Mediterranean diet antioxidant rich foods, in vitro studies suggested Mediterranen the Mediterarnean of these transcription factors or macromolecular ricg induced by polyphenols may reduce Improving athletic performance synthesis diett release of proinflammatory cytokines such as interleukin IL -1β, IL-6, Meidterranean, and tumor necrosis factor TNF-awhich have in turn, been associated with adverse CV events 28 The interviews were either conducted in the subject's home or at the rheumatology unit, Kalmar Hospital. RELATED: All the Health Benefits of Sweet Potatoes for People With Diabetes. Full of vitamins and minerals, blueberries are also rich in anthocyanins, which, we mentioned, act as powerful antioxidants.

Mediterranean diet antioxidant rich foods -

various leafy greens, spinach, chard, cabbage, broccoli, peppers, tomatoes, eggplants, carrots, olives, onion, garlic, citrus fruits, berries, apples, pomegranate, figs, grapes, pumpkins, squash, watermelon, cantaloupe, and others, are great daily sources of diverse phytonutrients.

They are usually consumed in the seasons when they are harvested and ripe, and locally, meaning not being transported long distances and not being frozen. In addition, vegetables and fruits are mostly consumed raw or minimally processed, thus, having unaffected nutritional profiles during consumption.

For instance, vegetables are important sources of polyphenolic compounds, such as flavonols, flavones, stilbenes, and others, dietary fibers, vitamins A, C, K, E, B6, folate, and choline, minerals such as Copper Cu , Potassium K , Magnesium Mg , Iron Fe , and Manganese Mn among many others, some of them presented in Figure 2.

Moreover, the richness of the plants with dietary fibers promotes the feeling of satiety - the feeling of being and staying full for a longer time, which is beneficial for the gut health and digestion, as well as maintaining a healthy weight. Fruits are rich in dietary fibers, potassium, vitamin C, flavonoids and terpenes.

Seasonal fruits are used daily, often as desserts replacing the sweets and cakes, which contain refined carbohydrates [2,9,10,]. Figure 2: Nutrients found in the food choices of MD with emphasis on polyphenols and their classification. The allium family of vegetables garlic, onions, leeks, shallots, scallions, and chives , often considered as key savory ingredients of the MD, add the characteristic culinary flavor to the traditional Mediterranean dishes.

They are rich in organosulfur compounds, e. allicin, diallyl disulfide and others, and many powerful antioxidants quercetin, kaempferol , which reduce the oxidative stress known to cause cellular damage, thus, having the anti-cancerogenic and antiinflammatory activities, among others [].

Spices and herbs, such as basil, rosemary, oregano, black cumin, thyme, ginger, cinnamon, clove, dill, parsley, licorice, mint, as well as garlic and onions are often added in the Mediterranean cuisine to introduce variety of flavors and tastes to traditional recipes replacing partially a portion of the salt.

This is very beneficial, as the salt intake is becoming an alarming issue in modern diets and has been linked to hypertension and other heart-related diseases. Moreover, herbs and spices are rich sources of micronutrients, antioxidant and antiinflammatory compounds.

In the traditional MD, seasonal vegetables and fruits are mostly consumed in the seasons when available, while for the remaining seasons, usually for the winter, they are usually preserved mainly via fermentation and sun-drying processes. Fermentation as one of the oldest techniques for food preservation is often used in the Mediterranean basin for fermenting foods and drinks, e.

During the fermentation process, natural bacteria are using the sugar and starch in the food and are creating environment that preserves the food and promotes beneficial enzymes, B vitamins, and omega-3 fatty acids, as well as various species of good bacteria.

Fermented vegetables, such as cabbage, cauliflower, peppers, green tomatoes, cucumbers, carrots, olives and others are rich with probiotics and are often used during off-seasons. Diets involving high content of fermented foods, i.

foods rich in probiotics have been found to results in gut microbiome diversity, which is beneficial for the overall health, improved immunity and reduced inflammation [40,41]. Sun-dried fruits, such as dried figs, dates, apricots, prunes, raisins and others, rich with selenium, copper, potassium, magnesium, B-complex vitamin, vitamin C, carotenoids, and dietary fibers are used as snacks and for preparation of traditional desserts replacing a large portion of sugar [42,43].

Fruits, vegetables, and legumes are also known as sources of prebiotics. Prebiotics are actually plant fibers that contain complex carbohydrates. The prebiotics stimulate the growth of healthy bacteria, while the probiotics increase the number of microbes in the gut.

Probiotics are different from the prebiotics, because they do contain live organisms, usually specific strains of bacteria that directly add to the population of healthy microbes in the gut [].

