Tag Archives: Mediterranean diet

Mediterranean Diet Reduces Risk of Mild Cognitive Impairment

Posted on June 1, 2012 | 1 comment

Mild Cognitive Impairment (MCI) is considered a precursor to dementia, although it does not always lead to dementia.

A study published in 2009 in the Archives of Neurology indicates that adherence to the Mediterranean diet reduces both the risk of developing MCI and the risk of MCI conversion to Alzheimer dementia.

Methodology

1,393 residents of a multi-ethnic community in New York were enrolled in the study. They were mentally normal at baseline and followed for an average of 4.5 years.

Another 482 residents were identified as having Mild Cognitive Impairment at baseline, and were followed an average of 4.3 years.

All participants were screened for cognitive impairments and surveyed to get an idea of usual food intake. Researchers used a 10-point scale to describe an individual participant’s adherence to the Mediterranean diet. The higher the score, the greater the participant’s adherence. Participants were then divided into thirds (tertiles) based on whether adherence was low, medium, or high. Average age of study subjects on entry was 77.

Results

275 of the 1,393 participants who were mentally normal at baseline developed Mild Cognitive Impairment over the 4.5 years of follow-up. Compared to those participants in the lowest third of Mediterranean diet adherence, those in the middle third had 17% less risk of developing MCI, and those in the highest third had 28% less risk.

Of 482 participants with Mild Cognitive Impairment at baseline, 106 later developed Alzheimer disease. Compared with participants in the lowest third of adherence, those in the middle third had 45% less risk of developing Alzheimer disease, and those in the highest third had 48% less risk.

Comments From the Study Authors

. . . potentially beneficial effects for mild cognitive impairment or mild cognitive impairment conversion to Alzheimer’s disease have been reported for alcohol, fish, polyunsaturated fatty acids (also for age-related cognitive decline) and lower levels of saturated fatty acids.

The Mediterranean diet tends to improve cholesterol levels, overall blood vessel function, reduce inflammation, and lower blood sugar levels, all of which could help preserve brain function.

My Comments

No surprise here.

The traditional Mediterranean diet has long been associated with lower risk of developing dementia, both Alzheimer and vascular dementia. Vascular dementia results from multiple strokes or poor blood flow to the brain. Since Mild Cognitive Impairment precedes Alzheimer dementia, it makes sense that the Mediterranean diet could help prevent both.

The lead author of the study at hand, Dr. Scarmeas, also reported in 2007 that the Mediterranean diet also prolongs life in established Alzheimer patients.

Steve Parker, M.D.

Reference: Scarmeas, Nikolaos, et al. Mediterranean Diet and Mild Cognitive Impairment. Archives of Neurology, 66 (2009): 216-225.

Additional Resource: Oldways’ Mediterranean diet information

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More Science in Favor of the Mediterranean Diet

Posted on May 30, 2012 | Comments Off on More Science in Favor of the Mediterranean Diet

The Mediterranean diet is linked yet again to improved health, according to an article in ScienceDaily May 29, 2012.  Study participants were Europeans whose health was monitored over the course of four years.

-Steve

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Mediterranean Diet Failed to Prevent Mental Decline in Women With Vascular Disease

Posted on May 30, 2012 | Comments Off on Mediterranean Diet Failed to Prevent Mental Decline in Women With Vascular Disease

Unfortunately, the Mediterranean diet failed to preserve cognitive function over the course of five years in the Women’s Antioxidant Cardiovascular Study (WACS).  The 2,500 women in the study, all over 65, at baseline had vascular disease or at least three risk factors for vascular disease.

Note that this research says nothing about prevention of age-related cognitive decline and Alzheimer dementia in women who don’t have baseline vascular disease.  The Mediterranean diet seems to help that population.

Steve Parker, M.D.

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2009 Study Confirms the Heart-Healthy Mediterranean Diet

Posted on May 27, 2012 | Comments Off on 2009 Study Confirms the Heart-Healthy Mediterranean Diet

Canadian researchers sought to systematically evaluate the strength of the evidence supporting links between dietary factors and coronary heart disease. Coronary heart disease (CHD) is the number one cause of death in Western societies.

