The Mediterranean Diet

The term comes from the Latin diaeta diet, which in turn comes from the greek δίαιτα, and it means "way of life"; it is not only the deprivation or temporary abstinence from food, but give the usual method of feeding a person, a group, a population in a certain period.

The nutritional model inspired by the cultural and culinary traditions of some countries of the Mediterranean basin, such as Italy, Greece, Spain and Morocco, is defined Mediterranean diet. The V Intergovernmental Committee of UNESCO (United Nations Educational, Scientific and Cultural Organization), which met in Nairobi (Kenya) from 15 to 19 November 2010, Tuesday, November 16 proclaimed the Mediterranean Diet "Intangible Cultural Heritage of Humanity '' by recognizing that assets to Italy, Spain, Greece and Morocco and then registering the DM in the list of World Heritage Sites. The prestigious list, which contains the elements of intangible cultural heritage considered as representative of humanity, consisted of 166 elements (including Argentine tango and Chinese calligraphy), including two Italians: the Opera dei Pupi Sicilian and Sardinian tenor singing . The Mediterranean diet is going to add so as the third Italian to the other two (1). A study by the FAO (Food and Agriculture Organisation of the United Nations) has shown that in recent decades the Mediterranean diet has been abandoned and from 1962 to 2002, in fifteen European countries examined, the daily calorie intake has increased by about 20 per percent, from 2,960 kcal to 3340 kcal. In Greece, Spain, Portugal, Cyprus, Malta and Italy daily calorie intake has increased by as much as 30 percent, with effects on the level of obesity and health. Ergo, the Mediterranean regions are undergoing a "nutrition transition" that is moving away from their old diet, long considered a model for healthy living and sustainable food systems that can preserve the environment and promote local producers ( 2).

The term Mediterranean diet, however, not only indicates a dietary pattern, but one LifeStyle; underlying this model is sharing: eating together is the foundation of the cultural identity and continuity of the communities around the Mediterranean basin. It is a time of social interaction and communication, affirmation and renewal of the family, group or community identity. The Mediterranean diet emphasizes the values ​​of hospitality, neighborliness, conviviality, intercultural dialogue and creativity, and a way of life guided by respect for diversity. It plays a vital role in the cultural spaces, at parties and celebrations, which brings together people of all ages, status and social class (3).

When was the Mediterranean Diet borned?

It all started in a vast territory, which is overlooked by many countries and many cultures: the Mediterranean, historically considered the "Cradle of the company." In these territories they were born important civilizations like Egyptian, Phoenician, Babylonian, Sumerian, Persian; since then, the Mediterranean has become the meeting place of people who have continuously changed cultures, customs, languages, religions and lifestyles. Collision and meeting of these cultures has also produced the partial integration of eating habits.

The Mediterranean diet has its roots as far back as the Middle Ages, where the ancient Roman model and even before Greek, were routinely used products such as bread, wine and oil, the symbols of the farming culture, accompanied by goat cheese, vegetables (leeks, mauve , lettuce, radishes, mushrooms) and a strong preference of the fish and seafood than meat, which was consumed very little. However, this food culture collided and mixed it soon with the culture of the Germanic peoples, mainly hunters and forest dwellers, eaters of pork and beer producers, with the few who cultivated cereals. The key elements of the DM, or the bread, wine and oil were exported in the region of Northern Europe by monastic orders that time migrated to evangelize new territories. In addition to the meeting between the two cultures, the Roman and the Germanic countries, there was a third contamination, or that of the Arab countries, which had developed its own food culture around the Mediterranean. The use of different products in agriculture generated a strong renewal of the industry and a strong influence on the dietary pattern: the use of products such as sugar cane cultivation, rice, eggplant, spices and citrus fruits were the first of Arab, a food reserved for the upper classes. So Islamic culture participates in the cultural renewal of the Mediterranean that Rome had begun, and provides a major contribution to the new model emerging culinary. One of the pivotal events in the Mediterranean cultural renewal that has affected the food model of the DM, was the discovery of America, which resulted in Europe "new" products: potatoes, corn, peppers, chili, several varieties of beans, and last but not least, the tomato, destined later to become the symbol of the Mediterranean diet.

The long history that goes by the Egyptians until the discovery of America led to the introduction of new foods and new ways of power, giving us what we today call "Mediterranean Diet" (4).