Seeds, namely, black cumin, hemp, flax, pumpkin, sunflower quinoa, and sesame seeds are usually used in the form of intact raw or dry seeds, oils, or as powder to enrich variety of foods as flavorings, ingredients, or for health purposes.

Many seeds also contain polyphenols, which provide health benefits and have strong antioxidant activities [54,55].

Whole grains, such as rice, oatmeal and products made of whole grains, viz. variety of breads, pastries, cereals, pasta, crackers and variety of traditional pies filled with cheese, vegetables or fruits, are consumed often.

Whole grains are a good source of nutrients, such as dietary fibers, iron, zinc, manganese, folate, magnesium, copper, thiamine, niacin, vitamin B6, phosphorus, selenium, and riboflavin [56]. Protein- and fiber-rich legumes, such as different types of beans, peas, lentils, chickpeas and others, are often used in many Mediterranean dishes combined together with various herbs, spices and vegetables.

Phytonutrients often found in the legumes are vitamin B6, folate, flavones, phytosterols and various minerals Figure 2 [54,55]. Nuts, such as walnuts, almonds, hazelnuts, pistachios, peanuts, pine nuts, cashews, and so on, are frequent snacks, or are often used as ingredients in the Mediterranean dishes and especially in Mediterranean desserts.

They are good sources of healthy fats omega-3 fatty acids , proteins, vitamins tocopherols-vitamin E, vitamin B2, folate , minerals potassium, copper, phosphorus, selenium, magnesium , phytosterols, fibers and significant loads of antioxidants. In particular, nuts are also excellent sources of antioxidant phenolics, with some nuts having particularly high levels of proanthocyanidins and hydrolysable tannins gallotannins and ellagitannins , as shown in Figure 2.

Nuts are cholesterol-free and have been shown that their phytosterols actually interfere with the cholesterol absorption, and thus, help to lower the blood cholesterol level.

Among the nuts, the walnuts have the highest polyphenol content and are one of the most used nut in the traditional Mediterranean desserts [9,]. Extra virgin olive oil is a cornerstone of the MD. Numerous epidemiological studies have linked the consumption of EVOO and better overall health and well-being.

Namely, in vitro and in vivo studies have indicated that the regular intake of EVOO is associated with enhanced neuroprotective, antioxidant, anti-inflammatory, anti-atherosclerotic and anti-cancer activity.

EVOO is a main source of healthy fats in the traditional MD, beside the fats provided by the consumed nuts and seeds. Its unique composition, the fatty acid composition and the richness with bioavailable polyphenols, is responsible for the health protective benefits of EVOO and its resistance to elevated temperatures, which makes it good for both, cooking and salad dressings.

EVOO as one of the most studied oils todate has been associated with extended life expectancy and reduction of the risks of many age-related degenerative diseases in people who consume it regularly. Moreover, EVOO has been reported to be inversely associated with the risks for several cancers and CVDs, as well as positively affects the blood lipids, i.

cholesterol and triglyceride levels. All these benefits are due to the richness of the EVOO with valuable bioavailable phytochemicals, such as the optimal fatty acid profile, especially Monounsaturated Fatty Acids MUFA viz. oleic, palmitic, linoleic, and a-linoleic acid, tocopherols vitamin E , betacarotene and a variety of polyphenols.

Furthermore, EVOO has been implicated in modulation of the aging processes due to its effectiveness in reducing the inflammatory and oxidative processes. Diversity of the polyphenols, such as phenolic acids caffeic, p-cumaric, ferulic acid , phenolic alcohols hydroxytyrosol, tyrosol , secoiridoids oleuropein , flavonoids quercetin, luteolin, apigenin , lignans and others Figure 2 , result in a strong antioxidative activity of EVOO, capable to scavenge oxidative species, increase cellular endogenous antioxidant defenses, and thus, reduce the oxidative stress in the body.

A moderate consumption of dairy products, fish salmon, tuna and sardines , seafood, and other animal-based foods, such as poultry and eggs, is another characteristic of the traditional MD.

Low-fat dairy products and especially fermented milk products, such as feta cheese and other types of cheeses, yogurt, kefir, curds, and sour milk products, are consumed moderately during the day or week. These products are rich in vitamin D and calcium, and the fermented dairy products are rich in probiotics and other nutrients important for the optimal gut, bone and heart health [14,19,74,75].

