Part Two

The Mediterranean Prescription
by Angelo Acquista, M.D.

(Page 2 of 2)

The Seven Countries Study also determined that rates of death from all causes, age for age, were among the lowest in the Mediterranean regions. The Seven Countries Study was essentially the launch for many studies to follow over the next several decades to try to elucidate what makes the Mediterranean diet so healthy, in addition to dramatically reducing heart disease. Currently it appears that concentrating on fresh, unprocessed food that was largely plant-based — along with some fish, olive oil, dairy, wine, and a little red meat — gave people of the Mediterranean the magic formula. Their diet had the best combination of fats, was high in complex carbohydrates and fiber, and was also rich in a combination of antioxidants, phytochemicals, vitamins, and minerals — the total effect of which cannot be duplicated with pills or supplements. These investigations have also taught us that, in addition to heart disease, the Mediterranean diet can help prevent obesity, heart attacks, cancer, arthritis, type 2 diabetes, hypertension, and the metabolic syndrome, among others.

In reading about Keys's studies, I learned that his first destination, back in 1952, was the southern Italian town of Naples. He was drawn there because of the reports he'd heard that heart disease barely existed among Neapolitans. As it turned out, area doctors confirmed that their hospitals rarely had coronary patients; the only cases were seen at private clinics for the well-to-do. The men of the working class — who couldn't afford the meats and dairy the upper classes could — had remarkably low cholesterol and almost no heart trouble. But the thing that struck me most about his experience was when he described the simple yet irresistible cuisine of the region:

The ordinary food of the common Neapolitans consisted of homemade minestrone/vegetable soup, pasta in endless variety, always freshly cooked, served with tomato sauce and a sprinkle of cheese, only occasionally enriched with some bits of meat, or served with a little local seafood without any cheese; a hearty dish of beans and macaroni; lots of whole-grain bread never more than a few hours from the oven and never served with any kind of spread; great quantities of fresh vegetables; a modest portion of meat or fish perhaps twice a week; red wine; always fresh fruit for dessert.

When Keys was asked years later to formulate a diet that might serve as a preventive against coronary heart disease, he could come up with nothing more suited for this purpose than the traditional working-class diet of early 1950s Naples. I realized with astonishment that he was talking about the diet I grew up on.

Sicily — an island off the southern coast of Italy and a place of dramatic beauty, history, and dazzlingly fresh and healthy cuisine — is the largest island in the Mediterranean. It's also the island I lived on until the age of nine, when my family moved to America. I lived in a small, hilly town near the Mediterranean Sea called Castrofilippo. To me it's the most beautiful place on earth — rugged, rocky, and colorful, with weather the most optimal in the world. Springtime occurs in February, and then there's virtually no rain from May to September. We had an abundance of different varieties of fruits and vegetables because of this climate. In fact, there were very few if any grocery stores where you'd buy vegetables because everyone grew their own. What's more, it was actually a necessity to eat a diet rich in vegetables, legumes, fruits, homemade whole-grain breads and pasta, and olive oil made from the olives of our own trees — even our wine was made from our own grapevines — because most people were poor and couldn't afford to buy much, meat in particular; meat was considered to be a luxury. However, because of our proximity to the ocean, we always had fresh fish available to us. Perhaps partly because of our limited access to a vast selection of foods, such as the options Americans have at their disposal today, we made the most of what we had and paid a lot of attention to food preparation, flavor, and mealtimes.

It should be noted, however, that though the culture I grew up in ate the traditional Mediterranean diet, it's not the case today. As my town as well as the rest of the Mediterranean became more affluent over the years, the diet of its inhabitants slowly became more Westernized, with more meats, dairy, and other sources of saturated fat entering into the diet, as well as refined grains. So even though the Mediterranean has historically been a healthy and lean region, it is not so anymore. Many more people there are carrying excess weight from their more Americanized diets — and American weight-related health problems have followed.

Because of the great benefits of the Mediterranean diet, I decided to adapt my weight-loss diet so that it could ease people into this exceptionally healthy way of eating. My goal was to take people from a rapid weight-loss phase with Mediterranean-style recipes into a maintenance plan in which they will be fully "eating Mediterranean." I designed it so that in the first two weeks you should lose five to ten pounds if you follow the diet plan closely. For those who wish to lose more than that, they can continue on the Two-Week Weight Loss Stage. When you are reach, you can transition to the Maintenance Stage. I knew the plan had to be practical, livable, effortless, and most of all delicious, or no one would adopt it into their lives. Once I had the foundation, I took it upon myself to select the perfect recipes for the plan.

