Research
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The Mediterranean Diet is one of the healthiest and most scientifically researched eating patterns in the world. What people don’t realize is that it is an American invention and not, as the name would suggest, a European invention.
These are the words of Dr. Ancel Keys, one of America’s most influential health and nutritional scientists and the person most credited for defining and popularizing the Mediterranean diet:
“One thing is certain: our diets have changed greatly from those of our ancestors and they will continue to evolve, not only because of the growth of nutritional knowledge, but perhaps even more as a result of advancing technology and the related economic pressures it produces. The most obvious influence on our diet is food availability; our current American diet reflects the fact that we now have a superabundance of foods in variety undreamed of not long ago. Great skill and effort goes into persuading us that every day should be a feast day by buying, and eating more of this and that food once reserved as a treat for the rich.”
This observational piece on the causes of excess weight gain could feature inside any modern science journal from any country around the world. In fact, Dr. Keys wrote this about the American diet in the 1950s.
Excessive overeating and the problems of obesity are not new, they have just escalated substantially since the late 1970s, and despite some of the best scientists and researchers in the world looking at the causes and solutions of excessive overeating the problems just keep getting worse.
In 1954, Life Magazine published a review on the growing American obesity problem mainly because it was becoming a noticeable issue as people grew larger in greater numbers, but also in part because the major health crisis of the time was heart disease which caused almost half of all preventable deaths.
The discovery of an American dream diet
In 1950 Dr. Keys, a professor at the University of Minnesota who died on November 24, 2004 aged 100, was asked to chair the World Health Organisation’s first commission on food and agriculture in Rome. During a short period he spent in Europe, an Italian colleague commented to Keys that Italy had very little heart disease compared to 1950s America.
After initial scientific dietary trials in Italy and the Greek island of Crete, an intrigued Dr. Keys pushed ahead and began one of the most famous dietary research projects ever undertaken: The Seven Countries Study.
Dr. Keys slowly defined and developed a scientific model which monitored the dietary and lifestyle patterns of nearly 12,000 men between the ages of 40 and 59 from Italy, the Greek islands, Yugoslavia, the Netherlands, Finland, Japan and the United States.
The Seven Countries Study began in 1958 and by 1980 Keys had published in one book all the major findings of his studies that had been presented to the science community in many influential scientific journals since the 1960s. The Seven Countries Study was the first major work to systematically review the relationships between lifestyle, diet, and the high rates of heart attack and stroke between contrasting populations.
Dr. Keys, along with many research colleagues from hospitals and universities around the world who worked on the project, discovered that in those societies where saturated animal fat was a major component of almost every meal, such as America and Finland, blood cholesterol was highest and the heart attack death rate was the greatest. In the countries where people ate a diet of fruit and vegetables, bread, nuts, legumes, fish and olive oil, blood cholesterol was low and heart attack rates were substantially lower.
This American led research work marks the origins of the modern day science behind the Mediterranean diet. But Dr. Keys was not the only American to have been influential in popularizing the Mediterranean diet.
A lesser known but highly skilled scientists named Dr. Leland Allbaugh was appointed Field Director by the Rockefeller Foundation in the early 1950s to investigate the causes of the high rates of death on the Greek island of Crete and to report to the Greek government on a model which could provide sustainable change to improve the lives of the affected people. It was envisioned that any adopted model could then be taken to other developing Western countries with similar rates of high mortality and deprivation.
After several years spent systematically reviewing every aspect of life on Crete and comparing it to life in mainland Greece and America, Dr. Allbaugh’s work provided some insightful data on heart disease and provided some useful references for the work later to be undertaken by Dr. Ancel Keys.
Dr. Allbaugh documented that the rates of death in Crete were high, but the primary problem was poor public health infrastructure, poor access to good quality medical care and the availability of drugs to combat infectious diseases such as malaria, typhoid and dysentery.
Dr. Allbaugh’s data had also inadvertently highlighted that the adults of Crete had substantially better rates of heart disease than in America with a third fewer deaths related to cardiovascular disease and just under a third fewer deaths from cancer.
