Towards a new paradigm for public health

Food-Vegetables-01In 1990, physician and health economist Christopher Murray at Harvard University and medical demographer Alan Lopez at the World Health Organisation embarked on the first ever attempt to measure the global burden of disease and developed the now-famous Disability Adjusted Life Year (DALY) metric that made it possible to combine estimates of mortality and morbidity burden around the world. DALY is the sum of years lived with disability [YLD] and years of life lost [YLL].

Since then, there have been estimates in 1999 to 2002 and 2004. But the latest iteration of the project, Global Burden of Disease 2010, has been on a different scale, involving nearly 500 researchers from more than 300 institutions in 50 countries. It is the largest ever systematic effort to describe the global distribution and causes of a wide array of major diseases, injuries, and health risk factors.

Twenty years ago, the project assessed the burden of 107 diseases and injuries and ten selected risk factors for the world and eight major regions over one calendar year. Now, thanks to advances in technology, the availability of data, and the participation of experts around the world, as well as the leadership of a core group of researchers, the scope has increased to 291 diseases and injuries in 21 regions, for 20 age groups, and an estimation of trends from 1990 to 2010. Global Burden of Disease 2010 also includes an assessment of 67 risk factors.

The results, published yesterday in seven articles in The Lancet, are set to shake up health priorities across the world.

In summary, the analysis shows that infectious diseases, maternal and child illness, and malnutrition now cause fewer deaths and less illness than they did twenty years ago. As a result, fewer children are dying every year, but more young and middle-aged adults are dying and suffering from disease and injury, as non-communicable diseases, such as cancer and heart disease, become the dominant causes of death and disability worldwide. Since 1970, men and women worldwide have gained slightly more than ten years of life expectancy overall, but they spend more years living with injury and illness.

There were 52.8 million deaths in 2010 compared with 46.5 million deaths in 1990. Of these, 12.9 million were from ischaemic heart disease and stroke, or one in four deaths worldwide, compared with one in five in 1990. Cancer claimed 8 million lives in 2010 compared with 5.8 million in 1990; trachea, bronchus and lung cancer accounted for 20% of these. Twice as many people died of diabetes in 2010 – 1.3. million – than in 1990, which is higher than deaths from tuberculosis or malaria (1.2 million each). Deaths from HIV/AIDS increased from 0.30 million in 1990 to 1.5 million in 2010, reaching a peak of 1.7 million in 2006. The fraction of global deaths due to injuries (5.1 million deaths) was marginally higher in 2010 (9.6%) compared with two decades earlier (8.8%). This was driven by a 46% rise in deaths worldwide due to road traffic accidents (1.3 million in 2010) and a rise in deaths from falls.

The contributions of risk factors to regional and global burden of diseases and injuries has shifted substantially between 1990 and 2010, from risk factors that mainly cause communicable diseases in children to risk factors that mainly cause non-communicable diseases in adults.

The proportion of overall disease burden attributable to childhood underweight – the leading risk factor worldwide in 1990 – had more than halved by 2010, making childhood underweight the eighth risk worldwide, behind six behavioural and physiological risks, and household air pollution from solid fuels. Other risks for child mortality, such as non-exclusive and discontinued breastfeeding, micronutrient deficiencies, and unimproved water and sanitation, have also fallen. However, child and maternal undernutrition risks collectively still account for almost 7% of disease burden in 2010, with unimproved water and sanitation accounting for almost 1%.

Of the non-communicable disease risks, high blood pressure, high body-mass index, high fasting plasma glucose, alcohol use, and dietary risks have increased in relative importance. This overall shift has arisen from a combination of the ageing population, substantial achievements in lowering mortality of children aged younger than 5 years, and changes in risk factor exposure.

These broad global patterns mask enormous regional variation in risks to health. In sub-Saharan Africa, risks such as childhood underweight, household air pollution from solid fuels, and suboptimal breastfeeding continue to cause a disproportionate amount of health burden, despite decreasing. The shift to risk factors for non-communicable disease was clear in east Asia, North Africa and Middle East, and Latin America.