It’s important to understand the two types of studies meta-analyzed by the Canadians.

Prospective cohort studies can be used to identify a dietary factor that may be associated with a disease or outcome. For example, researchers could study the health of 20,000 people over the course of 10 years, giving them questionnaires to find out what foods they typically ate. They might find after 10 years that the people who ate the most saturated fat tended to die earlier and had more heart attacks and strokes compared to the people who ate the least saturated fat. This would establish an association between dietary saturated fat and premature death, heart attacks, and strokes. It does not prove that saturated fats cause those outcomes, it’s just an association.

Randomized trials, often called randomized controlled trials (RCTs), typically take two groups of people and apply an intervention to one group but not the other. The groups are followed over time to see if there is a difference in outcome. For example, take another group of 20,000 people. Randomly assign 10,000 of them to eat more-than-usual saturated fat. The other 10,000 similar people serve as the control group, eating their usual amount of saturated fat. Follow these 20,000 people over 10 years, then compare their health outcomes: death, heart attacks, strokes. If the high-saturated-fat group has worse outcomes, you are much closer to proving that dietary saturated fat causes premature death, heart attacks, and strokes.

Methodology

The scientists located and analyzed every English-language prospective cohort study (146 studies) or randomized trial (43) investigating food intake and coronary heart disease (CHD), from 1950 through June, 2007. They wrote:

We used the Bradford Hill guidelines to derive a causation score based on four criteria (strength, consistency, temporality, and coherence) for each dietary exposure in cohort studies and examined for consistency with the findings of randomized trials.

The different dietary patterns evaluated in studies were noted. The “Mediterranean” dietary pattern emphasizes a higher intake of vegetables, legumes, fruits, nuts, whole grains, cheese or yogurt, fish, and monounsaturated relative to saturated fatty acids. The “prudent” dietary pattern is characterized by a high intake of vegetables, fruit, legumes whole grains, and fish and other seafood. The “western” pattern is characterized by a high intake of processed meat, red meat, butter, high-fat dairy products, eggs, and refined grains.

Results

Strong evidence (four Bradford Hill criteria satisfied) supported protection against CHD with consumption of:

  • vegetables
  • nuts
  • monounsaturated fatty acids [prominent in olive oil, for example]
  • Mediterranean diet
  • prudent diet

Modertately strong evidence (three criteria satisfied) supported protection against CHD with consumption of:

  • fish
  • marine omega-3 fatty acids
  • folate
  • whole grains
  • dietary vitamins E and C (as opposed to vitamin supplements)
  • beta carotene
  • alcohol
  • fruit
  • fiber

Strong evidence supported the following as harmful dietary factors, in terms of CHD:

Researchers found insufficient evidence (two or less criteria) to support an association between CHD and:

  • total fat
  • saturated and polyunsaturated fatty acids
  • eggs
  • meat
  • milk
  • vitamin supplements E and C
  • alpha-linolenic acid

Selected Comments of the Researchers [my comments in brackets]

Cohort studies provide abundant evidence of an association with total mortality for many dietary exposures. Randomized controlled trials corroborate these associations for the consumption of omega-3 fatty acids and a Mediterraneandiet because most of the other dietyary factors have not been evaluated to date.

Among the dietary exposures with strong evidence of causation from cohort studies, only a Mediterranean dietary pattern is related to CHD in randomized trials. [The association is inverse: Higher adherence to the Mediterranean diet leads to lower rates of CHD.]

A wealth of epidemiologic studies have evaluated associations between dietary exposures and CHD. The general consensus from the evidence currently available is that a reduced consumption of saturated and trans-fatty acids and a higher intake of fruits and vegetables, polyunsaturated fatty acids including omega-3 fatty acids, and whole grains are likely beneficial. This is reflected in the revised Dietary Guidelines for Americans 2005 from the US Departments of Health and Human Services and Agriculture. However, little direct evidence from RCTs supports these recommendations. [Emphasis added.] In some cases, RCTs have not been conducted, and RCTs that have been conducted have generally not been adequately powered or have evaluated surrogate end points rather than clinical outcomes.

