Dietetics and Nutrition in the Mediterranean

Dr. Alberto Fatticcioni

Eating in our time has gotten complicated. This is because people know supermarkets and food brands, but they don’t know what real food is.

The secret to eating well isn’t in biochemistry, it isn’t in food labels or in doctors’ advice. The secret to eating well is in the knowledge of food. We need to understand all the different aspects of food to create a food culture.

In food culture there are only three protagonists: the farmer who produces food with his work. The cook, who creates taste with his art. The innate necessity/pleasure to eat and taste of all of us .

Without food humans can’t survive, without good food humans can’t thrive.Nowadays there is a revival of food culture. This food culture makes food quality, food production quality and food cooking quality a basis for a new concept of well-being.

This new food philosophy is a way of life, where food is the core of this way of thinking.

This food consciousness connects food to agriculture, gastronomy, health, business, ecology, society, politics, history, science, religion, cooking and pleasure.

Food Consciousness

Taste and know (the gastronomy of knowledge): the gastronomy is a way of knowledge. Taste is culture. Restaurant like a museum.

Taste and ethics (sustainable gastronomy): the gastronomy is a moral guide. Taste is politics. Taste is economy. Taste is ecology.

Taste and art (artistic gastronomy): the gastronomy is art. Taste like the sight. Good like the beauty.

Cooking is the art of happiness.

Its ultimate aim is to give us an honest

pleasure to recover the meaning of the world.

Diet and nutrition

Diet is the amount of food consumed by a person, it is what someone eats.

Nutrition is the science which studies the relation between diet and health.

What is the Mediterranean diet?

The Mediterranean diet is a modern nutritional recommendation inspired by the traditional dietary patterns of the poor coastal regions of southern Italy (cucina povera), Crete, and coastal Greece in the 1960s, discovered by researchers from the Rockefeller University. The common Italian definition for some of these dietary patterns is “Cucina povera”. “Cucina povera” has been around for thousands of years in Italy, and it’s a sort of rural subsistence diet.

Mediterranean Sea

Mediterranean diet rulesThe Mediterranean diet is principally a plant based diet. Everyday the “mediterranean way” consists of:

• vegetables (at least 300-400 g a day) • fruit (at least 4 pieces or 400 g a day)• legumes and pulses• grains, pasta and/or bread (mostly wholemeal and unrefined) • olive oil and nuts• an abundant use of herbs and spices• water (more than 2 liters per day)• wine during meals ( maximum 2 glasses per day )

Mediterranean diet rules

In the Mediterranean diet the most important source of animal food is fish. The Mediterranean is a sea which is rich in fish, and to do things the “mediterranean way” we need to eat seafood frequently:

• seafood (fish, shellfish, mollusc), recommended 4-6 times a week, at least twice weekly

Mediterranean diet rules

The intake of dairy produce is low to moderate and usually in the form of goat’s and sheep’s cheese or yoghurt.

• yoghurt, recommended 2 - 4 times per week• cheese, recommended 1 - 4 times per week• milk, recommended 1 - 2 times per week• eggs, recommended 1 - 4 eggs per week (maximum 1 a day)

Mediterranean diet rules

The Mediterranean diet consists in a low intake of sweets, poultry and red meat, these types of foods are a sort of “special occasion food”. Processed food and junk food are forbidden.

• poultry, recommended 1 - 2 times per week• red meat, recommended 0 - 1 time a week • sweets, recommended 0 - 1 time per week • no junk food

Mediterranean Diet Rules• vegetables (at least 300-400 g a day) • fruit (at least 4 pieces or 400 g a day)• legumes and pulses• grains, pasta and/or bread (mostly whole) • olive oil and nuts• water (more than 2 liters per day)• wine during meals ( maximum 2 glasses per day )• seafood (fish, shellfish, mollusc), 4-6 times a week• yoghurt, 2 - 4 times per week• cheese, 1 - 4 times per week• milk, 1 - 2 times per week• eggs, 1 - 4 eggs per week (maximun 1 per day)• poultry, 1 - 2 times per week• red meat, 0 - 1 time a week • sweets, 0 - 1 time per week

Mediterranean diet rules

In synthesis, the principal aspects of this diet include high olive oil consumption, high consumption of legumes, high consumption of unrefined cereals, high consumption of fruit, high consumption of vegetables, moderate consumption of dairy products (mostly as cheese and yoghurt), moderate to high consumption of fish, low consumption of meat and meat products and moderate wine consumption.

