Going Mediterranean - food habits from the Mediterranean nations - Cover Story

Nutrition Action Healthletter, Dec, 1994 by David Schardt, Bonnie Liebman, Stephen Schmidt

He's a shepherd or small farmer, a beekeeper or fisherman, or a tender of olives or vines. He walks to work daily and labors in the soft light of his Greek Isle.

His midday, main meal is of eggplant, with large mushrooms, crisp vegetables, and country bread dipped in golden olive oil. Once a week there is a bit of lamb. Once a week there is chicken. Twice a week there is fish fresh from the sea. Other meals are hot dishes of legumes seasoned with meats and condiments.

The main dish is followed by a tangy salad, then by dates, Turkish sweets, nuts, or fresh fruits. A sharp local wine completes the meal.

--Henry Blackburn, M.D. University of Minnesota Co-Investigator, Seven Countries Study All that delicious food and wine and the lowest heart attack risk and lowest death rate in the Western world. What was it about peasants living on the Greek island of Crete in the 1960s that made them so healthy?

A small number of researchers, a slew of cookbook authors, and a few industries are betting that it was the olive oil and other foods they ate instead of a diet rich in meat, cheese, and butter.

Welcome to the marketing of the Mediterranean Diet.

What causes heart disease? In 1958, Ancel Keys of the University of Minnesota and an international team of scientists set out to see. Animal studies had suggested that fats were to blame, but "there was only anecdotal evidence about the role of diet" in humans, remembers coinvestigator Henry Blackburn.

During World War II, for example, heart disease rates plummeted in countries with shortages of meat and dairy products.

And when Keys and his wife traveled around Europe and Africa in the 1950s measuring blood cholesterol levels, they noticed that affluent people, who were eating more meat and dairy, were more likely to have high cholesterol and suffer heart attacks than poor people.

In Naples, Keys was taken to dinner at the Rotary Club. "The pasta was loaded with meat sauce and everyone added heaps of parmesan cheese," he recalls. "Roast beef was the main course. Dessert was a choice of ice cream or rich pastry."

Could a diet rich in saturated fat lead to heart disease? At the time, the notion was radical.

GOIN' TO THE COUNTRIES

Keys assembled a research team that looked at the diets, lifestyles, and blood cholesterol levels of more than 12,000 healthy middle-aged men in Finland, Greece, Italy, Japan, the Netherlands, the United States, and Yugoslavia.(1)

The participants in the Seven Countries Study ranged from 2,000 U.S. and 750 Italian railroad workers to 500 faculty members of the University of Belgrade to 1,000 residents of two fishing villages in Japan.

After five, ten, 15, and 20 years, Keys counted how many people had--or had died of--heart disease.

After ten years, the 775 men from east Finland fared the worst--28 percent of them had developed heart disease. The Finns were eating more saturated fat (mostly from cheese and butter) than almost anyone else in the world--24 percent of their calories. That's double what Americans now eat.

The 1,000 Japanese residents of the fishing villages of Tanushimaru and Ushibuka ate the least fat (nine percent of calories) and saturated fat (three percent of calories). Five percent of them had developed heart disease. That was far better than the Finns.

But it wasn't the best.

That honor went to the 655 men from the Greek island of Crete. After ten years, two percent of them had developed heart disease, and none of them had died.

Amazingly, the Cretans were eating about as much total fat as the artery-clogged east Finns. True, their intake of saturated fat was far lower (about eight percent of calories), but it wasn't as low as that of the mostly-rice-and-vegetables Japanese diet (see "Dueling Diets," p.7).

Dueling Diets

In the 1960s, the Greeks (not just the Cretans) and Japanese were eating much less saturated fat than the less-healthy Americans.

[CHART OMITTED]

The Greeks and Japanese of the 1960s ate more bread, beans, grains, fish, and alcohol than the Americans. (Note: the graph shows ounces of "pure" alcohol. A typical serving of wine, beer, or liquor contains one-third to one-half ounce of pure alcohol.)

[CHART OMITTED]

CRETAN EATIN'

You've heard about it on the news. You may have a copy of one of the cookbooks or the pyramid.

From kitchens in Milwaukee to trendy New York and L.A. bistros, the Mediterranean Diet is hot. The olive oil's flowing and the feta cheese is crumbling like there's no tomorrow. The foods of southern France and southern Italy are being touted as Roto-Rooters for your arteries.

Of course, many of those dishes aren't what the healthy Cretan peasants were eating back in the 50s and 60s.

"Their diet was dominated by olive oil and [whole-grain] bread--the two alone accounting for 50 to over 60 percent of their total calories," remembers Ancel Keys. It was also rich in beans and fresh fruits and vegetables. Meat--even poultry--was infrequent. So was sugar and most dairy.

That's a far cry from drenching your salad with olive oil instead of blue cheese dressing. Or from making the "Broad Beans with Sausages and Mint" in Diane Seed's Mediterranean Dishes cook-book.