WebMD Medical News
April 9, 2001

Now, New Reasons to Go Greek
Researchers are finding more evidence that supports the traditional Mediterranean diet.
Think fish, olive oil, fruits, and vegetables.
By Peter Jaret Reviewed by Dr. Dominique S. Walton

Glittering beaches, hillsides stitched with gnarled grape vines, lemon trees glistening in the sun...There are plenty of reasons to envy life in the Mediterranean. And if the warm climate and congenial lifestyle aren't enough, here's another: The traditional Mediterranean diet continues to be the healthiest, as well as one of the most delicious, in the world.

For years, of course, nutritionists have been lauding the Mediterranean diet as a way to lower heart disease risk. Now the latest evidence suggests that it may protect people who already have had a heart attack. In the GISSI-Prevenzione Study, presented at the conference of the American Heart Association in December 2000, Italian scientists followed 11,324 Italians who had suffered heart attacks, keeping track of the amounts of Mediterranean-style foods they ate (vegetables, fruit, fish, and olive oil) as well as their intake of butter, a decidedly non-Mediterranean food. Those who slathered on butter were three times more likely to die within the 42-month study period as those who filled their plates with the four traditional Mediterranean foods.

Why? Researchers are still tallying up the virtues that make the Mediterranean diet so beneficial. Dozens of studies have shown that replacing the saturated fat in butter with the monounsaturated form found in olive oil (as well as canola and peanut oil) improves the ratio of good cholesterol (high density lipoprotein, or HDL) to bad cholesterol (low density lipoprotein, or LDL). That, in turn, can help keep blood vessels unclogged with the waxy substance.

A cornucopia of health benefits
Other new findings suggest that the Mediterranean diet also may protect against heart disease by preventing LDL cholesterol in the blood stream from becoming oxidized--a process that damages the lining of blood vessels. In a study published in the Sept. 30, 2000, issue of Medicina Clinica, Spanish researchers put 41 healthy male volunteers on three consecutive four-week diets. The first month their menu was high in saturated fat. The second month they ate a diet low in both saturated and total fat. The third month their diet followed the Mediterranean model -- high in monounsaturated fat. Analyzing blood samples, the scientists found that the Mediterranean diet significantly reduced the oxidation of LDL particles.

Over time, that reduction could go a long way toward protecting blood vessels from the kind of damage that leads to heart disease. There's more to commend the Mediterranean diet. Two essential ingredients -- olive oil and onions -- have been shown to lower blood pressure, which would further decrease heart disease danger.

In a study published in February 2001 in the German journal Arzneitmittelforschung, researchers compared the effect of capsules containing macerated onion and olive oil with placebo pills. In the 24 volunteers, all of whom suffered from high blood pressure, the blood pressure significantly declined after a week on the onion-olive oil pills.

Eating like a Cretan
For researchers studying the Mediterranean diet--and for those of us who would like to follow its healthy principles--there's only one problem amid all this good news: There is no single Mediterranean menu. The cuisines in this region of the world include everything from North African couscous and Greek spanikopita to pasta con tono served up in an Italian osteria. The menu isn't the only thing that varies. Heart disease risk is also very different in different parts of the Mediterranean. In the famous Seven Countries study, the risk of dying of heart disease was more than twice as high among Italians as it was among the people of Crete. The inhabitants of that tiny Greek island, in fact, had the lowest risk of heart disease--and lowest death rates--found almost anywhere in the world. If you want to choose the healthiest diet, in other words, eat like a Cretan.

Fortunately, a new study by Greek scientists, published in the December 2000 Journal of the American Dietetic Association, makes that easier. The researchers have reconstructed a seven-day meal plan showing what the typical Cretan would have consumed in the 1960s, when the Seven Countries study was done. They've also compared it to what the typical teenagers of Crete are eating today. The differences are telling. For a midmorning snack, the traditional inhabitants helped themselves to pears or melons. Today's youngsters are guzzling chocolate milk, cookies, and carbonated drinks. For dinner, the residents of old Crete ate rice with spinach, yogurt, whole-wheat bread, stuffed tomatoes, lentils, and salad. Members of the new generation, adopting Western habits, are helping themselves to pizza, cola, hamburgers, and French fries.

It's no surprise that obesity is becoming a growing problem in Greece, researchers say--or that many epidemiologists expect to see an increase in heart disease risk. That's discouraging, of course. But there's also good news. The basic principles of the traditional Mediterranean diet turn out to be simple and adaptable to almost any cuisine.
Here are six simple ways to follow the heart-healthy example of those lucky inhabitants of sun-drenched Crete:

• Eat at least one piece of fruit for breakfast or your midmorning snack.
• Choose lunches and dinners that are loaded with vegetables, especially beans, lentils, and leafy greens like spinach, arugula, and kale.
• Snack on fresh fruit, dried fruit, or nuts.
• Go very easy on meat (it shows up only as a very special treat on the traditional Cretan menu). Help yourself to fish.
• Replace butter with olive oil or canola oil.

Not sure how to put it all together? There are dozens of terrific Mediterranean cookbooks that can help you turn those principles into some of the most delicious dishes the world has to offer. Not many of us are lucky enough to live like Mediterraneans. But at least we can learn to eat like them.

Peter Jaret is a freelance writer in Petaluma, Calif., who has written for Health, Hippocrates, and many other national publications.