For people aged 15 to 49 years, the leading risk factor worldwide was alcohol use, followed by tobacco smoking including second-hand smoke, high blood pressure, high body-mass index, diet low in fruits, drug use, and occupational risk factors for injuries. Risk factor rankings in this age group stayed broadly similar between 1990, and 2010, with the exception of iron deficiency, which dropped from the fourth leading risk factor in 1990, to ninth in 2010.

High blood pressure, tobacco smoking including second-hand smoke, alcohol use, and diet low in fruits were all in the top five risk factors for adults aged 50 to 69 years and adults older than 70 years, in both 1990, and 2010, accounting for a large proportion of disease burden in both age groups. Globally, high blood pressure accounted for more than 20% of all health loss in adults aged 70 years and older in 2010, and around 15% in those aged 50 to 69 years. Tobacco smoking including second-hand smoke accounted for more than 10% of global disease burden in each of these age groups in 2010.

Globally, the sum of years lived with disability and years of life lost (DALY), was influenced most by dietary risk factors and physical inactivity – together these were responsible for 10% of the global disease burden in 2010.

Of the individual dietary risk factors, the largest attributable burden in 2010 was associated with diets low in fruits (4.9 million deaths), followed by diets high in sodium (4.0 million deaths), low in nuts and seeds (2.5 million deaths), low in whole grains (1.7 million), low in vegetables (1.8 million deaths), and low in seafood omega-3 fatty acids (1.4 million deaths). Physical inactivity and low physical activity accounted for 3.2 million deaths.

This impressive analysis of global health issues by Christopher Murray and colleagues provides much reason for hope but also challenges the current medical paradigm and global healthcare system.

It shows clearly that the focus of global health authorities in recent decades on reducing infection and malnutrition has paid off – life expectancy has increased almost everywhere. This focus needs to continue to minimise incidence of diseases like tuberculosis, malaria and HIV/AIDs.

It also reveals, however, that the leading causes of death in the modern developed world are conditions which cannot be controlled by vaccinations, antibiotics, improved sanitation or insecticides. The data provide evidence that the risk factors for non-communicable diseases like heart disease, cancer and diabetes, are predominantly related to poor diet and lifestyle.

The large attributable burden for dietary risk factors such as diets low in fruits, vegetables, whole grains, nuts and seeds, and seafood omega-3 fatty acids might come as a surprise to some. The large burden is caused by both high exposure, e.g., low intake of fruits and vegetables in many regions – and large effect sizes.

Given the crucial role of dietary and lifestyle factors in determining long-term health, the answer to alleviating the suffering created by these chronic non-communicable diseases does not lie in the current medical model, with its preoccupation with drugs and surgery. Our doctors are trained to relieve symptoms not to address the underlying causes of chronic disease. Powerful commercial interests in the food, pharmaceutical and health sectors drown out the voices of those who can see that the solution is really very simple.

Widespread consumption of plant-based diets, rich in vegetables, fruit, whole grains, beans, nuts and seeds, together with not smoking and more physical activity, would transform people’s lives and radically reduce healthcare costs. It is not rocket science.

Dr Murray, I salute you and your colleagues for a first rate piece of work. May the truths you have exposed become part of mainstream understanding as quickly as possible and lead to a sea change in our approach to health and well-being.

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References

Murray et al (2012). Global Burden of Disease 2010. The Lancet, 13 December 2012.

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Nutrition – a game changer in global healthcare

Fierce political debate rages on both sides of the Atlantic about the rising cost of healthcare and what should be done about it.

Spending on health services in the UK has more than doubled in cash terms in the last decade, growing from £53 billion in 2000-01 to £120 billion in 2010-11; this is equivalent to an increase of around 80 per cent in real terms (1).  In England, 22 per cent of total public spending is devoted to healthcare.

