Beyond valuing the foods and nutrients that constitute this healthy eating pattern, it is necessary to reflect on the non-dietary characteristics that define the Mediterranean diet. Safeguarding them may hold the key to preventing the disappearance of this ancient way of eating.
The Mediterranean dietary pattern, encompassing multiple local variations, was built slowly through successive additions of plants and animals, made possible by the Mediterranean climate and accelerated by the ease of navigating the Mediterranean Sea (from the Latin mare mediterraneus , meaning "the sea between lands"), and began about 8,000 years ago, when the coastline was defined and allowed for the permanent settlement of humans on the islands and continental areas.
Within this model of the relationship between man and the environment, facilitated by the spatio-temporal acceleration stimulated and cosmopolitanized by a highly navigable sea, a dietary pattern developed that successively incorporated the food cultures of Egypt, Phoenician, Greek, Roman, and Arab cultures, as well as the dietary rules of the great monotheistic religions. Later, successive waves of food globalization brought by Portuguese, Spanish, Venetian, and English navigators and merchants allowed us to successively discover thousands of plants and animals that adapted to this ecosystem. An ecosystem made up of enormous human variety, biodiversity, technical knowledge, and popular-based culture that has made it a cultural heritage of humanity .
Dietary characteristics of the Mediterranean Diet
Despite this enormous cultural diversity, some common characteristics are significant, giving shape and synthesis to this way of eating, which in the 1950s and 60s was simplified by Ancel Keys and colleagues as the "Mediterranean Diet," based on its relationship with the well-being and improved health of the populations that consume it regularly . This is evidenced by numerous scientific studies, making this dietary pattern the most studied in the world .
Much of the observation of the Mediterranean dietary pattern consists of enumerating and quantifying the foods present or absent in this consumption model, in particular, olive oil, bread and cereals, wine, and vegetables. In 1993, at the International Conference on Diets of the Mediterranean , the main characteristics of this traditional way of eating were established: Abundant consumption of plant-based foods (vegetables, fruit, minimally processed cereals, dried and fresh legumes, nuts and oilseeds); Consumption of fresh, minimally processed, and seasonal regional products; Consumption of olive oil as the main source of fat; Low to moderate consumption of dairy products, preferably in the form of cheese and yogurt; Low and infrequent consumption of red meat; Frequent consumption of fish; Low to moderate consumption of wine, preferably with meals. With more or less variation, this model has been repeated and studied, characterizing this way of eating.
In this text, we intend to highlight some characteristics beyond the strictly dietary ones, allowing for a broader discussion of the determinants of adherence to this dietary pattern and the forms of public intervention that can safeguard this healthy consumption model. Unfortunately, and despite efforts to promote its consumption in national schools and the dissemination of its advantages, several studies have suggested that this consumption model is having fewer and fewer followers in Portugal, particularly among less educated, poorer, and sicker populations . Precisely those who should most adopt a dietary pattern that protects their health.
These characteristics of the Mediterranean diet that we have now identified, which urgently need reflection and, eventually, preservation, are frugality; a plant-based diet and the constant search for animal products to enrich it; seasonality and adaptation to climate change; culinary knowledge; and finally, conviviality.
Frugality
To understand this Mediterranean way of relating to food, to meals at the table, and to everything surrounding the act of eating, we must look at the climatic conditions and the difficulty in having productive or regular harvests in the Mediterranean basin. And at the arduous manual labor involved in cultivating these lands where water was scarce and the soil was shallow. In this relationship between scarce food, irregular production, and intense physical exertion, lies an idea of frugality and constant balance between what is ingested and what is expended, and a persistent fear of food scarcity. This forced energy balance and energy intake adapted to or even below needs is what we now know to be an important clue to understanding longevity and possibly even the absence of certain types of disease . The word "frugal," which is spelled practically the same in Portuguese, Spanish, French, Italian, English, or even German, is a way of defining someone who consumes according to their needs, sparingly and without waste—a very current concept, but one that perfectly defines the Mediterranean consumption model. Currently, adherence to the Mediterranean dietary pattern is lower among populations with lower economic capacity, and consequently, it is in these populations that worse health situations are identified. It is also the Mediterranean populations, particularly their children, who experience less frugal consumption and higher rates of obesity . This is a huge challenge for those who want to safeguard this mode of consumption.
A plant-based diet and a constant search for animal products to enrich it
Due to the difficulty in accessing animal protein, which requires a lot of water (usually absent) and pasture to be produced, particularly large ruminants like cattle, and their use to assist manual labor, another very distinctive characteristic of Mediterranean patterns emerges: the massive use of plants as an energy source. In particular, cereals and the fat from olives, but also legumes (chickpeas, lentils, peas…) that combine well with cereals to provide vegetable protein. And also a multitude of wild herbs (thyme, oregano, wild chard, purslane…) and vegetables that end up covering many of the vitamin and mineral needs, as well as other substances with functional characteristics necessary in our bodies. This does not invalidate the development of a prodigious technology for preserving the scarce animal protein in the Mediterranean, from salted fish to the enormous variety of meats preserved by smoking and salting, or goat and sheep cheese, which are central foods due to their scarcity and consequently symbolic and ritual value. Just consider our traditional smokehouses or cod. The Mediterranean diet is, therefore, a vegetarian-based diet, occasionally flavored with meat and fish, and thus also an environmentally sustainable model.
Seasonality, adaptation to climate change, and culinary knowledge
Adapting to the changing seasons and climate fluctuations is perhaps another major distinguishing feature of Mediterranean diets, allowing for the preparation of different meals throughout the year, depending on what is available and what the land provides . This ability to gather almost everything fresh locally and seasonally, and to cook almost everything possible, using highly elaborate and sophisticated cuisine (though labeled as simple) to create flavorful and diverse dishes adapted to uncertain agriculture and constant gathering, is another strength of this dietary pattern. Perhaps no other dietary pattern depends as much on botanical and culinary knowledge as this one. Indeed, this loss of practical knowledge is one of the factors rapidly condemning it, as women, the traditional holders of this knowledge, age and much of this oral and ancestral know-how is lost. An urgent mapping is needed where anthropology, sociology, and nutrition can collaborate.
Conviviality
Finally, there's the conviviality around the table, which means time to chew , to appreciate, and to learn the flavors and methods of combining foods. This is an area still little explored in nutritional science: the relationship and synergy between foods, and how cooking or other culinary techniques affect nutrient availability, or how, during a meal, the orderly combination of different foods enhances or negates certain physiological impacts . In other words, how a meal with vegetable soup, a meat stew, and fresh fruit, in that order, can have a different metabolic impact than another meal with the same food and even nutritional composition, but not ordered in the same way, and where the same culinary processes and consumption times and conviviality at the table . Much of this knowledge, which is now beginning to be scientifically validated, is identified in ancestral consumption practices in the Mediterranean world. Most likely not intentionally conceived with health or even environmental goals in mind (cooking in a group is environmentally friendly), but they are found within the framework of this dietary pattern.
Conclusion
Safeguarding the Mediterranean diet requires safeguarding production models that allow for the proximity and seasonality of its base of fresh, low-cost vegetables, maintaining knowledge and use of traditional Mediterranean culinary techniques, and providing the necessary time for convivial consumption. These conditions are currently absent for a large segment of the Portuguese population, distancing us further and further from the Mediterranean diet. In other words, it lacks knowledge, access at low cost, and available time. This is an area to be explored, both in research and in public and political intervention aimed at preserving this healthy dietary pattern.
Written by
Pedro Graça, Director of the Faculty of Nutrition and Food Sciences at the University of Porto