Human Nutrition - Mediterranean diet

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http://www.westonaprice.org/traditional_diets/the_mediterranean_diet.html

 

By Sally Fallon and Mary G. Enig, PhD

 

The Mediterranean diet " is characterized by abundant plant foods

(fruit, vegetables, breads, other forms of cereals, beans, nuts and seeds),

fresh fruit as the typical daily dessert, olive oil as the principal source

of fat, dairy products (principally cheese and yogurt) and fish and poultry

consumed in low to moderate amounts, zero to four eggs consumed weekly, red

meat consumed in low amounts, and wine consumed in low to moderate amounts,

normally with meals. This diet is low in saturated fat (less than or equal

to 7-8% of energy) with total fat ranging from less than 25% to greater than

35% of energy throughout the region. " 1

 

This, according to the Diet Dictocrats, is the diet that we should

adopt to protect ourselves from chronic disease, especially heart disease.

 

The author of this theory, and the first to describe the Mediterranean

diet in these terms, was Ancel Keys, architect of the lipid hypothesis,

namely that heart disease is caused by " the major dietary villain, "

saturated fat from meat and dairy products.2 According to Keys, his

introduction to the Mediterranean diet began in the early 1950s when he was

a visiting professor at Oxford. In 1951, he chaired the first conference of

the Food and Agriculture Organization of the United Nations at their

headquarters in Rome.

 

" The conference talked only about nutritional deficiencies. When I

asked about the diet and the new epidemic of coronary heart disease, Gino

Bergami, Professor of Physiology at the University of Naples, said coronary

heart disease was no problem in Naples. "

 

Dr. Keys returned to Oxford where, as an underpaid visiting professor,

he and his wife endured an unheated house and got by on food rations. He

then had the brilliant idea of visiting sunny Naples to check out Professor

Bergami's claim. Once there, he discovered the trotterias and dined on

" simple pasta and plain pizza. " Keys says he discovered that heart attacks

were indeed rare in Naples, " except among the small class of rich people

whose diet differed from that of the general population-they ate meat every

day instead of very week or two. " His wife amused herself by measuring serum

cholesterol concentrations " and found them to be very low except among

members of the Rotary Club. " After this exacting research, Keys was able to

conclude that " there seemed to be an association between the diet, serum

cholesterol and coronary heart disease. "

 

" The heart of what we now consider the Mediterranean diet is mainly

vegetarian, " he reports. " Pasta in many forms, leaves sprinkled with olive

oil, all kinds of vegetables in season, and often cheese, all finished off

with fruit and frequently washed down with wine. "

 

At first, Dr. Keys' found little support for his revolutionary

theories. But he encountered a sympathetic listener in 1952 when he

presented his views to a small audience in New York at Mt. Sinai Hospital.

Fred Epstein was convinced by Keys' data and began spreading the message

" with great effect over Europe and America. "

 

Keys then published his Seven Countries Study3 in which he claimed a

relationship between high rates of coronary heart disease and consumption of

saturated fat in seven countries. He was able to do this by handpicking

countries where both heart disease and consumption of saturated fats were

high and by ignoring countries with the same kind of diet but where heart

disease was low.4

 

Since Keys' published his " research, " the Mediterranean diet-at least,

what is perceived to be the Mediterranean diet-has become government policy.

The USDA has immortalized Keys' fond remembrance of trotteria fare from

sunny Naples in the form of a food pyramid, based on lots of white bread and

pasta topped with a generous layer of fruits and vegetables. This strangely

shaped pizza then gets a splash of olive oil and cheese, an anchovy or two,

a pinch of sugar and voila! the dietary solution to rampant chronic disease.

 

Chronic disease is still rampaging in spite of worldwide acceptance of

the food pyramid but Keys, at least, has fared rather well. In 1993, after

Fred Epstein gave the summary lecture at the international celebration of

the Seven Countries Study in Fukuoka, Japan, and at the fourth annual Ancel

Keys Lecture at the 1993 American Heart Association Convention, Keys' was

deluged with requests for interviews and advice. " In May 1993, a crew from

an American magazine came to our home Minnelea in Minnesota, bringing a

photographer from California to record the scene while I talked abut the

Mediterranean diet. "

 

Dr. Keys no longer has to winter in Minnesota but can escape to his

second home in southern Italy. But his vacations to Naples include some sad

moments as he observes unfortunate changes in the Mediterranean diet. " The

restaurants are increasingly popular but the food they serve is commonly far

from the Mediterranean pattern. . . Everything has to be loaded with butter

or margarine and ground meat. Serving only fruit for dessert is not common;

ice cream or pie is customary. Whereas Italian restaurants brag about the

healthy Mediterranean diet, they serve a travesty of it. " Keys does not tell

us whether his recent prosperity, which allows him to dine in

white-table-cloth restaurants rather than sidewalk cafes, has caused him to

abandon his monk-like regimen of " leaves sprinkled with olive oil " and fresh

fruit. It must be distressing indeed to observe sophisticated Italians

feasting on such travesties as pasta al Fredo, veal scallopini and

prosciutto, especially to one who has taken the stringent vows of the diet

priesthood.

