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. Here we highlight the most relevant undertakings following this recognition.

The ancient Greek philosopher ‘Antisthenes’ tells us that “The beginning of a right education is the examination of words.” Thus firstly, it is crucial to clarify the definition of the Mediterranean diet, since it is often misused, be it intentionally or not. The Traditional Mediterranean diet is defined as the diet prevailing in the olive tree-growing areas of the Mediterranean region up until the early 1960s. It is characterised by the high intake of vegetables, fruits, legumes, and cereals (mainly in unprocessed forms), the low intake of meat and meat products and low to moderate intake of dairy products, the moderate to high intake of fish, the high intake of unsaturated added lipids, particularly in the form of olive oil, and the modest intake of ethanol, mainly as wine during meals, if religious and social norms accept it.

The Mediterranean diet pyramid

UNESCO acknowledged the Mediterranean diet as an intangible cultural heritage in 2010 and initially four Mediterranean countries were mentioned in this 2010 UNESCO description Greece, Italy, Morocco and Spain with the list being expanded in 2013 to include Cyprus, Croatia and Portugal. The term ‘cultural heritage’ does not end at monuments and collections of masterful objects. It also includes traditions or living expressions inherited from our ancestors and passed on to our descendants.Thus, the last ten years has seen an emphasis on safeguarding the intangible heritage of the Mediterranean diet. Important activities have taken centre stage with the understanding that the ‘right education’ through the training of food producers, mass caterers, industry, as well as faculty, students, and interested individuals, can work to preserve the Mediterranean diet, and avoidpossible erosions which may affect it at a national, regional and local level. 

It is essential to ensure that the right things are being preserved. Gradually several myths and misconceptions associated with the traditional Mediterranean diet have emerged, all of which  should be clearly addressed and dispelled, particularly those that label as “Mediterranean” an eating pattern that is not in line with the traditional diet. Within this context, we can all agree on how vital definitions can be and the risk of taking liberties with interpretations. Any trends that move away from the responsible stewardship of this heritage should be monitored and robustly critiqued. 

What do we observe when definitions are correctly applied? Today, we see the Mediterranean diet at the centre of many alternative treatment paths. Recently there have been several efforts to integrate food and nutrition into healthcare for prevention, management, and treatment of diet-related disease.  There is accumulating evidence that the Mediterranean diet, beyond its preventive role, could be beneficial for some chronic diseases offering safe and effective alternative treatments that not only provide symptom relief but also slow the development of the disease. 

Having had the importance of preserving our heritage recognised, the importance of further research was also acknowledged. With funded research opportunities being made available, we have further robust epidemiological data that are concordant in suggesting that the Mediterranean diet decreases the risks for a variety of diseases. In other words, we have consistent epidemiological evidence of the beneficial effects of the Mediterranean diet.  From a health perspective, in the last decade, nutritional investigations have provided strong indications that a diet that adheres to the principles of the traditional Mediterranean diet is associated with more prolonged survival. Again, this could be partly attributed to Mediterranean traditional foods, which are critical components of this diet.

With the recognition of the Mediterranean diet as intangible cultural heritage we are charged with identifying the role this diet can play in preservation, or possibly focus more today on restoring health to both our ecosystems and populations to safeguard a future. Indeed, in just this last decade, the significance of the Mediterranean diet has evolved from being a registered healthy dietary pattern to, by definition, encompassing a sustainable dietary pattern – with low environmental impacts for present and future generations in which nutrition, food, cultures, people, environment, and sustainability all interact with each other. With the Mediterranean diet’s low consumption of animal products and being a mainly plant-based diet of grains, vegetables, fruits, legumes and seeds, there is  limited negative environmental impact. 

 A recently published article in the respected medical journal, The Lancet, entitled ‘Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems acknowledges that the “Mediterranean diet has emerged as a pattern that promotes good health. Indeed, in epidemiology, it is rare to have so consistent evidence of the beneficial effects of an exposure as it has been shown for the Mediterranean diet: a diet that maximises longevity, improves health-related quality of life and is ecologically sustainable and environmentally friendly”.

Of note, is that this article, details a universal healthy “reference diet”. This diet is designed to provide a basis for studying the health and environmental effects adopting a different diet to standard current diets, many of which are high in unhealthy foods. It is clear that the EAT healthy “reference diet” bears a strong resemblance to the traditional Mediterranean diet.

Through UNESCO recognition, we have become responsible for the restoration of the Mediterranean diet and over the past ten years have worked with integrity towards providing the tools to preserve and enlighten both ourselves and beyond. We are now charged with asking what the key obstacles are that we are currently facing to encourage adoption of these recognised principles; we continue this path today.  

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’.

*On 16 November 2020, the Federation of European Nutrition Societies (FENS) and  the Italian Society of Human Nutrition (SINU), organised a virtual international conference on “Emerging Topics on Mediterranean diet 2010-2020: Ten years after the recognition of the UNESCO’s intangible heritage”. Dr  Antonia Trichopoulou presented the opening  lecture  ‘Mediterranean diet as intangible heritage of humanity: 10 years on’. A summary of this address is presented below. Full text of this speech was published in the Nutrition, Metabolism and Cardiovascular Diseases Journal, April 2021:  Trichopoulou, A. Mediterranean diet as intangible heritage of humanity: 10 years on. Nutrition, Metabolism and Cardiovascular Diseases. 2021.

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