Med’s dead, baby

How the Mediterranean diet died

First time I snorkelled the Med, in 1956, the waters were very occupied. Shoals of small fish swarmed around – I remember how it felt when they brushed past me – while bigger fish flitted in and out of sight. Most of that has gone now. Over-fishing, bottom-trawling and pollution have left large areas of the Med almost empty, with much of the former marine culture dying or dead (1). 

Squid, sea urchins and starfish are still present in abundance, but the former glorious diversity of the sea between the lands, which spilled out of fishermen’s nets and fishmongers’ stores sixty years ago, is fading fast (1, 2). Dead zones in all the world’s oceans are multiplying (3), for basically the same reasons.

Seafood has always been an important part of the Mediterranean diet, but that too is dying.

It is being killed off by a handful of food multinationals who are flooding the world with their toxic products, changing traditional eating habits and spreading disease and death on an industrial scale; together, of course, with obesity. While underweight / malnourished people in the world have remained at around 800 million since the 90’s, the overweight / dysnourished overtook the starving in 2006 (4). 

Big Phood’s ultra-processed slop has poured into developed and developing markets alike (5-10), in parallel with the expansion of junk food chains such as McDonalds (9). Domestic manufacturers in the Far East, South America and Africa have been forced to produce competing products (11, 12), which are making current trends even worse (13). ‘Coca-colonisation’ (14, 15) brings disease and death in its wake. It started in South America, but is now firmly focused on Southern Europe.

A team of scientists from Bari, Barcelona and Naples recently found that the Mediterranean diet, one of the last hold-outs for good health, is on its way out too. Their paper (16) is a little flowery in parts but it documents the ongoing dietary decline, which picked up speed back in the 90’s (17-19) and continues to this day (20-23), in convincing detail. 

The shift includes a huge increase in the consumption of animal fats and plant oils, and an equally significant fall in the consumption of complex carbs (ie prebiotic fibers) in cereals and legumes (24). In food terms the folks who traditionally followed the Mediterranean diet are now consuming fewer fruits, vegetables and whole grains, and more products with low or zero nutrient density such as sugar-sweetened soft drinks, confectionery, bakery products, breakfast cereals and salted snacks; and they are becoming more malnourished as a result (25, 26). 

Many other countries, of course, are further down this Gadarene slope (27, 28), and for a while it seemed that important components of the Mediterranean lifestyle such as seasonality, the use of fresh and locally grown products and involvement in social and physical activity (29, 30), might hold Big Phood at bay. But the Med is dying, and the culture and its people will follow.

Adherence to the old Mediterranean diet conferred major health benefits (19, 24, 29, 30), including significantly reduced risk of cardiovascular disease (31-33), metabolic syndrome and diabetes (34, 35), various cancers (36-38), and possibly dementia (38, 40) and depression (41).

Killing the Med diet will inevitably increase the burden of chronic ill health all around the Mediterranean, and is yet another example of the way in which Big Phood privatizes its profits but socializes its costs.

We cannot afford to continue going down this road. The major food corporations must be forced to assume a degree of moral and financial responsibility for the damage they are doing to us. Only in this way will they be persuaded to make their products less toxic, and even pro-health. This is not technically difficult to do. 

For example, many baked goods can be turned into functional foods merely by altering the time and temperature of the cooking process, and changing some of the digestible starch into resistant (fermentable) starch. Alternatively, prebiotic fibers can be added to the dough before baking, together with a pinch of 1-3, 1-6 beta glucans. 

These very simple changes to currently toxic foods would reduce metabolic disease and diabetes, vastly increase herd immunity to infections of all kinds, and reduce allergy. They would add approximately 5% to manufacturing costs, which could be offset by government subsidies made available by the reduced need for health care spending. 

There are other benefits too. The core of the Mediterranean diet consists of regional and seasonal crops and is based on small-scale production methods, local distribution and low transport costs. This is the very opposite of the centralized technology and profiteering of the big corporations; and whereas centralised food production is environmentally ruinous (ie 42), local and small-scale is safer (any problems are localized), and sustainable (43, 44).

All it requires to make this happen is a political class that genuinely cares for its constituents. 

