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Mediterranean diet

 
Food and Fitness: Mediterranean diet
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Typically, a diet rich in pasta, bread, fruit, and vegetables, with moderate amounts of poultry and fish, cooked in olive oil and washed down with red wine. The Mediterranean diet is reputed to be among the healthiest in the world. Epidemiological studies show that Mediterraneans suffer less heart disease than people from northern Europe. Nutritionists believe that the typical Mediterranean diet reduces fat and increases the level of natural antioxidants such as vitamins C and E, significantly reducing the risk of heart attack.

Some people question the wisdom of a having a diet in which up to 40 per cent of the calories come from fat, and which encourages the use of alcohol. However, the fats in a Mediterranean diet are of a particular kind. Olive oil, the main fat in many meals, is very rich in monounsaturates. These are believed to protect cell membranes against the harmful effects of free radicals. The oily fish used in a Mediterranean diet (e.g. sardines and mackerel), are rich in long chain fatty acids, such as eicosapentaenoic acid (ESA). This acid apparently makes the blood less likely to clot and also makes the heart less prone to dangerous irregular contractions. The Mediterranean diet (especially of Cretans) often includes a salad made of walnuts and purslane. This is rich in alpha-linolenic acid, a fatty acid known to protect heart attack patients from further attacks. In moderate amounts, red wine is believed to reduce the risk of heart attacks by making blood less likely to clot. (This effect of wine is thought also to explain the ‘French paradox’; the relatively high longevity of French people despite their notoriously high alcohol consumption.)

The benefits of a Mediterranean diet could, therefore, be due to any of a number of dietary factors. Some researchers think that the lifestyle of Mediterraneans also has health benefits. Many Mediterraneans still tend crops and live stock. This will give them the same benefits as regular, vigorous aerobic exercise.

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Alternative Medicine Encyclopedia: Mediterranean Diet
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Definition

The Mediterranean diet is based upon the eating patterns of traditional cultures in the Mediterranean region.

Several noted nutritionists and research projects have concluded that this diet is one of the most healthful in the world in terms of preventing such illnesses as heart disease and cancer, and increasing life expectancy.

Origins

The countries that have inspired the Mediterranean diet all surround the Mediterranean Sea. These cultures have eating habits that developed over thousands of years. In Europe, parts of Italy, Greece, Portugal, Spain, and southern France adhere to principles of the Mediterranean diet, as do Morocco and Tunisia in North Africa. Parts of the Balkan region and Turkey follow the diet, as well as Middle Eastern countries like Lebanon and Syria. The Mediterranean region is warm and sunny, and produces large supplies of fresh fruits and vegetables almost year round that people eat many times per day. Wine, bread, olive oil, nuts, and legumes (beans and lentils) are other staples of the region, and the Mediterranean Sea has historically yielded abundant fish. The preparation and sharing of meals is a very important and festive part of Mediterranean culture as well, and Mediterranean cuisine is popular around the world for its flavors.

American interest in the therapeutic qualities of the Mediterranean diet began back in the late 1950s, when medical researchers started to link the occurrence of heart disease with diet. Dr. Ancel Keys performed an epidemiological analysis of diets around the world. Epidemiology is the branch of public health that studies the patterns of diseases and their potential causes among populations as a whole. Keys' study, entitled the Seven Countries Study, is considered one of the greatest epidemiological studies ever performed. In it, Keys gathered data on heart disease and its potential causes from nearly 13,000 men in Greece, Italy, Croatia, Serbia, Japan, Finland, the Netherlands, and the United States. The study was conducted over decades. It concluded that the Mediterranean people in the study enjoyed some significant health advantages. The Mediterranean groups had lower mortality rates in all age brackets and from all causes, particularly from heart disease. For instance, the rates of heart disease for Greek men aged 50–54 were 90% lower than for a comparable group of Americans. The study also showed that the Mediterranean diet is as high or higher in fat than other diets, obtaining up to 40% of all its calories from fat. It has, however, different patterns of fat intake. Mediterranean cooking uses smaller amounts of saturated fat and higher amounts of unsaturated fat, mostly in the form of olive oil. Saturated fats are fats that are found principally in meat and dairy products, although avocados, some nuts and some vegetable oils also contain them. Saturated fats are used by the body to make cholesterol, and high levels of cholesterol have since been directly related to heart disease.

