Lesson 8 mediterranean menu vegetarianism cancer osteoporosis

Dietetics and Nutrition in the Mediterranean
By Dr. Alberto Fatticcioni

Mediterranean diet rules
The Mediterranean diet is principally a plant based diet. Everyday the “mediterranean way” consists of:
vegetables (at least 300-400 g a day)
fruit (at least 4 pieces or 400 g a day)
legumes and pulses
grains, pasta and/or bread (mostly wholemeal and unrefined)
olive oil and nuts
an abundant use of herbs and spices
water (more than 2 liters per day)
wine during meals ( maximum 2 glasses per day )

In the Mediterraneandiet the mostimportant source ofanimalfoodisfish. The Mediterraneanis a seawhichisrich in fish, and to do things the “mediterranean way” weneedtoeatseafoodfrequently:
seafood (fish, shellfish, mollusc), recommended 4-6 times a week, at leasttwiceweekly

The intakeofdairy produce is low to moderate and usually in the formofgoat’s and sheep’s cheese or yoghurt.
yoghurt, recommended 2 - 4 times per week
cheese, recommended 1 - 4 times per week
milk, recommended 1 - 2 times per week
eggs, recommended 1 - 4 eggs per week (maximum 1 a day)

The Mediterraneandietconsists in a low intakeofsweets, poultry and redmeat, thesetypesoffoods are a sortof “specialoccasionfood”.
Processedfood and junk food are forbidden.
poultry, recommended 1 - 2 times per week
redmeat, recommended 0 - 1 time a week
sweets, recommended 0 - 1 time per week
no junk food

Mediterranean Vegetables
Vegetables are the most complex food we eat.
Roots and tubers (potatoes, carrots and parsnip)
Lower stems and bulbs (beets, celery root, turnip, radish, onion, garlic, leeks)
Stems and stalks (asparagus, celery, fennel, kohlrabi, cardoons)
Leaves (lettuces, chicories, dandelion greens, cabbage, kale, brussels sprouts, rocket, spinach)
Flowers (artichokes, broccoli, cauliflowers)
Fruits used as vegetables (tomatoes, eggplant, sweet peppers, cucumber, zucchini, pumpkin)

Mediterranean Fruits
Cherries
Watermelon
Fig, fresh and dried
Kaki
Melon
Pomegranate
Medlar
Kiwi
Clementine
Peches
Grapefruit
Blackberry
Raspberry
Blueberry
Redcurrant
Lemon
Persimmon
Plum, fresh and dried
Grape
Apple
Apricot
Orange
Strawberry
Pear

Mediterranean legumes
Chickpeas (dried and flour)
Lentils
Fava beans (fresh and dried)
Borlotti beans (fresh and dried)
Cannellini beans (fresh and dried)
Peas
Black Eyed Beans
Grass Pea

Mediterranean Grains
Durum wheat (whole pasta or refined, couscous)
Soft wheat (whole bread or refined)
Farro
Rice (whole or refined)
Maize (cornmeal)

Mediterranean Fats
Extravirgn olive-oil
Olive
Almond
Hazelnut
Walnut
Pine nuts
Pistachios
Flaxseeds

Mediterranean Seafood
Anchovies
Sardines
Tuna
Swordfish
Mekerel
Eel
Trout
Oyster
Mussels
Clam
Octopus
Squid
Ray
Shrimp
Cod
Cuttlefish
John Dory
Ombrine
Dogfish
Pike
Lobster
Sole
Salmon

MediterraneanDietRules
vegetables (at least 300-400 g a day)
fruit (at least 4 pieces or 400 g a day)
legumes and pulses
grains, pasta and/or bread (mostlywhole)
olive oil and nuts
water (more than 2 liters per day)
wine duringmeals ( maximum 2 glasses per day)
seafood (fish, shellfish, mollusc), 4-6 times a week
yoghurt, 2 - 4 times per week
cheese, 1 - 4 times per week
milk, 1 - 2 times per week
eggs, 1 - 4 eggs per week (maximun1 per day)
poultry, 1 - 2 times per week
redmeat, 0 - 1 time a week
sweets, 0 - 1 time per week

Vegetariandiets: historicalcontext
Forcenturiesvegetariandiets have been used in different parts of the world for various reasons.
Phythagoras is considered the founder of the vegetarian movement and advocates included other ancient Greeks, Hebrew writings documented the practice of vegetarian diets even from Old Testament Bible times. Eastern religions, including Buddhism, Zainism, and Hinduism, also promote vegetarian diets and continue to urge preservation of animal life.

