Mediterranean diet

In the 50s and 60s of the 20th century, authors such as the American Ancel Keys or the Spanish Francisco Grande Covián studied different aspects of diet and their relationship with diseases. Keys's observations of the possible relationship between fat and coronary artery disease prompted him to launch the first major international epidemiological study on the topic of diet-cholesterol-coronary heart disease, known as the "Seven Country Study."

This study made it possible to observe that the incidence of coronary heart disease was much lower in the countries of southern Europe and on the Mediterranean shore (Italy, Greece) compared to that of North and Central Europe (Finland, the Netherlands and the former Yugoslavia) and that this had to do with saturated fat intake. Other subsequent studies have corroborated these data.

It was Ancel Keys himself who coined the term Mediterranean diet to refer to the eating style that the inhabitants of the countries of the Mediterranean shore (Crete, Greece and southern Italy and Spain) had, and that was associated with a lower incidence of coronary heart disease and death from it. He did so in a book entitled "How to eat well and stay well, the Mediterranean way", published in 1975.

We should add to the concept of "Mediterranean diet" the "Mediterranean lifestyle", which would include a different way of understanding life, more open to the outside, with a climate or environmental conditions that are also different, which facilitate relationships and relationships. activities outside the home, where moderate and sustained physical activity is possible, and with a particular food culture that includes two or more main meals a day, carried out sitting around a table and as a family, and consuming garden products, wheat ( bread), olive (oil) and vine (wine), seasonal vegetables and fruits, little meat, dairy in the form of yogurt or cheese, fish / shellfish and salted foods, little sugar, and wine in moderate quantity with meals.

It is very difficult, if not impossible, to define what the Mediterranean diet is. The majority of authors, in fact, refer to the prototype of a diet that the population of the Mediterranean countries carried out approximately in the sixties. Thus, the "Mediterranean diet" was defined by the International Consensus Document (Rome, April 1997) as follows: "The traditional Mediterranean diet is characterized by the abundance of plant foods such as bread, pasta, vegetables, salads, legumes , fruit and nuts; olive oil as the main source of fat; moderate consumption of fish, poultry, dairy products and eggs; small amounts of red meat and low to moderate amounts of wine, consumed during meals. This diet is low in saturated fatty acids, rich in carbohydrates and fiber, and high in monounsaturated fatty acids that are derived mainly from olive oil ».

However, we must bear in mind several issues:

• Following a Mediterranean diet reduces but does not completely eliminate the presentation of cardiovascular diseases.
• There are differences in diet between different regions of Spain.
• The characteristics of the Mediterranean diet, which is what was done when the term was coined, has been lost with the westernization of our society.
• The concept of the Mediterranean diet has evolved, incorporating and eliminating some elements of the traditional Mediterranean diet to improve it. For this reason, it is better to speak of a "heart-healthy diet" to refer to a diet with the aforementioned characteristics of the Mediterranean diet and with these improvements.

The improved Mediterranean diet is characterized by:

• The high consumption of complex carbohydrates in the form of pasta, rice and bread (whole).
• The high consumption of fruits and vegetables.
• The high consumption of nuts and seeds.
• The habitual consumption of legumes.
• The predominance of fish consumption over meat.
• The moderate consumption of proteins of animal origin (red meat and derivatives).
• Low consumption of milk and dairy products.
• Low consumption of simple sugars.
• The use of olive oil as the main culinary fat.
• The use of garlic, onion, parsley, herbs and seasonings in the kitchen.
• The moderate consumption of wine with meals.
• Consuming water with meals instead of sugary sodas.

To all this must be added the overall control of the total fat intake (less than 35% of the energy ration) and the contribution of saturated fatty acids (less than 7%) and the habitual practice of physical activity, as we have said. before.

Numerous studies have shown that the Mediterranean diet (and, by extension, the heart-healthy diet) is beneficial to health and is protective against cardiovascular disease due to the components it contains (antioxidants, fiber, complex carbohydrates, monounsaturated fatty acids , polyphenols, minerals and vitamins).

It is very important to emphasize that the beneficial cardiovascular effects may not be accompanied by improvement in blood tests, that is, our "bad" cholesterol may not have been reduced in the analysis. This should not lead us to think that food is "not useful", on the contrary, the Mediterranean diet reduces the risk of cardiovascular diseases and death from them independently of the decrease in total cholesterol and LDL cholesterol, as already classic studies show (for example, the Lyon study, the GISSI-Prevenzione Trial, and the DART study).