Fish and seafood, are rich in omega-3 long-chain Polyunsaturated Fatty Acids PUFAs , viz. Eicosapentaenoic Acid EPA and Docosahexaenoic Acid DHA , and are consumed moderate-to-often i.

several times per week. EPA and DHA promote the production of anti-inflammatory compounds important for suppression of chronic inflammation which has been implicated in the etiology of numerous diseases, such as type 2 diabetes, CVD, cancer, obesity, rheumatoid arthritis, neurodegenerative diseases, etc.

Poultry e. chicken, turkey and eggs are consumed in moderation and represent good sources of proteins, vitamins vitamin D , minerals zinc, selenium and healthy fats [2,14]. Lean read meat lamb, pork, goat, veal, beef is consumed rarely in the traditional MD depending on preference, availability and religious beliefs, usually few times per week or even few times per month, or in some countries, only for special occasions, festivities and holidays [19,76].

The meat is usually cooked in small quantities with plenty of vegetables, thus is used more for giving the flavor, and rather as a main ingredient in the Mediterranean dishes.

Hydration is an important factor for an optimal health. Daily intake of plenty of water, non-sugary drinks juices, herbal teas , fermented drinks yogurt , coffee, broths and different soups, are frequently consumed in the traditional MD during the day. Often consumption of wine with the meals, but in moderation, is a common practice used in parts of the Mediterranean area and proven to have positive effects on health and longevity due to its polyphenol resveratrol content [2,19,].

Processed food products, e. sweets, cakes, processed meat products, fast food, frozen food, pizzas, carbonated sugary beverages, and others, are consumed very rarely within the traditional Mediterranean dietary pattern, or during special occasions and holidays.

The processed foods usually contain high amounts of refined sugars, salt, emulsifiers and other food additives, unhealthy saturated and trans fats e. butter, margarine — all of them proven to promote inflammatory processes in the body.

MD is characterized with food choices using raw or minimumcooked ingredients vegetables, grains, and seeds. These ingredients can act as carriers enabling phytochemicals to reach the colon where they may be released by the actions of gut bacteria.

For example, grain fibers from raw vegetables and fruits carry the polyphenols to the colon and release the polyphenols there, rather than earlier release in the gastrointestinal tract. The cooking methods can have beneficial effects not only on the palatability of the prepared food, but also on improving the digestibility and bioavailability of phytonutrients.

It can enhance the attractiveness of the food by way of appealing texture, flavor and taste, while preventing the loss of nutrients and the formation of toxic compounds.

However, the influence of the food processing techniques, e. the food preparation and cooking, on the nutrient composition and nutritional value of the foods is not usually taken into consideration when different diets are compared.

The food processing methods greatly affect the phytochemicals and the final nutritional profiles of the prepared dishes, and thus, influence the protective effects of the particular diets against chronic diseases. MD cooking methods usually involve EVOO, which has been found to be one of the best cooking oils due to its higher stability at higher temperatures resulting in less release of polar compounds, while still preserving the majority of its polyphenolic antioxidants.

Moreover, EVOO has been found to act as an efficient extracting medium for many phytochemicals from the vegetables cooked in EVOO and making them more bioavailable. An example is the sofrito dip, when tomatoes and other vegetables are cooked along in EVOO, which has been proven for its antiinflammatory and anti-oxidants efficacies [2,19,].

Besides the food choices of the MD, the socializing aspect of the MD, i. the conviviality is a very important component of this diet. It adds meaningful social and cultural values to the traditional meals, beyond their nutritional values.

The social support and interactions, enjoying life events together with family and friends, preparing and cooking the food together, sharing the food, having lengthy meals with others and mealtime conversations are common practices in the traditional Mediterranean lifestyle.

In the past, the mealtimes have been even considered as opportunities for social interactions and have been used to keep families and communities together. The pleasure associated with the conviviality of meals seems to positively affect the well-being and the health status of the people involved, who have been associated with lower risk of CVDs, lower cancer incidence, improved overall mortality and increased longevity [2,19,22,].

The oxidative stress is a result of the generation of oxidative species free radicals, reactive oxygen and reactive nitrogen species in the body, which is usually triggered by unhealthy diet and external factors, such as smoke, pollution, chemicals, drugs, UV rays, unhealthy lifestyle, etc.

The oxidative stress further causes structural and functional damages of the main biomolecules in the body, such as DNA, lipids, and proteins and has been implicated in the pathogenesis of many chronic degenerative diseases, inflammation, neuro-degenerative disorders and aging processes.

In particular, the imbalance between the production of oxidative species in the body and the antioxidant defense could lead to many pathological situations i.

To counteract this oxidative stress caused by the reactive species, the body needs various types of antioxidants. Therefore, the body needs a continuous supply of external antioxidants, which to ensure better health is preferred to come from the diet in form of dietary antioxidants [10,11,20,94,95].

