Mediterranean Diet

Introduction

The Mediterranean diet originates in the food cultures of ancient civilizations which
developed around the Mediterranean Basin and is based on the regular consumption of
olive oil (as the main source of added fat), plant foods (cereals, fruits, vegetables,
legumes, tree nuts, and seeds), the moderate consumption of fish, seafood, and dairy,
and low-to-moderate alcohol (mostly red wine) intake, balanced by a comparatively
limited use of red meat and other meat products.¹

Lăcătușu, C. M., Grigorescu, E. D., Floria, M., Onofriescu, A., & Mihai, B. M. (2019). The Mediterranean Diet: From an Environment-Driven Food Culture to an Emerging Medical
Prescription. International journal of environmental research and public health, 16(6), 942. https://doi.org/10.3390/ijerph16060942
● The term “Mediterranean diet” could be should be seen “as a whole”, comprising all its
features and not just a part of them.

● For eg. Mediterranean diet is the limited intake of alcohol, as red wine is consumed
only with meals, in small servings, with a limited frequency throughout the week, and
consumption of other alcoholic beverages such as liquors or beer is not part of the
traditional lifestyle.

● This unique dietary pattern, drew the attention of medical professionals by proving
extended health benefits.
 Application of Mediterranean diet ²
1) Cardiovascular diseases - Reduction in risk factors: blood lipids, blood pressure and inflammatory
biomarkers.Reduction in CHD, stroke, CVD incidence and mortality in large RCTs.
2) Type -2 Diabetes mellitus - glycaemic control in T2D patients. Lower risk of T2D incidence.
3) Metabolic syndrome -Greater probability of MetS remission with MedDiet.Lower risk of developing MetS.
4) Obesity -MedDiet greater weight loss than low fat diet at >12 months. Improved abdominal obesity, waist
circumference and visceral fat than controls.
5) Cancer - Inverse association with cancer incidence and mortality. Lower risks of colorectal, head and neck,
respiratory, gastric, liver, bladder and breast cancer.
6) Cognitive function-Beneficial for cognitive decline,Lower risk cognitive impairment and Alzheimer’s disease.
Guasch-Ferré, M., & Willett, W. C. (2021). The Mediterranean diet and health: a comprehensive overview. Journal of internal medicine, 290(3), 549–566.
https://doi.org/10.1111/joim.13333
 The Mediterranean diet reduces the genetic risk of chromosome 9p21 for
myocardial infarction in an Asian population community cohort study ³
The purpose of this study was to investigate whether a Mediterranean dietary styleModifed the genetic risk of developing CVD
in a Chinese cohort. A total of 2098 subjects with dietary Information from a Chinese community cohort study (longitudinal
study )were enrolled.
Candidate genes(gene that is believed to be related to particular trait ), including SNP markers(biological marker associate with
disease)Were genotyped to analyze the association with future CVD. The impact of dietary pattern was also Analyzed according
to adherence to the diet using the Mediterranean Diet Score (MDS). After an Average follow-up of 7.8 years, only the C risk
allele at chromosome 9p21.3 was associated With a higher risk of MI and the CC genotype had a higher risk of developing MI
However, the high MI risk of the CC genotype in individuals consuming unhealthy diet but significantly decreases in individuals
consuming a healthier diet indicating that a healthier Dietary pattern (higher MDS) modifed the risk of developing MI in carriers
of variants in CDKN2B.
Conclusion
Genetic variants of CDKN2B at 9p21 were significantly associated with future MI risk in a Chinese cohort,The genetic risk of MI
could be modified by a healthier diet.

