Mediterranean diet increases life span

Only problem now is to decide what is mediterranean diet... 🙂

Mirek

Wed, 22 Sep 2004 16:39:35 +0200 in article <[email hidden]>

Mirek Fidler said:

Only problem now is to decide what is mediterranean diet... 🙂

Not really. Many studies have developed a scoring system for measuring the
adherence to the Mediterranean diet. The details of the diet varies among
different Mediaterranean countries, but there are certain common factors.
The traditional diet of Crete is regarded as healthiest of all variations of
Mediterranean diets and therefore should perhaps be used as a general
guideline.

See for example

Pitsavos C, Panagiotakos DB, Chrysohoou C, Papaioannou I,
Papadimitriou L, Tousoulis D, Stefanadis C, Toutouzas P.
The Adoption of Mediterranean Diet Attenuates the Development of Acute
Coronary Syndromes in People with the Metabolic Syndrome.
Nutr J. 2003 Mar 19;2(1):1.
PMID: 12740043 [PubMed - as supplied by publisher]
<http://www.nutritionj.com/content/2/1/1>

An excerpt summarizinging the common features of Mediterranean diets:

"... The Mediterranean dietary pattern consists of:

(a) daily consumption: of non refined cereals and
products (whole grain bread, pasta, brown rice, etc),
vegetables (2 – 3 servings/day), fruits (6
servings/day), olive oil (as the main added lipid) and
dairy products (1 – 2 servings/day),

(b) weekly consumption: of fish (4–5
servings/week), poultry (3 – 4 servings/week), olives,
pulses, and nuts (3 servings/week), potatoes, eggs and
sweets (3 – 4 servings/week)

and

monthly consumption: of
red meat and meat products (4 – 5 servings/month). It is,
also, characterized by moderate consumption of wine (1 – 2
wineglasses/day) and high monounsaturated: saturated fat
ratio (> 2). This dietary pyramid was suggested by a
Harvard-led group with substantial input from Greek
scientists [13]. ..."

Evidence-based nutrition
Dimitrios TrichopoulosMD, Pagona Lagiou, and Antonia TrichopoulouMD
Asia Pacific Journal of Clinical Nutrition
Volume 9 Issue Suppl. Page S4 - October 2000
doi:10.1046/j.1440-6047.2000.00174.x>Vol. 9 Issue Suppl.
<URL:http://www.blackwell-synergy.com/links/doi/10.1046/j.1440-6047.2000.00174.x/full/>

"Overall, the traditional Mediterranean diet may be
thought of as having eight components:

(i) a high monounsaturated to saturated fat ratio;

(ii) moderate ethanol consumption;

(iii) high consumption of legumes;

(iv) high consumption of cereals (including bread);

(v) high consumption of fruits;

(vi) high consumption of vegetables;

(vii) low consumption of meat and meat products; and

(viii) moderate consumption of milk and dairy products."

[...]

Three studies have recently been published evaluating the role of the
Mediterranean diet as operationally defined through the eight
components discussed previously. The first of these studies was
conducted in Greece, 2 the second in Denmark 33 and the third in
Australia. 34 All have shown that the Mediterranean diet has
beneficial, substantial and statistically significant effects on
longevity."

Traditional Mediterranean (Greek & S.Italy) & Asian (Japan) Food Patterns of
the 1960's.
<URL:http://www.healthyeatingclub.com/info/articles/foodcult/mediterr-asia.htm>

"The Cretan diet was one of the highest fat diets in the study
(40% energy as fat, but low in saturated fat and high in
monounsaturated fat), but the Cretan Greeks eating it came out
with some of the lowest rates of CHD and all-cause mortality
and consequently had the longest life expectancies in the world
at that time. They were even living longer than mainland Greeks
and the Japanese.

[...]

The Cretan diet was also relatively low in carbohydrates (45%
energy) with most of the carbohydrates consumed being of low
glycaemic index. Even though the diet was high in fat, it
paradoxically had a low energy density because of the large
volume of plant foods consumed.

The Cretan diet in the 1960's consisted of a high intake of
vegetables (360g/day i.e. 2-3 cups/day), especially green leafy
types, high intakes of legumes (30g/day), nuts (30g/day), fruit
(460g/day i.e. 2-3 fruits /day) and wholegrain cereals
(450g/day i.e. 8 slices of bread/day).

Vegetables were used as an integral part of meals, not served
“on the side”. Breads were made by allowing dough to ferment
slowly, resulting in a lower glycaemic index. In contrast, many
breads we eat today use the rapid dough fermentation procedure
resulting in breads with a higher glycaemic index.

They also had moderate intakes of fish (40g/day), alcohol
(20g/day, with meals i.e. 2 standard drinks/day) and low
intakes of red/white meat (35g/day) and fermented sheep/goats
milk products (cheese/yoghurt consumed weekly). Unfermented
dairy products i.e. fresh sheep/goats milk was reserved for
children. The average daily intakes of some of these foods
converted to the real-life situation of weekly consumption,
would be: a 200g serving of fish twice a week, a 200g serving
of chicken/pork once a week, a serving of lamb once a week or
less, and bean/lentil soups or casseroles about 2-3 times a
week.

The Cretan diet was also low in animal fats (butter/margarine
rarely eaten) and saturated fat (8% energy), but high in total
fat (40% energy) and monounsaturated fat (25% energy) because
the major source of fat was olive oil (about 4
tablespoons/day), which was nearly always consumed as 'extra
virgin' or the first pressing of the olive and nearly always
consumed with plant food.

It was also high in omega-3 linolenic acid (probably about 1%
energy intake) due to the high intake of nuts (especially
walnuts), wild greens (especially purslane) and legumes.

Furthermore, animals (sheep, goats, pigs, chickens) were not
always fed on grains (which is relatively rich in n-6 fats),
but were also allowed to graze on wild plants and herbs,
resulting in fat deposits which were higher in n-3 fats. So the
little meat they ate tended to be leaner and the fat of these
animals was higher in n-3 fats and probably phytochemicals.