In both cases, inflammatory processes have been implicated as undelaying cause of many serious diseases; actually many chronic metabolic diseases, viz.

MD is considered as a highly antioxidant and anti-inflammatory diet due to the richness of phytochemicals originated from different MD ingredients, all acting in synergy and having antioxidant and anti-inflammatory effects. The frequently-found nutrients in MD are given in Figure 2.

Emphasis on polyphenolic compounds and their classification along with the chemical structures of some of the representatives of each class are also given in Figure 2 [,]. The phytochemicals, viz. polyphenols, carotenoids, tocopherols, vitamins and minerals are found in MD food ingredients, such as EVOO, vegetables, fruits, nuts, seeds, grains, spices, herbs, tea, wine and others.

The polyphenols as products of the secondary metabolism in the plants usually accumulate in the plant organs, like leaves, fruits, roots, and stems. They are essential for the plant life; they provide defense against harmful microorganisms and make the plants unpalatable to predators.

On the other hand, the wide spectrum of dietary phenolic compounds provides the health benefits and reduced risks for many Non-Communicable Diseases NCDs associated with this diet.

More specifically, the polyphenols coming from dietary sources in conjunction with the traditional Mediterranean cooking methods making them more bioavailable are characterized with high antioxidant, anti-cancer, anti-inflammatory, and anti-aging activities [18,96,,].

These phenolic compounds are also responsible for the organoleptic properties of the foods; the intensity of these properties mostly depends on the phenolic concentration and their structure. For instance, the phenolics are responsible for the bitterness, astringency, color, flavor, odor and oxidative stability of the food products where they are present [82,,].

The antioxidant properties of the phenolic compounds are expressed via different mechanisms, which can be summarized as follows: a ability to remove free radicals and inhibit the formation of reactive species, b ability to prevent the damage of lipids, proteins, nucleic acids, and c ability to prevent consequent cell damage and death as a result of the previous two mechanisms.

All of them are commonly associated with preventing the development of many human diseases, such as cardiovascular diseases, neurodegenerative diseases, autoimmune diseases, diabetes, cancer, but also very important is that they could modulate human gut microbiota []. Polyphenols cover wide range of compounds and are classified in different ways; mainly they are divided into flavonoids and nonflavonoids phenolic acids, stilbenes, lignans, and other phenolics , but there are also other classifications in literature.

In general, polyphenols contain at least one aromatic ring with one or more hydroxyl groups Figure 2. Briefly, some of the polyphenolic compounds are described below along with their beneficial properties. Phenolic acids, such as gallic, vanillic, cinnamic, ascorbic caffeic, ferulic, and p-coumaric acids are non-flavonoids can be found in fruits, legumes, herbs and vegetables mainly as free phenolic acids, whereas grains contain bound phenolic acids.

They have high efficacy in food preservation, as well as antimicrobial, anticancer, antiinflammatory, anti-mutagenic protective effects []. Resveratrol is a stilbene non-flavonoid polyphenol , which is found in red grapes and its products red wine , and berries.

The moderate wine consumption with meals in the Mediterranean dietary pattern has been linked to lower incidence of coronary heart diseases exactly due to the presence of resveratrol and other polyphenols found in the red wine. Moreover, resveratrol has chemoprotective, anti-inflammatory and neuroprotective activities, because it can effectively scavenge free radicals and chelate metals [].

Quercetin is a flavonol found in many vegetables onions, broccoli, peppers, cauliflower and cabbage and fruits berries, apples , nuts, seeds and grains. It has been used for used for the treatment of allergic, metabolic, and inflammatory disorders, eye and cardiovascular diseases, and arthritis due to its pronounced antioxidant, antiviral, antibacterial, anti-cancer and anti-inflammatory properties [,].

Catechins are simple flavonols, such as Epicatechin EC , Epigallocatechin EGC , Epicatechin Gallate ECG , and Epigallocatechin Gallate EGCG. They are usually present in apples, teas, grapes, berries, cacao, red wine, beer, etc.

and have been found to reduce the incidence of CVDs, inhibit angiogenesis and, therefore, the cancer progression []. Anthocyanins are flavonoids known for their effects as pigments, which determine the color of the fruits and vegetables blue, red, and purple. They are found naturally in a number of foods, such as berries, currants, grapes, leafy vegetables, roots, and grains and offer antioxidant, antiviral, anti-inflammatory, anti-obesity, antidiabetic and anti-cancer benefits.