3) Leu, HB., Chung, CM., Chen, JW. et al. The Mediterranean diet reduces the genetic risk of chromosome 9p21 for myocardial infarction in an Asian
population community cohort. Sci Rep 9, 18405 (2019). https://doi.org/10.1038/s41598-019-54938-w
Favorable association between Mediterranean diet (MeD) and DASH with NAFLD among Iranian adults of the Amol
Result - OfCohort
the 3220Study (AmolCS)⁴
recruited in the cohort, 1437 (44.6%) had
NAFLD, and 1438 (44.7%) were women. The mean age of
participants was 46.96 ± 14.67 years, and all baseline
Nonalcoholic fatty liver disease characteristics.
(NAFLD) is In Comparison with men, women had a higher rate
an emerging cause of chronic liver diseases and a major health
of BMI (body mass index), diabetes, metabolic syndrome, the use
problem. Research was conducted among 3220
of lipid-lowering adults
agents (55.3% men), age ≥agents,
and hypertension-lowering 18 years
urban(46.96 ± 14.67), we
measured usual dietary intake withresidency,
a total cholesterol,
validated food HDL, FBS, HbA1C,
frequency and a lower(FFQ)
questionnaire rate ofand then calculated
waist circumstance, alcohol consumption, smoking, heart disease,
dietary pattern scores for DASH and MeD.
physical activity level, triglyceride, AlT, AST, GGT (all p < 0.05).

Conclusion - In the current study, adherence to DASH and the

Mediterranean diet was inversely associated with NAFLD
prevalence in patients with abdominal obesity. Indeed, a similar
result remained for MeD and NAFLD patients without abdominal
obesity as well. This result suggests that MeD might represent a
better choice for NAFLD management, as reported by evidence.

4 ) Doustmohammadian, A., Clark, C.C.T., Maadi, M. et al. Favorable association between Mediterranean diet (MeD) and DASH with NAFLD among
Iranian adults of the Amol Cohort Study (AmolCS). Sci Rep 12, 2131 (2022). https://doi.org/10.1038/s41598-022-06035-8
Why and how the Indo-Mediterranean Diet May Be Superior to Other Diets:
In a systematic review among adults and
Theyears
older adults aged 17–84 Rolefromof28 Antioxidants in the Diet⁵ diet differs
The Indo-Mediterranean-style
developed countries, the(Indo- because it contains more whole grains, in
Mediterranean diet) findings suggested that particular millets, porridge, and green beans,
dietary patterns, possibly rich in and a variety of healthy spices such as
flavonoids,including higher intake of fruits, turmeric, coriander, cardamom, cinnamon,
legumes, vegetables, nuts, whole grains, cumin, black pepper, cloves, etc. This diet can
unsaturated vegetable oils, fish, and lean prevent the double burden of diseases due to
meat or poultry, were associated with a undernutrition and overnutrition
decreased risk of all-cause mortality

