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Why Greece and the Islands?

The special knowledge of Greek team leaders, Christ Aravanis and Andy Dontas, and their colleagues, students, families, and friends living on the islands of Corfu and Crete, provided the background for the scientific questions addressed there.

The chief question was the long-term effect of a diet high in fats, mainly monounsaturates, but low in saturated fatty acids. The theory that saturated fatty acids are the principal cause of mass elevation of blood cholesterol and thus, of coronary heart disease, was therefore addressed in the Greek Islands under the special condition of a high-fat, low-saturated-fat intake.

Questions about the alleged life-giving, mystical properties of olive oil also could be tested stringently. The Greek Islands share the salubrious Mediterranean environment and characteristic eating pattern: occasional meat and chicken, more frequent fish and seafood, and staples of grains and starches, legumes, vegetables, and fruits.

Aravanis, Dontas, and collaborators brought to the study their special interest in the metabolism and respiratory physiology of aging populations. All this, along with gaining Ancel Keys' and Paul White's attention, and Aravanis' influence and independent funding, made the Greek collaboration crucial and the Greek Islands a desirable Seven Countries region for study.

The beauty of the Islands has captured Western imagination since the Iliad and the Odyssey. But, in reality, the poor and scattered villages of the Greek Islands created major logistical problems for the study. Only with the help of the masterful, Zorba-like team leader, George Arniotakis of Crete, were these obstacles overcome.

Crete, Second Round, 1965

A pilot study in Crete in 1957 confirmed the feasibility of a study there, but due to delayed funding, the formal surveys began only in 1960, and then without Minnesota participation. First-round Greek survey data were locally collected in a standard manner, however, edited in the field, and forwarded to Minnesota for collation.

In Crete, in the fall of 1965, an international team met in Iraklion to schedule the second round survey, mainly operating out of Hotel Xenia. The survey team was compatible and very "Greek," loving and extolling their land. Together, we enjoyed meeting the dark "pappas," the old men of the villages, exploring their healthy diet and dignified lifestyle. We shared with them a lemonade or an ouzo in a local tavern, and listened, with appropriate skepticism, to the political rantings from Athens Radio broadcast in the square.

In those days, the men of Crete walked or rode bicycles to their fields or vineyards. It was only with the ten-year follow-up examinations that they acquired three- and four-wheeled motorized carts. Television was not yet a major influence, and even electricity arrived only with the ten-year survey.

We of the survey team were captured by the beauty of the arid, rock-strewn plateaus of Crete during the grain harvest, when the grain was winnowed in stone circles by the feet of men, or by women in black dresses and shawls, pulled around field circles by donkeys. With our own "Zorba," Arniotakis, "George," we traveled to high pastures in which men enjoyed each other's stories and on Saturday danced at midnight under the bright moon. We understood then the fictional Zorba's madness over the mystery of Crete. Our hearts, as his, welled with a love of life and of fellow man, as we worked in this stark, timeless land.

On workdays in the villages, we were amused by the hordes of scrawny Cretan cats on rooftops, or scurrying along every whitewashed wall. We were fascinated by peasant women nonchalantly knitting while riding their donkeys side-saddle, returning from the distant hills with large bundles of faggots.

We marveled at the potter's family on the lower side of Thropsanon, who maintained a centuries-old tradition of producing huge clay urns for water, wine, and oil. These were formed with an incomprehensible precision, without any visible measurement.

We watched the evolution of an entire ceramics process: molding by hand on the potter's wheel, cutting the soft clay with a string, adding the simple signature pattern of the family around the circumference, sun-drying two halves of the urns, firing in the kiln, and finally, the emergence of great Minoan-style vessels.

We were amazed by the apparent cleanliness of the island villages, where, in fact, everything used was bio-degradable.

In a land bathed in sea breezes, baking under the sun, and host to numerous scavengers, such cleanliness is natural. We watched the wine-pressing carried out in a traditional manner with bare feet in great tubs. On the plateau of Termidion, we saw thousands of cream-colored windmill sails turning softly in the evening light.

In Crete, we were mesmerized by the cicadas, sawing away at progressive frequencies as the day heated up, slacking off in the cool of dusk.

