What’ s the Mediterranean diet?

The Mediterranean diet is a nutritional model inspired by the traditional dietary patterns of the countries of the Mediterranean basin, particularly Italy, Greece, Portugal and Spain.
Common to the diets of these regions are a high consumption of fruit and vegetables, bread and other cereals, olive oil and fish; making them low in saturated fat and high in monounsaturated fat and fiber. A main factor in the appeal of the Mediterranean Diet is its rich, full flavored foods. Margarine and other unhealthy hydrogenated fats are considered bland and lacking the flavor olive oil can impart to foods. Red wine is also consumed regularly but in moderate quantities.
Although it was first publicized in 1945 by the American doctor Ancel Keys stationed in Salerno, Italy, the Mediterranean diet failed to gain common currency until the 1990s. It is based on what from the point of view of mainstream nutrition is considered a paradox: that although the people living in Mediterranean countries tend to consume relatively high amounts of fat, they have far lower rates of cardiovascular disease than in countries like the United States, where similar levels of fat consumption are found.
One of the main explanations is thought to be the large amount of olive oil used in the Mediterranean diet. Unlike the high amount of animal fats typical to the American diet, olive oil lowers cholesterol levels in the blood. In addition, the consumption of red wine is considered a possible factor, as it contains flavonoids with powerful antioxidant properties (see the French paradox).
Dietary factors may be only part of the reason for the health benefits enjoyed by these cultures. Genetics, lifestyle, and environment may also be involved.

 

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Secrets of … the Mediterranean Diet

A recent study has once again confirmed that people who closely follow ‘the Mediterranean Diet’ live longer than other Europeans . So what exactly is the Mediterranean diet and how does it exert this spectacular effect.

The Mediterranean diet is not a specific diet plan or diet program but a collection of eating habits that are traditionally followed by the people of the Mediterranean region. There are at least 16 countries bordering the Mediterranean Sea and food habits vary between these countries according to culture, ethnic background and religion. But there are a number of characteristics common to them all...
• A high consumption of fruits, vegetables, potatoes, beans, nuts, seeds, bread and other cereals
• Olive oil used for cooking and dressings
• Moderate amounts of fish but little meat
• Low to moderate amounts of full fat cheese and yogurt
• Moderate consumption of wine, usually with meals
• Reliance on local, seasonal, fresh produce
• An active lifestyle

Protection from chronic diseases
In a recent study the diets of more than 22,000 people living in Greece were ranked according to how closely they adhered to the traditional Greek style Mediterranean diet. During the 4 years of the study, it was found that the closer people followed the traditional diet the less likely they were to die from either heart disease or cancer, with slightly greater protection against heart disease than cancer. Overall, people following the Mediterranean diet most closely were 25% less likely to die during the study period than those who did not, suggesting that those closely following the Mediterranean diet end up dying later than those who do not.

The secret ingredients
Since mortality statistics first identified that Mediterranean populations were living longer than other Europeans, scientists have been trying to deduce which components of the Mediterranean diet are responsible for its considerable benefits. Here are some of the candidates so far…

Olive oil
Olive oil is first choice for investigation as it is used almost exclusively in Mediterranean cooking instead of butter, margarine and other fats. Olive oil is a rich source of monounsaturated fat, which is protective against heart disease, possibly because it displaces saturated fat from the diet. Olive oil is also a source of antioxidants including vitamin E. But it is important to remember that olive oil is used to prepare vegetable dishes, tomato sauces, salads and to fry fish.

Fruit and vegetables
A high intake of fresh fruit and vegetables has been shown to be protective against both heart disease and cancer; probably because of the antioxidants they contain (3). Tomatoes have come under particular scrutiny because they feature so heavily in Mediterranean food. Tomatoes are indeed a major source of antioxidants and heat processing such as cooking, as in the preparation of tomato sauces is recommended as it increases the availability of lycopene, one of the main antioxidants in tomatoes.

Oily fish
It has also been suggested that fish, in particular oily fish such as sardines, have important health benefits (4). Oily fish are a source of omega-3 polyunsaturated fats and the complex long chain derivatives of these fats appear to be particularly beneficial to heart health because of their anti-inflammatory and vasodilatory properties, which keeps blood flowing smoothly.

