1. The “MODMED” Diet
Based on the traditional Mediterranean
diet, this presentation is where the
“MODMED” diet was conceived
Albert Zumbé & Adam Lee
© Natraceutical UK 1st of March 2004
For more information: Info@natrauk.com

2. The Modern Mediterranean Diet
A diet for people on the move…..
Albert Zumbé & Adam Lee
Natraceutical S.A.
May 2004
Autovia A-3. Salida 343
Cami de Torrent, s/n 46930
Quart de Poblet
Valencia, Spain

3. Fact: the importance of nutrition
 Nutrition is a recognised key health
determinant1
 Poor diets are directly related to the increasing
burden of chronic diseases in Western
populations, notably:



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Cardiovascular disease
Obesity & its co-morbidities (diabetes)
Various cancers
Osteoporosis
1
Kafatos (2003) EGEA, International Conference on Health Benefits of the Mediterranean Diet

4. The North American/Western Diet
 The typical North American/Western diet is
characterised by2,3,4,5
High intakes
Low intakes
Sugars
Fresh fruits
Refined carbohydrate
Fresh vegetables
Saturated fats
Dietary fibre
Red meat
Some micronutrients
Frazao & Allshouse (2003) J. Nutr. 133: 844S-847S
Kantor (1998) USDA Report No. 772
4
ERS (2002) www.ers.usda.gov/data/foodconsumption
5
Howarth et al (2001) Nutr. Rev. 59: 129-139
2
3

5. Recommended and actual daily
dietary intake in the US3
Recommended
intake
Actual intake
Fats, oils, sweets
Use sparingly
34 tsp. added sugars
& 64 g added fats
Meat, poultry, fish,
beans, eggs, nuts
2 – 3 servings
2 – 5 servings
Fruit
2 – 4 servings
1.4 servings
Vegetables
3 – 5 servings
4 servings
3
Kantor (1998) USDA Report No. 772

6. “America has become the land of
the obese6”
 Obesity has become pandemic in the United
States:





61% of Americans >20 years are overweight or
obese7
At least 25% of Americans are clinically obese7
24% of the population has metabolic syndrome8
Obesity leads to 300,000 premature deaths every
year9
Obesity costs $90 billion in direct health care costs
annually in the USA alone9
Moore (2003) Cleve. Clin. J. Med. 70: 237-240
Montague (2003) ABNF J. 14: 56-60
8
Bray & Champagne (2004) J. Am. Diet. Assoc. 104: 86-89
9
Manson et al (2004) Arch. Intern. Med. 164: 249-258
6
7

7. The consequences of obesity and
physical inactivity
“Modern times may be characterised as a ‘feast’
environment, the consequences being an increase in
risk for several diseases”10
Cardiovascular disease11
 Hypertension12
 Type 2 diabetes12
 Insulin resistance12
 Cancer13

Wargovioch & Cunningham (2003) J. Nutr. 133: 2400S-2403S
Dubbert et al (2002) Am. J. Med. Sci. 324: 116-126
12
Sowers (2003) Am. J. Med. 115: Suppl 8A; 37S-41S
13
Giovannucci (2003) J. Womens Health 12: 173-182
10
11

8. Environmental & “lifestyle” factors
in the development of obesity
“Obesity is a multifactorial disease in which
environmental and genetic factors interact”14
Some environmental factors:
Poor palatability of alternative diets2
Poor nutrition knowledge2
Sedentary lifestyle9
Excess energy intake12
Increased portion sizes15
Increased availability of convenience food16
Busy lifestyle/time constraints16
Frazao & Allshouse (2003) J. Nutr. 133: 844S-847S
9
Manson et al (2004) Arch. Intern. Med. 164: 249-258
12
Sowers (2003) Am. J. Med. 115: Suppl 8A; 37S-41S
2
Clement et al (2002) Am. J. Pharmacogenomics 2: 177-187
Bellisle (2003) Nutr. Metab. Cardiovasc. Dis. 13: 189-193
16
Jeffery & Utter (2003) Obes. Res. 11: 12S-22S
14
15