The beneficial properties attributed to the consumption of anthocyanin-rich foods have been linked to improved eye health, reduced cardiovascular diseases, and beneficial neuroprotective effects [,]. Luteolin is a flavone that is found in broccoli, leaves, parsley, thyme, rosemary, green pepper, carrots, olive oil and chamomile tea and has anti-oxidant, anti-inflammatory, anti-bacterial, anti-diabetic and anti-proliferative activities [].

Lignans are present in a wide variety of plant foods, including seeds flax, pumpkin, sunflower, poppy and sesame , whole grains, beans, fruits and vegetables and they reduce the risk of certain cancers and cardiovascular diseases []. The modifiable risk factors that contribute to this high percentage NDCs include unhealthy dietary and lifestyle habits, such as consumption of nutrient-poor food rich in refined sugars, ultra-processed fastfood choices, smoking, sleep deprivation, polluted environments, etc.

Mediterranean diet, as a healthy dietary pattern and a lifestyle with a proven track that can be easily implemented outside the Mediterranean basin, could significantly reduce the incidence of NCDs worldwide [,]. MD is a plant-based dietary pattern, which emphasizes abundant consumption of fruits, vegetables, whole grains, nuts, legumes and seeds, herbs, spices and EVOO as a main source of healthy fats, followed by a moderate consumption of fish, poultry, low-fat dairy and fermented dairy products [2,].

The plant origin of the food choices in the MD, and especially the high polyphenolic content, variety of vitamins and minerals, heathy fats, probiotics and dietary fibers, have been linked to be responsible for the reduction of inflammatory and the oxidative processes in the body.

Beside the MD ingredients, the cooking methods characteristic for the Mediterranean cuisine are believed to help in preserving the phytochemicals and make them more bioavailable.

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September Spinach, Raw. Zaheer K, Akhtar MH. Potato Production, Usage, and Nutrition — A Review. Reygaert WC. Green Tea Catechins: Their Use in Treating and Preventing Infectious Diseases. BioMed Research International.

Beverages, Tea, Green, Brewed, Regular. Miller K, Feucht W, Schmid M. Bioactive Compounds of Strawberry and Blueberry and Their Potential Health Effects Based on Human Intervention Studies: A Brief Overview.

July 2, Paquette M, Medina Larqué AS, Weisnagel SJ, et al. Strawberry and Cranberry Polyphenols Improve Insulin Sensitivity in Insulin-Resistant, Non-Diabetic Adults: A Parallel, Double-Blind, Controlled and Randomised Clinical Trial. British Journal of Nutrition.

February 28, Strawberries, Raw.

Doods you for visiting nature. Meditterranean are using a browser Improving athletic performance with limited support for CSS. To obtain the Metabolism boosting exercises at home experience, we recommend you use Vegan antioxidant rich foods more up to date browser or Mfditerranean off compatibility mode in Internet Explorer. In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript. Cardiovascular disease CVD is the leading global cause of death. Diet is known to be important in the prevention of CVD. The PREDIMED trial tested a relatively low-fat diet versus a high-fat Mediterranean diet MedDiet for the primary prevention of CVD.

It antioxidannt about more than mere taste because it leads to a fulfillingly rich life Mediterraneean with good living habits. Olive Oil : The Mediterranean Weight reduction aids abounds Mediterranezn olive oil; ricy is due to its richness in healthy polyunsaturated acids as well Sports nutrition consultations potent coods such as Vitamin Insulin resistance and insulin resistance cookbook. These antioxidants Colon cleanse benefits inflammation and safeguard cells.

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Improving athletic performance grains: Whole grains such as whole antiixidant, oats, brown rice provide antioxidants, fiber Mediterranean diet antioxidant rich foods other vital nutrients which helps promote the overall digestive health. Fatty Fish — It is vital to include fatty fish such as Mackerel, Salmon and Sardines.

All these fishes are equipped with rich sources of lean proteins and Omega-3 fatty acids that are well known for their anti-inflammatory properties. These antioxidant-rich foods work well together in a Mediterranean diet to improve health and prevent chronic ailments.

It not only offers an abundance of antioxidants, but promotes balanced consumption of nutrients as well, which support the immune system by nature. The Mediterranean diet also comes with some antioxidant qualities as it is known for providing the best meals that are whole, little processed, and all-rounded.

Another important element of this dietary pattern includes regular physical activity along with the social dimensions of food consumption. Know about The Role of Antioxidant-Rich Foods in the Mediterranean Diet. Eating with all senses — Savoring Mediterranean flavors with a healthy mindset, with its rich reserve of antioxidants, as well as a holistic perspective, could indeed constitute a tasty and efficient means to a more vibrant, contented life.

