By Donna Feldman, MS, RD

The Mediterranean diet is not new. In fact, it is ancient. Inhabitants of the Mediterranean basin have been eating this “diet” for centuries. According to Artemis Simopoulos, of The Center for Genetics, Nutrition and Health, the term “Mediterranean Diet” is misleading, since there as many Mediterranean diets as there are countries around the Mediterranean Sea (J. Nutr. 131:3065S-3073S, November 2001). The result is that no one owns the Mediterranean diet the way Atkins or South Beach are ‘owned’ by the respective book authors. No one person or organization is uniquely qualified to dictate what a Mediterranean Diet looks like. Many interpretations are possible, but health researchers are in agreement on some of the basic principles gleaned from years of research on the relationship between local diet and disease patterns on the island of Crete, part of Greece. Studies begun in 1960, and continuing into the 1990s, show Cretan men to be the longest lived of other populations in the study, and to have the lowest percent of deaths caused by heart disease or cancer, thanks to their traditional Mediterranean diet.

Historical perspective
Chances are, when you hear Mediterranean, you think olive oil. And with good reason. The Mediterranean basin is considered the birthplace of olive oil. Wild olive trees are native to the region and are well adapted to the poor, rocky soil and hot, dry climate. Despite primitive processing methods, olive oil was widely used for lamps, lotions and in food thousands of years ago. Archaeological evidence indicates use of the oil along the eastern Mediterranean region before 4000 B.C., and in the Greek isles by 3000 B.C. Indeed, given the climate and geography, there were few other sources of fat in the diet. In Greece, for example, some 60% of cultivated land is still devoted to olive trees. Olive oil is a cultural phenomenon as much as a food.

But people cannot live by olive oil alone. The only domestic animals that thrived on the rocky landscape were goats and sheep, providing milk to make yoghurt and cheese. Large fields of grain crops were not possible on the steep terrain, but small plots of vegetables and legumes were. Various nut and fruit trees are native to the Mediterranean, thanks to mild winters. And of course, the sea was a constant presence. Without the tides and storms common in open oceans, fishing provided a ready and reliable source of high protein food.

Finally, there are grapes and wine. Like olive trees, grape vines are adapted to the Mediterranean climate, and were cultivated by ancient people. Wine has been consumed for thousands of years, and is still an important part of daily life. Most of the Mediterranean countries’ current food guides recommend moderate wine consumption.

Traditional Mediterranean
The health benefits of this high fat diet were first recognized in the 1960’s at the same time health officials in the U.S. were pushing for overall reduction in fat intake, to prevent heart disease. Strangely, on Crete and around the Mediterranean, the high fat intake (around 40% of calories) didn’t increase heart disease. So researchers zeroed in on olive oil, by far the biggest source of fat in the diet. The traditional foods of Crete provided few sources of the saturated fat that is so common in American and other Western diets. Most of olive oil is monounsaturated fat, and research has since shown that this particular form of fat is actually beneficial and does not contribute to heart disease.

The traditional diet is very simple:

• Breads, grains, legumes (beans), fruits and vegetables predominate
• Olive oil is used liberally in daily food preparation
• Fish, cheese and yoghurt (both from goats and sheep) are the main protein sources
• Very little meat is eaten, and available meats are lean
• Desserts are rare, honey is widely used for sweetening
• Wine is consumed daily

Contrast this list with a typical American fare:

• Meats and high fat cheeses are eaten daily, in quantity
• Cooking fats are primarily vegetable oils and hydrogenated shortening
• Many fried foods are consumed
• Sugar intake is high, due to soda pop, desserts and sweets.
• Breads and grain foods are predominantly from refined white flour
• Snack foods are common
• Vegetables and fresh fruit are a small part of the diet
• Salads are usually covered in vegetable oil-based dressings

Compared to American foods, traditional Mediterranean foods are low in trans fats, high fructose corn syrup, lower in saturated fat and higher in fiber and higher in omega 3 and monounsaturated fats, from fish and olive oil.

Subsequent clinical studies comparing Mediterranean-type diets, emphasizing olive oil, to the low fat diet recommended in the U.S. showed the Mediterranean diet had more beneficial effects on key indicators of heart disease risk (Ann Intern Med. 2006 Jul 4;145(1):1-11). Such studies continue, but are prone to problems, especially when conducted in non-Medieterranean countries like the U.S. Unless food is provided to the study subjects and intake is monitored, there is no guarantee that subjects will be able to stick to this diet on their own. If they don’t, the study results are compromised.

Why it’s healthier
It’s tempting to attribute all the health effects of the Mediterranean Diet to olive oil and wine. What could be easier? Just add olive oil to your food and drink more wine, no need to change anything else. Wrong. Nutritionists, including Simopoulos, point to many components of traditional Mediterranean foods that affect human health. The effect of the monounsatured fat in olive oil is well known, but other components of the oil may have beneficial biological activity. High intake of fish means high intake of omega 3 fats, which are also known to provide health benefits. The reliance on plant foods, in particular whole grains, beans, fresh vegetables and fresh fruit means a high intake of fiber, vitamins, minerals and antioxidants.

The Mediterranean Diet may also be healthier based on what it does not contain: trans fats, a high proportion of omega 6-type fats, such as from vegetable oils, and sweeteners like sugar and high fructose corn syrup. It is also likely lower in protein and salt than typical American diets, with few additives other than herbs and spices.

Warning: with all the talk of the Mediterranean “diet”, this is not in fact a weight loss diet. It may not even be lower in calories, depending on how much is eaten and what foods are chosen. Olive oil is still a fat, and has just as many calories, tablespoon for tablespoon, as corn oil or butter. Typically, fat is almost 40% of calories. How much olive oil is that? For a female who eats about 1600 calories a day, that’s about 6 tablespoons of olive oil. On the other hand, the higher fat content of the diet makes it more satisfying. Low fat diets are frequently criticized for having too little satiety value, leaving people constantly hungry.

Let’s say you make a serious effort to stick strictly to a Mediterranean food plan. You give up soda pop, chips, French fries and all the other high calorie food traps common in typical American diets. You may end up losing weight by eliminating those sources of unnecessary calories and increasing intake of more satisfying foods like vegetables and whole grains. If weight loss is one of your goals on a Mediterranean diet, you still have to pay attention to portion sizes and daily exercise. Mediterranean cuisine is known for heart health, not for any magic effect on metabolism.

Mediterranean foods and you
Other articles in this series provide some guidance on the basics of Mediterranean food selection, dining out,  and eating at home. The traditional Mediterranean Diet can be an extremely simple food plan to follow. Strange or hard-to-find foods and ingredients are not necessary, nor are complicated recipes or expensive restaurants. However, there is a wealth of resources for anyone who wants to cook more Mediterranean-style dishes. Cookbooks and the Internet can help with cooking tips, ingredients, recipes and menus.

The main problem will be implementing a Mediterranean diet in the midst of an American food environment. Many foods common to everyday life just won’t fit. Can you live without sweetened coffee drinks with whipped cream, bagels and cream cheese, burgers and fries, soda pop, chips, smothered burritos, enormous portions of meat, stacks of pancakes and supersized desserts to name just a few examples? Occasional indulgences are built into the Mediterranean diet. The seemingly daily indulgences common to some American eating patterns won’t work.

Conclusion
The Mediterranean Diet is an ancient cuisine with a message for health conscious people today. The health benefits are well documented. The basic plan of simple foods, most of which are widely available, make it a great choice for people concerned about heart disease and cancer risk. Mediterranean cuisine should be on everyone’s table.