My Research on Mediterranean Diet in Israel. June 2018
The term Mediterranean Diet refers to dietary patterns found in areas of the Mediterranean coastal region. The patterns differ depending on the culture and location, but its main components are mostly the same: high intake of seasonal fruits and vegetables, legumes and whole grains; production and use of olive oil for cooking, moderate consumption of wine and dairy products; and low intake of red meat and saturated fat.
In search of the Israeli-style of Mediterranean Diet, I had to consider broader cultural notions of the nation as they were entwined with its history and with other social themes, such as immigration and religion. All countries are unique, but Israel is arguably more acutely so than many others. The country has several distinctive features. Modern Israel is a new nation, being only 70 years of age. It is a state defined by a religion (a Jewish state), but one that has also revels in being proudly multi-ethnic. Israel is a country that has been remarkably successful at integrating diverse immigrant populations into a unitary nation state, especially considering the extent of the cultural, societal, and population diversity, and short timeframe since its establishment. Israel is a home for people who have suffered cascades of calamities during centuries of dispersion, culminating in the unprecedented horror of the Holocaust. It is also a nation that is embedded in one of the most conflict-ridden regions in the world today.
On the bright side, the shores of the Mediterranean Sea supply an abundance of fresh ingredients; olive trees and vineyards, have been in this area since time immemorial. In Israel, there is also the influence of the lands of the Middle East. For example, oranges and lemons originate from the Far East and were brought to Israel by Arabs. Some people have been inspired by their family heritage, derived from various points of origin. This creates a unique flavor, with sometimes surprising results, from trial and error experimentation which, spurred by curiosity and the desire to create a sense of self-identity, has culminated in a modern Israeli cuisine.
But my research is not about modern cuisine. My goal is to concentrate on traditions and to explore a more natural way of life, as it has been lived by generations in this region dating from the ancient times. The ingenious simplicity of this humble life fascinates me, and explains certain phenomena in very laconic ways, for example how simple 3-4 ingredient dishes from fresh, whole foods are much healthier than any modern smart meal, no matter how supposedly progressive it may be, or how innovative and backed by scientific claims for its benefits it may be.
The reason I chose this topic is because it connects the past with modern days. The Mediterranean diet is the product of a very unique place called the Mediterranean basin, also known as “the cradle of society”, because that’s where the whole history of the ancient world took place. The Mediterranean Diet as a nutritional model, while universally appreciated, is still defined by cultural, historical, social, and territorial factors, which has encompassed the Land of Israel throughout history. The story of this diet and its practitioners explains how the wisdom of ages is sometimes far more truthful than any current innovation can ever apprehend. The science of nutrition is relatively new and it is constantly changes with new findings; In my opinion, its limitation is that it tends to narrow its focus too closely to food components only, where in life, it is the many components of overall lifestyle that predict life expectancy, as well as the quality of life.
The Mediterranean diet dates back to the beginning of civilization, and to this day more and more research results demonstrate it to be the most healthful diet in the world. Israel’s location on the shore of the Mediterranean Sea offers the conditions for a long, healthy life, as described in longevity research findings, which include a great climate producing high amounts of fresh fruits and vegetables. My observations were key in reaching the conclusion that the situation in Israel is changing, as economic forces make it more modern and “Westernized” , which consequently leads to the adoption of the Standard American Diet (SAD) with all its health issues.
Before I dive into the dietary aspect of the Mediterranean coastal life, it is important to mention the other aspect of lifestyle, which is not food, but rather what people do with their time when they are not eating. Western diet and fast food combines with higher stress levels, but is offset by convenience, which often leads to a sedentary lifestyle. That is why it is so important to discuss the history of the nation, when life was less comfortable, as it remains in some parts of the world. That’s when (or where) people walk more and cook more, and approach problems in life with ease and fewer anxieties, due to close family ties and shared responsibilities with community members.
In my research I looked at different aspects of the current Israeli diet while trying to understand it from a historical perspective: how it used to be, how it changed its shape and form due to historical events such as immigration and economy, and how it was influenced by its regional proximity to the Middle East, and then finally, what it has become.
