Missed the introduction to our “Prolongevity”-Series? Here you go…
Mediterranean Diet or Cuisines?
What do you visualise when you hear the expression “Mediterranean Diet”: Tagliatelle in a luscious cream and mushroom sauce? Tajine and couscous? Assorted tapas or moussaka with a thick layer of cheesy
béchamel? Unless it is a fragrant flatbread with hummus? Or oodles of yummy gelato and nutty baklava?
We may have to disappoint you a bit… The so-called “Mediterranean Diet” is indeed inspired by the cuisines to be found around that water ex-panse, but it is more of a distant cousin, if not the poor cousin. Most of the delights just mentioned would not be condoned in a typical Mediterranean Diet meal plan, but elements from the dishes would certainly fit the bill: from olive oil to mushrooms, legumes and other vegetables, not to mention herbs, fruit and nuts. White flour, red meat, cream, sugar, or deep-fried goodies would not – or only as an exceptional treat.
Indeed, the Mediterranean Diet could best be described as a compila-tion of health-fostering and/or health-protective common denominators from the poor rural (wo)man’s diets of Southern Europe, the
Levant and North Africa. And the foods or nutrients it recommends would be those common to these different cuisines before the affluence generated by the post-WW2 economic boom and the global conquest of American-style convenience foods.
The Great-Grandmother Rule
Its motto could well be:“Don’t eat anything your great-grandmother wouldn’t recognize as food”. This was one of the rules that journalist and food writer Michael Pollan (whom we already quoted in a previous article) devised as the lowest common denominator for a healthy diet. Strictly speaking, we may need to go back even further in time than your great-grandmother’s era to find a diet devoid of “unrecognisable” foods since chocolate, tinned milk, instant broth or margarine, became available in the wake of the industrial revolution. Nevertheless, Pollan may still have a point.
Indeed, as hinted at it in our intro, Blue Zone inhabitants do not seem to derive their healthy longevity from consuming large amounts of dietary supplements, nor do they seem to thrive on processed foods. Instead, it is the quality of their traditional diets that appears to be one of the more crucial components of their healthy well-being.
New Diets for Lifestyle Diseases?
As a response to rising levels of so-called civilisation or lifestyle diseases, there have been many attempts over the past decades to devise new medical diets to manage the likes of diabetes, obesity, coronary heart disease or Alzheimer’s. Currently, popular protocols, such as DASH (Dietary Approaches to Stop Hypertension) or Low FODMAP (Fermentable, Oligosaccharides, Disaccharides, Monosaccharides And Polyols), rely on slowly accrued epidemiological and nutritional evidence from previous medical trials. The problem with these diets is that they may not appeal (or be known) to a broader health-conscious but not overtly sick audience. Also, the choice (or avoidance) of specific nutritional properties may only be beneficial to at-risk patients or patients already suffering from a particular condition. Last but not least, many recent medical protocols still lack a truly longitudinal and/or large-cohort perspective to make them suitable for larger swathes of the population.
In parallel, a slew of semi-serious to downright faddish diets have emerged in the 20th century to not only combat obesity, but also detox, heal or energise – from the likes of Paleo, Macrobiotics, Blood Type, Master Cleanse, Cabbage Soup or even the Lamb Chop and Pineapple diet of the 1920s… Beyond weak to inexistent medical evidence of their beneficial effects, the issue here is that, due to inbuilt nutrient imbalance, potentially serious side effects were and are often witnessed, be it a few weeks or a few months after an initial health improvement and/or an unnaturally rapid weight loss.
Traditional Lifestyles instead of Diets
Hence, a safer and more productive strategy appears to be the step taken by scientists, such as demographers or epidemiologists, to observe longevity trends worldwide and identify correlative if not always strictly causal patterns potentially favouring these trends. Indeed, given a certain perenniality of local diets and other traditions, it is easier to design longitudinal studies with larger cohorts in this context than to test the effects of a more artificially designed regimen.
A pioneering but controversial effort was that of Canadian dentist Weston A. Price, who tried to detect the root causes of dental decay and, by extension, overall health decline. His book "Nutrition and Physical Degeneration", published in 1939, featured the ethnographical nutritional findings he garnered over the course of his travels to e.g., Switzerland,
Polynesia, West Africa or Australia. His central thesis was that when indigenous diets were abandoned in favour of Western lifestyles, both dental and overall health suffered. Because his work was based on brief trips to remote regions and the evidence he gathered appeared too superficial or anecdotal to be considered consistently scientific, he was accused of reinforcing the stereotypical myth of the “healthy savage”. He nevertheless remains one of the founding fathers of holistic dentistry, and his nutritional guidelines are still revered in alternative health circles that do not eschew meat.
