The Mediterranean Diet: Its Past, Present, and Future
Imagine living along the coast of the Mediterranean Sea, surrounded by beauty and gifted with the abundance of food from the water and land. Before you lies a feast: olives, freshly caught fish, sheep’s feta, grapes, pomegranates, artichokes, rosemary, figs, date palms, honey, and freshly cold-pressed olive oil alongside a carafe of red wine. The heritage and romance in just the food alone is enough to inspire a change in diet and maybe even an outdoor meal in a beautiful setting with your partner. Now imagine living a long life with few health problems and without complications like cardiovascular disease, all due to this diet and the lifestyle that goes with it.
The contemporary Mediterranean diet originates from the food and cultures of ancient civilizations and reflects thousands of years of interactions between natural food resources and the customs of the native inhabitants.
While each country and region have their own specific foods and cooking practices, the dietary dimensions of the Mediterranean lifestyle revolves around a plant-based cuisine with moderate consumption of fish, seafood, and dairy. In this article, we’ll travel into the past and take a close look at the foods the ancient Mediterraneans ate and compare them to the Mediterranean diet of the present. This exploration may reveal to us the historical medical significance of how these foods continue to influence health in those who adopt this holistic and delicious way of eating.
A History of Abundance and Health
Mediterranean cuisine is bathed in the aromas, flavors, and colors that reflect the rich traditions of a people who have lived in harmony with nature since ancient times. The diet has its origins in what some historians call the “cradle of society”, the Mediterranean Basin. This region lies within the geographical borders where most of the history of the ancient world took place. Here have lived the sites of the ancient and advanced civilizations of the Sumerians, Babylonians, Persians, Cretans, Greeks, and the Roman Empire.
Of course, the passage of thousands of years’ time has changed the borders, and the regions are no longer governed by conquerors and emperors. They have been reshaped and renamed into nations that each have their own unique cultural characteristics. But lines on a map don’t change the foods that are grown locally or the timeless traditions of how they’re prepared and consumed that have been passed down from Mediterranean ancestors. And all the food and connected dietary patterns have a deep association with protecting against life-threatening disease and lifelong health.
Flora and Fauna of the Ancient Mediterranean
If you could travel back in time to the ancient Mediterranean, you’d see the pyramids of Giza, the Roman Colosseum, and the Greek Parthenon in a less ruinous state. But can you imagine the landscape instead of the landmarks? With its ever-changing topography, the Mediterranean region is defined by diversity, with high mountains, coastal wetlands, sandy beaches, and thousands of islands scattered across a brilliant blue sea. The climate is arid: dry and hot in the summer, cool and rainy in the winter. The sea and climate contribute to the region’s capacity for agricultural growth and development, especially in the region known as the Fertile Crescent—the birthplace of agriculture and trade.
In this distant past, the Mediterranean Sea was a crucial highway for seafaring merchants and people of broad origins to move throughout the lands. The region includes areas on three continents: Africa, Asia, and Europe. It was originally covered by thick forests filled with oaks and evergreens, but as humans settled the forests slowly disappeared and shrubs and agricultural fields took their place—with cereals and oil-producing crops becoming dominant.
The region is diverse, with a complex history of trade and conquest. Many of the plants and animals found throughout the Mediterranean originated elsewhere. Human contact between the East and West occurred between the fifth and fourth millennium BC, and with it came camels, horses, and chickens along with apples, pomegranates, pistachios, walnuts, rice, pepper, black mulberry, and roses.
Then there are the stone fruits: peaches and apricots. These were both fruits of the Silk Road—the ancient trade route that linked China with the West. Saffron-colored and dark-violet carrots were brought from the Himalayan region and were predecessors to the more common orange variety found today.
Crete, Mind-Body Holism, and the Heart of the Mediterranean Diet
The early Mediterranean diet was simple and based on plants that grew natively along the shores of the sea. Prior to the Greco-Roman civilization, vine arboriculture, olive trees, and cereal growing were the core elements that distinguished the Mediterranean basin from other agriculturally productive areas of the world. This food model is known as the bread-olive oil-wine triad and it was combined with a cultural model that was based in mind-body holism–the pursuit of pleasure via a balance of mental and physical health.
In classical times, the Greeks witnessed the connection of good health with social and physical environments and how both related with human behavior. This wisdom is reflected in the culture and lifestyle of Crete, a Greek island in the eastern Mediterranean Sea.