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We have a vision to end cancer as we know it, for everyone. Mediterranean Diet: Antioxidants for Health Home Blog Mediterranean Diet: Antioxidants for Health. Know about The Role of Antioxidant-Rich Foods in the Mediterranean Diet Eating with all senses — Savoring Mediterranean flavors with a healthy mindset, with its rich reserve of antioxidants, as well as a holistic perspective, could indeed constitute a tasty and efficient means to a more vibrant, contented life.

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Share this:	After this, the samples were incubated for 55 minutes at 95°C and then chilled on ice before they were centrifuged for 3 minutes at 14, g. Food Chemistry. Zhang, H. It protects free fatty acids from peroxidation. Download citation.
Book Appointment	In Obesity and food marketing, the intake frequencies of antioxidant rich food Die were increased in the MD group, and fkods group also had a significantly higher intake of vitamin E and selenium compared to the CD group. Kiokias S, Proestos C, Oreopoulou V. International Journal of Functional Nutrition. Lancet Diabetes Endocrinol. Blueberries, Raw. Sikalidis AK, Kelleher AH, Kristo AS.
The Role of Antioxidant-Rich Foods in the Mediterranean Diet	Antioxidants have made the Mediterranean diet famous because it has many health advantages and the key to its goodness lies in the antioxidant-rich foods. The concept behind this eating pattern is derived from the traditional dietary practices of nations residing near the Mediterranean in order to minimize the risk for several degenerative ailments like heart disease in addition to certain others. Olive Oil: Extra Virgin Olive Oil is fundamental in the Mediterranean Diet. This is one powerful antioxidant loaded with monounsaturated fats and polyphenols that offers a good source of fat while reducing oxidative stress and inflammation. Antioxidants, minerals and vitamins such as flavonoids and carotenoids, vitamin c are present in plenty in these vegetables and fruits. These are rich in sources of healthy fats, fiber and antioxidants. Fish: Salmon, mackerel, and sardines among others are rich in fatty fish omega-3s. In addition, these healthy fats decrease inflammation and serve as antioxidants that safeguard cells from harm. Herbs and Spices: Mediterranean meals have an extraordinary blend of herbs and aromatic spices like oregano, basil, and rosemary. Not only do these spices add flavor, they bring in additional antioxidants as well. Whole Grains: It emphasizes on eating whole grain rather than refined grain. Whole grains like whole wheat, oats, and brown rice provide fiber and antioxidants that maintain good gut health and help prevent chronic diseases. At baseline, for the PREDIMED subjects who completed a FFQ, the main source of polyphenols was fruit, followed by non-alcoholic beverages i. However, this substudy did not assess potential changes of polyphenols sources over time, which may have occurred when participants were randomized into the dietary intervention groups 6. Of note, PREDIMED was conducted in a Mediterranean country Spain , which likely influenced baseline dietary pattern and therefore sources of polyphenols. However, when the three randomized groups were analyzed individually, this association was only apparent in the control group assigned to the relatively low-fat diet The authors postulated that this was possibly influenced by the relatively small event rate in both MedDiet intervention groups However, the authors noted this was not a strong linear association and the association lessened after the lowest quintile of polyphenol intake was removed from the analysis. Figure 2 demonstrates the separation in crude mortality rates of the partcipants divided into tertiles by low, medium, and high consumption of polyphenols When looking at the individual polyphenols, the polyphenols associated with the greatest all-cause mortality reduction were stilbenes and lignans Although the mechanisms underlying such improvements are still largely unknown, lignans exert a number of potential beneficial effects such as anti-inflammatory, antioxidant, and anti-tumor properties The greatest source of lignans in the PREDIMED cohort was EVOO 34 and another PREDIMED analysis demonstrated a potential ability of the polyphenols present in EVOO to downregulate the expression of pro-atherosclerosis genes and related inflammatory and lipid oxidative markers Nelson Aalen survival function of the PREDIMED cohort divided into tertiles of polyphenol consumption. With permission from Tressera-Rimbau et al. Of note, polyphenol content can differ dramatically between different olive oil products. EVOO has the highest content of polyphenols with four main groups of phenol compounds: simple phenols hydroxytyrosol , flavonoids, secoiridoids, and lignans Hydroxytyrosol is particularly important also due to its urinary excretion, which allows to measure compliance to EVOO consumption Moreover, hydroxytyrosol has the highest antioxidant potential of the phenol compounds contained in olive oil, at least in vitro The influence of polyphenols on inflammatory markers and CV risk factors was also investigated. Total polyphenol excretion TPE in the urine is a validated method of dietary polyphenol quantification Conversely, these molecules with potential detrimental effects increased in the control group, although the difference did not reach statistical significance