The first in 1939 to expose the idea of ​​a "Mediterranean diet", in the sense of simple and natural diet for humans, and therefore estimate, was Lorenzo Piroddi (1911 to 1999). Young doctor and dietician, during World War II had the opportunity to analyze the relationship power-pathology by comparing the type of nutrition of German, American and Italian, sensing even without scientific confirmation that the power of the Italians led to a better expectation life (5). After him, the scientist Ancel Keys (1904-2004) of the University of Minnesota School of Power, he promoted the link between diet and cardiovascular disease for the first time (6); the first observations made by the scientist were based on the Lifestyle of small populations of southern Italy, as Nicotera in Calabria and the island of Crete, where the incidence of the disease was very low compared to wealthy families who lived in the United States. Keys attributed the low incidence of the disease to the power source of these populations and characteristic of that area. Keys, moved by this important observation, began the famous "Seven Countries Studies", a large study based on the eating habits of about 12,000 people from seven different countries (Finland, Japan, Greece, Italy, Netherlands, United States and Yugoslavia) . Thanks to this study, observational trials and mediating cross, Keys and his colleagues were able to scientifically prove the nutritional value of the Mediterranean diet and the contribution to the health of those populations that have adopted it (7). From the study it was found that the people who have adopted this system have lower blood levels of cholesterol, thus having a percentage much lower risk of coronary heart disease; these people used olive oil, bread, pasta, vegetables, different vegetables, garlic, red onions, herbs and a low consumption of meat (8), compared to the population as the Finnish where cardiovascular risk was higher because of 'high consumption of foods rich in saturated fats (eg. butter, lard, red meat). Keys moved to Italy, in Pioppi, a fishing village in the town of Pollica, where he bought a house in a seaside resort that will be baptized by him Minnelea a name that was intended to be a joint tribute to the city of Minneapolis and the nearby Greek polis Elea, Cilento, his adopted land. With him settled in that locality some of his friends and associates, as Martti Karvonen, Flaminio Fidanza, Alberto Fidanza, and Jeremiah Stamler. He remained in that location for 40 years, studying carefully the power of the local population and concluded that the Mediterranean diet was beneficial to health. Ancel Keys was the model from which to many researchers, that starting from the observational study of Keys have studied and analyzed the association between diet and chronic diseases.

Many studies and clinical trials have shown that the Mediterranean diet reduces the risk of cardiovascular disease and metabolic syndrome. The studies conducted so far have shown the beneficial effects of the Mediterranean diet about the main cardiovascular risk factors in humans, particularly those subject to the scheme improved the levels of plasma glucose, blood pressure, HDL levels were reduced and levels triglycerides and C-reactive protein (9). Even in people with diabetes seems to be an enhancement to the diet than others, especially in preventing cardiovascular consequences that a patient with diabetes may present; Studies have shown a reduction in HbA1c levels and reducing insulin resistance (10). An important and long study was the PREDIMED (Prevención with Mediterranean Diet) designed to evaluate the long-term effects of the Mediterranean diet on various subjects undergoing dietary different, two types of Mediterranean diet and a control diet; It was found in these subjects improved on lipid profile, lipoprotein, blood pressure, inflammation and oxidative stress, as well as on the expression of genes related to vascular events and atherogenic. In addition the results showed the preventive effect of a diet high in unsaturated lipids and antioxidants (11). However, the Mediterranean diet is not by itself able to produce the benefits mentioned because it is necessary to modify or delete all other risk factors; the main cardiovascular abnormalities and ischemic does not depend solely by incorrect dietary regime but also by other factors, such as sedentary lifestyle, smoking, stress or presence of pathologies such as obesity. A 2007 study showed a reduction in mortality risk with a physical activity (12); physical activity helps reduce cardiovascular risk factors such as hypertension, hypertriglyceridemia and insulin resistance (13); Furthermore, the exercise coupled to a correct power supply is able to decrease blood levels of LDL, improves myocardial function, increases the vasodilator capacity, muscle tone and reduces inflammatory stress (14).

