Mediterranean Cuisine - The Recipe for a Long and Healthy Life?

The food we eat is one of the leading causes of chronic disease. Overconsumption of meat, sugar and processed foods is driving up mortality rates worldwide. Yet in many healthcare systems, food plays only a minor role in promoting good health. Human beings often think that the best thing would be to find a magic pill that solves all of our problems. Almost every major disease is increased by this unhealthy Western dietary pattern. We know what will follow. From that will be more cardiovascular disease, kidney disease, more cancers. In recent decades, scientists around the world have turned their attention to an age-old culinary tradition with a host of health benefits, the Mediterranean diet. What really impressed us was how much this diet actually reduced inflammation and, in the long term, the development of tumors. Can a diet based on seasonal fruits and vegetables, whole grains and legumes, help us fight the greatest diseases of our time? And which ingredients are key to its power? Doctors, epidemiologists, nutritionists and food scientists are studying the Mediterranean diet in the hopes of creating the ultimate recipe for a perfect meal. The island of Crete is known for its rich history, breathtaking mountain landscapes and age-old traditions. The island is considered the birthplace of the Mediterranean diet. And yet, Crete is currently facing a rapidly growing obesity problem. Across the planet, unhealthy diets have led to an obesity epidemic, linked to rising rates of major chronic diseases. In Crete, the problem is especially acute among children. Concerning physical fitness, and physical activity, the aim was to walk more. Did you achieve that? Yes, we walk. Around the village? When they get older, their choices are influenced by friends at school, and they start going to the store to get sweets. Each kid gets a bag filled with chips, croissants, chocolates and sodas. And they eat it all. All the kids do it. There is a big obesity problem across Greece. Among kids ages 4 to 6, obesity is at 12. At 10 years, it's at 38% and goes up to 40% among 12-year-olds. The people in Crete adopted a Western-style diet. It's not very complicated to understand it. If you eat more calories than you're expending in physical activity, you're going to gain weight. When I was at a meeting in Crete, I talked to physicians working at local hospitals and lots of people in the health care system who were saying they were just overwhelmed with cases of heart disease and type 2 diabetes. The facts are simple. You know the chief killer of Americans is cardiovascular disease, disorders and degeneration of the heart and blood vessels. In the 1950s, heart disease mortality rates alarmed researchers in the United States. Of ten men, we can expect five to get it. One of these scientists was Ansel Keys, a physiologist who played a central role in creating K-rations used to feed soldiers during World War II. Based on his experience conducting starvation studies, Keys embarked on an ambitious new project. He studied the diets of thousands of men in the United States, Europe and Japan to discover the impact of food on our health. During field studies in Italy and Greece, Keys discovered what came to be known as the Mediterranean diet. We made studies of the total male population, 45 to 65, in these two towns, one in Italy and one in Crete. When they were in Crete, they discovered this diet that was relatively low in calories, very low in meat. Olive oil was the principal fat. There was no sugar. Here we are in the laboratory making some examinations, examining their heart, blood pressure, taking their electrocardiograms and blood for the test, while others took the history, extensive histories, on these patients. It was a starvation diet. These were very, very poor people in post-war Greece. They didn't have much money. There was very little electricity. There weren't any cars. They were very physically active. They were eating what they could grow and what they could provide. So their diet was largely based on plants, fruits, vegetables, grains, local produce, with some meat if they could get it, but in very, very small amounts. It's the kind of diet that we would say is super healthy right now. This was the typical Cretan daily food intake in the 1960s. 191 grams of vegetables, 463 grams of fruit, 453 grams of whole-grain breads and cereals, 90 grams of olive oil, 30 grams of legumes, 170 grams of potatoes, 39 grams of fish, 35 grams of meat, 15 grams of eggs, and 23 grams of alcohol. Following this diet, Cretan men had a 90% lower likelihood of death from heart attack compared to American men. The scientific community was baffled by these results. What made the Mediterranean diet so different? This is the question scientists around the world have been trying to answer. When we say Mediterranean diet, we're not referring to the diet followed today in Greece, Italy, Spain or North Africa. The young Spanish generations are adopting a diet typical of Texas, California or Wisconsin, not the diet followed by their grandparents in the last century. When I became interested in the Mediterranean diet, I had a very critical, very sceptical point of view. When I started to read the studies on the Mediterranean diet to see what scientific evidence there was, it seemed very weak to me. So, here in this office where we are now, we designed the first study that was carried out in the late 1990s. We collected data on the diet of every new patient with a heart attack admitted to one of the three large hospitals in Pamplona at that time. My first big surprise, which made me run into the hallway shouting, Eureka! was when we discovered that olive oil provided very strong protection against myocardial infarction. The same was true of the Mediterranean