9. The urgent need to reduce obesity
& obesity related disorders
 “The public would benefit from increased
availability of foods and food products low in
calories and total fat”17
 “Epidemiologic data and clinical trials suggest
that the beneficial impact of specific dietary
and lifestyle changes on cardiac event rates
could be greater than that achieved by any of
the drug or revascularisation trials to date” 18
17
18
The Surgeon General’s report on Nutrition & Health (1988) U.S. Dept. of Health & Human Services
Barringer TA (2001) Curr. Atheroscler. Rep. 3: 437-445

10. How to achieve a healthy diet & weight:
Recommendations of the American Heart
Association19
The AHA recommends consumption of:
 Fruits & vegetables
 Grains &
wholegrains
 Fish
 Lean meat
 Poultry
 Fat-free products
 Low-fat dairy
products
 Legumes
 Soluble fibre
 Plant sterols
 Less saturated fat
19
Kris-Etherton et al (2002) Curr. Opin. Lipidol. 13: 397-407

11. Which healthy diet can fulfil the
recommendations of the American Heart
Association?

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
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


Help achieve a healthy weight
Promote heart-health
Promote desirable lipid levels
Promote desirable blood pressure
Reduce risk of diabetes & metabolic syndrome
Reduce cholesterol levels
Is varied & pleasurable to consume

12. The Mediterranean Diet
“A proven cultural model for healthy
eating”20
20
Willett et al (1995) Am. J. Clin. Nutr. 61; (Suppl 6): 1402S-1406S

13. The Mediterranean basin: more than
20 countries border the Mediterranean
Spain
France
Italy
Greece
Turkey
Lebanon
Syria
Israel
Egypt
Libya
Morocco

14. Some characteristics of the
Mediterranean diet20,21
 Based on food patterns typical of Crete, most
of Greece & Southern Italy in the early 1960’s
 Adult life expectancy amongst the highest in
the World
 Rates of heart disease, cancers & diet related
diseases amongst the lowest in the World
 Lifestyle included regular physical activity
 Attractive, varied dietary pattern
 Highly palatable & enjoyable
20
21
Willett et al (1995) Am. J. Clin. Nutr. 61; (Suppl 6): 1402S-1406S
Nestle M (1995) Am. J. Clin. Nutr. 61; (Suppl 6): 1313S-1320S

15. Composition of the Mediterranean
Diet22
 High consumption of olive oil & low
consumption of animal fats
 High consumption of fruit & vegetables
 High consumption of legumes
 High consumption of grains & whole grains
 Moderate to high consumption of oily fish
 Moderate consumption of dairy products
 Moderate wine consumption
 Low consumption of meat & meat products
22
Naska (2003) EGEA, International Conference on Health Benefits of the Mediterranean Diet

16. The Mediterranean Diet Pyramid20
20
Willett et al (1995) Am. J. Clin. Nutr. 61; (Suppl 6): 1402S-1406S

17. The Mediterranean Diet
Health benefits

18. The Mediterranean diet and
coronary heart disease (CHD)
 Reduces the overall risk of CHD23,24
 Protects against CHD in Type II diabetics25
 Protects against CHD in subjects with
metabolic syndrome (35% reduced risk)26
 Protects against further cardiac events in
CHD patients27,28
Kok & Kromhout (2004) Eur. J. Nutr. 43; (Suppl 1): I2-I5
Srinath Reddy & Katan (2004) Public Health Nutr. 7 (1A): 167-186
25
Toobert et al (2003) Diabetes Care 26: 2288-2293
26
Pitsavos et al (2003) Rev. Med. Suisse Romande 123: 183-189
27
von Schacky (2003) MMW Fortschr. Med. 145 (13): 28, 30, 32-33
28
Martin-Du Pan (2003) Rev. Suisse Romande 123: 183-189
23
24

19. Cancer & Mediterranean dietary
traditions
“Approximately up to 25% of the incidence
of colorectal cancer, 15% of breast cancer
and 10% of the incidence of prostate,
pancreas and endometrial cancer could be
prevented if the populations of developed
Western countries could shift to the
traditional healthy Mediterranean diet” 29
29
Trichopoulou et al (2000) Cancer Epidemiol. Biomarkers Prev. 9: 869873

