Claudia Ripamonti

Claudia Ripamonti

Claudia Ripamonti

Many things may spring to mind when thinking about the Mediterranean- warm blue seas, hot summers, sunny skies, rugged hilly landscapes, fresh seafood, and lots of olive oil. It is a geographical region of lands surrounding the Mediterranean sea and its cuisine is one of the most appreciated aspects of this region. However, it should not be confused with the Mediterranean diet, which is an extensively researched, popular diet containing key components with many potential health benefits. This includes reducing risks of all-cause mortality, heart disease, metabolic diseases, and promoting longevity, common in countries such as Italy, Cyprus and Spain (1).

Let’s take a look at what the Mediterranean diet is and how the different components of the diet may benefit health.

What is the Mediterranean diet?

Originally formulated in the 1960s, the Mediterranean diet was inspired by the eating habits of those living near the Mediterranean sea in countries such as Greece, Spain, Italy and France (2). The Mediterranean diet is typically characterised by a (3,4):

  • high intake of vegetables, fruits, olive oil, legumes, nuts, seeds and whole unprocessed grains
  • moderate intake of fish, poultry and wine during meals
  • low intake of dairy products, red meat and sweets.

This diet is low in saturated and trans-fats, and is rich in monounsaturated and polyunsaturated fats, fibre, vitamins, and plant-derived compounds such as polyphenols (5). The schematic diagram below may provide a useful visual representation of what the diet consists of (6):

This diet is different from the eating patterns commonly seen in ‘western’ diets which include increased intakes of refined sugar, grains and highly processed foods. It is an extensively described and evaluated dietary pattern in scientific literature (7), and adherence to this diet has shown to be protective against many different diseases (8). There are unique dietary components to this diet which may be beneficial for health. The Mediterranean diet also emphasises the implementation of healthy lifestyle factors and the preservation of cultural elements, as they may contribute to the diet’s beneficial effects (9). The following foods and lifestyle factors are prioritised in a Mediterranean diet (6,9,10):

Daily Food Intake:

  • A variety of mainly plant-based food sources (vegetables, fruits, legumes and preferably wholegrain carbohydrates), herbs and spices
  • Healthy fats (through foods such as olive oil, nuts, seeds and oily fish)
  • A daily intake of water as the main beverage, and a moderate intake of red wine with meals

Weekly Food Intake:

  • Fish as the preferred animal protein source at least twice weekly
  • Other protein sources such as eggs, poultry and dairy products a few times weekly
  • Red meat consumption limited to less than twice weekly

Lifestyle Factors:

  • Eating in moderation
  • Socialising during meals
  • Cooking
  • Adequate rest
  • Regular physical activity
  • Prioritising seasonal, local and minimally processed foods

There are no specific portion sizes, but some guidance may be found in the pyramid (6,10). Quantities of foods making up an individual’s meal may vary, depending on the individual (10). Consulting a professional such as a nutritional therapist may be helpful to implement a specific healthy diet and lifestyle factors.

Health Benefits of the Mediterranean diet:

Some of the main mechanisms of key nutrition components in the diet include reduced inflammation, reduced blood lipids (fats), blood glucose (sugar) control, a reduction in cardiovascular risk factors, reduced oxidative stress (an imbalance between free radicals and antioxidants in the body) through its antioxidant properties, and an improvement in metabolic markers (such as insulin resistance) (5,11). Studies have shown numerous potential health benefits through these mechanisms including:

  • Reduced risks of developing type 2 diabetes mellitus (8,12,13)
  • Reduced central obesity and other obesity-related chronic disease risks (13)
  • Reduced risks of cardiovascular disease (8,14)
  • Protection against development of dementia (11)
  • Preservation of cognitive and brain function (11)
  • Supporting weight loss maintenance (15)
  • Higher adherence to the diet is associated with lower risks of cancer mortality (16)

Key dietary components may be underpinning these mechanisms and contributing to these potential health benefits.

Key Dietary Components of the Mediterranean Diet:

Olive Oil: Olive oil should be the main source of dietary fat in a Mediterranean diet. Its high content of monounsaturated fatty acids, antioxidant compounds and polyphenols (organic plant compounds) may be responsible for the positive effects it may exert on the body by reducing inflammation, reducing oxidative stress, supporting the cardiovascular system (heart health), improving insulin sensitivity and it may also support cognitive health (9,11).

