Mediterranean diet as intangible heritage of humanity: 10 years on.

Ten years ago the Mediterranean diet was inscribed into the United Nations Educational, Scientific and Cultural Organization (UNESCO) Representative List of Intangible Cultural Heritage of Humanity. This official recognition of the Mediterranean diet as intangible cultural heritage, and awareness of its significance, has provided us with a measure with which to monitor our path in the field. Indeed, the last ten years has seen several undertakings with varying implications in the years to come. Emphasis on safeguarding the intangible heritage of the Mediterranean diet and activities to avoid possible erosions which may affect it at a national, regional and local level have taken centre stage. Preserving our heritage also recognized the importance of further research and we ask what needs to be focused on over the next ten years. Gradually, several myths and misconceptions associated with the traditional Mediterranean diet have emerged and should be clearly addressed and dispelled, particularly those that label as "Mediterranean" an eating pattern that is not in line with the traditional diet. Going beyond physical health benefits, the Mediterranean diet naturally infuses any reference to 'Sustainability' by pure definition as ideally, sustainable diets are protective and respectful of biodiversity, culturally acceptable, accessible, economically affordable, nutritionally adequate, and safe and healthy. As our 'Regional' Mediterranean diet becomes the base for a global reference diet with all the acknowledged benefits, we agree that 'humanity as a whole' will benefit from its preservation and scientific-based evidence. A true 'intangible cultural heritage of humanity'.

The evolution of the heart-healthy diet for vascular health: A walk through time.

The rate of cardiovascular disease (CVD) mortality reduction in the United States has plateaued recently, despite the development of novel preventive pharmacotherapies, increased access to care, and healthcare spending. This is largely due to American's poor dietary patterns and practices causing increasing trends in the prevalence of obesity and type 2 diabetes mellitus. For decades, dietary guidelines on 'healthy diets' to reduce CVD risk, grounded in epidemiological research, have been nationally distributed to Americans. In this review, we highlight landmark events in modern nutrition science and how these have framed past and current understandings of diet and health. We also follow the evolution of dietary recommendations for Americans throughout the years, with an emphasis on recommendations aimed to reduce risk for CVD and mortality. Secondly, we examine how the low-fat ideology came to dominate America in the last decades of the 20th century and subsequently contributed to an excess intake of refined carbohydrates which, in the context of an increasingly sedentary lifestyle, may have fueled the obesity epidemic. We then examine the current major evidence-based dietary patterns and specific dietary approaches to reduce CVD risk, reviewing the literature surrounding nutritional components of the heart-healthy diet and discussing the dietary patterns proven most effective for CVD prevention: the Dietary Approaches to Stop Hypertension (DASH) diet, the Mediterranean diet, and the healthy vegetarian diet. Finally, we discuss emerging dietary trends, considerations for nutrition counseling, and future directions within the important field of nutrition, with the ultimate goal of improving vascular health.

Was Luigi Cornaro a Dietary Expert?

Luigi Cornaro (d. 1566) was a Venetian nobleman whose book De Vita Sobria (On the Temperate Life) was an instant success and has proved to be one of the most long-lasting and influential works of practical medical advice, counseling readers how to live long and healthily. Yet Cornaro was not a physician and his account raises a series of questions about the nature and location of medical expertise. Who can have that expertise? Can you, and should you, be your own physician, and, if so, on what grounds? I situate Cornaro's claims to expertise within a historically specific culture of medical dietetics in which personal experience counted for much. How did certain dietary practices "agree with" individuals? How did personal experience figure in constituting expertise? Was a healthy regime compatible with ordinary civic life and, if not, did it matter? What was the role of precise quantitative measure in prescribing the regime making for health and longevity? I address these questions with respect to Cornaro's historical setting and also in relation to pervasive commentary on his text over the centuries that followed.

Fat, Sugar, Whole Grains and Heart Disease: 50 Years of Confusion.

During the 1970s some investigators proposed that refined carbohydrates, especially sugar and a low intake of dietary fiber, were major factors in coronary heart disease (CHD). This suggestion was eclipsed by the belief that an excess intake of saturated fatty acids (SFA) was the key dietary factor, a view that prevailed from roughly 1974 to 2014. Findings that have accumulated since 1990 inform us that the role of SFA in the causation of CHD has been much exaggerated. A switch from SFA to refined carbohydrates does not lower the ratio of total cholesterol to HDL-cholesterol in the blood and therefore does not prevent CHD. A reduced intake of SFA combined with an increased intake of polyunsaturated fatty acids lowers the ratio of total cholesterol to HDL-cholesterol; this may reduce the risk of CHD. The evidence linking carbohydrate-rich foods with CHD has been steadily strengthening. Refined carbohydrates, especially sugar-sweetened beverages, increase the risk of CHD. Conversely, whole grains and cereal fiber are protective. An extra one or 2 servings per day of these foods increases or decreases risk by approximately 10% to 20%.

Yogurt's flexible image during its rise in popularity in post-war Belgium.

The consumption of yogurt in Western countries has risen for over a century, first slowly, then more rapidly. The purpose of the present study was to investigate this prolonged phase of growth, by examining the popularity and the projected image of yogurt. A particular focus was on the way these aspects were reflected in consumption patterns and media representations. The data showed how during its period of rapid popularization, yogurt's visibility in the media greatly increased. It was concluded that the product's image was highly flexible in post-war decades, evidenced by the multi-pronged approach taken by marketers. Yogurt was not only advertised as both tasty and healthy, but also as natural and convenient, a strategy that appears to have been informed by consumers' preferences and existing cultural values. This demonstrates how a high degree of product differentiation and diversification during a product's growth stage can result in a heterogeneous image, allowing for a broad range of marketing strategies.

The causal conundrum: the diet-heart debates and the management of uncertainty in American medicine.

Starting in the 1950s, physicians and researchers began to debate the exact nature of the relationship among blood cholesterol, diet, and cardiovascular risk. Using professional medical, public health, and scientific journals, this article examines the history of a series of intense and sustained debates regarding the credibility of the diet-heart hypothesis, which proposed that diet was causally linked to coronary artery disease. Brought about by intellectual disagreements and illuminated by personal quarrels, these debates created a profound professional rift among researchers who debated whether observational data could be used to prove that dietary intake caused heart disease and who sought to differentiate between "good" and "bad" science. But while the debate persisted into the early 1980s, Americans had begun to adopt the diet-heart hypothesis as public health truth as early as the 1960s, embracing cookbooks promoting "heart healthy" diets that promised to prevent coronary artery disease. Although critics and advocates of diet-heart continued to debate the theory's finer points, the widespread adoption of diet-heart in American homes meant that the debate had become almost moot by the time the National Heart, Lung, and Blood Institute officially endorsed the hypothesis in the 1980s.