Wine in moderation
Throughout the Mediterranean wine is drunk in moderation and usually taken with meals. For men moderation is two glasses per day, for women one glass per day.
Wine, especially red wine, contains a vast array of plant compounds with health-promoting qualities called phytonutrients. Among them, polyphenols, which are powerful antioxidants, protect against LDL oxidation and other pathologic sequelae of the oxidative process. Other phytonutrients play a role in the inhibition of platelet aggregation, vasodilation,etc.

Combined effect
In the Greek study individual components or food groups of the Mediterranean diet did not provide any significant protection. In practice it is likely that a combination of all the different ingredients of the diet make it so healthy. Not only that but other factors such as a more relaxed attitude to eating, plenty of sunshine and more physical activity are likely to be contributing to the overall healthy lifestyle in this region.

Times are changing
But times are changing and nowadays fewer people have the lifestyle to follow the traditional diet. Professor Lluis Serra, President of The Foundation for the Advancement of the Mediterranean Diet believes this is both an opportunity and a threat. ‘Sociological changes mean that people are less likely to spend time in the kitchen preparing food, but at the same time it is a great opportunity for catering outlets and restaurants, especially as Mediterranean people now know that their traditional fare is very healthy’ he said.

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Background

This pyramid, representing a healthy, traditional Mediterranean diet, is based on the dietary traditions of Crete, much of the rest of Greece and southern Italy circa 1960, structured in light of current nutrition research. The selection of these regions and this time period as a basis for the design follows from three considerations:

• Recognition that the rates of chronic diseases were among the lowest in the world and adult life expectancy was among the highest for these populations at that time, even though medical services were limited;
• Availability of data describing the character of food consumption patterns of the areas at that time; and
• The convergence of the dietary patterns revealed by these data and our current understanding of optimal nutrition based on epidemiological studies and clinical trials worldwide.
   

 

Variations of this diet have traditionally existed in other parts of Italy, parts of Spain and Portugal, southern France, parts of North Africa (especially Morocco and Tunisia), parts of Turkey, other parts of the Balkan region, as well as parts of the Middle East (especially Lebanon and Syria). The diet is closely tied traditionally to areas of olive oil cultivation in the Mediterranean region.
Given these carefully-defined parameters of geography and time, the phrase traditional Mediterranean diet is used here as shorthand for the healthy traditional diets of these regions at that time.
The design of the pyramid is not based solely on either the weight or the percentage of energy (calories) that foods account for in the diet, but on a blend of these that is meant to give relative proportions and a general sense of frequency of servings, as well as an indication of which foods to favor in a healthy Mediterranean-style diet. The pyramid describes a diet for most healthy adults. Whether changes would need to be made for children, women in the reproductive years, and other special population groups is an issue that needs further consideration.
A principal objective of this graphic illustration is to foster a dialogue within the international scientific, public health, food and agricultural, governmental and other communities as to what specific elements and configuration of the traditional diets of the Mediterranean should be regarded as healthful.
For Americans, northern and eastern Europeans and others who want to improve their diets, this model provides a highly palatable, healthful framework for change. Equally positive results can be obtained either by entirely adopting a Mediterranean-style diet, or by alternating meals based on this Mediterranean model with meals inspired by healthful dietary traditions of other cultures in other parts of the world. For those living in the Mediterranean region, this pyramid provides a basis for preserving and revitalizing, within a modern lifestyle, centuries-old traditions that contribute to excellent health and a sense of pleasure and well-being that are a vital part of our collective cultural heritage.
This pyramid was the first in a series in development to illustrate geographically the healthy traditional food and dietary patterns of various cultures and regions of the world. This initiative is an outgrowth of a multiyear conference series, "Public Health Implications of Traditional Diets," jointly organized by Harvard School of Public Health, a United Nations World Health Organization/Food and Agriculture Organization (WHO/FAO) Collaborating Center, and Oldways Preservation & Exchange Trust. These pyramids, taken as a collection, offer substantive refinements of the United States Department of Agriculture's Food Guide Pyramid, refinements that reflect the current state of clinical and epidemiological research worldwide and our understanding of what constitutes optimal human nutrition status.