In the USA, more than $2.5 trillion is spent annually on medical care.  But as recently as 1950, Americans spent only about $8.4 billion ($70 billion in today’s dollars).  After adjusting for inflation, Americans now spend as much on health care every ten days as they did in the entire year of 1950 (2).  In the USA, medical spending now represents nearly 20 per cent of gross domestic product (GDP).

The cost of health insurance continues to climb for US companies and workers, with annual family premiums growing at a pace triple that of 2010 and outpacing wage increases (3). The chairman and CEO of Starbucks, Howard Schultz, is quoted as saying that his company spends more money on insurance for its employees than it spends on coffee (4).

New legislation, large-scale reorganisation of health services, changes in insurance schemes and budget cuts are all among the radical measures being taken by governments to address this issue.

There is much less press coverage though about the real game changer with respect to reducing healthcare costs – improving nutrition and lifestyle.

Chronic or non-communicable diseases are the top cause of death worldwide, killing more than 36 million people in 2008.  Cardiovascular diseases were responsible for 48 per cent of these deaths, cancers 21 per cent, chronic respiratory diseases 12 per cent, and diabetes 3 per cent (5).

In most middle- and high-income countries non-communicable diseases were responsible for more deaths than all other causes of death combined, with almost all high-income countries reporting more than 70 per cent of total deaths due to non-communicable diseases (6).

In the UK and the USA, non-communicable diseases account for over 80 per cent of all deaths (5).

Common, preventable risk factors underlie most of these non-communicable diseases.  These risk factors are a leading cause of the death and disability burden in nearly all countries, regardless of economic development.

The leading risk factor globally for mortality is raised blood pressure (responsible for 13 per cent of deaths globally), followed by tobacco use (9 per cent), raised blood glucose (6 per cent), physical inactivity (6 per cent), and overweight and obesity (5 per cent) (7).

If we were to stop overeating, stop eating unhealthy foods, stop smoking and stop living sedentary lives, these risk factors would reduce, the prevalence of these diseases would reduce, healthcare costs would reduce and we would enjoy a greater quality of life.

Simple changes to diet and lifestyle really can make a dramatic difference to your health and well-being (8).

If you have enjoyed this post please leave your comments below.

If you would like to keep in touch, please click here to sign up for my free e-newsletter and browse my website.

You can also join me on FacebookTwitterPinterest and LinkedIn, where I post interesting information which is not included in this blog.

 

Works Cited

1. National Audit Office. Healthcare across the UK: A comparison of the NHS in England, Scotland, Wales and Northern Ireland. s.l. : National Audit Office, 2012.

2. Robbins, John and Robbins, Ocean. Beyond the Obamacare debate – why does healthcare cost so much? . s.l. : Fox News, 2012.

3. US Health Insurance Costs Rise. [Online] 27 September 2011. http://www.guardian.co.uk/world/2011/sep/27/us-health-insurance-costs-climb.

4. Businessweek. [Online] 21 November 2004. http://www.businessweek.com/stories/2004-11-21/online-extra-a-full-bodied-talk-with-mr-dot-starbucks.

5. World Health Organisation. Non-communicable diseases country profiles 2011.

6. —. Global status report on noncommunicable diseases 2010. . Geneva : s.n., 2011.

7. —. Global health risks: mortality and burden of disease attributable to selected major risks. . Geneva : s.n., 2009.

8. Willett, W.C. Eat, Drink and Be Healthy. New York : Free Press, 2001. ISBN 0 684 86337 5.

9. Parliamentary Office of Science and Technology. Health Behaviour. Postnote, May 2007, no. 283. 2007.

Healthy Food Healthy Business

Eating out is no longer an occasional luxury.  Consumers in the UK spent a staggering £81 billion on catering services in 2008 (1) and sales on food eaten out have increased by 23 percent since 2003 (2).  Market surveys estimate that between 7.5 and 8.5 billion meals were eaten out in the UK in 2009 (3).  DEFRA statistics suggest that one in every six meals in the UK is eaten out and the catering industry provides at least three meals per week for the average person in Britain (1).  Approximately 20 to 30 percent of each household’s food budget is spent on food and drink consumed outside the home (1). 