HOW IT USED TO BE: the history of the diet in Israel.
Modern Israeli diet is what remains of the ancient Mediterranean diet, resulting from such influences as immigration, globalization and economic development. To understand the dietary patterns of this particular region, I studied its history first.
Since Biblical times, also known as the time of Jesus, food consumption mainly evolved around 3 main staple ingredients: wheat, barley, and wine. For example, bread and wine was served during The Last Supper of Jesus. The ancient diet also included grapes and olives as a very important part of the Mediterranean diet, and figs, pomegranates, date honey, and whole grain flour made from ancient grains, such as wheat, barley, and spelt. All of these foods are now scientifically recognized as healthy food. The dietary laws of the Bible forbade mixing milk with meat and prohibit eating pig and seafood. These laws, called Kashrut, are still observed by the Orthodox Jewish community.
At the Biblical Reserve in Israel, I undertook an enchanting journey to the ancient Land of Israel to experience the traditions and the atmosphere of that era, and the living conditions prevalent when food was prepared outside over a live fire, where people would collect edible plants and spices in the field before making a meal, and discover through trial and error how some foods were more nutritious and some had medicinal value. Professor Tova Dickstein shared stories of legume consumption during Biblical times, such as the red lentils mentioned in the story of Jacob and Esau, one of whom sold his birthright for the “red stuff”, which most likely was a Middle Eastern version of red lentil soup popular in that region.
When I studied the ancient Middle - Eastern diet, I realized the enormous value of grain, bread, olives, olive oil, spices, and grapes, which become wine.
In the Mediterranean region, there has always been a strong belief that olive oil is the elixir of youth and health. Most centenarians in this region have been inclined to attribute their longevity to diet in general and to olive oil and wine consumption in particular. The Roman Empire was very heavily dependent on oil production, and according to Karen Pantzer, public health nutritionist from Florence, Italy, the olive in Israel had become one of the most basic dietary items in Israel by the time of the Roman conquest. She also mentioned that the history of the Mediterranean diet showed the influence of flavors from Persia and Iraq. Herbal spices were used as a very important staple, and trade records indicate it was exported in very large amounts. Israel’s geographic location on the southern shores of the Mediterranean Sea rendered it the “good land” between the East and the West, the clash of whose cultures produced partial integration, such that even eating habits would partly converge.
At the impressive ruins of the ancient Nabatean city of Shivta in the Negev desert, which dates back to Roman and Byzantine periods, I learned about ancient agricultural and archaeological facts from professor Tali Erickson-Gini. She described that settlers were farming various agricultural crops, and bringing wheat to grinding mills, which served as a social gathering place, both to grind the flour and to exchange it for other food crops.
This carbohydrate-heavy diet in the ancient world makes perfect sense, because meat consumption was minimal due to the difficulty of raising cattle, which, a) take a long time to grow, b) require a large amount of feed, thus making it very expensive. The natural consequence is that grains and plants were always more prominent.
According to Janna Gur the food journalist from Israel, “red meat was consumed very rarely during special occasions around 3 times a year. Meat was not a day to day food, that is why there is so many laws around it, to treat it as unique food that required special care process”. Due to its centrality to ritual, Kosher laws evolved mainly around foods of animal origin.
Ancient winery, which I observed in the Biblical park, apparently dates back to Biblical times. People would drink wine with or after meals, although they typically watered the wine down due to its scarcity, as well as for religious reasons, since being drunk was considered to be a sin. At the Shivta ruins, there was a wine press with two large pits for collecting wine, as well as the smaller, less elaborate wine presses at the site, indicative of both the scale of wine production and its popularity.
