Is chocolate a part of the traditional Mediterranean diet?

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Permalink Reply by Clay Gordon on January 13, 2009 at 11:27am

Steve:

Many of what are thought of as the traditional components of the Mediterranean diet pre-date the 1900s and in fact can be traced back hundreds if not thousands of years.

Taking that as the starting point, chocolate can not possibly be a part of the "traditional" Mediterranean diet because cacao did not make it to Europe until the late 1500s and did not spread much beyond Spain and its holdings until the mid-1600s or thereabouts. Other staples of the "traditional" Mediterranean diet are also relative newcomers, lycopene-rich tomatoes for example, are also a New World food and would not have been a part of any European's diet until at least the mid-1500s if not later.

It is important to keep in mind that until at least the 1840s (and really more like the 1870s in Europe and the 1890s in the US) chocolate was not readily affordable by the general population as well as the fact that during cacao's early history in Europe, physicians strove to fit cocoa and chocolate into the prevailing medical canon, based on Galen's "humors." Was chocolate hot, cold, wet, or dry? Simultaneously it was hailed as a miracle cure-all as well as to be avoided at all costs. (The True History of Chocolate by Sophie and Michael Coe has quite a bit to say on this subject.) So there was a lot of confusion about whether cacao was healthy or not (remember, tomatoes at one time were considered deadly poisonous).

Given all of the above, I would have to say that neither dark nor milk chocolate can be considered to be a part of the "traditional" Mediterranean diet but that dark chocolate (e.g., chocolate without any dairy protein or fats) does - in moderation - deserve a place in the "modern traditional Mediterranean diet." (NOTE: I am not a doctor and this does not constitute medical advice. It's merely my opinion based on meta-analysis reading lots of papers on the subject. Check with your physician first. YMMV.)

Coincidentally, there is a very interesting article in today's (January 13, 2009) New York Times Science Section, the Personal Health column by Jane Brody titled New Thinking on How to Protect the Heart. The article confirms the value of the Mediterranean diet with a twist:

The traditional Mediterranean diet is NOT low-fat, it's the type of fats that are consumed that are important. Reducing saturated fats (fats that are solid at room temperature) and replacing them with fats from fish, olives, nuts, seeds, and certain vegetables is one of the key beneficial elements of the diet.

Technically, cocoa butter is a saturated fat. However, the molecular structure of cocoa butter is such that it is metabolized by the body as if it were unsaturated. Several studies have confirmed that the consumption of cocoa butter does not contribute to elevated serum cholesterol levels.

As many may now, cholesterol is not a single number. There is LDL (low-density lipoprotein - bad) and HDL (high-density lipoprotein - good) to consider (not to mention VLDL (very low density-) and IDL (intermediate density-) but I just did) and it is not just the relationship between these but also the ratio between these and blood triglyceride levels. "Good" fats such as olive oil and cocoa butter work to reduce LDL, increase HDL (which transports cholesterol back to the liver for processing), and improves the ratio between these and triglycerides. While I am not an expert in the area, one of the effects appears to be that they also somehow reduce inflammation as well as affect blood's ability to coagulate.

CRP (or C-Reactive Protein) is apparently a better indicator of risk than absolute levels of LDL or HDL.

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Permalink Reply by Steve Parker, M.D. on January 13, 2009 at 1:08pm

Thanks for you comments, Clay.

This is what I've read in the medical literature recently about the fats in dark chocolate:

The fats are 1/3 oleic (healthy monounsaturated, as in olive oil), 1/3 stearic (saturated, but no effect on cholesterol levels, unlike some other saturated fats), and 1/3 palmitic (saturated, and could increase cholesterol levels and heart risk). So it’s sort of a wash in terms of adverse health effects.

That's compatible with your remarks.

And regarding dark chocolate's antioxidant flavonoids:
Elevation of HDL cholesterol, with no effect on total and LDL cholesterol,
Decreased LDL cholesterol oxidation, leading to fewer atherosclerotic complications.

Researcher Ancel Keys, who I consider the father of modern cardiovascular epidemiology, was the key investigator (pun intended) for the Seven Countries Study, published in the journal Circulation in 1970, then as a book by Harvard University Press in 1980. This study is the one that found lower rates of cardiovascular disease and longer lifespans in association with the "Mediterranean diet." The version of the Mediterranean diet he studied was the one eaten around 1950-1960, or so. That's when the Seven Countries Study research was done.

Many say that the Mediterranean diet of that period was unusually low in meat, a result of post-World War II economic deprivation.

To my knowledge, no one was comparing diet and rates of chronic disease and death across various cultures 150 to 200 years ago. So we don't know with certainty if the traditional Mediterranean diet of 1809 was any healthier than any others in existence then or now.

BTW, I'm working on a blog post about the recent Italian study showing significantly lower CRP levels in healthy people eating an average of 20 grams of dark chocolate every three days.

-Steve

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Permalink Reply by Clay Gordon on January 13, 2009 at 1:25pm

You can do some research on what was eaten during the period before the 1950-1960 period, albeit unscientifically, by taking a look at the cookbooks of the time and relating that to contemporary written records that talk about meals, etc.

And/or you can qualify your terminology by saying that the "traditional" diet is actually a very modern, post-WWII, artifact. When I think of culturally-based food traditions I think back several centuries, not several decades.

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