In the 18 thcentury, Benjamin Franklin wasperhaps the mostfamousof the scientists, physicians, and philosopherswhosupportedvegetariandiets.
The vegetarianmovementexpandedconsiderably in the 19 th and 20 thcentury.
A 1994 surveyreportedthat some 12.4 million people in the UnitedStatescallthemselvesvegetarians. The samepolladministered in the year 2000 concludedthat 2.5% of the USA population can beconsideredvegetarian.

The reasonsforadopting a vegetarian lifestyle are varied. Historically, vegetarian diets were associated with certain religious practices. Currently, health appears to be the primary reason for adopting a vegetarian diet. Other reasons encompass ecologic and environmental issues relating to the large differences in resources necessary to support animal and plant based diets. Another common reason relates to ethical concerns about the treatment of animals for clothing or research. In many cases, however, multiple reasons underlie vegetarian dietary practices.

Vegetariandiets: definitions
The termvegetarianencompasses a wide rangeofdietarypractices; cerealgrains, fruits, vegetables, legumes, nuts and seedsform the basisofvegetariandiets, withvarying amounts of dairy products and eggs. Vegetarians exclude meat; the type of animal products included frequently are used to identify the kind of vegetarian diet:
Lactoovovegetarians (LOVs)
Lactovegetarians
Ovovegetarians
Vegans (exclude all animal products)
Fruitarians (fruits, vegetables fruits, nuts, seeds)

Vegetariandiets: dietaryintake
Dietsofvegetarians tend to be lower in total fat, saturated fat and cholesterol, and higher in fiber, than the diets of non-vegetarians. Vegetarians tend to consume more grains, legumes, vegetables, fruit and wine than non-vegetarians.
Other studies also reported that, among vegetarians, intakes of soy and nutrients such as folate, vitamin C, beta-carotene, vitamin E, copper, and magnesium are higher than among non-vegetarians, but intakes of vitamin A, vitamin B12, vitamin D, omega-3, calcium, selenium and zinc are lower.

Vegetariandiets and protein
Oneof the mostfrequentquestionsregarding the nutritionaladequacyofvegetariandietsrelatestoproteinrequirements. However, the inadequateenergyintake in some vegetariansmay compromise protein status aswell. Moreover, becauseof the lowerdigestibilityofplantproteins, the proteinrequirementofvegansmaybehigherthanthoseofnon-vegetarians.
Foodsofplantorigin are oftensaidtolackcertainindispensable amino acids and thustoprovideproteinoflesserqualitythan in foodsofanimalorigin.

RecommendedProteinIntake
Infants: 2.2 grams per kg of body weight.
Children: 1.0-1.6 grams per kg of body weight.
Adults: 0.8 grams per kg of body weight.
Adultathletes: 1.5-2.0 grams per kg of body weight.
Currentevidencesuggeststhat a lowerintakeofanimalproteinmaybebeneficial and maylowerurinarycalciumexcretion and slow the progressionofrenaldisease and osteoporosis; thisrelathionshipisnotseenwhenplantproteinisconsumed.

Vegetariandiets and protein
Two amino acids are ofparticular interest in vegetariandiets; lysine, the limiting amino acid in cerealgrains, and methionine, the limiting amino acid in legumes.

Compositionof Dry Legumes

Vegetarians, Legumes and Protein
Legumesare 20 to 25% proteinbyweight, whichisdouble the proteincontentofwheat and threetimesthatofrice. Forthisreason, legumesare called "vegetarian's meat". Whilelegumesare generally high in protein, and the digestibilityofthatproteinisalso high, theyare oftenrelativelypoor in the essential amino acid methionine. Grains (which are themselvesdeficient in lysine) are commonlyconsumedalongwithlegumestoform a complete proteindietforvegetarians.

