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Living the Mediterranean Lifestyle

By Emily Roberts

The Mediterranean Diet is based on the eating patterns in the Mediterranean region and focuses on fruits, vegetables, fish, whole grains and healthy fats (1).  A diet not invented, but discovered, is now recognized as one of the healthiest dietary patterns (2). UNESO defines it as “a social practice based on all the “savoir-faire”, knowledge, traditions ranging from the landscape to the table and covering the Mediterranean Basin, cultures, harvesting, fishing, conservation, processing, preparation, cooking and in particular the way we consume” (3). The Mediterranean region is considered the Mediterranean Basin that borders the Mediterranean Sea and includes parts of seven countries: France, Portugal, Italy, Spain, Greece, Malta and Cyprus (4). There have been foreseen health benefits of consuming this diet, classifying it as “heart healthy” due to its likelihood to reduce the risk for heart disease (5,6). Living on the southern coast of France, I not only experience the Mediterranean lifestyle, but I have the opportunity to consume a Mediterranean Diet.

The Discovery

The Mediterranean Diet was discovered to have particular health benefits by Ancel Keys of the University of Minnesota in the 1950’s. He happened upon this discovery while studying the health of poor populations in Southern Italy in comparison to the wealthy in New York. He found the Italian populations had lower levels of cholesterol and a low rate of coronary heart disease (1).

Typical Foods

The diet is full of fresh foods including fruits, vegetables, herbs, fish, olive oil, breads, nuts and pastas (1). There is a very low consumption of red meats, poultry, butter, refined grains and processed foods. The diet is rich in fiber, monounsaturated fats and polyunsaturated fats, antioxidant compounds, and essential vitamins and minerals; conversely, it is very low in saturated fats. Given the diet’s composition of nutrient dense foods, strong adherence to this diet is associated with improved nutritional adequacy (2).

The Benefits

A strong adherence to the Mediterranean Diet enhances the chances of improving your health status. It has been found to reduce the risk for mortality, especially due to cardiovascular disease (7). There have been many cohort studies conducted in the Mediterranean Basin often showing good adherence to the diet and resulting in reduced incidence for cardiovascular events (6). The benefits of the diet are likely to improve with physical activity as well, such as decreased blood levels of LDL (1).

My observations

During my time in the south of France I have noticed the influence the agriculture and natural resources of the Mediterranean Basin has on the cuisine. This area is rich in olive groves, offering a plentiful supply of fresh olive products. The sea offers fresh fish, shellfish and other seafood, while local markets sell fresh fruits and vegetables. Cattle farms are not as populous in this area, so the consumption of red meat and butter is not as high as other European regions (such as Northern France). However, considering I am still residing in France, pastries, baguettes, and of course cheese are a typical part of the French dietary meal pattern. This differentiates my diet somewhat from other Mediterranean regions. Thankfully, walking as a means of transport is very common if not necessary, offering an efficient form of daily exercise. Fresh and homemade are the two words that best describe home cooking near the Mediterranean.  While residing with a local French family, I ate many freshly prepared meals. Everything made from scratch from salad dressings to whole grain bread.

The Mediterranean Diet is not an effort, rather a daily practice for many Europeans. As Americans, we may recommend it as a diet intervention or integrate it into our own eating habits for health reasons. This diet is seen to be successful by offering significant health benefits. This encourages me to try various diets from around the world that could potentially provide various health benefits for Americans, as well as a taste of a new culture.


3.La DiÈte MÉditerranÉenne 2010. Candidature transnationale en vue de l’inscription sur la Liste ReprÉsentative du Patrimoine Culturel ImmatÉriel de l’HumanitÉ. Espagne / GrÈce / Italie/Maroc, Version Informations Additionnelles.

Fish Consumption during Pregnancy: Weighing the Risk-Benefit

By Christopher Radlicz

Currently, only one-quarter of pregnant women in the United States are eating the amount of fish recommended for optimal maternal and child health (1). On the other end of the spectrum, about 10% of women of childbearing age have higher than recommended blood mercury concentrations (2).

