The Traditional Mediterranean Diet An Ancient Prescription for Health and Longevity ■

Stephanie Maxine Ross, MH, MS, HT, CNC, PDMT Holist Nurs Pract 2015;29(3):174–177

Modern Civilization was born dietary intake. However, the nutritional around the basin of the Mediterpatterns among these countries share many “Olea prima ranean Sea. Here the ancient commonalities, the most notable is olive omnium Greeks and Romans created a oil, which holds an esteemed position central arborum est. culinary culture that flourished for to their dietary and lifestyle plan. With [The olive tree centuries, continuing into modern this in mind, the Mediterranean diet has been is first of all times. The ancient Greeks, for exdefined as a nutritional pattern characteristic trees.]” ample, used the oil expressed from to the olive-growing areas of the olives as their main source of fat Mediterranean region, particularly in Greece, Columella, Roman because they considered fat derived and southern Italy between the late 1950s agronomist, from animals to be an unhealthy and the early 1960s, when the consequences De Re food. Olive oil entered its golden of World War II were overcome, and before Rustica, age with the Greek culture, which the introduction of the fast-food culture.1 Book V The interest in the Mediterranean diet held the olive tree (Olea europaea) has grown on an international level during sacred and used the miracle the last 25 years, due to its association with an of its oil in an incredible variety of ways: as a food, skin emollient, preservative, perfume, increase in longevity and a decreased incidence of cardiovascular disease (CVD) and CVD mortality, and adornment, as well as a cure for heart ailments. cancer, age-associated cognitive decline, and a lower The Mediterranean culture integrates the past with risk of chronic diseases than in other parts of the the present through the beneficial properties associated with the traditional Mediterranean diet and world.2-4 Research studies have focused on the health benefits attributed to the Mediterranean diet and its lifestyle. Although 20 neighboring countries are various components, specifically extra virgin olive oil considered to be part of the Mediterranean region, (EVOO). their populations vary in culture, religion, ethnicity, economics, and other factors that can influence

Author Affiliation: College of Nursing and Health Professions, Drexel, University, Philadelphia, Pennsylvania. The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: Stephanie Maxine Ross, MH, MS, HT, CNC, PDMT, Associate Science Editor, Director and Clinical Assistant Professor, Advanced Study in Complementary and Integrative Health Programs, College of Nursing and Health Professions, Drexel University, 1601 Cherry St, Philadelphia, PA 19102 ([email protected]). DOI: 10.1097/HNP.0000000000000089

TRADITIONAL MEDITERRANEAN DIET AND LIFESTYLE PLAN The Mediterranean diet is a holistic lifestyle that includes a healthy nutritional plan, physical activity, stress management, and meals shared with family and friends. Although the Mediterranean diet may vary according to each European region, due to food availability and cultural traditions, its nutritional foundation provides optimum levels of micronutrients,

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Traditional Mediterranean Diet

antioxidants, minerals, vitamins, and fiber that work together to protect against chronic diseases.5

Beneficial components of the Mediterranean diet The overall eating plan consists of fresh food sources, including vegetables, legumes, whole-grain cereals, Mediterranean Diet Pyramid

Meats & Sweets

Poultry, eggs cheese & yogurt


fruit, nuts, and EVOO; moderate-to-high consumption of fish and poultry; and a relatively low consumption of red meat and dairy products that contributes synergistically to what has become known as the Mediterranean lifestyle diet plan, a holistic prescription for good health and longevity.6,7 The Mediterranean diet pyramid (Figure) is designed to illustrate relative proportions and frequency of servings of foods that contribute to the overall dietary pattern. The primary foods and food group components that characterize the Mediterranean diet are delineated in the Table, whereas the following components represent the foundational food elements that distinguish the traditional Mediterranean healthy nutritional pattern.

Fish & seafood

Fruits, vegetables, grains (mostly whole), olive oil, beans, nuts, legumes, seeds, herbs & spices, and lifestyle



Meats and sweets

Less often

Poultry, eggs, cheese, and yogurt

Moderate portions, daily to weekly

Fish and seafood

Often, at least two times a week

Fruits, vegetables, grains (mostly whole), olive oil, beans, nuts, legumes, seeds, herbs & spices, and lifestyle

Base every meal on these foods

@ 2009 Oldways Preservation & Exchange Trust. www.oldwayspt.org.

FIGURE. Mediterranean diet pyramid.

Olive oil The olive tree (Olea europaea) and its fruit and leaves have a long historical reference as a medicinal remedy for treating physical and mental well-being. Hippocrates (400 BC), the “father of medicine,” is known to have used the oil expressed from the olive fruit for treating his patients. Today, research continues to confirm the health benefits of extra virgin oil in association with the Mediterranean diet and lifestyle. Extra virgin olive oil is produced from the first pressing of the olive fruit through the cold-pressing extraction method and is the most valued form of olive oil for both its taste and health benefits because it maintains the integrity of the full spectrum of chemical constituents. The major chemical components of EVOO are glycerol fractions composing up to 90% to 99% of the olive fruit and unsaponifiable fractions containing phenolic compounds that make up to 0.4% to 0.5% of the olive fruit.5 Research studies have demonstrated that EVOO phenolic compounds are highly bioavailable in