So what are the most important factors driving consumer food choices in the eating out market?

Recent surveys by the Food Standards Agency (4) and leading market research organizations (3), as well as sales data from supermarkets (5), indicate that health consciousness has moved right to the top of the consumer agenda. There is growing evidence that consumers are beginning to give health similar priority to price and value for money when deciding what to eat. 

Worldwide, more than 60 percent of deaths are caused by chronic diseases (6), thus almost everyone knows someone who has suffered from cancer, heart disease, stroke and diabetes.  Public awareness of the key role played by diet in the development of many of these diseases is increasing.  People are therefore concerned about the amount of calories, salt, saturated fat and sugar they are consuming.  As eating out becomes more common, the nutritional quality of the eating out diet is starting to receive scrutiny.

Latest figures show that 11 percent of total energy intake comes from eating out (1).  This number would be substantially higher if alcohol consumption were included.  The eating out diet has more fat and less carbohydrate than the household diet. 

Several consumer surveys conducted in the UK and the USA between 2006 and 2009 point to a growing demand for healthier menu items and a frustration at this need not being met (3) (7) (8) (9).  In one UK survey conducted by Consumer Focus (10), 94 percent of respondents indicated a desire for increased availability of healthier food when eating out.  At the same time, Datamonitor reported that 35 percent of European consumers cannot find healthier menu items when dining out (8).  On top of this, consumers are beginning to request more information about the provenance of their food and its nutritional content (11). 

Supermarkets have already reacted to this trend and implemented front of pack ‘traffic light labelling’ to provide consumers with information on the content of major nutrients and on whether the item is relatively healthy (green) or unhealthy (amber or red).  In 2009, Sainsbury’s reported a dramatic shift in purchasing patterns as a consequence of introducing such labels.  Sales of healthier items increased by 40 to 97 percent, whilst those of less healthy items decreased by 30 to 40 percent (5).

The National Restaurant Association reported that 60 percent of US consumers are aware of calorie information when making menu choices and 25 percent use this information to influence their choices (12).  A study published by Stanford University in January 2010 looked at the impact of mandatory calorie labelling in Starbucks in New York, Boston and Philadelphia.  They found that calorie posting led to a 6 percent reduction in calories per transaction.  This was entirely related to food choices and did not affect beverage consumption.  Interestingly, in Starbucks outlets within 50m of a competitor, the calorie posting led to an increase in Starbucks’ revenue (13).

In the UK, the FSA started working with 18 large catering businesses in 2009 to provide voluntary labelling of calorie content of menu items; the outcome of this is still being evaluated.

So the evidence suggests that today’s eating out consumers are cost-conscious, health-conscious and ethically-conscious.  The successful catering business will capitalise on these trends and create value by delivering what the consumer wants.

The good news is that making small and simple changes to menus to reduce content of calories, saturated fat, salt and sugar can enhance both health and profit margins.  Training courses are available to provide information and practical suggestions about how this can be achieved (14).

For example, there is plenty of scope to reduce portion size and reduce costs and food wastage.  The latest National Diet and Nutrition Survey published in February 2010 shows that average intake of protein is almost double that of the guideline intake (15).  Protein content of dishes can thus be reduced, thereby reducing cost.  Likewise, a number of businesses have reported increased margins as a result of reducing fat content of their menu items.

As life expectancy of the burgeoning world population continues to rise along with the incidence of overweight and obesity, the number of people with chronic diseases will increase.  There is also an increase in the number of the “worried well”.  Health consciousness is likely to intensify and caterers who provide healthier menu choices will position themselves to generate healthier businesses.