Single-nutrient RCTs have yet to evaluate whether reducing saturated fatty acid intake lowers the risk of CHD events.

More recently, the lack of benefit of diets of reduced total fat has been established [in women only? (reference below)], and the evidence supporting the adverse effect of trans-fatty acids on cholesterol levels and CHD has increased, which is reflected in our findings. [This is the only mention of cholesterol in the report.]

My Comments

I wonder about vegetarian/vegan diets. Have they been tested for efficacy against CHD? What about Dr. Dean Ornish’s program?

Although not mentioned in the text of the article, Table 3 on page 664 shows that the positive association between CHD and high-glycemic index/load is much stonger in women than in men. Relative risk for women on a high-glycemic index/load diet was 1.5 (95% confidence interval = 1.29-1.71), and for men the relative risk was 1.06 (95% confidence interval = 0.91-1.20). I question whether the association for men is statistically significant.

Why wasn’t there discussion of dietary cholesterol? The public and physicians have been told for years that dietary cholesterol causes or aggravates coronary heart disease. Is there no evidence?

Note that the researchers found no clear association between CHD and saturated and total fat intake. In traditional medical circles, these findings are considered sacrilegious!

Medical schools and cardiologists have been teaching for thirty or more years that they are related positively. “Positively” means the more saturated and total fat in your diet, the more likely you are to develop atherosclerosis, which in the heart is coronary heart disease. Dietary cholesterol is often thrown into the equation. The is the dogmatic Diet-Heart Hypothesis.  It doesn’t hold much water these days, if any.

Steve Parker, M.D.

References:

Mente, Andrew, et al. A Systematic Review of the Evidence Supporting a Causal Link Between Dietary Factors and Coronary Heart Disease. Archives of Internal Medicine, 169 (2009): 659-669.

van Dam, R.M., et al. Dietary glycemic index in relation to metabolic risk factors and incidence of coronary heart disease: the Zutphen Elderly Study. European Journal of Clinical Nutrition, 54 (2000): 726-731.

Howard, B.V., et al. Low-fat dietary pattern and risk of cardiovascular disease: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial. Journal of the American Medical Association, 295 (2006): 655-666.

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Mediterranean Diet Cuts Stroke Risk In Women

Posted on May 24, 2012 | Comments Off on Mediterranean Diet Cuts Stroke Risk In Women

The journal Circulation in 2009 reported that the Mediterranean diet reduces risk of stroke in women by 13%. This supplements our prior knowledge that the healthy diet is associated with lower risk of coronary heart disease in both men and women.

Researchers in Boston analyzed the records of 74,886 middle-aged women in the Nurses’ Health Study to deteremine how closely they followed a Mediterranean diet pattern. They followed participants’ health status for 20 years, noting how many women developed stroke, coronary heart disease, and “cardiovascular death” (fatalities from strokes and coronary heart disease combined).

Compared with the women who adhered minimally to the Mediterranean diet pattern, the women with highest compliance had 13% fewer strokes. Consistent with earlier studies, the Mediterranean dieters had 39% lower risk of cardiovascular death and 29% lower risk for coronary heart disease (again, comparing the women with highest and lowest compliance).

Take-Home Points

To gain the health benefits of the Mediterranean diet, consider making changes to the way you eat.

Here are the characteristics of the traditional Mediterranean diet:

  • It maximizes natural whole foods and minimizes highly processed ones
  • Small amounts of red meat
  • Less than four eggs per week
  • Low to moderate amounts of poultry and fish
  • Daily fresh fruit
  • Seasonal locally grown foods with minimal processing
  • Concentrated sugars only a few times per week
  • Wine in low to moderate amounts, and usually taken at mealtimes
  • Milk products (mainly cheese and yogurt) in low to moderate amounts
  • Olive oil as the predominant fat
  • Abundance of foods from plants: vegetables, fruits, beans, potatoes, nuts, seeds, breads and other whole grain products

Steve Parker, M.D.

Reference: Fung, Teresa, et al. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation, 119 (2009): 1,093-1,100.

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Which Components of the Mediterranean Diet Prolong Life?

