ANCEL KEYS, THE FOUNDER
The origins of the traditional Mediterranean diet date back several millennia, but it was not until the mid-20th century that the first detailed research of the diet was conducted. In 1948, Leland Allbaugh, an American social scientist, on behalf of the Rockefeller Foundation, conducted a seven-month study on the Greek island of Crete; then considered an underdeveloped area.
His research showed that while the island had the lowest incomes in Greece and widespread malnutrition; it still had surprisingly good local nutrition and the men had extremely low rates of chronic western diseases. They suffered only a third as many heart disease-related deaths as Americans, and cancer was rare. Allbaugh also noted in his study published in1953, that the island residents were extremely liberal in their use of olive oil, whole grains, fruits, fish, and vegetables.
At the same time, Ancel Keys, a professor of physiology, began conducting studies examining the sudden deaths of middle-aged men in the United States. What he didn’t know at this point was that this would be the catalyst for a later seven-country study. In 1951, at the invitation of a colleague, who claimed that Neapolitan workers rarely had heart attacks, Keys took an academic sabbatical. He and his wife, Margaret Haney Keys, a biochemist, began doing some studies on blood pressure, cholesterol, and nutrition in Italy.
The results of those studies prompted him to launch what has become his now famous seven-country study. It was the first detailed analysis documenting results across a wide range of nations. The study was funded by grants from the U.S. Public Health Service, the U.S. National Heart, Lung and Blood Institute and the American Heart Association.
Keys brought together researchers from around the world to study a systematic comparison of diet, risk factors for heart disease and disease experiences among men in seven countries. The countries – with different traditional eating habits and lifestyles — included Japan, Finland, Greece, Italy, the former Yugoslavia, the Netherlands, and the United States.
Study participants in each country were healthy males between the ages of 40 and 59 at the start of the research, who were then carefully monitored for signs of coronary artery disease for the next 25 years. Diet and lifestyle habits were documented at five-year intervals. As the subjects entered their 80’s and 90’s from 1983 onwards, additional tests were added to also examine cognitive decline.
The health results of this landmark study of nearly 13,000 men, published February 29, 1980, strongly supported the theory that lifestyle and diet are directly related to a person’s overall risk of coronary artery disease. Populations from countries where olive trees grow naturally and who followed a Mediterranean-based diet exhibited longevity that was among the highest in the world.
At the same time, they had the lowest incidence of coronary heart disease (CHD), cancer, and other non-communicable diseases. It was also found that men living in Italy and Greece, with similar diets, had less CHD than men in Japan who also had a mostly plant-based diet. Although the Japanese diet was very low in fat and the Mediterranean diet was relatively high in fat, 35% of those calories came from unsaturated fats, mostly from olive oil.
Finland and the United States had the highest rates of CHD due to diets high in saturated animal fat. What particularly underpinned the results was the outcome of heart disease deaths. Finland showed 171 deaths, USA 92, while Crete only 3 per thousand! The Cretan version of the Mediterranean diet, also known as the ‘poor man’s diet’, consisting of simple dishes with lots of fresh vegetables and olive oil, fresh fruit for dessert and a very small portion of meat or fish, was the most protective against heart disease.
After publication, it became the focus of medical research, where various dietary patterns with health benefits were studied. Most of the evidence in the literature is attributable to that from the Mediterranean region. More than 6,500 scientific studies have been carried out in different population groups examining the beneficial effects associated with adhering to the Mediterranean diet in terms of the prevention/treatment of age-related diseases such as cardiovascular and metabolic diseases. These include neurodegenerative diseases, cancer, depression, respiratory diseases, and fragility fractures.
According to current knowledge, the Mediterranean diet is not only healthy, but also an ecologically sustainable way of eating and living. After worldwide recognition, it was included in the Representative List of the Intangible Cultural Heritage of Humanity by UNESCO in November 2010 at the request of Spain, Greece, Italy, and Morocco. In 2013 the entry was expanded to include Croatia, Portugal and Cyprus. During the studies, Keys moved to the Mediterranean, living in Pioppi on the Cilento Coast, a region at the southern end of the province of Salerno in Italy. The area had long been known for its relatively high percentage of centenarians.
