The traditional Mediterranean diet’s emphasis on plant foods (including olive oil) makes it a rich source of phytochemicals, as well as HDL-boosting monounsaturated fats.
Truly a diet for the new millennium, the traditional Mediterranean diet is the best of paradoxes: an ancient eating tradition with cutting-edge health benefits that is both simple to prepare and perfectly delicious.
The magnificent diet of the Mediterranean region has been evolving for thousands of years. The history of the region, coupled with its distinct (though widely various) climate and the pervasive influence of the sea, has shaped the choice of foods and the types of cooking so characteristic of traditional Mediterranean culture. Bread, olive oil, and wine which continue to play a significant role in the Mediterranean diet today accompanied meals in ancient times. The cultivated vegetables and other plant-based foods so central to the diet date back to Neolithic times. According to archeological evidence and depictions and descriptions of food and meals in the art and literature of ancient Greek and Roman civilizations, ancient populations probably relied primarily on plant foods, with only occasional indulgence in meat and seafood.
More recent studies of the Mediterranean diet, from the 1950s and 1960s, reveal eating habits and preferences similar to the ancient diet: a primarily plant food–based diet that included minimal processing, whole grains, olive oil as the primary fat source, and animal products (with the exception of cheese in some areas and yogurt in some areas) consumed only a few times per month. The groundbreaking Rockefeller Foundation study of the Cretan diet around 1950 stated that “olives, cereal grains, pulses, wild greens and herbs, and fruits, together with limited quantities of goat meat and milk, game, and fish have remained the basic Cretan foods for forty centuries . . . no meal was complete without bread . . . [and] Olives and olive oil contributed heavily to the energy intake.” This study, originally undertaken to determine how the people of Greece could improve their diets after World War II, concluded that the diet couldn’t get much better. While the Mediterranean diet today strays from its original roots somewhat (due to the “McDonald’s invasion” and other nutritionally tragic “modern” influences, such as the growing popularity of heavily processed convenience foods), the Mediterranean diet in the first half of the twentieth century, with appropriate modifications to make it more suitable and convenient for contemporary eating.
Eating the traditional Mediterranean way is largely a seasonal and regional affair. While each country has its unique customs, every country produces foods locally or regionally and serves them soon after harvest. In spring, the freshest new vegetables are harvested and eaten, often within a few miles of where they were picked wild greens, thin zucchini, green beans, spinach, spring peas, finocchi, cherries, and wild mushrooms. Summer marks the arrival of an abundance of tomatoes, eggplant, peaches, cantaloupe, watermelon, figs, peppers, and onions. Outdoor markets offer the freshest fruits and vegetables. The pale, bland produce so often available in American supermarkets would be virtually unrecognizable next to the vibrantly colored and succulent array of regionally produced plant foods. The perfect dessert? Fresh fruit, of course. Throughout the summer, most Mediterranean countries enjoy an overflow of the best garlic, onions, and tomatoes. At the end of the summer, the grape harvest and wine pressing begin. Persimmons and pomegranates follow, and then olives are harvested and pressed to yield the oil so essential to Mediterranean cuisine, an important component of the heart-healthy, traditional Mediterranean diet.
Bread has always been a staple, even in Italy, where that more famous Italian starch, pasta, is consumed so readily. Traditional Mediterranean bread, especially in rural areas, is dark, heavy (some loaves could weigh almost five pounds!), and full of whole grains, unlike the soft, refined white bread neatly sliced and conveniently bagged for American consumers. Whole grains are consumed in abundance outside the obligatory loaf of bread rice in the form of paella, risotto, and pilaf; pasta in its many incarnations, from Italian spaghetti to Moroccan couscous; and the versatile cornmeal mixture called polenta. Legumes are another staple inexpensive and high in protein, they were an essential part of the traditional Mediterranean diet. White haricot beans, small red cranberry beans, lentils, chickpeas, and fava beans remain popular options today. Another common Mediterranean theme is wine, although it was traditionally consumed primarily by men and always with meals, never recreationally. A small piece of cheese to begin or end a meal was common, but food was never smothered in cheese the way it sometimes is in Americanized Italian dishes. Many Mediterranean dishes share a similar flavor and character due to a few popular flavoring ingredients: garlic, onion, lemons, olive oil, basil, oregano, Italian parsley, and often a few small pieces of pancetta (an unsmoked bacon).
Beyond the ingredients themselves, eating the traditional Mediterranean way is a philosophy in itself: Life is for savoring, and food is a glorious and beautiful expression of life. Meals are gatherings of family and friends genuine events, not inconvenient chores. Food sustains life, and the quality of the food we eat, not to mention the manner and spirit in which it is prepared, is a reflection of the quality of our lives. In traditional Mediterranean culture, food was both more and less significant than it is in the United States today. Food was less important because it wasn’t the source of anxiety we often make it today. Neither was it a commodity, continually reinvented to be faster, cheaper, lower in fat (in other words, tapping the latest buzzwords to make it a more profitable industry). Yet, in the Mediterranean, food was and arguably still is far more important than in the United States. Handled and consumed with reverence for its life-sustaining capabilities, food celebrated the beautiful, the simple, the healthful. Food means vitality, a ritual to share with loved ones, an integral part of life itself.