The traditional Ancient Roman diet was very basic, limited by the local landscape, found in bread, wine and oil products a symbol of rural culture and agriculture. Their humble diet was considered a key to the performance of soldiers at war and therefore the survival of the nation, so they ate to be strong and healthy. One of the rules was not to overindulge, as overindulgence would have had a negative effect on their physiques as warriors, and their energy levels. Peak fitness and performance was achieved on a diet mainly consisting of locally grown ingredients. Common foods were meat and fish, honey, milk, cheese, bread, and wine. The rich loved the fresh fish and seafood, while slaves and servants were limited to food based on bread and olives. Fish and seafood were frequent in meals, even in rural areas distant from the sea as they were dried or salted. Meat was only present in a few meals, generally during holidays, and lamb was preferred. All of these habits were salutary additions to the Mediterranean diet.
In the centrality of vegetables lies one of the most distinctive traits of the Mediterranean tradition. It is important to remember the role of cereals as the basis of simple cooking, and as a weapon of daily survival, because of their “ability to fill,” reducing hunger in the poor classes and low-income communities.
In many regions of the Mediterranean Basin people were eating the same type of food, even though recipes differed. Fresh fruit grew well in the warm Mediterranean coastal weather, providing the citizens with lots of variety. Dairy was also a commonplace in the ancient diet, consumed in moderation, often as fresh cheese from the milk of local sheep and goats. While visiting Shai Seltzer goat farm in the Judean hills of Israel, I observed firsthand the oldest techniques of artisanal cheesemaking, and learned from people who cherish the authentic traditions of small-batch, locally-sourced seasonal cheesemaking, which kept dairy foods affordable and available to the poor classes, who were able to raise goats or sheep on grass feed, and so produce milk daily. The consumption of milk, aside from calcium, also provided significant amounts of protein of high nutritional value.
During the era of Ottoman rule in the 7th century, this region was governed by the Muslim religion, which prohibited alcohol consumption and introduced spices and foods like rice, sugarcane, citrus, and almonds. Prayers and faith, although subject to conflicting doctrines between Jews and Muslims, still reflected common strong sense of belief in a higher entity and a willingness to fight for their values, traditions, history, and most importantly, land. Diet was regulated by ritual holy days, and the daily diet was mostly plant based. Favorable terroir provided a bounty of legumes and beans. According to linguistic historian Israel Benjamin Hary, by 1200, 90% of the Jewish people spoke Arabic as their native language. Therefore, the cultural overlap becomes more marked, with a stronger Islamic role in the change and transformation of the cultural unity of the Mediterranean.
HOW IT WAS CHANGING: Development of Israeli diet.
The growth in the population of Israel, tenfold or more in less than seven decades since its creation as an independent state, has been an important catalyst for many advances in many aspects of health, both individual and nationwide.
During the 20th century, waves of immigrants came from Northern regions and were introduced to the unfamiliar products and ingredients of the Middle East. Each group had a tendency to hold on to cooking and eating habits brought from its country of origin, which were not always best-suited for life in the Palestine region, and were adjusted over time and through assimilation with the locals. The Jewish community was comprised mostly of Sephardic Jews originating from Arabic countries, where they lived and interacted with Arab neighbors. According to Yael Raviv, the author of “The Falafel Nation,” they had been living in Palestine long before the arrival of the first Zionists around the 13th Century, whereas European Ashkenazi Jews followed afterwards .
Use of seasonal fruits and vegetables by the “natives of the country”, served as an example for other ethnic groups. Some recipes were changed to fit the Israeli palette and temperament and include more locally sourced ingredients. For example, chopped liver salad and pickles were brought from Polish land to Israel, and became one of the most iconic Jewish foods.
Ronit Vered, journalist on food and culture discussed the complexity of Israeli diet with 2 major influences, namely local Arab and Palestinian cuisine, and Jewish communities from different places around the world. She averred that nowadays Ashkenazi food is no longer a big part of the Israeli diet, because it did not survive assimilation to the new land. The local climate and the traditions of the new land together favored olive oil usage in place of the schmaltz (chicken fat) traditional among the Ashkenazi Jews of Europe. Balanced nutrition, and the importance of eating a diet right for a particular climate, were eventually understood and incorporated. Eating a large amount of fruit and vegetables due to the warmer climate, reduced meat consumption, while increasing that of fish and some dairy products, culminated in a distinctive new Mediterranean seacoast diet.
