40 Years of the Mediterranean Diet: What's Next for the World's Healthiest Eating Plan

In 1958, a phys­i­ol­o­gist from the University of Minnesota School of Public Health observed that inci­dents of coro­nary heart dis­ease were more com­mon in mid­dle-aged Americans than their European coun­ter­parts liv­ing in Mediterranean coun­tries.

Ancel Keys pos­tu­lated that a cor­re­la­tion existed between peo­ple’s risk for heart dis­ease and their eat­ing habits and lifestyle.

This obser­va­tion led Keys to launch his sem­i­nal study, with par­tic­i­pants from seven coun­tries around the world – the United States, Italy, Greece, Yugoslavia, the Netherlands, Japan and Finland – to ver­ify the hypoth­e­sis.

Consequent research showed a large dis­crep­ancy in the inci­dence and mor­tal­ity of heart dis­ease among the mon­i­tored pop­u­la­tions.

Participants from Italy and Greece, espe­cially Crete, who had sim­i­lar eat­ing habits, had the low­est heart dis­ease rates among other par­tic­i­pants. The same was true for their Japanese coun­ter­parts, whose diet was also plant-based, but lacked the unsat­u­rated fat that Mediterranean pop­u­la­tions were receiv­ing mainly from olive oil.

Participants from Finland and the United States, on the other hand, had the high­est rates of heart dis­ease due to their high intake of sat­u­rated ani­mal fat, the research con­cluded.

The Seven Countries Study demon­strated that low rates of heart dis­ease can occur both with a low and a high intake of fat, depend­ing on its nature and the dietary habits of the par­tic­i­pants.

This rev­e­la­tion led to the for­mal def­i­n­i­tion of the Mediterranean diet in 1980 after the first results of the study were pub­lished by Harvard University.

On the for­ti­eth anniver­sary of the pub­li­ca­tions of these results, experts from var­i­ous fields spoke with Olive Oil Times about the char­ac­ter­is­tics of the diet and its future.

Markos Klonizakis, a clin­i­cal phys­i­ol­o­gist at Sheffield Hallam University, in England, said one of the ben­e­fits of the Mediterranean diet is that there are many vari­a­tions, mak­ing it adapt­able across cul­tures.

“My team tried to apply a MedDiet closer to the Greek type, con­tain­ing fruits, veg­eta­bles, legumes, fish, olive oil and more,” Klonizakis said. ​“Our research has repeat­edly shown that the MedDiet can act defen­sively, pro­vid­ing short-term and longer-term ben­e­fits, either on its own or in con­junc­tion with mild exer­cise.”

”Recently, we found that a Mediterranean-style eat­ing pat­tern can quickly lessen the impact of Type 2 dia­betes on microves­sels, but more time is needed to ease the impact of aging on peo­ple,” he added.

Klonizakis argued that the eat­ing pref­er­ences of peo­ple can be shaped by many fac­tors and the cur­rent pan­demic may be one of them.

“Unhealthy food is eas­ier to pre­pare. Maybe the coro­n­avirus pan­demic is a chance for us to start eat­ing bet­ter,” he said. ​“Of course, eat­ing pat­terns are also a mat­ter of trend, for exam­ple, the vegan regime has many adher­ents even though its ben­e­fits are not widely estab­lished, but nutri­tional tra­di­tion usu­ally endures through time.”

David Katz, a doc­tor from Yale University and the founder of the True Health Initiative agrees. He told Olive Oil Times that part of the rea­son the Mediterranean diet is able to endure and remain pop­u­lar is due to its cul­tural impor­tance. It is not just a pass­ing fad.

“It has been mak­ing and keep­ing peo­ple healthy for gen­er­a­tions,” he said.

Katz added that sup­ple­ment­ing the MedDiet with extra vir­gin olive oil makes it more plea­sur­able and enhances its health ben­e­fits. Following a healthy diet helps to improve the immune sys­tem.

“You can make extra vir­gin olive oil part of a dietary pat­tern to improve your health acutely and reduce your risk of severe coro­n­avirus infec­tion,” he said.

Mary Yannakoulia, an asso­ciate pro­fes­sor of nutri­tion and eat­ing behav­ior at Harokopio University of Athens, named some of the traits of the Mediterranean diet demon­strated by numer­ous sci­en­tific stud­ies.

