"When we examined the diet on Crete, for instance, we found that it was very high in fat-in some areas, as high as 37 percent of total calories. But the fat was almost all from olive oil. There were people who drank a glass of raw olive oil in the morning before heading out to the fields to work. And these were people with exceedingly low risk of heart disease."
Dr. Ancel Keys
There's so much misinformation out there on diet and health these days that it's hard to keep track of what's right, what's wrong and what's well-intentioned but inaccurate. Even for me-a non-scientifically oriented, food-loving, food professional who reads constantly-it's darned hard to keep it all straight. Every two days you pick up the paper and find out that something someone told you was good for you isn't, and vice versa. It's hard not to think back to that scene in Woody Allen's "Sleeper" where they joke about how "recent" discoveries have shown that chocolate and steak are actually good for you. The result of which is that, while I have lots of personal opinions and have gathered a fair amount of information over the years, for the most part I've just steered clear of the subject in this newsletter. I don't want to be one more voice adding to the already confounding level of consumer confusion.
But (you knew there was going to be a "but" in there someplace, didn't you?) one of my biggest frustrations over the last decade or so has been the American infatuation with the belief that strict low-fat diets are directly linked to healthful living. Why am I frustrated? Because despite the proliferation of best-selling low-fat diet foods and diet books, the reality of the scientific world is that most nutritionists are saying something completely different: that there is no linkage between overall health and the consumption of a low-fat diet.
On the other hand, there is a great deal of evidence showing a connection between good health and eating what is often referred to as a Mediterranean Diet: a diet low in saturated fats (as in red meat and white milk); high in mono-unsaturated fats-specifically olive oil-high in consumption of fruits, vegetables, legumes, and grains; regular, though moderate, consumption of wine; and a fair amount of fish around the edges. All of which, combined with a regular exercise program and a good dose of balanced mental health, have been continually shown to lead to reduced risks of heart disease.
Now, I know there's already someone out there shaking their head in frustration. The low fat=long life mindset is so ingrained into popular American culture these days that some people may no longer want to hear the truth on this issue. We seem obsessed with the search for simplistic answers, a straightforward "find that fountain of youth" mentality, that the extremely complex, varied reality of real life gets pushed aside.
So why bring this up now? Because a few months back I spent a week in Crete listening to one respected scientist after another stand up and say what I just said here: The only link that has been demonstrated is between reduction of saturated fats and heart disease. Overall fat is not part of the issue.
The conference-"Crete, Greece and Healthy Mediterranean Diets"-was one of an ongoing series put together by the people at the Oldways Preservation and Exchange Trust of Boston to improve understanding of traditional foodways, and to promote healthful, well thought out and enjoyable eating. These are rare events in that they bring together food-oriented folks like me with some of the top scientific scholars in the world.
The conference was important for me, because, ironically, even though I was a non-believer, I too had gotten caught up in the standard hearsay of the whole "fear of high fat" thing. So when speaker after speaker stood up to state essentially the same message-that there has been no demonstrated link between reducing overall fat consumption and heart disease-I was taken aback by how different what they were saying was from the standard wisdom being communicated to consumers in this country.
Now before I even get into any details, let me tell you that this was not some collection of quacks, nor was it just a bunch of unscientific cooks like me getting up and expounding about some made up merits of a fanatical, high-fat diet. These were serious academics, with seriously significant credentials in the scientific community. Folks like Marion Nestle, chairperson of the New York University Dept. of Nutrition and Food Studies, Meir Stampfer of the Harvard School of Public Health;, Rosemary Stanton a leading Australian nutrition educator, and Antonia Trichopolou of the Athens School of Public Health, just to name a few.
The major scientific message from leading nutrition and medical experts from this conference was that limiting overall fat intake is NOT an effective path to a healthful diet. Much, though by no means all, of this information originated with the Seven Countries Study, a project begun in 1952 by the eminent epidemiologist Dr. Ancel Keys. The study tracked the health and diet of men in rural areas of Yugoslavia, the United States, Finland, Italy, the Netherlands, and, last, but definitely not least, Greece. During the late '50s and early '60s the study showed that while Greeks and Americans ate about the same amount of total fat (nearly 40 percent of their diet), the Americans were consuming primarily saturated fats, while the Greeks were eating mostly olive oil and fats from other plant sources like nuts. At the same time, the Greeks had heart disease rates an amazing 90 percent lower than we did in this country! The question is "Why?"