 

But the life of the missionary is never easy. No, it is a lonesome

road, filled with disappointment. Imagine the late-night soul-searching of

Dr. Perez-Llamas and his colleagues who set out to study the consumption

patterns of a group of adolescents in the region of Murcia, in southeastern

Spain.5 Were these Mediterranean teenagers consuming a " balanced diet, " with

plenty of vegetables and fruit? Not at all. The naughty youngsters consumed

mostly sausage! " The results showed a very low consumption of vegetables,

some deficiencies in the intake of the milk and fruits and an excessive

intake of fats. . . while the intake of fish and pulses was insufficient in

our study. "

 

Alas, lamented Dr. Perez-Llamas, " the study reveals that although

Murcia is a typically Mediterranean region, the characteristics of the diet

of Murcian adolescents are quite different in some respects from the typical

alimentary habits of the Mediterranean diet. "

 

Dr. Perez-Llamas proposed to remedy these dietary sins with the modern

version of the Spanish inquisition: " . . . nutritional advice was given to

mothers and adolescents. The use of Spanish portions from the six basic food

groups proved to be a very helpful method to popularize the principles of

balanced diet in our population. "

 

Another group of diet-priests, headed by Dr. Alberti-Fidanza, made a

pilgrimage in 1994 to study elderly Italians in the rural areas of

Crevalcore and Montegiorgio, two of the districts Keys had included in the

Seven Countries Study.6 But the older generation had fallen away! They no

longer practiced the food Puritanism that Keys claimed he observed three

decades earlier. " In both areas, but particularly in Montegiorgio, these

subjects have been abandoning the traditional Mediterranean diet. "

 

The question that the believers haven't asked themselves is this: Was

the lean, so-called Mediterranean diet they observed after the war the true

Mediterranean diet? Or were they observing the tail end of deprivation

engendered by half a decade of conflict? Were the inhabitants of Crevalcore

and Montegiorgio abandoning the traditional Mediterranean diet, or were they

taking it up again? And did Keys miss the sight of Italians enjoying rich

food in the early 1950s because Italians had never done such a shameful

thing, or was the visiting professor too poor at the time to afford anything

more than plain pizza in a sidewalk cafe?

 

Recipes of All Nations7 was published in 1935, almost two decades

before the new diet religion was proclaimed to the suffering millions.

Consider the description of food in Sardinia. Grains are certainly a part of

their diet, consumed as bread, pasta or polenta, but in most interesting

ways. " One of their favorite ways of cooking macaroni is to cook it in

either lamb or pork fat . . . with small pieces of either lamb or pork,

chopped tomatoes, chopped garlic and curd, mixed with a little water and

salt and moistened with a little game stock, if this is obtainable. " Gnocchi

is flavored with saffron and " served with a tomato sauce, or with gravy and

cheese made from ewe's milk. " Bland polenta is enlivened with " chopped salt

pork, small pieces of sausages and grated cheese. " La Favata is made with

" pieces of salt pork, cut in large chunks, ham bone, special homemade

sausages, a handful of dried beans, wild fennel, and other herbs and a

little water. "

 

Nothing lowfat so far. But perhaps Keys and his entourage were right

when they said that meat is eaten sparingly in the Mediterranean region.

Read on. " The Sardinians are great meat eaters, but their methods of cooking

various kinds of meat are simple-almost primitive, in fact. " Like most

Italians, the Sardinians prefer young animals-lamb, kid or suckling

pig-usually roasted in front of a wood fire. " The meat is finally browned by

constant basting with hot fat. . . " The baby pigs " are so tender that even

the skin, ears and all can be eaten. "

 

The diet of Corsica " has in no way been subjected to any outside

influence. . . " No new catechism, no diet evangelists here. So Corsicans can

enjoy the following without guilt: All manner of fish, including small

lobster, cuttlefish and shellfish; anchovy paste made with the addition of

figs; dried salt cod; beef browned in lard; strips of goat fillet, salted

and sun dried; chestnuts mixed with polenta and cream and served with

different kinds of meat or black pudding.

