Just how healthy is Spain’s famed Mediterranean diet?

It didn’t take the food industry long to realize that putting “Mediterranean diet” on its products or advertising would make consumers immediately associate the term with healthy eating, even in the case of industrial-grade pizza, alcoholic drinks, or snacks packed with salt, sugar and the wrong kind of fats.

If you’re really interested in healthy eating, then it’s important to understand where science ends and advertising begins.

It could be argued that the popularity of the Mediterranean diet is largely the result of four decades of marketing

Scientific interest in the Mediterranean diet dates at least to 1953, when an epidemiologist called Leland G. Allbaugh published Crete: A Case Study of an Underdeveloped Area, which noted that people on the Greek island ate little meat, some fish, and plenty of olives, cereals, pulses, fruits, vegetables and wild plants, and above all, plenty of olive oil.

The study caught the attention of US physician Dr. Ancel Keys, who began 15 years of research into why Cretans, with their poor diet, were healthier than most Americans. The result of his work was Coronary Heart Disease in Seven Countries, an exhaustive study based on analysis of the lifestyles and diet of some 13,000 men in the former Yugoslavia, Italy, Greece, Finland, the Netherlands, the United States and Japan, and which took into account variables such as smoking, weight, physical activity, heart rate, lung capacity, cholesterol, and of course diet.

In brief, one of the conclusions of the work, published in 1980 as Seven countries: a multivariate analysis of death and coronary heart disease was that saturated fat in diets was a major conditioner of heart disease, along with cholesterol and high-blood pressure. Keys’ conclusions were criticized and questioned by many academics at the time, but undeterred, he and his wife published Eat Well and Stay Well in 1959, which became an immediate bestseller. Each recipe included nutritional information along with factoids about which foods could help combat disease and boost health.

Then, in 1975, Keys published How to eat well and stay well. The Mediterranean way, which really fired the public’s imagination and saw the widespread use of the term Mediterranean diet.

Henry Blackburn, who worked with Keys for three decades at the University of Minnesota, explains here why Keys should be considered the father of the Mediterranean diet, noting that : “…the traditional “Mediterranean Way” is more than particular foods and cuisines or eating patterns. It involves aspects of lifestyle and the economy, such as walking to and from work in physically active occupations (e.g. agriculture, crafts, fishing, herding); taking the major meal at midday, associated with a siesta or major work respite. Thus, the lifestyle is related to the human dimensions of the traditional communities. And even tobacco is locally cured and more sparsely used in such cultures.”

So is the Mediterranean diet healthy?

Maybe, maybe not. In 2011, the European Food Safety Authority published a position document arguing that it is not possible to establish whether a Mediterranean diet is healthy or not. It points out that there are many definitions of the diet and that many contradict each other. It adds that based on current legislation, it is not possible to call a diet healthy if it includes products with more than 1.2% of alcohol in them, and that wine is a key part of the Mediterranean diet.

The Mediterranean diet’s inclusion on UNESCO’s Representative List of the Intangible Cultural Heritage of Humanity is not primarily for its health-giving qualities; instead UNESCO highlights: “a set of skills, knowledge, rituals, symbols and traditions concerning crops, harvesting, fishing, animal husbandry, conservation, processing, cooking, and particularly the sharing and consumption of food.”

It could be argued that the popularity of the Mediterranean diet is largely the result of four decades of marketing, rather than its health benefits. That said, many of its main principles, despite having been liberally interpreted, are worth following. For example, eating plenty of seasonal, rather than processed, vegetables. But there are plenty of other diets out there, such as the DASH and TLC diets, or the Harvard School of Public Health’s Healthy Eating Plate recommendations.

We should be wary of processed products with “Mediterranean” on their labels, which probably have little to do with a genuine Mediterranean diet.

The benefits of the Mediterranean diet are not just physical, and as UNESCO points out, there is a strong cultural element involved: Eating together is the foundation of the cultural identity and continuity of communities throughout the Mediterranean basin. It is a moment of social exchange and communication, an affirmation and renewal of family, group or community identity. The Mediterranean diet emphasizes values of hospitality, neighborliness, intercultural dialogue and creativity, and a way of life guided by respect for diversity.

English version by Nick Lyne.