The diet also had a favourable n-6: n-3 ratio (<5:1) due to the
absence of polyunsaturated oils in the diet, the high intake of
olive oil and foods high in n-3 fatty acids (including fish).
In the 7 countries study, Cretan men had the lowest incidences
of CHD and cancer, followed by Japan. Even though the fat
content of the two diets was very different (40% vs. 10% total
energy respectively) both were rich in omega-3 fatty acids
(Simpoulos Prostaglandins, Leukotrienes & Ess Fatty Acids 1999;
60: 421-9). Cretan men were found to have 3-fold higher intakes
of n-3 linolenic compared with the cohort from the Netherlands
and 21% lower intakes of n-6 linoleic acid (Sandker et al. Eur
J Clin Nutr 1993; 47: 201-8).

[...]

Mediterranean diet and Survival in the Elderly in the 1990's.

Further evidence in support of the Mediterranean food pattern
of the 1960s has come from three prospective cohort studies
which described the food habits of people aged 70 and over in
Greece (Trichopoulou, Kouris-Blazos et al., BMJ 1995; 311
(7018): 1457-1460), Australia (Kouris-Blazos et al. Br J Nutr,
1999; 82: 57-61) and Denmark (Osler & Schroll, Int J Epidem
1997; 26 (1): 155-9). These cohorts were followed-up 5-6 years
later to ascertain survival status. The Australian study
included Greek-born and Anglo-Celtic born elderly living in
Melbourne.

Subjects with food patterns consistent with the food patterns
found in Greece in the 1960s had a reduced risk of death by
about 50%, even as late as 70 years and onwards. Smoking and
male gender were not significant predictors of mortality. The
food pattern was defined as follows:

1) high consumption of vegetables;
2) high consumption of legumes;
3) high consumption of fruits;
4) high consumption of cereals;
5) low consumption of dairy products;
6) low consumption of meat and meat products;
7) moderate ethanol consumption;
8) high monounsaturated: saturated fat ratio.

Subjects achieved greater mortality advantage if they followed
the entire food pattern, suggesting synergy between food
groups. To read the full text BMJ paper on the study in Greece
go to: http://www.bmj.com/cgi/content/full/311/7018/1457

Close Adherence to a Traditional Mediterranean Diet Promotes Longevity
Benefits of following the diet long-term appear to increase with age
<URL:http://www.hsph.harvard.edu/press/releases/press06252003.html>

"The traditional Mediterranean diet features an abundance of
vegetables, legumes, fruits, nuts and cereals and regular use
of olive oil (monounsaturated fats), moderate amounts of fish
and dairy products (mostly yogurt or cheese), small amounts of
red meat (low intake of saturated fats) and moderate
consumption of alcohol, usually in the form of wine and
consumed at meals."

Mediterranean Diet: More Than Olive Oil
'Divine Mix' Prevents Death From Cancer, Heart Disease
<URL:http://my.webmd.com/content/article/67/80070.htm>

"When the researchers looked at the individual components of
the Mediterranean diet, they found no significant decrease in
death with any one type of food.

In addition to having olive oil with most meals, the typical
Mediterranean diet is very high in vegetables, fruits, legumes,
nuts, and cereals; moderate in fish intake; and has lower
amounts of meat and dairy than the typical American diet.
Drinking alcohol is also a frequently practiced dining ritual.

"God knows what sorts of interactions take place within the
foods, and we need further research to pinpoint them exactly,"
Trichopoulos tells WebMD.

"But typically, people in Greece eat twice as many vegetables
as Americans -- nearly a pound a day. And you really can't eat
a pound of vegetables a day unless you have olive oil to make
them appetizing. My advice is to try to double the amount of
vegetables and fruits you currently have, and eat more fish,
legumes, and non-refined cereals."

While olive oil itself showed little benefit, the researchers
note a significant reduction in death rates from a higher
overall ratio of monounsaturated fats to saturated fats. Olive
oil is among the best sources of monounsaturated fats -- and
happens to be the main cooking oil in most Mediterranean
countries -- but other oils frequently consumed by Greeks and
others surrounding the Mediterranean Sea also contain these
healthy fats. "

Simopoulos AP.
The Mediterranean diets: What is so special about the diet of Greece?
The scientific evidence.
J Nutr. 2001 Nov;131(11 Suppl):3065S-73S. Review.
PMID: 11694649 [PubMed - indexed for MEDLINE]
<URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11694649&dopt=Abstract>

The Mediterranean Diet Pyramid
<URL:http://www.oldwayspt.org/pyramids/med/p_med.html>
<URL:http://www.e-guana.net/organizations.php3?orgid=61&typeID=193&action=printContentItem&itemID=1529>
<URL:http://www.diet-i.com/mediterranean-diet-pyramid.htm>

Mediterranean Diet Guidelines
<URL:http://www.diet-i.com/mediterranean-diet.htm>

Quantum - Mediterranean Diet Guidelines
<URL:http://www.abc.net.au/quantum/stories/meddiet.htm>

Essential Elements of the Mediterranean Diet
<URL:http://www.trincoll.edu/~jvillani/Ingredients.htm>

Cretan diet and food details. Diet and food of Crete island quality,
benefits and cretan food producers
<URL:http://greekproducts.com/greekproducts/cretan.html>

Crete | The Cretan Diet - Cretan cuisine & healthy food - by
CreteTravel.com
http://www.cretetravel.com/Cretan_Diet/Cretan_Diet_1.htm

The Mediterranean Diet
<URL:http://www.cheshire-med.com/services/dietary/nutrinew/mediter.html>

The Mediterranean Diet and Mortality — Olive Oil and Beyond
<URL:http://www.medical-journals.com/r03266b.htm>

Postgraduate Medicine: Understanding the Mediterranean diet
<URL:http://www.postgradmed.com/issues/2002/08_02/curtis.htm>

Quoted message said:

vegetables (2 - 3 servings/day), fruits (6
servings/day), olive oil (as the main added lipid) and
dairy products (1 - 2 servings/day),

And here problems arise - in the original article posted by markd, it is
specifically noted that " low in meat and dairy products ".

Now here it is 1-2 servings of dairy / day. Not quite a low.

Quoted message said:

"The Cretan diet was one of the highest fat diets in the study
(40% energy as fat, but low in saturated fat and high in

Well, now we have high fat diet 🙂

Quoted message said:

[...]