References

1. The State of World Fisheries and Aquaculture. Food & Agriculture Organisation of the UN, Sofia 2020. http://www.fao.org/state-of-fisheries-aquaculture/en/
2. Katsanevakis S, Coll M, Piroddi C, Steenbeek J, Lasram FBR, Zenetos A, Cardozo AC. Invading the Mediterranean Sea: biodiversity patterns shaped by human activities. Front Mar Sci, 30 September 2014
3. Breitberg D, Levin LA, Oschlies A, Gregoire M, Chavez SP, Conley DJ and 16 others. Declining oxygen in the global ocean and coastal waters. Science 05 Jan 2018; 359 (6371), eaam7240
4. http://www.oecd.org/document/30/0,3746,en_2649_33929_12968734_1_1_1_1,00.html
5. Bruinsma, J. World agriculture: towards 2015/2030: an FAO perspective. Earthscan/James & James 2003
6. World Bank (2008). World Development Report 2008
7. UNCTAD (2009). World Investment Report: Transnational Corporations, Agricultural Production and Development.
8. Wilkinson, J. (2008). The food processing industry, globalization and developing countries. in: McCullough EB, Pingali P, Stamoulis KG. (Eds.), The transformation of agri-food systems: globalization, supply chains and smallholder farmers Food & Agriculture Organization of the UN (FAO), p. 87
9. Pingali P, Khwaja Y. (2004). Globalisation of Indian diets and the transformation of food supply systems.Indian J Agric Market, 18, 1.
10. GereffiG, Christian M (2010) in: Trade, Food, Diet and Health: Perspectives and Policy Options, Trade, transnational corporations and food consumption: A global value chain approach, eds Hawkes C, Blouin C, Henson S, Drager N, Dubé L (Wiley-Blackwell, Oxford), pp 91 – 110.
11. Vepa SS. (2004). Impact of globalization on the food consumption of urban India.Globalization of food systems in developing countries: impact on food security and nutrition, 83 ed. Food and Agriculture Organization of the United Nations, p. 215
12. Wilkinson J. (2009). Globalization of Agribusiness and Developing World Food Systems. Monthly Review 61
13. Mazzocchi M. The development of global diets since 1992: influences of agri-food sector trends and policies.FAO Commodity and Trade Policy Research Working Paper No 34. https://www.academia.edu/2830617/the_development_of_global_diets_since_icn_1992_influences_of_agri_food_sector_trends_and_policies?email_work_card=view-paper

14.Leatherman TL, Goodman A. Coca-colonization of diets in the Yucatan. Soc Sci Med. 2005 Aug;61(4):833-46.

15. Himmelgreen DA, Cantor A, Arias S, Romero Daza N. Using a biocultural approach to examine migration/globalization, diet quality, and energy balance. Physiol Behav. 2014 Jul;134:76-85.
16. Bottalico F, Medina X, Capone R, Bilali HE, Debs P. Erosion of the Mediterranean Diet in Apulia Region, South-eastern Italy: Exploring Socio-cultural and Economic Dynamics. J Food Nut Res. 2016, 4(4); 258-266
17. Ferro-Luzzi A, Branca F. Mediterranean diet, Italian-style: prototype of a healthy diet.  Am J Clin Nutr 61(Suppl): 1338S-45S,1995.
18. Alberti-Fidanza A, Fidanza F, Chiuchiu M, Verducci G, Fruttini D. Dietary studies on two rural Italian population groups of the Seven Countries Study 3. Trend of food and nutrient intake from1960 to 1991.Eur J Clin Nutr . 53:854-60, 1999.
19. Nestle M. Mediterranean diets: historical and research overview. Am J Clin Nut; 61(suppl.):1313S-20S, 1995
20. Da Silva R, Bach-Faig A, Raido Quintana B, Buckland G, Almeida MDV, Serra-Majem L. World variation of adherence to the Mediterranean diet, in 1961-1965 and 2000-2003, World variation of adherence to the Mediterranean diet, in 1961-1965 and 2000-2003. Public Health Nutr; 12(9A):1676-84, 2009.
21. Ferro-Luzzi A, Branca F. Mediterranean diet, Italian-style: prototype of a healthy diet.  Am J Clin Nutr 61(Suppl): 1338S-45S,1995.
22. Alberti-Fidanza A, Fidanza F, Chiuchiu M, Verducci G, Fruttini D. Dietary studies on two rural Italian population groups of the Seven Countries Study. 3. Trend of food and nutrient intake from 1960 to 1991.Eur J Clin Nutr . 53:854-60, 1999.
23. Garcia-Closas R, Berenguer A, Gonzalez C. Changes in food supply in Mediterranean countries from 1961 to 2001. Public Health Nutr; 9(1):53-60, 2006
24. Maillot M, Issa C, Vieux F, Lairon D, Darmon N. The shortest way to reach nutritional goals is to adopt Mediterranean food choices. Evidence from computer-generated personalized diets.Am J Clin Nutr; 94(4):1127-37, 2011.
25. Serra-Majem L, Ribas L, Ngo J, Aranceta J, Garaulet M, Carazo E, Mataix J, Pérez-Rodrigo C, Quemada M, Tojo R. et al. Risk of inadequate intake of vitamins A, B1, B6, C, E, folate, iron and calcium in the Spanish population aged 4 to 18. J. Vitam. Nutr. Res. 2001; 71: 325-331.
26. Serra-Majem L, Ribas L, Pérez-Rodrigo C, García-Closas R, Peña-Quintana L, Aranceta J. Factors associated to nutrient intake among children and adolescents: Results from the EnKidstudy. Nutr. Metab 2002; 46:31-38.
27. Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev. 2012 Jan;70(1):3-21.
28. Popkin BM. The nutrition transition: an overview of world patterns of change. Nutr Rev 2004 Jul;62(7 Pt 2):S140-3.
29. Medina FX. Assessing sustainable diets in the context of sustainable food systems – socio-cultural dimensions. In,Assessing diets within the sustainability of food systems, Proceedings of an international FAO/CRA/FQH workshop. Eds. Meybeck A, Redfern S, Paoletti F, Strassner C. FAO, Rome 2015. 163-166.
30. Lacirignola C, Dernini S, Capone R, Meybeck A, Burlingame B, Gitz V, El Bilali H, Debs Ph, Belsanti V. Towards the development of guidelines for improving the sustainability of diets and food consumption patterns: the Mediterranean Diet as a pilot study. CIHEAM/FAO – Options Méditerranéennes, Series B: Studies and Research, N° 70; Bari, 2012. 67 p. Available: http://om.ciheam.org/om/pdf/b70(en)/b70 (en).pdf.

