How many times have you heard folk say the Mediterranean diet is the best. There was a time when I really did not want to believe that but even the medical profession think it is true.

We were selling a house and we had some interest from a man who had lived in our town but finally settled for the sunshine in Spain. He had put down root there, loved it but was a little homesick.

As he aged he felt he wanted to come back home, saw our house advertised and was interested. He came come to see friends and for a health check.

He was due to come at 3pm but the telephone rang and he said  he could not buy our house although he was interesed,  as he would miss his diet and die sooner.

It would appear he had seen his specialist before viewing our house. The consultant’s advice was ,”Stay where you are living”. He told his  patient  if he came back to the UK after the healthy life style he was living he would cut at least 10 years off his life. We evenutally sold the house, and he is probably still alive and feeling fit.

So now I am looking at a story about the Mediterranean diet and it seems it is really true.


From the FMS Global News Desk of Jeanne Hambleton    24th July 2014                           Posted by Biome Research


The Mediterranean diet – characterised by olive oil, fresh vegetables and whole grains –  is hailed as a means to protect against heart disease, cancer, and a variety of other ailments.

The value of this diet has been so strongly asserted that researchers are now investigating what specific aspects of the Mediterranean diet confers these health benefits.

Here Senior Editor for BMC Medicine Claire Barnard speaks to three researchers in diet and health – Miguel Martinez-Gonzalez, Dariush Mozaffarian, and Antonia Trichopoulou – to find out just what the Mediterranean diet entails, methods to measure its effects, and how we can reap some of its health benefits.

“There is overwhelming evidence that the Mediterranean diet conveys protection against coronary heart disease and thrombotic stroke, and compelling […] evidence that it conveys protection against some forms of cancer” said Antonia Trichopoulou, University of Athens.

Antonia Trichopoulou is Director of the World Health Organization Collaborating Centre for Nutrition at the University of Athens in Greece, where she is also a professor. Here she explores the numerous health benefits studies have revealed are associated with the Mediterranean diet.

Receiving her medical training from the University of Athens, Greece, Trichopoulou went on to obtain a PhD in nutrition and biochemistry and has since dedicated her career to public health nutrition. She was appointed Professor of Nutrition and Biochemistry in the National School of Public Heath, Greece, and has served on numerous public health nutrition committees for the World Health Organization and the European Union. Trichopoulou also lead the creation of the non-profit organisation, the Hellenic Health Foundation.

Martínez-González, Professor and Chair of the Department of Preventive Medicine and Public Health, University of Navarra, Spain.

Whilst the health benefits of Mediterranean are clear, there is still discussion over what precisely constitutes a Mediterranean diet, as explained by Miguel Martinez-Gonzalez, Professor and Chair of the Department of Preventive Medicine and Public Health at the University of Navarra, Spain.

“Most definitions of Mediterranean diet include cereals, but nowadays we have highly refined cereals and we know that these highly refined cereals can be detrimental for diabetes and cardiovascular health,” said Professor Miguel Martinez-Gonzalez.

Martinez-Gonzalez leads one of several initiatives that forms part of the PREDIMED interventional study for the prevention of cardiovascular disease. He received his medical training at Granada University, Spain, and went on to specialise in cardiology, before returning to Granada University to obtain a PhD in epidemiology and a Masters in public health.

The debate around what constitutes a Mediterranean diet feeds into research that aims to quantify which elements of the diet have the greatest impact on positive health outcomes. Martinez-Gonzalez discusses how this can be achieved from both epidemiological and interventional standpoints.

Once the evidence basis is there, the next challenge arises in translating these findings to public health policies and ensuring the correct aspects are emphasised, as Dariush Mozaffarian, Tufts University, explains.,

 “Most of our dietary focus in terms of policy has been on reducing the bad stuff, initially focusing on lowering saturated fat and not enough on increasing the good stuff.”

Mozaffarian is Dean of the Friedman School of Nutrition Science & Policy at Tufts University, USA, prior to which he was an associate professor in the Department of Epidemiology at the Harvard School of Public Health, USA. Trained as a cardiologist and epidemiologist, his research has focused on the effects of lifestyle and diet on cardiometabolic health and disease, as well as the effectiveness of policies to improve diet and reduce disease risk. In this podcast, Mozaffarian takes the discussion from the level of public policy back down to the individual, highlighting what steps a person can take to attain a healthy diet.

  A full transcript of this podcast can be viewed here. http://www.biomedcentral.com/biome/podcast-transcript-mediterranean-diet/

This Biome podcast accompanies the Forum article in BMC Medicine on ‘What is the Mediterranean diet and how can we study the benefits?’.