The Cretan diet was also relatively low in carbohydrates (45%
energy) with most of the carbohydrates consumed being of low

And low-carb. 🙂

Quoted message said:

They also had moderate intakes of fish (40g/day), alcohol
(20g/day, with meals i.e. 2 standard drinks/day) and low
intakes of red/white meat (35g/day) and fermented sheep/goats
milk products (cheese/yoghurt consumed weekly).

How it comes that previous list has 2 servings of dairy / day?

Quoted message said:

5) low consumption of dairy products;

Now I am really confused 🙂

Quoted message said:

of olive oil (monounsaturated fats), moderate amounts of fish
and dairy products (mostly yogurt or cheese), small amounts of

And once again moderate....

That said, I going to prepare my dinner:

2 tomatoes, 1 cucumber, 2 pepperoni, olives, mediterranean type "wet"
cheese and olive oil (quite a lot - I am on high fat diet in the end 🙂.
I call it "Greek salad" 🙂

Mirek

Wed, 22 Sep 2004 18:46:09 +0200 in article <[email hidden]>

Mirek Fidler said:

Quoted message said:

vegetables (2 - 3 servings/day), fruits (6
servings/day), olive oil (as the main added lipid) and
dairy products (1 - 2 servings/day),

And here problems arise - in the original article posted by markd, it is
specifically noted that " low in meat and dairy products ".

Now here it is 1-2 servings of dairy / day. Not quite a low.

Meat consumptions is _very_ low in the traditional Cretan diet, perhaps only
once month or so. The "general" Mediterranean diet pattern includes slightly
more meat. Dairy product intake was low to moderate, lower in Crete than
elsewhere. Only fermented dairy products (goat/sheep milk feta cheese and
yoghurt) were used in Crete, and the Greek ortodox tradition advised to
avoid even these every Wednesday and Friday throughout the year and during
religious fast periods.

Quoted message said:

Quoted message said:

"The Cretan diet was one of the highest fat diets in the study
(40% energy as fat, but low in saturated fat and high in

Well, now we have high fat diet 🙂

Nothing wrong with that if the fats are of right kind.

Quoted message said:

Quoted message said:

They also had moderate intakes of fish (40g/day), alcohol
(20g/day, with meals i.e. 2 standard drinks/day) and low
intakes of red/white meat (35g/day) and fermented sheep/goats
milk products (cheese/yoghurt consumed weekly).

How it comes that previous list has 2 servings of dairy / day?

1-2 servings. The first list described the general Mediterranean dietary
pattern and this list the traditional Cretan diet, which includes less dairy
products.

Quoted message said:

Quoted message said:

5) low consumption of dairy products;

Now I am really confused 🙂

This describes food patterns found in Greece in the 1960s of which the
traditional Cretan diet is the prime example. No reason to get confused, if
you just read the whole texts and place the described pattern in the right
context.

Quoted message said:

Quoted message said:

of olive oil (monounsaturated fats), moderate amounts of fish
and dairy products (mostly yogurt or cheese), small amounts of

And once again moderate....

This is Harvard's very brief and general summary of the traditional
Mediterranean diet. The traditional Cretan diet is slightly stricter with
dairy products.

To summarize, the traditional Cretan diet is slightly stricter with meat and
dairy products than the "general" Mediterranean food pattern, which
otherwise seems fairly consistently defined.

The Cretans also used a lot of local wild herbs.

Quoted message said:

That said, I going to prepare my dinner:

2 tomatoes, 1 cucumber, 2 pepperoni, olives, mediterranean type "wet"
cheese and olive oil (quite a lot - I am on high fat diet in the end 🙂.
I call it "Greek salad" 🙂

The "wet" cheese is feta cheese, preferably made of goat or sheep milk.
It is indeed called Greek salad everywhere.

When traditional Cretan diet is described, often the effects of Greek
orthodox fasting periods' effects are not discussed or even mentioned. Sarri
et al [1,2] have recently researched the effects of these periods. They
describe these fasts as follows [2]:

"Orthodox Christian holy books recommend a total of 180–200
days of fasting per year. The faithful are advised to avoid
olive oil, meat, fish, milk and dairy products every Wednesday
and Friday throughout the year. Additionally, there are three
principal fasting periods per year: i) a total of 40 days
preceding Christmas (meat, dairy products and eggs are not
allowed, while fish and olive oil are allowed except on
Wednesdays and Fridays), ii) a period of 48 days preceding
Easter (Lent). During Lent fish is allowed only two days
whereas meat, dairy products and eggs are not allowed. Olive
oil consumption is allowed only at weekends, iii) a total of 15
days in August (the Assumption) when the same dietary rules
apply as for Lent with the exception of fish consumption which
is allowed only on August 6th. Seafood such as shrimps, squid,
cuttlefish, octopus, lobsters, crabs as well as snails are
allowed on all fasting days throughout the year. The Greek
Orthodox fasting practices can therefore be characterized as
requiring a periodic vegetarian diet including fish and
seafood.

The variant of vegetarianism followed during fasting periods by
Orthodox Christians, with a diet of vegetables, legumes, nuts,
fruits, olives, bread, snails and seafood, is a type of the so-
called Mediterranean diet [15,16]. To date little is known as
to the effects of this 'hidden' element of the traditional
Orthodox Christian diet on health and no data exist on the
effect of Orthodox Christianity's dietary rules on blood lipid
levels and obesity. The objective of this study was therefore
to assess the effects of intermittent short-term religious
fasting, according to the dietary rules of the Orthodox
Christian Church, on blood lipoprotein profile and the
prevalence of obesity."

During the fasts LDL, BMI and intake of energy and calcium are statistically
significantly reduced, and intake of fiber and folate are statistically
significantly increased.

References:

1: Sarri KO, Linardakis MK, Bervanaki FN, Tzanakis NE, Kafatos AG.
Greek Orthodox fasting rituals: a hidden characteristic of the Mediterranean
diet of Crete.
Br J Nutr. 2004 Aug;92(2):277-84.
PMID: 15333159 [PubMed - in process]
<URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15333159>

2: Sarri KO, Tzanakis NE, Linardakis MK, Mamalakis GD, Kafatos AG.
Effects of Greek Orthodox Christian Church fasting on serum lipids and
obesity.
BMC Public Health. 2003 May 16;3(1):16.
PMID: 12753698 [PubMed - indexed for MEDLINE]
<URL:http://www.biomedcentral.com/1471-2458/3/16>
<URL:http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=12753698>

--
Matti Narkia

Matti Narkia said:

Wed, 22 Sep 2004 18:46:09 +0200 in article <[email hidden]>
"Mirek Fidler" <[email hidden]> wrote:
The Cretans also used a lot of local wild herbs.