Mediterranean Diet begets Blue Zone
Approximately a decade later, American physiologist Ancel Keys, also launched a new discipline, namely cardiovascular disease epidemiology through his work on the positive effects of starvation on coronary health during WW2 and by fathering the so-called “Seven Countries Study”. This study was designed as a longitudinal, relatively large-cohort comparative endeavour to investigate the cardiovascular health of men aged 40 and above in seven regions of the world between 1958 and 1999. Despite this ambitious set-up, the study had obvious limitations, as sketched on its website: “The cohorts in the Seven Countries were chosen as cultures apparently contrasting in lifestyle, eating habits, risk factor levels, and, pre-sumably, incidence of and mortality from CHD, though the latter was un-known. They were not statistically representative of the correspondent countries and the choice was partly made on the basis of convenience.”
Nevertheless, it became a landmark study since it was the first to establish plausible links between lifestyle, diet, coronary heart disease and stroke. The “HALE Study” (Healthy aging: a Longitudinal study in Europe), a 2001 offshoot of the “Seven Countries Study” based on some of its data as well as data from two other longitudinal studies, highlighted one of the most striking associations, namely an up to 17 or 18% lower 10-year all-cause mortality according to two indexes “based on foods characteristic of the traditional Mediterranean diet in the 1960s. Within these dietary patterns, grains, fruit, and fish were most strongly and inversely related to all-cause mortality”.
In parallel, the term “Blue Zone” was widely popularised by American reporter Dan Buettner based on the original work of Gianni Pes, a
Sardinian physician and medical statistician, and Belgian demographer Michel Poulain on Sardinian communities with a high concentration of centenarians – before being extended to other regions such as e.g., Okinawa in Japan or Nicoya in Costa Rica.
From the Mediterranean Diet to the Mediterranean Lifestyle?
These early studies contributed to a true research frenzy on the benefits of the Mediterranean Diet – not to mention a popular marketing craze for various “Mediterranean” (and “Blue Zone”) protocols or ingredients. To this day, PubMed lists over 11,000 articles on the subject and even transhumanist biohacker Bryan Johnson has launched his own (currently
Chilean!) “Blueprint” olive oil…
Over the last couple of decades, most studies have been able to establish positive links between the Mediterranean Diet and longevity, as well as the mitigation of lifestyle diseases. Study types encompass virtually every design: from cell models to randomised control trials over animal models and observational studies. Some focus on overall dietary patterns, others on specific nutrient intake such as e.g., quercetin (from e.g., fruit) or omega-3 fatty acids (from e.g., fish). While the latter design
makes it somewhat easier to establish causal links, the former must often be content with correlative ones.
All study designs are of course justified, and these various avenues will no doubt be further pursued. But a number of more recent review studies come to a similar conclusion: there needs to be more randomised control trials of the Mediterranean diet (and by extension Blue Zone diets) as an overall pattern – and this in different cultures and geographical contexts with attention paid to age, sex and genotype – to better understand its mechanisms of action. Furthermore, a number of re-searchers are seeking to remind both the scientific and popular communities that “diet” is but one pillar of the healthy longevity observed in specific Mediterranean communities. Exercise, stress management, community life, relationship with nature and spirituality may be just as important in upholding the diet’s positive effects while counterbalancing some of the dietary “sins” to be found in the communities observed.
Another timely admonition is that contexts, hence dietary patterns, evolve. In Mediterranean countries (and Blue Zones), traditional diets (and lifestyles) have become watered down, leading to increases in lifestyle disease and higher mortality. Hence, you cannot expect to rejuvenate by simply copying the recipes and the “dolce far niente” you may have enjoyed during a holiday in these regions.
The Mediterranean Diet at Home
Instead, you need to heed the “Great-Grandmother Rule” we alluded to above, while operating synergistically (cook fresh and local foods, eat at table with friends and family, move more and outside, catch more sleep, relax and maybe meditate…) and applying common sense. Indeed, depending on where you live and where you come from, it may be smarter to transfer the principles of the Mediterranean Diet to your preferred or locally available diet. This means an emphasis on fresh, seasonal, mostly plant-based whole foods, using locally sourced and sustainable staples. This, for instance, seems to be the rationale behind the recent popularisation of the so-called “Nordic Diet”.
In a recent National Geographic article, preventive medicine specialist
David Katz provides a most eloquent parting shot about the allure, the effectiveness and the perenniality of the Mediterranean Diet: “It seems to be the universal love donor—it has real foods, predominantly plants, and it offers pleasure,” […] “It captures the fundamentals of whole nutrition—it takes us out of the realm of quick fixes and into the realm of lifestyle. The Mediterranean diet has worked for generations and it works for lifetimes.”