Crete is a veritable window to the past, as its cuisine has remained essentially unchanged for centuries. This small island reflects the culinary influence of the entire Mediterranean region, including mainland Greece, Turkey, and Italy. And while Crete’s cuisine was originally based on the cereal-olive oil-wine triad, the introduction of foods from throughout the world was accepted in such a way that the original balance was maintained, and health and longevity were promoted.
Health, Longevity, and the Contemporary Mediterranean Diet
The contemporary Mediterranean diet reflects foods originating from the 22 countries that surround the Mediterranean Sea. Before the advent of global trade, people would eat only the foods readily available to them in their region and made available by their seasonal growing. And today, this diet is known as one of the healthiest in the world.
Seven Countries Study and Beyond
The Mediterranean dietary lifestyle consists of a primarily plant-based cuisine consisting of fruits, vegetables, cereals, legumes, and nuts—most of which are cooked using generous amounts of olive oil. Meat, especially red meat, and alcohol (mostly red wine) are consumed, but only in moderation.
In 1958, a Minnesota physiologist named Ancel Keys initiated a breakthrough body of medical research that became known as the “Seven Countries Study”. He first noticed the low incidence of cardiovascular disease associated with the Mediterranean Diet and the social habits and physical environments that go along with it. He brought together researchers from around the world to collectively study the predominance of heart and vascular diseases among those with traditional eating patterns based on local foods. (this was the first study to relate diet with cardiovascular disease).
The Seven Countries Study was one of the outcomes of a previous study Keys had performed in Minnesota a decade earlier. His earlier research focused on understanding why seemingly healthy middle-aged American men were dropping dead of heart attacks for no apparent medical reason. In 1947, Keys developed a prospective study to identify the key difference between those who suffered a cardiovascular event and those who remained healthy. If he could identify the different risk factors that led to the heart attacks, perhaps he could find a means to prevent the premature deaths.
In 1951, Ancel took an academic sabbatical leave at Oxford University where he met an Italian colleague who told him that Southern Italian workers rarely had heart attacks. After extensive background research, Keys confirmed that in this region men had a lower incidence of heart disease and low levels of blood cholesterol. This discovery inspired him to begin a long chain of studies that eventually encompassed seven countries (where the study’s name comes from): Finland, the United States, Japan, Yugoslavia, The Netherlands, Italy, and Greece. The study was limited to men aged 40-59 with many of the subjects haling from well-selected rural communities.
Keys’ initial observation, guided by his Italian colleague, was centered in Italy where he connected the low incidence of heart disease with the typical setting of the Mediterranean lifestyle. Greece also lent itself to observing a population that consumed a high-fat diet, but one with a low intake of saturated fats. In both countries, the primary source of fat was olive oil, which is rich in monounsaturated fatty acids. By contrast, people from Finland and The Netherlands were very fit but had a high incidence of heart disease and a high intake of saturated fat. The United States was chosen because it had a high incidence of heart disease. And Japan was chosen because their diet minimizes the intake of fat in general.
Spotlight on Crete: Healthiest Hearts in the World
The results of the Seven Countries study showed significant differences between each geographical area. Notably, Japan and the Greek islands Corfu and Crete had the lowest rates of heart attack events, while the highest rates were located in Finland and the United States. Of the two islands, Crete was and continues to be where the lowest rates of heart disease and the highest rates of longevity exist in the world today. Let’s go a little deeper.
In Keys’ study, the people from Crete had the lowest rates of cardiovascular disease of all the populations observed in the Seven Countries Study. Despite the Cretans having one of the highest fat-content diets of the nations studied (37% of their calories came from fats), their cardiovascular health excelled against all the other countries (even better than the Japanese who had the lowest caloric percentage from fats: 9% from fish).
The sources of fat in the Cretan diet came primarily from olive oil, followed by large amounts of fish (more than the Japanese). The Crete population also ate wild plants (such as the succulent purslane), walnuts, green vegetables, legumes, and figs. Aside from fish, they also ate free-range meats and chickens—animals that ate purslane, grasses, insects, worms, and figs, but notably were not grain fed.
Keys concluded that the dietary habits inherent in traditional Mediterranean populations like Crete were directly associated with a reduced risk of developing cardiovascular disease. At this time, Keys named this dietary lifestyle the “Mediterranean diet”, wrote two books about it, and adopted the diet for himself. On November 20, 2004, Ancel Keys died, two months shy of his 101st birthday.
