The Mediterranean diet, inspired by the traditional eating habits of countries bordering the Mediterranean Sea such as Greece, Italy, Spain, and France, has garnered significant attention for its potential health benefits. The principles of this diet are based on the work of Ancel Keys, PhD, whose research explored the relationship between diet and cardiovascular health.
The Foundation: Ancel Keys and the Seven Countries Study
Ancel Keys launched his landmark Seven Countries Study in 1958. By analyzing the diet and health data from more than 12,000 men from different countries, Dr. Keys concluded that there is a correlation between a diet that’s high in saturated fat and cholesterol, and the development of cardiovascular disease. The study was essential in forming the belief that consuming saturated fat increases blood cholesterol, leading in turn to atherosclerosis and heart disease. It was one of the largest and most ambitious scientific projects undertaken at the time, and Keys quickly became a well-known public authority on heart disease.
Keys formulated his diet-heart hypothesis based on research he carried out personally in Greece, Italy, Spain, South Africa, Japan, and Finland. This led to a 1953 publication laying out his thinking and supporting his conclusions with what he would later call a “remarkable relationship” between fat consumption and heart-disease fatality visible even in easily available national statistics.
Core Principles of the Mediterranean Diet
The Mediterranean diet emphasizes whole, fresh ingredients and simple eating habits. The majority of the foods in the Mediterranean diet comes from plants. These include fruits, vegetables, seeds, nuts, whole grains, herbs, spices, and olive oil.
Plant-Based Emphasis
The Mediterranean diet prioritizes plant-based foods. This doesn’t mean you have to become vegetarian. It simply implies that the majority of the ingredients in your meals should be plant-based. Fruits and vegetables make up the majority of the Mediterranean diet. They are high in dietary fiber and flavonoids, which decrease the risk of heart disease and stroke because of their anti-inflammatory properties.
Read also: Alicia Keys on self-love and wellness
Lean Protein Sources
The Mediterranean diet focuses on lean sources of protein, including fish and poultry. Fish, which is high in omega-3 fatty acids, is the main source of animal protein in the diet. Some of the best options include lake trout, albacore tuna, salmon, and sardines. Eggs, chicken, low-fat dairy, and cheese can be consumed in small portions a few times each week.
Healthy Fats
The Mediterranean diet emphasizes healthy fats, especially from olive oil, nuts, and avocados. Not all olive oils are created equal. Varieties include extra-virgin, virgin, cold-pressed, filtered, stone-milled, etc. But if you have to chose just one, pick extra-virgin, as it’s considered to be the highest grade of olive oil.
Moderation and Lifestyle
Unlike most eating plans, the Mediterranean diet isn’t restrictive and regimented. This means you can still indulge in sweets and alcohol from time to time, though as with all things in life, moderation should be practiced. Sweets should come in small, manageable portions, just enough to satisfy the sweet tooth.
When considering the Mediterranean diet, you need to know that food is just part of the equation. Mediterranean’s are known for their slow and relaxed way of living. When they eat, they actually sit down and enjoy their food with others. They do not eat in a rush or sit in front of the television. Physical activity also plays an important role in keeping these people healthy. People in Mediterranean countries walk a lot! So, aside from sticking to the Mediterranean diet basics, also try to emulate how the Mediterranean’s live. Eat slowly, learn to deal with stress effectively, and try to incorporate physical activity in your lifestyle.
Getting Started with the Mediterranean Diet
Getting started is the hardest part of any lifestyle change. Fortunately, starting can be quite easy with the Mediterranean diet because it isn’t as restrictive as other diets. If you look into the basics of the Mediterranean diet, you’ll see that it’s really all about simple eating and making meals from whole and fresh ingredients. It’s easier to stick with the lifestyle if you have the basic ingredients in your pantry. The Mediterranean diet is known for being low on meat, especially red meat. There are different ways to eat less meat with little effort. Fish and other sources of lean animal protein are highly recommended in the Mediterranean diet. They’re rich in omega-3 fatty acids, which reduce the risk of heart disease, improve skin and hair, and help prevent cognitive decline.
Read also: Keys' Fitness Regimen
Controversies and Criticisms of Keys' Work
Certain critical issues, however, have always undermined the study’s core conclusions. They are manifest in Keys’ thinking and have been institutionalized in nutritional epidemiology research ever since. While this bolder statement could be drawn from the data Keys presented for the six countries he selected for his graph, there were several methodological and analytical flaws, as Yerushalmy and Hilleboe pointed out in their 1957 rebuttal (and in a separate 1957 paper published by Hilleboe), beginning with the selection bias inherent in the data. “In studies of association, as in any other study, the method of selecting data largely determines whether the results can safely be generalized. … Hence, it is of first importance to know on what basis the six countries were selected, in order to determine whether the findings for them can be generalized to other countries.