And they also eat snails, which eat these herbs. These herbs have been
tested as part of a margarine in a study in France on CHD and
cholesterol. They have shown quite significant improvements in the lipid
profiles. Interrestingly enough, the manufacturer of the margarine
decline to market it, and preferred to push it's "high" omega-3
sunflower margarine instead...
The problem when you study a diet like this is missing "tiny" details
like these herbs. It would be like studying the American diet, and
coming with the conclusion that it is good for cholesterol levels (it
is, cholesterol levels are lower in the USA than in France). Of course,
that study would have forgotten tiny facts, like an increasing number of
Americans being on statins or other anti-cholesterol drugs, which are a
rarity in France.
The mediterrannean diet has an history of being distorted to match the
point of view of the author. It used to be sold (in France) as a low fat
diet for instance, which it certainly isn't.

Quoted message said:

Quoted message said:

That said, I going to prepare my dinner:

2 tomatoes, 1 cucumber, 2 pepperoni, olives, mediterranean type "wet"
cheese and olive oil (quite a lot - I am on high fat diet in the end 🙂.
I call it "Greek salad" 🙂

The "wet" cheese is feta cheese, preferably made of goat or sheep milk.
It is indeed called Greek salad everywhere.

Add some onion, some lemon juice and it's a great summer salad. 🙂 Eat
with some Italian ham, and you have a whole meal...

Quoted message said:

Meat consumptions is _very_ low in the traditional Cretan diet,

perhaps only

Quoted message said:

once month or so. The "general" Mediterranean diet pattern includes

slightly

Quoted message said:

more meat. Dairy product intake was low to moderate, lower in Crete

than

Quoted message said:

elsewhere. Only fermented dairy products (goat/sheep milk feta cheese

and

Quoted message said:

yoghurt) were used in Crete, and the Greek ortodox tradition advised

to

Quoted message said:

avoid even these every Wednesday and Friday throughout the year and

during

Quoted message said:

religious fast periods.

Well, Matti, but that is why my original complaint about m. diet was
that it is a little bit hard to determine exactly what m. diet is.

In any case, there are some important lessons that are probably correct:

a) a lot of veggies and fruits
b) a lot of olive oil
c) relatively low carbs and relatively high fat
d) fish

Quoted message said:

Quoted message said:

Well, now we have high fat diet 🙂

Nothing wrong with that if the fats are of right kind.

Yes!

Quoted message said:

Quoted message said:

Quoted message said:

5) low consumption of dairy products;

Now I am really confused 🙂

This describes food patterns found in Greece in the 1960s of which the
traditional Cretan diet is the prime example. No reason to get

confused, if

Quoted message said:

you just read the whole texts and place the described pattern in the

right

Quoted message said:

context.

Well, I was making a bit of fun. What I wanted to point out that m. diet
is VERY often used as buzzword to promote very different nutritional
approaches. E.g. it is sometimes even described as low-fat, high carb
diet, which seems to be absolute nonsense - even if it is true that
mediterranean covers pretty big area with very different lifestyles, so
that Italian diet is probably thousands light years different from
Greece.

Anyway, it is true that above 4 points are shared, esp. compared to
traditional USA diet.

Quoted message said:

To summarize, the traditional Cretan diet is slightly stricter with

meat and

Quoted message said:

dairy products than the "general" Mediterranean food pattern, which
otherwise seems fairly consistently defined.

I am afraid it is not....

Quoted message said:

Quoted message said:

2 tomatoes, 1 cucumber, 2 pepperoni, olives, mediterranean type "wet"
cheese and olive oil (quite a lot - I am on high fat diet in the end

🙂.

Quoted message said:

Quoted message said:

I call it "Greek salad" 🙂

The "wet" cheese is feta cheese, preferably made of goat or sheep

milk.

Quoted message said:

It is indeed called Greek salad everywhere.

I know what real feta is, but I called my version "wet" m. type, because
unfotunatly real feta is not easily available....

Anyway, our local (and not so expensive) version tastes very good too
(when mixed with other ingredients).

Quoted message said:

When traditional Cretan diet is described, often the effects of Greek
orthodox fasting periods' effects are not discussed or even mentioned.

Sarri

Quoted message said:

et al [1,2] have recently researched the effects of these periods.

They

Quoted message said:

describe these fasts as follows [2]:

Very good point. One should also take into account general climate in
the area. These things are often being forgotten by experts trying to
explain everything by diet composiion.

Quoted message said:

is allowed only on August 6th. Seafood such as shrimps, squid,
cuttlefish, octopus, lobsters, crabs as well as snails are
allowed on all fasting days throughout the year.

Seems fish consumption might have been even higher than suggested...

Quoted message said:

The Greek
Orthodox fasting practices can therefore be characterized as
requiring a periodic vegetarian diet including fish and
seafood.

What nonsense is this? "Vegetarian diet including fish and seafood" ?!

Quoted message said:

fruits, olives, bread, snails and seafood, is a type of the so-

Snails ? 🙂 Do they have the right kinds of fats? 🙂

Mirek

Wed, 22 Sep 2004 20:40:29 +0200 in article <[email hidden]>

Mirek Fidler said:

Quoted message said:

To summarize, the traditional Cretan diet is slightly stricter with meat and
dairy products than the "general" Mediterranean food pattern, which
otherwise seems fairly consistently defined.

Quoted message said:

I am afraid it is not....

IMHO it is, at least in studies about Mediterranean diet. But these are
usually based either on the traditional Greek Mediterranean diet or
especially on the traditional Cretan Mediterranean diet.

Other public descriptions may vary. But even in them there is a pattern
which clearly distinguishes Mediterranean diet for example from a typical
American, Eastern European, English, German or Japanese diet.

