When Mount Vesuvius, a volcano near Naples Italy, erupted in 79 AD, it caught the townspeople of nearby Pompeii and Herculaneum by surprise. Many were able to escape, but many died instantly, buried by lava and volcanic ash. Due to the nature of their death, their bodies were well preserved. Recently, scientists were able to study the bodies of these early Mediterranean people and were able to determine what they ate. How does the ancient Mediterranean diet compare to the modern version? How can the study of ancient peoples give us insight regarding heart healthy diets in today’s world?
The Mediterranean basin has been called the cradle of civilization. It stretches from the Nile to Rome and has housed advanced civilizations for thousands of years, including the Egyptian, Assyrian, Babylonian, Persian, Phoenician, Greek and Roman. The Mediterranean diet is linked to the fertile land of the region. It is more than a diet; it is a way of life and based on traditions linking the land to the preparation, cooking and enjoyment of the food. The key elements of the Mediterranean diet include oil (especially olive oil), whole grains, wine, vegetables, sheep and goat cheese, seafood and very little meat. Whole grains include bread, cereals, couscous, pasta, rice, corn, oats and barley. The description of the ancient Mediterranean diet comes mainly from written accounts. For example, texts describe the diet of the ancient Greek Olympic athletes starting around 700 BC. The diet was mostly vegetarian, consisting of barley porridge, cheese, fresh vegetables, lentils, beans, seafood, eggs and fresh fruit, mainly figs. Sweets were frowned upon. Initially meat was not a part of the athlete’s diet, but as time went on, meat was incorporated more and more. Fast forwarding to Pompeii and the modern day, we now have concrete proof of what Roman era Mediterranean people actually ate. Scientists have been able to test the bones of the people frozen in time by the eruption of Mt Vesuvius. Using bioarcheological approaches they determined that the people of Pompeii ate a lot of fish, more than is consumed with the modern Mediterranean diet. In addition, locally grown fruits and vegetables were eaten. The majority of their food energy came from seafood and cereals, although grain consumption was less than today’s diet. After the fall of Rome, the Mediterranean diet faded during the Middle Ages. It rose again from the ashes and poverty following World War II when meat was scarce and people turned once again to what could be grown locally. The cardiac benefits of the Mediterranean diet were first described in the 1950’s by Ancel Keys, a University of Minnesota researcher who discovered that people in poor towns in southern Italy were healthier than wealthy people in New York City. He conducted the Seven Countries Study and showed that the Mediterranean diet resulted in low levels of cholesterol in the blood as well as low levels of heart artery blockages.
Anthropological data has shown that pre-agricultural hunter-gatherer populations derived a majority of their energy from animal based foods such as meat, fish, birds and eggs. The keto and paleo diets were developed to mimic these eating patterns. These diets are very low in carbohydrates and high in saturated fat. It is generally believed that hunter-gatherers had low levels of heart disease. Is this true? A recent study performed CT scans on mummies from four regions, including ancient Egypt, Peru, southwest US, the Aleutian Islands and going back 4000 years. Atherosclerosis (calcified plaque in the wall of an artery) was found in 34% of the mummies and was found in all four regions. In addition, atherosclerosis was present in 60% of the hunter-gatherers. Atherosclerosis is felt to be a modern disease, but it is clearly present in our ancient ancestors, including hunter-gatherers.
Since atherosclerosis seems to be a fact of human existence, which diets help protect the most against atherosclerotic heart artery disease? In 2021 the American Heart Association outlined its requirements for a heart healthy diet and ranked popular diets on how well they met the criteria. The recommendations included consuming:
Fruits and vegetables
Whole grains (rather than refined grains)
Plant based proteins (such as legumes and nuts)
Fish and seafood
Low-fat or fat-free dairy products
Lean meat or poultry
Plant oils (such as olive oil)
Minimally processed foods
Minimal added sugar
Little or no salt
Low amounts of alcohol
The dietary patterns that aligned the most with these criteria included Mediterranean, DASH (Dietary Approaches to Stop Hypertension), pescetarian vegetarian (excludes meat and poultry, includes fish), vegan and low fat. At the bottom of the list were the keto and paleo diets. Is there data, some meat, to back these rankings? One study reviewed all of the literature on seven diets. It found that the Mediterranean diet lowered all deaths, cardiac deaths, stroke and heart attacks. The low fat diet lowered all cause deaths and heart attacks. All of the other diets, including the very low fat Ornish and Pritikin diets, had little or no benefit. Studies on low carbohydrate, high fat “keto-like” diets have not been good. One study had 1220 people and followed them for 12 years. The keto-like diet patients had high levels of LDL cholesterol and were twice as likely to suffer from cardiac events. Another study of 370,000 people, followed for 23 years, found a higher mortality rate for those on a low carbohydrate diet compared to a low saturated fat diet.
Clearly no randomized controlled trials were done in ancient times to see if any of the diets conferred benefit from heart disease. This was due to a lack of scientific knowledge as well as the fact that our ancestors succumbed at early ages due to infectious disease, famine, the tip of the sword from an enemy or volcanic ash, well before heart disease became manifest. What is clear from the study of mummies is that high fat diets, keto or paleo, did not protect against atherosclerosis. In addition, our modern studies show that these diets are detrimental to heart health. Heart patients should avoid these types of diets. On the other hand, the Mediterranean diet is a sustainable, lifelong eating plan that continues to sit atop Agamemnon’s throne as the king of the heart healthy diets. The Mediterranean diet, along with DASH, vegetarian, vegan and low fat diets should continue as staples for the heart patient.
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