The Seven Countries Study is ongoing: its results have shown, and continue to show, that the countries where people ate the highest levels of saturated fat in their diets had the highest instances of heart attack. Conversely, those who ate what is now known as the Mediterranean Diet have the lowest risk of heart disease. To quote from Jean Mayer's forward in Ancel Keys, How to Eat Well and Stay Well the Mediterranean Way, "The accidents of soil, climate and history have made the choice of foods and the types of cooking which developed around the Mediterranean much better for your cardiovascular health than the rich diets of Normandy, the high fat cuisines of central Europe-or the 'typical' American diet." In Japan, where they also have very low rates of heart disease, they also eat a primarily plant based diet that is very, very low in saturated fats of all sorts. Saturated fat-not total fat-is the problem. The good news is that with modern methods of transportation we all have access to fresh fruits, vegetables, fish, olive oil and other nutritious foods even if we don't get to live on the shores of the Mediterranean.
Rosemary Stanton, the Australian nutritionist, put it this way: "'No fat' is not the Mediterranean Diet." So, then why the hype about no-fat? Because, she says, "Every time we find a good factor, people want to make a product." They want the easy answer that allows them to alter one small behavior and in return be granted near-eternal health and happiness. And there is no easy answer.
What all of these academics at the Crete conference said was, essentially, that the results of this (and other studies) show that overall fat consumption is not the problem for most people. In fact, scientists at the conference consistently reported that, as Meir Stampfer of Harvard said, "driving fat levels down is misguided and not based on scientific evidence." Reducing calories from fat alone:
a) cannot even be directly shown to lead to weight loss. To the contrary: total calorie consumption in the United States has been significantly reduced in recent years. Yet weight levels are not declining. Why? Because people eat less fat, but also lots of processed foods and lots of sugar. And perhaps most importantly, people buy low-fat food but fail to get on a regular program of exercise.
b) does not seem to reduce cancer risk. Increases in disease have been shown from increased levels of animal fats, but not from total fats.
c) does not reduce risk of coronary disease, as the ongoing work of the Seven Countries Study continues to show.
Instead the nutritionists are stating unequivocally that the path is to:
a) Use plenty of olive oil, while reducing intake of saturated fats.
Olive oil is a key to the Mediterranean Diet. As a monounsaturate, it reduces your LDL (or negative cholesterol) while increasing your HDL (or, as my doctor says, "happy cholesterol"). Despite all the bias towards low-fat diets in this country, the Seven Countries Study continues to show that diets high in fat consumption often have low levels of heart disease when that fat is primarily olive oil. Olive oil cannot be replaced by other monounsaturates like canola oil. We have no history of health benefits from eating large amounts of canola oil. Only what my high school algebra teacher called the transitive property: if olive oil is good for you, and olive oil is a mononunsaturate, then since canola oil is also a monounsaturate, it too must be good for you." Not necessarily, folks. To quote Rosemary Stanton, "Canola oil is not the Mediterranean Diet."
Perhaps even more important, may be reducing intake of transfatty acids from the partially hydrogenated fats used in so many processed foods. These reduce the levels of HDL (that's the good one) cholesterol and raise the levels of LDL (that's the bad one). How's that for ineffective?
b) Increasing fruit and vegetable intake.
One thing that every Mediterranean culture and cuisine has in common is very high consumption of fruits and vegetables. Here, on the other hand, we eat relatively small amounts of fresh produce, all the while consuming large quantities of fat-free cookies, light beer and diet sodas, and of course, a major amount of meat. But every study seems to be showing that the way to go is to make meat more of a condiment, a flavoring agent, and less as the main course. Instead of a pork chop with a little rice and asparagus on the side, make a risotto with asparagus, seasoned with a little bit of pork.
c) Regular exercise.
Without regular physical activity, no diet is going to be effective. Granted I'm a runner, so in some ways I'm sure I'm pre-disposed to hear this, but in my opinion, this is the piece of the puzzle that most Americans don't want to hear. It's much easier to look for-and believe in-some simple dietary adjustment, than to accept that eating boxes of "Fat-Free Snackwells" while sitting stagnant in front of the television isn't going to make you thin. But the reality is that every study I've seen shows that regular physical activity is a critical component of good health. In fact studies conducted by Dr. John Foreyt, Ph.D. at Baylor University in Texas, have shown that regular exercise-more than dieting of any sort-is most likely to lead to better health and longer life.
Pass the Cheese Please
Obviously, cheese is a saturated fat, and even those advocating the Mediterranean Diet put it on their list of foods to eat less of. But, interestingly, although none of the scientists came right out and said it, the research to date does not seem to indicate that cheese has a detrimental effect on health. Now this is me talking, not anyone of meaningful medical background, so take it for what it is-an interested layperson reading data presented by more qualified professionals who don't seem to want to talk much about this subject. But, interestingly, the Greeks-who have the lowest rates of heart disease in the Seven Country Study-also have the highest per capita cheese consumption in the world. They also eat lots and lots of yogurt. Americans, on the other hand, have much lower intake of cheese and yogurt, but much higher overall dairy consumption, and much higher intake of saturated fat from meat.