Posted on May 22, 2012 | 1 comment

Researchers at Harvard and the University of Athens (Greece) report that the following specific components of the Mediterranean diet are associated with lower rates of death:

  • moderate ethanol (alcohol) consumption
  • low meat and meat product intake
  • high vegetable consumption
  • high fruit and nut consumption
  • high ratio of monounsaturated fat to saturated fat
  • high legume intake

Minimal, if any, contribution to mortality was noted with high cereal, low dairy, or high fish and seafood consumption.

The researchers examined diet and mortality data from over 23,000 adult participants in the Greek portion of the European Prospective Investigation into Cancer and nutrition. You’ll be hearing more about the EPIC study for many years. Over an average follow-up of 8.5 years, 1,075 of participants died. 652 of these deaths were of participants in the lower half of Mediterranean diet adherence; 423 were in the upper half.

Alcohol intake in Greece is usually in the form of wine at mealtimes.

The beneficial “high ratio of monounsaturated fat to saturated fat” stems from high consumption of olive oil and low intake of meat.

It’s not clear if these findings apply to other nationalities or ethnic groups. Other research papers have documented the health benefits of the Mediterranean diet in at least eight other countries over three continents.

The researchers don’t reveal in this report the specific causes of death. I expect those data, along with numbers on diabetes, stroke, and dementia, to be published in future articles, if not published already. Prior Mediterranean diet studies indicate lower death rates from cardiovascular disease and cancer.

Steve Parker, M.D.

Reference: Trichopoulou, Antonia, et al. Anatomy of health effects of the Mediterranean diet: Greek EPIC prospective cohort study. British Medical Journal, 338 (2009): b2337. DOI: 10.1136/bmj.b2337.

Additional Information: Childs, Dan. Take it or leave it? The truth about 8 mediterranean diet staples. ABC News online, June 24, 2009. Accessed June 25, 2009.

Addendum:

Here’s a direct quote from the study at hand:

Among the presumed beneficial components of the Mediterranean diet score, high consumption of all but fish and seafood was inversely associated with mortality, although none of these associations was statistically significant.

“. . . none of these associations was statistically significant.” So I can understand some skepticism about this journal article. The researchers had to use some very sophisticated statistical manipulation to come up with the “healthy components” list. I’m not saying that’s wrong. I will admit that the statistical analysis is beyond my comprehension, so I’m trusting the authors and peer-review process to be honest and effective. My college statistics course was too many years ago.

The take-home point for me is that the health benefits of the Mediterranean diet probably stem from an overall combination of multiple foods rather than any single component.

And remember to exercise regularly, maintain a healthy weight (BMI 18.5-25), keep your blood pressure under 140/90, and don’t smoke.

-Steve

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Low-Carb Mediterranean Diet Beats Low-Fat For Recent-Onset Type 2 Diabetes

Posted on May 20, 2012 | 2 comments

A low-carbohydrate Mediterranean diet dramatically reduced the need for diabetic drug therapy, compared to a low-fat American Heart Association diet. The Italian researchers also report that the Mediterranean dieters also lost more weight over the first two years of the study.

Investigators suggest that the benefit of the Mediterranean-style diet is due to greater weight loss, olive oil (monunsaturated fats increase insulin sensitivity), and increased adiponectin levels.

The American Diabetes Association recommends both low-carbohydrate and low-fat diets for overweight diabetics. The investigators wondered which of the two might be better, as judged by the need to institute drug therapy in newly diagnosed people with diabetes.

Methodology

Newly diagnosed type 2 diabetics who had never been treated with diabetes drugs were recruited into the study, which was done in Naples, Italy. At the outset, the 215 study participants were 30 to 75 years of age, had body mass index over 25 (average 29.5), had average hemoglobin A1c levels of 7.73, and average glucose levels of 170 mg/dl.

Participants were randomly assigned to one of two diets:

  1. Low-carb Mediterranean diet (“MED diet”, hereafter): rich in vegetables and whole grains, low in red meat (replaced with poultry and fish), no more than 50% of calories from complex carbohydrates, no less than 30% of calories from fat (main source of added fat was 30 to 50 g of olive oil daily). [No mention of fruits. BTW, the traditional Mediterranean diet derives 50-60% of energy from carbohydrates.]
  2. Low-fat diet based on American Heart Association guidelines: rich in whole grains, restricted additional fats/sweets/high-fat snacks, no more than 30% of calories from fat, no more than 10% of calories from saturated fats.

