Origins and Definition of the Mediterranean Diet

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 healthy 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 within the last year.

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 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.  In other words, the allegation is that he used information if it supported his theory, while ignoring data that was contrary or neutral.  Subsequent studies indicate a weak link, if any, between saturated fat consumption and heart disease.  A list of the pertinent studies de-linking heart disease and saturated fat is at my 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.

PS:  The Mediterranean diet has too many carbohydrates (55% of total energy) for for most people with diabetes.  Hence, the Low-Carb Mediterranean Diet.

References:

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.

6 Comments

Filed under Mediterranean Diet

6 responses to “Origins and Definition of the Mediterranean Diet

  1. How would you define “low” or “low to moderate” in a rough sense? 1 a day?

  2. Ancel Keys is a sort of pariah in Low Carb diet circles because of his advocacy of low fat, therefore higher carb diets. Medical studies done in the late 40’s and 50’s seem almost inhumane today, but his starvation studies pale in comparison to the Army’s studies on the effects of CO exposure.

    But perhaps the cautionary tale is not that Keys was a bad man, but that a grain of truth pushed far beyond its meaning can be harmful. Combine an idea with government advocacy and you have decades of misguided “official” dietary advice that has made us fatter and less healthy.

  3. Good points, Frank.

    Isaac, no hard and fast guidelines on “low to moderate,” but around 2 to 5 servings a week, roughly.

  4. Steve

    I’ve heard that Keys advocated low fat. How on earth was that? The cretan diet was 42% fat (or thereabouts). Steve – I think your carb figure should be ammended to 45% carbs. The cretan diet was moderate carb.

    Then again, I’m a bit fanatical about the Cretan diet being the true mediterranean diet (‘cos it was the one with the health benefits we desire).

    Steve
    Oz

  5. I’ll have to look, but I think Keys’ emphasis was on changing the type of fat in the typical diet from saturated fat to unsaturated fat (i.e., plant oils rather than animal based oils).

    • You’re right, Frank. Keys thought that saturated fats raised cholesterol levels (true enough), which then predisposed to cardiovascular disease (highly debatable if not outright wrong).

      -Steve