A Visit to the Land of Happy Old People

Reflections on the Mediterranean diet as an antidote to encroaching middle age

nina burleighFollowJun 4

CILENTO, ITALY — By the time my husband and I set off on our hike in the Cilento, an Edenic mountainous region of Italy where some of the longest-lived people on Earth dwell, we’d been in Italy gorging on antipasti, primi, secondi, dolci, and vino twice dailyfor almost a week. To say we staggered to the edge of paradise would be only a slight exaggeration.

The Cilento is Italy’s second largest national park, encompassing thousands of square kilometers of cliffs, gorges, mountain peaks, plunging waterfalls, and verdant ravines. Situated on the edge of the Mediterranean just south of the Amalfi Coast, Cilento stretches far inland to include the mountainous regions of Magna Graecia, the ancient Greek colony on the ankle and toe of the Italian boot, near UNESCO sites like Pompeii and the idyllic temple complex of Paestum.

Besides blissful sheep, jolly goats, olive trees the size of oaks, and vistas of misty mountains splintered with birds-eye views of Homer’s wine-dark sea, the Cilento is said — and not by ancient legend, but by modern scientists — to be home to some of the healthiest human beings on earth.

My husband and I dropped in for what turned into an eat-fest a few days after our 20th wedding anniversary. Two decades after we first went to Italy on our honeymoon we are improbably rolling into middle age together, with two cute kids, having survived financial ups and downs, health and marriage still intact, and still having fun.

“I don’t really want to live forever, but if I could just keep riding my bike until the day I croak, I’d be okay with that.”

Despite all that, the creaks and groans of middle age are growing louder. For me, middle age put a tiny crack in the rigor, the self-denial, and discipline that got me to this point. I used to be, metaphorically speaking, an early to bed, early to rise woman. Now, I linger later at the feast. I think, just one more sip! One more experience that could be even better than the last one. Maybe there’s even a better house, a better lover, or a better life!

Beyond the vague discontent, the specter I fear most is becoming immobilized by disease. I can deal with turning into a wizened crone, and I don’t really want to live forever, but if I could just keep riding my bike until the day I croak, I’d be okay with that.

It turns out there might be a way to get there. In 2016, the University of San Diego and La Sapiens in Rome released the results of their CIAO study(acronym for Cilento on Aging Outcomes). The researchers studied the diets and blood of 29 centenarians living in the Cilento region — men and women who had spent their lives walking up and down steep ancient trails and stone steps on the hamlets that cling to the mountainsides, living simple lives, and consuming the basics of the Mediterranean Diet, high in olive oil, nuts, and vegetables, low in dairy and meat, lower still in sugar. They found a lower than average blood biomarker associated with heart problems, as well as higher levels of metabolites possibly associated with longevity and general health.

The CIAO study landed coverage from CNN and the New York Times, including headlines that suggested the secret to longevity is lots of sex and healthy food. Pictures of wrinkled happy geriatric men and women, holding hands, accompanied each story.

As it happens, I had met some of those people before the study. I first visited Acciaroli eight years ago, not to study how its inhabitants were living longer, but to learn why one of them had died. I was assigned to write an article about the unsolved murder of a beloved mayor named Angelo Vassalo, who’d been re-elected four times by the people of the hamlet Acciaroli, then executed by the criminal underworld for his success at modernizing the region into a model of local food and communitarian living.

I interviewed cheesemongers,olive oil cooperatives, and fishermen who’d been fishing alici — the local sardine, ancient staple, out of the nearby sea. Vigorous old people, leather-faced, vital, passionate, angry, talked to me about their beloved mayor.

Mayor Vassalo grew up fishing those waters, and as a boy became concerned about the trash dumped by cruise ships from the Amalfi Coast. He started a cleanup project. Then he made a regional alliance with the Slow Food Movement, an international organization promoting traditional agriculture, sustainable foods and local businesses worldwide. It started in Italy in

1986, in response to the opening of a McDonald’s near the Spanish Steps in Rome. Vassalo’s work attracted the attention of Italy’s malavita, who was intent on building ugly tourist-attracting McVillas with cheap materials on a swath of Mediterranean coast that had hitherto been too poor and undeveloped to attract notice. The killer, or killers, have never been caught, although reports have suggested that he was murdered after he stood up to illegal construction rackets from Naples over environmental issues.