Several other studies have validated Keys' findings regarding the good health of people in the Mediterranean countries. The World Health Organization (WHO) showed in a 1990 analysis that four major Mediterranean countries (Spain, Greece, France, and Italy) have longer life expectancies and lower rates of heart disease and cancer than other European countries and America. The data are significant because the same Mediterraneans frequently smoke and don't have regular exercise programs like many Americans, which means that other variables may be responsible. Scientists have also ruled out genetic differences, because Mediterraneans who move to other countries tend to lose their health advantages. These findings suggest that diet and lifestyle are major factors. A 1994 study conducted in France found that the rate of heart attacks and the rate of cardiac deaths were lower for the Mediterranean diet group than for a group of controls.

The Mediterranean diet gained more notice when Dr. Walter Willett, head of the nutrition department at Harvard University, began to recommend it. Although low-fat diets were recommended for heart disease, Mediterranean groups in his studies had very high intakes of fat, mainly from olive oil. Willett and others proposed that the risk of heart disease can be reduced by increasing one type of dietary fat—monounsaturated fat. This is the type of fat in olive oil. Willett's proposal went against conventional nutritional recommendations to reduce all fat in the diet. It has been shown that unsaturated fats raise the level of HDL cholesterol, which is sometimes called "good cholesterol" because of its protective effect against heart disease. Willett has also performed studies correlating the intake of meat with heart disease and cancer.

Willett, other researchers at Harvard, and the WHO collaborated in 1994 and designed the Mediterranean Food Pyramid, which lists food groups and their recommended daily servings in the Mediterranean diet. These nutritionists consider their food groups a more healthful alternative to the food groups designated by the U.S. Department of Agriculture (USDA). The USDA recommends a much higher number of daily servings of meat and dairy products, which Mediterranean diet specialists attribute to political factors rather than sound nutritional analysis.

Benefits

The Mediterranean diet is a recommended preventive diet for heart disease, strokes, cancer, and the improvement of general health. The diet offers foods that are tasty, economical, and easy to prepare. Another benefit is that many people are more familiar with purchasing, preparing, and eating Mediterranean foods than some foods that are central to other dietary therapies.

Description

The Mediterranean diet has several general characteristics:

  • The bulk of the diet comes from plant sources, including whole grains, breads, pasta, polenta (from corn), bulgur and couscous (from wheat), rice, potatoes, fruits, vegetables, legumes (beans and lentils), seeds, and nuts.
  • Olive oil is used generously, and is the main source of fat in the diet as well as the principal cooking oil. The total fat intake accounts for up to 35% of calories. Saturated fats, however, make up only 8% of calories or less, which restricts meat and dairy intake.
  • Fruits and vegetables are eaten in large quantities. They are usually fresh, unprocessed, grown locally, and consumed in season.
  • Dairy products are consumed in small amounts daily, mainly as cheese and yogurt (1 oz of cheese and 1 cup of yogurt daily).
  • Eggs are used sparingly, up to four eggs per week.
  • Fish and poultry are consumed only one to three times per week (less than 1 lb per week combined), with fish preferred over poultry.
  • Red meat is consumed only a few times per month (less than 1 lb per month total).
  • Honey is the principle sweetener, and sweets are eaten only a few times per week.
  • Wine is consumed in moderate amounts with meals (1–2 glasses daily).

Preparations

Many Mediterranean cookbooks are available that can help with planning and preparing meals. A good first step is eliminating all oils, butter, and margarine and replacing them with olive oil. Meals should always be accompanied with bread and salads. Mediterranean fruits and vegetables are generally fresh and high in quality; American consumers may find equivalents by shopping in farmers' markets and health food stores that sell organic produce. Meat intake should be reduced and replaced by whole grains, legumes, and other foods at meals. The dairy products that are used should be yogurt and cheese instead of milk, which is not often used as a beverage by Mediterraneans.

