The Mediterranean Fountain of Youth

Researchers first stumbled on the health benefits of foods native to the
sun-splashed Mediterranean region more than a half-century ago. Scores of studies
have since supported the diet’s protective strengths against heart disease, cancer,
arthritis, respiratory illness, Alzheimer’s and other afflictions. It turns out that Spanish
explorers who centuries ago searched Florida for the fabled Fountain of Youth might
have had more success mining their own backyards.

by Allan Richter

May 2008

Jeanne Calment died in 1997, but she lived long enough to have known Vincent Van Gogh. She was born in Arles, the artist’s stomping ground in the south of France, in 1875, one year before Alexander Graham Bell invented the telephone. She lived a comfortable life of leisure—bicycling, swimming, playing tennis—having married a wealthy storeowner. Though she was blind, almost deaf and wheelchair-bound in her last years, she remained mentally sharp until the end.

Calment lived 122 years, 5 months and 14 days, and holds the record as the world’s oldest person whose age is officially verifiable. Living testimony to the benefits of the Mediterranean diet and lifestyle, Calment attributed her longevity in interviews in her twilight to a diet rich in olive oil, regular glasses of port wine and an easy smile.

Though few who indulge in Calment’s diet and lifestyle may ever live to her extraordinary age, the Mediterranean approach to diet—abundant with both healthy foods and habits—can give them a head start. It marks a sharp contrast to that of the West, where stressed-out commuters and other working people on the run grab a quick meal of sugar-rich coffee, nitrate-filled hot dogs and fatty french fries. Meals in the Mediterranean, on the other hand, are centerpieces of the daily routine. As such, they are carefully thought out, built around fresh ingredients, rich in flavor and meant to be enjoyed at a slower pace that is geared toward healthier digestion.

Behind Sardinian Longevity

They say the only two sure things in life are death and taxes, but there are places around the world where people seem to cheat the first by living longer than other folks. One of these “blue zones,” as explorer and author Dan Buettner calls them, is Sardinia, an island off Italy’s west coast known for its unique, throaty style of singing—and for its concentration of centenarians.

The mountainous terrain explains at least part of the island’s anti-aging secret. “I could see why residents here might be physically fit,” writes Buettner in The Blue Zone (National Geographic). “A trip to the local market meant a workout more rigorous than a half hour on a StairMaster.” The locals are shepherds by trade, burning up to 490 calories an hour as they roam the hillsides.

The meals are rough but hearty, based on whole-grained breads “with an onion [or] a little fennel” at lunch and minestrone, or vegetable soup, in the evenings. Wine and fish, two Mediterranean staples, don’t figure prominently in the diet, but then neither does meat; goat’s milk and olive oil are two dietary mainstays.

In her book From Tapas to Meze: Small Plates from the Mediterranean (Ten Speed Press), chef Joanne Weir writes of the many unhurried hours she spent at outdoor taverns and cafes in Greece and Italy. Served a succession of plates bearing fish, cheese, pastas and vegetables while socializing and soaking up the sun and ocean breeze, she realized that her mission involved more than a gathering of recipes. “All of these evenings had more to do with feeding our hearts and souls than our stomachs,” Weir says.

“I was on the island of Crete, at this restaurant, and we sat down at the table,” Weir recalls. “The person came out to us and said, ‘Of course you’re going to have fish. Come inside and choose which fish you want.’ I thought that I’d go in and the fish would be in a case in ice, but they were in a bucket of water, and the fishermen were still delivering their fish. And a lot of places like that there have no menus. People talk it over based on what’s available and fresh.”

In the Mediterranean, meat, fish and dairy products are used as condiments. They find their way into the small dishes that comprise a meal’s first course, whether tapas in Spain, hors d’ouvres in France, antipasti in Italy or primi piatti and cichetti in Greece, Turkey and the Middle East.

Just about every aspect of the preparation of those first courses is healthy, observes Weir. Hosts prepare the food well ahead of serving time so they can partake with their guests rather than be stuck in the kitchen, Weir notes. Further, these dishes are served neither too hot nor cold so the palate can completely savor the dishes’ flavor and so diners can relax without rushing through a dish when its full appreciation requires that the dish be at a certain temperature.

The Mediterranean’s sun-baked fields and groves produce a rich, year-round bounty of fruits and vegetables that fill plates with a plethora of fresh, vitamin-filled seasonal foods, observes Weir. She points to the summer’s yield of eggplants, peppers, tomatoes, onions, garlic and squash. The fall turns out artichokes, squash and fennel. Winter brings lemons and oranges. And radishes, lettuces and asparagus are harvested in the spring.