Both diet groups were instructed to limit daily energy intake to 1500 (women) or 1800 (men) calories.

All participants were advised to increase physical activity, mainly walking for at least 30 minutes a day.

Drug therapy was initiated when hemoglobin A1c levels persisted above 7% despite diet and exercise.

The study lasted four years.

Results

By the end of 18 months, twice as many low-fat dieters required diabetes drug therapy compared to the MED dieters—24% versus 12%.

By the end of four years, seven of every 10 low-fat dieters were on drug therapy compared to four of every 10 MED dieters.

The MED dieters lost 2 kg (4.4 lb) more weight by the end of one year, compared to the low-fat group. The groups were no different in net weight loss when measured at four years: down 3–4 kg (7–9 lb).

Compared to the low-fat group, the MED diet cohort achieved significantly lower levels of fasting glucose and hemoglobin A1c throughout the four years.

The MED diet group saw greater increases in insulin sensitivity, i.e., they had less insulin resistance.

The MED group had significantly greater increases in HDL cholesterol and decreases in trigylcerides throughout the study. Total cholesterol decreased more in the MED dieters, but after the first two years the difference from the low-fat group was not significantly different.

Comments

The MED diet here includes “no more than 50% of calories from complex carbohydrates.” The authors don’t define complex carbs. Simple carbohydrates are monosaccharides and disaccharides. Complex carbs are oligosaccharides and polysaccharides. Another definition of complex carbs is “fruits, vegetables, and whole grains,” which I think is definition of complex carbs applicable to this study.

The editors of the Annals of Internal Medicine conclude that:

A low-carbohydrate, Mediterranean-style diet seems to be preferable to a low-fat diet for glycemic control in patients with newly diagnosed type 2 diabetes.

I’m sure the American Diabetes Association will take heed of this study when they next revise their diet guidelines. If I were newly diagnosed with type 2 diabetes, I wouldn’t wait until then.

This study dovetails nicely with others that show prevention of type 2 diabetes with the Mediterranean diet, reversal of metabolic syndrome—a risk factor for diabetes—with the Mediterranean diet (supplemented with nuts), and prevention of type 2 diabetes and pre-diabetes in people who have had a heart attack.

Studies like these support my Low-Carb Mediterranean Diet.

For general information on Mediterranean eating, visit Oldways.

Steve Parker, M.D.

Reference: Esposito, Katherine, et al. Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes. Annals of Internal Medicine, 151 (2009): 306-314.

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Mediterranean Diet Linked to Lower Stomach Cancer Risk

Posted on May 15, 2012 | Comments Off on Mediterranean Diet Linked to Lower Stomach Cancer Risk

The Mediterranean diet is associated with a 33% reduction in stomach cancer, according to a study published in the American Journal of Clinical Nutrition.

Stomach cancer (aka gastric cancer) is uncommon in the U.S. Most cases are advanced and incurable at the time of diagnosis. So prevention is ideal.

European investigators studied 485,000 people over the course of nine years, during which 449 cases of stomach cancer were found. Surveys determined how closely the food consumption of study participants tracked nine key components of the Mediterranean diet. Compared with people who had low adherence to the Mediterranean diet, those with high adherence had 33% less risk of developing stomach cancer.

The Mediterranean diet has long been associated with a lower risk of cancer: specifically, cancers of the breast, colon, prostate, and uterus. We can add stomach cancer to the list now.

Steve Parker, M.D.

Reference: Buckland, Genevieve, et al. Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study. American Journal of Clinical Nutrition, December 9, 2009, epub ahead of print. doi: 10.3945/ajcn.2009.28209

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Heart Patients, Listen Up: Mediterranean Diet to the Rescue

Posted on May 8, 2012 | 1 comment

The Mediterranean diet preserves heart muscle performance and reduces future heart disease events, according to Greek researchers reporting in the American Journal of Clinical Nutrition, May 19, 2010.