The exhibition called “Table Manners” at Tel Aviv University covered food and its place in culture, and presented works of local artists that reflect the social behaviors and meanings of food, one of the most basic human activities. Artists resonated with the complex history of Israel that shaped modern food, for example during times of hardship ( i.e. immigration or war), when survival is the top priority, saving and stretching food, and using leftovers, takes precedence over any concerns about taste and aesthetics.
During the post-World-War years, the island mentality of Israel, a product of conflict with neighboring countries, encouraged people to use more local products. Hard economic reality promoted the ideal of self-reliance in a new Israeli Jewish nation, different in every way from the old days of the diaspora. Higher import costs during World War II also played a role. This all resulted in the creation of a more united community, which achieved a more homogenous character from a very diverse immigrant society. Originally, when Israeli society was still fighting for its identity in the Middle East, food was valued according to practical considerations: whether it was healthy, economical or difficult to make.
From my personal experience, being a bilingual, multicultural student, I was able to notice how assimilation is felt by Israel’s citizens on a much more deeply personal level than by anyone else. Pride in one's heritage and the urge to assert one's identity amidst a new community were muted for some time, while keeping an open mind and absorbing the way of life as it was lived by people who had been living on the land before you were encouraged.
A variety of ethnic influences from neighboring Arab countries were favored by a new, unified culture and cuisine (even though they were actually from older traditions). Each community learned from others and adopted the most convenient and beneficial practices. Openness to multiple influences helped those whose goal was to build a new life in Israel, while diminishing differences during assimilation. As Janna Gur, food writer and cookbook author, puts it the “history of Israeli cuisine is very diverse and is shaped by the historical changes the land of Israel had been going through.”
The unique and new flavor and aroma contributed to a greater variety of dishes that were consumed and chosen to represent Israeli cuisine, with one common positive characteristic: that they are based on natural, seasonal products of the country. For example, dishes originating from Arab countries, such as hummus and falafel , which originated in Yemen and Lebanon, became popular and were “nationalized” by Israelis. Various foods and recipes were adapted to local ingredients, such as borekas, originally from the Balkan region, and now consumed as an Israeli food and considered to be one of the iconic Israeli foods. Chickpeas were borrowed from neighboring counties in an attempt to create more locally sourced Israeli cuisine, as distinct from the practice of the diaspora.
Dishes from the Middle east and North Africa were also incorporated into the daily Israeli diet, including Arab pita bread, labneh, and shish kebab, among others. Sephardic food is much sharper and spicier, introducing new flavors which included green, red, and black pepper, cumin, cinnamon, and pine nuts, as well as herbs like parsley, cilantro, and lemon. The use of local products is essential for health, besides being of “economic-national importance”, as they boost the health of the citizens, which is evident in the success of the Mediterranean diet. Additionally, local restaurant cuisine in Israel offers an abundance of vegetables, be it as main course, appetizer or side dishes. I was very impressed with the abundance of various vegetable options everywhere I went, from the most popular restaurants to hummus and shawarma joints, all of which offered many colorful plates of vegetarian starters, salad toppings and side dishes.
Located in the Southern Mediterranean, Israeli climate is hotter than other regions of the Mediterranean basin, comprised mostly of sandy deserts. At the research and development agricultural center in Ashelim, I noticed that the desert agriculture, although not easy to master, is still capable of producing fresh foods and vegetables, such as eggplants, which are one of the locally grown vegetables typical of the Mediterranean coastal diet. This one vegetable is unique in its ubiquity. Some favorite Israeli eggplant recipes include eggplant soup, eggplant salads, stuffed eggplant, and eggplant jam.