THE MAGIC DISCOVERED
In the early 1950s, the great American researcher Ancel Keys and his wife, Margaret, traveled to the southern Italian shores, not just to escape the cold and dark skies of Oxford, England, where Keys was spending a year sabbatical as a visiting professor at MagdalenCollege, but to explore the curious notion that heart disease was apparently almost nonexistent in this area. At a time when Americans, particularly those in their forties and fifties, were subject to an unusually high rate of heart disease in the United States, Keys was intrigued by reports that the then-new American epidemic was almost unheard of in southern Italy. Heart disease appeared to occur with any significance only within a small upperclass subculture. Also intriguing were reports of the diet of this region, which was described as nutritionally wholesome but containing very little food from animal products. The diet was low in total fat, with minimal amounts of saturated fat, and consisted primarily of plant foods such as vegetables, fruits, and whole grains.
This was 1950 a time when Americans in general believed large steak dinners, baked potatoes, and refined white bread rolls slathered in butter, along with a hefty glass of whole milk, made a nutritious dinner. How couldsuch a meager, plant-based diet result in such heart-healthy citizens? It seems obvious to us now, but at the time, Keys felt compelled to investigate. Ancel Keys helped to define the link between nutrition and health as we understand it today. Before Keys, awareness of the connection between diet and health was tenuous at best. Keys suspected the link to be more than incidental, and we can credit him with the discovery of the relationship of diet to coronary heart disease. From as early as the 1940s, his clinical work at the University of Minnesota as well as epidemiological observations showed how blood cholesterol was an indicator of heart disease, and that diet particularly the type of fat consumed affected blood cholesterol levels. His interest in the relationship of prolonged dietary habits to coronary heart disease rates led him to spearhead one of the greatest and most influential epidemiological studies of our time, the Seven Countries Study.
Keys began his research in Naples, Italy, where he and his wife, Margaret, along with local medical colleagues, studied the blood cholesterol levels and heart disease rates of the local working men. Serum measurements from the initial study subjects revealed extraordinarily low blood cholesterol levels. The male subjects in their forties were especially impressive, with blood cholesterol averaging 165 compared with about 230 from blood samples of males of the same age living in Minnesota. As Keys must have suspected, heart disease and low cholesterol levels rarely coincide.
Even considering that the rich were more able to afford hospitalization at this time and in this area, evidence suggested that deaths attributable to heart attack among the working classes were far lower than those among the richer classes. According to Keys, the diet of the Neapolitan working class was of a quite different composition than the diet consumed by the upper classes, who consumed meat daily, as opposed to once every week or two. The diet of the working class sounds both simple and irresistible, as Keys describes it:
The ordinary food of the common Neapolitans consisted of homemade minestrone/vegetable soup, pasta in endless variety, always freshly cooked, served with tomato sauce and a sprinkle of cheese, only occasionally enriched with some bits of meat, or served with a little local seafood without any cheese; a hearty dish of beans and short lengths of macaroni (pasta e fagioli); lots of whole grain bread never more than a few hours from the oven and never served with any kind of spread; great quantities of fresh vegetables; a modest portion of meat or fish perhaps twice a week; (red) wine; always fresh fruit for dessert.
Keys states in his book that, when asked years later to formulate a diet that might serve as a preventive against coronary heart disease, he could come up with nothing more suited for this purpose than the traditional working-class diet of early 1950s Naples.
EATING THE “OLDWAYS” WAY
The Oldways Preservation and Exchange Trust may not be familiar to the public, but this nonprofit organization based in Cambridge, Massachusetts, has been highly influential in the dissemination of information about the benefits of the traditional Mediterranean diet. This group seeks to resurrect many of the “old ways” of eating before the advent of food processing, and they have published guidelines for eating in the traditional Mediterranean way. Among these guidelines is their own version of the Food Guide Pyramid, the Mediterranean Food Guide Pyramid. Citing a recognition of high adult life expectancy rates and low chronic disease rates in the Mediterranean region around 1960, knowledge of food typically consumed in the area during this time, and the compatibility of these eating patterns with current knowledge of nutrition science, Oldways developed a list of “Characteristics of Traditional Healthy Mediterranean Diets” that make the diet sound anything but unusual:
• A diet centered on foods from plant sources: vegetables, fruits, whole grains, bread, pasta, nuts, and seeds.
• Focus on foods that are locally grown and minimally processed.
• Olive oil as the primary source of fat.
• Total fat consumption between 25 percent to over 35 percent of calories, with no more than 7 to 8 percent of calories from saturated fat.
• Daily consumption of low to moderate amounts of cheese and/or yogurt (preferably low-fat or nonfat).
• Weekly consumption of low to moderate amounts of fish and poultry (with an emphasis on fish).
• No more than four eggs per week, including those used in cooking and baking.
• Fresh fruit as a typical dessert; high-sugar and/or high-fat desserts no more than a few times per week.
• Red meat only a few times per month (no more than 12 to 16 ounces or 340 to 450 grams per month).
• Regular physical activity to promote a healthy weight and overall fitness.
• Moderate wine consumption with meals (although Oldways now emphasizes this as an optional component, not appropriate for everyone).
These guidelines give a simple overview of trends in the general Mediterranean diet. According to Oldways, the widely circulated United States Department of Agriculture (USDA) dietary guidelines and their Food Guide Pyramid have not made enough of an impact on the public health profile in the United States.
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