Medicine for 2009: Nine ways to healthier eating, Mediterranean style
There are good reasons to follow the traditional diets of Greece and Italy.
If you're thinking about New Year's resolutions, consider making 2009 the year you try eating the Mediterranean way. Picture a plate full of fresh vegetables, tasty grains, and fish or beans prepared with olive oil and sprinklings of herbs, spices, cheeses, and nuts, accompanied by a glass of red wine and some hearty bread. These are key components of the traditional, largely plant-based diet of countries surrounding the Mediterranean. It's not only delicious but also appears to protect against heart disease and many other chronic conditions.
A Mediterranean-style diet isn't the only traditional eating pattern that's good for your health. But it's been studied the longest, and it's practical for most Americans. It also fits in nicely with the latest approach to nutrition. Experts stress overall eating patterns rather than "magic bullets" that don't always live up to their advertising (for example, vitamin E, beta carotene, and isoflavones). Individual nutrients are important — for one thing, they can help to correct deficiencies — but the greatest health benefits are likely to result from the synergy of many foods with different nutrient qualities.
History of the "Mediterranean diet"
The Mediterranean region is culturally diverse, and its inhabitants don't all eat the same way. But a typical Mediterranean dietary pattern was identified in the late 1950s as part of the landmark Seven Countries Study, led by Ancel Keys of the University of Minnesota. Keys spent more than a decade studying lifestyle, particularly the influence of diet, and its relationship to cardiovascular disease in nearly 13,000 men in Finland, southern Italy, the Greek islands of Corfu and Crete, Japan, Yugoslavia, the Netherlands, and the United States. Keys was particularly interested in dietary fat and was one of the first to recognize that there are "good" fats and "bad" fats, noting that despite limited medical care and sometimes high fat consumption (in Crete, for example, up to 40% of calories came from fat), the Greek and Italian participants lived the longest and had the lowest rates of heart disease (so did the Japanese, whose diets contained very little fat). The fats consumed in Greece and Italy were generally unsaturated, deriving mainly from olive oil and fish. The highest rates of heart disease were found in countries where people consumed the most saturated fat (for example, Finland and the United States).
The Seven Countries Study introduced the Mediterranean style of eating, which was modeled on the typical dietary pattern of Crete in the 1950s and 1960s, to a wider audience. But the term "Mediterranean diet" was more or less formally adopted in 1993 at a meeting organized by the Harvard School of Public Health and the Oldways Preservation and Exchange Trust, a nonprofit group that promotes education on healthful eating and the diets of traditional cultures. The Harvard nutrition experts described a traditional diet consisting mostly of plant foods (fruits, vegetables, grains, beans, nuts, and seeds), with animal protein consumed chiefly in the forms of fish and poultry, olive oil as the principal fat, and wine taken with meals. They also noted that this diet was complemented by regular physical activity in the form of "work in the field or kitchen."
Evidence piles up
Features of the traditional Mediterranean lifestyle other than diet undoubtedly contribute to the region's health. But there are indications that the dietary pattern alone offers important protections. There have been many positive findings over the years. Here are some of the latest:
Research has also found Mediterranean-style eating associated with improvements in rheumatoid arthritis, reduced risk for chronic obstructive pulmonary disease, and reduced risk for recurrence of colon cancer.
Why it may work
We don't know all the mechanisms behind the healthfulness of the Mediterranean diet. But research suggests a number of facto