Quoted message said:

Snails ? 🙂 Do they have the right kinds of fats? 🙂

Yep, omega-3, especially alpha-linolenic acid. At least in Crete :-).

--
Matti Narkia

Wed, 22 Sep 2004 22:17:32 +0300 in article
<[email hidden]> Matti Narkia

Quoted message said:

Quoted message said:

Yep, omega-3, especially alpha-linolenic acid. At least in Crete :-).

The last sentence may be significant. Most land snails eat plants and other
vegetation, and some wild weeds and herbs in Crete, especially purslane,
have high alpha-linolenic acid content.

--
Matti Narkia

Wed, 22 Sep 2004 20:40:29 +0200 in article <[email hidden]>

Mirek Fidler said:

Very good point. One should also take into account general climate in
the area. These things are often being forgotten by experts trying to
explain everything by diet composiion.

Yes. Still it has been demonstrated in some studies that many of the health
benefits of the traditional Cretan diet are transferrable to other
populations and climates by following the main principles of the diet.
See the references in the end of this message.

Quoted message said:

Quoted message said:

The Greek
Orthodox fasting practices can therefore be characterized as
requiring a periodic vegetarian diet including fish and
seafood.

What nonsense is this? "Vegetarian diet including fish and seafood" ?!

Well, perhaps a bit bad formulation of something like "a basically
vegetarian diet plus some fish and seafood". The authors are Greek, perhaps
they should have used a professional translator :-).

References

1: Kouris-Blazos A, Gnardellis C, Wahlqvist ML, Trichopoulos D, Lukito
W, Trichopoulou A.
Are the advantages of the Mediterranean diet transferable to other
populations?
A cohort study in Melbourne, Australia.
Br J Nutr. 1999 Jul;82(1):57-61.
PMID: 10655957 [PubMed - indexed for MEDLINE]
<URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10655957&dopt=Abstract>

"A prospective cohort study, involving 141 Anglo-Celts and 189
Greek-Australians of both sexes aged 70 years or more, was
undertaken in Melbourne, Australia. The objective was to
evaluate whether adherence to the principles of the
Mediterranean diet affects survival of elderly people in
developed non-Mediterranean countries. Diet was assessed using
an extensive validated questionnaire on food intake. A one unit
increase in a diet score, devised a priori on the basis of
eight key features of the traditional common diet in the
Mediterranean region, was associated with a 17% reduction in
overall mortality (two-tailed P value 0.07). Mortality
reduction with increasing diet score was at least as evident
among Anglo-Celts as among Greek-Australians. We conclude that
a diet that adheres to the principles of the traditional
Mediterranean diet is associated with longer survival among
Australians of either Greek or Anglo-Celtic origin."

2: Singh RB, Dubnov G, Niaz MA, Ghosh S, Singh R, Rastogi SS, Manor O, Pella
D, Berry EM.
Effect of an Indo-Mediterranean diet on progression of coronary artery
disease in high risk patients (Indo-Mediterranean Diet Heart Study): a
randomised single-blind trial.
Lancet. 2002 Nov 9;360(9344):1455-61
<URL:http://www.thelancet.com/journal/vol360/iss9344/full/llan.360.9344.original_research.23027.1>

3: de Lorgeril M, Renaud S, Mamelle N, Salen P, Martin JL, Monjaud I,
Guidollet J, Touboul P, Delaye J.
Mediterranean alpha-linolenic acid-rich diet in secondary prevention of
coronary heart disease.
Lancet. 1994 Jun 11;343(8911):1454-9. Erratum in: Lancet 1995 Mar
18;345(8951):738.
PMID: 7911176 [PubMed - indexed for MEDLINE]
<URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7911176&dopt=Abstract>

4: Renaud S, de Lorgeril M, Delaye J, Guidollet J, Jacquard F, Mamelle
N, Martin JL, Monjaud I, Salen P, Toubol P.
Cretan Mediterranean diet for prevention of coronary heart disease.
Am J Clin Nutr. 1995 Jun;61(6 Suppl):1360S-1367S.
PMID: 7754988 [PubMed - indexed for MEDLINE]
<URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7754988&dopt=Abstract>

5: De Lorgeril M, Salen P, Martin JL, Mamelle N, Monjaud I, Touboul P,
Delaye J.
Effect of a mediterranean type of diet on the rate of cardiovascular
complications in patients with coronary artery disease. Insights into the
cardioprotective effect of certain nutriments.
J Am Coll Cardiol. 1996 Nov 1;28(5):1103-8.
<URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8890801&dopt=Abstract>

6: de Lorgeril M, Salen P, Martin JL, Monjaud I, Boucher P, Mamelle N.
Mediterranean dietary pattern in a randomized trial: prolonged survival
and possible reduced cancer rate.
Arch Intern Med. 1998 Jun 8;158(11):1181-7.
<URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9625397&dopt=Abstract>

7: de Lorgeril M, Salen P, Martin J-L, Monjaud I, Delaye J, Mamelle N:
Mediterranean diet, traditional risk factors and the rate of
cardiovascular complications after myocardial infarction. Final report of
the Lyon Diet Heart Study.
Circulation 1999, February 16, 99:779-785
<URL:http://circ.ahajournals.org/cgi/content/full/99/6/779>

8: Leaf A.
Dietary prevention of coronary heart disease: the Lyon Diet Heart Study.
Circulation. 1999 Feb 16;99(6):733-5.
<URL:http://circ.ahajournals.org/cgi/content/full/99/6/733>

9: Serge Renaud: from French paradox to Cretan miracle.
Lancet 2000; 355: 48 - 52.
<URL:http://www.thelancet.com/journal/vol355/iss9197/full/llan.355.9197.news.2419.1>

--
Matti Narkia

Matti Narkia said:

Wed, 22 Sep 2004 20:40:29 +0200 in article

<[email hidden]>

Quoted message said:

Mirek Fidler said:

Very good point. One should also take into account general climate

in

Quoted message said:

Quoted message said:

the area. These things are often being forgotten by experts trying

to

Quoted message said:

Quoted message said:

explain everything by diet composiion.

Yes. Still it has been demonstrated in some studies that many of the

health

Quoted message said:

benefits of the traditional Cretan diet are transferrable to other
populations and climates by following the main principles of the

diet.