Welcome to this podcast covering the BMC Medicine Forum article on the Mediterranean diet and its health benefits. I am Claire Barnard, Senior Editor for BMC Medicine. The Mediterranean diet has long been held up as a path to good health and well-being. Studies have attributed reduced mortality risk and a lower incidence of cardiovascular disease to this dietary regime. But what exactly is the Mediterranean diet? How does it differ from other healthy diets across the globe? And how can we study its benefits? Clinicians and researchers with an interest in the effect of diet on health tackle these very questions in the BMC Medicine Forum article. Here we spoke to three of the authors to get their opinions on what the key elements to this diet are, what health benefits it provides, and how we can reap its advantages.

Kicking off the discussion, Miguel Martinez-Gonzalez, Professor and Chair of the Department of Preventive Medicine and Public Health at the University of Navarra in Spain, reveals how the definition of what makes a Mediterranean diet still is not entirely clear…..

Miguel Martinez-Gonzalez, Professor and Chair of the Department of Preventive Medicine and Public Health at the University of Navarra, Spain.

Miguel Martinez-Gonzalez, MMG: The disparity of definitions for the Mediterranean diet does not have an easy explanation; the reasons are complicated and not completely understood. I think the opinions differ in several aspects. First, the total amount of fat, second the specific culinary fat to be used, third the role of low fat dairy and fourth whether to include refined cereals or only wholegrains. The total amount of fat is not the same in all Mediterranean countries. I think that any definition of Mediterranean diet needs to allow for the abundant intake of total intake of fat, provided that this high lipid intake comes from virgin olive oil or tree nuts or fatty fish. The second point is the culinary use of olive oil. For me it is the hallmark of the Mediterranean diet, I mean in my view this specific role of olive oil should be present in any definition of the Mediterranean diet.

Other disparities are related to the potential inclusion of low fat dairy; traditionally there were rarely no fat or low fat dairy products in Mediterranean countries, and they were mainly in the form of yoghurt or cheese, always in small amounts. And the fourth point is that most definitions of Mediterranean diet include cereals, but nowadays we have highly refined cereals and we know that these highly refined cereals can be detrimental for diabetes and cardiovascular health, especially when persons are already overweight or obese.

Claire Barnard CB: Although there are many subtleties to consider when defining the Mediterranean diet – from how much fat is acceptable to whether low fat dairy should be included – is it clear that the potential health benefits are numerous, as Antonia Trichopoulou, Professor and Director of the World Health Organization Collaborating Centre for Nutrition at the University of Athens in Greece, explains…

Antonia Trichopoulou,AT: There is overwhelming evidence that the Mediterranean diet conveys protection against coronary heart disease and the thrombotic type of stroke, and compelling, though not concluding, evidence that it conveys protection against some forms of cancer, including the very common colorectal and breast cancer. There have also been reports that the Mediterranean diet slows down cognitive decline and osteoporosis, that are associated with aging. In any case, several studies have shown that adherence to the Mediterranean diet is associated with longer life expectancy. It is not known which components of the Mediterranean diet drive its beneficial effects, or whether the same components of the diet are involved in different disease entities. Moderate consumption of wine during meals in the formation of nitro fatty acids as a result of simultaneous consumption of olive oil and vegetables have been cited. But it is also possible that the health influences of the components of the Mediterranean diet, including high consumption of vegetables, legumes, fruits and nuts, and low consumption of meat products, contribute in an additive way.

Claire Barnard CB: Whether it’s reducing risk for cardiovascular disease and cancer or mitigating the effects of cognitive decline, the Mediterranean diet ranks highly for its beneficial influence. However it is not the only dietary regime noted for its health benefits. Dariush Mozaffarian, Dean of the Friedman School of Nutrition Science & Policy at Tufts University in the US, takes note of the other global dietary trends that have received similar attention…

Dariush Mozaffarian DM: The other dietary patterns that people are most interested in and talk most about related to health include the vegetarian diet, or vegan diet, the DASH diet, which is an American diet and stands for Dietary Approaches to Stop Hypertension, and then a traditional diet in Japan, from the island of Okinawa. So among these diets I would say by far the strongest evidence for health benefits is from the Mediterranean diet.

Claire Barnard CB: Although evidence for the advantages of the Mediterranean diet continues to grow, quantifying the contribution of this diet to positive health outcomes remains a challenge. Martinez-Gonzalez explains how employing scoring systems can help, picking up on work by Trichoupoulou from an epidemiological standpoint, and noting the interventional study for the prevention of cardiovascular disease, PREDIMED…

Miguel Martinez-Gonzalez MMG: I think that two different settings should be considered. First, an epidemiological study and second, an interventional study. In my view, for the first setting the ideal approach would be the index developed and proposed by Professor Antonia Trichopoulou. She did an extraordinary contribution to the science of nutrition in proposing this operational definition from 0 to 9, taking into account specific medians of the sample, consumption of six beneficial components: the lipid ratio, fruit and nuts, vegetables, legumes, cereals and fish.

