Nobody questions the pleasure principle involved: an all-Mediterranean buffet might include hummus and tabouli, pasta all’amatriciana, Provencal fish stew, Greek spinach pie . . . ““Superlatively good food,’’ as epidemiologist Ancel Keys described it. Keys discovered both the pleasure and the health principles of the Mediterranean diet back in the ’50s, when he and his colleagues began the now famous ““Seven Countries’’ study, an investigation into the diet and health of nearly 13,000 men in Greece, Italy, Finland, Japan, the Netherlands, the United States and Yugoslavia. The highest rates of heart disease, it turned out, were in Finland, where the men’s diets got 40 percent of calories from fat. The lowest rates were in Crete – where the diets also got 40 percent of calories from fat. The difference was in the fat. The Finns ate meat and dairy products, while the Cretans reveled in olive oil – they cooked vegetables in it, they poured it over hunks of brown bread and sometimes they drank it straight.
Since that time other studies have confirmed Keys’s high opinion of the Mediterranean diet, but there’s been little agreement on precisely why it’s so effective. Most likely all its components are important: the fish supply omega-3 fatty acids, which protect against the formation of blood clots in the arteries; moderate consumption of wine raises HDL, the ““good’’ cholesterol, and also helps keep arteries clear; vitamin-rich fruits, vegetables and grains are known to fight off cancer and heart disease.
Then there’s the fat – the most controversial element of the Mediterranean diet. Recently, representatives from the Harvard School of Public Health, the World Health Organization and the nonprofit Oldways Preservation & Exchange Trust (a Boston-based think tank on food issues, which receives some funding from the olive-oil industry) unveiled what they call ““The Traditional Healthy Mediterranean Diet Pyramid.’’ Like the food-guide pyramid promoted by the U.S. Department of Agriculture, the Mediterranean pyramid gives pride of place to fruits, vegetables and grains. But it devotes a generous chunk of space at midpyramid to olive oil, representing a whopping 25 to 40 percent of calories. Unlike the saturated fats in meat and dairy products, olive oil lowers LDL, or ““bad’’ cholesterol, but the calorie count is the same as all other fats: about 100 per tablespoon. Walter Willett, chair of the nutrition department at Harvard’s School of Public Health, says that much oil can be perfectly healthful. ““As long as you’re careful about the kind of fat – not saturated, not red meat, not trans-fatty acids – there’s a lot of flexibility in the total,’’ he says.
Yet Cretan farmers of nearly half a century ago, who spent their lives laboring outdoors, never once phoning for a pizza, may not constitute the most realistic role models for Americans today. Many nutrition experts were appalled by the wide range of fat permitted. ““We believe for most Americans fat should be decreased,’’ says Nancy Schwartz of the American Dietetic Association. ““We do not believe olive oil is magical.''
The new pyramid keeps other sources of fat to a minimum, with one surprising exception: nuts. These have a niche in the largest section of the pyramid, the one for fruits, vegetables and beans. Although nuts are very high in fat – about 17 grams, or about four teaspoons, in fewer than seven walnuts – the fat is mostly unsaturated, as it is in olive and canola oil. Nuts are scattered through many typically Mediterranean dishes, and recent studies (some funded by the nut industry) indicate that people who eat nuts regularly may lower their risk of heart disease. But research has not yet determined whether it’s the nuts themselves that offer protection or simply the fact that people ate a few nuts instead of meat, potato chips or other fatty foods. So don’t race to the salted-snack section of the grocery store just yet.
By now, so many studies have piled up showing the heart-healthy properties of Mediterranean foods, including an obscure green called purslane that the Cretans apparently doted on, that it’s a wonder anyone in the region ever died. But most elements of the diet show up in countries all over the world – wherever people still eat the way their grandparents did. From Japan to Mexico to Hawaii to Sri Lanka, traditional diets are low in saturated fat and high in vegetables and other plant foods. Only the tastes are different. Flavor, like God, is in the details.
