Alla Salute: A Look At The Mediterranean Diet

June 7, 2013
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By Teresa Liccardi, M.D.

As summer approaches the warm nights bring to my mind memories of my Neapolitan immigrant grandmother who passed many years ago at 98 years of age.

Family and friends would congregate at her Bronx home on summer nights to chat and play. My grandmother was best known for her meals. Any time day or night if you said you were hungry instantly a spoonful of pasta in homemade sauce, or a mouthful of freshly sautéed vegetables was spoon-fed to you. Everything was cooked in olive oil – even her pound cakes. The scents and flavors are still clear in my memory.

I also remember my grandmother walking about our home and shaking her head disappointed in our landscaping. She would say, “In my old country every tree had a purpose. You could always find nuts, olives or fruit on the trees.”

Living in the Northeast climate may make it more difficult to have the similar fruit-bearing trees, but her point was well made. Our diets are not fresh and natural any longer. We depend on processed food and genetically altered food. Her mental sharpness, health, and longevity were attributable to a life of eating well.

There has been a lot of talk about different diets such as the DASH, Atkins, Flat Belly Diet, etc. But it is the Mediterranean diet that has received attention as a means of reducing cardiovascular risk at a population level. The Mediterranean diet consists of eating fresh fruits, vegetables, grains and fish but very little red meat and dairy products. It is rich in monounsaturated fats, omega-3 fatty acids and phytonutrients that act as antioxidants.

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As early as the 1950s Ancel Keys proposed that a diet based largely on plants had health benefits after observing that countries along the Mediterranean Sea had lower rates of chronic disease and higher life expectancies than other countries not explained by socioeconomic status or educational level.

The New England Journal of Medicine in April 2013 presented evidence from a study among Spanish researchers that demonstrated a 30 percent relative risk reduction in cardiovascular events in those at high risk for cardiovascular events when individuals consumed an energy (calorie) unrestricted Mediterranean diet supplemented with extra virgin olive oil (EVOO) – more than 4 tablespoons daily and mixed nuts – at least 1 ounce daily – among other foods.

New research from The University of Louisiana demonstrates that EVOO in the diet may also contribute to preventing Alzheimer’s disease. A study out of St. Louis University suggests EVOO may be linked to improved cognition and decreased memory loss.

The Mediterranean diet with EVOO appears to improve insulin metabolism, blood glucose and lipids and have a favorable effect on obesity and blood pressure.

EVOO is defined by a free fatty acid (FFA) content of less than 0.8 percent and a peroxide value of less than 20 milliequivalents per kilogram.

Pure, light olive oil and pomace olive oil are refined and flavor and nutrients are often stripped away. Olive oil over time loses its nutritional value, so it is important to check the harvest date and the best buy date for olive oils.

There are less expensive alternatives to supplement EVOO. Canola oil and tree nuts such as almond, walnuts and hazelnuts are also high in monounsaturated fats.

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Phytonutrients found in plants act as antioxidants. Antioxidants reduce free radical formation that leads to cell aging and cell death. The Sunday New York Times of May 26 presented an article about phytonutrients in various produce. Modern genetic engineering has deleted many of the phytonutrients in our produce. Dark colored salads and vegetables, including colored corns, not sweet white corn, and produce that is a little bitter like arugula are higher in phytonutrients.

When we embrace the Mediterranean diet, it is important to consider the quality of the food that we eat: What type of olive oil; what type of produce and grains; where and how were they were grown; and how fresh are these products?

One last memory I have with my grandmother is sitting after a Sunday meal and dipping crusty Italian bread into a glass of homemade red wine for our dessert; the Mediterranean diet includes red wine with meals as well.

If we sit back and enjoy healthy fresh food based on the Mediterranean diet, we may embrace a lifestyle rather than be consumed by the chore of dieting. Eating healthfully will bring about a better mindset for exercise and portion control rather than forcing a dictum of calorie counting and guilt upon ourselves. Primary prevention of cardiovascular disease may well start with a Mediterranean diet.

Alla Salute e Buon appetito!


Dr. Teresa Liccardi, who is board certified in internal medicine and nephrology, maintains a clinic for hypertension and chronic kidney disease at the Parker Family Health Center in Red Bank.

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