Published on March 5, 2014
The “MODMED” Diet Based on the traditional Mediterranean diet, this presentation is where the “MODMED” diet was conceived Albert Zumbé & Adam Lee © Natraceutical UK 1st of March 2004 For more information: Info@natrauk.com
The Modern Mediterranean Diet A diet for people on the move….. Albert Zumbé & Adam Lee Natraceutical S.A. May 2004 Autovia A-3. Salida 343 Cami de Torrent, s/n 46930 Quart de Poblet Valencia, Spain
Fact: the importance of nutrition Nutrition is a recognised key health determinant1 Poor diets are directly related to the increasing burden of chronic diseases in Western populations, notably: Cardiovascular disease Obesity & its co-morbidities (diabetes) Various cancers Osteoporosis 1 Kafatos (2003) EGEA, International Conference on Health Benefits of the Mediterranean Diet
The North American/Western Diet The typical North American/Western diet is characterised by2,3,4,5 High intakes Low intakes Sugars Fresh fruits Refined carbohydrate Fresh vegetables Saturated fats Dietary fibre Red meat Some micronutrients Frazao & Allshouse (2003) J. Nutr. 133: 844S-847S Kantor (1998) USDA Report No. 772 4 ERS (2002) www.ers.usda.gov/data/foodconsumption 5 Howarth et al (2001) Nutr. Rev. 59: 129-139 2 3
Recommended and actual daily dietary intake in the US3 Recommended intake Actual intake Fats, oils, sweets Use sparingly 34 tsp. added sugars & 64 g added fats Meat, poultry, fish, beans, eggs, nuts 2 – 3 servings 2 – 5 servings Fruit 2 – 4 servings 1.4 servings Vegetables 3 – 5 servings 4 servings 3 Kantor (1998) USDA Report No. 772
“America has become the land of the obese6” Obesity has become pandemic in the United States: 61% of Americans >20 years are overweight or obese7 At least 25% of Americans are clinically obese7 24% of the population has metabolic syndrome8 Obesity leads to 300,000 premature deaths every year9 Obesity costs $90 billion in direct health care costs annually in the USA alone9 Moore (2003) Cleve. Clin. J. Med. 70: 237-240 Montague (2003) ABNF J. 14: 56-60 8 Bray & Champagne (2004) J. Am. Diet. Assoc. 104: 86-89 9 Manson et al (2004) Arch. Intern. Med. 164: 249-258 6 7
The consequences of obesity and physical inactivity “Modern times may be characterised as a ‘feast’ environment, the consequences being an increase in risk for several diseases”10 Cardiovascular disease11 Hypertension12 Type 2 diabetes12 Insulin resistance12 Cancer13 Wargovioch & Cunningham (2003) J. Nutr. 133: 2400S-2403S Dubbert et al (2002) Am. J. Med. Sci. 324: 116-126 12 Sowers (2003) Am. J. Med. 115: Suppl 8A; 37S-41S 13 Giovannucci (2003) J. Womens Health 12: 173-182 10 11
Environmental & “lifestyle” factors in the development of obesity “Obesity is a multifactorial disease in which environmental and genetic factors interact”14 Some environmental factors: Poor palatability of alternative diets2 Poor nutrition knowledge2 Sedentary lifestyle9 Excess energy intake12 Increased portion sizes15 Increased availability of convenience food16 Busy lifestyle/time constraints16 Frazao & Allshouse (2003) J. Nutr. 133: 844S-847S 9 Manson et al (2004) Arch. Intern. Med. 164: 249-258 12 Sowers (2003) Am. J. Med. 115: Suppl 8A; 37S-41S 2 Clement et al (2002) Am. J. Pharmacogenomics 2: 177-187 Bellisle (2003) Nutr. Metab. Cardiovasc. Dis. 13: 189-193 16 Jeffery & Utter (2003) Obes. Res. 11: 12S-22S 14 15
The urgent need to reduce obesity & obesity related disorders “The public would benefit from increased availability of foods and food products low in calories and total fat”17 “Epidemiologic data and clinical trials suggest that the beneficial impact of specific dietary and lifestyle changes on cardiac event rates could be greater than that achieved by any of the drug or revascularisation trials to date” 18 17 18 The Surgeon General’s report on Nutrition & Health (1988) U.S. Dept. of Health & Human Services Barringer TA (2001) Curr. Atheroscler. Rep. 3: 437-445