This study was followed by several others that further confirmed the health benefits of the Mediterranean diet. One notable study, the Lyon Diet Heart Study, revealed that not only did adopting this diet reduce new acute coronary episodes in people who had already suffered a heart attack, but also reduced the number of new cancer cases and all-cause mortality. Other more current studies have shown that adopting a Mediterranean diet can reduce your risk for developing endocrine diseases, improves depressive symptoms, and even improves sleep quality (among a number of other positive aspects).
The Mediterranean Diet Looking Forward
The Mediterranean diet as a nutritional model is now universally appreciated as a cultural, historical, and environmental lifestyle that is scientifically validated to improve health and quality of life. In the contemporary sense, this diet is based in the regular consumption of the following:
· Olive oil (as the main source of added fat)
· Plant foods (i.e., fruits, vegetables, legumes, tree nuts, seeds, and cereals)
· Fish, seafood, and dairy (with limited use of red meat)
This dietary pattern consists of plant-derived foods as the main source of energy, vitamins, and fibers; nuts and legumes as the primary source of healthy proteins and fats along with the moderate intake of dairy, eggs, poultry, fish, and meat. Extra virgin olive is the supreme choice for dressing in this diet and wine is enjoyed, but in moderation.
Decades ago, the Mediterranean diet beckoned medical professionals to explore its promise of extended health benefits. From the first reports guided by health pioneers like Ancel Keys, this diet seemed to protect people from cardiovascular disease, while also reducing the risk for developing metabolic syndromes associated with obesity, type 2 diabetes, and neurodegenerative diseases. In the decades since, research continues to confirm the Mediterranean diet can positively affect physical, mental, and brain health.
Wrapping It Up
If you need to improve your health or are tired of feeling fatigued and bored with the conventional Western fast food diet lifestyle, consider changing your daily food choices and journey into the past with Mediterranean food choices. You may find that exploring these simple, yet delicious foods can transform your health and lift your spirit.
Resources
Altomare, R., Cacciabaudo, F., Damiano, G., Palumbo, V. D., Gioviale, M. C., Bellavia, M., … & Monte, A. I. L. (2013). The Mediterranean diet: a history of health. Iranian Journal of Public Health, 42(5), 449. Retrieved from PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684452/
Capurso, A. (2024). The Mediterranean diet: a historical perspective. Aging Clinical and Experimental Research, 36(1), 78. Retrieved from PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10960751/
de Lorgeril, M., Salen, P., Martin, J. L., Monjaud, I., Boucher, P., & Mamelle, N. (1998). Mediterranean dietary pattern in a randomized trial: prolonged survival and possible reduced cancer rate. Archives of Internal Medicine, 158(11), 1181-1187. Retrieved from JAMA Network: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/206745
Godos, Justyna, Raffaele Ferri, Giuseppe Lanza, Filippo Caraci, Angel Olider Rojas Vistorte, Vanessa Yelamos Torres, Giuseppe Grosso, and Sabrina Castellano. 2024. “Mediterranean Diet and Sleep Features: A Systematic Review of Current Evidence” Nutrients 16, no. 2: 282. Retrieved from MDPI: https://doi.org/10.3390/nu16020282
Keys, A. (1968). Diet and the prevention of coronary heart disease. Work, Environment, Health, 5(1), 34-38. Retrieved from JSTOR: https://www.jstor.org/stable/44376267
Lăcătușu, C. M., Grigorescu, E. D., Floria, M., Onofriescu, A., & Mihai, B. M. (2019). The Mediterranean diet: from an environment-driven food culture to an emerging medical prescription. International journal of environmental research and public health, 16(6), 942. Retrieved from MDPI: https://www.mdpi.com/1660-4601/16/6/942
Kris-Etherton, P., Eckel, R. H., Howard, B. V., St. Jeor, S., & Bazzarre, T. L. (2001). Lyon diet heart study: benefits of a Mediterranean-Style, National Cholesterol Education Program/American Heart Association Step I dietary pattern on cardiovascular disease. Circulation, 103(13), 1823-1825. Retrieved from AHA: https://www.ahajournals.org/doi/full/10.1161/01.CIR.103.13.1823
Rishor-Olney CR, Hinson MR. (2024). Mediterranean diet. StatPearls [Internet]. Retrieved from StatPearls: https://www.ncbi.nlm.nih.gov/books/NBK557733/