Post-WWII Discovery

Foods of the Mediterranean are simple, accessible to anyone and not just the domain of the wealthy. In fact, the first study examining the health status of the people of Crete was conducted post-World War II, at the end of the 1940s, when people in the region were most deprived and poverty-scarred by war. Yet the study, by the Rockefeller Foundation, found that the cardiovascular health of the people of Crete exceeded that of US residents. Diet was cited as the reason for the gap.

A few years later, a group of nutrition scientists and doctors, including Paul Dudley White, President Eisenhower’s heart physician, were on vacation in Pioppi, an Italian village south of Naples. Among these scientists were Ancel Keys, PhD, a Minnesota physiologist who was famous for developing military K rations. Like the researchers in Crete a few years earlier, Keyes noticed the stamina and robust health of the area’s residents.

“The people were older and vigorous. They were walking up and down the hillside collecting wild grains, and were out fishing before sunup and going out again in late afternoon and rowing boats,” says Dun Gifford, president of the Oldways Preservation Trust (www.oldwayspt.org). The Boston food-issues think tank promotes the Mediterranean Diet food pyramid, which it helped develop with the Harvard School of Public Health 15 years ago. “They were clear that exercise had something to do with it,” Gifford says of the researchers in Pioppi, “but they knew it was more than that.”

Exotically Tasty Health

There’s so much to savor in Mediterranean cooking: The decadent richness of olive oil, the pungent aroma of garlic, the tang of lemon contrasting with the earthiness of dill.

The dominant flavors of these related cuisines also signal the health advantages for which the Mediterranean diet is so deservedly famous. The following items do their part to benefit the body even as they gratify the tongue:

Olive oil—In addition to healthy fats, this very essence of the Mediterranean contains vitamin K, vital for bone formation, and all-around antioxidant vitamin E.

Garlic—The “stinking rose” helps slow down lipid peroxidation, the kind of blood-fat rancidity tied to artery-clogging plaque, and has been linked to reductions in digestive-system tumors.

Tomatoes—These luscious fruits (technically, at least) are loaded with lycopene, a phytonutrient with heart-protective and anti-cancer properties.

Fish—Sardines, a rich addition to pasta sauce, contain omega-3 fats.

Whole Grains—Whole-grain breads and pastas provide plenty of fiber, a boon to both digestion and blood circulation.

Spices—Each Mediterranean country from Spain right around to Greece and beyond has its own signature spices. These include cumin, which in studies has had a steadying effect on blood sugar; paprika, packed with vitamin C; cinnamon, which may lower both glucose and cholesterol levels; anise, long used as a stomach soother; Spanish saffron, a possible (and novel) mood booster; lemon, source of a phytonutrient called limonene that helps fight cancer; mint, another traditional digestive aid that has also been used to ease respiratory distress; and parsley, a rich source of iron and other minerals.

From these observations began Keys’ landmark Seven Countries study of 1,200 healthy, middle-aged men in Italy, the Greek islands and countries outside the region. The study began in 1958 and lasted decades. As a result, Keys identified saturated fat as a leading cause of heart disease and was the first scientist to laud the Mediterranean diet as a potential shield against it. And this despite more than 35% of the diet’s calories coming from fat.

Keys and his wife, a biochemist, lived on nourishing Mediterranean meals in a Naples home they built  on royalties from their books Eat Well and Stay Well and How to Eat Well and Stay Well the Mediterranean Way, according to Keys’ New York Times obituary. Keys died in 2004—10 months after reaching his 100th birthday.

The Mediterranean Diet Pyramid, in addition to calling for daily physical activity, has a foundation of daily helpings of bread, pasta, rice, couscous, polenta and other whole grains, as well as potatoes.

Above that on the pyramid, also to be consumed daily, are fruits; beans, legumes and nuts; and vegetables. The next two levels up, as part of the daily routine, are olive oil on one, then cheese and yogurt above that. Fish, poultry, eggs and sweets should be consumed weekly. Finally, at the top of the pyramid, is meat, recommended only monthly. The diet also calls for six glasses of water daily and wine in moderation.

The pyramid is clearly an adaptation of the Mediterranean diet for the West. Its call for only monthly servings of meat, for example, flies in the face of the more frequent, albeit small-scale, meat portions consumed in the Mediterranean: small slices of prosciutto or salami on pizza, for instance, or bits of meat to give flavor and texture to sauces.