Quoted message said:

See the references in the end of this message.

I agree that Cretan diet seems to be transferrable to areas as well.
Still I would like to add that Cretans live very close to nature. I
remember reading that the longest lived people where farmers. I suppose
that they spent a lot of time outdoors in the nature. That might have
some health benefit also which is not accountable to the diet.

Jan

22 Sep 2004 13:19:13 -0700 in article
<[email hidden]> "Jan"

Quoted message said:

I agree that Cretan diet seems to be transferrable to areas as well.
Still I would like to add that Cretans live very close to nature. I
remember reading that the longest lived people where farmers. I suppose
that they spent a lot of time outdoors in the nature. That might have
some health benefit also which is not accountable to the diet.

Walking probably was an important factor. According to some sources in 1960s
and earlier Cretans walked in average about 13 kms in their daily duties.

--
Matti Narkia

"Mirek Fidler" <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

Only problem now is to decide what is mediterranean diet... 🙂

Mirek

Yeah, they seem to think that it is low in animal proteins and fats.
I'm not sure that that is accurate.

TC

22 Sep 2004 13:53:12 -0700 in article
<[email hidden]> [email hidden]

(tcomeau) said:

"Mirek Fidler" <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

Only problem now is to decide what is mediterranean diet... 🙂

Mirek

Yeah, they seem to think that it is low in animal proteins and fats.
I'm not sure that that is accurate.

Who are these "they" and where are they hiding? Certainly I haven't heard of
"them". Mediterranean diet is _not_ low in fat. It's moderate to high fat
diet. Most of the fat consists of monounsaturated fatty acids from olive
oil. Omega-6:omega-3 ratio is very good especially in the traditional Cretan
diet. In addition to EPA and DHA from fish and other seafood, the
traditional Cretan diet contained a lot of alpha-linolenic acid, mainly from
snails and wild plants like purslane. The main sources of animal protein in
the traditional Cretan diet were fish and other seafood, dairy products and
eggs. Perhaps some poultry. Vegetable sources of protein such as beans and
other legumes, nuts and whole meal grain products were used in larger
quantity than animals sources of protein. Red meat was rarely consumed,
perhaps once in a month. Even then it was meat of goats and sheep, which had
been eating wild grass and plants with relatively high omega-3 content.
Therefore the fatty acid profile of the meat consumed deviated greatly from
the meat of grain fed animals.

--
Matti Narkia

Wed, 22 Sep 2004 18:46:09 +0200 in article <[email hidden]>

Mirek Fidler said:

Quoted message said:

The Cretan diet was also relatively low in carbohydrates (45%
energy) with most of the carbohydrates consumed being of low

And low-carb. 🙂

I'm not sure if the Cretan diet can be described as a low carb diet. Perhaps
moderate carb, but definitely low glycemic index and low glycemic load.

--
Matti Narkia

Wed, 22 Sep 2004 20:31:51 +0200 in article
<[email hidden]> Lictor

Quoted message said:

Matti Narkia said:

Wed, 22 Sep 2004 18:46:09 +0200 in article <[email hidden]>
"Mirek Fidler" <[email hidden]> wrote:
The Cretans also used a lot of local wild herbs.

And they also eat snails, which eat these herbs. These herbs have been
tested as part of a margarine in a study in France on CHD and
cholesterol. They have shown quite significant improvements in the lipid
profiles. Interrestingly enough, the manufacturer of the margarine
decline to market it, and preferred to push it's "high" omega-3
sunflower margarine instead...

Yep, in the Lyon Diet Heart Study. More about it in

Serge Renaud: from French paradox to Cretan miracle.
Lancet 2000; 355: 48 - 52.
<URL:http://www.thelancet.com/journal/vol355/iss9197/full/llan.355.9197.news.2419.1>

de Lorgeril M, Renaud S, Mamelle N, Salen P, Martin JL, Monjaud I,
Guidollet J, Touboul P, Delaye J.
Mediterranean alpha-linolenic acid-rich diet in secondary prevention of
coronary heart disease.
Lancet. 1994 Jun 11;343(8911):1454-9. Erratum in: Lancet 1995 Mar
18;345(8951):738.
PMID: 7911176 [PubMed - indexed for MEDLINE]
<URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7911176&dopt=Abstract>

Renaud S, de Lorgeril M, Delaye J, Guidollet J, Jacquard F, Mamelle
N, Martin JL, Monjaud I, Salen P, Toubol P.
Cretan Mediterranean diet for prevention of coronary heart disease.
Am J Clin Nutr. 1995 Jun;61(6 Suppl):1360S-1367S.
PMID: 7754988 [PubMed - indexed for MEDLINE]
<URL:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7754988&dopt=Abstract>

de Lorgeril M, Salen P, Martin J-L, Monjaud I, Delaye J, Mamelle N:
Mediterranean diet, traditional risk factors and the rate of
cardiovascular complications after myocardial infarction. Final report of
the Lyon Diet Heart Study.
Circulation 1999, February 16, 99:779-785
<URL:http://circ.ahajournals.org/cgi/content/full/99/6/779>

Leaf A.
Dietary prevention of coronary heart disease: the Lyon Diet Heart Study.
Circulation. 1999 Feb 16;99(6):733-5.
<URL:http://circ.ahajournals.org/cgi/content/full/99/6/733>

--
Matti Narkia

22 Sep 2004 13:37:33 GMT in article

Quoted message said:

Here is another news article how this diet increases by 50 percent life
span in the elderly:

http://www.eurekalert.org/pub_releases/2004-09/jaaj-mda091604.php

This study is

Mediterranean Diet, Lifestyle Factors, and 10-Year Mortality in Elderly
European Men and Women.
The HALE Project.
Kim T. B. Knoops, MSc; Lisette C. P. G. M. de Groot, PhD; Daan Kromhout,
PhD; Anne-Elisabeth Perrin, MD, MSc; Olga Moreiras-Varela, PhD; Alessandro
Menotti, MD, PhD; Wija A. van Staveren, PhD
JAMA, September 22/29, 2004; 292:1433-1439.
<URL:http://jama.ama-assn.org/cgi/content/full/292/12/1433>

The full text is freely available on-line.