For further information and practical suggestions for providing healthier menu items, please come to a Healthier Catering Training Course in the UK.  Suitable for caterers and for professionals involved in encouraging healthy eating in the population.

Works Cited

1. DEFRA. Food Statistics Pocketbook. 2009.

2. Mintel. Eating Out Review. 2009.

3. Allegra Strategies. Review. 2009.

4. Food Standards Agency. Quarterly Public Attitudes Tracker. December 2009.

5. Sainsbury’s. Effect of food labelling on food purchasing choices. 2009.

6. World Health Organisation. World Health Report. 2002.

7. Nestle Professional. 2010.

8. Datamonitor. Workplace consumption: targeting a captive audience. 2005.

9. Aramark (NYSE, RMK) Dining Styles. Research presented to clinical researchers and health professionals at the 2006 NAASO Obesity Summit in Boston October 22-24. 2006.

10. Consumer Focus. s.l. : http://www.consumerfocus.org, 2006.

11. Food Standards Agency. June 2008.

12. National Restaurant Association. 2008.

13. Bollinger, B., Leslie, P. and Sorenson, A. Calorie posting in chain restaurants. s.l. : Stanford University, http://www.gsb.stanford.edu/news/StarbucksCaloriePostingStudy.pdf, January 2010.

14. Philpott, J.K. Healthier Catering Training Courses. s.l. : http://www.cookingforhealth-uk.com/healthier-catering.php.

15. Food Standards Agency and Department of Health. National Diet and Nutrition Survey. Headline results from Year 1 of the Rolling Programme 2008-2009. s.l. : FSA and DoH, February 2010.

Fruit and vegetable consumption low across the world

eating-burger_280_528732a1A new study to be published in the May edition of the American Journal of Preventive Medicine paints a depressing picture of the dietary habits of modern man across the globe.

National Diet and Nutrition Surveys in the UK have found that less than 15 per cent of the population eats the recommended 5 portions of fruit and vegetables per day; a similar situation exists in the USA.  It appears that the same is also true in developing countries, where traditional diets are threatened by the introduction of processed food.

A survey of over 200,000 people in developing countries showed that overall 77.6 per cent of men and 78.4 per cent of women consumed less than the suggested five daily servings of produce. 

“Low fruit and vegetable consumption is a risk factor for overweight and obesity, and adequate consumption decreases risk for developing several chronic diseases,” said lead author Spencer Moore. “The release of the 2002-2003 World Health Survey data provided a unique opportunity to examine global differences in low fruit and vegetable consumption in a way that has until now simply not been possible.”

There were wide variations among nations, ranging from 37 percent of men in Ghana who did not meet that standard – to 99 percent of Pakistani men. The researchers saw similar findings in women with the same two countries at the high and low ends of the spectrum.

The prevalence of low fruit and vegetable intake increased with age and decreased with income. This contrasts with findings from the UK where, on average, older people consume more fruit and vegetables than younger people.

family-eating-banana1

Epidemiological studies show that societies consuming high quantities of fruit, vegetables and whole grains are at lower risk of developing chronic diseases such as diabetes, heart disease and cancers than those that consume low quantities.  Such societies are often, but not exclusively, in less economically developed parts of the world.  As GDP per capita increases, countries opt for eating more meat, more processed food and less fruit, vegetables and whole grains.  This dietary shift leads to an epidemiological shift – away from infectious diseases and other diseases associated with lack of food, towards chronic noncommunicable diseases such as heart disease, stroke and cancer. 

The decline in consumption of fruit and vegetables in developing countries is disturbing as it is likely to give rise to an increase in the incidence of chronic diseases, leading to huge burdens on the healthcare systems of those countries, which may be ill-equipped to cope.

For information and practical tuition in how to create mouth-watering dishes with locally produced fruit and vegetables, come along to Cooking for Health courses held throughout the year in Somerset, UK.