Indo – Mediterranean diet has all 10

qualities. The major constituents responsible
There is evidence that a diet rich in healthy,
for the superiority of the Indo-Mediterranean
plant-based foods and with fewer animal
diet are more whole grains, such as millets,
source foods such as fish, other sea foods,
porridge, beans, brown rice, spices
and poultry (up to five servings of animal
(coriander, turmeric, fenugreek, cumin, and
source foods per week) can confer both
cinnamon), peppers, onion, garlic, curd, and
improved health and environmental benefits.
buttermilk, and lack of animal foods, except
fish.
5) Singh, R.B.; Fedacko, J.;Fatima, G.; Magomedova, A.;Watanabe, S.; Elkilany, G.
Why and How the Indo-Mediterranean Diet May Be Superior to Other Diets: The Role of Antioxidants in the Diet Nutrients 2022, 14, 898.
https://doi.org/10.3390/nu14040898
Conclusion
The high content of flavonoids in the Indo-Mediterranean diet, similar to the traditional Japanese diet (1800 vs. 1500
mg/day, respectively), indicates that this diet can play a potential role in the management of CVDs and T2DM. The
Indo-Mediterranean diet could be superior to DASH, Mediterranean, and Japanese diets due to greater food diversity
and lower glycemic index foods. The high quality of the Indo-Mediterranean diet may be because of the increased
content of whole grains, millets, porridge, and beans, as well as spices, which are not commonly found in other types
of protective diets.
Ketogenic Diet
Ketogenic Diet
• The ketogenic diet assumes a very high-fat and low-
carbohydrate diet, reducing carbohydrate to ≤10% of
consumed energy.
• This may be achieved, due to a macronutrient ratio of 4:1 90% Fat
(4 g fat to every 1 g protein and carbohydrates)
• Therapeutic diet for pediatric Epilepsy
• The ketogenic diet induces a rapid weight loss and Ketogenic diet 6% Protein
reduction in hemoglobin A1c, but raises LDL cholesterol.
• Short term symptoms like nausea, vomiting, headache,
fatigue, dizziness, insomnia, difficulty in exercise tolerance, 4%
and constipation carbohydrates
•  Long-term adverse effects include hepatic steatosis,
hypoproteinemia, kidney stones, and vitamin and mineral
deficiencies.
Food to be included and avoided in ketogenic diet
Food to include
The following foods contain negligible
amounts of protein, fat ,carbohydrate and may
be used more frequently.
• Coffee (normal and decaffeinated) and tea
• Broth or consommé (clear soup)
• Animal Proteins, seafood, meat Poultry, eggs
• Keto cheese, cream, butter
• Unsweetened cocoa powder and gelatin
• Mustard dry, salt and pepper, parsley and
other herbs, and vinegar.
Food to avoid
The following foods contain substantial
amounts of carbohydrates and should be
Avoided.
• All breads and cereals
• Cakes or cookies, pastries
• Carbonated beverages, sherbet and sweet
juices
• Puddings and pies
• Candy and chewing gum
• Jams, jellies, marmalade and honey
• Syrups, sugar and condensed milk
 Dietary prospects of coconut oil for the prevention and
treatment of Alzheimer's disease (June 2021) 

• The cerebral plaques and neurofibrillary tangles potentially affect the

neuronal synaptic transmission and ultimately cause cognitive decline.
• Dysregulation of brain glucose metabolism is an early detectable trait of AD.
• The role of coconut oil-derived medium chain fatty acids (MCFAs) which are rapidly
metabolized into ketone bodies to serve as an alternate source of energy for the cerebral
tissue is well recognized. 
• Biochemical basis of coconut oil-induced amelioration of AD symptoms including its
dietary role in suppression of neuro-inflammation, reversing the process of
neurodegeneration, enhancement of cell survival pathways and inhibition of
secretion of Aβ peptides are presented. 
Ketogenic diet and Drug Resistant Epilepsy
(2019)
• A ketogenic diet should be considered for patients who have not
responded to well-dosed antiepileptic drugs.
• The diet mimics the fasting state, altering the metabolism to use fats
as a primary fuel source; catabolism of fatty acids in the liver produces
ketone bodies.
•  KD is involved in multiple mechanisms responsible for biochemical
alterations, including cellular substrates and mediators responsible for
neuronal hyperexcitability.
• Improve the quality of life with a significant decrease in seizure
frequency.
Ketogenic Diet and Weight Loss: Is There an Effect on Energy
Expenditure? (2022)
Introduction
• The DASH, stands for Dietary
Approaches to Stop Hypertension.
• The DASH diet is rich in fruits,
vegetables, whole grains, and low-
fat dairy foods; includes meat, fish,
poultry, nuts and beans; and is
limited in sugar-sweetened foods
and beverages, red meat, and
added fats.
• The DASH diet includes foods that are rich in potassium, calcium
and magnesium. 
• Studies have shown that the DASH diet can lower blood
pressure in as little as two weeks. The diet can also lower low-
density lipoprotein (LDL or "bad") cholesterol levels in the blood.
 DASH DIET TO STOP HYPERTENSION
• Dietary Approaches to Stop Hypertension (DASH) diet originated in the
1990s.  
• 1992, the National Institute of Health (NIH) found that only the dietary
intervention alone could decrease systolic blood pressure by about 6 to 11
mm Hg. This effect was seen both in hypertensive as well as normotensive
people. Based on these results, in some instances, DASH has been advocated
as the first-line pharmacologic therapy along with lifestyle modification.
• DASH promotes the consumption of vegetables and fruits, lean meat and
dairy products, and the inclusion of micronutrients in the menu. It also
advocates the reduction of sodium in the diet to about 1500 mg/day. DASH
emphasizes on consumption of minimally processed and fresh food. DASH
diet has many similarities to some of the other dietary patterns which are
promoted for cardiovascular health. 
A typical serving guide for a patient following the DASH diet
is as follows:
• Vegetables: about five servings per day
• Fruits: about five meals per day 
• Carbohydrates: about seven servings per day
• Low-fat dairy products: about two servings per day
• Lean meat products: about two or fewer servings per day
• Nuts and seeds: 2 to 3 times per week
Fats – 
• Some of the sources of good fats also included in DASH
include: Olive oil ,Avocados, Nuts ,Hempseeds ,Flax seeds,
Fish rich in omega-3 fatty acids
DASH Dietary Pattern: A Treatment for Non-
communicable Diseases 