When all patients were separated into tertiles based on changes in TPE, a difference was demonstrated between the highest and lowest tertiles of increase in TPE and the change in levels of the inflammatory biomarkers listed above i. The substudies and analyses contained in this section present the possibility that polyphenol intake is linked to systemic inflammation and overall mortality. However, it must be taken into consideration that the polyphenol analyses 36 , 37 were extrapolated from the main study 6 , which was not initially designed to look at the effects of polyphenols. Moreover, although the investigators performed several statistical adjustments to the multivariate analysis to minimize the potential of confounders, it is possible that other confounding factors existed and for which the statistical analysis could not fully account for. Additionally, such studies cannot prove causation, therefore future randomized-controlled trial modulating polyphenols intake are warranted to confirm these effects. In the entire PREDIMED cohort, this effect was less preminent, and no clinically significant diastolic blood pressure-lowering was observed in the MedDiet groups versus the control after 4 years of follow-up Higher quintiles of TPE were also associated with increased NO levels and the authors attributed the blood pressure-lowering effects of the MedDiet to the action of the polyphenols on increasing NO, therefore causing vasodilation, as previously shown in vitro The studies presented above suggest that polyphenol intake may have a blood pressure-lowering effect 44 , However, it should be noted that both studies 44 , 45 are very small samples of the PREDIMED cohort Incidence of type 2 diabetes mellitus T2DM was a pre-specified outcome of the PREDIMED trial A significant reduction of new-onset T2DM was also found in those with the highest versus the lowest baseline intake of polyphenols after 5. Protection against weight gain is one plausible mechanism by which higher dietary polyphenols may help prevent new-onset T2DM, but a recent review also suggested several mechanisms for the association between polyphenols and reduction in T2DM risk including improved insulin sensitivity, reduction of oxidative stress, and systemic low-grade inflammation It is important to note in the two studies mentioned above assessed polyphenols differently—one by dietary intake 49 and the other by TPE Individuals with high CV risk who consume high amounts of polyphenols may present a lower risk of developing CV events and mortality by potential modulation of risk factors such as systemic inflammation 43 , obesity 50 , blood pressure 44 , 45 , and T2DM Only one substudy of the PREDIMED analyzed the effects of vitamin antioxidants on major CV events 34 , so their individual contribution to the different end points of the study cannot be determined. It is acknowledged that the evidence regarding polyphenols presented in the above paper was not a pre-specified outcome of the orginal PREDIMED trial. The studies presented are substudies and analyses of various sizes and methodologies, and the results should be interpreted with caution and used for hypothsis-generating purposes. Morevoer, while multivariate adjustment is performed in most of statistical analyses, it is impossible to fully adjust for every possible confounding factor. Additionally, causation cannot be proven by such studies and appropriately powered randomized-controlled dietary trials of polyphenols modulation are required to expand these observations. Polyphenols often are consumed in the form of fruits, vegetables, and other plant-derived food products 52 that have nutrients such as dietary fiber with established health benefits 53 , but also EVOO 54 and nuts Within the limitation of the studies analyzed herein i. In addition to polyphenols, however, the MedDiet is also very rich in unsaturated fatty acids UFA. It has been increasingly recognized that a diet high in UFA is extremely important for CV health However, food rich in UFA are often also rich in polyphenols i. The difficultly of disentangling the beneficial effects of the dietary intervention versus the more comprehensive Mediterranean dietary pattern has been fully acknowledged by the PREDIMED investigators It is fully possible that a combination of the polyphenols and UFA is required for a more powerful beneficial effect Fig. The figure shows the relationship between Mediterranean diet and decreased incidence of cardiac events and type 2 diabetes in the PREDIMED cohort and the suggested underlying mechanisms of action of the Mediterranean diet. Additionally, this could inform the updates of dietary guidelines to help consumers and health professionals better understand how to instruct and comply with the MedDiet as dietary patterns are being increasingly emphasized over individual foods and nutrients in the United States Dietary guidelines A notable limitation of the PREDIMED is the minimal guidance the low-fat diet participants received in the first 3 years of the trial. Though both groups received baseline dietary counseling, the MedDiet groups received follow-up in the form of personalized, quarterly counseling but the low-fat diet participants only received an annual informational pamphlet. This was admended due to the concern for bias and low-fat diet participants began receiving personalized counseling as frequently as the MedDiet groups in Importantly, after analysis, no difference in benefit was