The Mediterranean traditions of this region offer a cuisine rich in colors, aromas, and flavors, which support the tastes and the spirits of those who live in harmony with nature. The traditional Mediterranean Diet may be summarized in eight components:
high monounsaturated/saturated fat ratio -- use of olive oil, and less of animal products
moderate ethanol consumption --1 glass of red wine a day
high consumption of legumes -- chickpeas, fava beans, and lentils, all great source of plant-based protein
high consumption of grains and cereals -- bread, pita, rice, barley, wheat
high consumption of fruits -- dates, figs, pomegranates, grapes, oranges
high consumption of vegetables -- tomato, eggplant, leeks, onions
low consumption of meat and meat products -- expensive, or not available
moderate consumption of milk and dairy products --sheep and goat milk cheeses
HOW IT IS NOW: The current dietary patterns in Israel.
Human genetic profiles have not changed significantly over the past 10 000 years, whereas, lifestyle has been revolutionized. Modern industrialized populations are characterized by reduced energy expenditure and increased energy intake. Current trends of eating on the go, or while watching television, promote unhealthy, quick meals and hinder social family communication. In the old days, meal times (generally twice a day) nurtured relationships and facilitated communication. The social setting for eating promotes fixed meal times and may overcome the reluctance to change lifestyle experienced today. In Israel, these traditions are cherished and practiced to this day like nowhere else in the world. I am talking about Shabbat dinner, when once a week the whole family gathers around the table for a family meal. This is an important positive aspect, which though driven by religious reasons, contains an incredibly valuable lifestyle component, promoting closer family ties, and most importantly furthers the passage of knowledge, not only about religious traditions, but also recipes for home cooked meals. Joy taken in preparing and eating food with family is an important component of the Mediterranean way of life. I was able to not only observe, but participate in a Shabbat dinner at a Kibbutz, which was a highlight of my visit to Israel. The conviviality of the dinner party, graciously hosted by the family of Professor Lisa Sasson, demonstrated the Mediterranean way of life most vividly and emphatically. I observed that the sense of community in these groups, such as the Kibbutz, all contribute to better health, as a result of lower stress from individual responsibilities, and a strong support network.
Israel is a country of immigrants, much like the US, but on a smaller scale. It is a nation comprised of a multitude of ethnic groups with a widespread openness towards the residents to the outside world, and a wish to be recognized as sophisticated citizens of this world. The growth of the nation has benefited from the absorption of successive waves of immigrants, along with impressive increases in longevity and higher birth rates. The unique challenges and opportunities of immigrant life are driving the development of a new face for the Israeli citizen -- energetic and robust in their approach to life and committed to “never taking life for granted.” The Israel character is worth noting, in order to get a clearer picture of who we are dealing with when talking mostly about their food. The attitude, as described by Nir Avieli in the article “Nobody’s Sucker,” draws a pretty detailed picture of what I was able to observe while in Tel Aviv. Direct and friendly, confident and willful, and even sometimes impatient. The hot climate of the Middle East, combined with the unstable safety conditions and existential security threats, makes an Israeli resident very sharp, alert and shrewd.
The current health status of Israelis, as discussed by Dorit Adler, chief dietician at the Israeli Council for Nutrition Security, is being challenged by the same problems found in the rest of the world - food processing and the lack of nutrition education in low income areas. According to Dorit Adler, “Israel’s 20th century residents are faced with health issues which are closely related to the diet consumed, which very often contains little and insufficient fresh produce, such as vegetables and fruits.” Today’s fast pace and chronic lack of time or money results in a situation where busy people living in urban societies cook at home less often, and therefore become less connected to the land. According to surveys, 15-year-olds who drink soft drinks daily, are present at higher rates in Israel than in the US:
Israel: 41% girls, 45% boys
US: 30% girls, 37% boys
When looking back at historical aspect of beverage consumption, sugar sweetened beverages did not exist before the 20th century; people were drinking more water. Nowadays 1 can a day is the average consumption for teenagers and adults, which accounts for an increase in sugar intake which eventually leads to health issues, such as in increase in weight. Another problem is high sodium intake, which can potentially be harmful and cause heart disease. The recommendation is only 5 grams of salt per day, which is equivalent to about 1 teaspoon. According to chief dietician at the Israeli Council for Nutrition Security Dorit Adler, average consumption of 9.5 grams of salt is recorded for adults, and children 12 grams a day, mostly from ultra-processed snacks and packaged foods, which, unfortunately, are often preferred to homemade cooked meals by the younger generations. The reality is that those foods are heavily marketed items, as well as low-priced, which not only makes them easily affordable, but also more desirable to a modern consumer, who is not easily satisfied and is stimulated by newness and a sense of discovery. Current efforts in promotion of national health are embracing this information. For example, Yaakov Litzman, the Minister of Health, is setting a great example for politicians around the globe by expressing serious concern and offering a clear plan of action, declaring that "Israel must find alternatives to sugary, oily Hanukkah treats, and educate children to eat better. "