Main awards

In 2008, the Ministry of Agriculture and Forestry, recognize the Mediterranean diet as a diet reference biological. We May 9, 2010 was held the third International Symposium in Nicotera, on the occasion of the fiftieth anniversary of the discovery of food consumption in 1960, at that meeting have been defined the association between the Mediterranean diet and the expression of certain genes that control 'inflammation and atherosclerosis providing the basis by which the molecular nutrition offers a perspective effective intervention, defining the intake of specific nutrients in accordance with energy requirements and the genetic individual. The International Congresses devoted to the subject have been held since 1996 in Spain, which also worked on the promotional aspect. In June 2013, the Cultural Foundation "Paul of Tarsus" idea and realizes the project "Mediterranean Diet - Future Food" in collaboration with the Chamber of Commerce of Cosenza, the Academy of the Mediterranean Diet of Cosenza, the Movement for the Mediterranean Diet The Healthy Food and Health. For its high ethical goals, the project has received the support of the President of the Italian Republic and with the direction Agribusiness economist Prof. Fausto Cantarelli, he directed his attention to the economic issue linked to the Mediterranean diet intended as a model for economic development Southern Italy whose lands are known for the production of foods and products of the Mediterranean Diet. The positive results of the aforementioned project has meant that the UNICAL - University of Calabria - Di.BEST - Department of Biology, Ecology and Earth Sciences, propose a Master's degree in "Green Economy, the Mediterranean Diet and Environmental Sustainability: Management of Safety, Quality and Economics Agribusiness" successfully activated the day Friday, January 31, 2014. The growing interest due to the many activities of the above and the implications Academic led the Foundation "Paul of Tarsus" to establish the first World Expo of the Mediterranean Diet in 2016 that will focus its attention on the rights of Man access to Healthy Food. In 2012 the Foundation ITS BACT created and held the 1st event "Convivio Mediterranean exhibition on the gastronomic culture of the Mediterranean Diet" in Vico Equense (NA) in the Monumental Complex "SS. Trinity and Heaven", while the 2nd similar event It was held in Benevento in spring 2014 for the Universal Forum of Cultures in the Cloister of St. Sophia (good UNESCO) (15).

The main foods

The Mediterranean diet includes a large consumption of vegetables, fruits and vegetable protein, an average consumption of whole grains, and low consumption of red meat. The regular use of fish, olive oil and dried fruit makes this type of diet much more "oily" of any other diet for optimum health, but the quality of fats assumed, prevalence unsaturated, causes the DM can prevent cardiovascular disease

Cereals and tubers

Cereals are the basis of the DM. The wealth of research and still in place indicate that regular consumption of cereals, mostly grains, reduces the risk of cardiovascular disease, type 2 diabetes, certain types of cancer and gastrointestinal diseases. The difference between whole grains and refined grains has reached a very wide audience, and is much discussed topic today. Italian researchers recently published an article where it is proposed to amend the wording of cereals in the food pyramid, since the category "cereal" is very heterogeneous, and underlined the importance in the selection of cereals and especially of those grains, although it is difficult probably for the availability of certain foods in Italy (16). Whole grains contain all parts of the grain (bran, germ and endosperm), than refined; They are rich in substances with recognized health benefits, such as dietary fiber, antioxidants that include phenolics, phytoestrogens, including the lignans, vitamins and minerals. The advantage in the consumption of whole grains is also linked to a higher content of essential fatty acids, vitamins of the B complex, vitamin E, Fe, K, Mg, Zn, selenium and other bioactive elements (17). In the broad range of cereals includes: bread, pasta, rice, barley, spelled, corn, kamut, oats, and less common millet and quinoa. It should however emphasize that the important beneficial properties of cereals, do not lead to a consumption consigliarne exorbitant but always proportional to the need.

The most famous tuber and present on our tables is the potato, although it is more and more frequent use of other tubers in modern kitchen, such as Jerusalem artichokes or celery root, not to mention the presence of many roots in our diet, as ginger, horseradish and turmeric roots, which gives the latter; these foods are rich in minerals, vitamins and anti-inflammatory properties are known. The "Queen" is the potato and its different varieties; indeed, it is a good source of energy, fiber, B vitamins and potassium. Potatoes also contain vitamin C. They are rich in starch, which is rapidly converted to glucose. Potatoes are often meant as a vegetable, but they have different properties, so they are counted separately from taking vegetables. To underline that the excessive consumption of this food does not provide a benefit, since the high starch content of the potatoes, and then an excess of glucose, is associated with risk of diabetes type 2. Also for this food applies the concept of consume the product in proportion to the body's needs.