Is the Mediterranean diet the official diet in the Mediterranean area?

Despite its name, the “Mediterranean diet” is not the official diet in the Mediterranean area, but its nutrition patterns are similar in all the Mediterranean nations. In Northern Italy or France, 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 are traditional staple fats.

Mediterranean diet rulesUnconventional rules:

• Eat food in season, mostly plants (roots, stalks, flowers) especially leaves.• Eat foods with different colors.• Avoid food products with the terms “low fat” or “fat free” in their names, prefer whole food.• Eat foods made from ingredients that you can picture in their raw state or growing in nature, when you eat, think about where your meal comes from.• When you go to the supermarket choose food that is in season. Buy food that is organic.• Buy your food at the farmers’ market.

Mediterranean diet rules…unconventional rules: • Eating animals without legs (fish) is better than eating what stands on two legs (poultry), which is better than eating what stands on four legs (cows, pigs and other mammals)• Eating animals that have themselves eaten well• Eat well-grown food from healthy soil• Eat wild food when you can• Eat sweet foods as you find them in nature• Eat food not supplements• Eat when you are hungry, not when you are bored• Eat slowly

Mediterranean diet rules…unconventional rules: • Breakfast like a king, lunch like a prince, dinner like a pauper• Limit your snacks to unprocessed plant foods• Try not to eat alone• Plant a vegetable garden if you have the space, a window box if you don’t• Eat fresh food, food which is no longer fresh can not sufficiently nourish people who want to live a long life • Quality in food, not quantity

The health effects of the Mediterranean diet

Nobody knows for sure what the ideal diet is, but there are good reasons to believe that the Mediterranean diet may come closer to it than any other realistic diet.

• Thanks to fruit and vegetables it is high in fiber, vitamins, minerals, antioxidants and phytochemicals• Thanks to olive oil and nuts it is low in saturated fats and high in monosaturates• Thanks to whole grains and legumes it is high in complex carbohydrates with a low glycemic index• Thanks to seafood and greens it is high in omega-3 fatty acid

The health effects of the Mediterranean diet

Food is more than the sum of its nutrients, and diet is more than the sum of different foods. In the Mediterranean Diet the synergic effect of food influences our health.

The analysis of single nutrients does not take into consideration the important interactions between the components of a diet and, more importantly, because people do not eat isolated nutrients but foods.

The health effects of the Mediterranean diet

A meta-analysis published in the British Medical Journal (September 12, 2008) showed that following the Mediterranean diet strictly reduced the risk of dying from cancer and cardiovascular disease as well as the risk of developing Parkinson's and Alzheimer's disease. The findings report a 9%, and 6% reduction in overall cardiovascular, and cancer mortality respectively. Additionally a 13% reduction in the incidence of Parkinson's and Alzheimer's diseases is to be expected provided strict adherence to the diet is observed.

The health effects of the Mediterranean diet

These findings seem to be clinically relevant for public health, in particular for encouraging a Mediterranean-like dietary pattern for primary prevention of major chronic diseases.

Copyright ©2008 BMJ Publishing Group Ltd.

Sofi, F. et al. BMJ 2008;337:a1344

Fig 2 Risk of ALL CAUSE MORTALITY associated with two point increase in adherence score for Mediterranean diet. Squares represent effect size; extended lines show 95%

confidence intervals; diamond represents total effect size

Copyright ©2008 BMJ Publishing Group Ltd.

Sofi, F. et al. BMJ 2008;337:a1344

Fig 3 Risk of mortality from CARDIOVASCULAR DISEASES associated with two point increase in adherence score for Mediterranean diet. Squares represent effect size;

extended lines show 95% confidence intervals; diamond represents total effect size

Copyright ©2008 BMJ Publishing Group Ltd.

