adopting Mediterranean diets (MD) against inflammatory conditions and cancer.

Study: The Mediterranean Lifestyle to Contrast Low-Grade Inflammation Behavior in Cancer. Image Credit: alicjaneumiler/


Cancer represents the second leading cause of death worldwide, immediately after cardiovascular diseases. Obesity is linked to long-term chronic non-communicable diseases such as cardiovascular disease, diabetes, and cancer.

Studies have indicated that weight management and physical exercise may be effective strategies to prevent and combat cancer; however, physical exercise and nutrition are not usually included in standard oncological therapy.

About the review

In the present review, researchers reported the benefits of Mediterranean diets and regular physical exercise in lowering inflammation and the associated risk of cancer development.

Physical activity, inflammation, and cancer

A sedentary lifestyle and prolonged inactivity can result in obesity, especially visceral fat accumulation, with elevated levels of inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and plasminogen activator inhibitor 1 (PAI-1).

The immunological hyperactivation could lead to low-grade chronic inflammation, insulin resistance, and hormonal dysfunction, resulting in cardiometabolic diseases, degenerative diseases, and cancer.

Physical exercise improves insulin sensitivity and lowers adiposity by restoring adipokine production to normal levels, favoring anti-inflammatory cytokines such as IL-10, lowering estrogen levels, enhancing cognition, and increasing lifespan.

Lower levels of inflammatory markers such as C-reactive protein (CRP) are usually observed in physically active individuals engaging in 150 to 300 minutes of moderate-intensity exercise weekly or 75 minutes to 150 minutes of high-intensity exercise.

Physical exercise results in muscle contraction, improved lymphatic flow, and myokines release, which may alter bone, glucose, and lipid metabolism. Physical inactivity alters steroid hormone levels, causes hyperinsulinemia, and increases insulin resistance, with elevated insulin-like growth factor-1 (IGF-1) levels and aromatase enzyme activity.

As a result of physical activity, the reduction in estrogen levels reduces the induction of cell proliferation, progression, and angiogenesis and increases apoptosis of tumor cells via increased sex hormone-globulin (SHBG) production. Studies have reported that physical activity may prevent the side effects of radiation and chemotherapy, such as nausea and weariness.

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Further, regular exercise may result in epigenetic alterations in genes such as the ASC gene and p53 tumor suppressor gene.

Mediterranean diet, inflammation, and cancer

A healthy and balanced diet ensures an adequate nutrient supply, meeting the body's demands and enhancing the prevention and/or protective bodily functions against disease. Well-balanced diets lower cancer-associated mortality and tumor recurrence.

Adopting a Mediterranean lifestyle, the two fundamental components of physical exercise and nutrition, may prevent cancers and strengthen the immunological combat against cancer. MD recommendations include consuming whole grains once daily, vegetables thrice daily, fruits twice daily, and legumes three to four times weekly.

Limiting the intake of red meat, processed meat, frankfurters, and high glycemic index foods, including white bread, sweets, and white rice, is advised. In addition, avoiding packaged foods, french fries, and bakery products with high polyunsaturated (trans) fatty acid content should be avoided.

Carbohydrates are advised to be avoided since they increase acidity and could increase insulin and blood glucose levels. Fruits should be consumed on an empty stomach in the morning or late afternoon.

Fruit salads must be avoided since they comprise fruits with varying pH levels and could result in bowel and stomach issues. Dietary supplements, unless validated in clinical trials, should be avoided.

Calorie intake is advised to be limited to once or twice weekly, and 30-minute brisk-waking, 10,000 steps, or one hour at the gym daily is advised.

Physical exercise coupled with MD can regulate insulin levels, lower insulin resistance, oxidative stress, IGF-1, and estrogen levels, and decrease the production of inflammatory cytokines and leptin (a mitogenic factor).

Additionally, physical exercise increases adiponectin (pro-apoptotic factor) production by adipocytes and restores intestinal microbiome balance for anti-cancer and anti-inflammatory action.

Reducing caloric intake stimulates the adenosine monophosphate (AMP)-activated protein kinase (AMPK) pathway, decreasing the levels of mammalian target of rapamycin (mTOR), a major oncogene and regulator of cell proliferation. By mTOR blockade, limiting caloric intake may limit tumor cells' deoxyribonucleic acid (DNA) repair ability.


Based on the review findings, Mediterranean diets, and regular physical exercise may prevent cancer, enhance cancer therapy, reduce tumor recurrence, and prolong cancer patients' survival. This could be achieved by inhibiting inflammatory pathways, restoring endocrinal imbalance, reducing intestinal dysbiosis, regulating genetic transcription, and activating immunological defense mechanisms.

Journal reference:
  • Divella, R. et al. (2023) "The Mediterranean Lifestyle to Contrast Low-Grade Inflammation Behavior in Cancer", Nutrients, 15(7), p. 1667. doi: 10.3390/nu15071667.

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Pooja Toshniwal Paharia

Dr. based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.

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