diet pattern. We started thinking about the PREDIMED study from that moment on, because we saw what olive oil could do. The PREDIMED study focused on the diets of approximately 7,500 people. These participants were at high risk of cardiovascular disease because they had hypertension, diabetes, hypercholesterolemia and obesity and had a high probability of having a heart attack, a stroke or even dying from cardiovascular disease. We brought together a group of researchers and set out to do something that no one else had dared to do before. Observational studies only collected data from people, but when you do an intervention study, you manipulate people's exposure to nutrition. We were so revolutionary that we said, we're going to do it for six years. For six years, these people are not going to eat what they like, but what we tell them to eat. My doctor, who knew me well, told me about it and suggested I take part. There were various dietary recommendations. I was advised to eat more vegetables, avoid red meat, especially pre-cooked foods, nothing like that. What they mostly recommend is vegetables that are in season, all cooked well with extra virgin olive oil. That's important, the liquid gold as they call it. The PREDIMED study consisted of three groups. Two of them were what we call Mediterranean diet groups. Their only difference is that one group was provided with free extra virgin olive oil and the other was provided with nuts. Then there was a third group, the CONTROL group, which was recommended to follow a low-fat diet. What is recommended by the American Heart Association is a low-fat diet. We give that to one group. It has to be good because it is recommended by the AHA. But although it's good, there might be something better, which is a diet not low in fat, but rich in fat. As long as the fat comes from natural vegetable sources, such as extra virgin olive oil or nuts. It's a whole dietary pattern for which we developed recipes, shopping lists, spring, summer, fall and winter menus, with what to eat each week. I usually follow the recipes that PREDIMED recommends. I improvise, but I always adapt to the advice I'm given. My wife's reaction was, don't get me involved in this. You eat what you want and so will I. And we actually make two separate menus, almost always. Sometimes she gives in, sometimes I give in. But I don't give in very often. Once a month or so I go to the doctor's office at the health center. There they measure and weigh me. Then they ask me a lot of questions about the kind of food I eat, to see if it's the right food or not. And here are your three bottles of olive oil. I'll use it to make great stews. The results of PREDIMED were truly spectacular and groundbreaking. The first thing we saw was a 30% reduction in the risk of myocardial infarction, stroke or cardiovascular death. We had planned a six-year trial, but we stopped it at 4.8 years, because it would be unethical to keep 2,500 people on a low-fat diet when they could benefit from a Mediterranean diet. Scientists discovered that different types of fats affect our health in dramatically different ways. Saturated fats, mainly from animal sources like red meat and dairy products, increase the build-up of bad cholesterol in our arteries and the risk of heart disease and stroke. Unsaturated fats, found in foods like olive oil, nuts and fish, improve blood cholesterol levels and the overall health of our heart. A third category of fats, called trans fats, is mostly man-made. It was used by the food industry to give longer shelf life to packaged products. Found in thousands of fried, baked and processed foods, trans fats have a devastating effect on our health. Scientists have discovered that if every day we consume 2% more trans fats, our risk of heart disease increases by 23%. In contrast, unsaturated fats found in olive oil have the opposite effect. That's a 22% lower risk of cardiovascular disease, 16% lower risk of diabetes and 11% lower risk of premature death. The initial studies in the 1950s and 60s showed how the Mediterranean diet affects heart disease. But US epidemiologist Walter Willett had a hunch that diet also played a role in the other big killer, cancer. Until the 1980s, there was no discussion about any relationship between diet and cancer. In fact, cancer was almost viewed as something that the gods sent down to us if we were bad or something like that or just by chance. There was some evidence emerging that tobacco smoking was a problem. But beyond that, there was really almost no question raised about why someone developed cancer. Our first study on long-term diet and health began in 1980 when we started collecting data from about 100,000 women in the United States. They were all registered nurses, so we called this the Nurses' Health Study. And our primary hypothesis was that high-fat diets are related to higher risk of breast cancer. But as our studies emerged, it was mainly a concern about saturated fat and cholesterol in the diet from basically high-fat dairy foods and red meat. There are various meats available to the housewife. It doesn't take much skill to make an excellent meal from the most tender T-bone steak to set before her family. Only very recently have we had evidence that high consumption of red meat by girls during high school years was related to higher risk of breast cancer. And if you put it all together, it appears that the Mediterranean type dietary pattern during high school years is importantly related to lower risk of breast cancer later in life. More evidence on the relation between diet and cancer came in the 1990s from early results in a pan-European study called EPIC. Its scope is unprecedented, collecting data from over half a million people across 10 countries. It has been ongoing for more than 30 years. The EPIC study found a link