Legumes

The properties of the vegetables in the diet have been the subject of study and interest from around the world of research and clinical scope. They represent one of the main foods consumed in the Mediterranean areas, less frequent in the North of Europe. Legumes are the most common dry peas, chickpeas, beans, beans and lentils, but fall within the legume family as well as soybeans, peanuts, clover and alfalfa. The physiological effects of the different pulses vary significantly according to the different content starch, protein and phytochemicals (18), which act as protection against diseases and disorders. Concomitant intake of cereals and legumes provide humans a daily requirement and complete protein of high biological value because the amino acids that are lacking in grains are present in legumes and vice versa (respectively lysine cereals and legumes for methionine) ; this aspect is of fundamental importance because taking these foods, is obtained in a proportion of protein complex of similar value to that of meat, which to its disadvantage, however, has the high content in saturated fats, and therefore in this way it can be assumed less meat to favor of legumes and cereals (19). They represent an important source of dietary fiber which itself has no nutritional value or energy (except for the small amount of energy coming from the fatty acids in short chains formed by fermentation in the colon), but it is equally very important for the regulation of different physiological functions in the body: it delays gastric emptying, facilitates the passage of the food bolus and the evacuation also increase the feeling of satiety and regulates the absorption of important nutrients, all the glucose. The legumes, unlike the grains that contain insoluble fiber (cellulose, lignin), containing soluble fiber (pectins, gums) (19).

Fruits and vegetables

Consumption of fruits and vegetables daily can cause a benefit to the body, especially the consumption of fruit and vegetables and seasonal freshest possible. A key role is also that of the sun, as the plant subjected to the heat of the sun and not grown in greenhouses, have a larger quantity of nutrients and vitamins, without a great demand for pesticides, which can act as a strong interfering body ( 4). The reasons why we recommend more servings of fruits and vegetables a day are manifold: they are regulators of water balance for their significant contribution to water; They have a significant amount of dietary fiber; They have a very low calorie and have a preventive role against diseases such as obesity; They are rich in vitamins such as A, found mainly in tomatoes, peppers, carrots, cantaloupe and apricots, and C, found in tomatoes, strawberries, citrus and kiwi; They are rich in minerals, such as potassium, selenium and zinc; have a number of substances with antioxidant role, ie carotenoids, tocopherols and phenolic compounds. Among the cruciferous vegetables they play a vital role, as some substances in the latter type have been studied with respect to their potential preventive effects against cancer. For example, different classes of sulfur compounds at the cellular level facilitate the elimination of carcinogenic substances: among these ditioltioni and isothiocyanates, which are rich in cruciferous vegetables like broccoli, cauliflower, cabbage, and allilsolfuri which is rich garlic. So far no study has shown that administration of the individual components in the form of supplements can give the same beneficial effects that are associated with ingestion of fruits and vegetables. It is hypothesized that such effects are mainly due to the synergistic action of multiple constituents, which seems to be less at the time when such compounds are to be ingeritisingolarmente and in relatively concentrated form (supplements) (4,19). Unlike the vegetable, the fruit has a more substantial contribution glucide, in particular, are more abundant in the form of simple sugars glucose and fructose.

Milk and dairy products

The main function of these foods provide calcium, in a highly bioavailable form, that can be easily used by those who assume. In addition to low-fat milk or other low-fat, in this category they are to be preferred cheese and low-fat dairy. In addition to football these foods have other substances, such as proteins: the most represented is casein, the base of the preparation of the cheeses, and lactalbumin. Other substances are vitamins, in particular vitamins of group B and A, and mineral salts. A valid alternative to milk is represented, as well as from cheese, from yogurt, currently on the market in different modes and flavors. The deficiency of lactase in humans can generate the classic lactose intolerance, with different symptoms especially gastrointestinal; currently on the market are products without sugar (lactose) in order to allow the use of milk in intolerant people. Finally it must be stressed that some milk product casearii, such as whole milk, cream, butter and cheese, have a high content of saturated fatty acids, known to favor the rise of cholesterol in the bloodstream (19).