Researchers have been quick to point out that there may be other factors that influence the effectiveness of the Mediterranean diet. Getting plenty of physical exercise is important, as is reducing stress. Researchers have noted that Mediterraneans' attitude toward eating and mealtimes may be a factor in their good health as well. Meals are regarded as important and joyful occasions, are prepared carefully and tastefully, and are shared with family and friends. In many Mediterranean countries, people generally relax or take a short nap (siesta) after lunch, the largest meal of the day.

Precautions

Although wine is recommended with meals in the Mediterranean diet, those with health conditions and restrictions should use caution. The diet allows generous quantities of olive oil, but only when the olive oil substitutes for other fats and is not used in addition to them. In other words, consumers may have to significantly reduce fat intake from meat and dairy products, margarine, cooking oils, and other sources.

Resources

Books

Jenkins, Nancy Harmon. The Mediterranean Diet Cookbook. New York: Bantam, 1994.

Vegetarian Times Cooks Mediterranean. New York: William Morrow, 2000.

Willett, Walter, M.D. Nutritional Epidemiology. London: Oxford University Press, 1998.

Organizations

Oldways Preservation and Exchange Trust (provides information on the diet). 45 Milk Street. Boston, MA 02109. (617) 695-0600.

[Article by: Douglas Dupler]

Food & Culture Encyclopedia: Mediterranean Diet
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The Mediterranean diet is defined variously. It sometimes refers simply to the dietary patterns and social mores surrounding eating in the countries bordering the Mediterranean Sea. In nutritional parlance the meaning is somewhat more confined. It applies to the traditional diet of European countries on the Mediterranean as characterized by foods and by patterns of nutrient intake.

Italy, Greece, France, and Spain are particularly associated with the diet because they were involved in the several ecological studies of dietary patterns, lifestyles, and coronary artery heart disease in the 1950s and 1960s led by Ancel Keys of the University of Minnesota (Keys, 1970, 1995; Keys et al., 1954). These landmark studies associated the relatively high dietary fat intake in those countries with a much lower prevalence of coronary artery disease than in the United States or northern Europe. Since dietary fat was thought to be the major culprit in coronary artery disease, this seemed remarkable at the time. Later discoveries linked saturated fat and cholesterol rather than total fat to heart disease risk. Olive oil, high in monounsaturated fat, and fish, high in polyunsaturated fat, which constituted the majority of the fat in the Mediterranean diet, were associated with lower risk. Other aspects of the food and nutrient profiles and lifestyles (for example, more physical activity, less smoking, etc.) may have contributed to low disease risk as well.

Reasons for Interest

Originally, interest in the Mediterranean diet was based on that association with decreased risk of coronary artery disease. The traditional Mediterranean diet included liberal amounts of fruits, vegetables, legumes, grains, and wine; high amounts of monounsaturated fats; moderate consumption of alcohol; liberal amounts of fish; and low amounts of meat and milk products. The diet was accompanied by a lifestyle that involved a good deal of obligatory physical activity, no smoking, and a relaxed attitude toward life. The actual diets were usually moderate in energy for physical activities. They were also relatively low in saturated fats and sugars and relatively high in most of the fat-and water-soluble nutrients and phytochemicals.

In the late twentieth century nutritional scientists attempted to examine whether or not the Mediterranean diet is associated with decreased risks of other diseases. Where traditional diets conforming to the Mediterranean pattern are eaten, health benefits seem to be present. In addition, the increased American interest in fine dining, ethnic cuisine, and food habits contributed to the popularity of the Mediterranean diet.

Evolution of the Mediterranean Diet Concept

Keys popularized the Mediterranean diet in the early 1970s, and other nutritionists, culinary experts, and commodity groups subsequently advocated it. In the early 1990s, Oldways, a group dedicated to preserving traditional eating patterns, joined members of the Harvard School of Public Health in conducting a series of conferences and other activities to popularize the Mediterranean pattern. This group published a healthy-eating Mediterranean pyramid based on the dietary traditions of the region.

