The ‘Mediterranean Diet’ in 2011

The Mediterranean Diet describes eating patterns of the traditional cultures around the Mediterranean Basin. Thus, it is quite varied, even between the familiar cuisines of Italy, Spain, France, and Greece, and even between the meridional and interior regions of those countries. Then, think of the different foods and cuisines of North Africa, the Near and Middle East, and back to the Balkans!

Ancel Keys spoke rather of eating and living in “The Mediterranean Way.” He wrote in 1975 that: “. . it would be wrong to insist too much about uniformity in the Mediterranean diet. . .there are some large differences between Mediterranean countries. And in the case of Spain and France, it is necessary to concentrate on the Mediterranean parts of these countries. .. for example, in Mediterranean France the per capita consumption of mutton and lamb is twice that of France as a whole, while only half as much butter is eaten” (Keys 1975, 38).

Yet there are important commonalities of the eating patterns around this ancient sea: they include the base of plant foods: whole grains and grain products (pasta, couscous, breads), legumes (peas, beans, and lentils), nuts, vegetables, fruits, olive oil, and a staple in non-Muslim areas, wine.

All the region surpasses U.S. consumption of fruit and fresh vegetables and of legumes, while the U.S. consumption of beef and dairy products is several times that of most Mediterranean countries. But large regional differences are found in Italy, Spain and France and around the sea.

Depending on the locale, there is greater and lesser emphasis on fishes and seafood, chicken and fowl, meats as lamb, mutton, or game (versus lean beef or pork), and dairy products, including mainly yogurt and skimmed-milk cheese (feta).

There is wide variation in available domestic and wild plant foods; vegetables (peppers, onions and garlic, tomatoes, eggplant, and mushrooms), and types of wild greens or “edible weeds.”

Fruits sweep in abundantly by the season around the basin: citrus, cherries, peaches, figs, pomegranate, dates, and melons. And then comes the grape harvest.

Desserts are neither a daily nor essential component; sweets are commonly taken as pastries or biscuits, and as honey or sugar in tea and candies.

Then, there is the added aspect of freshness of food grown locally and bought and prepared daily.

But, of course, the traditional “Mediterranean Way” is more than particular foods and cuisines or eating patterns. It involves aspects of lifestyle and the economy, such as walking to and from work in physically active occupations (e.g. agriculture, crafts, fishing, herding); taking the major meal at midday, associated with a siesta or major work respite. Thus, the lifestyle is related to the human dimensions of the traditional communities. And even tobacco is locally cured and more sparsely used in such cultures.

The elongate but rhythmic workday traditionally ends with a simple family supper and then early to bed, except for the weekend celebration of life with family and community (social drinking and the dance). This is followed by a quiet family time on the Sabbath.

Other aspects of traditional rural and small-town culture provided (since it is now changing) clear social structure, roles, and identity that likely affect health, habits, and functional status.

Shockingly, today, many nutritional experts in the Western world and in the Mediterranean region say that the traditional Mediterranean Diet no longer exists. Surely, fewer and fewer people eat the commonalities described above, and many children have never eaten that way nor lived in the simple patterns of traditional cultures. These were the societies we were fortunate to visit and measure in the Seven Countries Study starting in the 1950s.

But they no longer exist with their centuries-old traditions. The farms dwindle, food arrives by sea and air and fast-food chains are the more frequented. Only “foodie tourism” maintains the traditional restaurants abandoned by the locals. Vespas transport all noisily and dangerously; everyone watches much TV (I heard “Dallas” being broadcast to women in an adobe dwelling in a Saharan oasis!), and youth with their cell phones move to the cities!

But the basic economic advance in the region since our studies began 50 years ago is the primary agent of change and the main influence on the disappearance of subsistence farming and traditional lifestyles. The lentils of poverty are replaced by the meats of plenty!

Now, in the traditional areas we studied and filmed, we no longer find the orchards and the kilns and the balanced lives. Instead, we are nearly run down by giant tourist buses or chased down the street by the desperate vendors of tourist kitsch!

So, we are talking today about a Mediterranean Diet and Lifestyle thought to be non-existent or almost disappeared. True, the lifestyle is quite over. The eating pattern persists, however, in sophisticated subsets of populations where it's also often called the “prudent diet.” This is sometimes measured by academics, according to Jacobs, using principal components (factor scores) derived solely from correlations among foods eaten, not by region or culture so much as by the choices of informed individuals. The “good” Mediterranean scores effectively predict less disease risk.

Thus, the Mediterranean Diet survives, even thrives, among the cognoscenti, due to good evidence that it is a most healthy way of eating and is still a worthy personal as well as communal goal.

Questions

Q. What’s so good about these Mediterranean foods and cuisines?

A. We are still learning about food composition and biological activity, and the metabolic roles of foods, after a half-century of deconstructing diets and foods to a few nutrients and vitamins. This was a needed step for understanding but one from which we must move on. Now, in the view of researcher David Jacobs, we might think of foods as natural combinations that evolved for the foods’ own purpose of survival, thus having bioactive phytochemicals and protective components good for the plants (vitamins and anti-oxidants, probiotics, phytochemicals and fibers). In their natural composition in foods, when eaten in combinations of foods, they also apparently protect animals and humans.

Jacobs talks this way about today’s recommendations for diet:

“A diet pattern rich in plant foods that are high in biologically active compounds .. has been shown over and over again to be associated with reduced risk. Thus .. attempting to formulate diet recommendations entirely based on foods makes sense to me.

All the current arguments go around nutrients, with the exception of sugar, which is a monomolecule that by definition competes with other foods that are much better conveyers of a wide variety of bioactive substances.”

Q. Why is Ancel Keys credited with leading us to the Mediterranean Diet?

A. His “cook books,” written with his wife Margaret, evolved from “Eat Well-Stay Well” in 1958, to “Eat Well-Stay Well The Mediterranean Way” in 1975, pointing out the facts Keys had documented, that the Mediterranean life pattern, including the habitual diets of tradition, were associated with the longest, healthiest, disease-free lives of civilized peoples. Food experts, chefs, and food commerce took that demonstration and ran with it, to give us the elegant and now chic “Mediterranean Diet.” It is the people of the Mediterranean Basin who have abandoned it, along with its associated poverty. (Henry Blackburn)

Keys, Ancel and Margaret 1975. How to Eat Well and Stay Well the Mediterranean Way. Garden City, New York: Doubleday. 488.