Most of today’s illnesses are the result of excesses. These excesses of food (and the wrong types of foods) cause obesity, coronary atherosclerosis, high blood pressure, and diabetes.

 

As a cardiologist, it is easy to become part of the “food police” to restrict fats, cholesterol, calories, and salt. When our dietary recommendations fail to meet established guidelines in our patients, we quickly prescribe liberal doses of statins, diuretics, diabetes medications, and blood pressure medications. As physicians, we spend little time with our patients actually talking about diet. We follow our patients robotically with tests that measure weight, blood pressure, cholesterol level, and fasting glucose. We adjust prescriptions to correct laboratory values and then dismiss the patient until the next visit. Have we really done all that we can to improve that patient’s health? Are we treating the whole person?  

What are the benefits that we should try to adapt from the Mediterranean way of life and what are the limitations?

First, body mass index (BMI) is very important as a major risk factor for coronary artery disease. Diet and exercise are so intricately related that they cannot be separated in any lifestyle evaluation. A physically active lifestyle can make up for a lot of today’s dietary indiscretions. Historically, in Italy people have been very active with walking, physical work, and normal daily activities. I can attest to the fact that walking up and down the Italian hills all day made me tired and hungry for good food. Typically Italians are lean and have reduced BMI when compared to most Americans. They have no gimmick to maintain this leanness. It is simply the result of less caloric intake combined with increased caloric expenditure.  

To further expand upon the importance of BMI and risk for heart disease, the recently updated Honolulu Heart Study (HHS) is helpful (7,8). The HHS has been an ongoing longitudinal study over the past 60 years studying men of Japanese background in Japan and Hawaii and comparing various risk factors for disease with observed events. In the updated study, we studied the sons of the original participants to try  to control the genetic component and make generational a comparisons.


 With regard to the “Japanese paradox” increased smoking in the Japan group probably in part did keep the BMI down; however, it is not to be endorsed as a healthy habit since it still increased the risk for many types of cancer and increases risk for sudden cardiac death. The lower incidence of heart disease in Japanese from Japan may best be explained by the increased consumption of seafood rich in omega-3 fatty acids. 

Italians love their sweets; so why are so many of them thin? Clearly, carbohydrate intake needs to be in balance with daily activity and most carbohydrate intake should be from complex carbohydrates (whole grains, brown rice, and jams) rather than refined carbohydrates (white sugar, white flour, and white rice). Complex carbohydrates are absorbed more slowly and have more fiber making them less glycemic. This causes less elevation of glucose and less elevation of insulin. When Italians have a sweet dessert, they have just a small amount and savor it. In other words, their glycemic rush is slowed. They take an hour to savor an espresso coffee with a little sugar. They also have almost no high fructose corn syrup in their diets, which is common in America and often blamed for increasing obesity rates. Foods rich in high fructose corn syrup are very glycemic.  

In general Italians are much more physically active and burn off their carbohydrates. However, obesity is increasing in Italy (and elsewhere in the Mediterranean area) as people continue to eat all those lovely sweets, pasta, and now increasing exposure to highly glycemic foods like soda drinks. They also exercise less thanks to their cars, computers, and televisions. Just like modern Japanese in Hawaii, many of the young Italians definitely have increased BMIs and are not as healthy as their parents.  

Another important factor in the benefits of the Mediterranean diet is consuming whole natural foods. Recent trends in nutrition stress consuming whole foods as opposed to processed foods. Processed foods not only have diminished nutritional value but often contain harmful things such as hydrogenated fats (transfats) that actually promote atherosclerosis. Therefore, eating plenty of fresh vegetables (preferably organically grown) is a mainstay in any healthy diet. Vegetables are not only tasty, but they have benefits as natural whole food with essential nutrients to both heal the body and maintain optimal daily function. Research demonstrates that diets that are predominantly plant-based over animal-based have definite benefits in reducing the risk of both heart disease and cancer. An estimated 75% of atherosclerotic heart disease and several forms of cancer could be prevented with a plant-based diet. Furthermore, since vegetables are relatively low calorie density and low glycemic food, in general people who eat a lot of vegetables in place of refined carbohydrates and fats are thinner  

Tasty vegetables grow in most parts of the world. Asian cuisines are particularly known for their use of vegetables and in general there has been much less heart disease in these populations. However, they should not be cooked in oil. (Vegetables cooked in oil or coconut milk loses much of their nutritional value and become caloric-dense secondary to the increased concentration of saturated fat.) Judiciously eating fresh fruits and nuts adds additional definite health benefits to eating vegetables. The only caution is that excessive fruits and fruit drinks can be glycemic and excessive nuts can cause weight gain. The main problem worldwide is getting people to just eat more vegetables and fruits and less meat. This is not only good for them; it is good environmentally for our planet. Unfortunately, as underdeveloped countries urbanize there is greater demand for meat. This is usually when we see a rise in illnesses of excess.