Mediterranean Diet Pyramid

The Mediterranean diet pyramid is available at the website. W. C. Willett, and colleagues described it at length in "Mediterranean Diet Pyramid," published in the American Journal of Clinical Nutrition in 1995. The pyramid puts bread, other grain products, and potatoes at the base. The second tier is vegetables, including beans, other legumes, and nuts, and fruits. Third is a shallow tier for olive oil, and next is a cheese and yogurt tier. All of these foods should be consumed daily.

Near the top of the pyramid are small blocks for foods consumed a few times a week, including fish, poultry, eggs, and sweets. At the peak of the pyramid are foods consumed only a few times a month, including red meats, fats, oils, and sweets. The pyramid is accompanied by a wineglass to indicate "wine in moderation" and a running stick figure with the headline "regular physical activity" (Wilson, 1998).

Acceptable Alternative or Dietary Imperative?

Is consumption of a Mediterranean diet mandatory for good health? The notion of a single Mediterranean cuisine has been criticized on the grounds that no single such diet exists and that to contend one does promotes stereotypes and fails to account for the dynamic nature of dietary changes. Also, diets in the Mediterranean region and elsewhere in Europe change rapidly and no longer reflect those of yesteryear. Many healthful dietary patterns are associated with diets designed to reduce chronic disease risks. It is not necessary to consume diets similar to those traditionally eaten in the Mediterranean to stay healthy, but the Mediterranean diet is one alternative that provides an appropriate and healthful nutrient pattern.

Does the inclusion of Mediterranean-type foods make contemporary American diets healthier? This depends on a number of factors, chiefly how they are used. While decreased risk is associated with traditional Mediterranean diets, the patterns in these countries have changed a great deal since the early 1950s. They may not always provide all of the health advantages their traditional counterparts did, especially if food is eaten in excess. The specific health benefits of individual foods rather than the entire Mediterranean pattern are also unclear. Although most of the traditional foods are delicious and nutritious, other foods with similar nutrient compositions would seem to be equally effective. Therefore simply adding one or more "Mediterranean" foods to American diets does not necessarily provide positive health effects. The overall pattern in moderation has been linked to positive health outcomes.

During the late twentieth century, awareness of the considerable culinary and aesthetic advantages of the Mediterranean diet grew. Many staples of traditional Mediterranean diets have become popular and are widely available in the United States and other Western countries.

The plant-based Mediterranean diets of the early and mid-twentieth century were environmentally sound and responsible in the locales in which they flourished. Whether they are exportable and feasible on a large scale in other climates in non-Mediterranean countries is a matter of debate.

Traditional food habits typical of countries bordering the Mediterranean Sea in the mid-1950s have health and nutritional advantages. Guides for eating in the Mediterranean manner are readily available, but following their advice is not mandatory for good health.

Bibliography

Crotty, P. A. "Response to K. Dun Gifford." Nutrition Today 33 (1998): 244–245.

Ferro-Luzzi, A., and S. Sette. "The Mediterranean Diet: An Attempt to Define Its Present and Past Composition." European Journal of Clinical Nutrition 43, supp. 2 (1989): 12–29.

Gifford, K. Dun. "The Mediterranean Diet as a Food Guide: The Problem of Culture and History." Nutrition Today 33 (1998): 233–243.

Keys, Ancel. "Coronary Disease in Seven Countries." Circulation 41, supp. (1970): 1–21.

Keys, Ancel. "Mediterranean Diet and Public Health: Personal Reflection." American Journal of Clinical Nutrition 61, supp. (1995): 1321S–1323S.

Keys, Ancel, and Margaret Keys. How to Eat Well and Stay Well the Mediterranean Way. Garden City, N.Y.: Doubleday, 1975.

Keys, Ancel, et al. "Studies on Serum Cholesterol and Other Characteristics of Clinically Healthy Men in Naples." Archives of Internal Medicine 93 (1954): 328–335.

Nestle, M. "Mediterranean Diets: Historical and Research Overview." American Journal of Nutrition 61, supp. 13 (1995): 135–205.