A qualitative study done in 2010 has helped explain why women may be consuming less than the recommended two-servings of fish per week (1). Pregnant women in the Boston area, who under-consumed fish according to these guidelines, were broken into focus groups and discussed what was keeping them from eating more fish. These groups revealed that many women knew that fish might contain mercury, but were naïve of the fact that fish contained beneficial fatty acids, such as docosahexaenoic acid (DHA), which is essential for optimal fetal brain development (3). The women admitted that they hadn’t received advice to eat more fish or more specifically to eat fish that contain lower amounts of mercury and higher amounts of beneficial fatty acids. Instead, the women confessed that they were advised to limit fish intake due to possible mercury exposures.

Are these women misguided in keeping their fish consumption below the recommended two-servings per/week during pregnancy?

This past February, The 2015 Dietary Guidelines Advisory Committee reiterated that women who are pregnant, nursing, or are planning to become pregnant should still consume fish because neither the risk of mercury nor other organic pollutants outweigh the benefits (4). In a recent New York Times article on the issue, Dr. Steve Abrams, medical director of the Neonatal Nutrition Program at Baylor College of Medicine and panel member on the advisory committee commented on tuna consumption, explained, “The benefit of having (omega-3 fatty acids) in your diet really exceeds the likely risk of contamination. The point is that you should have a variety of types of seafood and not limit yourself to one type, and variety includes canned tuna.”(5).

The intake of fish during pregnancy is certainly more nuanced than simple elimination from the diet due to potential mercury exposure. Fish contains essential nutrients proven to have beneficial effects on brain neurodevelopment and may prevent cardiovascular disease (6). These benefits have been attributed in part to the long chain polyunsaturated fatty acids (LCPUFAs), DHA and eicosapentaenoic acid (EPA), but in addition seafood is a good source of protein, selenium, iron, iodine, choline, and vitamins E and D (4,7). These LCPUFAs are essential throughout pregnancy but are critical from the beginning of the third trimester until about 18 months after birth when the human brain is growing the fastest. Neglecting to supply LCPUFA among other nutrients during this period may result in deficits in brain development (9).

That being said, mercury exposure is a real possibility. Methylmercury is the organic form of mercury that we are exposed to when consuming fish in our diet. This form of mercury is relatively stable, mobile within the body, and exhibits a high potential to damage the brain (8). Mercury poisoning outbreaks in Japan are a testament to the wide spread damage that can occur from exposure to methylmercury, resulting in infants born with serious neurological damage, even when mothers were seemingly unaffected (10).

Extreme exposure to mercury in the food chain as in the case of Japan is a rather isolated instance though. But what is the balance? Do the beneficial effects of fish counteract the adverse effects of toxicants?

In the literature, detection of methylmercury exposure in infants is typically done by measuring levels in maternal hair, maternal toenails, cord blood, and maternal blood. These methods are variable in measuring biomarkers and on certain occasion, can be imprecise (5,7). Additionally, many observational studies do not statically control for negative confounders. This means that majority of the cohort studies done in this field have focused on either the risk of methylmercury or on nutrient benefits but not both (7).

All of the complications in study design and analysis show the complexity of establishing recommendations from these studies. Even with good study designs, clear-cut recommendations as to how much fish pregnant women should eat may still not be feasible, due to the variability of toxicants in seafood species. Empowering pregnant women by informing them of seafood that is lower in mercury levels and higher in LCPUFAs is a practical solution. A pertinent rule to apply when making seafood choices is that small sea creatures, which live shorter lives and are lower on the food chain, tend to be the lowest in methylmercury levels and exponentially higher in LCPUFAs. Larger seafood, on the other hand, tends to have higher levels of methylmercury due to a longer lifespan and their higher settlement on the food chain allowing for an accumulation of more methylmercury. The Dietary Guidelines Advisory Committee is in consensuses with the FDA and EPA in advising pregnant women to avoid eating these larger fish, such as swordfish, tilefish, shark, and king mackerel due to their high levels of methylmercury (4,7).