Legumes and Aminoacids
Legumescontainrelatively low quantitiesof the essential amino acid methionine. To compensate, the MediterraneanDietserveslegumesalongwithgrains, which are low in the essential amino acid lysine, whichlegumescontain. Thus a combinationoflegumeswithgrainsforms a well-balanceddietforvegetarians. Common examplesofsuchcombinations are pasta and beans “pasta e fagioli” andemmerwheat and legume soup “zuppa di legumi e farro”.

Complete proteinfoodforvegetarians
Complete proteinscontain a balanced set ofessential amino acidsforhumans. Animalsourcessuchasmeat, poultry, eggs, fish, milk, and cheeseprovideallof the essential amino acids. Near-completeproteins are alsofound in some plantsourcessuchasquinoa,buckwheat, and amaranth. Soyaappearsaslower in methionine and cysteine. Itisnotnecessarytoconsumeplantfoodscontaining complete proteinsas long as a reasonablyvarieddietismaintained. Byconsuming a wide varietyofplantfoods, a full set ofessential amino acidswillbesuppliedand the human body can convert the amino acidsintoproteins.

Vegetarians and Iron
Non-hemeironfromplant foods is less available than heme iron, and plant foods contain a variety of substances known to reduce iron availability. However, plant foods also contain other substances that enhance iron uptake, and well-planned vegetarian diets often contain more iron than omnivorous diets.
Some studies suggest that long-term LOVs, even with a higher fiber intake, maintain iron status no different from that of omnivores. The high levels of iron in well planned vegetarian diets (15-20mg per day) combined with the frequent intake of fruits and vegetables rich in vitamin C appear to protect against iron deficiency.

Top 10 plant foods richest in iron/100 g
14,30 mg pure cocoa
10,00 mg germ of wheat
9,00 mg dried beans
8,00 mg lentils
7,80 mg green radicchio
7,30 mg pistachios
6,40 mg chickpeas
5,30 mg dried apricots
5,20 mg arugula, oats
5,00 mg dark chocolate, fava beans
4,50 mg peas

Top 10 plant foods richest in iron/100 g
4,00 mg buckwheat
3,90 mg dried plums
3,50 mg peanuts, olives
3,30 mg hazelnuts, raisins
3,00 mg dried figs, almonds, whole flour, dried dates
2,90 mg spinach
2,70 mg green beetroots
2,60 mg walnuts
2,00 mg chard
2,00 mg zucchini flowers
1,70 mg endives

Top 10 foodsforVitamin C content /100g
Redcurrants 200 mg
Red peppers 151 mg
Broccoli and arugula 110 mg
Kiwis 85 mg
Brusselsprouts and turnip 81 mg
Cauliflower 59 mg
Strawberries, clementines, spinach 54 mg
Oranges and lemons 50 mg
Kale 47 mg
Tangerines 42 mg

Top 10 fruitsforVitamin C content /100g
Redcurrants 200 mg
Kiwis 85 mg
Strawberries and clementines 54 mg
Oranges and lemons 50 mg
Tangerines 42 mg
Grapefruit 40 mg
Melons 32 mg
Raspberries 25 mg
Persimmons 23 mg
Blackberries 19 mg

Vegetarians and Vitamin B12
The usualdietarysources of this vitamin are animal products, plants do not synthesize or store vitamin B12; persons who include only plant foods in their diet, such as vegans and others who consume only raw foods, are at increased risk of deficiency. Vitamin B12 deficiency can result in serious and irreversible neurologic and neuropsychiatric abnormalities. Serum vitamin B12 levels in vegans are generally lower than those in omnivores, with intermediate levels found in LOVs. The requirement of vitamin B12 is very low and cases of B12 deficiency are rare.

