THE MEDITERRANEAN DIET PARADOX Dr. Domenico Pratico', MD, FCPP
The Mediterranean diet is a diet adopted for more than 2000 years by people living in countries surrounding the Mediterranean Sea, which include, among others, Italy, Greece. Spain, and North Africa.
It is characterized by daily intake of fresh fruit and vegetables, legumes, nuts, unrefined cereals, and olive oil, and weekly intake of fish and lean meat such as chicken, and a very limited amount of sugar.
Overall, a diet which emphasizes mostly plant-based food but most importantly products that are easily available in that area.
Historically, it was recognized for the first time more than 60 years ago in “The Seven Countries Study” by Ancel Keys who compared diets and lifestyles across the USA, Finland, Netherlands, Italy, Greece, former Yugoslavia, and Japan. It revealed that countries folowing this diet had lower rates of death from any cause and coronary heart disease compared to northern European and U.S. countries
For the last 2 decades, evidence supporting the beneficial clinical effects of Mediterranean Diet has been accumulating.
They include benefits on cardiovascular health (reduced risk of heart disease, stroke, lower levels of LDL cholesterol), metabolic health (reduced risk of type 2 diabetes, improved blood sugar control, reduced risk of obesity), cancer prevention (lower risk breast and colon cancer), and brain health (reduced risk of Alzheimer's disease and other forms of dementia, improved memory and cognitive performance).
Therefore, it should not come as a surprise to anyone the fact that for the last eighth years in a row, U.S. News & World Report named the Mediterranean Diet as the "Best Diet of the year".
Despite all these facts, in recent years the adherence to this diet has been getting lower and lower across Europe not only among adults but also younger people, and, surprisingly, in the very countries that are considered the cradle of the diet.
Sadly, in these very countries we are now observing at the same time a significant increase in obesity and metabolic chronic diseases.
For kids in Greece, Spain and Italy, Mediterranean Diet is almost not existent, according to the World Health Organization, which says that children in Sweden are more likely to eat fish, olive oil and tomatoes than those in southern Europe.
For instance, in Italy, adherence to the traditional Mediterranean Diet has been declining for decades, especially among the younger generation, with multiple studies showing a significant shift toward a more "Westernized" dietary pattern, characterized by higher consumption of meat, processed foods, and sugary drinks, and lower intake of vegetables, legumes, and fish.
Several factors may contribute to this shift; among them I would like to mention the followings:
Economic factors: The cost of fresh, high-quality ingredients like olive oil, fish, and produce can be a barrier. Processed, high-energy foods are often cheaper, particularly affecting lower socioeconomic groups.
Westernization: Globalization and the influence of American fast-food culture have introduced new, convenient, and less healthy food options. This has led to the proliferation of fast-food chains in major cities.
Lifestyle changes: Urbanization, a faster-paced lifestyle, and more people entering the workforce mean less time for cooking traditional, home-prepared meals. This drives demand for quick, processed, and ready-made foods.
Environmental challenges: Climate-related issues can affect the availability and affordability of key ingredients, putting further pressure on the cost of adhering to a traditional Mediterranean Diet.
Today we are at a crucial point at which we can still probably reverse the trend before is too late. Here are some initiatives aimed at encouraging healthier eating habits.
Educational campaigns: National and international organizations focused on nutrition and health should act by promoting Mediterranean Diet through educational initiatives and updated nutritional guides that target young people.
School programs: Educational programs and novel approaches in schools should be used to raise awareness about healthy eating and Mediterranean Diet among students.
Sustainability focus: The diet should be promoted as a sustainable model for the future, with a lower environmental footprint than Westernized diets. This aligns with growing interest in sustainability among young consumers.
In summary, today we are witnessing what I call the "Mediterranean diet paradox” which reflects the coexistence of two opposing phenomena: increasing international adoption of Mediterranean dietary principles and decreasing adherence among Mediterranean populations themselves.
The “Mediterranean diet paradox” is alarming and cannot be ignored.
It requires immediate attention and comprehensive public health strategies aimed at preserving and promoting traditional healthy dietary patterns within the Mediterranean region itself.
Future efforts should therefore focus on improving nutritional education, supporting sustainable food systems, increasing accessibility to healthy foods, and promoting policies capable of preserving the cultural and health-related value of the Mediterranean diet for future generations.
If you are interested in reading more of my blogs:
Domenico Praticò, MD, holds the Scott Richards North Star Charitable Foundation Chair for Alzheimer’s Research and serves as a Professor at the Alzheimer’s Center at Temple, as well as a Professor of Neural Sciences at Lewis Katz School of Medicine at Temple University.
For more information on the research conducted by Dr. Domenico Pratico, please visit this link.
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Stay updated with the work happening at Dr. Domenico Pratico's lab by visiting the Pratico Lab website.
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