Content uploaded by Katerina Sarri
Author content
All content in this area was uploaded by Katerina Sarri on Sep 27, 2017
Content may be subject to copyright.
Letter to the Editor
The Seven Countries Study in Crete: olive oil, Mediterranean diet
or fasting?
Sir,
In the December 2004 issue of your journal, in his Out of
the Box column
1
, Geoffrey Cannon referred to Ancel Keys’
Seven Countries Study
2
and the fact that Keys and his
colleagues seemed to have ignored the possibility that
Greek Orthodox Christian fasting practices could have
influenced the dietary habits of male Cretans in the 1960s
3
.
For this reason, we had a personal communication with
Professor Christos Aravanis, who was responsible for
carrying out and following up the Seven Countries Study
in Greece
4
. Professor Aravanis confirmed (Aravanis C,
personal communication) that, in the 1960s, 60% of the
study participants were fasting during the 40 days of Lent,
and strictly followed all fasting periods of the church
according to the Greek Orthodox Church dietary
doctrines. These mainly prescribe the periodic abstention
from meat, fish, dairy products, eggs and cheese, as well as
abstention from olive oil consumption on certain Wednes-
days and Fridays.
However, it is indeed the case that this was not noted in
the study, and no attempt was made to differentiate
between fasters and non-fasters. In our view this was a
remarkable and troublesome omission.
The Greek Orthodox Church prescribes almost 180 days
of fasting per year. It is unknown to what extent the
Cretans who were the original subjects of the Seven
Countries Study and who fasted during Lent also followed
the precepts of their Church throughout the year, and thus
on how many days in total and to what extent the Cretan
participants of the Seven Countries Study fasted.
Therefore, it still remains unknown whether the results
of the Seven Countries Study in Crete, which have been
very widely cited and have crucially influenced dietary
guidelines and industrial practices all over the world, were
about olive oil in particular, the Mediterranean diet in
general – or the beneficial effects of fasting in the sense of
regular restriction of certain foods, notably those of animal
origin.
Nevertheless, from our own recent studies
3,5
, we are
sure that the effects on serum lipids and longevity of
fasting according to Greek Orthodox Church practices
would have been significant, if relative data had been
made available in the Seven Countries Study. Geoffrey
Cannon was right to propose this.
Katerina Sarri and Anthony Kafatos
Preventive Medicine and Nutrition Clinic
Department of Social Medicine
Faculty of Medicine, University of Crete
PO Box 2208
Iraklion 71003, Crete, Greece
Email: katsarri@med.uoc.gr
DOI: 10.1079/PHN2005765
References
1 Cannon G. Out of the Christmas Box. Public Health Nutrition
2004; 7(8): 987–90.
2 Aravanis C, Corcondilas A, Dontas AS, Lekos D, Keys A.
Coronary heart disease in seven countries. IX. The Greek
islands of Crete and Corfu. Circulation 1970; 41(4 Suppl.):
I88–100.
3 Sarri KO, Linardakis MK, Bervanaki FN, Tzanakis NE, Kafatos
AG. Greek Orthodox fasting rituals: a hidden characteristic of
the Mediterranean diet of Crete. British Journal of Nutrition
2004; 92(2): 277–84.
4 Verschuren WM, Jacobs DR, Bloemberg BP, Kromhout D,
Menotti A, Aravanis C, et al. Serum total cholesterol and long-
term coronary heart disease mortality in different cultures.
Twenty-five-year follow-up of the seven countries study.
Journal of the American Medical Association 1993; 274(2):
131–6.
5 Sarri KO, Tzanakis NE, Linardakis MK, Mamalakis GD, Kafatos
AG. Effects of Greek Orthodox Christian Church fasting on
serum lipids and obesity. BMC Public Health 2003; 3(1): 16.
qThe Authors 2005
Public Health Nutrition: 8(6), 666