Meat, eggs and fish

The meat is a food that gives those who consume a high amount of protein of high biological value, in other words, it has the essential amino acids necessary for protein synthesis in optimal amounts. The meat also contains a good percentage of B-complex vitamins and trace elements such as iron, copper and zinc. The egg (the most commonly used are those of hen) are a high-protein food, especially in its "white" part defined albumen, composed of water and protein, while the "red" is the yolk, consisting well as proteins and water, also from fat. Also eggs are rich in vitamin A, riboflavin, folic acid, vitamin B6, vitamin B12, choline, iron, calcium, phosphorus and potassium; choline in particular is an important nutrient for brain development. Fish consumption is highly recommended, especially the fish so-called "poor": bluefish, sea bream, sea bass, octopus favorite to tuna and swordfish; Fish is a source of omega-3, an essential fatty acid, unsaturated, which does not increase the level of blood cholesterol and triglycerides, and decreases the ability of platelet aggregation, avoiding the risk of thrombosis and protecting the body from risks cardiovascular. Consumption of fish has shaped the culture and style of countries bordering the Mediterranean; the consumption of the latter should be preferred to that of meat, even for the fish with the lower intake of saturated fat; particularly among those preferring lean meats and white than red, which must have a frequency of monthly consumption. For eggs it is preferable to a weekly consumption, a maximum of 3-4 eggs per week (4,19).

Fats and oils seasoning

This category includes vegetable oils, including olive oil, and fats of animal origin, such as butter and margarine, or lard. The oils and fats are needed to enhance the flavor of our food, but they also provide essential fatty acids and fat-soluble vitamins, useful for the formation of cell membranes (4). What are fats prefer and why? The animal fats are high in calories and are related to the risk of developing obesity and other related diseases, so it is highly advisable not to excess (20). As for the vegetable oils, the habitual use is quote for some pathologies: olive oil is considered one of the key foods in the Mediterranean diet, which contributes to preventing from cardiovascular disorders, with anti-thrombotic and anti-inflammatory (21) own of the phenolic substances and antioxidants contained in it; it contains monounsaturated fatty acids, including oleic acid, which lowers the blood levels of LDL and VLDL, which carry most of the so-called "bad cholesterol", which can be deposited in the arteries causing inflammation and atherogenic; also it can increase the level of other lipoproteins, HDL, which operate precisely to eliminate cholesterol from arteries ripulendole (19), from here the role of the oil of "artery cleaner". Seed oils, often used for frying food, are rich in omega-6, which are also involved in the action of reduction of LDL and VLDL. In some products derived from animals, or subjected to industrial change, such as margarine, are trans fatty acids, which are harmful to health as increase the level of bad cholesterol in the blood, so it is not advisable to use these condiments, as well as palm oil and coconut, rich in saturated fatty acids (19). It can be concluded that the use of extra virgin olive oil raw as a condiment is not only an exaltation of taste for food, strong support for the prevention of your health. Oil also are important antioxidants, including oleuropein, foreign polyphenol hydroxytyrosol responsible all'oleocantale with the bitter taste of extra virgin olive oil, with antioxidant, anti-inflammatory, anti-atherogenic and anti- tumor (22). Furthermore animal studies have demonstrated the effect of reducing the oxidative stress caused by smoking (23).

 Wine

The wine is culturally drink symbol of the Mediterranean diet, both for his role as a vehicle for conviviality, as well as for its health properties. In addition to water and ethyl alcohol, the wine has substances that from the point of view of health have a positive impact, such as polyphenols and anthocyanins. Among them is resveratrol, the polyphenol content in grapes, berries and indeed, the red wine. In studies on animals, it has been shown that resveratrol, the chemical compound present in red wine, has protective properties for the circulatory system and towards external agents (24). The wine, however, also contains alcohol, for this consumption should not be excessive, since alcohol has harmful effects on the nervous system and organism in general. The famous saying "red wine makes good blood" is actually a misconception because the wine may also be responsible for various forms of anemia and increase blood fats (19). The consumption of alcoholic beverages with low alcohol content must be controlled, moderate and regular, because in this way can have a positive effect on the incidence of some chronic diseases without exposing the body to excessive concentrations of ethanol.

Even today, in 2015, and at the gates of 2016, the Mediterranean diet has gained acceptance and positive opinions from all sectors, culinary, gastronomic, cultural and, not least medical and scientific. Dissemination and promotion of high quality Lifestyle can not walk on the same track of the proper nutrition of Mediterranean type. At the Expo in Milan in October, almost at the end of the world exhibition, several representatives of centenarians Campania region, more specifically Cilento, were welcomed as ambassadors and witnesses of the doctrine begun by Keys and carried forward today by this' and the last by all the inhabitants of the lands of the Mediterranean, taking up the name of the Mediterranean diet and the healthy lifestyle.

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