Although no link was made at the time between diet and heart disease, the research found that the number of daily calories eaten by a typical family in Crete was relatively high and was composed of similar components as found in an American diet, but in substantially different food groups and nutrient sources for the main calories:
| Sources of calories consumed, by percentage,Crete, Greece and United States, 1948 | |||
| Food Group | CreteFall 1948 | Greece1948-1949 | USA1948-1949 |
| Cereals | 39 | 61 | 25 |
| Potatoes | 4 | 2 | 3 |
| Sugar and honey | 2 | 4 | 15 |
| Pulses and nuts | 7 | 6 | 3 |
| Vegetables and fruits | 11 | 5 | 6 |
| Meat, fish and eggs | 4 | 3 | 19 |
| Dairy products | 3 | 4 | 14 |
| Oils and fats | 29 | 15 | 15 |
| Wine, beer & spirits | 1 | not given | not given |
| Total calories per person per day | 2,547 | 2,477 | 3,129 |
| Sources of protein in the diet, by percentage | |||
| Animal protein | 24 | 19 | 66 |
| Vegetable protein | 76 | 81 | 34 |
| MediterraneanDiet.tv | |||
Allbaugh, 1953
The work of Dr. Keys was later to show that cholesterol from saturated animal fat was a major contributor to heart disease and excessive weight gain. Today, the once healthy people on the island of Crete are excessively overweight because they eat far more saturated fat (mainly from animal protein), fast food meals and more processed foods than the dietary components that originally made them famous for being heart healthy.
Good fats, bad fats and the problem of blocked arteries
Dr. Keys’s findings on the health implications of eating a diet heavily laden with animal fats was the basis for the 1960s and 1970s American dietary recommendations that advised people to consume less animal fat and refined processed sugars, which led to Keys being labelled the father of the low-fat diet.
Fat itself is not bad, as many studies have shown. It is the type, source and artificial processing of fat, in particular the hydrogenation of fat, also called ‘trans fat’, to make it more stable for longer-term storage, that causes elevated levels of LDL cholesterol (the bad cholesterol) and forces down HDL cholesterol (the good cholesterol which the body produces naturally to remove excess levels of LDL from the bloodstream).
Elevated levels of LDL cholesterol is particularly bad because it more easily sticks to any imperfections or damage in blood vessels. Once LDL cholesterol begins to form it acts like Velcro and traps more LDL until arteries and many other minor blood vessels are blocked and blood flow is restricted; this is the first step in causing heart attacks and strokes.
What Dr. Keys and Dr. Allbaugh showed, and which has been verified by many since, is that the people who live in the Western countries around the southern coasts of the Mediterranean sea had better health because they used olive oil as their main dietary fat and they consumed very little in the way of animal fat and animal protein. But they did not give it up completely.
At the time, the low rates of protein consumption was due to meat being prohibitively expensive and so it was mainly eaten when families gathered for their weekly and very long weekend lunches. The rest of the time, protein was obtained from nuts, legumes and fish, which remained cheap because of the many fishing villages and towns along the entire coast of the Mediterranean sea.
More modern studies have shown that fish oil, olive oil and the natural oils found in nuts and legumes, which were eaten to compensate for the lack of dietary meat, provide the necessary calories in the diet which gives people a feeling of satiety. In addition, it is the omega-3 oils found in these foods that provide the health protection against high circulating levels of the bad cholesterol in the blood, help provide antioxidant protection and help repair damaged cells.
Sustained weight management
One of the benefits of feeling full on these types of calories from plant sources and fish oils, is that the energy in a typical Mediterranean diet is released slowly, the foods have a low GI, meaning that there is an extended time delay between feeling the need to eat again and so it reduces the desire to snack excessively.
The typical nutrients within many Mediterranean diet recipes are also high in the most beneficial vitamins and minerals and so the body does not encourage a feeling of craving ever more highly palatable foods in order to increase intake so that it can sieve out essential nutrients.
These and many more factors combine to make the Mediterranean diet a surprisingly good way to lose weight, despite the relatively high levels of calories and the moderate levels of wine consumption – another feature of the diet that has been found to be protective to health from the alcohol and the antioxidants found in grapes, particularly in the skin of red grapes.
The 2010 Dietary Guidelines for Americans
Following the decades of research into healthy eating patterns, the Mediterranean diet has consistently been shown to have many health benefits and it is closely aligned with good nutritional guidelines and a multitude of public health objectives.