Reuters and other news services have covered the story.

The Mediterranean diet is well-established as an eating pattern that reduces the risk of death or illness related to cardiovascular disease—mostly heart attacks and strokes. Most of the studies in support of the heart-healthy diet looked at development of disease in general populations. The study at hand examined whether the diet had any effect on patients with known heart disease, which has not been studied much.

How Was the Study Done?

The study population was 1,000 consecutive patients admitted with heart disease to a Greek hospital between 2006 and 2009. In this context, heart disease refers to a first or recurrent heart attack (70-80% of participants) or unstable angina pectoris. Acute heart attacks and unstable angina are “acute coronary syndromes.” Average age was 64. Sixty percent had a prior diagnosis of cardiovascular disease (coronary heart disease or stroke). Thirty percent had diabetes. At the time of hospitalization, half had diminished function of the main heart pumping chamber (the left ventricle), half had normal pump function. Men totalled 788; women 212.

On the third hospital day, participants were given a 75-item food frequency questionnaire asking about consumption over the prior year. If a potential enrollee died in the first two hospital days, he was not included in the study. A Mediterranean diet score was calculated to determine adherence to the Mediterranean diet. Mediterranean diet items were nonrefined cereals and products, fruits, nuts, vegetables, potatoes, dairy products, fish and seafood, poultry, red meats and meat products, olive oil, and alcohol.

Left ventricle function was determined by echocardiogram (ultrasound) at the time of study entry, at the time of hospital discharge, and three months after discharge. Systolic dysfunction was defined as an ejection fraction of under 40%. [Normal is 65%: when the left ventricle is full of blood, and then squeezes on that blood to pump it into the aorta, 65% of the blood squirts out.]

Participants were then divided into two groups: preserved (normal) systolic left ventricular function, or diminished left ventricular function.

They were followed over the next two years, with attention to cardiovascular disease events (not clearly defined in the article, but I assume including heart attacks, strokes, unstable angina, coronary revascularization, heart failure, arrhythmia, and death from heart disease or stroke.

Results

  • Four percent of participants died during the initial hospitalization.
  • At the three month follow-up visit, those with greater adherence to the Mediterranean diet (a high Mediterranean diet score) had higher left ventricular performance (P=0.02).
  • At the time of hospital admission, higher ejection fractions were associated with greater adherence to the Mediterranean diet (P<0.001).
  • Those who developed diminished left ventricular dysfunction had a lower Mediterranean diet score (P<0.001)
  • During the hospital stay, those in the highest third of Mediterranean diet score had lower in-hospital deaths (compared with the lower third scores) (P=0.009).
  • Among those who survived the initial hospitalization, there was no differences in fatal cardiovascular outcomes based on Mediterranean diet score.
  • Food-specific analysis tended to favor better cardiovascular health (at two-year follow-up) for those with higher “vegetable and salad” and nut consumption. No significant effect was found for other components of the Mediterranean diet score.
  • Of those in the highest third of Mediterranean adherence, 75% had avoided additional fatal and nonfatal cardiovasclar disease events as measured at two years. Of those in the lowest third of Mediterranean diet score, only 53% avoided additional cardiovascular disease events.

The Authors’ Conclusion

Greater adherence to the Mediterranean diet seems to preserve left ventricular systolic function and is associated with better long-term prognosis of patients who have had an acute coronary syndrome.

My Comments

I agree with the authors’ conclusion.

We’re assuming these patients didn’t change their way of eating after the initial hospitalization. We don’t know that. No information is given regarding dietary instruction of these patients while they were hospitalized. In the U.S., such instruction is usually given, and it varies quite a bit.

In this study, lower risk of cardiovascular death was linked to the Mediterranean diet only during the initial hospital stay. Most experts on the Mediterranean diet would have predicted lower cardiovascular death rates over the subsequent two years. Mysteriously, the authors don’t bother to discuss this finding.

For those who don’t enjoy red wine or other alcoholic beverages, this study suggests that the Mediterranean diet may be just as heart-healthy without alcohol. A 2009 study by Trichopoulou et al suggests otherwise.

Steve Parker, M.D.