TABLE. Beneficial Components of the Mediterranean Dieta Lifestyle Food derived from plants Seasonally fresh foods Olive oil is the principal fat Daily consumption Weekly consumption Poultry Common sweets Meat Alcohol a

Regular physical activity is at the base of the pyramid Fruit and vegetables, bread and whole grains, legumes, nuts, and seeds Olives, avocados, grapes, tomatoes, broccoli, peppers, garlic, almonds, walnuts, and peanuts 25%-35% of calories; 7%-8% of calories with saturated fat Low to moderate amounts of cheese and yogurt Moderate amounts of fish (shellfish, sardines, salmon) Up to 4 eggs/wk including those used in cooking Fruit, honey, pastries, ice cream, and cookies Common meats are veal and lamb Red wine consumed in moderation and with meals

With permission from Perez-Lopez et al.8

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humans. The high bioavailability of these compounds lends support to the evidence that phenolic compounds have positive effects on certain physiological parameters such as plasma lipoproteins, oxidative stress, inflammatory markers, platelet and cellular function, antimicrobial activity, and bone health. Fruit and vegetables The word “vegetable” is derived from the Latin term vegetare, meaning “to enliven or animate.” A high intake of fresh fruit and vegetables has been shown to protect against many diseases, especially chronic degenerative diseases such as heart disease, cancer, diabetes, and arthritis. Vegetables provide the most extensive range of nutrients and phytochemicals, especially fiber and carotenes, of any food group. Fruit and vegetable antioxidants, including flavonoids and vitamins, have a potent anti-inflammatory effect.9-11 In addition, vegetables high in fiber play a critical role in the prevention of inflammation, since there is an inverse association between fiber intake and C-reactive protein (CRP).12,13 Studies show that a greater intake of fruit and vegetables is associated with lower CRP and homocysteine levels. The Massachusetts Hispanic Elders Study found that with each added serving of fruit and vegetables, the risk factor of high levels of CRP and homocysteine decreased 21% and 17%, respectively.14 The Mediterranean diet is characteristically high in tomatoes (Lycopersicon esculentum), a member of the Solanaceae family, which contain high levels of antioxidants such as vitamin C, carotenoids (especially lycopene), flavonoids, biotin, and vitamin K.15 They are also an excellent source of vitamin B6 , niacin, pantothenic acid, folic acid, and dietary fiber. The health-promoting ability of tomatoes is due largely to the lycopene content, which is rich in antioxidant activity. This red carotene pigment has been demonstrated to be extremely protective against different types of cancers, such as breast, colon, lung, skin, and prostate cancer. Lycopene helps neutralize the harmful effects of oxygen free radicals (oxidative stress) and has also been shown to decrease the risk of CVD, cataracts, and macular degeneration. Although present in many fruit and vegetables, lycopene is found in higher concentrations in cooked tomatoes16,17,18 because the heat processing disrupts the cellular membrane and cell walls surrounding the chromoplasts, specialized plant cells (plastids) that contain color pigments, resulting in an increased release of lycopene pigment. However, industrialized processing

of tomatoes into tomato paste undergoes several heat treatments that may potentially result in a decrease in antioxidant content, only to illustrate that freshly prepared foods are highest in nutritional content. Whole grains Whole grains are fundamentally the most important food crop in the world, literally the “staff of life,” and provide one of the foundational food components in the Mediterranean diet. Grains contain a high content of nutrients that are related to beneficial health effects, such as vitamins E and B, minerals, antioxidants, and a wide range of phytochemicals that are associated with long-term health. The intake of whole grains, in particular whole-grain bread, is associated with a broad array of health benefits that include a decrease in CVD, type 2 diabetes, and metabolic syndrome.

SUMMARY AND CONCLUSION Traditional Mediterranean diet, health, and longevity The Mediterranean diet is based on food patterns characteristic of Crete, Greece, and southern Italy in the early 1960s, where adult life expectancy was rated among the highest worldwide and rates of CVD and other diet-related chronic diseases were among the lowest. Biochemical, clinical, and epidemiological research has provided a solid biological foundation for the health benefits of the traditional Mediterranean diet, which have consistently shown that a high degree of adherence to the traditional Mediterranean diet and lifestyle results in a reduction of overall mortality19-21 ; reduced incidence of chronic diseases, especially CVDs22 ; and an increased probability of healthy aging.23 In the Nurses’ Health Study, a population-based cohort study that examined whether the adherence to the Mediterranean diet was associated with a longer telomere length, a biomarker of aging, it was shown that greater adherence to the Mediterranean diet was associated with longer telomeres. These results serve to further support the benefits of adherence to the Mediterranean diet for promoting health and longevity.24

AUTHOR COMMENTS The Mediterranean diet is associated with a lower incidence of CVDs, chronic degenerative disease

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Traditional Mediterranean Diet

states, and higher levels of life expectancy. The Mediterranean diet is a holistic lifestyle that embodies healthy foods, including EVOO, physical activity, stress management, and meals shared with family and friends. It is important to realize that its health benefits are derived from a synergy and balance of the whole spectrum of essential elements, rather than any individual part.

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The traditional Mediterranean diet: an ancient prescription for health and longevity.

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