20. The Mediterranean diet and
cancer: clinical studies results
“Greater adherence to the Mediterranean diet is
associated with a significant reduction in mortality
due to cancer”30
The Mediterranean diet significantly reduces the risk
of:
 Cancers of the upper aerodigestive tract 31
 lung cancer32
 Colorectal cancer33
 Breast cancer34 Trichopoulou et al (2003) N. Engl. J. Med. 348: 2599-2608
30
Bosetti et al (2003) Cancer Epidemiol Biomarkers Prev. 12: 1091-1094
Fortes et al (2003) Nutr. Cancer (2003) 46: 30-37
33
Riboli & Norat (2003) EGEA
34
Adderley-Kelly & Williams-Stephens (2003) ABNF J. 14: 61-65
31
32

21. Other health benefits of the
Mediterranean diet
 Reduces serum low density lipoprotein (LDL) &
increases serum high density lipoprotein
(HDL)35
 Reduces hypertension & controls blood
pressure36
 Reduces serum lipids37
 Improves glycemic control25
 Rich in antioxidants38
Toobert et al (2003) Diabetes Care 26: 2288-2293
25
Haban et al (2004) Med. Sci. Monit. 10: PI49-PI54
Panagiotakos et al (2003) J. Hypertens. 21: 1483-1489
37
Panagiotakos et al (2004) Atherosclerosis 173: 351-359
38
Visioli & Galli (2001) Lipids 36; Suppl: S49-S56
35
36

22. The Mediterranean diet is
compatible with “Low Carb” foods
Serum glucose
Serum glucose
Low carb and/or low net carb = low Glycemic Index (GI)
Time after meal (hours)
Time after meal (hours)
High carbohydrate
ingredient
Low carbohydrate
Mediterranean
ingredient

23. The importance of antioxidants:
“oxidative stress” and disease39,40
 Reactive oxygen species (ROS) or “free
radicals” play a major role in the
development of:

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Oxidative stress states
Cardiovascular disease
Hypertension
Diabetes
Cancer
39
40
Castronova (2003) Rev. Med. Liege 58: 231-239
Taniyama & Griendling (2003) Hypertension 42: 1075-1081

24. Diets rich in antioxidants prevent
organic deterioration caused by
excessive oxidative stress41
 Key Mediterranean foods with high
antioxidant activity:

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Olives & olive oil
(hydroxytyrosol, oleuropein)
Tomatoes
(lycopene)
Red wine
(procyanidins)
Fruits & vegetables (various polyphenols)
Cocoa derivatives (flavonoids)
41
Elejalde Guerra (2001) An. Med. Interna. 18: 326-335

25. Choose the right type of fats:
prevent atherosclerosis42
 The main sources of fat in the Mediterranean
diet are olive oil & oily fish:

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Rich in unsaturated fatty acids
Reduces low density lipoprotein concentrations
Increases high density lipoprotein concentrations
Helps prevent atherosclerosis & cardiovascular
disease
Helps prevent coronary heart disease
42
Moreno & Mitjavila (2003) J. Nutr. Biochem. 14: 182-195

26. Alkalinizing effect of fruits & vegetables
in the Mediterranean diet43,44
 Fruits & vegetables in the Mediterranean diet
are rich in K+ ions
 These neutralise “fixed acidity” which reflects
metabolism of dietary proteins
 High K+ fruits & vegetables and Ca2+ from dairy
products must be consumed with high protein
diets to prevent metabolic acidosis and
deleterious effects on Ca2+ status
43
44
Remesy & Demigne (2003) EGEA, International Conference on Health Benefits of the Mediterranean Diet
Weisburger (2000) Nutrition 16: 767-773

27. The big question: can the
Mediterranean diet help weight loss?
 Results of clinical studies in which obese
subjects consumed a prescribed
Mediterranean diet show:

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
Weight loss & strong reduction in cholesterol
levels45
Weight loss & beneficial effects on blood
pressure46
Significant weight loss & superior long-term
adherence to the prescribed diet47
Castagnetta et al (2002) Ann. N. Y. Acad. Sci. 963: 282-289
Bautista-Castano et al (2003) Med. Clin. (Barc) 121: 485-491
47
McManus et al (2001) Int. J. Obes. Relat. Metab. Disord. 25: 1503-1511
45
46