To mark the pyramid’s 15th anniversary, Oldways is hosting a November conference at which scientists will take a closer look at research supporting the Mediterranean diet’s health benefits. For example, new work is building on studies that two years ago identified an anti-inflammatory compound in extra virgin olive oil. As a result, “we might be able to design new anti-inflammatory compounds that would be more potent,” says Gary Beauchamp, PhD, director at the Monell Chemical Senses Center, a Philadelphia research center. “Inflammation is central to all of our diseases,” he adds, “and to understand the pathways is fundamentally important to develop” new treatments.

They will also revisit and update the food pyramid. On the carbohydrates front, Oldways’ Gifford says the group is likely to put less emphasis on bread and more on pasta dishes. “We noticed on visits to the Mediterranean over the last decade that there’s less bread on the tables than when we went there in the 80s,” Gifford says.

Pasta, Gifford adds, is simply healthier than bread. “By the nature of its manufacture, pasta is a slow-release carbohydrate in your stomach; its not like white bread or potatoes or even fruit, which give you a rush of fine carbohydrate particles and which your body turns right into glucose,” Gifford says. “So there’s always a concern that the white-bread generations coincide with the diabetes generations.”

Of course, a plate of pasta with a slab of melted butter won’t cut it. The Mediterranean way is to eat the pasta with all the other rich nutrients ubiquitous in the region. “The pasta meal is fascinating because you have this carbohydrate, the pasta itself, and you always put on it some tomato sauce and some cheese or vegetable and fish, and usually herbs and spices,” says Gifford. “That looks like a very ideal dish from the point of view of healthfulness. They might add a glass of wine, and all of that slows the digestion so you don’t get these rushes of glucose.”

The idea that combinations of ingredients and factors might benefit health helps explain the paradox that the health gains of some widely consumed foods in the Mediterranean are looked at in the West with some skepticism. Pasta, frowned on because of its carbs, and cheeses, for their fat, are two strong examples.

“Think of their salads,” observes Gifford. “They’re much more likely to have a sprinkle of nuts, like walnuts, or they eat a lot of chestnuts in parts of Italy where there’s higher ground. But they also eat these hard cheeses that they crumble in their salad. Why is cheese in a healthy diet? We’ve been persuaded in this country that you can’t have cheese because it is fattening: ‘Only have pasteurized cheese and slices that come in little polyethylene sleeves.’”

Similarly, also still puzzling scientists is the French paradox. The French appetite for foie gras, eggs, cream and cigarettes belies their lower heart disease rates and obesity levels than many in the West. Since life expectancy is higher in the south of France, signs point to the Mediterranean diet, with its red wine and vegetables, as the explanation.

Weir offers another explanation, if not for the French paradox, then for the healthy dynamics of theMediterranean diet even as it includes foods such as moussaka, a sort of Greek shepherd’s pie or lasagna, that is heavily adorned with cheese and butter-heavy bechamel sauce.

“Everything is in moderation,” Weir explains. “You don’t have to eat the whole moussaka. When I sit with people in the Mediterranean, they’ll have one piece; they’re not going to have seconds and thirds. And they haven’t had ice cream in the afternoon or an iced coffee drink with 1,000 calories; they might have an espresso after lunch.”

Benefits Are Broad

Weir’s first-hand observation that the Mediterranean diet feeds “hearts and souls” is apt. Although each country in the region has its own distinct cuisine, what Weir calls the Medi­terranean trinity of olive oil, garlic and tomatoes are ubiquitous in the region. “There is hardly a dish,” Weir observes, “that doesn’t include at least one of these ingredients.” They are decidedly heart-healthy ingredients on their own—tomatoes are one of the few foods whose key healthy ingredient, lycopene, is actually enhanced rather than lost as it is cooked—and in combination.

Though cardiac health was the first strong point noticed by researchers who discovered the benefits of the Mediterranean diet more than half a century ago, scores of studies have since reported on the diet’s protective strengths against cancer, arthritis, respiratory illness, Alzheimer’s and other afflictions.

Many Western countries lack the temperate climates and long shorelines that provide a rich harvest of fruit of the land and sea. But food experts say the diet can be replicated without too much hardship. Oldways bemoaned the lack of fresh olives, their oils, balsamic vinegar and sun-dried tomatoes on American retail shelves when it helped develop the Mediterranean Pyramid 15 years ago. That has all changed, and a trip to the market makes it much easier now to toast “Yasou!—To your health!”

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