Oldways website. "Mediterranean Diet Pyramid." Available at http://www.oldwayspt.orghtml/meet.htm.

Willett, W. C., F. Sacks, A. Trichopoulou, G. Dresher, A. Ferro-Luzzi, E. Helsing, and D. Trichopoulos. "Mediterranean Diet Pyramid: A Cultural Model for Healthy Eating." American Journal of Clinical Nutrition 61, supp. (1995): 1402S–1406S.

Wilson, C. S. "Mediterranean Diets: Once and Future?" Nutrition Today 33 (1998): 246–249.

—Johanna Dwyer

Wikipedia: Mediterranean diet
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This article is about the dietary recommendation that became popular in the 1990s. For food of the areas around the Mediterranean Sea, see Cuisine of the Mediterranean.

The modern incarnation of the Mediterranean diet [1] [2]is based upon the traditional dietary patterns of the countries of the Mediterranean Basin. Thus, our understanding of the Mediterranean diet is really a composite of several foods commonly consumed in the countries surrounded or bordered by the Mediterranean Sea.

Even within the borders of a single Mediterranean country, such as Italy, you can find very different diets for those people living along the coastal regions, such as the Neapolitans and those living in the Abruzzi Mountains, less than 250 kilometres away. Neapolitans will eat far more fish and seafood, while residents of the Abruzzi will consume considerably more meat, chicken and legumes.

The most commonly-understood version of the Mediterranean diet was presented by Dr. Walter Willett of Harvard University's School of Public Health in the mid-1990s.[3] Based on "food patterns typical of Crete, much of the rest of Greece, 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.[4]

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[5].

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.[6] 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.[7]

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.[8] 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.[9]

The benefits of the Mediterranean diet were promoted in England during the early Renaissance period when the Italian, Giacomo Castelvetro, wrote his book, “A Brief Account of the Fruits, Herbs and Vegetables of Italy.” [10] He attempted, without success, to convince the English to eat more fruits and vegetables. It is interesting that recent epidemiological studies seem to support the notion that “The Sacred Law of Salads” (i.e., raw salads and generous amounts of olive oil) - originally proposed in Castelvetro’s book is considered the first example of customized diets for cancer prevention based on individual genetic makeup.[11]


Contents

History

Although it was first publicized in 1945 by the American doctor Ancel Keys stationed in Salerno, Italy, 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 States, where similar levels of fat consumption are found. A parallel phenomenon is known as the French Paradox.[12]

Health effects

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

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.[13] 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.[14]

In addition, the consumption of red wine is considered a possible factor, as it contains flavonoids with powerful antioxidant properties[15].

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.[16]

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.[citation needed]

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.[17]

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. [18] [19] 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. [20]

Medical research

The Seven Countries Study[21] 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[22] 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.[23]

According to a study published in the British Medical Journal (May 29, 2008), the traditional Mediterranean diet provides substantial protection against type 2 diabetes.[24] The study involved over 13 000 graduates from the University of Navarra in Spain 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.[25]

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.[26]

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.[27]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[28].

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.[29]