How to achieve a healthy diet & weight: Recommendations of the American Heart Association19 The AHA recommends consumption of: Fruits & vegetables Grains & wholegrains Fish Lean meat Poultry Fat-free products Low-fat dairy products Legumes Soluble fibre Plant sterols Less saturated fat 19 Kris-Etherton et al (2002) Curr. Opin. Lipidol. 13: 397-407
Which healthy diet can fulfil the recommendations of the American Heart Association? Help achieve a healthy weight Promote heart-health Promote desirable lipid levels Promote desirable blood pressure Reduce risk of diabetes & metabolic syndrome Reduce cholesterol levels Is varied & pleasurable to consume
The Mediterranean Diet “A proven cultural model for healthy eating”20 20 Willett et al (1995) Am. J. Clin. Nutr. 61; (Suppl 6): 1402S-1406S
The Mediterranean basin: more than 20 countries border the Mediterranean Spain France Italy Greece Turkey Lebanon Syria Israel Egypt Libya Morocco
Some characteristics of the Mediterranean diet20,21 Based on food patterns typical of Crete, most of Greece & Southern Italy in the early 1960’s Adult life expectancy amongst the highest in the World Rates of heart disease, cancers & diet related diseases amongst the lowest in the World Lifestyle included regular physical activity Attractive, varied dietary pattern Highly palatable & enjoyable 20 21 Willett et al (1995) Am. J. Clin. Nutr. 61; (Suppl 6): 1402S-1406S Nestle M (1995) Am. J. Clin. Nutr. 61; (Suppl 6): 1313S-1320S
Composition of the Mediterranean Diet22 High consumption of olive oil & low consumption of animal fats High consumption of fruit & vegetables High consumption of legumes High consumption of grains & whole grains Moderate to high consumption of oily fish Moderate consumption of dairy products Moderate wine consumption Low consumption of meat & meat products 22 Naska (2003) EGEA, International Conference on Health Benefits of the Mediterranean Diet
The Mediterranean Diet Pyramid20 20 Willett et al (1995) Am. J. Clin. Nutr. 61; (Suppl 6): 1402S-1406S
The Mediterranean Diet Health benefits
The Mediterranean diet and coronary heart disease (CHD) Reduces the overall risk of CHD23,24 Protects against CHD in Type II diabetics25 Protects against CHD in subjects with metabolic syndrome (35% reduced risk)26 Protects against further cardiac events in CHD patients27,28 Kok & Kromhout (2004) Eur. J. Nutr. 43; (Suppl 1): I2-I5 Srinath Reddy & Katan (2004) Public Health Nutr. 7 (1A): 167-186 25 Toobert et al (2003) Diabetes Care 26: 2288-2293 26 Pitsavos et al (2003) Rev. Med. Suisse Romande 123: 183-189 27 von Schacky (2003) MMW Fortschr. Med. 145 (13): 28, 30, 32-33 28 Martin-Du Pan (2003) Rev. Suisse Romande 123: 183-189 23 24
Cancer & Mediterranean dietary traditions “Approximately up to 25% of the incidence of colorectal cancer, 15% of breast cancer and 10% of the incidence of prostate, pancreas and endometrial cancer could be prevented if the populations of developed Western countries could shift to the traditional healthy Mediterranean diet” 29 29 Trichopoulou et al (2000) Cancer Epidemiol. Biomarkers Prev. 9: 869873
The Mediterranean diet and cancer: clinical studies results “Greater adherence to the Mediterranean diet is associated with a significant reduction in mortality due to cancer”30 The Mediterranean diet significantly reduces the risk of: Cancers of the upper aerodigestive tract 31 lung cancer32 Colorectal cancer33 Breast cancer34 Trichopoulou et al (2003) N. Engl. J. Med. 348: 2599-2608 30 Bosetti et al (2003) Cancer Epidemiol Biomarkers Prev. 12: 1091-1094 Fortes et al (2003) Nutr. Cancer (2003) 46: 30-37 33 Riboli & Norat (2003) EGEA 34 Adderley-Kelly & Williams-Stephens (2003) ABNF J. 14: 61-65 31 32