Fish: Oily fish including salmon, sardines, tuna and mackerel are rich in omega-3 fatty acids (11). Omega-3 fatty acids are known to have anti-inflammatory effects in the body, and may also support cardiovascular and cognitive function (7,11). Omega-3 fatty acids include both eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and these fatty acids cannot be produced efficiently within the body (11). It is therefore important that these nutrients are regularly consumed as part of an individual’s diet.

Fruits and vegetables: An increased intake of fruits and vegetables has been associated with higher blood nutrient levels, reduced oxidative stress, and improved cognitive function (11). Vegetables such as fresh green salad leaves, tomatoes, aubergine, cucumber and cabbage, along with many others, contain important natural compounds such as polyphenols and flavonoids (7). Fruits such as citrus fruits, berries and pomegranates also contain these natural compounds (7). Food sources high in polyphenols may have anti-inflammatory effects in the body as they may inhibit various pro-inflammatory markers (5), and they may also lower fasting blood glucose levels, increase antioxidant potential, and support endothelial function (7), which is important for heart health. Flavonoids may also provide cardio- and neuroprotective properties (11). In addition to these compounds, fruits and vegetables also contain dietary fibre. Dietary fibre may contribute to improvements in insulin sensitivity and managing blood glucose levels (7). Dietary fibre may also positively influence the gut microbiota (community of gut bacteria) by stimulating the production of short-chain fatty acids (SCFAs) (17). SCFAs may help regulate glucose and fat metabolism in the body (17). Increased fruit and vegetable intake has also been associated with reduced risks of all-cause mortality, type 2 diabetes and adiposity, amongst other things (7).

Nuts: Nuts are a good source of monounsaturated and polyunsaturated fatty acids, protein, natural compounds such as phenols and flavonoids, fibre, vitamins and minerals (7). Nuts such as pistachios, almonds, walnuts and hazelnuts may be commonly consumed in a Mediterranean diet (7). The fatty acids contained in nuts may have anti-inflammatory effects and support lipid metabolism and brain function (11).

Red wine: Red wine consumed with meals, in moderation, may be an important component of the Mediterranean diet. Red wine contains resveratrol which is a plant compound with antioxidant properties. Resveratrol has shown to exert cardioprotective, antiviral, antioxidant, anti-inflammatory and neuroprotective effects in the body (18).

The Mediterranean diet is more than just a diet, it is also a lifestyle model. As discussed, various food components in this diet may be beneficial to health, but at a more holistic level, lifestyle factors such as exercise, community living and rest may also play a role in supporting health along with diet. The extensive research conducted around this diet has allowed us to identify many potential foods and lifestyle principles which may support optimal health. Adoption of a Mediterranean diet may include making dietary and lifestyle changes which are long-term and sustainable. It provides a loose guide for a healthful diet which is rich in nutrients such as healthy fats, polyphenols, dietary fibre and protein. Adherence to this diet has shown to be supportive of health in many ways and protective against several chronic diseases.

Claudia Ripamonti is completing her final year in Personalised Nutrition (BSc). She has an interest in gut health and is passionate about supporting others in their health journeys. To see more of her posts and healthy food creations, she can be found on Instagram as @happy_whole_healthy.

References:

  1. World Economic Forum, 2020. This is where people live the longest in the EU. [online] Available at: < https://www.weforum.org/agenda/2020/12/longest-life-expectancy-europe/> [Accessed: 28 November 2022]
  2. Trichopoulou, A., Martínez-González, M.A., Tong, T.Y., Forouhi, N.G., Khandelwal, S., Prabhakaran, D., Mozaffarian, D. and de Lorgeril, M., 2014. Definitions and potential health benefits of the Mediterranean diet: views from experts around the world. BMC medicine, 12(1), pp.1-16.
  3. Willett, W.C., Sacks, F., Trichopoulou, A., Drescher, G., Ferro-Luzzi, A., Helsing, E. and Trichopoulos, D., 1995. Mediterranean diet pyramid: a cultural model for healthy eating. The American journal of clinical nutrition, 61(6), pp.1402S-1406S.
  4. D’Innocenzo, S., Biagi, C. and Lanari, M., 2019. Obesity and the Mediterranean diet: a review of evidence of the role and sustainability of the Mediterranean diet. Nutrients, 11(6), p.1306.
  5. Sood, S., Feehan, J., Itsiopoulos, C., Wilson, K., Plebanski, M., Scott, D., Hebert, J.R., Shivappa, N., Mousa, A., George, E.S. and Courten, B.D., 2022. Higher Adherence to a Mediterranean Diet Is Associated with Improved Insulin Sensitivity and Selected Markers of Inflammation in Individuals Who Are Overweight and Obese without Diabetes. Nutrients, 14(20), p.4437.
  6. Fundación Dieta Mediterránea, 2010. Mediterranean Diet Pyramid: a lifestyle for today. [pdf] Available at: <http://www.mediterradiet.org/dietamed/piramide_INGLES.pdf> [Accessed: 21 November 2022].
  7. Schwingshackl, L., Morze, J. and Hoffmann, G., 2020. Mediterranean diet and health status: Active ingredients and pharmacological mechanisms. British journal of pharmacology, 177(6), pp.1241-1257.
  8. Muscogiuri, G., Verde, L., Sulu, C., Katsiki, N., Hassapidou, M., Frias-Toral, E., Cucalón, G., Pazderska, A., Yumuk, V.D., Colao, A. and Barrea, L., 2022. Mediterranean Diet and Obesity-related Disorders: What is the Evidence?. Current Obesity Reports, pp.1-18.
  9. Bach-Faig, A., Berry, E.M., Lairon, D., Reguant, J., Trichopoulou, A., Dernini, S., Medina, F.X., Battino, M., Belahsen, R., Miranda, G. and Serra-Majem, L., 2011. Mediterranean diet pyramid today. Science and cultural updates. Public health nutrition, 14(12A), pp.2274-2284.
  10. Harvard T.H Chan, 2018. Diet Review: Mediterranean Diet. [online] Available at: <https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/mediterranean-diet/#:~:text=The%20Mediterranean%20diet%20is%20a,protein%20being%20fish%20and%20seafood> [Accessed: 23 November 2022].
  11. Gauci, S., Young, L.M., Macpherson, H., White, D.J., Benson, S., Pipingas, A. and Scholey, A., 2021. Mediterranean diet and its components: potential to optimize cognition across the lifespan. In Nutraceuticals in Brain Health and Beyond (pp. 293-306). Academic Press.
  12. Ahmad, S., Demler, O.V., Sun, Q., Moorthy, M.V., Li, C., Lee, I.M., Ridker, P.M., Manson, J.E., Hu, F.B., Fall, T. and Chasman, D.I., 2020. Association of the Mediterranean diet with onset of diabetes in the Women’s Health Study. JAMA network open, 3(11), pp.e2025466-e2025466.
  13. Bendall, C.L., Mayr, H.L., Opie, R.S., Bes-Rastrollo, M., Itsiopoulos, C. and Thomas, C.J., 2018. Central obesity and the Mediterranean diet: A systematic review of intervention trials. Critical reviews in food science and nutrition, 58(18), pp.3070-3084.
  14. Estruch, R., Ros, E., Salas-Salvadó, J., Covas, M.I., Corella, D., Arós, F., Gómez-Gracia, E., Ruiz-Gutiérrez, V., Fiol, M., Lapetra, J. and Lamuela-Raventos, R.M., 2018. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. New England journal of medicine, 378(25), p.e34.
  15. Poulimeneas, D., Anastasiou, C.A., Santos, I., Hill, J.O., Panagiotakos, D.B. and Yannakoulia, M., 2020. Exploring the relationship between the Mediterranean diet and weight loss maintenance: The MedWeight study. British Journal of Nutrition, 124(8), pp.874-880.
  16. Schwingshackl, L., Schwedhelm, C., Galbete, C. and Hoffmann, G., 2017. Adherence to Mediterranean diet and risk of cancer: an updated systematic review and meta-analysis. Nutrients, 9(10), p.1063.
  17. Martín-Peláez, S., Fito, M. and Castaner, O., 2020. Mediterranean diet effects on type 2 diabetes prevention, disease progression, and related mechanisms. A review. Nutrients, 12(8), p.2236.
  18. Salehi, B., Mishra, A.P., Nigam, M., Sener, B., Kilic, M., Sharifi-Rad, M., Fokou, P.V.T., Martins, N. and Sharifi-Rad, J., 2018. Resveratrol: A double-edged sword in health benefits. Biomedicines, 6(3), p.91.