Foodsrich in VitaminA mcg/100g
Carrots 1149
Pumpkin 599
Spinach 485
Pecorino 380
Parmigiano 373
Apricots 360
Cicory 267
Chard 263
Kaki 237
Lettuce 229
Broccoli and eggs 225
Brusselsprouts 220
Mozzarella 219
Endives213
Celery 207
Melon 189
Medlar 170
Escarole 167
Sweetpeppers139
Ricotta 128

Vegetarians: Calcium and Vitamin D
Adequatecalcium and vitamin D intakes are importanttoensureoptimalbone status over lifetime. Evidence suggests that calcium may also be important in regulating blood pressure and preventing colon cancer (milk and dairy products supply 70% of calcium in US diets).
Calcium intake among LOVs appears to be similar to that of omnivores, whereas intake in vegans is less; in addition, vegans, consume less vitamin D. The low consumption of vitamin D may be further exacerbated in some cases by limited exposure to light.

Vegetarians: Calcium and Vitamin D
Low vitamin D concentrations and secondaryhyperparathyroidismweredocumentedduring the winter in vegans living at northernlatitudes. In some casesbonemineral density tended to be lower in the vegan group compared with lactovegetarians and omnivores. A high intake of sodium increases calcium excretion (the same for animal protein).
Vegans may need to give attention to obtaining an appropriate calcium intake especially during periods of growth.

Foodsrichest in Calciumcontent mg/100g
Pecorino 1160
Parmigiano 1159
Arugula 309
Ricotta 295
Almonds 240
Driedfigs 186
Oysters 186
Green beet 160
Mozzarella 160
Hazelnuts 152
Cicory 150
Anchovies 148
Octopus 144
Squid 143
Chickpeas 142
Cannellini 132
Walnuts 131
Agretti 131
Pistachios 130
Yogurt 125
Milk 119
Radicchio 115
Shrimps 110
Buckwheat 110
Borlotti 102
Broccoli 97
Cardoons 96
Endives 93
Fava beans 90
Mussels 88
Artichokes 86
Driedapricots 85
Spinach 78
Raisins 78
Dates 69
Chard 67
JhonDory 65
Hare 64
Olives 63
Kale 62
Cauliflower 60

Foodsrichest in Vitamin D contentmcg/100g
Tuna 16.30
Anchovies 11
Swordfish 11
Trout 10.60
Pike 10.60
Carp 10.60
Shark 9.10
Salmon 8
Eel 4.90
Sardines 4.50
Butter 4.35
Eggs 1.75

Vegetarians and Zinc
Meat, fish, and poultryprovide 40 to 45% of the zinc in the US diet; the absorptionforzincisreducedwithvegetariandiets.
An Australian study found that vegetarian women had significantly lower zinc intake than omnivores, but their zinc concentration was not different.
A lower zinc intake was found among vegetarian children and adolescents, but growth was not affected; the vegetarians in the study were slightly taller than the non-vegetarians.

Foodswithrichestzinccontent mg/100g
Beefliver 6
Beef 5,70
Ham 5,20
Octopus 5,10
Anchovies 4,20
Cuttlefish 4,20
Parmigiano 4
Rabbit 3,90
Bresaola 3,87
Horsemeat 3,72
Hare 3,65
Cannellini 3,6
Pecorino 3,50
Chickpeas 3,20
Squid 3,10
Oats 3,10
Walnuts 3
Whole pasta 3
Artichoke 2,90
Borlotti 2,90
Lentils 2,90
Mozzarella 2,60
Mushrooms 1,50
Spinach 1,43

Vegetarians and omega-3
Vegetariandiets are typically low in omega-3 polyunsaturatedfattyacids.
Sourcesrich in omega-3 suchasflaxseed, walnuts, canolaoils and soyoilsshouldbeincluded in the vegetariandiet, and the intakeofrich omega-6 fattyacidsshouldbedecreasedtooptimizeconversiontoeicosapentanoic acid and DHA.

Percentageof Omega-3, Omega 6, and Omega-9 FattyAcids In Some SaladCookingOils

OSTEOPOROSIS

Osteoporosis
One and halfmillionosteoporotic fractures of the spine, wrist, hip and other sites occur each year, primarily in postmenopausal white women.
In the United States, direct medical costs of fractures among the population age 45 an older totaled nearly $14 billion in 1995. Treatment of men accounted for approximately $3 billion, or 20% of the total amount.
Physical inactivity and diet are the most important risk factors of this pathology.