That being said, I shouldn’t fail to mention how easy it is to make healthy vegetarian meals in Israel. Anyone can make tahini and drizzle it over eggplant prepared over a fire. During my hands-on cooking experience at the Danon Culinary School in Tel Aviv, I observed how easy and practical it was to make delicious vegetarian meals in a short period of time. It is my belief that having this practical knowledge is essential for living in the big cities, so as to avoid relying on fast food for easy and quick meals. Chef Hagai Lerner mentioned during his class how traditional meals of the Middle East, like hummus and falafel, are enjoyed by people around the world, and that Israel’s capital is proudly considered to be a vegetarian mecca, based on the breadth and popularity of its vegetarian diet. And although the Mediterranean Diet is not vegetarian, most importantly, it is low in the saturated fat and cholesterol long-associated with higher rates of mortality in countries like the U.S.
The leading cause of death in the state of Israel is cardiovascular disease...the same as in the US. According to the World Health Organization, it was responsible for 26% of total deaths in 2014. The Israeli healthcare system is very similar to that of the US, confronting increasing health problems such as obesity and heart disease, which are more common among low-income residents in both countries. In the US we still have food deserts, which are regions where families don’t have access to basic foods. During my studies in Israel, I spent a night at a Bedouin village, where I slept in a tent and was able to observe the humble life that they led. Bedouins are Arab tribes traditionally residing in the Negev region of Israel. Their members had previously sustained themselves through agriculture - herding and growing field crops, but the global decrease in prices on agriculture produce and the development of modern manufacturing techniques have reduced their income. For this reason, the Bedouins have had to look for an alternative means of making a living, while facing the difficulties of living on the periphery and lacking infrastructure. This has led to malnutrition and poor health among the members of Bedouin communities--approximately 4% of Israel’s population.
It is not surprising that these challenges share a common need for inter-ministerial strategic planning integrated at the national level, extending well beyond the Ministry of Health. For its part, the Ministry of Education has an important part to play in nutrition education and health literacy for elementary and secondary schools. The Ministry of Social Affairs and Social Services and Immigrant Absorption addresses many aspects of the socioeconomic underpinnings for desired health outcomes - most importantly, reducing economic disparities and the accompanying health inequities.
The influence of religious leadership cannot be overstated in Israel. The health promotion should be engaged and presented by religious leaders. The religious principles of health preservation and the dietary traditions of home-made meals can be promoted so as to influence the food production and distribution sector with the goal of reducing consumption of fast foods rich in sugar, saturated fat, and excess salt, which endanger the metabolic health of all Israelis, child and adult alike.
Research Discussion: The reason to value the old version of Israeli diet.
While studying research on the Mediterranean diet I found scientific proof of my theory that the natural diet supplied by the abundant land of the Mediterranean coastal region is not only beneficial, but also the healthiest approach to life overall, which, for the most part, requires living actively and relying on local ingredients.
The discovery of the health benefits of the Mediterranean Diet is attributed to the American scientist Ancel Keys of the University of Minnesota School of Power, who pointed out the correlation between cardiovascular disease and diet for the first time in his book called “How to eat well and stay well, the Mediterranean way,” published in 1975. The author was struck by, but could provide no explanation for, this phenomenon: the poor population of small towns in southern Italy was much healthier than the wealthy citizens of New York. During his famous study he evaluated the relationship between lifestyle, nutrition and cardiovascular disease, and was able to prove scientifically the nutritional value of the Mediterranean diet, and its contribution to the health of the population which adopted it, and presented a very low rate of cholesterol in the blood and, consequently, a minimum percentage of coronary heart disease. Starting from these findings, many other scientific researches have analyzed the association between dietary habits and chronic disease. It is now possible to state that there is enough evidence to prove the beneficial qualities of the Mediterranean diet, which include longer lifespan, less cancer, reduction of heart disease, prevention of type 2 diabetes, and longer telomeres.