In the same issue of JAMA there is also another study about Mediterranean
diet:

Effect of a Mediterranean-Style Diet on Endothelial Dysfunction and Markers
of Vascular Inflammation in the Metabolic Syndrome.
A Randomized Trial.
Katherine Esposito, MD; Raffaele Marfella, MD, PhD; Miryam Ciotola, MD;
Carmen Di Palo, MD; Francesco Giugliano, MD; Giovanni Giugliano, MD; Massimo
D'Armiento, MD; Francesco D'Andrea, MD; Dario Giugliano, MD, PhD
JAMA, September 22/29, 2004; 292:1440-1446.
<URL:http://jama.ama-assn.org/cgi/content/short/292/12/1440>

--
Matti Narkia

Matti Narkia said:

Wed, 22 Sep 2004 16:39:35 +0200 in article

<[email hidden]>

Quoted message said:

Mirek Fidler said:

Only problem now is to decide what is mediterranean diet... 🙂

Not really. Many studies have developed a scoring system for

measuring the

Quoted message said:

adherence to the Mediterranean diet. The details of the diet varies

among

Quoted message said:

different Mediaterranean countries, but there are certain common

factors.

Quoted message said:

The traditional diet of Crete is regarded as healthiest of all

variations of

Quoted message said:

Mediterranean diets and therefore should perhaps be used as a general
guideline.

See for example

Nobody has mentioned the use of honey in the traditional Cretan diet.
Perhaps we tend to think that it is not so essential part of a healthy
diet, but I think that if we are to learn about the Cretan diet we
should have an open and unbiased look at it. Honey is definitely a part
of traditional Mediterranean and Cretan diet. Already the Roman
Vergilius (70-19 B.C.) praised bees and honey in his Georgica.
Especially Cretan thyme honey is a traditional sweetener consumed with
joghurt. Also pastries are made with honey. Both honey and thyme are
antimicrobial and honey promotes the growth of healthy bifido-bacteria
in the gut.

http://www.crete.tournet.gr/cuisine-en.jsp

http://www.crete-today.com/honey/about.htm

BTW, I am aware of the high glycemic index of honey. I am not
suggesting its use in massive amounts.

Jan

Matti Narkia said:

Walking probably was an important factor. According to some sources in 1960s
and earlier Cretans walked in average about 13 kms in their daily duties.

Where the average American (with the exception of NYC) walks 500m a
day... That's certainly a huge difference! When you see studies
establish that even a mere 30 minutes of walking a day is enough to
reduce risks for several diseases (CHD, diabete), 13km is *huge*.
Another factor is the overall stress level. The whole mediterrannea area
has a whole different approach towards work than the USA for instance.
French people often get laugh at for being always on hollydays or "RTT",
but that's also typical of the overall lifestyle of the area. Life
goes beyond what you do in the office, and your job is only a way to
earn enough money to enjoy life outside of it. This reduces the need to
"perform", and as a result the overall stress level. Moderate alcohol
consumption also helps. Stress has been recognized as a major risk
factor in many diseases, at least on the same level as diet.
The diet itself does not explain everything...

Wed, 22 Sep 2004 18:42:12 +0300 in article
<[email hidden]> Matti Narkia

Quoted message said:

Wed, 22 Sep 2004 16:39:35 +0200 in article <[email hidden]>

Mirek Fidler said:

Only problem now is to decide what is mediterranean diet... 🙂

Not really. Many studies have developed a scoring system for measuring the
adherence to the Mediterranean diet. The details of the diet varies among
different Mediaterranean countries, but there are certain common factors.
The traditional diet of Crete is regarded as healthiest of all variations of
Mediterranean diets and therefore should perhaps be used as a general
guideline.

The scoring system used in the subject study

Mediterranean Diet, Lifestyle Factors, and 10-Year Mortality in
Elderly European Men and Women.
The HALE Project.
Kim T. B. Knoops, MSc; Lisette C. P. G. M. de Groot, PhD; Daan
Kromhout, PhD; Anne-Elisabeth Perrin, MD, MSc; Olga Moreiras-
Varela, PhD; Alessandro Menotti, MD, PhD; Wija A. van Staveren,
PhD
JAMA, September 22/29, 2004; 292:1433-1439.
<URL:http://jama.ama-assn.org/cgi/content/full/292/12/1433>

is described there as follows:

"To assess the association of diet and the lifestyle factors
with mortality, a low-risk group was defined for diet and
lifestyle factors. For dietary intake, the low-risk group
was defined as those who had a score of at least 4 on a
modified version of the Mediterranean diet score proposed by
Trichopoulou et al.4

The modified Mediterranean diet score comprised 8
components: ratio of monounsaturated to saturated fat;
legumes, nuts, and seeds; grains; fruit; vegetables and
potatoes; meat and meat products; dairy products; and fish.
Intake of each component was adjusted to daily intakes of
2500 kcal (10.5 MJ) for men and 2000 kcal (8.5 MJ) for
women. The sex-specific median intake values were taken as
cutoff points. The diet score varied from 0 (low-quality
diet) to 8 (high-quality diet). For the components
monounsaturated fatty acids to saturated fatty acids (MUFA
to SAFA) ratio; fruits and fruit products; vegetables and
potatoes; legumes, nuts, and seeds; fish; and grains, a
value of 1 was assigned to persons whose consumption was at
least as high as the sex-specific median value, and 0 to the
others. The vegetables group of the original Mediterranean
diet score was replaced by the vegetables and potatoes group
because the European classification system (EUROCODE) was
used when the 2 food groups were assessed together.16 For
meat and meat products and dairy products, a value of 1 was
assigned to persons whose consumption was less than the sex-
specific median and 0 to the others.

The low-risk group for alcohol was defined as those who
consumed more than 0 g of alcohol per day. Alcohol
consumption was initially divided into 3 groups: 0 g, 1 to
29 g, and 30 g or more of alcohol per day. However, the
Kaplan-Meier survival curves of the 3 alcohol groups showed
no difference in survival between participants who consumed
between 1 g to 29 g of alcohol per day and those who
consumed 30 g or more alcohol per day.

