The Mediterranean Diet
What exactly is the Mediterranean Diet? Is it the same as the French Paradox? The French people eat butter and cheese, yet, don’t gain weight. That is not the Mediterranean Diet. That is the French Paradox, which is something different.
The Mediterranean Diet actually came out of a study done in the 1960’s called the Seven Countries Study. The health of people in seven countries of Europe was studied. Researchers were surprised by the robust health of the people of the Mediterranean Basin, specifically Crete. So, the Mediterranean Diet is really the diet of the people of the island of Crete, where the diet was studied most intensely. We can include the food of Greece, Italy, southern France and Spain. The fundamentals are the same for these lands that border the Mediterranean Sea.
Today, when a physician tells someone to eat a Mediterranean Diet, the advice is to replace beef with fish and chicken. Eat some nuts every day, use olive oil, and eat more whole grains and vegetables. That is the same advice given to patients who are involved in research studies on the Mediterranean Diet. Although the advice is correct (fish, chicken, nuts, olive oil, vegetables and grains), it is the crib-note version. There is so much more to this diet. If we go through the origins, you will be able to interpret the Mediterranean Diet for yourself.
Most important are the vegetables, and we aren’t talking about boiled string beans or steamed broccoli. A leafy green vegetable everyday is paramount and, not just any leafy green vegetable. The greens are bitter, and preferably wild. If you ask people in Crete for the secret to their health, they will tell you it is in the wild greens. People eat a variety of wild greens, like dandelion. There is a whole list of wild greens, which can be found at your local farmer’s market in the springtime, or even in your backyard. Purslane, escarole, chicory, chard, borage, collard greens, beet greens, and even spinach all fit the bill. Wild greens are high in Omega-3 fatty acids. Surprised? Omega-3’s don’t originate in fish. These healthy oils come from the algae eaten by the little fish, which are then eaten by the bigger fish, which then end up in your tuna salad.
The Omega-3 content of the traditional Mediterranean Diet was much higher than our American diet today. Obviously, the people of the Mediterranean Basin are also obtaining Omega-3’s from seafood, but their ratio of Omega-6 to Omega-3 oils was 2:1. Two parts Omega-6 for every one-part Omega-3. Our American diet today is closer to a ratio of 16:1. Yes, sixteen parts Omega-6 to one part Omega-3. So your Omega-3 intake is the first thing to tackle for your diet more like a traditional Mediterranean Diet. Ramp up your intake of Omega-3’s, not just with seafood, but also with a bowl of sautéed bitter greens every day. The Italians sauté their greens in olive oil and garlic. Vegetables are always somehow served with olive oil (sautéed in olive oil or as a dressing on a salad) since the oil helps the body absorb fat-soluble vitamins. The Greeks squeeze some lemon juice over their sautéed greens. Maybe there is something about adding some acid to the greens to release the anti-oxidants.
Nuts are part of the Mediterranean Diet, especially almonds and walnuts. When we were growing up, “dessert” was a bowl of fruit and a basket of unshelled nuts. Since the nuts were still in the shell, it took time to crack them open. There was no way one could mindlessly eat a thousand calories of nuts, unless you wanted to sit at the table with a nutcracker until midnight.
The recommendation to replace red meat with chicken and fish is true, but more complicated than that. First of all, cows don’t do well in hot, rocky, mountainous terrain. You’ll find lamb, goat, pork, chicken, and rabbit on the menu, but meat is not eaten everyday. The main meal of the day was just as likely to be beans or legumes as it was to be fish, or meat. Beans or legumes combined with a grain supply a complete protein. Lentil and barley soup was a typical Italian meal, as was pasta with beans. This is called “Cucina Povera” in Italy, which translates to “Cuisine of the Poor”. It may be food of the poor, but delicious and healthy nevertheless.
Olive oil is the next item on the menu of the Mediterranean Diet. Yes, the cooking of the Mediterranean uses olive oil, and lots of it too. If you watch some of the cooking shows where the chef is from Spain or Greece or Italy, the olive oil is almost a green color. Those olive oils have a much stronger olive flavor. The olive oils in the typical American supermarket are bland in comparison. If you are trying to eat a Mediterranean-type diet, see if you can find one of these intense olive oils at a specialty store. Something else you can do is to eat the olives themselves. These you will definitely need to find at a specialty store. The jarred olives packed in water at the local supermarket just don’t fit the bill. Oil-cured olives come in a variety of sizes and shapes and flavors. Bitter or sweet, big or small, green, black or red, olives are eaten as a snack all over the Mediterranean. A simple dinner might have been nothing more than olives, cheese, bread and fruit.
Cheese is loved all over Europe. This is one place where the advice from physicians today diverges from the traditional Mediterranean Diet. People today are told to limit their cheese, but cheese is eaten freely in Greece, Italy, Spain, and France. True, cheese is high in calories. If you are restricting calories, you might need to limit your cheese intake. If you are not restricting calories, i.e., are not trying to lose weight, but are simply trying to reconstruct a Mediterranean Diet for your health, go ahead and enjoy cheese. Those flat orange pieces of processed cheese-product packaged in plastic should not be considered cheese. They are not a part of the Mediterranean Diet. Processed foods, in any way, shape or form is not part of this food plan.
You may be wondering: nuts, olive oil, olives, and cheese? Isn’t that too much fat? The American Heart Association recommends a diet in which 30% of calories come from fat. The Mediterranean Diet probably is 40% fat. Don’t worry about it. It all comes out in the wash. You save calories by not eating any sweets. Sweets are simply not a part of the traditional Mediterranean Diet. Fruits are eaten as dessert. Cake and candy were rare and expensive luxuries in Crete of 1960′s.
There are certainly so many points I am sure I missed in this brief summary. Tomatoes are loved and used for more than just pasta sauce. The sheer volume of vegetables eaten (not just bitter greens) was greater than what we eat in America today. As far as the meat, no part of the animal was wasted. Liver, heart, kidneys were all eaten. Our Italian grandmother was particularly fond of brains. As far as fruit is concerned, the southern Europeans eat more grapes than we do. Then of course, there is the red wine served every day at dinner, and probably lunch too.
Lastly, the people of the Mediterranean were far more physically active than we are here in America today and simply did not eat as much as we do today.
After graduating from NYU School of Medicine in 1987, and completing my Internal Medicine residency at Lenox Hill Hospital in 1990, I went to work at the AIDS clinic at Bellevue.