28. Evolution of the Mediterranean
diet
A highly adaptable & constantly
evolving diet

29. Evolution of the Mediterranean diet
 The virtues of the Mediterranean diet were
promoted as early as 161448
 Now defined on the basis of dietary patterns found
in the region in the 1950’s and early 1960’s 22
 Evolved over many years & still evolving
 Incorporates non-native foods from many other
continents and countries
 Great variation but with common characteristics
22
48
Naska (2003) EGEA, International Conference on Health Benefits of the Mediterranean Diet
Haber (1997) Am. J. Clin. Nutr. 66; (Suppl 4): 1053S-1057S

30. The Mediterranean diet incorporates foods
from many non-Mediterranean sources49
 Grapes (Vitis vinifera)
Central & South
East Asia
South East Asia &
India
South America
 Citrus fruit (Citrus sp.)
 Tomatoes (Lycopersicon sp.)
 Peppers & chillis (Capsicum sp.)
 Cocoa (Theobroma cacao)
49
Central & South
America
Central & South
America
Smartt (1995) Evolution of crop plants, 2 nd Ed.

31. Further adaptation of the
Mediterranean diet for a modern
Western lifestyle
 Although healthy, the traditional Mediterranean
diet needs to be adapted for modern Western
societies
 Modern Western societies are:



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Highly mobile but sedentary
Increasingly busy but without hard physical labour
May not have the time needed to source & prepare
Mediterranean foods
Have an urgent need for convenient healthy food
choices

32. The Modern Mediterranean Diet
The “MODMED” diet
A diet for people on the move…..

33. The “MODMED” diet: incorporates
traditional Mediterranean foods
 Incorporates the key healthy ingredients
of the traditional Mediterranean diet
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Olives & olive oil
Fruits & vegetables
Cereals & whole grains
Oily fish
Red wine

34. The “MODMED” diet: incorporates
novel functional foods
 Incorporates novel, key, functional food
ingredients and functional consumer products

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Olive Powder
Cocoa Bean Powder
Nopal Powder
Tomato Powder
Low fat chocolate sauce/spread
Low fat olive spread
Low fat tomato sauce
Low fat olive sauce

35. Functional “MODMED” food
ingredients from Natraceutical S.A.
Chocolate sponge cake
Olive bread
Ingredient: Cocoa Bean Powder
Claims: Made from whole cocoa beans
High in dietary fibre
Low fat product
High in natural antioxidants
Natural cocoa taste
Ingredient: Olive Powder
Claims: Made from fresh olives
High dietary fibre
High in natural antioxidants
Improves shelf life
Natural olive taste

36. Functional “MODMED” food
ingredients from Natraceutical S.A.
Ingredient: Nopal Powder
Claims: Made from the “prickly pear”
Reduces glycemic index of foods
High in soluble dietary fibre
Low fat product
Ingredient: Tomato Powder
Claims: High in dietary fibre
Low fat product
High in natural antioxidants

37. Functional “MODMED” consumer
products from Natraceutical S.A.
Product: Chocolate spread/sauce
Claims: Made with chocolate flakes
Low fat product
Cholesterol free
Trans fatty acids free
High in natural antioxidants
Product: Olive Light
Claims: Made with olive oil
Low fat product
Cholesterol free
Trans fatty acids free
High in natural antioxidants

38. Functional “MODMED” consumer
products from Natraceutical S.A.
Product: Olive Sauce
Claims: Made with Mediterranean ingredients
Low fat product
Cholesterol free
Trans fatty acids free
High in natural antioxidants
Product: Tomato Sauce
Claims: Made with Mediterranean ingredients
Low fat product
Cholesterol free
Trans fatty acids free
High in natural antioxidants

39. Summary:
 Obesity & it’s co-morbidities are pandemic in
Western societies
 The Mediterranean diet is a proven cultural model
for healthy eating
 The Mediterranean diet can be adapted to suit busy
Western societies
 Functional food ingredients & consumer products
can be incorporated into the Mediterranean diet to
give the “MODMED” diet
 The “MODMED” diet could help management of
obesity and associated diseases

40. For more information see:
 www.olivepowder.com
 www.wholecocoabeanpowder.com
 www.chocolatepowder.com
 www.natraceuticaluk.com

41. “Let food be our first medicine”
Hippocrates (400 BC)
Autovia A-3. Salida 343
Cami de Torrent, s/n 46930
Quart de Poblet
Valencia, Spain
www.natraceuticals.com
info@natraceuticals.com