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. ^ Burros, Marian (29 March 1995). "Eating Well". New York Times. http://query.nytimes.com/gst/fullpage.html?res=990CEFD81438F93AA15750C0A963958260&sec=&spon=&pagewanted=all. Archived by Webcite
  4. ^ Willett WC (01 June 1995). "Mediterranean diet pyramid: a cultural model for healthy eating". American Journal of Clinical Nutrition 61 (6): 1402S–6S. PMID 7754995. http://www.ajcn.org/cgi/content/abstract/61/6/1402S. 
  5. ^ "Get your Meds: the Mediterranean Diet and Health", Ellen Gooch, Epikouria Magazine, Fall 2005
  6. ^ Massimo Alberini, Giorgio Mistretta, Guida all'Italia gastronomica, Touring Club Italiano, 1984
  7. ^ Tapper, Richard; Zubaida, Sami (2001). A Taste of Thyme: Culinary Cultures of the Middle East. Tauris Parke Paperbacks. ISBN 1-86064-603-4. 
  8. ^ 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.
  9. ^ Covas, M.I., (March 2007). “Olive oil and the cardiovascular system”. Pharmacol. Res. 55 (3): 175–86.
  10. ^ Castelvetro. G., The Fruits, Herbs and Vegetables of Italy, London, Viking, 1989, translated from the original published in 1614.
  11. ^ Colomer, R., Lupu, R., Papadimitropoulou, A., et al., « Giacomo Castelvetro’s salads. Anti-HER2 oncogene nutraceuticals since the 17th century?” Clinical and Translational Oncology, 10(1), 30-34, (2008).
  12. ^ Bruno Simini, "Serge Renaud: from French paradox to Cretan miracle" The Lancet 355:9197:48 (1 January 2000) at Science Direct (subscription)
  13. ^ 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).
  14. ^ 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.
  15. ^ Baron-Menguy C, Bocquet A, Guihot AL, et al. (November 2007). "Effects of red wine polyphenols on postischemic neovascularization model in rats: low doses are proangiogenic, high doses anti-angiogenic". Faseb J. 21 (13): 3511–21. doi:10.1096/fj.06-7782com. PMID 17595348. 
    "Chemical In Red Wine, Fruits And Vegetables May Stop Cancer, Heart Disease, Depending On The Dose." ScienceDaily 1 November 2007.
  16. ^ Guiliano, Mireille. French Women Don't Get Fat. Knopf,. 
  17. ^ "Mediterranean Diet TV". http://www.mediterraneandiet.tv. 
  18. ^ Brown JM, Shelness GS, Rudel LL (December 2007). "Monounsaturated fatty acids and atherosclerosis: opposing views from epidemiology and experimental animal models". Curr Atheroscler Rep 9 (6): 494–500. doi:10.1007/s11883-007-0066-8. PMID 18377790. 
  19. ^ Rudel LL, Kelley K, Sawyer JK, Shah R, Wilson MD (01 November 1998). "Dietary monounsaturated fatty acids promote aortic atherosclerosis in LDL receptor-null, human ApoB100-overexpressing transgenic mice". Arterioscler Thromb Vasc Biol. 18 (11): 1818–27. PMID 9812923. http://atvb.ahajournals.org/cgi/reprint/18/11/1818. 
  20. ^ Wong A (2008). "Incident solar radiation and coronary heart disease mortality rates in Europe". Eur J Epidemiol. 23 (9): 609–14. doi:10.1007/s10654-008-9274-y. PMID 18704704. 
  21. ^ "Coronary heart disease in seven countries". Circulation 41 (4 Suppl): I1–211. April 1970. PMID 5442782. 
  22. ^ "Lyon Diet Heart Study". http://www.americanheart.org/presenter.jhtml?identifier=4655. 
  23. ^ de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. (1999). "Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study". Circulation 99 (6): 779–85. PMID 9989963. 
  24. ^ Martínez-González MA, de la Fuente-Arrillaga C, Nunez-Cordoba JM, et al. (June 2008). "Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study". BMJ 336 (7657): 1348–51. doi:10.1136/bmj.39561.501007.BE. PMID 18511765. 
  25. ^ The Traditional Mediterranean Diet Protects Against Diabetes Newswise, Retrieved on July 2, 2008.
  26. ^ Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, Golan R, Fraser D, Bolotin A, Vardi H, Tangi-Rozental O, Zuk-Ramot R, Sarusi B, Brickner D, Schwartz Z, Sheiner E, Marko R, Katorza E, Thiery J, Fiedler GM, Blüher M, Stumvoll M, Stampfer MJ; Dietary Intervention Randomized Controlled Trial (DIRECT) Group. (July 17 2008). "Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet.". N Engl J Med 359: 229–241. doi:10.1056/NEJMoa0708681. PMID 18635428. 
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  28. ^ http://www.neurology.org/cgi/content/abstract/69/11/1084
  29. ^ "Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study". http://www.bmj.com/cgi/content/abstract/338/jun23_2/b2337?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=mediterranean&searchid=1&FIRSTINDEX=0&sortspec=date&resourcetype=HWCIT. 

See also

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