More recent research conducted in Spain in 2013 concluded that a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the rate of major cardiovascular events. In this study, participants were asked to increase their intake of olive oil, legumes and fish, in comparison with those in the control group. Other research findings that support the benefits of the Mediterranean diet for cardiovascular risk reduction include a study by Harvard School of Public Health. Researchers found that women who regularly consumed a diet rich in olive oil, nuts, beans, fish, fruits, vegetables, and wine in moderation, have a longer life expectancy. Additional factors described that may contribute to the efficacy of the Mediterranean lifestyle include: relaxing psychosocial environment, mild climate, preservation of the extended-family structure, and even a siesta, as well as regular physical activity, such as walking, and an overall active lifestyle. All are important components of longevity and lower the risk of disease.
The July 17, 2008, issue of the New England Journal of Medicine has a well-done study comparing the Mediterranean, low-carb, and low-fat weight-loss diets in an Israeli population over the course of two years. The researchers conclude that the low-carb/Atkins and Mediterranean diets were more effective than the “low-fat” diet currently recommended by the AHA (American Heart Association).
The traditional Mediterranean diet has demonstrable long-term health benefits: longer lifespan, less cancer (colon, prostate, breast, uterus), reduction of cardiovascular disease, less dementia, and prevention of type 2 diabetes. The Atkins diet cannot make those claims.
In defiance of common wisdom, the Mediterranean diet is high in total fat, around 40 % of total energy intake. It should be remembered that consumption of added lipids in the Mediterranean region is higher than the total fat intake in the United States , yet the incidence of heart disease, as well as cancer rates, is higher in the United States, suggesting that these differences are not due to the amount of fat consumed, but rather the type of fat and other components of the diet.
Recent studies imply that other compounds of the Mediterranean diet, such as antioxidants, which exist in abundance in vegetables, fruit, beverages and also virgin olive oil, may contribute to the prevention of heart diseases, and possibly several forms of cancer and other diseases, thus providing a plausible explanation for its apparent benefits. Fruits, vegetables and beverages contain a significant amount of flavonoids; whereas the main polyphenolic compounds of virgin olive oil, also have antioxidant properties. These antioxidants are central to the benefits of the Mediterranean Diet and help explain the relatively low incidence of several forms of cancer in the Mediterranean region.
The main takeaway from the research findings is the Mediterranean Diet Food Pyramid , with its emphasis on the important concept of “proportionality”, that is, choosing the the right amount of foods from for each group--the “portion” size decreases as the pyramid level rises, and “variety” is defined as changing the choices within each food group, and “moderation” in the consumption of certain foods, such as fats and sweets.
Biochemical, clinical, and epidemiologic research during the last 15 years has provided a solid biologic foundation for the health benefits of the Mediterranean diet. It further proves that moderate drinking of alcoholic beverages reduces the risk of coronary heart disease, by increasing levels of serum high-density lipoprotein (HDL) cholesterol. More importantly, it has been observed that monounsaturated fat, namely olive oil, increases HDL substantially as well.
Although there have been setbacks in the Israeli style Mediterranean diet, as well as a lot of challenges and changes, nevertheless the laborious collection of products in the land of Israel ensures, that if consumed in an appropriate manner, in a diet rich in tradition and in association with one active lifestyle, it is the model that everyone should follow.
Authors of the “Health is Israel” series of articles suggest that Israel has achieved important milestones in health. Nevertheless, this trajectory of achievement is threatened by various serious challenges, including insufficient progress in resolving health disparities in income and employment.
