Abstract
The Mediterranean diet is a dietary regime derived from the one followed by the ancient civilizations of the Mediterranean region. It is characterized by many healthy constituents, among which are cereals, legumes, fruits, vegetables, olives, and white meat. Many studies suggest that this dietary regime is the key to obtaining a healthy and long life, like that of the Mediterranean peoples. Despite its popularity among health professionals, this diet is still confined to a certain geographical area of the world. Due to globalization and the modern busy lifestyle, this cultural diet is losing ground even in its home region, with more and more people embracing the so-called Western diet. An awareness of health benefits of the individual components of the Mediterranean diet will therefore draw attention from all over the world to this healthy and affordable dietary pattern, which can not only improve the overall health, but also reduce the risk of developing chronic and infectious diseases. In this regard, garlic and Mediterranean legumes present a huge repertoire of phytochemicals having both nutritive and nutraceutical properties, which therefore should be included in our daily dietary routines in moderate proportions. This narrative review aims at summarizing the principal components and health benefits of the Mediterranean diet, in particular of garlic and legumes
References
[2] Diószegi J, Llanaj E, Ádány R. Genetic background of taste perception, taste preferences, and its nutritional implications: a systematic review. Front Genet 2019:1272. https://doi.org/10.3389/fgene.2019.01272
[3] Lăcătușu CM, Grigorescu ED, Floria M, Onofriescu A, Mihai BM. The Mediterranean Diet: From an Environment-Driven Food Culture to an Emerging Medical Prescription. Int J Environ Res Public Health 2019;16:942. https://doi.org/10.3390/ijerph16060942.
[4] Gotsis E, Anagnostis P, Mariolis A, Vlachou A, Katsiki N, Karagiannis A. Health benefits of the Mediterranean Diet: an update of research over the last 5 years. Angiology 2015;66:304-18. https://doi.org/10.1177/0003319714532169
[5] Dernini S. The erosion and the renaissance of the Mediterranean diet: A sustainable cultural resource. Quaderns de la Mediterrània 2011;16:75–82.
[6] Bower A, Marquez S, de Mejia EG. The Health Benefits of Selected Culinary Herbs and Spices Found in the Traditional Mediterranean Diet. Crit Rev Food Sci Nutr 2016;56:2728-46. https://doi.org/10.1080/10408398.2013.805713
[7] Bindu J, Narendhirakannan RT. Role of medicinal plants in the management of diabetes mellitus: a review. 3 Biotech 2019;9:4. https://doi.org/10.1007/s13205-018-1528-0
[8] Phan ADT, Netzel G, Chhim P, Netzel ME, Sultanbawa Y. Phytochemical characteristics and antimicrobial activity of australian grown garlic (allium sativum l.) cultivars. Foods 2019;8:358. https://doi.org/10.3390/foods8090358
[9] Amagase H, Petesch BL, Matsuura H, Kasuga S, Itakura Y. Intake of garlic and its bioactive components. J Nutr 2001;131:955S-62S. https://doi.org/10.1093/jn/131.3.955S
[10] Ried K, Fakler P. Potential of garlic (Allium sativum) in lowering high blood pressure: mechanisms of action and clinical relevance. Integrated blood pressure control. 2014;7:71-82. https://doi.org/10.2147/IBPC.S51434
[11] Juszkiewicz A, Zaborska A, Łaptaś A, Olech Z. A study of the inhibition of jack bean urease by garlic extract.