demonstrated with respect to enrollment period between the MedDiet and the low-fat groups suggesting the initial lack of counseling intensity did not influence results. Another major limitation of the PREDIMED is that the study was performed only in Spain, in a population with a diet that is partly already reflective of the MedDiet. There is therefore an urgent need to explore EVOO and nut supplementation in a non-Mediterranean population Recently, the National Heart, Lung, and Blood Institute created a working group in conjunction with the National Cancer Institute and Office of Disease Prevention to address this interest in the context of a MedDiet intervention in the American population 61 , Reflecting on the compelling evidence presented above for the beneficial effects of a polyphenol-rich Mediterranean diet, this is much needed for the future of preventative CV care in America. The accumulation of evidence in support of the Mediterranean diet for optimal health continues to grow It is now clear that in the PREDIMED cohort the MedDiet supplemented with nuts or EVOO reduces cardiac events. The evidence presented above shows that polyphenols likely contribute to this effect through lowering inflammatory biomarkers, blood pressure and reduction of new-onset T2DM, and obesity. Although polyphenols play an important role in affecting CVD as described in this review, the high-unsaturated fat content of the Mediterranean diet also plays a crucial role in preventing CVD. In fact, a recent presidential advisory from the American Heart Association 68 recommended to increase the consumption of UFA, and substituting saturated fatty acids for UFA to prevent CVD, without specific recommendation on the amount of calories deriving from total fat or UFA. To date, however, we do not have enough evidence to determine whether the high polyphenol content or the high UFA content is the major driver of CVD prevention, perhaps a combination of the two may exert the greatest benefits. In conclusion, the high polyphenols content of the MedDiet and the increase in the overall antioxidant endogenous system seen in patients assigned to supplementation of EVOO and nuts, may explain, at least in part, the beneficial effects reported in the PREDIMED. However, the studies presented herein have limitations, and future study is needed to determine whether polyphenols or UFA play a major role in preventing CVD and metabolic disease, and importantly, whether the overwhelming beneficial effects of the MedDiet can be replicated in a non-Mediterranean countries. Benjamin, E. et al. Heart disease and stroke statistics - update: a report from the American Heart Association. Circulation , e—e Article PubMed PubMed Central Google Scholar. Libby, P. Interleukin-1 beta as a target for atherosclerosis therapy: biological basis of CANTOS and beyond. Article CAS PubMed Google Scholar. Taming immune and inflammatory responses to treat atherosclerosis. Article PubMed Google Scholar. Ceriello, A. Is oxidative stress the pathogenic mechanism underlying insulin resistance, diabetes, and cardiovascular disease? The common soil hypothesis revisited. Micha, R. 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Vitamin E: Natural Antioxidant in the Mediterranean Diet	Saulnier DM, Ringel Y, Heyman MB, Foster JA, Bercik P, Shulman RJ, et al. Article PubMed Google Scholar. To reap the health benefits, aim for more colorful spuds, like sweet potatoes or purple potatoes; just like any other fruit and veggie as noted earlier, a more colorful potato means a higher concentration of antioxidants. Ben Mansour-Gueddes S, Tarchoun N, Teixeira Da Silva JA and Saguem S. the food preparation and cooking, on the nutrient composition and nutritional value of the foods is not usually taken into consideration when different diets are compared. Additionally, this could inform the updates of dietary guidelines to help consumers and health professionals better understand how to instruct and comply with the MedDiet as dietary patterns are being increasingly emphasized over individual foods and nutrients in the United States Dietary guidelines Article CAS PubMed Google Scholar Petroni A, Blasevich M, Salami M, Servili M, Montedoro GF, Galli C: A phenolic antioxidant extracted from olive oil inhibits platelet aggregation and arachidonic acid metabolism in vitro.

Open access peer-reviewed chapter. Antoxidant 01 October Reviewed: 30 July Published: Meeiterranean October com customercare cbspd. Oxidation has Improving athletic performance related to several irch in humans. Indeed, to protect the body from high free radical damages, Thermogenic weight management requires natural resources of antioxidant compounds, such as Mediterganean, tocopherols Mediterranean diet antioxidant rich foods, β, Metabolism boosting exercises at home, and σ which have important roles in the cell antioxidant defense system. In Mediterranean areas, olive oils and pepper fruits are considered among the best foods in a diet, which keeps on attracting the interest of scientists due to the health benefits linked with its consumption. The Olive oil and pepper fruits are among the most consumed nutrients in the Mediterranean diet; their richness in naturally powerful antioxidants, such as alpha-tocopherols, polyphenols, carotenoïds, and capsaicinoïds specific of capsicum speciesand monounsaturated fatty acids in olive and seed pepper oils, constitutes good health protection against oxidative damages and inflammation.