While I come from a family with a long tradition of cooking, I never cooked until I went to medical school. It began as a matter of necessity. The deal I had with my roommates was that I would cook and they would wash the dishes. They soon caught on that I was getting my mother to make the meatballs and sauce. I would heat up some pasta, throw the pre-made meatballs and sauce over the pasta, and then go into my bedroom to relax. My roommates were faintly annoyed, but they couldn't resist the meals, so they let me continue for the whole first year of school. As time wore on, though, in the second and third years of medical school, I'd call my mother to get advice on how she made this or that. I began to keep her on the phone with me the whole time I was cooking. It was fun for me to cook and for us to bond in this way. And my roommates continued to do all the cleaning. At this point, they were so supportive of the deal that they started coming home early so we could all eat together.

Eventually I began cooking for family and countless friends as well, and it became a big part of my life. I love making and creating delicious dishes and then sharing them. Trying my recipes definitely seems to be my patients' favorite part of my diet. It makes me feel great that they enjoy them so much and that they are taking pleasure in something I provided. In fact, it's no surprise that the Mediterranean diet has demonstrated over and over in studies that because of its palatability, people are able to stick with it, much more so than other diets. You can eat Chicken Cacciatore, Grilled Shrimp with Thyme, Sweet-and-Sour Red Snapper, Halibut N.S.E.W. (potato halibut), Striped Bass Oreganato, Lentil Soup, and Pasta with Peas, Asparagus, and Tomato Sauce — now, that doesn't sound like deprivation, does it?

I want to emphasize that it's not just about the food, however. Part of the wonderful beneficial health effects from living in the Mediterranean just may be due to the lifestyle as well. During the postwar era, when the studies were done, Mediterraneans were physically active, had a slower pace of living, relied on and communed with family and friends, and — probably as a result of all of the above — had less stress. They had great reverence for the food on their table. I greatly encourage you to follow their course. Take the time to eat. Take the time to do what's important in life, which is to make good food and share it with friends and family. These meals are highly nutritious for the whole family (anyone over the age of two), so prepare them to share. I truly believe this is one of the problems our country faces — we have deemphasized dinnertime with our families and the importance of food in our daily lives.

Mealtime should be a time to enjoy, gather, savor, and linger. Food should be a pleasure, not a forbidden, dreaded part of life ridden with anxiety and guilt. I have created delicious, easy-to-follow recipes as a starting point. My goal in helping you make a lasting change in weight and health was to make a plan that was desirable, pleasurable, simple, and maintainable, and I think I have done that. It cannot be a regimented, day-by-day rule book; it must be infinitely variable and flexible, able to adjust to a person's cravings and degree of hunger, the contents of the refrigerator, or the offerings at whatever restaurant he or she winds up at. Moreover, in place of food that is mouth-watering and high in calories, there must be something healthy but equally mouth-watering and easy to attain, and that is what this book provides.

You can change your life if you follow my plan. You need to be at your best weight to be your best self, and I want to help you get there. In essence, when you become fit, you become able to free your mind from worrying about weight control and instead can concentrate on the things that matter most to you in life. First and foremost, you need to get rid of the idea of "keeping it off." I think most people who feel they have excess pounds feel "overweight" — that is, like a normal-size person who is over his or her natural weight. "Keeping it off" implies you are a fat person struggling to maintain an unnaturally thin state. Instead, I will show you how to find your comfortable weight and stay there. Once you've reached your new set point, the reduction of your cravings and your new mind-set will make you feel as if you belong there, not that you're fighting anything. The struggle is over. This book is not just a quick fix for the high school reunion; it's a prescription for life.

Copyright © 2006 by Dr. Angelo Acquista. Excerpted by permission of Ballantine Books, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

About the Author

Dr. Angelo Acquista received his medical degree from the New York University School of Medicine and is affiliated with Lenox Hill Hospital in Manhattan as an attending physician and clinical instructor. He is board-certified in internal medicine, pulmonary medicine, and tropical diseases. He served as medical director for the New York City Office of Emergency Management and on Mayor Guiliani's Task Force on Bioterrorism. He is the New York Times bestselling author of The Survival Guide: What to Do in a Biological, Chemical, or Nuclear Emergency. He lives in New York City.