Foodchemistry. 2004;85:553-8. https://doi.org/10.1016/j.foodchem.2003.07.033
[12] Kim JS, Kang OJ, Gweon OC. Comparison of phenolic acids and flavonoids in black garlic at different thermal processing steps. J Funct Foods 2013;5:80-6. https://doi.org/10.1016/j.jff.2012.08.006
[13] Balasenthil S, Arivazhagan S, Nagini S. Garlic enhances circulatory antioxidants during 7, 12-dimethylbenz[a] anthracene-induced hamster buccal pouch carcinogenesis. J Ethnopharmacol 2000;72:429-33. https://doi.org/10.1016/s0378-8741(00)00264-6
[14] Amagase H. Clarifying the real bioactive constituents of garlic. J Nutr 2006;136:716S-725S. https://doi.org/10.1093/jn/136.3.716S
[15] Keys A. Wine, garlic, and CHD in seven countries. Lancet 1980. https://doi.org/10.1016/s0140-6736(80)90620-0
[16] Rahman K, Billington D. Dietary supplementation with aged garlic extract inhibits ADP-induced platelet aggregation in humans. J Nutr 2000;130:2662-5. https://doi.org/10.1093/jn/130.11.2662
[17] Shang A, Cao SY, Xu XY, Gan RY, Tang GY, Corke H, Mavumengwana V, Li HB. Bioactive compounds and biological functions of garlic (allium sativum l.). Foods 2019;8:246. https://doi.org/10.3390/foods8070246
[18] Nagella P, Thiruvengadam M, Ahmad A, Yoon JY, Chung IM. Composition of polyphenols and antioxidant activity of garlic bulbs collected from different locations of Korea. Asian J Chem 2014;26:897-902. https://doi.org/10.14233/ajchem.2014.16143A
[19] Diretto G, Rubio-Moraga A, Argandoña J, Castillo P, Gómez-Gómez L, Ahrazem O. Tissue-specific accumulation of sulfur compounds and saponins in different parts of garlic cloves from purple and white ecotypes. Molecules 2017;22:1359. https:// doi.org/10.3390/molecules22081359
[20] McRae MP. Therapeutic Benefits of l-Arginine: An Umbrella Review of Meta-analyses. J Chiropr Med 2016;15:184-9. https://doi.org/10.1016/j.jcm.2016.06.002
[21] Bayan L, Koulivand PH, Gorji A. Garlic: a review of potential therapeutic effects. Avicenna J Phytomed 2014;4:1-14.
[22] Petrovic V, Nepal A, Olaisen C, Bachke S, Hira J, Søgaard CK, Røst LM, Misund K, Andreassen T, Melø TM, Bartsova Z, Bruheim P, Otterlei M. Anti-Cancer Potential of Homemade Fresh Garlic Extract Is Related to Increased Endoplasmic Reticulum Stress. Nutrients. 2018;10:450. https://doi.org/10.3390/nu10040450
[23] Shirin H, Pinto JT, Kawabata Y, Soh JW, Delohery T, Moss SF, Murty V, Rivlin RS, Holt PR, Weinstein IB. Antiproliferative effects of S-allylmercaptocysteine on colon cancer cells when tested alone or in combination with sulindac sulfide. Cancer research 2001;61:725-31.
[24] Szulińska M, Kręgielska-Narożna M, Świątek J, Styś P, Kuźnar-Kamińska B, Jakubowski H, Walkowiak J, Bogdański P. Garlic extract favorably modifies markers of endothelial function in obese patients -randomized double-blind placebo-controlled nutritional intervention. Biomed Pharmacother 2018;102:792-7. https://doi.org/10.1016/j.biopha.2018.03.131
[25] Khoobkhahi N, Delavar R, Nayebifar SH. The combinatory effects of combined training (endurance–resistance) and garlic supplementation on oxidative stress and antioxidant adaptations in untrained boys. Sci Sports 2019;34:410.e1-410.e7. https://doi.org/10.1016/j.scispo.2019.05.007
[26] Aalami-Harandi R, Karamali M, Asemi Z. The favorable effects of garlic intake on metabolic profiles, hs-CRP, biomarkers of oxidative stress and pregnancy outcomes in pregnant women at risk for pre-eclampsia: Randomized, double-blind, placebocontrolled trial. J Matern Fetal Neonatal Med 2015;28:2020-7. https://doi.org/10.3109/14767058.2014.977248
[27] Ahmadian F, Mozaffari-Khosravi H, Azaraein MH, Faraji R, Zavar-Reza J. The effect of consumption of garlic tablet on proteins oxidation biomarkers in postmenopausal osteoporotic women: A randomized clinical trial. Electron Physician 2017;9:5670-5. https://doi.org/10.19082/5670
[28] Percival SS. Aged garlic extract modifies human immunity. J Nutr 2016;146:433S-436S. https://doi.org/10.3945/jn.115.210427
[29] Nantz MP, Rowe CA, Muller CE, Creasy RA, Stanilka JM, Percival SS. Supplementation with aged garlic extract improves both NK and γδ-T cell function and reduces the severity of cold and flu symptoms: a randomized, double-blind, placebocontrolled nutrition intervention. Clin Nutr 2012;31:337-44. https://doi.org/10.1016/j.clnu.2011.11.019
[30] Alma E, Eken A, Ercil H, Yelsel K, Daglioglu N. The effect of garlic powder on human urinary cytokine excretion. Urol J 2014;11:1308-15.