Other health benefits of the Mediterranean diet Reduces serum low density lipoprotein (LDL) & increases serum high density lipoprotein (HDL)35 Reduces hypertension & controls blood pressure36 Reduces serum lipids37 Improves glycemic control25 Rich in antioxidants38 Toobert et al (2003) Diabetes Care 26: 2288-2293 25 Haban et al (2004) Med. Sci. Monit. 10: PI49-PI54 Panagiotakos et al (2003) J. Hypertens. 21: 1483-1489 37 Panagiotakos et al (2004) Atherosclerosis 173: 351-359 38 Visioli & Galli (2001) Lipids 36; Suppl: S49-S56 35 36
The Mediterranean diet is compatible with “Low Carb” foods Serum glucose Serum glucose Low carb and/or low net carb = low Glycemic Index (GI) Time after meal (hours) Time after meal (hours) High carbohydrate ingredient Low carbohydrate Mediterranean ingredient
The importance of antioxidants: “oxidative stress” and disease39,40 Reactive oxygen species (ROS) or “free radicals” play a major role in the development of: Oxidative stress states Cardiovascular disease Hypertension Diabetes Cancer 39 40 Castronova (2003) Rev. Med. Liege 58: 231-239 Taniyama & Griendling (2003) Hypertension 42: 1075-1081
Diets rich in antioxidants prevent organic deterioration caused by excessive oxidative stress41 Key Mediterranean foods with high antioxidant activity: Olives & olive oil (hydroxytyrosol, oleuropein) Tomatoes (lycopene) Red wine (procyanidins) Fruits & vegetables (various polyphenols) Cocoa derivatives (flavonoids) 41 Elejalde Guerra (2001) An. Med. Interna. 18: 326-335
Choose the right type of fats: prevent atherosclerosis42 The main sources of fat in the Mediterranean diet are olive oil & oily fish: Rich in unsaturated fatty acids Reduces low density lipoprotein concentrations Increases high density lipoprotein concentrations Helps prevent atherosclerosis & cardiovascular disease Helps prevent coronary heart disease 42 Moreno & Mitjavila (2003) J. Nutr. Biochem. 14: 182-195
Alkalinizing effect of fruits & vegetables in the Mediterranean diet43,44 Fruits & vegetables in the Mediterranean diet are rich in K+ ions These neutralise “fixed acidity” which reflects metabolism of dietary proteins High K+ fruits & vegetables and Ca2+ from dairy products must be consumed with high protein diets to prevent metabolic acidosis and deleterious effects on Ca2+ status 43 44 Remesy & Demigne (2003) EGEA, International Conference on Health Benefits of the Mediterranean Diet Weisburger (2000) Nutrition 16: 767-773
The big question: can the Mediterranean diet help weight loss? Results of clinical studies in which obese subjects consumed a prescribed Mediterranean diet show: Weight loss & strong reduction in cholesterol levels45 Weight loss & beneficial effects on blood pressure46 Significant weight loss & superior long-term adherence to the prescribed diet47 Castagnetta et al (2002) Ann. N. Y. Acad. Sci. 963: 282-289 Bautista-Castano et al (2003) Med. Clin. (Barc) 121: 485-491 47 McManus et al (2001) Int. J. Obes. Relat. Metab. Disord. 25: 1503-1511 45 46
Evolution of the Mediterranean diet A highly adaptable & constantly evolving diet
Evolution of the Mediterranean diet The virtues of the Mediterranean diet were promoted as early as 161448 Now defined on the basis of dietary patterns found in the region in the 1950’s and early 1960’s 22 Evolved over many years & still evolving Incorporates non-native foods from many other continents and countries Great variation but with common characteristics 22 48 Naska (2003) EGEA, International Conference on Health Benefits of the Mediterranean Diet Haber (1997) Am. J. Clin. Nutr. 66; (Suppl 4): 1053S-1057S
The Mediterranean diet incorporates foods from many non-Mediterranean sources49 Grapes (Vitis vinifera) Central & South East Asia South East Asia & India South America Citrus fruit (Citrus sp.) Tomatoes (Lycopersicon sp.) Peppers & chillis (Capsicum sp.) Cocoa (Theobroma cacao) 49 Central & South America Central & South America Smartt (1995) Evolution of crop plants, 2 nd Ed.