31. Trichopoulou A, Bamia C, Trichopoulos D. Mediterranean diet and survival among patients with coronary heart disease in Greece. Arch Intern Med 25; 165(8):929-35, 2005.
32. Trichopoulou A, Bamia C, Trichopoulos D. Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study.BMJ ; 338: 2337, 2009.
33. Estruch R, Ros E, Salas-Salvadó J, Covas M.-I, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem Ll, Pintó X, Basora J, Angel Muñoz M, Sorlí JV, Alfredo Martínez J, Martínez-González MA. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet.N Engl J Med , 368/14:1279-1290,2103.
34. Tortosa A, Bes-Rastrollo M, Sanchez-Villegas A, Basterra-Gortari FJ, Nunez-Cordoba J.M, Martinez-Gonzalez MA. Mediterranean diet inversely associated with the incidence of metabolic syndrome: the SUN prospective cohort. Diabetes Care ;30(11):2957-2959, 2007.
35. Salas-Salvadó J, Bulló M, Babio N, Martínez-González MÁ, Ibarrola-Jurado N, Basora J, Estruch R, Covas MI, Corella D, Arós F, Ruiz-Gutiérrez V, Ros E, PREDIMED Study Investigators. Reduction in the incidence of type 2 diabetes with the Mediterranean diet: results of the PREDIMED-Reus nutrition intervention randomized trial.Diabetes Care 34: 14-19, 2011.
36. La Vecchia C. Mediterranean diet and cancer. Public Health Nutr, 7(7):965-968, 2004
37. Vernele L, Bach-Faig A, Buckland G, Serra-Majem L. Association between the Mediterranean diet and cancer risk: a review of observational studies.Nutr Cancer, 62(7): 860-870,2010
38. Mentella MC, Scaldaferri F, Ricci C, Gasbarrini A, Miggiano GAD. Cancer and Mediterranean Diet: A Review. 2019 Sep 2;11(9):2059.
39. Petersson SD, Philippou E. Mediterranean Diet, Cognitive Function, and Dementia: A Systematic Review of the Evidence. Adv Nutr. 2016 Sep 15;7(5):889-904.
40. Radd-Vagenas S, Duffy SL, Naismith SL, Brew BJ, Flood VM, Fiatarone Singh MA. Effect of the Mediterranean diet on cognition and brain morphology and function: a systematic review of randomized controlled trials. Am J Clin Nutr. 2018 Mar 1;107(3):389-404.
41. Psaltopoulou T, Sergentanis TN, Panagiotakos DB, Sergentanis IN, Kosti R, Scarmeas N. Mediterranean diet, stroke, cognitive impairment, and depression: A meta-analysis. Ann Neurol. 2013 Oct;74(4):580-91.
42. Hribar C, Schulz M (ed). Understanding Concentrated Animal Feeding Operations and their Impact on Communities. National Association of Local Boards of Health, CDC. (2010). https://www.cdc.gov/nceh/ehs/docs/understanding_cafos_nalboh.pdf

43. Dernini S, Berry EM, Serra-Majem L, La Vecchia C, Capone R, Medina FX, Aranceta-Bartrina J, Belahsen R, Burlingame B, Calabrese G, Corella D, Donini LM, Lairon D, Meybeck A, Pekcan AG, Piscopo S, Yngve A, Trichopoulou A. Med Diet 4.0: the Mediterranean diet with four sustainable benefits. Public Health Nutr. 2017 May;20(7):1322-1330.
44. Serra-Majem L, Ortiz-Andrellucchi A. La dieta mediterránea como ejemplo de una alimentación y nutrición sostenibles: enfoque multidisciplinar. Nutr Hosp. 2018 Jun 12;35(Spec No4):96-101. Spanish.