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Selected Sources (last retrieved: 27.11.2023)
“List of Diets”, Wikipedia. Online: https://en.wikipedia.org/wiki/List_of_diets
Price, Weston, A. Nutrition and Physical Degeneration: A Comparison of Primitive and Modern Diets and Their Effects (1939) Paul B. Hoeber, Inc; Medical Book Department of Harper & Brothers
Website of the "Weston A. Price Foundation": https://www.westonaprice.org
“Weston A. Price”, Wikipedia. Online: https://en.wikipedia.org/wiki/Weston_A._Price
Website of the “7 countries Study”: https://www.sevencountriesstudy.com/about-the-study/
Michel Poulain, Giovanni Mario Pes, Claude Grasland, Ciriaco Carru, Luigi Ferrucci, Giovannella Baggio, Claudio Franceschi, Luca Deiana. “Identification of a geographic area characterized by extreme longevity in the Sardinia island: the AKEA study”, Experimental Gerontology, Volume 39, Issue 9, 2004, 1423-1429.https://doi.org/10.1016/j.exger.2004.06.016. Online: https://www.sciencedirect.com/science/article/pii/S0531556504002141 and in PDF: https://shs.hal.science/halshs-00175541/file/2004%20POULAIN%20BZ%20EXP%20GERONT.pdf
Buettner, Dan. The Blue Zone: Lessons for Living Longer from the People Who've Lived the Longest. Washington: National Geographic Books, 2008.
Official “Blue Zones” website: https://www.bluezones.com/
Gensous, N., Garagnani, P., Santoro, A. et al. “One-year Mediterranean diet promotes epigenetic rejuvenation with country- and sex-specific effects: a pilot study from the NU-AGE project”. GeroScience 42, 2020, 687–701.https://doi.org/10.1007/s11357-019-00149-0. Online: https://link.springer.com/article/10.1007/s11357-019-00149-0
Angelo Campanella, Giovanni Misciagna, Antonella Mirizzi, Maria GabriellaCaruso, Caterina Bonfiglio, Laura R Aballay, Liciana Vas de Arruda Silveira, Antonella Bianco, Isabella Franco, Paolo Sorino, Claudia Buongiorno, Anna Maria Cisternino, Maria Notarnicola, Vito M B Guerra, Alberto R Osella. “The effect of the Mediterranean Diet on lifespan: a treatment-effect survival analysis of a population-based prospective cohort study in Southern Italy”. International Journal of Epidemiology, Volume 50, Issue 1, February 2021, 245–255.https://doi.org/10.1093/ije/dyaa222 Online: https://academic.oup.com/ije/article/50/1/245/5959821
Shannon, O.M., Ashor, A.W., Scialo, F. et al. “Mediterranean diet and the hallmarks of ageing”. European Journal of Clinical Nutrition 75,2021, 1176–1192. https://doi.org/10.1038/s41430-020-00841-x. Online: https://www.nature.com/articles/s41430-020-00841-x
Finicelli M, Di Salle A, Galderisi U, Peluso G. “The Mediterranean Diet: An Update of the Clinical Trials”. Nutrients. 2022 Jul 19; 14(14):2956. doi: 10.3390/nu14142956. PMID: 35889911; PMCID: PMC9317652. Online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9317652/
Andreo-López, Maria Carmen, Victoria Contreras-Bolívar, Manuel Muñoz-Torres, Beatriz García-Fontana, and Cristina García-Fontana. "Influence of the Mediterranean Diet on Healthy Aging". International Journal of Molecular Sciences, 24(5), 2023, 4491. https://doi.org/10.3390/ijms24054491. Online: https://www.mdpi.com/1422-0067/24/5/4491
Giovanni Mario Pes, Maria Pina Dore, Fotini Tsofliou, Michel Poulain. “Diet and longevity in the Blue Zones: A set-and-forget issue?”, Maturitas, Volume164, 2022, 31-37. https://doi.org/10.1016/j.maturitas.2022.06.004. Online: https://www.sciencedirect.com/science/article/pii/S0378512222001323
Colino, Stacey, „The Mediterranean diet has stood the test of time for a reason: It works”, National Geographic, 28.08.2023. Online: https://www.nationalgeographic.com/premium/article/mediterranean-diet-chronic-illness-longevity
Illustrations
Paul Deetman / pexels & epiAge
Tristan Le / pexels
Lisa Foti / pexels
Dana Tentis / pexels
Tim / pexels
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