In industrialized nations such as the United States, heart disease and cancer have replaced infectious diseases as the top killers, and medicine has shifted its focus from vaccines and quarantines to Lipitor and lifestyle. People who live near the Mediterranean Sea and eat lots of fruit, vegetables, and nuts and little saturated fat, live longer on avarage and have less heart disease than Americans, and many think the diet makes the difference. Two studies by European researchers looked at the effects of a Mediterranean diet on health.

What they wanted to know: Can a Mediterranean-style diet help people live longer and healthier lives?

What they did: In one study, the researchers used data collected through a couple of different surveys of people ages 70 to 90 from 13 different countries throughout Europe, stretching from Finland to Portugal. Participants answered questions about smoking, drinking, and physical activity, and nutritionists collected information about their diets. Researchers followed the participants for about 15 years to keep track of deaths. Those who conducted the second study recruited 180 people undergoing treatment for metabolic syndrome, which is characterized by obesity, high blood pressure, and diabetic symptoms. Some participants went to monthly small-group counseling sessions and received individual advice about the benefits of a Mediterranean diet. Other participants had similar sessions but were given only general advice on how to eat a balanced diet, and were not told specific foods to eat or avoid. That study lasted for two years and included blood tests, heart-rate measures, and other laboratory tests.

What they found: Both studies found huge benefits to eating a Mediterranean style diet. In the first study, people who ate a Mediterranean-style diet reduced their risk of dying during the follow-up period by about 25 percent. People who ate those kinds of foods, were physically active, moderate drinkers, and hadn't smoked in at least 15 years had less than half the mortality rate of others in the study. All of those factors individually were associated with lower death rates, too. In the second study, less than half of the people in the group that was counseled about the benefits of a Mediterranean diet still had symptoms of metabolic syndrome after two years, whereas only 12 out of 90 in the noncounseled group had managed to control their symptoms. The researchers found that symptoms such as high blood pressure and sugar sensitivity went away even after controlling for weight, showing that the Mediterranean diet may help patients with metabolic disorder even if they don't lose weight.

What it means to you: These studies provide some of the strongest evidence yet of the benefits of a diet low in saturated fats and high in fiber, fruits, and vegetables. As Harvard epidemiologist Eric Rimm points out in a related editorial, Americans spend billions of dollars a year on medications for diseases they could prevent at a fraction of the cost by changing their diet and lifestyle–with greater benefits. People who do not smoke, do not drink heavily, are active for at least 30 minutes a day, and who eat a Mediterranean style diet will likely live longer than those who don't.

Caveats: In both studies, the researchers lumped many different foods together so that they could tell whether the Mediterranean diet, as a whole, helps prolong life or reduce symptoms of metabolic disorders. However, neither study was able to say whether specific foods in the Mediterranean diet caused the effects they saw or whether it was the combination.

Find out more: The American Heart Organization explains the Mediterranean diet at: http://www.americanheart.org

Mediterranean foods are as different as the many cultures in that region, so there is no one set cuisine. Some Mediterranean recipes (mainly Italian) can be found at: http://www.trincoll.edu

Greek recipes are at: https://www.greekinternetmarket.com

Read the articles: Knoops, K.T.B. et al. "Mediterranean Diet, Lifestyle Factors and 10-Year Mortality in Elderly European Men and Women: The HALE Project." Journal of the American Medical Association. Sept. 22, 2004, Vol. 292, No. 12, pp. 1433-1439.

Esposito, K. et al. "Effect of aMediterranean-Style Diet on Endothelial Dysfunction and Markers of Vascular Inflammation in the Metabolic Syndrome." Journal of the American Medical Association. Sept. 22, 2004, Vol. 292, No. 12, pp.1440-1446.

Rimm, E.B. and Stampfer, M.J. "Diet, Lifestyle, and Longevity–the Next Steps?" Journal of the American Medical Association. Sept. 22, 2004, Vol. 292, No. 12, pp. 1490-1492.

Abstract online: Knoops et al (full text): http://jama.ama-assn.org/cgi/content/full

Esposito et al: http://jama.ama-assn.org/cgi/content/short

Rimm editorial: http://jama.ama-assn.org/cgi/content/extract