 

A beautiful new encyclopedia of traditional foods, You Eat What You

Are,8 also gives a rather different view of Italian cuisine than the one

proclaimed in the gospel according to Ancel Keys. Author Thelma Barer-Stein

notes that butter is the cooking fat of choice in northern Italy, lard in

the middle region and olive oil in the south. But pork is consumed

throughout the entire peninsula, usually in the form of sausages-which

anyone but an American visiting professor could discern are the sin qua non

of Italian cuisine. Salami, bologna, mortadella and zamponi-there would be

no Italian cuisine without these. Sausage is a way of making innards taste

delicious-as in pezzante, an Italian speciality made from sinews, livers and

lungs. Cooks use plenty of pancetta (Italian-style bacon) and children love

crisp cracklings of pig skin called fritolli, rich in vitamin D.

 

Jews living in Italy made sausage and cold cuts, but they did not use

pork. In her book The Classic Cuisine of the Italian Jews,9 author Edda

Servi Machlin remembers her father's carne secca (salt dried meat) and

salsicce de minao (beef sausage.) " Both dishes were renowned and appreciated

among the Jewish communities all over Italy. " These foods were made in late

winter and hung in " an open north window " for four to six weeks to air dry.

Other specialities included lingua salmistrata (pickled beef tongue), the

aroma of which would " resuscitate the dead, " and salame d'oca (goose

sausage). (See Food Feature, page 48.) These meats were all fermented-and

eaten raw.

 

About eggs, Machlin reports: " Eggs have always been among the most

inexpensive of the highly nutritious foods. For us, they were not only a

staple, but also a universal remedy for most ailments, real or imaginary,

much as vitamins are for many people today. In order to be fully effective,

eggs had to be ingested raw and very fresh-in fact, warm, directly from the

chicken nest. So, naturally, every family had a small poultry yard in their

orchard. "

 

Italy produces as many kinds of cheese as France, including two of the

very best: Parmesan and Gorgonzola, both full fat and creamy rich. Italian

cheese garnishes more than pizza. It is used in turnovers, vegetable dishes,

salads and sandwiches. A favorite is mozarella, cut into squares, dipped in

batter and deep fried.

 

Italians are masters at preparing every kind of meat-from sweetbreads

to knuckle bones. Lean meat gets a cream sauce or stuffing of ham and

ricotta cheese.

 

Fish and shellfish of every variety are used in seafood platters, fish

soups and fish stews. The Diet Dictocrats, flush with the success of their

food pyramid, seem to have missed the ecstatic experience of calamari,

dipped in batter, deep fried and served heaped up on platters-a healthy

snack as long as traditional fats, not partially hydrogenated vegetable

oils, are used in frying. In Naples, where Keys had heard that heart disease

was rare, snacks of fresh seafood are as popular as pizzas and small

containers of oysters can be eaten on the run.

 

Italians love their vegetables for sure and that's because they know

how to make them taste good. They know that salads taste better with a good

dressing of aged vinegar and olive oil; and cooked vegetables blossom when

anointed with butter, lard or cream.

 

Italians don't generally start with day with eggs but they make up for

it later on. Eggs are used in rich sauces and custards, like zabaglione.

Soups are often served with poached egg.

 

And what about ice cream? Is this something new to the Italian diet-an

American travesty? Not quite. " The first ice cream shops or gelateria opened

in Tuscany in the 1500s, but the Southern Italians are believed to be

responsible for the popularity of ice cream in North America. " And no one

uses ice cream with greater inventiveness than the Italians, from the

spumone of Naples to cassata, a decorative ice cream cake, to semifreddi, " a

type of soft foamy ice cream that also comes in many flavors. " It is true,

however, that Italians sometimes consume ice cream with fresh fruit.

 

As it's clear to anyone who has traveled to Italy or eaten in an

Italian restaurant, the backsliding Italians have reverted to the food

paganism of their ancestors-if they ever left it. So orthodox nutritionists

have recently enshrined the Greek diet as the most virtuous of politically

correct Mediterranean cuisines, described as consisting principally of olive

oil, bread and tomatoes.

 

Rosemary Barron ran a cooking school on Crete from 1980-1984 and has

spent many months living there, as far back as 1963 when she participated in

an archeological dig. In 1991 she published Flavors of Greece, which

received an " Editor's Choice " award in the New York Times Book Section.