Whereas one point is given when the consumption is low for detrimental products; for meat and their products and for alcohol, one point is given for moderate consumption. All this is in the context and in the setting of an epidemiological study. This process is time-consuming because it requires processing the full-length food frequency questionnaire and a comparison with sample medians.

Another easier approach would be needed in the context of an interventional study because in an interventional study you need a fast, immediate feedback to the participant. In this context I would recommend a 14 point score developed by the PREDIMED trial, in which we have questions in terms of servings per day or servings per week.

If you achieve that number of servings you achieve one point for the beneficial components. If you are under the servings you achieve one point for detrimental components. So I would recommend this shorter, easier method for an interventional study.

Claire Barnard CB: The use of scoring systems to measure adherence to a Mediterranean diet allows data on its health benefits to be amassed more objectively. The next, equally challenging, step is to translate these findings into dietary policies and guidance. Mozaffarian shares his thoughts on what key messages for policy have emerged from the research so far…

Dariush Mozaffarian DM: I think one of the most important things we have learnt about diets and health, especially obesity, diabetes, heart disease and stroke, is that we cannot make decisions about helpfulness of diets based on looking at isolated nutrients, like just looking at fat, or just looking at saturated fat, or just looking at nutrient X or Y or Z.

And we cannot actually make decisions on the healthfulness of foods based on calories, just say this food is higher in calories and that food is lower in calories, so I should just choose the food lower in calories. Those lead to really wrong decisions.

What we have learned is that it is the foods that are important, not the single nutrients. And we have to actually focus on foods. So that is the first lesson that we need to translate into policy.

And the second thing that we have learned, which I think is also emphasised by the Mediterranean diet, is that we need to focus what is missing from the diet, the good foods that should be consumed, the positive message, just as much or even more than the bad things in the diet.

That is actually a pretty big change. Most of our dietary focus in terms of policy has been on reducing the bad stuff, initially focusing on lowering fat, on lowering saturated fat and not enough on increasing the good stuff.

Claire Barnard CB: Dietary recommendations should therefore focus on the foods rather than the individual nutrients, and should also encompass positive dietary recommendations. However, as Mozaffarian explains, this is only part of the puzzle, and a more holistic approach is needed to tackle poor diets…

Dariush Mozaffarian DM: In terms of specific policies, I think we need to move beyond just dietary guidelines, recommendations, food labeling. We need to target the whole food system. We need to have policies that change the prices of foods, that make fruits and vegetables and fish and wholegrains and nuts much less expensive and make other foods more expensive.

We need to change the availability of foods, we need to have changes in agricultural policies. A lot of things can and should be done to focus on making healthier diets for not only people in wealthy countries, but people around the world.

Claire Barnard CB: For those in wealthy countries, where a greater choice of diets is available, there is still often a sense that a healthy diet costs more. So how about the cost of the Mediterranean diet?

Dariush Mozaffarian DM: We did a meta-analysis where we looked at all the scientific evidence on costs of foods purchased in supermarkets, healthy versus less healthy options.

We found the healthiest diets most like a Mediterranean diet actually did cost more on average than the least healthy, worst diets, but it was about US $1.50 a day, which is less than £1 a day difference. That is not zero, $1.50 a day is something, but on the other hand it is about the price of a cup of coffee.

So for the poorest people in various countries and in the world, $1.50 a day is important, and we need to change our food pricing at the government level to get rid of that difference, or even reverse that difference.

But for most people, middle class people in wealthy countries, $1.50 per day is nothing. So I think people should really understand that you can have a healthy diet without much expense.

Claire Barnard CB: We have heard about what constitutes a Mediterranean diet, how it compares with different diets around the world, and we have addressed how we can assess its benefits to extract the key public health messages. But what does it all come down to for the individual? Mozaffarian highlights what you can do to gain some of the benefits of the Mediterranean diet…

Dariush Mozaffarian DM: One of the first things is to take a near-term, very specific goal. So rather than say I am going to change my whole diet over some undefined period and become more like a traditional Mediterranean diet, that is a very hard goal. Have a specific goal. Say, “hey how much fruit do I eat right now?”, I am going to increase my fruit intake to three servings a day within four weeks.

So that is as an example. So pick a very specific goal that you are going to change in a specific amount of time, related to one component, whatever component you like, of the Mediterranean diet. And then, the second thing that is needed is to keep track of that goal.

So record what you eat every day towards following that goal and give yourself feedback based on what you are recording. And if you can have somebody to do it with, to give you feedback, some group support, either a family member or a friend to do it with you, that is even better.

One step at a time, one can change their diet from the traditional western, highly processed and packaged food diet toward a healthier Mediterranean diet.

 My comments

With winter not that far away, I would not mind living on a Mediterranean diet in the sun somewhere for the duration. It would be hard to give up steak, mushrooms, onions and chips though. Talk soon, Jeanne



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