[31] Xu C, Mathews AE, Rodrigues C, Eudy BJ, Rowe CA, O’Donoughue A, Percival SS. Aged garlic extract supplementation modifies inflammation and immunity of adults with obesity: A randomized, double-blind, placebo-controlled clinical trial. Clin Nutr ESPEN 2018;24:148 55. https://doi.org/10.1016/j.clnesp.2017.11.010
[32] Memon AR, Ghanghro AB, Shaikh IA, Qazi N, Ghanghro IH, Shaikh U. Effects of olive oil and garlic on serum cholesterol and triglycerides levels in the patients of type–II diabetes mellitus. J Liaq Uni Med Health Sci 2018;17:101-5.
[33] Kojuri J, Vosoughi AR, Akrami M. Effects of anethum graveolens and garlic on lipid profile in hyperlipidemic patients. Lipids Health Dis 2007;6:5. https://doi.org/10.1186/1476-511X-6-5
[34] Turner B, Mølgaard C, Marckmann P. Effect of garlic (Allium sativum) powder tablets on serum lipids, blood pressure and arterial stiffness in normo-lipidaemic volunteers: a randomised, double-blind, placebo-controlled trial. Br J Nutr 2004;92:701-6. https://doi.org/10.1079/bjn20041255
[35] Ashraf R, Aamir K, Shaikh AR, Ahmed T. Effects of garlic on dyslipidemia in patients with type 2 diabetes mellitus. J Ayub Med Coll Abbottabad 2005;17:60-4.
[36] Ashraf R, Khan RA, Ashraf I. Effects of garlic on blood glucose levels and HbA1c in patients with type 2 diabetes mellitus. J Med Plant Res 2011;5:2922-8.
[37] Parham M, Bagherzadeh M, Asghari M, Akbari H, Hosseini Z, Rafiee M, Vafaeimanesh J. Evaluating the effect of a herb on the control of blood glucose and insulin-resistance in patients with advanced type 2 diabetes (a double-blind clinical trial). Caspian J Intern Med 2020;11:12-20. https://doi.org/10.22088/ cjim.11.1.12
[38] Salimzadeh A, Alipoor E, Dehghani S, Yaseri M, Hosseini M, Feinle-Bisset C, Hosseinzadeh-Attar MJ. The effect of 12-week garlic supplementation on symptom relief in overweight or obese women with knee osteoarthritis. Int J Clin Pract 2018;72:e13208. https://doi.org/10.1111/ijcp.13208
[39] Dehghani S, Alipoor E, Salimzadeh A, Yaseri M, Hosseini M, Feinle-Bisset C, Hosseinzadeh-Attar MJ. The effect of a garlic supplement on the pro-inflammatory adipocytokines, resistin and tumor necrosis factor-alpha, and on pain severity, in overweight or obese women with knee osteoarthritis. Phytomedicine 2018;48:70-5. https://doi.org/10.1016/j.phymed.2018.04.060
[40] Thomas A, Thakur S, Habib R. Comparison of Antimicrobial Efficacy of Green Tea, Garlic with Lime, and Sodium Fluoride Mouth Rinses against Streptococcus mutans, Lactobacilli species, and Candida albicans in Children: A Randomized Double-blind Controlled Clinical Trial. Int J Clin Pediatr Dent 2017;10:234-9. https://doi.org/10.5005/jpjournals-
10005-1442
[41] Andrianova IV, Sobenin IA, Sereda EV, Borodina LI, Studenikin MI. Vliianie chesnochnykh tabletok prolongirovannogo deĭstviia “allikor” na zabolevaemost’ ostrymi respiratornymivirusnymi infektsiiami u deteĭ [Effect of long-acting garlic tablets “allicor” on the incidence of acute respiratory viral infections in children]. Ter Arkh 2003;75:53-6.
