Mediterranean thoughts

Mary Yannakoulia,1 PhD, Meropi Kontogianni,1 PhD, Nikolaos Scarmeas,2 MD, PhD

1 Department of Nutrition and Dietetics, Harokopio University, Athens, Greece

2 Department of Social Medicine, Psychiatry and Neurology, National & Kapodistrian, University of Athens, Greece

The concept of the Mediterranean diet was originally conceived by Ancel Keys, in the Seven Countries Study [1-2]. However, the core foods of the diet of people living around the Mediterranean basin have been recognized since the BC era: bread, olive oil, and wine were staple foods in the Greek and Roman diets; bread was symbolic of agriculture and human civilization and olive trees were the identity of Mediterranean lands [3].

One of the main conclusions that came up from the Seven Countries Studies was that all-cause and coronary heart disease death rates were lower in cohorts that had olive oil as the main dietary fat compared to northern European ones [4]; thereafter, the notion that the high consumption of olive oil, bread, fruits, vegetables, and cereals may be  responsible for profound health benefits was spread in the scientific community [5]. Nowadays, the term Mediterranean diet is widely used to describe the traditional dietary habits of people leaving around Mediterranean Sea, and it is schematically depicted as a pyramid (Simopoulos, 2001; Willett et al., 1995). This dietary pattern is mainly characterized by the abundance of plant foods: fruits, as the typical after-dinner dessert, vegetables, either as main or side dish, a lot of bread, other forms of cereals, legumes, nuts, and seeds. Olive oil is the principal source of fat. Mediterranean diet also includes moderate amounts of dairy products (mostly cheese and yogurt), low to moderate amounts of fish and poultry, red meat in low amounts and wine, consumed modestly, normally with meals [6-7].

In numerous epidemiological studies, greater adherence to a Mediterranean dietary pattern, as described above, has been associated, with longevity, with lower prevalence and incidence of several chronic diseases (cardiovascular disease, including stroke, type 2 diabetes mellitus, and several cancers), both in Mediterranean and non-Mediterranean populations [8-20]. Mediterranean diet is also protective against mild and advanced cognitive impairment, including Alzheimer’s disease [21-23]. The more prevailing mechanisms underlying the aforementioned health benefits are the anti-inflammatory and anti-oxidative properties of this diet. Much research has been conducted in relation to the potentially beneficial nutrients abundant in the Mediterranean diets. However, the properties of the whole pattern seem to be well beyond the individual effects of nutrients. Furthermore, eating is a complex behavior consisting of several individual behaviors, among others, the choice of specific foods or food groups, the organization of food into meals, and the conditions around or preceding eating. Overall, lifestyle may be as important as food per se.

In fact, in the earlier work by Ancel Keys [2] as well as in the early Mediterranean diet pyramid [6], lifestyle behaviors have been underlined as important component of the Mediterranean way of living: apart from physical activity, lifestyle factors that were extracted as being of particular interest are social support, sharing food, having lengthy meals and post-lunch siestas. The modern Mediterranean diet model re-emphasizes the lifestyle approach [26]. Thus, the concepts of moderation in food consumption and frugality are promoted. The preference for seasonal, fresh and minimally processed foods may, in most cases, maximize the content of protective nutrients and molecules in the diet. Consuming traditional, local, eco-friendly and biodiverse products contributes to the sustainable character of the diet. The conviviality aspect of eating is important, as it contributes to strengthening socialization, communication and social support, whereas devoting enough time and space to culinary activities is also stressed. Finally, regular practice of moderate physical activity (at least 30min throughout the day) and adequate sleep and resting during daytime (naps) serve as basic complements to the dietary pattern.

Can we, thus, attempt to say that foods are the body of our Mediterranean diet, whereas the way of eating and living in community the heart of our cultural intangible heritage? Mediterranean food for thought.


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