Prior to the 1940’s nutritional health was defined by the nutritional needs of carbohydrates, essential amino acids, fatty acids, minerals and vitamins. Once these nutritional requirements were fulfilled, the manner in which it was fulfilled was unimportant.
The concept that the composition of a diet eaten by a population was a conclusion made by Ancel Keys as a result of the observational study of the relationship of heart disease and diet in firemen of Naples, Italy. This study evolved into the scientifically sound prospective cohort study known as the Seven Countries Study. The study demonstrated the importance of the Mediterranean Diet in cardiovascular risk factor modification. Prior to the epic study, the American Heart Association and the FDA recognized publicly in 1956 the health risk of a diet rich in butter, animal fat, beef and eggs as well as the advantage of a diet low in saturated fat. In 1959 Ancel and his wife, Margaret, published Eat Well and Stay Well to meet the requests of colleagues as well as the needs of the general public.
The Seven Countries Study, the Lyon Diet Heart Study and others have demonstrated through clinical trials the advantage of a diet rich in fresh vegetables and fruit, fish, poultry, whole grains, cereals, nuts, olive oil, limited red meat and sweets. The Mediterranean Diet is a ‘Whole diet approach’ because it is not known whether individual nutrients confer the benefits or if it is the accumulation of multiple nutrients that account for the favorable cardiovascular effects. In regard to the Mediterranean Diet, it appears that the sum of the whole confers the cardioprotective benefits of the diet.
The observation that a cookery of a people of the Mediterranean region recognized, hypothesized then proven by a professor of epidemiology has changed nutritional health as evidenced by its often referenced existence in textbooks and the plethora of books about the Mediterranean Diet. Unfortunately food photography and inviting recipes have quietly replaced the need to reference the yellowed pages of my cherished first edition of Eat Well and Stay Well by Ancel and Margaret Keys.
Keys, A. & Keys, M., 1959, Eat Well and Stay Well., Doubleday.
Keys, A. & Keys, M., 1975, How to Eat Well and Stay Well the Mediterranean Way., Doubleday.
Keys, A., 1980, Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease., Harvard University Press.
de Lorgeril M., et al., 1999, Mediterranean Diet, Traditional Risk Factors, and the Rate of Cardiovascular Complications After Myocardial Infarction: Final Report of the Lyon Diet Heart Study, Circulation, Volume 99, pp. 779-785.