If you are a caterer, or a professional responsible for encouraging healthier catering practices in your community, you will benefit from participating in a two-day training course on Healthier Catering.   By the end of the course, participants will: 

  • Understand the basic principles of nutrition
  • Be aware of the importance of food in the maintenance of health and well-being
  • Appreciate the role of lifestyles and culture in influencing diet
  • Recognise the potential benefits for both caterers and customers of providing a choice of healthier options
  • Know more about ingredient selection and methods of food production and processing that can be used to create healthier options, whilst being attractive and convenient to modern tastes and lifestyles
  • Be able to apply appropriate and relevant skills and knowledge when advising catering businesses or when planning, preparing, promoting and serving healthier foods

For further details about the course content and the course tutor, Dr Jane Philpott, please see http://cookingforhealth-uk.com/healthier-catering.php.

Reference

Hall JN, et al. Global variability in fruit and vegetable consumption. Am J Prev Med. 36(5), 2009.

Over-eating when eating out

Recently, I gave the menu of a well-known chain restaurant to a group of students and asked them to select what they would eat if they were dining there. 

 

They selected a starter (garlic bread with cheese), a main course (traditional lasagne with a salad), a dessert (ice cream) and a drink (a can of coke). 

 

Using the restaurant’s own nutritional information, they calculated the nutrient content of what they had chosen (Table 1).  The results left the students open-mouthed.

 

Their menu selection had provided:

 

n 106% of the guideline daily amount of calories (assuming 2000 kcal per day);

n 141-171% of the guideline daily amount of protein (depending on whether they were male or female);

n 61% of the guideline daily carbohydrate;

n 109% of the guideline daily amount of total fat;

n 192% of the guideline daily amount of saturated fat

n 52% of the guideline daily amount of salt. 

 

It is worth noting that the dietary reference value for salt in the UK is 6 g per day, compared with 2.3 g per day in the USA.

 

Thus, one meal out would have provided more than the entire day’s requirement for calories; enough protein to last for one and a half days; and enough saturated fat to last for two days.

 

Most people have no idea of the nutrient content of the food they are eating, nor of the potentially damaging effects on their health of a dietary excess of sugar, saturated fat and salt. 

 

Given that at least one–third of household expenditure on food and drink is spent on food eaten outside the home in the UK, food manufacturers and caterers have a real opportunity to contribute to an improvement in public health whilst also making a profit themselves. 

 

There is now convincing research evidence to suggest that increasing the amount of fruit, vegetables and whole grains in the diet, whilst decreasing the amount of sugar, saturated fat and salt, helps to protect the body from chronic conditions such as obesity, type 2 diabetes, heart disease and various cancers.

 

A two-day professional training course is offered, tailored to equip caterers, and those involved in encouraging healthier catering practices, with information and practical tools to achieve healthier eating in the population.

 

By the end of the course, participants will:

  • Understand the basic principles of nutrition
  • Be aware of the importance of food in the maintenance of health and well-being
  • Appreciate the role of lifestyles and culture in influencing diet
  • Recognise the potential benefits for both caterers and customers of providing a choice of healthier options
  • Know more about ingredient selection and methods of food production and processing that can be used to create healthier options, whilst being attractive and convenient to modern tastes and lifestyles
  • Be able to apply appropriate and relevant skills and knowledge when advising catering businesses or when planning, preparing, promoting and serving healthier foods

For further information on the course content and the course tutor, Dr Jane Philpott, please click http://cookingforhealth-uk.com/healthier-catering.php.