Osteoporosis
The term osteoporosis refers to a condition in which the skeleton is subject to an increased risk of fractures due to the decreased mass and alteration of bone microarchitecture.Osteoporosis, although generally considered as a disease of the bones, for some is a paraphysiological process; the presence of which predisposes to a greater development of diseases and a consequent reduction in life expectancy, if not properly treated.

Types Osteoporosis is divided into primary (original) or a secondary event related to or achieved (hyperparathyroidism, osteotoxic drugs, etc.). The primary form is the most exclusive form (95% of cases).
Primaryosteoporosis
* Idiopathicosteoporosis (the rarestformofall, the cause isunclear * Type I osteoporosis or postmenopausal (due to a fall in hormone production)
* Type II or senile osteoporosis (due tovariouscauses, includingimmobilization, reduced production ofsomatotropin, testosterone, calcium, magnesium, vitamin D and otherimportantmicronutrients, reducedfunctionof the enzyme 1a-hydroxylase whichproduces the activehormonevitamin D, ie, calcitriol).
Occurs mainly in trabecular bone, this is the shape with a greater number of fractures.
Secondaryosteoporosis
The secondaryosteoporosisis a group full ofvariations, buttheyrepresentonly 5% ofosteoporosis. The mainones are classifiedascausedby: * Hyperparathyroidism * Osteopenizzantidruguse (steroids, antiepilepticdrugs, heparin, oralanticoagulants, loopdiuretics) * Low body weight * Prolongedimmobilization * Hypersurrenalism * Hypercalciuria * COPD (chronicobstructivepulmonarydisease) * Rheumatoidarthritis Sarcoidosis * * Celiacdisease * Malignancy * Reducedintestinalabsorptionofnutrients

Etiology
The cause is the loss of the balance between osteoblasts and osteoclasts. The first category of cells contributes to bone formation, the latter contributes to bone reabsorption, where osteoclasts working faster than osteoblasts, the bone deteriorates. Menopause (form I) there is an increased production of osteoclasts, due to loss of estrogen that leads to a possible elevation of cytokines, related to the production of osteoclasts. In the second form, with advancing age the activity of osteoblasts decreases.

Symptomatology
Osteoporosis is manifested initially by a decrease in tone calcium in bone mass (osteopenia). The bones more easily affected by the decrease in tone lime are the vertebrae back injury, the femur and the wrist.Initially asymptomatic, that is for 2 / 3 of people. The first signs appear with fractures, bone pain and muscle such as is typical of the presence of fractures, but they may also go unnoticed by the individual and can show even the least traumatic. Usually the pain is back, is acute and growing in the presence of load. With the further development of osteopenia vertebral collapse or fracture of femoral neck may occur.The fractures can lead to cervical cyphosis and lordosis.

Riskfactors
Uneditable
* Age - is the highest risk factor, as usually happens in old age deterioration of bone mass, very important for women is also the age at which you reach the menopause
* Genetic factors, including whether or not you are completely * Lack of hormones such as estrogen (for females), somatotropin, testosterone (for both males and females, the only form II);
* Presence of diseases like cirrhosis, rheumatoid arthritis * Hereditary diseases: osteogenesisimperfecta, homocystinuria, renal tubular acidosis
* Endocrine abnormalities, Cushing's syndrome (excess cortisol)
Invariant
* Diet, lackofcalcium, protein, vitamin C. and vitamin D
* Low body weightmustbelessthan 85% ofthatconsideredideal, or otherwisegenerallyaround 55 kg;
* Abuseofalcohol
* Cigarette smoking
* Algodystrophy
* Anorexia nervosa
* Physicalinactivity, whichrangesfrom a sedentarylifestyleuntil the paralysis;
* Hypercalciuria (urine pH low acid) Hypogonadism
* Useofdrugssuchasheparin, methotrexate, ethanol and glucocorticoids, which alter the metabolism and produce damagetobones
* Neoplasmsbonemarrow

Nutritionaldeterminantsofbone density
Manynutritionalfactors have been examined for associations with osteoporosis and bone mass. Calcium, phosphorus, trace minerals, and protein are components of bone tissue.
The most important nutritional determinants are:
calcium intake
vitamin D, A, K
potassium
protein
Sodium
caffeine
alcohol