 

It is true, she reports, that the Greeks eat lots of bread. In the

countryside, family bread is still usually made with stone-ground flour in

wood-burning ovens. White bread is found in the stores but there still is a

long and strong tradition of all sorts of brown breads, including a

fermented " shepherd's " loaf made with wheat bran, oat bran and whole wheat

flour. Much bread is " twice-baked " into rusks, which are normally consumed

at breakfast.

 

Rosemary estimates that Cretans probably eat several pounds of cheese

per week, providing about 600 calories of fat per day, or 25% of calories in

a 2400-calorie diet, just from cheese alone. Since the fat in goat milk

cheese is almost 70% saturated, one-half pound of cheese per day would

supply about 18% of calories as saturated fat, more than twice as much of

that " dietary villain " as sanctioned by the diet-priests.

 

Other sources of saturated fat include yoghurt, milk and small amounts

of butter, used in pastries. Olive oil is the preferred fat for cooking and

salads. It is used very generously, providing lots more fat calories,

including some calories as saturated fat.

 

And there's also plenty of saturated fat from meat in the Cretan diet.

Lamb or kid is eaten in the spring and goat throughout the year. Pork is

eaten frequently, either as chops or roast, and old hens and roosters are

served up boiled. The most common meat of all is game in season-birds,

rabbit and hare. Tiny birds grilled and wrapped in vine leaves are popular.

Thin smoked sausages serve as appetizers and garnishes.

 

Egg consumption averages about ten per week, used as ingredients in

omelets, cakes, savory dishes and avgolemono, an egg-lemon sauce. Rosemary

remembers her surprise on cracking her first Cretan egg-the yolk was bright

orange, so bright that the scrambled eggs she made with it were also orange.

 

Cretans love unusual foods like snails and organ meats-kidneys, liver

and spleen. Fish roe is considered a delicacy and may be made into small

cakes and fried in oil, or into taramosalata, a paste served as an

appetizer.

 

Those who live near the coast eat fresh seafood every day-including

shellfish, sea urchins, octopus, squid and cuttlefish. Until recently, the

only transport was by donkey and there were no refrigerators. This meant

that unless you lived by the sea, you rarely ate fresh seafood. Cretans had

several methods for preserving fish by salting or smoking, and for creating

odorous sauces from rotting fish. Smaller fish were placed in earthenware

jars and covered with herbs and olive oil. Donkeys then carried these " fish

up the path " to the interior.

 

All of these animal foods, including the orange egg yolks, are

excellent sources of vitamins A and D, the fat-soluble vitamins Weston Price

discovered to be vital for good looks and robust health. When foods rich in

these fat-soluble activators are abandoned, subsequent generations have more

narrow faces, more tooth decay and more disease. They are less attractive

and less strong. The presence of adequate amounts of vitamins A and D in the

Cretan diet is probably what protects populations throughout the

Mediterranean from the high amount of bread or pasta and frequent use of

sweets.

 

Cooking is simple on Crete and throughout most of Greece. Rather than

make stock or broth, Cretans cook meat and fish with the bones. In fact,

traditionally no meat or fish was sold without bones, as bones are a proof

of freshness.

 

Even today most food on Crete is cooked in communal ovens. Thus the

typical meal is prepared in a shallow casserole that can be carried to the

ovens. Good fish and tender cuts of meat are cooked on outdoor grills.

 

Wonderful fresh vegetables, including artichokes and eggplant,

luscious fruits, almonds, pistachios, lentils and chick-peas all contribute

to this delicious Mediterranean cuisine. The preferred beverage is homemade

wine.

 

The main meal in most of Greece is lunch, eaten at home and consisting

of a main course, usually a stew or casserole containing meat, along with

vegetables, salad, bread and cheese. Then everything shuts down until about

5 PM. Dinner is late by our standards, preceded by a few hours of mezedes

(little nibbles) taken in a cafe, or at home with a drink. Mezedes might be

bits of cucumber, tomato, cheese, olives, seafood or slices of sausage. In a

typical village scene, the men sit in cafes for a couple of hours and the

women sit outside their houses, chatting to each other. The men then come

home to dinner about 10 PM. Desserts like ice cream and pastries are eaten

in cafes during family outings and at home on feast days.

 

The European Union is a breeding ground for zealots of food Puritanism

so the Greeks are being pressured to conform. No more long lunches and

leisurely hors d'oeuvres. Greece has to follow the same hours as the rest of

Europe-and eat the same foods, like standardized lowfat factory-made

cheeses, white bread, lean meat packaged without the bone, commercial baked

goods based on vegetable oils and soft drinks. These are the real travesty

of the modern Mediterranean diet, not foods rich in animal fats, and this

garbage is much easier to sell when doctors say that it's better for your

health than the traditional foods of your ancestors.