For smoking, individuals were considered to be at low risk
if they had never smoked or had stopped smoking more than 15
years ago.17-19

Individuals with a score in the intermediate and the highest
tertile on the Voorrips or Morris questionnaire were
considered the low-risk group for physical activity.14-15

A lifestyle score was calculated by adding the individual
scores for diet, physical activity level, smoking status,
and alcohol intake. Individuals scored 1 point if they
belonged to the low-risk group for diet or a particular
lifestyle factor and 0 if they belonged to the high-risk
group. In total, an individual could obtain 4 points: 1
point for a Mediterranean diet and 3 points for the
healthful lifestyle factors."

Te above cited "the Mediterranean diet score proposed by Trichopoulou et
al.4" is described in the study

Trichopoulou A, Costacou T, Bamia C, Trichopoulos D.
Adherence to a Mediterranean diet and survival in a Greek population.
N Engl J Med. 2003 Jun 26;348(26):2599-608.
PMID: 12826634 [PubMed - indexed for MEDLINE]
<URL:http://content.nejm.org/cgi/content/full/348/26/2599?ijkey=954de3729cd4bf6a762b30acdf92d99b1f97f246>

as follows:

"A scale indicating the degree of adherence to the
traditional Mediterranean diet was constructed by
Trichopoulou et al.6 and revised to include fish intake.35 A
value of 0 or 1 was assigned to each of nine indicated
components with the use of the sex- specific median as the
cutoff. For beneficial components (vegetables, legumes,
fruits and nuts, cereal, and fish), persons whose
consumption was below the median were assigned a value of 0,
and persons whose consumption was at or above the median
were assigned a value of 1. For components presumed to be
detrimental (meat, poultry, and dairy products, which are
rarely nonfat or low-fat in Greece), persons whose
consumption was below the median were assigned a value of 1,
and persons whose consumption was at or above the median
were assigned a value of 0. For ethanol, a value of 1 was
assigned to men who consumed between 10 and 50 g per day and
to women who consumed between 5 and 25 g per day. Finally,
for fat intake, we used the ratio of monounsaturated lipids
to saturated lipids, rather than the ratio of
polyunsaturated to saturated lipids, because in Greece,
monounsaturated lipids are used in much higher quantities
than polyunsaturated lipids. Thus, the total Mediterranean-
diet score ranged from 0 (minimal adherence to the
traditional Mediterranean diet) to 9 (maximal adherence)."

"A scale indicating the degree of adherence to thetraditional Mediterranean
diet was constructed by Trichopoulou et al.6" in the above excerpt refers to
the study

Trichopoulou A, Kouris-Blazos A, Wahlqvist ML, Gnardellis C,
Lagiou P, Polychronopoulos E, Vassilakou T, Lipworth L,
Trichopoulos D.
Diet and overall survival in elderly people.
BMJ. 1995 Dec 2;311(7018):1457-60.
PMID: 8520331 [PubMed - indexed for MEDLINE]
<URL:http://bmj.bmjjournals.com/cgi/content/full/311/7018/1457>

An excerpt from there:

"For analysis the frequency of consumption of different food
items was quantified approximately in terms of the number of
times a month the food was consumed, as done by Graham et
al4 and Katsouyanni et al.5 Thus, daily consumption was
multiplied by 30 and weekly consumption by 4, a value of 0
was assigned to food items rarely or never consumed. Food
items were considered in groups as recommended by Davidson
and Passmore6 and used by Graham et al,4 Dales et al,7 and
Trichopoulou et al.8 Food frequencies were translated into
food quantities in grams per day on the basis of standard
portion size estimations, and they were further adjusted to
daily intakes of 2500 kcal for men and 2000 kcal for women.
Nutrient intakes for individual people were estimated by
multiplying the nutrient contents of a selected typical
portion for each specified food item by the frequency that
the food item was eaten a month and adding these estimates
for all food items. Data on the nutrient composition of
Greek foods and recipes were based on a nutrient database
developed in Greece by the department of nutrition and
biochemistry, National School of Public Health.9 The
estimation of portion size was based on the results from
previous validation studies.3 10 11

Composite scores are often used to describe total diet;
these scores are necessary for the evaluation of
epidemiological associations,11 12 although they require
some operational definitions. We used the food groups
recommended by Davidson and Passmore6 in devising a score
except that we combined starchy roots with cereals and did
not consider sugars and syrups for which no systemic health
implications have been documented over and beyond their
contribution to net energy intake. The traditional
Mediterranean diet is also defined in terms of these food
groups with the addition of moderate intake of ethanol13 14
and therefore can be reasonably scored in terms of eight
component characteristics: high monounsaturated:saturated
fat ratio; moderate ethanol consumption (there were no men
who drank more than seven glasses of wine a day and no women
who drank more than two glasses of wine a day so that no
study subject could be considered a heavy drinker); high
consumption of legumes; high consumption of cereals
(including bread and potatoes); high consumption of fruits;
high consumption of vegetables; low consumption of meat and
meat products; and low consumption of milk and dairy
products. We used as a cut off point for all characteristics
the corresponding median values specific for each sex. We a
priori hypothesised that a diet with more of these
components has beneficial health effects whereas a diet with
fewer of these components would be less healthy. These
considerations are based on the collective epidemiological
and biological evidence as summarised in the report of the
National Academy of Science1 and a recent critical
overview.15 In our study sample only 34 subjects (or 19% of
the total) were found to have two or fewer of the eight
desirable dietary components, whereas 104 subjects (57%)
were found to have four or more of the eight desirable
components, a reasonable pattern given the attachment of
elderly rural Greeks to their traditional diet.

The statistical analysis was undertaken by modelling the
data through Cox's proportional hazards regression.16 This
approach takes into account not only the event of death but
also the time until its occurrence. An assumption in the
model is that the rate ratio is constant over follow up
time. Initially, eight Cox's models were developed; these
controlled for age at enrolment (in three month intervals),
sex (0=female, 1=male), and current smoking status (0=non-
smoker, 1=smoker) and evaluated alternatively the eight
individual components of the diet score adjusted for energy.
An additional Cox's model was developed that controlled for
age at enrolment, sex, and current smoking status and
evaluated the total diet score as a predictor of the hazard
of death. Survival curves were plotted by using the Kaplan-
Meier method."

--
Matti Narkia