Bone density and calcium
Bone mass duringchildhoodand adolescence can be increased by increasing calcium intake; adequate intake values of 1300 mg/day for age 9 through 18 years and 1000 mg for ages 19 through 50 years, for both men and women.
Increased calcium intake causes about a 10 to 15% reduction in the bone remodeling rate in adult women; 1000-1500 mg/day is correct calcium intake for premenopausal and postmenopausal women.
With foods rich in vitamin C it is possible to absorb more calcium.

Foodsrichest in Calciumcontent mg/100g
Pecorino 1160
Parmigiano 1159
Arugula 309
Ricotta 295
Almonds 240
Driedfigs 186
Oyster 186
Green beet 160
Mozzarella 160
Hazelnuts 152
Cicory 150
Anchovies 148
Octopus 144
Squid 143
Chickpeas 142
Cannellini 132
Walnuts 131
Agretti 131
Pistachios 130
Yogurt 125
Milk 119
Radicchio 115
Shrimp 110
Buckwheat 110
Borlotti 102
Broccoli 97
Cardoons 96
Endive 93
Fava beans 90
Mussels 88
Artichoke 86
Driedapricot 85
Spinach 78
Raisin 78
Dates 69
Chard 67
JhonDory 65
Hare 64
Olive 63
Kale 62
Cauliflower 60

Top 10 foodsforVitamin C content/100g
Redcurrant 200 mg
Red pepper 151 mg
Broccoli and arugula 110 mg
Kiwi 85 mg
Brusselssprouts and turnip 81 mg
Cauliflower 59 mg
Strawberry, clementines, spinach 54 mg
Orange and lemon 50 mg
Kale 47 mg
Tangerines 42 mg

Top 10 fruitsforVitamin C content /100g
Redcurrant 200 mg
Kiwi 85 mg
Strawberry and clementines 54 mg
Orange and lemon 50 mg
Tangerines 42 mg
Grapefruit 40 mg
Melon 32 mg
Raspberries 25 mg
Persimmon 23 mg
Blackberries 19 mg

Bone density and Vitamin D
The roleofvitamin D insufficiency in osteoporosis is recognized. Increasing intake of vitamin D can increase intestinal calcium absorption, lower the circulating levels of PTH (parathyroid hormone) and reduce rate of bone loss.
There is also evidence that supplementation with vitamin D can lower fractures.

VitaminD richestfoodmcg/100g
Tuna 16,30
Anchovies 11
Swordfish 11
Trout 10,60
Pike 10,60
Carp 10.60
Shark 9,10
Salmon 8
Eel 4,90
Sardines 4,50
Butter 4,35
Eggs 1,75
40 to 80 mcgofvitamin D are recommended in osteoporosis

Bone density and potassium
An increase in serum potassium concentration arising from high dietary potassium intake, stimulates intestinal calcium absorption; increasing potassium has an opposing effect on calcium lost through the urine.
Prolonged dietary potassium deficiency can deplete the serum level and result in enhanced resorption of this mineral from bone. For a portion of the elderly population, potassium deficiency is a concern.

Top 10 fruitsforpotassiumcontent/100g
kiwi 400
bananas350
melon333
apricots320
pomegranate290
watermelon280
figs270
peches, blackberries260
ananas, medlar, 250
grapefruit230
cherries229
raspberries220
clementines210
oranges200
grape192
plums, susine 190
kaki 170
strawberries, blueberries160
pear127
apple125

Bone density and sodium
Sodium causes an increase in renal calcium excretion. At the high levels of sodium intake typical in US, more than 90% of ingested sodium is excreted.
Optimal intake to minimize bone loss were estimated at approximately 1000 mg/day of calcium, 4000 mg/day of potassium and no more than 2000 mg of sodium

Lesson 8 mediterranean menu vegetarianism cancer osteoporosis

by Alberto Fatticcioni on May 06, 2010

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Lesson 8 mediterranean menu vegetarianism cancer osteoporosis — Presentation Transcript