between the Mediterranean diet and a lower risk of colon and breast cancer. Following those findings, French scientists launched NutriNet Santé in 2009. It records the dietary habits of more than 170,000 adults in detail, looking at the link between certain food groups and diseases, notably cancer. This double entry table presents the correlations between different food groups and types of cancer. The food groups in green have protective attributes. All fruits and vegetables are associated with a lower risk of aerodigestive cancer. Including mouth, pharynx, larynx, esophagus, stomach and colorectal cancers. Foods that should be limited, such as red meat, are known to increase the risk of colorectal cancer. Same for charcuterie. An interesting find is that the Mediterranean diet is also associated with a lower risk of obesity. This is very relevant in terms of cancer, since we know that obesity is a very important risk factor for several types of cancer. The scientific evidence that we have accumulated through NutriNet Santé, EPIC and other studies around the world allows us to study the relationships between nutrition, the Mediterranean diet and disease, as well as by which mechanisms this occurs. Is it related to increased inflammation, oxidative stress or metabolic disturbance? Thanks to these samples, we'll soon know. Epidemiological studies like NutriNet Santé are helping to uncover the correlation between diet and disease. But to understand precisely how some foods increase the risk of cancer while others prevent it, scientists need to dig deeper. In some clinical trials we're changing what people eat to see how this affects disease. Obviously, when we study tumors, this takes a lot of time. Ladies and gentlemen, we present you with four tartines as appetizers for the summer season. We have olive paste, chickpea hummus, mackerel paste and tahini with miso. This began as a pilot study. The main criterion to select our volunteers is a genetic disease in which there's a mutation in a gene controlling the reproduction of cells. Due to this mutation, during their lifetime, these patients develop thousands of polyps inside their intestine. There is a 100% chance that these polyps will become cancerous. Our approach was to use an anti-inflammatory diet. We moved their diet back to a more Mediterranean one. So definitely no sugar, no processed red meats. We removed refined plain flour. As you know, we use fats mainly derived from plant products because of their anti-inflammatory properties. Sesame, for example, is an oily seed which is very rich in anti-inflammatory substances. The nutritional intervention was intensive. For three months the volunteers came to eat with us at least once a week. So it's a very strong intervention. They received recipes from us, attended classes. And there's always a nutritionist along with the cook, showing them the dish they'll eat next. The moment I remember the most is when we all met for the first time. It was something totally new. You believe you're going to the hospital, but instead you're in this kitchen, in this tavern. I really liked it. After 40 or more years following a certain type of diet, it was a revolution to remove many of my everyday foods. As the volunteers changed their diet, scientists studied the changes in tumor growth, focusing on levels of inflammation. Normally inflammation is a defense mechanism that helps our body heal injured tissue. But when we eat certain unhealthy foods, the mechanism fails. Inflammation lasts longer than needed, thereby damaging healthy cells. This is called chronic inflammation, and it's one of the main causes of cancer. Many of the foods that we like very much and want to eat very often are the opposite of the Mediterranean diet and cause inflammation. One of the main causes is meat. On the other hand, there are foods that have the opposite effect. They have an anti-inflammatory function. Fruits and vegetables can reduce inflammation. Their main ingredients are called phytochemicals. These are produced exclusively by fruits and vegetables. We do not otherwise find them in humans or in other foods that we eat. Plants contain many kinds of phytochemicals which are beneficial to our health. The simplest way to get them all is to eat a variety of vegetables and fruits of different colors. Green vegetables like broccoli, spinach and cabbage contain a variety of phytochemicals which prevent cancer. Yellow to orange and red vegetables and fruits like carrots, pumpkins and tomatoes contain carotenoids which are anti-inflammatory and enhance our immune system. Blue, purple and red fruits like berries and grapes contain anthocyanins which protect against type 2 diabetes, cancer and heart disease. We were struck by how much this diet reduced inflammation and, in the long term, tumor growth. By following the principles of the Mediterranean diet we can reach a state where there is very little or no inflammation at all. Studies in recent years have gone even further. In addition to preventing heart disease and cancer they are discovering that the Mediterranean diet is also connected with a lower risk of dementia often called the silent epidemic of our time. I had a strange symptom. I suddenly found myself on a road not remembering where I was. And it worried me. I had read a lot about Alzheimer's so I decided to check. Albion is a study which recruited people who were worried about their cognitive health. Our goal is to get them at that very early stage before the problems start and study how lifestyle and diet affect our likelihood of developing dementia. Open your eyes now. Look straight ahead. A significant part of what causes these diseases is non-genetic. Maybe up to 40%. One of those non-genetic factors that appears to affect dementia is diet. How does the Mediterranean diet help? Does it reduce