Book Review

The Mediterranean Diet: Origins and Myths

N Engl J Med 2001; 344:940March 22, 2001

Article

The Mediterranean Diet: Origins and Myths
By Dario Giugliano, Michael Sedge, and Joseph Sepe. 266 pp., illustrated. Naples, Italy, Idelson-Gnocchi, 2000. $79.90. ISBN: 1-928649-06-8

Three types of diet are widely reputed to be associated with good health and longevity, mostly on the basis of ecologic and geographic evidence: the Chinese, the Japanese, and the Mediterranean diets. Though it is not easy to compare these diets directly with respect to their healthfulness, there is good evidence that the Mediterranean diet is the realistic choice for people who engage in moderate-to-low levels of physical activity and consume moderate-to-high levels of dietary lipids. The evidence for this recommendation has been widely embraced by experts in the field.

There are several definitions of the Mediterranean diet, but in essence it emerged when poverty in the region limited access to all but locally produced plant foods. The addition of olive oil facilitated the consumption of raw or cooked vegetables, legumes, wild greens, and even cereals.

The association of the Mediterranean diet with some of the greatest ancient civilizations — Egyptian, Phoenician, Greek, Etruscan, and Roman — may have been coincidental, although the pioneering British nutritionist John Waterlow has argued, “It is difficult to conceive how the Greeks and Romans could have achieved such remarkable feats, which involved far more than a small elite, if they had not in general had an adequate and nourishing diet.” This theory cannot be refuted by the fact that some key elements of the modern Mediterranean diet, notably tomatoes and some fruits, were introduced into the region much later; the defining elements of the diet — olive oil, grains, and wine — have been in the region for millennia.

The task of tracing the origins of the Mediterranean diet is fraught with difficulties. Diet is not a popular archeological or historical subject, and memorable events depicted in ancient artifacts do not, in most cases, refer to the everyday activities of the average person. Nevertheless, with The Mediterranean Diet, Giugliano and his colleagues have produced a delightful book that is pleasant to read and educational in various ways.

The book presents the health effects of diet with a simplicity that does not seriously compromise scientific accuracy, and it treats the various Mediterranean cultures with respect, notwithstanding some unattractive dietary habits (Seneca is quoted as saying that Romans did not hesitate to induce vomiting in order to indulge again in the pleasure of eating). The reader will also be enchanted by the magnificent illustrations of farming, traditional festivities, symposia, and wine drinking.

The book has other less obvious, but equally impressive, qualities. The authors explicitly stress that the benefits of no diet can be evaluated in isolation from physical activity. Indeed, the rise and fall of the Roman empire are seen to be paralleled by a cultural change from a physically active life to a sedentary life and hedonistic habits. It may or may not be intentional, but most of the illustrations in the excellent chapter on exercise and body care are based on images from classical Greece at its prime. Moreover, the authors emphasize that the health advantages of the Mediterranean diet may be enhanced by the traditionally relaxed lifestyle and social coherence of the Mediterranean peoples. Indeed, the illustrations in the last three chapters are a tribute to rural Mediterranean life.

The book does have some weaknesses, but for the most part they are trivial. The authors state that dietary lipids should not exceed 30 percent of the total energy intake, but they ignore the fact that most Greeks consume 40 percent of their total energy intake in the form of lipids (mostly olive oil) and are at least as healthy as Italian or French people. Also, the authors do not adequately focus on diet-related health problems and mortality from other than cardiovascular diseases.

This is a book that is worth owning and reading: the text is valuable, the illustrations are magnificent, and the production overall is excellent. The Mediterranean Diet will enrich the library of any educated person, not only those with medical backgrounds or Mediterranean roots.

Antonia Trichopoulou, M.D.
University of Athens Medical School, GR 11527 Athens, Greece