1.Bloomingdale A, Guthrie LB, Price S, Wright RO, Platek D, Haines J, Oken E. A qualitative study of fish consumption during pregnancy. Am J Clin Nutr 2010; 92: 1234-40. doi:10.3945/ajcn.2010.30070

2.Mahaffey KR, Clickner RP, Bodurow CC. Blood organic mercury and

dietary mercury intake: National Health and Nutrition Examination

Survey, 1999 and 2000. Environ Health Perspect 2004 ;112:562–70.

3.Koletzko B, Cetin I, Thomas Brenna J. Dietary fat intakes for pregnant

and lactating women. Br J Nutr 2007;98:873–7.

4.United States Department of Agriculture. Scientific Report of the 2015 Dietary guidelines Advisory Committee. Washington, DC. 2015.

5.Parker-Pope T. (2015, March 2). Should Pregnant Women Eat More Tuna. The New York Times. Retrieved from

6.Anon. The Madison Declaration on Mercury Pollution. Ambio 2007;36:62–65. [PubMed: 17408191]

7.Choi AL, Cordier S, Weihe P, Grandjean G. Negative Confounding in the Evaluation of Toxicity: The Case of Methylmercury in Fish and Seafood. Crit Rev Roxicol. 2008; 38: 877-893. doi:10.1080/10408440802273164.

8.Clarkson CW, Vyas JB, Ballatori N. Mechanisms of Mercury Disposition in the Body. American Journal of Industrial Medicine 2007;50:757-764.

9.Innis SM. Essential fatty acids in growth and development. Prog Lip Res 1991; 30: 39.

10.Harada M. Minamata Disease: Methylmercury Poisoning in Japan Caused by Environmental Pollution. Crit Rev Toxicol 1995;25:1–24.

11.Hibbeln JR, Davis JM, Steer C, Emmett P, Rogers I, Williams C, Golding J. Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study. Lancet 2007;369:578–585.


Is Fish Smelly?

What makes fish smell “fishy”?

By Ann L.

If you have ever caught fresh fish, you know that it doesn’t have a particularly strong odor, maybe a hint of ocean or lake water.But sometimes the fish you get from the store can have a pungent “fishy” odor.What causes that smell?

The answer has to do with some interesting physiology unique to sea creatures.Water in the open ocean is about 3% salt by weight, but the optimal levels of dissolved minerals inside an animal cell is less than 1%.In order to maintain fluid balance, ocean creatures must fill their cells with amino acids and amines to counter the saltiness of seawater. Ocean fish tend to rely on trimethylamine oxide (TMAO) for this purpose.

The problem is that when fish are killed, bacteria and fish enzymes convert TMAO into trimethylamine (TMA), which gives off the characteristic “fishy” odor.This smell can be reduced in two ways.TMA on the surface of the fish can be rinsed off with tap water.Treating the fish with acidic ingredients such as lemon, vinegar, or tomato can also cause TMA to bind to water and become less volatile.Thus the odor compounds do not reach the nose.

Freshwater fish generally do not accumulate TMAO because their environment is less salty than their cells.As a result their flesh tends to be milder, and they do not get as “fishy” as ocean fish.However, freshwater fish sometimes suffer from an unpleasant “muddy” aroma.This often occurs in bottom-feeders such as catfish, and is caused by two compounds produced by blue-green algae (geosmin and methylisoborneol).These chemicals concentrate in the skin and dark muscle tissue of the fish.Acidic conditions will cause these compounds to break down, so there is good reason for the inclusion of acidic ingredients in traditional recipes.

Next time you have fish be sure to give it a squeeze of lemon or a splash of vinegar!

Reference: McGee, Harold.On Food and Cooking: The Science and Lore of the Kitchen.New York: Scribner, 2004.