April 20, 2013
John DiTraglia MD
As the American empire seems to be developing cracks, at least where it comes to diet, we can learn something from the ancient Roman empire and their Mediterranean diet. The term Mediterranean derives from the Latin word mediterraneus, meaning “in the middle of earth” or “between lands” (medi-; adj. medius, -um -a “middle, between” + terra f., “land, earth”) The Romans also called it simply Mare Nostrum (Latin, “Our Sea”). This week’s New England Journal of Medicine has another article and two editorials tauting the virtues of the Mediterranean diet. (1,2,3)
The “classic” Mediterranean diet is high intakes of olive oil, fruit, nuts, and whole-grain cereals, moderate consumption of fish and poultry, low intakes of dairy, red meat, and sweets, and often moderate drinking of red wine. It has become the picture of healthy eating. It appears to reduce the risk of heart disease, cancer, Alzheimer’s disease and Parkinson’s disease and death overall.
In a way this simplifies dietary advice - instead of trying to figure out recommended details of carbohydrate, fat and protein, just eat like a Mediterranean. In a way this complicates things - what is it about this diet that works? Maybe people who inherit the ancient Roman empire are different in other ways - their lives and environment and genes are different.
In this multi-center trial in Spain, 7,447 persons who were at high risk of heart disease and stroke but who had no evidence of disease at enrollment were randomly assigned to one of three diets: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet that was advice to reduce fat. On the basis of results of an interim analysis, the trial was stopped prematurely at about five years because the incidence of major heart events and stroke were already significantly reduced in the Mediterranean diet groups. The extra extra-virgin olive oil group and the extra mixed nuts group were not significantly different in outcome.
There was no mention of weight reduction by the Mediterranean diet. It’s not about that anymore. Although, as part of being high risk in this study, most of the subjects were overweight or obese and had waist circumferences of 40 inches on average. The diet did reduce blood pressure.
It’s interesting that this used to be considered a poor Greek’s diet. But olive oil and nuts are a lot more expensive than MacDonald’s food. In this study the one group got a liter of extra-virgin olive oil per week. I don’t think I drink a liter of Pepsi and beer combined every week. “Extra-virgin” means that it is the product of the first easy squeezing of the olives and not the later squeezing under heat and high pressure. This doesn’t mean necessarily that extra-virgin olive oil is better than cheaper, though not cheap, olive oil. It does taste better though.
Also these were Spaniards after all. Spain is one of the world’s biggest exporters of wine, fruits, vegetables and olive oil. The control group was probably eating a pretty Mediterranean diet too. A Mediterranean diet would probably be an even bigger benefit to us members of the Pepsi generation.
1. Estruch R et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013;368:1279-90.
2. Tracy SW. Something new under the sun? The Mediterranean diet and cardiovascular health. N Engl J Med 2013;368:1274-6.
3. Appel LJ, Van Horn L. Did the PREDIMED trial test a Mediterranean diet? N Engl J Med 2013;368:1353-4.