It is almost inconceivable that the Seven Countries Study was performed with such scientific abandon.Keys’ interpretation of this data and failure to understand basic principles of scientific methodology were then manifest in the subsequent Seven Countries Study, in which he once again selected his countries and the sites of study knowing in advance what he was likely to find (5). That more famous work would be criticized by many, including Russell Smith, Ph.D. “The word ‘landmark’ has often been used to describe Ancel Keys’ Seven Countries Study, commonly cited as proof that the American diet is atherogenic. The dietary assessment methodology was highly inconsistent across cohorts and thoroughly suspect. In addition, careful examination of the death rates and associations between diet and death rates reveal a massive set of inconsistencies and contradictions. . . Whether or not there truly was, or is, a correlation between fat intake and heart disease in the countries Keys surveyed, the data was insufficient to clearly show fat intake was the primary factor affecting heart-disease risk.
Evolution and Misinterpretations
Everyone is talking about the Mediterranean diet, but few are those who do it properly, thus generating a lot of confusion in the reader. And so for some it coincides with the pizza, others identified it with the noodles with meat sauce, in a mixture of pseudo historical traditions and folklore that do not help to solve the question that is at the basis of any diet: combine and balance the food so as to satisfy the qualitative and quantitative needs of an individual and in a sense, preserves his health through the use of substances that help the body to perform normal vital functions.
Misadventures in low-fat eating, to say nothing of low-fat junk foods, cannot legitimately be attributed to any position espoused by Keys over the course of his career.
The Mediterranean Diet's Enduring Appeal
The Mediterranean Diet is a nutritional model so universally appreciated that belongs to the cultural, historical, social, territorial and environmental and is closely related to the lifestyle of the Mediterranean peoples throughout their history. The Candidature Dossier submitted to UNESCO defines the Mediterranean Diet as follows:”… The Mediterranean diet, known primarily as a food model, enhances the quality and safety of foods and their link to the land of origin. It offers a simple cuisine, but rich in imagination and tastes, taking full advantage of all aspects of a healthy diet. It is an ethical choice that preserves the traditions and customs of the peoples of the Mediterranean Basin (9).
Read also: The Hoxsey Diet
Many studies and clinical trials have shown that the Mediterranean diet reduces the risk of cardiovascular disease and metabolic syndrome. However, we must point out that the Mediterranean diet is not able to produce, by itself, the benefits listed above if you do not change at the same time other risk factors (obviously those modifiable). In fact, ischemic heart disease depends not only on errors in the composition of the diet, to which attaches a dominant role, but also by other factors, such as a reduced or absent physical activity, caloric intake in excess of the energy needs of the organism, the presence of metabolic diseases such as diabetes and obesity, stress, cigarette smoking, high levels of homocysteine in the blood, high levels of triglycerides. Therefore, it is not surprising that about half of all cases of stroke occur in individuals with a normal level of cholesterol in the blood.
The Mediterranean Diet is therefore characterized by the balanced use of foods rich in fiber, antioxidants and unsaturated fats, a healthy approach designed to reduce the consumption of animal fats and cholesterol in a diet with an appropriate balance between energy intake and expenditure. The relationships between the macronutrient energy answer to those recognized as adequate, ie 55-60% of carbohydrates of which 80% complex carbohydrates (bread, pasta, rice), 10-15% of proteins about 60% of animal origin (especially white meat, fish), 25-30% fat (mostly olive oil) (22).
Food Pyramid and Guidelines
The guidelines developed by nutritionists to improve the eating habits of consumers can be represented by an effective image, the “Food Pyramid”. The main concepts of the Food Pyramid are the “proportionality”, that is the right amount of foods to choose from for each group, the “portion” standard quantity of food in grams, which is assumed as the unit of measurement to be a balanced feeding, the “variety”, i.e., the importance of changing the choices within a food group, and “moderation” in the consumption of certain foods, such as fat or sweets. As you can see, at the base of the pyramid are grains, followed by fruits and vegetables, legumes, olive oil, low-fat cheese and yogurt, which should be eaten daily. Meat is not excluded, but is given the preference to that of chicken, rabbit and turkey than beef. Along with fish and eggs should be eaten a few times a week, for the supply of high quality protein.
The Legacy of Ancel Keys
In December 2004, just over 20 years ago, Prof. Ancel Keys passed away on the eve of reaching the age of 101 years. Despite the many critics of his scientific work, he has been defined as “a giant in physiology, nutrition, and public health” in a 2021 paper by Prof. JP Montani, University of Fribourg, Switzerland, where an extraordinary summary was described of his various scientific accomplishments [1].
Keys championed the Mediterranean Diet (high in unsaturated fats and full of legumes, whole grains, fruits, vegetables, and nuts) and, following his own dietary and lifestyle advice, spent much of his last three decades in the Italian region of Campania, south of Naples; he lived until just short of his 101st birthday.
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