Food pyramid from the perspective of traditional Persian medicine and its comparison with modern medicine

Dear Editor
From the perspective of Iranian traditional medicine, food is referred to as 'good blood' (Saleh) and used as a substitute for exhausted food (''Badala Ma Yatahallal''). Additionally, food includes edible items that humans consume to satisfy their hunger and provide sustenance for their bodies. According to traditional Persian medicine, the human body has varying needs at different times and stages of life, requiring either nourishing substitutes or consumable food to maintain bodily equilibrium.¹
 
The food pyramid in modern medicine
The food pyramid is designed as a nutritional guide for healthy individuals aged two years or older. The guide emphasizes consuming a diverse array of foods from the five primary food groups while limiting fat and sugar intake. A triangle shape symbolically represents the daily amount of food in each category. The pyramid consists of four layers.^2,3
Layer 1 (main floor): This level represents carbohydrates, including bread, rice, pasta, cereal, and all other grain-based foods.
Layer 2 (second layer): This layer is split into two subcategories: plant-based foods rich in vitamins, minerals, and fiber (fruits and vegetables).
Layer 3 (the third layer): This layer is also divided into two subcategories: animal-based foods like milk, yogurt, cheese, meat, poultry, fish, eggs, beans, and nuts. These foods provide essential proteins, calcium, iron, and other nutrients.
Layer 4 (top layer): This final layer comprises high-calorie, low-nutrient foods such as sauces, dressings, oils, creams, margarine, sugary drinks, candies, and sweet desserts. While these foods may be enjoyed occasionally, they should not make up a significant portion of one's diet due to their lack of essential nutrients.
 
The food pyramid in ancient literature (Persian medicine)
The food pyramid, from the perspective of different periods' philosophers according to various conditions, seems to have changed. However, it has largely been preserved as a whole. Razi, the Persian physician, philosopher, and alchemist, reports and advises in his book (Manafe ol-Agheh) that the main foods of people are as follows: Since the main meals of people are bread, water, and other drinks, and meat as well, and almost all of their meals are composed of these materials, I would like to start my advice with this food. The author of Khol ast-e Tajarob had attractive descriptions of the diet of people in this country: People are very long-lived and have often been healthy. And their meals for their whole lives were based on different types of flour (barley, wheat, maize, peas, and beans), sometimes different rice, bread, yogurt, yogurt drink (doogh), and vinegar.^4,5
Naser Al-Hokamah has reported an eloquent expression: "It is incumbent upon those who wish to preserve their health to limit their diet to pure wheat bread (not containing rotten substances), obtained through proper cultivation without any pests or damages, and Ambar of Gilan rice with a desirable fragrance, Chanpay of Shiraz, and Peshawar rice, which preserves health and prolongs lifespan, and should not mix with black wheat (Shilm) as it would cause intoxication and alter one's temperament. Also included in this diet are one-year-old lamb meat free of illness, six-month-old yeanlings, one-year-old calves, partridges, francolins, chicks, roosters, and small fresh fish meat, such as white fish and salmon fish, provided they are not enclosed and confined but instead graze in open fields and good pastures. For sweets and biscuits, it is preferable to mix sugar and almonds together and consume them, as the sweetness is beneficial for the liver. Juicy fruits like figs, grapes, and subacid pomegranates are advantageous to consume before meals, while melons and ripe dates, along with others, may be consumed between two meals. Individuals residing in regions producing these fruits can utilize them. However, if they import dates or other fruits from abroad, they are unsuitable due to their potential harmful effects and similarity to the previously listed foods." This dietary policy is ideal for individuals seeking optimal health.⁶
From the perspective of physicians in the past, the "food pyramid of patients" was conducted under special rules, and this issue was one of the most detailed parts of the treatment. It was not only based on quantity or quality but also involved other indices.⁷
As mentioned earlier, the food pyramid in ancient sources differed in various conditions, such as age, climate, temperament, and the seasons. This dietary diversity provides a valuable hint in this regard.
 
Discussion
According to traditional Persian medicine's perspective and comparison with modern medical views, it is evident that ancient Iranian sages accurately described the principles of proper nutrition with precision and delicacy. This highlights their knowledge and insights from back then. A crucial aspect of food and beverage strategies is recognizing that eating and drinking are interconnected with the six fundamental aspects of "Setah Zaroriah," including movement and repose, sleep and wakefulness, sensory experiences, retention, vomiting, and air quality. Each of these factors can have either positive or adverse impacts on the functioning of the others. These findings underscore the importance of the food pyramid in light of the five earlier-mentioned principles and necessitate careful consideration for the pyramid of life mentioned above.⁸
Nowadays, due to the rise in prevalence of chronic diseases such as metabolic syndrome, cardiovascular diseases, and cancer, in the updated food pyramid, sports and physical activity are given a significant position and are viewed as crucial factors in tailoring one's diet. This stance has gained widespread acceptance in recent studies. In classical nutritional texts, the types and sources of nutrients were paramount, and the focus was not solely on measuring macronutrient intakes like carbohydrates, fats, and proteins. As such, selecting the right foods for a healthy lifestyle is essential. Consequently, there is an emphasis on consuming and utilizing specific foods.^9,10
 
Conclusion
According to the current food pyramid, the use of carbohydrates, meats, vegetables, and fruits has been considered, but Persian Medicine's Sages have viewed the food consumption pattern and food pyramid in a specific format. Temperament, age, gender, climatic conditions, health and sickness, seasons, and special circumstances such as pregnancy and breastfeeding must be considered when creating the food pyramid, and these modifications in dietary intake are not only quantitative but also give special attention to quality and food interactions. Moreover, they recommend using various kinds of specific foods at the appropriate time, such as milk among young people during springtime and among older individuals in warmer seasons, or eating more cold-natured foods in warm seasons and vice versa.
Nowadays, there has been a shift towards prioritizing chronic disease prevention, and as such, the food pyramid has undergone revisions in recent studies. Physical activity has also been incorporated into the base of the pyramid. For individuals suffering from illnesses, this can be tailored to their specific needs and circumstances using precise guidelines. While many people may choose food based solely on its affordability ($), accessibility, and taste, it is crucial to recognize that food plays a vital role in maintaining overall health beyond simply filling the stomach. In traditional Persian medicine, nutrition is seen as more than just fuel for the body but rather a means of preserving health through the provision of essential nutrients for metabolism and tissue repair, as well as influencing both physical and mental wellbeing. As such, careful consideration and attention must be given when selecting foods for optimal temperament balance and meeting the body's requirements.