Q J Med 2001; 94: 173-174
© 2001 Association of Physicians
Correspondence |
The Mediterranean diet revisited
Blackburn Royal Infirmary, Blackburn
Sir,
There is no question that there is a low incidence of coronary heart disease among people who live close to the Mediterranean, and obviously eating is an essential part of living. Unfortunately, there is within society at large and scientific medicine also, a tendency to jump to the conclusion that an association inevitably involves causation. For a number of years, we have therefore had a strong view expressed and indeed an assumption made that coronary heart disease is basically dietary, and that the adoption of a Mediterranean diet is the way to reduce coronary heart disease in north-west Europe. The recent editorial ‘The Mediterranean diet revisited, towards resolving the (French) Paradox’,1 once again makes the assumption that diet is the causative link, and does not consider an alternative model of causation.
In hypothesis generation, it is important to look at all possibilities and the editorial failed to look at the major alternative hypothesis that the Mediterranean diet and a low rate of coronary heart disease might have a common causative factor. In other words, the link between living by the Mediterranean and having a low incidence of coronary heart disease might be mediated by something other than diet.
Climate is the obvious contender. It is quite clear that coronary heart disease rates are low where the olive tree grows. My colleagues and I have expressed the view that the common causative factor is sunlight energy at ground level, which is responsible for the maturation of the olive, and also which is known to be metabolically active in the human.2,3 If the French or Mediterranean paradox is to be resolved, then this model needs to be considered seriously. The very presence of a paradox is a good reason for a radical rethink, and the suggestion that we have made means that the paradox disappears.
It is also important to look at the bigger picture. It is clear that it is not simply coronary heart disease that has a low incidence in the Mediterranean countries, but comparative data between Belfast and Toulouse show quite clearly that the death rate from ‘all causes’ in middle age men is significantly lower close to the Mediterranean.4 We therefore need to find a factor which has a major influence of human health and which is protective against more than coronary heart disease. Sunlight energy might be just as important for the health of the human as it is for the production of olive oil.
References
1.
The Mediterranean diet revisited—towards resolving the (French) paradox. Yarnell JWG, Evans AE. Q J Med2000; 93:783–5.
2.
Grimes DS, Hindle E, Dyer T. Sunlight, cholesterol and coronary heart disease. Q J Med1996; 89:579–89.
3.
Grimes DS, Hindle E, Dyer T. Respiratory infection and coronary heart disease: progression of a paradigm. Q J Med2000; 93:375–83.
4.
The PRIME Study Group. The PRIME study: classical risk factors do not explain the several-fold difference in risk of coronary heart disease between France and Northern Ireland. Q J Med1998; 91:667–76.
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