• NCDs – The four main NCDs are cancer, cardiovascular

diseases, chronic respiratory diseases, and diabetes. 
• The DASH diet is a reasonable approach to reduce
anthropometric measures of adiposity and blood pressure,
exerting a beneficial effect on blood lipids by reducing the TC
and LDL-C levels as well.
• Combating methods - avoid excessive alcohol consumption,
smoking and physical inactivity, and follow a healthy diet. 
CONCLUSION
• The DASH diet is a feasible approach to weight loss and to
control blood pressure and hypercholesterolemia.
• The DASH diet is a reasonable approach to reduce anthropometric
measures of adiposity and blood pressure, exerting a beneficial effect
on blood lipids by reducing the TC and LDL-C levels as well. In
contrast, we did not find significant results for glycemic parameters
(blood glucose, insulin, and HOMA-IR), HDL-C, TG, VLDL-C, and
CRP levels as compared to control groups. At least, therefore, clinical
attention to the DASH diet is worthwhile when we aim at weight loss
and the control of blood.
Many diets focus
on what to eat,
but intermittent
FASTING
is all
about when you
eat.
 Intermittent fasting refers to regular periods with no or very limited
caloric intake. It commonly consists of a daily fast for 16 hours, a 24-
hour fast on alternate days, or a fast 2 days per week on non-
consecutive days. During fasting, caloric consumption often ranges
from zero to 25% of caloric needs. (1)

https://www.youtube.com/watch?v=AhdFpWBeJSQ

Welton S, Minty R, O'Driscoll T, Willms H, Poirier D, Madden S, Kelly L. Intermittent fasting and weight loss: Systematic review. Can Fam Physician. 2020 Feb;66(2):117-125. PMID: 32060194; PMCID:
PMC7021351
Abdullahi Bagudu, Khadijah & Noreen, Sana & Rizwan, Bahisht & Bashir, Shahid & Khan, Mudassir & Chishti, Komal & Hussain, Soha & Wahid, Saba. (2021). Intermittent Fasting Effect on Weight
Loss: A Systematic Review.
Nain, Shivali & Jain, Agrim & Kumar, Kaushalendra. (2020). Intermittent Fasting (IF): An Approach to a Healthy body. Journal of Biological Engineering Research and Review. 7. 24-32.
 IMPACT OF INTERMITTENT FASTING ON
HUMAN HEALTH
Ramadan is a fast of 29-30 days in Islamic culture, where foods, fluids, medications, drugs, and
smoking are prohibited during day light time which can be of average 14 hours per day and can
eat after that. he main aim of this study is to determin the effects of Ramadan fasting on
certain physiological and biochemical parameters in healthy medical students aged between 18
to 28 years, and to find out whether or not Ramadan fasting has any beneficial or harmful
effects on the human body.
Materials and Methods
• The study was carried out on 50 healthy, volunteer medical students of different tertiary
health centers in the city.
• Inclusion Criteria: Healthy young, medical students aged between 18 to 28 years, they should
be fasting according to the recommendations of Ramadan fasting for the whole month.
• Exclusion Criteria: Students with any major illness like hypertension, type-2 diabetes mellitus
hyperthyroidism, hypothyroidism, hypercholesterolemia, Cushing’s disease or on any
medication.
Thus concluding that Ramadan type of intermittent fasting has
beneficial effect on the human body in terms of betterment in
physiological systems and significant reduction in Body Weight, Body
Mass Index, Waist-Circumference, Waist to Hip Ratio, Pulse Rate.
Impact of Intermittent Fasting on Lipid Profile-A Quasi-
Randomized Clinical
(Ahmed, Naseer & Farooq, Javeria & Hasan, Salman & Meo, Ayoub & Kulsoom, Bibi & Laghari, Abid & Jamshed, Humaira & Pasha, Farooq)

