The late U.S. physiologist Ancel Keys is the person most closely associated with popularizing the origins of the Mediterranean Diet. He coined the term when he published the findings of his ongoing research throughout his career, while spending a great deal of time living Southern Italy, in the tiny village of Pioppi, just south of Naples. He observed that this area had the highest concentration of centenarians in the world, and he hypothesized that a Mediterranean-style diet, low in animal fat, protected against heart disease, while a diet high in animal fats led to an increased risk for heart disease.
The research expanded to other countries, and the results are what later became known as the Seven Countries Study. It appeared to show that serum cholesterol was strongly related to death by coronary artery disease. Keys concluded that saturated fats as found in meat and dairy products have adverse effects, while unsaturated fats found in vegetable oils had beneficial, protective effects.
As a result, in 1956 the American Heart Association informed the public that a diet which included large amounts of butter, lard, eggs, and beef would lead to coronary heart disease. But then, very quickly, this message became distorted and obscured, in no small part due to the lobbying efforts of the beef and dairy industries. The original message, “Eat less meat,” was abruptly replaced with, “Choose meats, poultry and fish that will reduce saturated-fat intake.”
A subtle but important change in wording, which served to not only confuse the public, but to exonerate the foods that people were familiar with, and place the blame on nebulous concepts that the average consumer didn't understand, namely saturated fat and cholesterol.
This led to a national campaign against all fats, and we entered an age of highly-processed foods that conformed to a marketing message rather than sound nutritional advice. The food industry began reformulating their products accordingly, taking out the perceived “bad” ingredients (fat), and replacing it with something even worse in many cases (refined sugar and/or added salt) in order to keep the flavor.
Origins of The Mediterranean Diet
Well, it’s easy to criticize all of this retrospect. But the truth is, we have a lot more research now to better inform this debate. So let’s look back and see what our good friend Ansel Keys got right… and what he might have missed.
What Keys Got Right
It is undoubtedly true that there is a strong correlation between a large of amount of animal fat in the diet of a population and the prevalence of certain illnesses such as heart disease and cancer. A correlation doesn’t necessarily mean causation, but there is enough long-term population data, along with laboratory experiments on mice and other mammals, that we can now feel very confident of this relationship.
It also seems likely that “good” fats, such as are found in olive oil, avocados, and other plant sources are protective against heart disease. There are a few notable experts that dispute this (saying that ALL fats and oils are bad), but the scientific consensus remains strongly in its favor.
What Keys Got Wrong
Perhaps his biggest mistake--and it’s an easy/common one--is that he oversimplified the very complex topic of human dietary needs in the modern world. He didn’t address the cultural parameters that surround eating habits. How often do people in the Mediterranean eat? How much do they eat? Alone or in the company of friends and family? What about levels of physical activity?
But he also missed (or rather, refused to acknowledge) a big detail in the diet itself: the role of refined sugars in causing the most common chronic diseases.
John Yudkin was a British nutritionist and the founding professor of the Department of Nutrition at Queen Elizabeth College, London. In 1972 he published a book called, "Pure, White and Deadly" written for the general population rather than doctors and academics. Its scope was to present evidence that the over-consumption of refined sugar was leading to an increased incidence of coronary thrombosis, and that it was certainly involved in dental caries, as well as obesity, diabetes, and liver disease.
Predictably, this message was unwelcome to the sugar industry and manufacturers of processed foods. The final chapter of the book lists several examples of attempts to interfere with the funding of his research and to prevent its publication. It also refers to the personal smears used by Ancel Keys to dismiss the evidence that sugar was the true culprit.
These days, we know that refined sugar plays at least as big of a role as animal protein/fat (cholesterol) in overall mortality rates. Somebody has even coined the phrase that “sugar is the new fat.”
Big Pharma Hits a Grand Slam Home Run
Well, the role of fat and cholesterol in causing coronary artery disease lingered in the public discourse, which proved to be a huge win for the pharmaceutical industry, in particular Pfizer, who patented the molecule that we know as Lipitor. This was the first in a class known as statin drugs that are very effective in doing one thing: lowering the serum levels of cholesterol in a relatively short time.
What still remains unclear is if this actually does much at all in lowering risks of heart attacks and strokes. In other words, mortality rates.
But for both the patient and the doctor, its effects are comforting. You take the drug and you can watch your numbers go down month after month. There is a great deal of satisfaction in this sort of easy correlation. And psychologically, the patient now feels free to indulge in his or her favorite treats, loaded with saturated fats (and often sugar, too).
The result is that the lifestyle goes unchanged, while the cholesterol continues to lower. At the same time, there are some pretty objectionable side-effects, not the least of which is the cost...to the individual as well as to the healthcare system at large. (Meanwhile, Pfizer made $13 BILLION in revenue in 2006 from Lipitor sales alone!)
At the end of the day people want to do what is easiest, and that usually comes in the form of a pill. The instructions on the bottle are much easier to follow than trying to mimic the Mediterranean Diet in 21st Century America. Our food delivery systems are not set up to accommodate that choice, and the marketing messages are certainly not imploring us to eat more fresh vegetables. It’s up to the individual to make the effort to fight for their own health.
In 21st Century America, our #food delivery systems are not set up to accommodate #healthy choices. It’s up to the individual to fight for their own health. #mediterraneandiet #italianfood
And whatever happened to Ansel Keys? Well, he lived to be 101 years-old, still preaching and eating Mediterranean-style meals right up to the end. In the village of Pioppi where he once lived, there's now a museum dedicated to him and his famous diet.
American physiologist Ancel Keys championed a diet that mimics the traditional diet and lifestyle of Mediterranean countries.
Although many of his conclusions remain valid today, he definitely made some major mistakes, as well, such as ignoring the role of refined sugars.
Statin drugs lower serum cholesterol levels, but whether or not this directly leads to lower morality rates, is much less clear.