This is the reason why the 2010 Dietary Guidelines for Americans now recommend a dietary pattern which closely resembles a Mediterranean diet, as was recognized during a briefing by the US Department of Agriculture on June 15, 2010, where the extensive research findings of the high profile government Advisory Committee were confirmed:
The Committee summarized this approach by describing a total diet that is:
- Energy balanced, limited in total calories, and portion controlled
- Nutrient-dense and includes:
– Vegetables, fruits, high-fiber whole grains
– Fat-free or low-fat fluid milk and milk products
– Seafood, lean meat and poultry, eggs, soy products, nuts, seeds, and oils
- Very low in solid fats and added sugars
- Reduced in sodium
The Committee also noted that physical activity will assist in the helping to achieve a balance between calorie intake and expenditure, leading to body weight maintenance.
What to Eat
One of the most insightful observations of Dr. Keys from his authored works and scientific journal publications was that the people who benefited most from the health and weight management properties of the Mediterranean diet were the ordinary people of the countries he and his colleagues studied and visited.
While each country and region within the Mediterranean has a signature dish that it is proud of, what actually provides the benefits are the every day foods that people eat based on recipes passed down from generation to generation. Many of the popularized dishes tend to be rich in flavor, high in calories and expensive to make and so they are eaten rarely or on special occasions.
The historical development of these very ordinary recipes in France, Spain, Greece and Italy were originally influenced by financial limitations, but because people invented different ways to make them fresh, tasty and easy to make, they have withstood the test of time.
The majority of people in America, Britain, Canada and Australia would find most of the ingredients familiar, easy to find and affordable because they were developed for daily consumption, but they happened to have formidable health benefits.
Learning from history
While Dr. Keys’s work had shown the cardiovascular health problems caused by poor dietary choices and highlighted the more beneficial alternative food choices found in the Mediterranean diet, this approach to eating has actually been a way of life since people first learned how to farm and keep animals, more than 10,000 thousand years ago, in the Eastern part of the Mediterranean sea along an area called the Fertile Crescent.
This fertile area, created after the end of the last ice age when great Canadian frozen lakes thawed and flooded the worlds seas and overfilled the Mediterranean basin some 12,000 years ago, allowed many types of cereals, legumes and animals to flourish and this attracted more people to the region where they found a stable and abundant source of food.
This enabled the birth of small villages around 10,000 years ago and eventually the growth of towns and the formation of the larger cities of the ancient worlds of Greece and Egypt some 3,000 to 5,000 years ago. The rise of the Egyptian kingdoms and the creation of the great pyramids were only possible through the payment of farmed cereals, legumes and other foods to working peasants. The continued advancement of these ancient worlds eventually led to the creation of almost all of today’s modern day biblical references.
The major religions, which can chart back a few common roots to Abraham who lived near the Fertile Crescent, all have some record of this early dietary consumption. Most notably, many people are aware that the bible records Jesus as sharing a last supper of bread and wine with his 12 twelve Apostles and disciples before his crucifixion, but historical records also show that they ate fish and olives as depicted in the Great Tapestry found in The Vatican and also in Leonardo da Vinci’s famous painting.
The Mediterranean diet is not a new concept but a way of life that first cradled the growth human populations some 10,000 years ago. The stability of good quality food from farming allowed great cities to form into industrial and influential centers of power that drove technological revolutions; it enabled the creation of religious moral frameworks; and it provided a starting point from which civilization was able to thrive in good health.
The dietary pattern is now internationally recognized by UNESCO as a way of living worth preserving and promoting when it became Inscribed in November 2010 on the Representative List of the Intangible Cultural Heritage of Humanity, such is its importance to advancing good health.
From its modern defining history in the 1950s and 1960s, to its origins as the source of modern technology advancement, it is no wonder that many nutritional experts and American government scientists are now recommending recipes that closely match the Mediterranean diet.
This overview has been adapted from our new book on the Mediterranean diet, including an introduction to the brain science of excessive overeating. The book is due for public release in Spring 2012, shortly after the release of the 2010 Dietary Guidelines For Americans, from our website and wider distribution in the Fall. This work will be accompanied with a recipe book and meal planner. Be the first to know of advanced publications by following us on twitter @MediterraneanDi or on Facebook.
© 2011 Francesca Sales