Objective:
The aim of the study was to evaluate the effect of IF on lipid profile and HDL-
cholesterol in a sample of South Asian adults.
Methods:
A 6-week quasi-experimental (non-randomized) clinical trial was conducted
on participants with low HDL (< 40 mg/dl for men and < 50 mg/dl for women).
Participants of the control group were recommended not to change their diet.
The intervention group was recommended to fast for ∼12 h during day time,
three times per week for 6 weeks. Pulse rate, blood pressure, body weight,
waist circumference, serum lipid profile, and blood glucose levels were
measured at baseline and after 6 weeks
Result

A total of 40 participants were enrolled in the study (N = 20 in each

group), while 35 (20 control and 15 intervention) completed the trial
and were included in data analysis of the study.
Body measurements, including body weight, BMI and waist
circumference, showed significant interaction effects (p’s < 0.001),
indicating that there were larger reductions in the IF group than in the
control group. Significant interaction effects were also observed for
total (p = 0.033), HDL (p = 0.0001), and LDL cholesterol (p = 0.010) with
larger improvements in the IF group.

Conclusion:

• This study suggests that intermittent fasting may protect cardiovascular

health by improving the lipid profile and raising the sub-optimal HDL.
Intermittent fasting may be adopted as a lifestyle intervention for the
prevention, management and treatment of cardiovascular disorders.
Study of Beneficial Impact on Specific Biomarkers in
Type 2 Diabetes During Ramadan Fasting
(Unintentional Intermittent Fasting)
The study was attempted to know • A total 50 patients of T2D were
the alterations in biomarkers viz. selected for above-mentioned
body weight (BW), body mass biomarkers assessment
index (BMI), serum glycated immediately before the starting
haemoglobin (HbA1c), systolic of fast followed by after 45 days.
and diastolic blood pressure (SBP
and DBP) due to Ramadan IF on
type 2 diabetes (T2D) patients of
western India.

Objective Methods
Results
The present results indicated the beneficial impact on intermittent
fasting among patients (baseline versus followed up) by detecting the
alterations of above-mentioned biomarkers. In overall results (n=50),
the BW (Kg) and BMI (Kg/m2) values were significantly decreased in
followed-up patients when compared to baseline value while the level
of HbA1c was also significantly decreased in followed-up patients when
compared to baseline value. But no significant changes in the values of
SBP and DBP were observed.
Conclusion
This observational study revealed the reduction of body weight, BMI
and serum HbA1c levels probably due to IF for the T2D patients during
the holy month of Ramadan. Moreover, the IF can be utilized as a
therapy along with other pharmacological therapies. It is suggested
future research work with other important biomarkers, which can be
easier for T2D therapy.
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• Abdullahi Bagudu, Khadijah & Noreen, Sana & Rizwan, Bahisht &
Bashir, Shahid & Khan, Mudassir & Chishti, Komal & Hussain, Soha &
Wahid, Saba. (2021). Intermittent Fasting Effect on Weight Loss: A
Systematic Review.
• Shivali & Jain, Agrim & Kumar, Kaushalendra. (2020). Intermittent
Fasting (IF): An Approach to a Healthy body. Journal of Biological
Engineering Research and Review. 7. 24-32.