In conclusion, the Mediterranean diet emerged as a healthy food regimen long before it was recognized which nutrients or foods were responsible for its observed benefits. It was only in the middle of last century that the first scientific approaches appeared. Studies converged, first by investigating at single nutrients or foods, then by adopting the more holistic approach of dietary patterns. Lifestyle factors such as physical activity for energy balance, outdoor life for vitamin D synthesis, and conviviality, are probably also partly responsible for the health benefits.
My research findings seem congruent with the current recommendations of nutrition counselors, and their main thrust that, through education, we can raise awareness of the importance of eating locally sourced, seasonal produce, which is far more beneficial than any ultra-processed smart meal with health claims and a long ingredients list. It is important to educate the citizens of Israel, just as we do in the States, about the individual’s responsibility to make the right choice when it comes to food, diet and an overall lifestyle. History serves as a great example of how the Mediterranean diet and lifestyle was shaped by climatic conditions, poverty and hardship, rather than by intellectual insight or wisdom. In matters ranging from the means of survival to matters of wise consumption, it becomes clear that people should treat food as natural nourishment from the land they live on, and feed their community with the food they make by hand. We are now well under way to understanding that there’s nothing better for human health then what is created by nature. And the results from methodologically superior nutritional investigations have provided strong support for the benefits of the Mediterranean way of life. The greatest thing that one can do to promote this way of life is to support local farmers and artisanal food producers, such as cheese makers and small wineries, by consuming fresh seasonal produce grown in the region.
Evidence shows that the Mediterranean diet can contribute to greater health among the Mediterranean residents, although cultural and economic changes effects such as Westernization are leaving it vulnerable to the major health problems of the First World, i.e diabetes, cancer and cardiovascular disease. Nature has been trying to tell us, through the otherwise unexplained good health of the Mediterranean people, that the further you get from nature, the sicker you become.
I come away from the Holy Land with a great sense of appreciation for the Israeli-style Mediterranean diet and admiration for its cornucopia of food and recipes, as well as providing an important point of contact between the people and the land. I feel optimistic about any ongoing challenges. I believe that by increasing the investment in the health sector, which includes the social, political, and educational underpinnings of health, far more can be achieved to shift Israel to a model of global stature in health and education, and turn health into an engine for economic wellbeing and development. As the nation’s first Prime Minister, David Ben-Gurion, put it, “In Israel, in order to be a realist, you must believe in miracles.”
References:
Healthy Traditional Mediterranean Diet: An Expression of Culture, History, and Lifestyle Antonia Trichopoulou, M.D., and Pagona Lagiou, M.D. Lead Review Article November 1997, 383-389.
The Mediterranean diet: health, science and society. Mariette Gerber, Richard Hoffman. British Journal of Nutrition (2015), 113, S4–S10
The Mediterranean Diet: A History of Health. Roberta Altomare, Francesco Cacciabaudo, Giuseppe Damiano. Review Article, Iranian J Public Health, Vol. 42, No 5, May 2013, pp 449457.
The Middle Eastern and biblical origins of the Mediterranean diet. Elliot M Berry, Yardena Arnoli, and Michael Aviram. Public Health Nutrition: 14(12A), 2288-2295. September 7, 2011.
Israel: Health and beyond. Karl Skorecki, Richard Horton. Health in Israel 5, Lancet 2017, 389: 2551-62. May 8, 2017.
Primary Prevention of Cardiovascular Disease with a Mediterranean Diet, The New England Journal of Medicine. Ramon Estruch, M.D., Ph.D., Emilio Ros M.D., Ph.D. April 4, 2013. Vol.368 No 14
Keys, AB (1980) “Seven countries: a multivariate analysis of death and coronary heart disease”. Cambridge, Mass Harvard University Press.
World Health Organization, Noncommunicable country profile, 2014.
Mediterranean Diet and telomere length in Nurses’ Health Study population based cohort study. British Medical Journal 2 December, 2014. BMJ 2014;349:g6674
Shai, Iris, et al. Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet. New England Journal of Medicine, 359 (2008): 229-241.
“How to eat well and stay well, the Mediterranean way”, Keys AB, Keys M. 1975 New York: Doubleday.