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How to make the nutrient-rich Mediterranean diet more accessible

Article-How to make the nutrient-rich Mediterranean diet more accessible

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Adherence to the traditional Mediterranean diet is falling. Supplements and functional foods fortified with polyphenols and antioxidants promise to recreate the health benefits – but the solution is not so simple, warn nutrition experts.

Said to be one of the healthiest in the world, the traditional Mediterranean diet is characterised by a high intake of whole plant-based foods – seasonal fresh fruit and vegetables, nuts, and wholegrain cereals – and olive oil; a moderate intake of fish and poultry; and low intakes of dairy products, red and processed meats, and sweets.

Adherence is associated with a lower risk of cardiovascular disease, type 2 diabetes, obesity, and metabolic-related conditions. There is evidence of its potential role in preventing some cancers, while emerging research suggests it may also prevent cognitive decline and depression.

However, as processed food and drink products play an increasingly large role in everyday life, the Mediterranean diet is on the decline – along with its health benefits.

In 2018, the World Health Organization (WHO) shared preliminary data from its Childhood Obesity Surveillance Initiative, which showed that European rates of obesity and overweight among children were highest in Mediterranean countries.

Forty-three percent of children in Cyprus were overweight and, of these, 21% of boys and 19% of girls were obese. Similar figures were reported for Greece, Italy, and Spain.

“The Mediterranean diet for the children in these countries is gone,” said João Breda, head of the WHO European office for the prevention and control of non-communicable diseases (NCDs). “There is no Mediterranean diet anymore. Those who are close to the Mediterranean diet are the Swedish kids. The Mediterranean diet is gone, and we need to recover it.”

‘Rich in antioxidants and polyphenols’: The next nutrition trend?

Polyphenols are natural plant compounds found in foods such as fruit, vegetables, green tea, and wine, and are known to have antioxidant and anti-inflammatory properties. The high polyphenol content in the Mediterranean diet is said to be one of the reasons for its healthiness.

During a webinar this week on health and wellbeing, held as part of the Fi Webinar Series, Rick Miller, associate director of specialised nutrition at Mintel, noted that antioxidant claims are on the rise in functional food and drink products.

Professor Tim Spector, an epidemiologist, microbiome expert, and co-founder of personalised nutrition startup Zoe, echoed this at a recent industry event.

"In the past five years, people have switched on not only to fibre and probiotic foods [...] but, also, the new concept of polyphenol-rich foods, [which] is really taking off,” he said.

Spector predicted an increase in consumer interest but said that educating the public and changing the narrative from “antioxidant foods”, which he described as “a vague term”, to the more specific label “polyphenol-rich foods”, would be instrumental to this.

Laboratories that offer analytical services to food manufacturers have also noted an uptick in interest. Jane Staniforth, head of sales at UK-based Reading Scientific Services Ltd (RSSL), said that RSSL had seen an increase in enquiries from food manufacturers looking to develop methods to measure the polyphenol content of their products.

Even pet food brands, tapping into trend of “humanising” pets, are getting involved. One Spanish dog food brand, aptly called Mediterranean Diet, has developed a range of functional pet food products that contain virgin olive oil as a source of oleocanthal and hydroxytyrosol, a polyphenol and antioxidant found in olive oil.

“If it’s so beneficial for our health, why not trying to bring those benefits to our pets?” asks the brand.

Supplanting the Mediterranean diet with supplements?

Some supplement brands have also tried to pack the benefits of the Mediterranean diet into pill form.

Consumer-facing brand Olivino makes food supplements that it says deliver the health benefits of the Mediterranean diet in a convenient capsule form, providing nutrients that promote cardiovascular health, maintain healthy blood pressure, fight inflammation, protect against free radical-induced skin damage, maintain a healthy blood sugar level, and promote healthy prostate function.

The nutrients in question include grape -seed-derived polyphenols, lycopene from tomatoes, resveratrol, and antioxidants and polyphenols from olives.

Another US brand, VitalGreek by the manufacturer Mterra, contains proanthocyanins from Italian grapes and grape seeds for brain health; hydroxytyrosol from Spanish olives to maintain normal oxidation of LDL cholesterol and support normal heart health; and lycopene from Israeli tomatoes for normal cell division and “longevity”.

“Our patent-pending multivitamin uses advanced nutrition analytics to accurately deliver you the vitamin and mineral fingerprint of the Mediterranean diet, as well as some of its most iconic healthy foods,” says the brand.

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Whole diet approach ‘more consistent and effective’ than supplementation

However, reaping the benefits of the Mediterranean diet may not be as simple as focusing on single nutrients or even specific foods, warn nutrition experts at the Harvard School of Public Health.

“Research supports the health benefits of a Mediterranean-style eating pattern that includes several different foods,” they said. “It is the combination of these foods that appear protective against disease, as the benefit is not as strong when looking at single foods or nutrients included in the Mediterranean diet.

“Therefore, it is important to not simply add olive oil or nuts to one’s current diet but to adopt the plan in its entirety.”

Dietitian Dr Carrie Ruxton said she would not encourage brands to fortify processed products with compounds such as flavanols and polyphenols.

“Studies show that supplementation with individual polyphenols gives inconsistent health effects, while adding naturally polyphenol-rich foods into the diet appears to be more consistent and effective. This has been seen with hesperidin – a citrus polyphenol – whereby supplements of hesperidin were far less effective than drinking 100% orange juice,” she told Fi Global Insights previously.

Supplementation also ignores the importance of macronutrients, such as fibre, to health.

Improving the affordability and accessibility of fresh, whole foods that make up the Mediterranean diet may therefore be more beneficial to public health, as well as developing tools to improve adherence.

Researchers from the University of Bern recently developed an artificial intelligence-powered platform and smartphone app that individuals can use to quantify their adherence to the Mediterranean diet.

“The feedback from the participants [...] was very positive,” they concluded, following a feasibility study that evaluated the app’s performance.