the substances causing Alzheimer's in the brain? Does it help protect vessels in our brain? Or does it reduce inflammation in our brain? We want to understand the impact of nutrition on biological rhythms. To study in great detail what we eat, how we eat it, how foods are combined, what time of the day, what comes before and after, it is a whole new dimension of nutrition that has not been explored in relation to brain function. I'll ask you some questions about your diet. I'd like to know what you ate yesterday from morning until night time when you fell asleep. In the morning I usually eat two cookies. We create a total score for each participant. The cookies were plain or with chocolate? Plain. I don't eat them every day. Every other day? The higher the rating on this scale, the closer you are to the traditional Mediterranean pattern. A small glass of raki. In our studies, we found that the more you adhere to the Mediterranean diet, the lower the chance of either having cognitive problems or developing future problems like dementia or Alzheimer's disease. Dr. Skarmeas demonstrated that increased adherence to a Mediterranean-type diet is associated with decreased cognitive decline with age. It was the first time that epidemiological studies were able to demonstrate this. It turns out that the Mediterranean diet contains a wide variety of nutrients that help fight against all the components of brain aging. The impact on these diseases is fundamental. It's enormous. We have decided here in Bordeaux to investigate cerebral aging from the age of 50 and study it for 10 to 20 years before the diagnosis of a disease. One of our challenges is related to biobanking. We're using biological material to get data which allows us to do deep phenotyping, to have an extremely detailed view of the environment in which these people live thanks to biomarkers. I'll cut some of your hair, don't move. A biomarker is a sample found in biological fluid which indicates which environmental factors we've been exposed to. Hair is like fingernails. It carries a lot of information. It can be a contaminant, a pesticide for example, or a nutrient that comes from food. 169. Check again. Still 169. Oh my, I'm shrinking. We found that people with Alzheimer's disease had very particular dietary patterns that reflect what we call a Western diet with red and processed meats that were central to their eating habits. We measured different nutrients provided by the Mediterranean diet. These include carotenoids which are provided by certain types of fruits and vegetables and long-chain omega-3 acids which are provided by fatty fish. We showed that people who had the lowest circulating values in these nutrients were three times as likely to develop Alzheimer's disease. We are starting the first sequence. We will focus on the white matter vessels. So white matter is a tissue of the nerve cell that allows different areas of the brain to connect. As we age, this white matter becomes somewhat damaged. Let's see if there's a problem with that network. We used structural neuroimaging to look at the quality of the fibers that connect the brain regions and guarantee the transmission of nerve impulses. We've shown that the more we adhere to a Mediterranean diet the more our brain preserves these white matter fibers. We found that fish has a protective effect especially the long-chain omega-3s provided by fatty fish. These acids are incorporated into the cell membranes particularly neurons. And because they are highly unsaturated they allow these membranes to be fluid and flexible. This is very important for the brain which is a plastic organ that is constantly being remodeled. These omega-3s are incorporated and become part of the structure of the brain tissue. This is fundamental during the development of a baby's brain but also throughout our life and during aging in order to avoid atrophy. It's over. I'm coming to help you get out. The results are stunning. Daily consumption of fruits and vegetables is associated with a 30% lower risk of dementia. Higher levels of omega-3 fat circulating in the blood provided by fish in particular are associated with a 36% lower risk of dementia. When we released the statistical results of our neuroimaging colleagues couldn't believe their eyes. The result was very strong. It was huge. The approach doesn't require technology. It's just a matter of eating right. It adds up to thousands of cases each year that will no longer develop Alzheimer's disease. One of the findings that's emerged and really surprised me as well is that diet is connected to almost every disease that we study whether it be cancer or cataracts or kidney stones or dementia. We see that diet influences virtually every disease that people develop. For decades the medical community failed to prioritize food and its profound effects on our health. But this is changing. Scientists, nutritionists and cooks are joining forces to create the perfect meal based on the principles of the Mediterranean diet. One can say, I want to follow the Mediterranean diet. I want to improve the quality of my diet. But how do I do it? Human beings often think that the best thing would be to find a magic pill that solves all our problems. Culinary medicine has allowed us to identify what we could call the gastro-healthy dish. A perfect meal. It's defined as a dish that is 50% fruit and vegetables. A quarter of the total should be whole grain cereals. That would be the source of carbohydrates and fiber, which are very important. It also contains chickpeas, a legume which is rich in protein. Vegetable protein. The other quarter should be protein from plants, for example legumes. In the context of a Mediterranean lifestyle, I can imagine this meal at a family gathering where there's gratitude, a sense of togetherness, interaction and sharing.