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

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

"I do think there is a risk in making any traditional diet gentrified," says Walter Willett, chair of the Department of Nutrition at the Harvard School of Public Health. "The usual tendency is to pick out the meat dishes which might be eaten only on holidays and special occasions and treat that as the norm."

When you get right down to it, the Cretan diet was near-vegetarian. "It's not a diet that most Americans would find very easy to adopt," says Marion Nestle of New York University, who co-chaired (with Willett) the 1993 International Conference on the Diets of the Mediterranean.

HIT THE BOTTLE?

Let's say you could kiss goodbye the burgers and fries, the chicken salad sandwiches, the double cheese pizzas, and the chocolate-iced cakes. That would eliminate a good chunk of artery-clogging saturated fat. But how would you replace most of those missing calories?

You could hit the bottle (olive oil, that is) and go the high-fat Mediterranean route. Or you could turn towards the low-fat Orient by loading up on carbohydrates like rice, breads, cereals, beans, and pasta.

Is one healthier than the other? It depends on who you are.

* Heart Disease. Olive oil is rich in monounsaturated fat, "which appears to raise blood levels of HDL," explains researcher Scott Grundy of the University of Texas Health Sciences Center in Dallas. HDL ("good") cholesterol seems to protect people against heart disease, perhaps by ferrying cholesterol away from the arteries and out of the body.

Low-fat, high-carbohydrate diets, on the other hand, can lower HDL. Does that mean low-fat diets lose the HDL battle? It's not quite that simple.

"If I put you on a pure vegetarian, low-fat, high-carbohydrate diet, your HDL is going to fall," explains William Castelli, director of the Framingham Heart Study in Massachusetts. "But your LDL ['bad' cholesterol] will fall far faster, and your ratio of total cholesterol to HDL will actually improve.

"If you look around the world, countries that have very low heart attack rates [like China and Japan] actually have lower HDLs than we do. But they have very much lower LDLs, too, so their ratios are better."

Of course, looking at entire populations obscures differences between people. If your genes predispose you to low HDL, a diet that gets, say, only 15 percent of calories from fat could make things worse.

"An extra-low-fat diet will, in many people, elevate triglyceride levels, which lowers HDL levels," says Alice Lichtenstein, a heart disease researcher at Tufts University in Boston.

But, she adds, an extra-low-fat diet may make things better for someone who has a tendency to put on weight. "What frequently happens when overweight people drastically cut the fat content of their diet is that they lose weight." And that raises their HDL.

* Cancer. The Greeks and Japanese were not only less likely candidates for heart disease, they also were (and are) less likely to get breast, colon, and prostate cancer (see "Have a Heart"). What's more, a recent study from Spain found that women who consumed the most olive oil were a third less likely to develop breast cancer than women who ate the least olive oil.(2)