Over many years, research has been growing around the profound impacts that nutrition and diet have on the health of the human body. Dietary fibre has been recognised as a nutritionally important, health-promoting food ingredient for many years (1). ‘Fibre’ is a word which often appears on food labels and may be described as being a good nutrient to include in one’s diet, however, many may not know why this nutrient is so remarkable and important for health.

Let’s discuss what fibre is, what it does in the body, why it is important for health, how much fibre to consume, and how to include more of it in the diet.

What is fibre?

Dietary fibre is a nutrient contained in plant-based carbohydrates which cannot be digested or absorbed in the body (1). Instead, fibre passes through the stomach and small intestine relatively unchanged, and then makes its way into the large intestine. It is at this point where fibre may be metabolised and have its greatest effects on the body, as it is fermented by certain species of gut bacteria (1).

What does fibre do in the body?

When fibre passes through the gastrointestinal tract (the gut), it is fermented by gut bacteria (1). Once fermented, short chain fatty acids (SCFAs) are produced, providing the bacteria with energy to thrive on (2). SCFA production is known to positively regulate sugar and fat metabolism, as well as exert other beneficial effects (3).

Although these terms are not officially used to define fibre, fibre is commonly classified as ‘soluble’ or ‘insoluble,’ which refers to its ability to dissolve in water (4). Soluble fibre dissolves in water to form a material which is gel-like, and may help lower blood cholesterol and glucose levels (4). Foods containing soluble fibre may include psyllium, oats, beans, apples and carrots. Insoluble fibre does not dissolve in water and instead promotes the movement of material through the digestive system, increasing stool bulk (4). Some good sources of insoluble fibre may include vegetables such as cauliflower and green beans, nuts, and wholegrains. The amount of soluble and insoluble fibre present in plant foods is different, which is why eating a wide variety of fibre-containing foods is important in order to achieve an optimal intake of fibre, and to experience its various health benefits.

Health benefits of fibre

  • Regulates blood sugar levels: fibre helps to decrease the absorption of glucose/sugar from food, allowing for a more controlled rise in blood sugar and insulin, which is important for supporting healthy weight and reducing risks of developing type-2 diabetes or obesity (5).
  • Regulates hunger hormones and promotes satiety: fibre helps regulate the release of insulin, which is the hormone responsible for determining whether food is used for fuel or stored as fat. It also promotes the secretion of Glucagon-Like Peptide-1, Cholecystokinin, Leptin and Peptide YY, which are hormones involved in signalling to the brain that the body is full and satiated (6).
  • Supports gut health: an individual’s diet may significantly influence the make-up of the gut microbiome, which is the community of bacteria in the gut which may influence the overall health of an individual (2). Dietary fibre may play a fundamental role in gut health due to its interaction with gut bacteria. It may also alter the composition of the gut microbiome, as well as increase bacterial diversity (2).
  • Reduces inflammation: through its effects on the gut microbiome and the production of SCFAs which may inhibit inflammatory processes in the body (7).
  • Reduces risks of developing certain diseases: such as type 2 diabetes, heart disease, colorectal cancer, constipation and diverticular disease (8,9).

How much fibre should I consume?

In the UK, it is recommended that adults consume 30g of fibre per day. As there are different types of fibre, consuming a range of fibre-rich food sources may help to ensure an optimal fibre intake. To give an indication of how consuming 30g fibre/daily may be achieved through main meals:

  • Breakfast: ½ cup cooked porridge oats (2g), with ½ cup raspberries (4g), and a tablespoon of chia seeds (5.5g). Total: 11.5g fibre
  • Lunch: 2 slices of wholemeal/wholegrain toast (4g), with ½ an avocado (5g) and a side salad with 100g baby spinach (2.2g) and a sliced tomato (1.5g). Total: 12.7g fibre
  • Dinner: A portion of meat with ½ cup of cooked, cubed sweet potato (2g), 1 cup steamed broccoli (5.1g) and 1 cup cooked cauliflower (2g). Total: 9.1g fibre
    Total: 33.3g fibre

Currently, the average intake of dietary fibre for adults in the UK is about 20g a day (10), which is below the recommended intake. Modern dietary habits have shown a decrease in overall fibre consumption, and this may be due to food processing and the emergence of “western diets” (1). Nowadays, western diets include more processed and refined foods. In the refining process, fibre is often extracted to improve the taste or texture of the food, potentially contributing to less fibre being consumed in the diet. With the emergence of low-fibre western diets, links have been found between these diets and an increased occurrence of diseases including type-2 diabetes mellitus, obesity, metabolic syndrome and inflammatory bowel disease (1).