 

 

Table 1

Menu item

Calories per portion

Protein g per portion

Carbohydrate g per portion

Total fat g per portion

Saturated fat g per portion

Salt g per portion

 

Starter

 

568

 

29.8

 

35.6

 

34

 

16.5

 

1.15

 

Main course

 

934

 

 

42.2

 

74.4

 

33.1

 

14.6

 

1.84

 

Dessert

 

 

475

 

5.5

 

18.8

 

18.1

 

11.1

 

0.15

 

Drink

 

 

139

 

0

 

35

 

0

 

0

 

0

 

 

 

 

 

 

 

 

Total

 

 

2116

 

77.5

 

163.8

 

85.2

 

42.2

 

3.14

 

Gov guideline

 

 

2000 kcal

 

45 g/day (women)

55 g/day (men)

 

267 g per day

 

78 g per day

 

22 g per day

 

6 g per day

 

% of guidelines

 

 

106%

 

171% (women)

141% (men)

 

 

61%

 

109%

 

192%

 

52%

 

 

 

Mediterranean diet may help prevent prostate cancer

Recently reviewed evidence relating diet and prostate cancer suggests that a traditional Cretan Mediterranean style diet based on a variety of plant foods (fruits, vegetables, wholegrain cereals, nuts and legumes), olive oil as the main source of fat, moderate to low intake of dairy foods, moderate to high intake of fish and moderate intake of wine, mostly with meals, may be helpful in reducing prostate cancer risk.

mediterranean_food

A recent meta-analysis of prospective cohort studies using a score to assess adherence to a Mediterranean diet found that stronger adherence was associated with reduced all cause, cardiovascular and cancer mortality, as well as decreased incidence of Parkinson’s and Alzheimer’s diseases [i].

Two intervention studies have supported the benefits of a Mediterranean style diet on metabolic risk factors [ii] [iii].  In a Spanish study, men and women with elevated levels of cardiovascular risk factors were randomised to either of two ‘Mediterranean’ diets and provided with either olive oil and nuts, or to a control low fat diet.  After 3 months the Mediterranean diet groups had lower mean plasma glucose, systolic blood pressure and total/HDL cholesterol ratio than the control group [ii].  Italian adults with the Metabolic Syndrome were randomised to a ‘Mediterranean’ diet or a ‘prudent’ diet, both with similar macronutrient (carbohydrate, protein, fat) composition.  The ‘Mediterranean’ diet was associated with greater improvements in markers of vascular risk and endothelial function than the control group [iii].  In both studies the ‘Mediterranean’ diet groups received more nutrition education than the control groups.

The Lyon Heart Study demonstrated that a modified Cretan diet low in butter and meats, and high in fish, fruits and enriched with alpha-linolenic acid from canola oil was more effective than a ‘prudent’ diet in the secondary prevention of coronary events and overall mortality [iv]. 

Simopoulos [v] notes that the traditional Greek diet resembles the Paleolithic diet in terms of fibre, antioxidants, saturated and monounsaturated fat, thus is consistent with human evolution.  While traditional diets must reflect regionally available foods, the dietary principles of the traditional Greek diet may be applied in many countries.  The evidence suggests that a traditional Greek or Cretan style diet is consistent with what humans have evolved to consume and may protect against common chronic diseases, including prostate cancer.

For information and practical tuition in how to incorporate the dietary principles of the Mediterranean diet into your own cooking, why not come along to a Cooking for Health course, run throughout the year in Somerset, UK.

Jane Philpott

References

[i] Sofi, F., Cesari, F., Abbate, R., Gensini, G F., Casini, A. Adherence to Mediterranean diet and health status: meta-analysis.  BMJ 2008: 337: a1344.

[ii] Estruch, R., Martinez-Gonzalez, M A., Corella, D. et al.  Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomised trial.  Ann Intern. Med. 2006: 145: 1-11.

[iii] Esposito, K., Marfella, R., Ciotola, M. et al.  Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomised trial.  J Am Med Assoc 2004; 292: 1440-6.

[iv] de Lorgeril, M., Salen, P. Modified Cretan Mediterranean diet in the prevention of coronary heart disease and cancer.  In Simopoulos A,P., Visioli, F. eds.  Mediterranean Diets.  World Review Nutr. Diet. Basel: Karger, 2000: 1-23.

[v] Simopoulos, A P. The traditional diet of Greece and cancer.  Eur J Cancer Prev 2004; 13:219-30.