“Many stud­ies have shown that higher adher­ence to the MedDiet, leads to lower risk for coro­nary dis­ease, can­cer, demen­tia and Alzheimer’s,” she told Olive Oil Times. ​“In my opin­ion, the MedDiet is a healthy dietary pat­tern that can be used in Greece to pro­mote the cit­i­zens’ health, and even pre­vent var­i­ous dis­eases, given the avail­abil­ity of the sta­ple Mediterranean food and its direct con­nec­tion with the tra­di­tion and the cul­ture of our coun­try.”

In 2013, the MedDiet was named as a UNESCO Intangible Cultural Heritage of Humanity for both its health ben­e­fits and its cul­tural impor­tance to the Mediterranean region.

In spite of all this, Yannakoulia remains skep­ti­cal about the long-term adher­ence of con­sumers in Greece to the MedDiet.

“It is a ques­tion of how much we have moved away from the MedDiet,” she said. ​“No easy answer exists, con­sid­er­ing that eat­ing habits change over time, as do soci­eties.”

“Basic ele­ments of the MedDiet con­tinue to exist in the dietary pat­terns of peo­ple in Greece, such as the every­day use of olive oil and the fre­quent con­sump­tion of fruits, veg­gies, legumes and grains,” she added. ​“On the other hand, many peo­ple in Greece nowa­days have started to con­sume more meat and processed food.”

However, on the other side of the Atlantic, Lizzy Freier believes the Mediterranean diet will con­tinue to gain pop­u­lar­ity with younger con­sumers. Freier works at Technomic, a food­ser­vice research and con­sult­ing com­pany in Chicago, and said that the diet is linked to many cur­rent healthy eat­ing trends.

“These health trends include the growth of veg­etable-for­ward diets and a focus on unprocessed foods — both of which are core attrib­utes of Mediterranean fare,” she told Olive Oil Times. ​“Emphasizing health ben­e­fits of Mediterranean items espe­cially appeal to younger con­sumers who are con­sci­en­tious, are increas­ingly chang­ing their diets to limit ani­mal prod­ucts and are look­ing to include more nat­ural foods.”

Freier cited some mar­ket research sta­tis­tics to back up her obser­va­tion and said that 42 per­cent of con­sumers have tried and liked Mediterranean cui­sine. An addi­tional 37 per­cent have not yet tried a Mediterranean eat­ing plan, but would like to do so.

“As health and diets evolve and con­sump­tion of eth­nic food con­tin­ues to expand, the Mediterranean diet is poised to grow as a pop­u­lar cui­sine that appeals to din­ers with fla­vor­ful, healthy dishes,” Freier said.

Brynn McDowell, an American dieti­cian and blog­ger, agrees that the Mediterranean diet is likely to con­tinue grow­ing in pop­u­lar­ity in the U.S. She said the flex­i­bil­ity of the diet plays a big part in mak­ing it an easy eat­ing plan to fol­low.

“There aren’t any strict rules, instead it’s based on a set of guide­lines such as includ­ing more fruits, veg­eta­bles, whole grains, legumes, beans and nuts,” she told Olive Oil Times. ​“Emphasis is placed on what you should add to your diet for health. While some foods, such as red meat and sug­ary desserts and pas­tries, are rec­om­mended to be enjoyed in mod­er­a­tion, they aren’t for­bid­den. This makes the Mediterranean diet eas­ily cus­tomiz­able to your lifestyle.”

McDowell sees this flex­i­bil­ity as a way to pre­vent con­sumers from get­ting frus­trated by the lim­i­ta­tions of the diet, which is one of the key rea­sons why peo­ple find more strict diets harder to fol­low.

“I feel like peo­ple are start­ing to get frus­trated with the newest fad or restric­tive diet and instead, get­ting back to falling in love with good food and healthy, fresh ingre­di­ents again, which is what the Mediterranean diet is all about,” she said. ​“It’s my opin­ion that the Mediterranean diet is here and pop­u­lar for the long haul.”

The Mediterranean diet has been selected as the best diet of 2020 by the U.S. News and World Report. It was the third con­sec­u­tive year that the eat­ing plan was selected as the top diet.

• Seven Countries Study