Natural Foods Merchandiser

Mediterranean Diet Sets Sail for Health

The Mediterranean-style diet, rich in whole grains and vegetables, is making its way from the cafes of Crete to the dinner tables of mainstream America, with the support of such high-profile advocates as health guru Andrew Weil, M.D. But this summer, the diet received perhaps its most important endorsement yet—a hefty serving of hard science concluding that its benefits truly can be lifesaving.

In studying the dietary habits of more than 22,000 Greeks for an average of four years, scientists with the University of Athens Medical School and the Harvard School of Public Health found that strict followers of the Mediterranean diet not only had significantly lower rates of heart disease and cancer but also lived longer than those who did not follow the diet (New England Journal of Medicine, June 26, 2003).

Perhaps most notably, the researchers found weak evidence that any one particular food group—including the diet's hallmark ingredient, olive oil—could be directly associated with health benefits. Instead, substantial benefits were seen only in relation to the full combination of foods in the diet, along with exercise.

"It really makes sense, because it's artificial to break down foods and look at them out of the context of the larger diet," says Dimitrios Trichopoulos, Ph.D., a senior author of the study and a professor in the department of epidemiology at the Harvard School of Public Health. "You cannot expect to get the benefit from a diet by focusing on any particular food."

To conduct the study, researchers assigned scores to participants based on dietary intake. Points were awarded when participants ate recommended amounts of each food in the diet.

The researchers' final analysis was striking: Each two-point increase in a subject's score corresponded to no less than a 25 percent reduced chance of death during the follow-up period; a 33 percent reduction in risk of heart disease; and a 24 percent lower risk of cancer.

When participants omitted important factors, such as exercise, they received lower scores, even if such an omission might be argued as being beneficial—cutting out wine, for example.

"Wine, in moderation, plays an important role in the diet, and if someone didn't consume that, points were deducted," Trichopoulos explains.

That's why Trichopoulos stresses that, contrary to common connotations of a "diet," there are no stringent restrictions with Mediterranean-style eating. "You don't need to avoid anything completely. You don't have to say no to red meat, for instance, because everything is acceptable so long as it's within the broader concept of the diet."

A Daily Dose

The components of the traditional Mediterranean diet include daily servings of:

  • Fruits and vegetables
  • Whole-grain cereals, nuts and legumes
  • Olive oil as the principal source of fat
  • Dairy products such as cheese and yogurt in moderation
  • Fish and poultry several times per week
  • Infrequent consumption of red meat
  • Wine consumed in moderation, usually with meals
In an accompanying editorial in the journal, Frank B. Hu, M.D., of Brigham and Women's Hospital in Boston, further speculates on the diet's collaborative benefits. "The effects of single nutrients or foods may be too small to detect, whereas the cumulative effects of multiple dietary components may be substantial," Hu writes. "In addition, there may be synergistic or interactive effects among nutrients or foods, which the score automatically takes into account."

Olive Oil's Slippery Role
With that in mind, do the researchers think there is an over-emphasis on the diet's famous association with olive oil? "No," responds Trichopoulos. "The olive oil is as important a factor as any."

It's not the first time the Mediterranean diet—and olive oil—has been lauded by scientists. In the 1950s, the Seven Countries Study, initiated by researcher Ancel Keys, found that residents of the Greek island of Crete had exceptionally low rates of coronary disease and of certain types of cancer, and had long life expectancies—despite the high intake of fat in their diets. Meanwhile, mortality rates due to cardiovascular disease were exceptionally high in cultures where meat and saturated fat intake was greater, notably Finland and the United States.

The evidence became clear that the Greek preference for olive oil, high in monounsaturated fat, was making a big difference.

To determine if some elusive component distinctive to Greek culture or cuisine wasn't also at play in the Greek mortality rates, researchers recently decided to test the diet beyond the boundaries of the Mediterranean region.

In the Indo-Mediterranean Diet Heart Study, a Mediterranean-style diet was transported across culinary cultures and tailored for 1,000 patients in India with, or at risk of, coronary disease. The revised diet called for increased levels of mustard or soybean oil, nuts, vegetables, fruits and whole grains.

The results showed that, compared with those on a control diet, patients on the Indo-Mediterranean diet indeed had one-third the rate of fatal heart attacks, and rates of sudden death from cardiac events dropped by a whopping two-thirds (Lancet, Nov. 9, 2002).

Good Fat, Bad Fat
With word of the Mediterranean diet's benefits having now traveled from the Acropolis to the Oprah show, there are strong signs in the marketplace that many of the core principles of the diet are indeed being adopted in the United States. Sales of extra-virgin olive oil, for instance, have more than quadrupled here since the early 1990s, according to the International Olive Oil Council.

Without specifically merchandising the Mediterranean diet, Wild Oats Markets, based in Boulder, Colo., nevertheless promotes many of its nutritional assertions. "We do talk about the benefits [of Med-style eating], but we haven't yet packaged anything as being 'suggested by the Mediterranean diet,'" says Sonja Tuitele, spokeswoman for Wild Oats. "We sponsor, for instance, Heart Health month in February, which focuses on the attributes of the diet, but we try to stay away from being too trendy, and instead focus on the nutritional and health benefits of the food."

Even at the fast-food level, availability of such options as whole-grain buns indicates an increased awareness—and demand—for the healthier aspects of Mediterranean-style eating, says Christopher Speed, senior nutritionist with Boston-based nutritional think tank Oldways Preservation & Exchange Trust. "Most of the whole-grain companies that we work with agree that consumers are becoming more loyal at the point of sale to products that indicate some type of whole-grain content," he says.

Since its inception in the early 1990s, Oldways has led an aggressive campaign to boost awareness of the Mediterranean diet's benefits and to challenge the all-fat-is-bad model of the U.S. Department of Agriculture Food Guide Pyramid.

Speed suggests the pyramid's endurance may have as much to do with long-held economic influences as with old-school nutritional beliefs. "Making the science [behind the Mediterranean diet] part of the U.S. dietary guidelines is likely getting some resistance because it's not in the best interests of the beef, cattle and dairy industry," he says. "But that's what we're here for. We're saying, 'What's the cost to life for these recommendations?'"

Nancy Melville is a freelance writer based in Tucson, Ariz. She may be reached at [email protected].

Natural Foods Merchandiser volume XXIV/number 9/p. 74

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