We enjoyed the donkeys' bray and the calls of the whippoorwill and nightingale at dawn.

We were enchanted by a purple sky melding into a dark sea, a softly lapping surf, and sunlight dappled through grape arbors as we gathered to rest and chat during the long siesta.

We were fascinated by the preoccupation to obtain water in a dry land, and by the lushness of oases where water is artfully conserved, using ancient techniques. We found shade under panoplies of olives, grapes, or, on the southern coast, bananas.

The pastoral life of the island has changed little for several thousand years, and continues comfortably side by side with the ancient ruins of Knossus, Matala, and Phaestos, sites of the Minoan civilization. In ancient times, the high priests and upper classes lived in handsome palaces, in symbiosis with the peasantry, each class accepting its role.

Modern elements have affected mainly the region around Xanes and its British naval base captured by German parachutists in World War II. It became a post-war American naval base with an Armed Forces Radio and TV network. This influence in the 1960s was largely limited to the trade area west of Iraklion, and we felt little of its impact on "our villages" in central and eastern Crete.

The major products of Crete - grapes, fruits, and vegetables, and olives and olive oil - remained the major products during the baseline, five- and ten-year Seven Countries surveys. During these years, the Seven Countries Study was able to tap the essence of traditional Greek Island culture. Since that time, Crete has been invaded by mass tourism, and many lifestyle changes have resulted.

Collaborators
	Christ Aravanis The cardiological units, hospitals, and medical factions in Athens are beyond my ken, but Aravanis represents the grand, traditional Old School. I suspect that he is politically conservative, while medically liberal. Aravanis has a long face with sad eyes and the dignified demeanor of a senior consultant. He has shown clear vision and authority over the years, implementing effectively the Seven Countries Study undertakings in the Aegean and Ionian isles. Aravanis also had access to the Orthodox priests of the islands. One of the more colorful photographs of the Seven Countries expeditions (above) shows Ancel Keys bowing low, in an exaggerated Japanese style, before a dark, handsome, unbowed priest on Crete. Priests hold remarkable power in their communities and they provided great credibility to our efforts. Aravanis put together a staff of younger colleagues he had trained in cardiology, including Demetrios Lekos and Adrian Corcondilas, plus nursing faculty and local practitioners. He was able to augment the meager Seven Countries allocations with local staffing, housing, and transportation. Aravanis met Ancel Keys in the early 1950s at a meeting of the American Heart Association in Chicago, where Aravanis trained and found his bride, Tula. He was invited to join Keys and White on their first trial run, in Nicotera in southern Italy, in the fall of 1957. Directly thereafter, he escorted the pilot survey team by DC 3 from Athens to Iraklion. A classic photograph (below) shows the team of pioneer investigators lined up on the dirt airfield along the sea in northern Crete. It included White, Noboru Kimura, Martti Karvonen, Aravanis, Dontas, Keys, Flaminio Fidanza, and their spouses. Aravanis has remained a steady colleague in the Seven Countries Study. Even though his politics were not always in line with the Greek military junta or the subsequent political swings in Greece over the last twenty- five years, he has managed to keep the Seven Countries Study operation going on a shoestring - sufficient to follow the five- and ten-year formal surveys with continuous mortality surveillance up to thirty years. He has presided over independent and collaborative developments of the Seven Countries Study data. Strong in the clinic and an international leader in cardiology, Aravanis has participated vigorously in the new science of cardiovascular disease epidemiology. He is among its insightful pioneers.
	Andy Dontas "Andy" is the diminutive anglicization of "Anastasios." Dontas was educated in Athens and at the University of Michigan. A bright, sensitive, and enthusiastic investigator of wide interests, and a worrying perfectionist, Dontas provides the ideal complement to the sober Aravanis as co-investigator for the Greek studies. His industry and his personal researches in gerontology are a driving force to independent publications from the Seven Countries Greek populations. A frequent visitor to the Stadium Gate 27 Laboratory and Division of Epidemiology at Minnesota, he remains an active participant in field studies in Greece and in the other Seven Countries areas. A charming and effective colleague, Dontas deserves credit for the practical operations of the Greek team and for much of its intellectual stimulation. He has provided the glue between Greece and Minnesota, professionally and collegially.