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The Mediterranean diet is a modern nutritional recommendation inspired by the traditional dietary patterns of poor coastal regions of southern Italy, Cretemarker, and coastal Greecemarker in the 1960's.

Despite its name, this diet is not typical of all Mediterranean cuisine. In Northern Italy, for instance, lard and butter are commonly used in cooking, and olive oil is reserved for dressing salads and cooked vegetables. In North Africa wine is traditionally avoided by Muslims. In both North Africa and the Levant, along with olive oil, sheep's tail fat and rendered butter (samna) are traditional staple fats.

The most commonly-understood version of the Mediterranean diet was presented by Dr. Walter Willett of Harvard Universitymarker's School of Public Health in the mid-1990s.

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Based on "food patterns typical of Cretemarker, much of the rest of Greecemarker, and southern Italy in the early 1960s", this diet, in addition to "regular physical activity," emphasizes "abundant plant foods, fresh fruit as the typical daily dessert, olive oil as the principal source of fat, dairy products (principally cheese and yogurt), and fish and poultry consumed in low to moderate amounts, zero to four eggs consumed weekly, red meat consumed in low amounts, and wine consumed in low to moderate amounts". Total fat in this diet is 25% to 35% of calories, with saturated fat at 8% or less of calories.

The principal aspects of this diet include high olive oil consumption, high consumption of legumes, high consumption of unrefined cereals, high consumption of fruits, high consumption of vegetables, moderate consumption of dairy products (mostly as cheese and yogurt), moderate to high consumption of fish, low consumption of meat and meat products, and moderate wine consumption.

More than any other food ingredient, olive oil represents the Mediterranean diet. Olive oil confers excellent flavor and mouthfeel to all foods on which it is used. Olive oil is also nutritious and contains a very high level of monounsaturated fats, most notably oleic acid. Epidemiological studies suggests that a higher proportion of monounsaturated fats in the diet is linked to a reduction in coronary heart disease risk. There is also considerable clinical data to show that antioxidants in olive oil can provide additional heart health benefits such as positive cholesterol regulation and LDL cholesterol reduction, and that it exerts additional anti-inflammatory and anti-hypertensive effects in humans.

A rich in salads was promoted in England during the early Renaissance period by Giacomo Castelvetro in A Brief Account of the Fruits, Herbs and Vegetables of Italy. He attempted, without success, to convince the English to eat more fruits and vegetables.

History

Although it was first publicized in 1945 by the Americanmarker doctor Ancel Keys stationed in Salernomarker, Italymarker, the Mediterranean diet failed to gain widespread recognition 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 Statesmarker, where similar levels of fat consumption are found. A parallel phenomenon is known as the French Paradox.

Health effects

The diet is often cited as beneficial for being low in saturated fat and high in monounsaturated fat and dietary fiber.

One of the main explanations is thought to be the health effects of olive oil included in the Mediterranean diet.

The Mediterranean diet is high in salt content. Foods such as olives, salt-cured cheeses, anchovies, capers, salted fish roe, and salads dressed with olive oil all contain high levels of salt. Salt is particularly important for salads dressed with virgin olive oil, because the antioxidants it contains are slightly bitter.

A study published in Archives of General Psychiatry shows that people who followed the Mediterranean diet, an eating regimen that is rich in fruits, vegetables, whole grains, fish, and nuts, were less likely to develop depression.

In addition, the consumption of red wine is considered a possible factor, as it contains flavonoids with powerful antioxidant properties

"Chemical In Red Wine, Fruits And Vegetables May Stop Cancer, Heart Disease, Depending On The Dose." ScienceDaily 1 November 2007..

Mireille Guiliano, author of the #1 bestseller French Women Don't Get Fat, credits the health effects of the Mediterranean diet to factors such as small portions, daily exercise, and the emphasis on freshness, balance, and pleasure in food.

Dietary factors may be only part of the reason for the health benefits enjoyed by these cultures. Genetics, lifestyle (notably heavy physical labor), and environment may also be involved.

In industrialized countries, about 75% of deaths in persons older than the age of 65 are now from cardiovascular diseases and cancer. However, a 10 year study published in the Journal of American Medicine found that adherence to a Mediterranean diet and healthful lifestyle was associated with more than 50% lowering of early death rates.

The putative benefits of the Mediterranean diet for cardiovascular health are primarily correlative in nature; while they reflect a very real disparity in the geographic incidence of heart disease, identifying the causal determinant of this disparity has proven difficult. The most popular dietary candidate, olive oil, has been undermined by a body of experimental evidence that diets enriched in monounsaturated fats such as olive oil are not atheroprotective when compared to diets enriched in either polyunsaturated or even saturated fats.

A recently emerging alternative hypothesis to the Mediterranean diet is that differential exposure to solar ultraviolet radiation accounts for the disparity in cardiovascular health between residents of Mediterranean and more northerly countries. The proposed mechanism is solar UVB-induced synthesis of Vitamin D in the oils of the skin, which has been observed to reduce the incidence of coronary heart disease, and which rapidly diminishes with increasing latitude.

Medical research

The Seven Countries Study found that Cretan men had exceptionally low death rates from heart disease, despite moderate to high intake of fat. The Cretan diet is similar to other traditional Mediterranean diets, consisting mostly of olive oil, bread, abundant fruit and vegetables, fish, and a moderate amount of dairy foods and wine.