[42] Dreher ML. Dietary patterns and whole plant foods in aging and disease. New York: Humana Press; 2018.
[43] Jin ZY, Wu M, Han RQ, Zhang XF, Wang XS, Liu AM, Zhou JY, Lu QY, Zhang ZF, Zhao JK. Raw garlic consumption as a protective factor for lung cancer, a population-based case-control study in a Chinese population. Cancer Prev Res (Phila) 2013;6:711-8. https://doi.org/10.1158/1940-6207.CAPR-13-0015
[44] Li H, Li HQ, Wang Y, Xu HX, Fan WT, Wang ML, Sun PH, Xie XY. An intervention study to prevent gastric cancer by micro-selenium and large dose of allitridum. Chin Med J (Engl) 2004;117:1155-60.
[45] Li WQ, Zhang JY, Ma JL, Li ZX, Zhang L, Zhang Y, Guo Y, Zhou T, Li JY, Shen L, Liu WD, Han ZX, Blot WJ, Gail MH, Pan KF, You WC. Effects of Helicobacter pylori treatment and vitamin and garlic supplementation on gastric cancer incidence and mortality: follow-up of a randomized intervention trial. BMJ 2019;366:l5016. https://doi.org/10.1136/bmj.l5016
[46] Myasoedova VA, Kirichenko TV, Melnichenko AA, Orekhova VA, Ravani A, Poggio P, Sobenin IA, Bobryshev YV, Orekhov AN. Anti-atherosclerotic effects of a phytoestrogen-rich herbal preparation in postmenopausal women. Int J Mol Sci 2016;17:1318. https://doi.org/10.3390/ijms17081318
[47] Jung ES, Park SH, Choi EK, Ryu BH, Park BH, Kim DS, Kim YG, Chae SW. Reduction of blood lipid parameters by a 12-wk supplementation of aged black garlic: a randomized controlled trial. Nutrition 2014;30:1034-9. https://doi.org/10.1016/j.nut.2014.02.014
[48] Matsumoto S, Nakanishi R, Li D, Alani A, Rezaeian P, Prabhu S, Abraham J, Fahmy MA, Dailing C, Flores F, Hamal S, Broersen A, Kitslaar PH, Budoff MJ. Aged garlic extract reduces low attenuation plaque in coronary arteries of patients with metabolic syndrome in a prospective randomized double-blind study. J Nutr 2016;146:427S-432S. https://doi.org/10.3945/jn.114.202424
[49] Sobenin IA, Pryanishnikov VV, Kunnova LM, Rabinovich YA, Martirosyan DM, Orekhov AN. The effects of time-released garlic powder tablets on multifunctional cardiovascular risk in patients with coronary artery disease. Lipids Health Dis 2010;9:119. https://doi.org/10.1186/1476-511X-9-119
[50] Zeb F, Safdar M, Fatima S, Khan S, Alam S, Muhammad M, Syed A, Habib F, Shakoor H. Supplementation of garlic and coriander seed powder: Impact on body mass index, lipid profile and blood pressure of hyperlipidemic patients. Pak J Pharm Sci 2018;31:1935-41.