Reference:

Chrysohoou, C., Panagiotakos, D., Aggelopoulos, P., Kastorini, C., Kehagia, I., Pitsavos, C., & Stefanadis, C. (2010). The Mediterranean diet contributes to the preservation of left ventricular systolic function and to the long-term favorable prognosis of patients who have had an acute coronary event American Journal of Clinical Nutrition DOI: 10.3945/ajcn.2009.28982

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The Ever-Popular Mediterranean Diet: Origins and Definition

Posted on May 6, 2012 | Comments Off on The Ever-Popular Mediterranean Diet: Origins and Definition

ORIGINS

It all starts with Ancel Keys.

Keys was the leader of the team who put together the Seven Countries Study, which seemed to demonstrate lower rates of coronary heart disease in countries consuming less saturated fat. [Coronary heart disease is the leading cause of death in Western cultures.] He also found that cardiovascular disease rates rose in tandem with blood cholesterol levels. The two countries particularly illustrative of these connections were Italy and Greece, both Mediterranean countries.

The other countries he analyzed in “Seven Countries” were the United States, Yugoslavia, Japan, Finland, and the Netherlands.

Keys and his wife Margaret, a biochemist, drilled deeper in to the “Mediterranean diet” that was characteristic of Italy, Greece, and other countries on or near the Mediterranean Sea in the 1950s and 1960s. [“Diet” in this context refers to the usual food and drink of a person, not a weight-loss program.] Their efforts culminated in the publication of several best-selling Mediterranean diet books in the 1970s, and Keys’ photo on the cover of Time magazine in 1961.

Thus began the still-popular Mediterranean diet.

Oldways Preservation Trust re-invigorated the Mediterranean diet around 1990, helping the public incorporate Mediterranean diet principals into everyday life. Oldways founder, K. Dun Gifford, passed away in 2011.

DEFINITION

There is no monolithic, immutable, traditional Mediterranean diet. But there are similarities among many of the regional countries that tend to unite them, gastronomically speaking. Greece and southern Italy are particularly influential in this context.

So here are the characteristics of the traditional, healthy Mediterranean diet of the mid-20th century:

•It maximizes natural whole foods and minimizes highly processed ones

•Small amounts of red meat

•Less than four eggs per week

•Low to moderate amounts of poultry and fish

•Daily fresh fruit

•Seasonal locally grown foods with minimal processing

•Concentrated sugars only a few times per week

•Wine in low to moderate amounts, and usually taken at mealtimes

•Milk products (mainly cheese and yogurt) in low to moderate amounts

•Olive oil as the predominant fat

•Abundance of foods from plants: vegetables, fruits, beans, potatoes, nuts, seeds, breads and other whole grain products

•Naturally low in saturated fat, trans fats, and cholesterol

•Naturally high in fiber, phytonutrients, vitamins (e.g., folate), antioxidants, and minerals (especially when compared with concentrated, refined starches and sugars in a modern Western diet)

•Naturally high in monounsaturated and polyunsaturated fats, particularly as a replacement for saturated fats

CONTROVERSIES

Keys has been criticized for “cherry-picking” the data that linked saturated fat consumption with increased heart disease. Subsequent studies indicate a weak link, if any. A list of the pertinent studies de-linking heart disease and saturated fat is at the Advanced Mediterranean Diet Blog.

The Seven Countries Study included only men. It’s practical implications, therefore, may not apply to women.

The traditional Mediterranean diet is increasingly a thing of the past as Mediterranean countries adopt the Western diet characterized by “fast food” and highly processed foods.

FUN FACTS FOR FOOD GEEKS

Ever heard of K rations used by the U.S. military in World War II? Keys invented them. He earned Ph.D.s in biology and physiology. Keys lived to age 100 and was said to be intellectually active through his 97th year.

Steve Parker, M.D.

References:

Keys, Ancel (1970). Coronary heart disease in seven countries. Circulation, 41

Keys, Ancel. Coronary heart disease in seven countries. Circulation, 41, (1970) supplement I: I-1 through I-211.

Keys, Ancel. Seven Countries: A Multivariate Analysis of Death and Coronary Artery Disease. Harvard University Press, 1980.

Oldways website.

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