Mediterranean diet still healthy when authentic, not Americanized

May 1, 2000
Web posted at: 12:24 PM EDT (1624 GMT)

In this story: When a good diet goes bad Recapturing the Mediterranean ideal RELATED STORIES, SITES

By Sarah Yang

(WebMD) -- Ask Ancel Keys, 96, the secret of his long life, and he's likely to point to tonight's meal: baked cod fillets flavored with lemon juice and a bit of olive oil, steamed broccoli, roasted potatoes and a glass of white wine.

It's quintessentially Mediterranean fare, befitting the man who first promoted the health benefits of the Mediterranean diet. As a young scientist more than 50 years ago, Keys showed that among people in countries where fresh fruits and vegetables are plentiful and olive oil flows freely -- Greece, southern Italy, southern France and parts of North Africa and the Middle East -- heart disease is exceedingly rare. In countries where people fill their plates with beef, cheese and other foods high in saturated fat -- places like the United States -- it's a leading cause of death.

Thanks to Keys' efforts, the Mediterranean diet and way of cooking have become synonymous with good health. But the cuisine that's touted as the healthiest in the world has taken some knocks lately.

Last year in the American Journal of Clinical Nutrition, Italian scientists linked refined bread, pasta and rice to an increased risk of certain cancers, particularly thyroid, colon and stomach cancers. Two separate nutrition studies published in 1998 found similar results. Meanwhile, the Center for Science in the Public Interest (CSPI) issued a scathing report on the food served in Italian restaurants. Menu staples like fettuccine Alfredo, CSPI found, are often laden with as much saturated fat as three pints of butter-almond ice cream. A serving of fried calamari may have the cholesterol equivalent of a four-egg omelet.

Those entrees are a long way from the foods that Keys first promoted. The original Mediterranean diet was that eaten by rural villagers on the Greek island of Crete. "The Mediterranean diet was nearly vegetarian, with fish and very little meat and was rich in green vegetables and fruits," says Keys, who is now a professor emeritus at the University of Minnesota. People living on Crete got more than one-third of their calories from fat, most of it from olive oil, which is rich in monounsaturated fatty acids. They also consumed wine every day.

Unfortunately, something got lost in the translation when these traditional diets were brought to America. "They may call it Italian, but it's very different from the food we studied," says Keys, who for the past 35 years has divided his time between Minneapolis and a small village 40 miles south of Naples, Italy, on the shores of the Mediterranean. "What happens here is we add a great deal of meat, also sugar and a lot of cream sauces."

Registered dietician Jayne Hurley, the senior nutritionist who helped conduct the survey of Italian restaurants for CSPI, agrees. "We're not saying Italian food is unhealthy," says Hurley. "But the food we saw had been Americanized." While the traditional diets used cheese and meat sparingly as a condiment, for instance, our versions are typically loaded with them. Spaghetti, as served in the United States, often includes a generous helping of grated cheese and up to a pound of ground meat, says Nancy Harmon Jenkins, a food writer and author of "The Mediterranean Diet Cookbook."

"Traditional food can easily become corrupted from simple ignorance of the cook," says Paula Wolfert, a San Francisco-based author of several Mediterranean-style cookbooks. At one restaurant she visited, Moroccan kebabs were made with pork. "The population of Morocco is predominantly Muslim, and they don't eat pork products," she says. Kebabs are traditionally made from lamb, chicken or fish.

What's more, many breads and pastas are no longer prepared the traditional way. Refined flours were never part of the original Mediterranean diet, says K. Dun Gifford, president of the Oldways Preservation and Exchange Trust, a food education and policy group based in Massachusetts. The diet that Keys studied was one eaten by poor farmers and laborers, who ate whole grain breads and pastas. "White flour was more expensive than whole grain flour," says Gifford, who has earned a reputation as a crusader for back-to-the-basics cooking. "We call it peasant bread, or rough country bread."

With a few careful choices, you can still treat yourself to one of the world's healthiest -- and most delicious -- cuisines. For starters, fill your plate with fresh fruits and vegetables. The people of Crete were called "mangifolia," which means "leaf-eaters," because they consumed so many leafy green vegetables, foraged from the steep hillsides of the island. Fruits and vegetables are low in calories and fat and very rich in nutrients, including cancer-fighting antioxidants.

If you're dining out, look for entrees with plenty of vegetables and very little cream or cheese -- a vegetarian pasta tossed in olive oil and a little parmesan cheese, for instance, or grilled fish served with steamed vegetables.

When buying bread, choose loaves made with whole grains and flours. Refined foods cause blood sugar levels to spike because they are so easily digested, says David Jacobs Jr., professor of epidemiology at the University of Minnesota in Minneapolis. Less processed, whole grain ones provide a more sustained level of energy over a longer period, making them more healthful, says Keys.

For dessert, choose something that provides one serving of fruit. Tonight, at his home in Minneapolis, Keys ends his meal with a dessert that perfectly reflects the Mediterranean ideal: baked apple slices, sprinkled lightly with cinnamon and sugar.

© 2000 Healtheon/WebMD. All rights reserved.

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Center for Science in the Public Interest
American Heart Association -- Mediterranean diet
Oldways Preservation and Exchange Trust: Mediterranean food pyramid

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