 

The people of Greece enjoy one of the longest life-spans in the world,

but it may not last if they adopt the American professor's version of the

Mediterranean diet, which actually hastens the trend towards processed food.

 

" Unhappily, " writes Keys, " the current changes in Mediterranean

countries tend to destroy the health virtues of the diet as we saw them

forty years ago. Efforts are needed to reverse this change. Education is

important. We should concentrate on the medical profession and the schools.

It is not enough that doctors measure serum cholesterol and tell patients

with high values to avoid butter and fatty meat. They also should emphasize

prevention by targeting the general public. "

 

This means more seminars, in villages by the sea. The second annual

meeting, Keys reports, was held in Pioppi, a village on the Mediterranean

coast, " about four kilometers from our home in Italy. " Sponsored by the

International Society and Federation of Cardiology, these retreats have

attracted " some 800 doctors from 30 cities in 22 countries. " Oh, what

sacrifices are made in the name of science!

 

And what does this College of Cardiologists eat when convened on their

Italian retreat? Do the learned doctors confine themselves to plain pasta

and lean meat? Do they nibble on lemons and leaves in the land of spumone?

 

The greatest of the seven deadly sins is not gluttony but pride, pride

so blinding that it presumes to inflict one's own pathology of renunciation

upon a whole population, starting with the children. " In these seminars, "

says Keys, " we stress the Mediterranean type of diet and its helpful role

in controlling the concentration of serum cholesterol and reducing the

associated risk of coronary heart. . . I believe it is important to bring

the diet message to school children. . . Our challenge is to figure out how

to make children tell their parents that they should eat as Mediterraneans

do. At least, we should help children get rid of some nonsense ideas and

convince them that meat and rich dairy products will not make the boys any

stronger and the girls any prettier. " 10

 

References

 

1. W C Willett, et al, " Mediterranean diet pyramid: a cultural model

for healthy eating, " American Journal of Clinical Nutrition June 1995

61(6S):1402S-1406S

 

2. Ancel Keys, " Mediterranean diet and public health: personal

reflections, " American Journal of Clinical Nutrition 1995

61(suppl):1321S-1323S

 

3. Ancel Keys, " Coronary heart disease in seven countries, "

Circulation, 1970 41, (Suppl.1)

 

4. The statistician Russell H. Smith had this to say about the Seven

Countries Study: The word " landmark " has often been used. . . to describe

Ancel Keys' Seven Countries study, commonly cited as proof that the American

diet is atherogenic. . . . the dietary assessment methodology was highly

inconsistent across cohorts and thoroughly suspect. In addition, careful

examination of the death rates and associations between diet and death rates

reveal a massive set of inconsistencies and contradictions. . . It is almost

inconceivable that the Seven Countries study was performed with such

scientific abandon. It is also dumbfounding how the NHLBI/AHA alliance

ignored such sloppiness in their many " rave reviews " of the study. . . In

summary, the diet-CHD relationship reported for the Seven Countries study

cannot be taken seriously by the objective and critical scientist. " Diet,

Blood Cholesterol and Coronary Heart Disease: A Critical Review of the

Literature, Volume 2, November 1981 pages 4-47 - 4-49

 

5. F Perez-Llamas, et al, " Estimates of food intake and dietary habits

in a random sample of adolescents in southeast Spain, " Journal of Human

Nutrition and Diet, December 1996 9:(6):463-471

 

6. A Alberti-Fidanza, et al, " Dietary studies on two rural Italian

population groups of the Seven Countries Study. 1. Food and nutrient intake

at the thirty-first year follow-up in 1991, " European Journal of Clinical

Nutrition February 1994 48(2)85-91

 

7. Recipes of All Nations, Wm H. Wise & Co, New York, 1935, pages

779-781

 

8. Thelma Barer-Stein, PhD, You Eat What You Are: People, Culture and

Food Traditions, Firefly Books, Willowdale, Ontario, Canada 1999

 

9. Edda Servi Machlin, The Classic Cuisine of Italian Jews, Dodd, Mead

and Company, New York, 1981, pages 83-87

 

10. Keys, op cit, 1995

 

Reprinted from Wise Traditions in Food, Farming and the Healing Arts,

the quarterly magazine of the Weston A Price Foundation, Spring 2000.

 

 

© The Weston A. Price Foundation. .