[51] Ried K, Frank OR, Stocks NP. Aged garlic extract reduces blood pressure in hypertensives: a dose-response trial. Eur J Clin Nutr 2013;67:64-70. https://doi.org/10.1038/ejcn.2012.178
[52] Steiner M, Khan AH, Holbert D, Lin RI. A double-blind crossover study in moderately hypercholesterolemic men that compared the effect of aged garlic extract and placebo administration on blood lipids. Am J Clin Nutr 1996;64:866-70. https://doi.org/10.1093/ajcn/64.6.866
[53] Rebello CJ, Greenway FL, Finley JW. A review of the nutritional value of legumes and their effects on obesity and its related co-morbidities. Obes Rev 2014;15:392-407. https://doi. org/10.1111/obr.12144
[54] Smýkal P, Coyne CJ, Ambrose MJ, Maxted N, Schaefer H, Blair MW, Berger J, Greene SL, Nelson MN, Besharat N, Vymyslický T. Legume crops phylogeny and genetic diversity for science and breeding. CRC Crit Rev Plant Sci 2015;34:43-104.
[55] Kouris-Blazos A, Belski R. Health benefits of legumes and pulses with a focus on Australian sweet lupins. Asia Pac J Clin Nutr 2016;25:1-17. https://doi.org/10.6133/apjcn.2016.25.1.23
[56] Marventano S, Izquierdo Pulido M, Sánchez-González C, Godos J, Speciani A, Galvano F, Grosso G. Legume consumption and CVD risk: a systematic review and meta-analysis. Public Health Nutr 2017;20:245-54. https://doi.org/10.1017/S1368980016002299
[57] Mullins AP, Arjmandi BH. Health benefits of plant-based nutrition: focus on beans in cardiometabolic diseases. Nutrients 2021;13:519. https://doi.org/10.3390/nu13020519
[58] Polak R, Phillips EM, Campbell A. Legumes: health benefits and culinary approaches to increase intake. Clin Diabetes
2015;33:198-205. https://doi.org/10.2337/diaclin.33.4.198
[59] Geraldo R, Santos CS, Pinto E, Vasconcelos MW. Widening the perspectives for legume consumption: the case of bioactive non-nutrients. Front Plant Sci 2022;13:772054. https://doi. org/10.3389/fpls.2022.772054
[60] Ferreira H, Vasconcelos M, Gil AM, Pinto E. Benefits of pulse consumption on metabolism and health: A systematic review of randomized controlled trials. Crit Rev Food Sci Nutr 2021;61:85-96. https://doi.org/10.1080/10408398.2020.1716680
[61] Ferreira CD, Bubolz VK, da Silva J, Dittgen CL, Ziegler V, de Oliveira Raphaelli C, de Oliveira M. Changes in the chemical
composition and bioactive compounds of chickpea (Cicer arietinum L.) fortified by germination. LWT 2019;111:363-9. https://doi.org/10.1016/j.lwt.2019.05.049
[62] Ayyash M, Johnson SK, Liu SQ, Al-Mheiri A, Abushelaibi A. Cytotoxicity, antihypertensive, antidiabetic and antioxidant
activities of solid-state fermented lupin, quinoa and wheat by Bifidobacterium species: In-vitro investigations. Lwt 2018;95:295-302. https://doi.org/10.1016/j.lwt.2018.04.099
[63] Kalogeropoulos N, Chiou A, Ioannou M, Karathanos VT, Hassapidou M, Andrikopoulos NK. Nutritional evaluation and bioactive microconstituents (phytosterols, tocopherols, polyphenols, triterpenic acids) in cooked dry legumes usually consumed in the Mediterranean countries. Food Chem 2010;121:682-90. https://doi.org/10.1016/j.foodchem.2010.01.005
[64] Kan L, Nie S, Hu J, Wang S, Cui SW, Li Y, Xu S, Wu Y, Wang J, Bai Z, Xie M. Nutrients, phytochemicals and antioxidant activities of 26 kidney bean cultivars. Food Chem Toxicol 2017;108:467-77. https://doi.org/10.1016/j.fct.2016.09.007
[65] Liu R, Zheng Y, Cai Z, Xu B. Saponins and flavonoids from adzuki bean (Vigna angularis L.) ameliorate high-fat dietinduced