Sofi, F. et al. BMJ 2008;337:a1344

Fig 4 Risk of occurrence of or mortality from CANCER associated with two point increase in adherence score for Mediterranean diet. Squares represent effect size; extended lines

show 95% confidence intervals; diamond represents total effect size

Copyright ©2008 BMJ Publishing Group Ltd.

Sofi, F. et al. BMJ 2008;337:a1344

Fig 5 Risk of PARKINSON'S DISEASE AND ALZHEIMER'S DISEASE associated with two point increase in adherence score for Mediterranean diet. Squares represent effect size;

extended lines show 95% confidence intervals; diamond represents total effect size

Top 10 Foods contributing to Energy Intake in the U.S population

Rank Food % of total energy

1 Regular soft drinks 7.1

2 Cake, sweet rolls, doughnuts, pastries

3.6

3 Hamburgers, cheeseburgers, meat loaf

3.1

4 Pizza 3.1

5 Potato chips, corn chips, popcorn

2.9

6 Rice 2.7

7 Rolls, buns, English muffins, bagels

2.7

8 Cheese or cheese spread 2.6

9 Beer 2.6

10 French fries, fried potatoes 2.2

Top 10 Food Groups Contributing to Energy Intake in the U.S population

Rank Food % of total energy

1 Sweets, desserts 12.3

2 Beef, pork 10.1

3 Bread, rolls, crackers 8.7

4 Mixed dishes 8.2

5 Dairy products 7.3

6 Soft drinks 7.1

7 Vegetables 6.1

8 Chicken, fish 5.7

9 Alcoholic beverages 4.4

10 Fruit, juice 3.9

For the most part, these foods contain far more calories than can be justified by their nutritional values. In part, this is because they’re largely made from corn, in the form of extracted protein or oil; or refined wheat-white flour all processed to the point where they’re nutritionally worthless or even damaging.

The USA is a victim of the industrialization of eating.

The Food Energy - Calories

Food energy is the amount of energy obtained from food.Food energy is expressed in calories (kilocalorie, kcal) or joules (kilojoules, kJ).Fats, alcool, carbohydrates, protein present in food release energy: • 1 g of fat 9 kcal• 1 g of alcool 7 kcal• 1 g of carbohydrates 4 kcal• 1 g of protein 4 kcal

Energy Balance

In biology, energy balance is the biological homeostasis of energy in living systems.

Energy balance =

energy intake – energy expenditure

Energy intake: is part of the diet, which is mainly regulated by hunger and food energy of what is consumed

Energy Expenditure

Energy expenditure is mainly a sum of internal heat produced and external work

Energy expenditure =

Basal metabolic rate (BMR) + thermic effect of food + physical activity level

(PAL)

Basal metabolic rate (BMR)

Basal metabolic rate (BMR), is the amount of daily energy expended while at rest in a neutrally temperate environment, in the post-absorptive state (meaning that the digestive system is inactive, which requires about twelve hours of fasting in humans).

The release of energy in this state is sufficient only for the functioning of the vital organs, the heart, lungs, nervous system, kidneys, liver, intestine, sex organs, muscles, and skin.

Thermic effect of food (TEF)

Thermic effect of food (TEF), is the increment in energy expenditure due to the cost of processing food for storage and use. The primary determinants of daily TEF are the quantity and composition of the food ingested; food rich in protein and fiber have an high TEF.Dietary fat is very easy to process and has very little thermic effect, while protein is hard to process and has a much larger thermic effect. Raw celery and fennels are often claimed to have negative caloric balance, because the thermic effect is greater than the caloric content, due to the high fiber.

Physical activity level (PAL)

Physical activity level (PAL) is the energy expenditure depending on physical exercise.Man 80 kg (176 lb) energy expenditure per minute:• Writing 2,3 kcal/min• Cooking 3,8 kcal/min• Yoga 5,0 kcal/min• Golf 6,8 kcal/min• Bowling 7,7 kcal/min• Jump rope (110 round/min) 11,3 kcal/min• Tennis 11,5 kcal/min• Boxe 17,8 kcal/min• Chop the wood 23,8 kcal/min

Average Energy Allowance

Man: 2300 - 2900 kcal/ dayWomen: 1900 – 2200 kcal/day

Energy balance =

energy intake – (basal metabolic rate + thermic effect of food + physical activity)