Further adaptation of the Mediterranean diet for a modern Western lifestyle Although healthy, the traditional Mediterranean diet needs to be adapted for modern Western societies Modern Western societies are: Highly mobile but sedentary Increasingly busy but without hard physical labour May not have the time needed to source & prepare Mediterranean foods Have an urgent need for convenient healthy food choices
The Modern Mediterranean Diet The “MODMED” diet A diet for people on the move…..
The “MODMED” diet: incorporates traditional Mediterranean foods Incorporates the key healthy ingredients of the traditional Mediterranean diet Olives & olive oil Fruits & vegetables Cereals & whole grains Oily fish Red wine
The “MODMED” diet: incorporates novel functional foods Incorporates novel, key, functional food ingredients and functional consumer products Olive Powder Cocoa Bean Powder Nopal Powder Tomato Powder Low fat chocolate sauce/spread Low fat olive spread Low fat tomato sauce Low fat olive sauce
Functional “MODMED” food ingredients from Natraceutical S.A. Chocolate sponge cake Olive bread Ingredient: Cocoa Bean Powder Claims: Made from whole cocoa beans High in dietary fibre Low fat product High in natural antioxidants Natural cocoa taste Ingredient: Olive Powder Claims: Made from fresh olives High dietary fibre High in natural antioxidants Improves shelf life Natural olive taste
Functional “MODMED” food ingredients from Natraceutical S.A. Ingredient: Nopal Powder Claims: Made from the “prickly pear” Reduces glycemic index of foods High in soluble dietary fibre Low fat product Ingredient: Tomato Powder Claims: High in dietary fibre Low fat product High in natural antioxidants
Functional “MODMED” consumer products from Natraceutical S.A. Product: Chocolate spread/sauce Claims: Made with chocolate flakes Low fat product Cholesterol free Trans fatty acids free High in natural antioxidants Product: Olive Light Claims: Made with olive oil Low fat product Cholesterol free Trans fatty acids free High in natural antioxidants
Functional “MODMED” consumer products from Natraceutical S.A. Product: Olive Sauce Claims: Made with Mediterranean ingredients Low fat product Cholesterol free Trans fatty acids free High in natural antioxidants Product: Tomato Sauce Claims: Made with Mediterranean ingredients Low fat product Cholesterol free Trans fatty acids free High in natural antioxidants
Summary: Obesity & it’s co-morbidities are pandemic in Western societies The Mediterranean diet is a proven cultural model for healthy eating The Mediterranean diet can be adapted to suit busy Western societies Functional food ingredients & consumer products can be incorporated into the Mediterranean diet to give the “MODMED” diet The “MODMED” diet could help management of obesity and associated diseases
For more information see: www.olivepowder.com www.wholecocoabeanpowder.com www.chocolatepowder.com www.natraceuticaluk.com
“Let food be our first medicine” Hippocrates (400 BC) Autovia A-3. Salida 343 Cami de Torrent, s/n 46930 Quart de Poblet Valencia, Spain www.natraceuticals.com firstname.lastname@example.org
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