obesity in ICR mice. Front Pharmacol 2017;8:687. https://doi.org/10.3389/fphar.2017.00687
[66] Chai WM, Ou-Yang C, Huang Q, Lin MZ, Wang YX, Xu KL, Huang WY, Pang DD. Antityrosinase and antioxidant properties of mung bean seed proanthocyanidins: Novel insights into the inhibitory mechanism. Food Chem 2018;260:27-36. https://doi.org/10.1016/j.foodchem.2018.04.001
[67] Zhang B, Peng H, Deng Z, Tsao R. Phytochemicals of lentil (Lens culinaris) and their antioxidant and anti-inflammatory effects. JFB 2018;1:93-103. https://doi.org/10.31665/JFB.2018.1128
[68] Mamilla RK, Mishra VK. Effect of germination on antioxidant and ACE inhibitory activities of legumes. Lwt 2017;75:51-8. https://doi.org/10.1016/j.lwt.2016.08.036
[69] Luo J, Cai W, Wu T, Xu B. Phytochemical distribution in hull and cotyledon of adzuki bean (Vigna angularis L.) and mung bean (Vigna radiate L.), and their contribution to antioxidant, anti-inflammatory and anti-diabetic activities. Food Chem 2016;201:350-60. https://doi.org/10.1016/j.foodchem.2016.01.101
[70] Rizkalla SW, Bellisle F, Slama G. Health benefits of low glycaemic index foods, such as pulses, in diabetic patients and healthy individuals. Br J Nutr 2002;88:S255-S262. https://doi.org/10.1079/BJN2002715
[71] Hosseinpour-Niazi S, Mirmiran P, Hedayati M, Azizi F. Substitution of red meat with legumes in the therapeutic lifestyle
change diet based on dietary advice improves cardiometabolic risk factors in overweight type 2 diabetes patients: a crossover randomized clinical trial. Eur J Clin Nutr 2015;69:592-7. https://doi.org/10.1038/ejcn.2014.228
[72] Ascherio A, Rimm EB, Giovannucci EL, Colditz GA, Rosner B, Willett WC, Sacks F, Stampfer MJ. A prospective study of nutritional factors and hypertension among US men. Circulation 1992;86:1475-84. https://doi.org/10.1161/01.cir.86.5.1475
[73] Venn BJ, Perry T, Green TJ, Skeaff CM, Aitken W, Moore NJ, Mann JI, Wallace AJ, Monro J, Bradshaw A, Brown RC, Skidmore PM, Doel K, O’Brien K, Frampton C, Williams S. The effect of increasing consumption of pulses and wholegrains in obese people: a randomized controlled trial. J Am Coll Nutr 2010;29:365-72. https://doi.org/10.1080/07315724.2010.10719853
[74] Jayalath VH, de Souza RJ, Sievenpiper JL, Ha V, Chiavaroli L, Mirrahimi A, Di Buono M, Bernstein AM, Leiter LA, Kris-Etherton PM, Vuksan V, Beyene J, Kendall CW, Jenkins DJ. Effect of dietary pulses on blood pressure: a systematic review and meta-analysis of controlled feeding trials. Am J Hypertens 2014;27:56-64. https://doi.org/10.1093/ajh/hpt155
[75] Papanikolaou Y, Fulgoni VL 3rd. Bean consumption is associated with greater nutrient intake, reduced systolic blood pressure, lower body weight, and a smaller waist circumference in adults: results from the National Health and Nutrition Examination Survey 1999-2002. J Am Coll Nutr 2008;27:569-76. https://doi.org/10.1080/07315724.2008.10719740
[76] Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, Golan R, Fraser D, Bolotin A, Vardi H, Tangi-Rozental O, Zuk-Ramot R, Sarusi B, Brickner D, Schwartz Z, Sheiner E, Marko R, Katorza E, Thiery J, Fiedler GM, Blüher M, Stumvoll M, Stampfer MJ; Dietary Intervention Randomized Controlled Trial (DIRECT) Group. Weight loss with a lowcarbohydrate, Mediterranean, or low-fat diet. N Engl J Med
2008;359:229-41. https://doi.org/10.1056/NEJMoa0708681