The thing is that the scientific community seems to assume that all dairy fat is the same. But apparently no one has done a study that actually separates liquid milk consumption from cheese consumption. To a non-scientist like me, the data would seem to indicate that liquid milk may cause increased risk of heart disease but that the fermentation process (or some other aspect) of cheesemaking may alter the fat structure in such a way that it is not (as) harmful to human health. And in fact, this is the same theory that was put forward five years or so ago by Dr. Serge Reneaud from the University of Bordeaux, in his work commonly referred to as "The French Paradox."
Now mind you, this cheese theory is not something that can be stated scientifically at this point. And I'm not recommending you run and start eating as much cheese as you can tomorrow. But what I asked half a dozen of the presenting scientists about this issue, not a single one gave me anything resembling a real, meaningful answer. Rather, they gave me what were referred to during the investigation of the Watergate scandal as "non-denial denials." They never said it was wrong, and mostly they didn't say much of anything, while seeming to skirt the issue. What does seem clear is that, based on the presentations and on all the non-denial denials that followed them, it is not as "obvious" as it's been made to seem that "cheese is harmful to your health."
Alternatively, it may be that:
a) it's cow's milk cheese, not all cheese, which is potentially harmful. Greeks eat primarily sheep and goat milk cheese-Americans, of course, eat almost exclusively cow's milk cheeses.
b) it's cow's milk cheese from Holstein (the predominant dairy breed in the United States and Europe) milk that has potentially harmful fat. In fact, a new study from New Zealand shows that milk from other, older breeds may be more easily assimilated by the human system.
What's the Point?
I guess the thing that riles me up the most is that the trendiness of low-fat and no-fat is turning the authentic, traditional values of the food world inside out, but benefiting primarily large commercial food processors. Read the labels on all those prepackaged "lean" frozen dinners and "no fat" cookies and what you'll find, most of the time, is that a search for salvation through fat avoidance is allowing large food processors to sell what is essentially sugar, chemicals and air to consumers. And they can sell these products much more profitably than they can offer real, traditionally grown food.
The best way we've discovered to focus our attention on the taste deadeners and silent killers in highly-processed foods," said Oldways President K. Dun Gifford, "is to invoke the clean, natural foods and memorably-tasty meals of the tables of our grandmothers' times. Fortunately, there is a spreading revolution out there among the world's educated youth about these things, and it is they who are creating the amazing world-wide growth in demand for healthy, sustainable foods grown and prepared in the old ways."
Meir Stampfer of Harvard pointed out-as already mentioned above-that the real villain in eating isn't even saturated fat, but rather the transfatty acids-like the partially hydrogenated fats that are so common in heavily processed foods. These actually raise your LDL (that's the lousy one) cholesterol, AND lower your HDL (good) cholesterol levels! They actually cause harm! So what happens when people eat lots of heavily-processed, often "low-fat" foods? All that processed stuff leaves them feeling unsatiated. So they go on to eat enormous quantities of "low-fat" food, instead sticking with a reasonable ration of the real thing. Obviously each of us can and does make his or her own choices here. But I've watched people sit down and consume a quarter pound of low-fat cheese (which of course still has fat in it) instead of savoring an ounce or so of full fat-but also full flavored-traditional cheese. Who are the losers in this scenario? In my opinion, the consumers and the producers of traditional foods. Who wins? Only the big food processors.
(Ironically, the Mediterranean itself is not exempt from this trend. Jilly Smith, in "The Virgin, The Olive, and The Diet" (Taste, April, 1992) reported that, "Statistically, it's the poor who are the suckers for the sweet and processed food industries. Fast food chains loom ominously on an ever widening horizon. While we (non Mediterranean natives) may be wising up to a better diet, the tentacles of the industrialized food machine creep south and strangle the local markets of the Mediterranean.")
So what does one do? As I alluded to above, the studies are showing that the highest correlation between good health comes when you lead a (psychologically and physiologically) balanced life, including:
1) Eating lots of fresh fruit and vegetables
2) Making sure the majority of the fat you eat comes from plant-based sources, especially olive oil
3) Eating meat in small quantities
4) Drinking and eating most everything in moderation
5) Exercise regularly
In case you think any of this is really new or particularly innovative, let me leave you with this quote from an elderly Cretan man interviewed by the Seven Country Study. "What was the secret of his long life?" he was asked.
His answer:
"I always ate simple foods. I walked a lot every day. I avoided smoking. I stayed away from politics, courts, and doctors. And, as for sex, I always did my best."