Fibre is an important nutrient to support health, and there are many food sources of fibre and ways to include it in the diet.

Food sources of fibre

  • Vegetables
  • Fruits
  • Nuts
  • Seeds
  • Beans and Pulses
  • Wholegrains

How to include more fibre in the diet

  • Include a variety of vegetables in every meal (aim for 3-5 different vegetables)
  • Include low sugar fruits such as berries in a meal or as a snack
  • Swap refined white bread or pasta for wholegrain options
  • Sprinkle nuts and seeds on yoghurt, porridge or salads
  • Leave skins on fruits and vegetables
  • Add pulses such as beans, lentils or chickpeas to bulk up meals, or eat as side dishes instead of white rice or other starchy options

Consuming too much fibre too quickly may cause bloating, gas and constipation. When increasing fibre intake in the diet, it is helpful to do so gradually so that there is time for the natural gut bacteria in the digestive system to adjust to the change. It is also important to drink 6-8 glasses of fluid a day, especially when increasing fibre intake, as a diet higher in fibre may work best when water is absorbed (11).

Dietary fibre is a powerful nutrient, and if adequate amounts of it are consumed in the diet, health benefits may be experienced. Fibre plays an important role in maintaining gut health, and in turn, the health of the entire body.

Claudia Ripamonti is about to start her final year of studying Personalised Nutrition. She has an interest in gut health and learning how to support others in their health journeys. To see more of her posts and healthy food creations, she can be found on Instagram as @happy_whole_healthy.

References:

  1. Cronin, P., Joyce, S.A., O’Toole, P.W. and O’Connor, E.M., 2021. Dietary fibre modulates the gut microbiota. Nutrients, 13(5), p.1655.
  2. Zhang, N., Ju, Z. and Zuo, T., 2018. Time for food: The impact of diet on gut microbiota and human health. Nutrition, 51, pp.80-85.
  3. Den Besten, G., Van Eunen, K., Groen, A.K., Venema, K., Reijngoud, D.J. and Bakker, B.M., 2013. The role of short-chain fatty acids in the interplay between diet, gut microbiota, and host energy metabolism. Journal of lipid research, 54(9), pp.2325-2340.
  4. BNF, 2018. Dietary fibre. [online] Available at: <https://archive.nutrition.org.uk/healthyliving/basics/fibre.html?limitstart=0> [Accessed 13 October 2022].
  5. Hasbay, I., 2019. Dietary Fiber and Nutrition. In Dietary Fiber: Properties, Recovery, and Applications (pp. 79-123). Academic Press.
  6. Rao, T.P., 2016. Role of guar fiber in appetite control. Physiology & Behavior, 164, pp.277-283.
  7. Al Bander, Z., Nitert, M.D., Mousa, A. and Naderpoor, N., 2020. The gut microbiota and inflammation: an overview. International journal of environmental research and public health, 17(20), p.7618.
  8. Ma, W., Nguyen, L.H., Song, M., Jovani, M., Liu, P.H., Cao, Y., Tam, I., Wu, K., Giovannucci, E.L., Strate, L.L. and Chan, A.T., 2019. Intake of dietary fiber, fruits, and vegetables, and risk of diverticulitis. The American journal of gastroenterology, 114(9), p.1531.
  9. Harvard T.H Chan, 2022. Fiber. [online] Available at: < https://www.hsph.harvard.edu/nutritionsource/carbohydrates/fiber/> [Accessed 17 October 2022].
  10. NHS, 2022. How to get more fibre into your diet. [online] Available at: <https://www.nhs.uk/live-well/eat-well/digestive-health/how-to-get-more-fibre-into-your-diet/> [Accessed 18 October 2022].
  11. NHS, 2021. Water, drinks and your health. [online] Available at: <https://www.nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/water-drinks-nutrition/#:~:text=The%20Eatwell%20Guide%20says%20we,tea%20and%20coffee%2C%20all%20count.> [Accessed 18 October 2022].
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