mod med diet
TRANSCRIPT
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: [email protected]
The Modern Mediterranean Diet
A diet for people on the move…..
Albert Zumbé & Adam LeeNatraceutical S.A.May 2004
Autovia A-3. Salida 343Cami de Torrent, s/n 46930Quart de PobletValencia, 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
2 Frazao & Allshouse (2003) J. Nutr. 133: 844S-847S3 Kantor (1998) USDA Report No. 7724 ERS (2002) www.ers.usda.gov/data/foodconsumption5 Howarth et al (2001) Nutr. Rev. 59: 129-139
High intakes Low intakes
Sugars Fresh fruits
Refined carbohydrate Fresh vegetables
Saturated fats Dietary fibre
Red meat Some micronutrients
Recommended and actual daily dietary intake in the US3
Recommended intake
Actual intake
Fats, oils, sweets Use sparingly34 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”
6 Moore (2003) Cleve. Clin. J. Med. 70: 237-2407 Montague (2003) ABNF J. 14: 56-608 Bray & Champagne (2004) J. Am. Diet. Assoc. 104: 86-899 Manson et al (2004) Arch. Intern. Med. 164: 249-258
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
The consequences of obesity and physical inactivity
10 Wargovioch & Cunningham (2003) J. Nutr. 133: 2400S-2403S
11 Dubbert et al (2002) Am. J. Med. Sci. 324: 116-12612 Sowers (2003) Am. J. Med. 115: Suppl 8A; 37S-41S13 Giovannucci (2003) J. Womens Health 12: 173-182
“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
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
2 Frazao & Allshouse (2003) J. Nutr. 133: 844S-847S 14 Clement et al (2002) Am. J. Pharmacogenomics 2: 177-1879 Manson et al (2004) Arch. Intern. Med. 164: 249-258 15 Bellisle (2003) Nutr. Metab. Cardiovasc. Dis. 13: 189-19312 Sowers (2003) Am. J. Med. 115: Suppl 8A; 37S-41S 16 Jeffery & Utter (2003) Obes. Res. 11: 12S-22S
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 The Surgeon General’s report on Nutrition & Health (1988) U.S. Dept. of Health & Human Services18 Barringer TA (2001) Curr. Atheroscler. Rep. 3: 437-445
How to achieve a healthy diet & weight: Recommendations of the American Heart Association19
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
The AHA recommends consumption of:
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
SpainFranceItalyGreeceTurkeyLebanonSyriaIsraelEgyptLibyaMorocco
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 Willett et al (1995) Am. J. Clin. Nutr. 61; (Suppl 6): 1402S-1406S21 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
23 Kok & Kromhout (2004) Eur. J. Nutr. 43; (Suppl 1): I2-I524 Srinath Reddy & Katan (2004) Public Health Nutr. 7 (1A): 167-18625 Toobert et al (2003) Diabetes Care 26: 2288-229326 Pitsavos et al (2003) Rev. Med. Suisse Romande 123: 183-18927 von Schacky (2003) MMW Fortschr. Med. 145 (13): 28, 30, 32-3328 Martin-Du Pan (2003) Rev. Suisse Romande 123: 183-189
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 tract31
lung cancer32
Colorectal cancer33
Breast cancer3430 Trichopoulou et al (2003) N. Engl. J. Med. 348: 2599-2608 31 Bosetti et al (2003) Cancer Epidemiol Biomarkers Prev. 12: 1091-1094 32 Fortes et al (2003) Nutr. Cancer (2003) 46: 30-3733 Riboli & Norat (2003) EGEA 34 Adderley-Kelly & Williams-Stephens (2003) ABNF J. 14: 61-65
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 antioxidants3825 Toobert et al (2003) Diabetes Care 26: 2288-2293
35 Haban et al (2004) Med. Sci. Monit. 10: PI49-PI54 36 Panagiotakos et al (2003) J. Hypertens. 21: 1483-1489 37 Panagiotakos et al (2004) Atherosclerosis 173: 351-35938 Visioli & Galli (2001) Lipids 36; Suppl: S49-S56
The Mediterranean diet is compatible with “Low Carb” foods
Time after meal (hours) Time after meal (hours)
Ser
um g
luco
se
Ser
um g
luco
seHigh carbohydrate
ingredientLow carbohydrate
Mediterranean ingredient
Low carb and/or low net carb = low Glycemic Index (GI)
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 Castronova (2003) Rev. Med. Liege 58: 231-239
40 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 Remesy & Demigne (2003) EGEA, International Conference on Health Benefits of the Mediterranean Diet44 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
45 Castagnetta et al (2002) Ann. N. Y. Acad. Sci. 963: 282-28946 Bautista-Castano et al (2003) Med. Clin. (Barc) 121: 485-49147 McManus et al (2001) Int. J. Obes. Relat. Metab. Disord. 25: 1503-1511
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’s22
Evolved over many years & still evolving Incorporates non-native foods from many other
continents and countries Great variation but with common characteristics
22 Naska (2003) EGEA, International Conference on Health Benefits of the Mediterranean Diet48 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
Citrus fruit (Citrus sp.) South East Asia & India
Tomatoes (Lycopersicon sp.) South America
Peppers & chillis (Capsicum sp.) Central & South America
Cocoa (Theobroma cacao) Central & South America
49 Smartt (1995) Evolution of crop plants, 2nd 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.
Ingredient: Cocoa Bean PowderClaims: Made from whole cocoa beans High in dietary fibre Low fat product High in natural antioxidants Natural cocoa taste
Ingredient: Olive PowderClaims: Made from fresh olives High dietary fibre High in natural antioxidants Improves shelf life Natural olive taste
Chocolate sponge cake
Olive bread
Functional “MODMED” food ingredients from Natraceutical S.A.
Ingredient: Nopal PowderClaims: Made from the “prickly pear” Reduces glycemic index of foods High in soluble dietary fibre Low fat product
Ingredient: Tomato PowderClaims: High in dietary fibre Low fat product High in natural antioxidants
Functional “MODMED” consumer products from Natraceutical S.A.
Product: Chocolate spread/sauceClaims: Made with chocolate flakes Low fat product Cholesterol free Trans fatty acids free High in natural antioxidants
Product: Olive LightClaims: 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 SauceClaims: Made with Mediterranean ingredients Low fat product Cholesterol free Trans fatty acids free High in natural antioxidants
Product: Tomato SauceClaims: 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.comwww.wholecocoabeanpowder.comwww.chocolatepowder.comwww.natraceuticaluk.com
“Let food be our first medicine”
Hippocrates (400 BC)
Autovia A-3. Salida 343Cami de Torrent, s/n 46930Quart de PobletValencia, Spain