The Lyon Diet Heart Study set out to mimic the Cretan diet, but adopted a pragmatic approach. Realizing that some of the people in the study (all of whom had survived a first heart attack) would be reluctant to move from butter to olive oil, they used a margarine based on rapeseed (canola) oil. The dietary change also included 20% increases in vitamin C rich fruit and bread and decreases in processed and red meat. On this diet, mortality from all causes was reduced by 70%. This study was so successful that the ethics committee decided to stop the study prematurely so that the results of the study could be made available to the public immediately.

According to a study published in the British Medical Journal (May 29, 2008), the traditional Mediterranean diet provides substantial protection against type 2 diabetes. The study involved over 13 000 graduates from the University of Navarra in Spainmarker with no history of diabetes, who were recruited between December 1999 and November 2007, and whose dietary habits and health were subsequently tracked. Participants initially completed a 136-item food frequency questionnaire designed to measure the entire diet. The questionnaire also included questions on the use of fats and oils, cooking methods and dietary supplements. Every two years participants were sent follow-up questionnaires on diet, lifestyle, risk factors, and medical conditions. New cases of diabetes were confirmed through medical reports. During the follow-up period (median 4.4 years) the researchers from the University of Navarra found that participants who stuck closely to the diet had a lower risk of diabetes. A high adherence to the diet was associated with an 83% relative reduction in the risk of developing diabetes.

A study published in The New England Journal of Medicine (July 17, 2008) examined the effects of three diets: low-carb, low-fat, and Mediterranean. The study involved 322 participants and lasted for 2 years. The low-carb and Mediterranean diet resulted in the greatest weight loss, 12 lbs and 10 lbs, respectively. The low-fat diet resulted in a loss of 7 lbs. One caveat of the study is that 86% of the study participants were men. The low-carb and Mediterranean diets produced similar amounts of weight loss in the overall study results and in the men. In the remaining participants who were women, the Mediterranean diet produced 3.8 kg (8.4 lbs) more weight loss on average than the low-carb diet.

A meta-analysis published in the British Medical Journal (September 12, 2008) showed that following strictly the Mediterranean diet reduced the risk of dying from cancer and cardiovascular disease as well as the risk of developing Parkinson's and Alzheimer's disease. The results report 9%, 9%, and 6% reduction in overall, cardiovascular, and cancer mortality respectively. Additionally a 13% reduction in incidence of Parkinson's and Alzheimer's diseases is to be expected provided strict adherence to the diet is observed.As well, a 2007 study found that adherence to the Mediterranean diet (MeDi) may affect not only risk for Alzheimer disease (AD) but also subsequent disease course: Higher adherence to the MeDi is associated with lower mortality in AD. The gradual reduction in mortality risk for higher MeDi adherence tertiles suggests a possible dose-response effect.

A study published in the British Medical Journal (June 23, 2009) showed some components of the Mediterranean diet, such as high vegetable consumption and low meat and meat product consumption, are more significantly associated with low risk of mortality than other components, such as cereal consumption and fish consumption. As part of the European Prospective Investigation into Cancer and Nutrition study, researchers followed more than 23,000 Greek men and women for 8.5 years to see how various aspects of a Mediterranean diet affect mortality. Moderate alcohol consumption, high fruit and nut consumption, and high legume consumption were also associated with lower risk of mortality.

References

  1. Alberto Capatti et al., Italian Cuisine: A Cultural History, p. 106.; Silvano Serventi and Francoise Sabban, Pasta, p. 162.
  2. Satin, Morton The Mediterranean Diet, Salt and Health Newsletter, summer, 2009.
  3. Massimo Alberini, Giorgio Mistretta, Guida all'Italia gastronomica, Touring Club Italiano, 1984
  4. "Get your Meds: the Mediterranean Diet and Health", Ellen Gooch, Epikouria Magazine, Fall 2005
  5. Keys, A., Menotti, A., Karvonen, M.J., et al. (December 1986). «The diet and 15-year death rate in the seven countries study,» Am. J. Epidemiol. 124 (6): 903–15.
  6. Covas, M.I., (March 2007). “Olive oil and the cardiovascular system”. Pharmacol. Res. 55 (3): 175–86.
  7. Castelvetro. G., The Fruits, Herbs and Vegetables of Italy, London, Viking, 1989, translated from the original published in 1614.
  8. Bruno Simini, "Serge Renaud: from French paradox to Cretan miracle" The Lancet 355:9197:48 (1 January 2000) at Science Direct (subscription)
  9. C. Leclercq and A. Ferro-Luzzi, “Total and domestic consumption of salt and their determinants in three regions of Italy,” European Journal of Clinical Nutrition, Mar, 45(3), 151-9, (1991).
  10. Sanchez-Villegas, A., Delgado-Rodriguez, M., Alonso, A., Schlatter, J., Lahortiga, F., Serra Majem, L., Martinez-Gonzalez, M. A., Association of the Mediterranean Dietary Pattern With the Incidence of Depression: The Seguimiento Universidad de Navarra/University of Navarra Follow-up (SUN) Cohort, Arch Gen Psychiatry. 2009;66(10):1090-1098.
  11. The Traditional Mediterranean Diet Protects Against Diabetes Newswise, Retrieved on July 2, 2008.
  12. http://www.neurology.org/cgi/content/abstract/69/11/1084




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