In the year before he was murdered, Vassalo was president of Cittaslow, an organization related to Slow Food, and he was so successful at promoting local cheeses and other products to restaurants in Milan and Rome that young people who left small family farms to find industrial jobs in the north were returning to the region to produce artisanal products. Now, 26 products grown or made in the Cilento park have the Slow Food stamp of approval.

Vassalo’s legacy is that the link between Cilento and the Mediterranean Diet has enriched the region, and he’s given much credit for its influence. But it was always there. Ancel Keys, a World War II Navy medic and cardiologist, “discovered” the Mediterranean Diet in the Acciaroli area in the late 1940s and early 1950s, shortly after World War II, as he studied why the natives seemed immune to heart disease.

In 1958, he tested the theory more widely, with the so-called Seven Countries Study. Over the decades, the study followed 12,000 healthy middle-aged men in Italy, the Greek Islands, Yugoslavia, the Netherlands, Finland, Japan, and the United States. The results confirmed that diets high in saturated fats led to more heart attacks.

In 1980, Keys published the first of several books on the diet, from his villa in Pioppi, just a few miles down the coast from Acciaroli. In the 70-odd years since Keys identified it, science has further confirmed that the Mediterranean diet is linked to reduced heart disease, and less cancer, Alzheimer’s and diabetes, among other conditions. Keys ate as he wrote, and crossed the centenary line, dying at 101.

Today, the town of Pioppi, located a few kilometers south of Acciaroli on the coast, has a little shrine to him and the Mediterranean Diet, a small museum in an old palazzo by the sea. There visitors can peruse the books from Keys’ library, taste-test extra virgin olive oil, and contemplate displays of the healthy food pyramid (sugar at the pinnacle, legumes as the base, dairy and meat only as condiments). There were agreeable posters stating “Wine: As Much as You want.”

I thought about the paradisal quality of Cilento often over the years after I got back to New York. It became a daydream sanctuary where I imagined a shack with some goats overlooking the Med, myself supine as sunlight shafted down through a lemon tree, and figs, olives, and walnuts fell into my mouth. I would reach out lazily for the occasional sardine, and wait in blossom-scented hills for the inevitable but hopefully soft touch of the Grim Reaper.

I wanted my husband to see Cilento, and taste it. We are not foodies, but we’ve both come a long way from our childhood diets of bologna sandwiches on Wonderbread, Kraft Mac and Cheese, and Ho-Hos for dessert. Years of living in France and Italy changed our eating habits. We cook with extra virgin olive oil and drizzle the freshest bottles of it on bread, savoring the spicy kick in the throat; we eat minimal amounts of meat, we put greens on our plates every night, and we snack on almonds all day, washing it down with a glass or two of red wine — a modified version of the Mediterranean Diet.

On this trip to Italy, we started off in Naples, driving south into the mountains and through autostrada tunnels, and then down into the coast of the Cilento, veering off the highway and up into medieval cliffside towns overlooking the sea. One of these, Castellabate, is so perfectly made and situated that Napoleon’s brother-in-law, Joachim Murat, briefly appointed King of Sicily, uttered words that are today engraved on a plaque in the main piazza: “Here, one need never die.”

Dr. Holly Nicastro, PhD, program director of the National Heart, Lung, and Blood Institute, a brand of the National Institute of Health, can’t validate that observation. But she says that Keys’ Seven Countries Study remains a seminal point of reference in diet and health research because it highlighted substances that increase risks, like saturated fats. As a longitudinal study, its implications are limited because researchers don’t change anything people are doing, they just watch and collect data, she explained. “You can’t say people live longer because they did X, you can say they live longer, but you can’t say you have a cause and effect.”

More recent randomized clinical trials have gone further into cause and effect and confirm that the diet is protective against cardiovascular events. The firstwas conducted only in France in 1999, though, which Nicastro said limits its implications for Americans whose lifestyle, in terms of stress levels, circadian rhythms, and baseline poorer diet, differentiates them from the French.

Another recent five-year study in Spain, published in 2018, is more relevant, she says. Subjects were divided into groups, and given either a liter a week of extra virgin olive oil, a daily ration of nuts (both elements of the Mediterranean Diet) or were put on a low-fat diet. The two Mediterranean Diet arms of the study — the extra virgin olive oil group and nuts group — produced a 30% decreased risk of heart attack and stroke death compared to those on a low-fat diet.

Scientists are still trying to explain precisely what those foods do to the body. “We don’t know the exact mechanism — or more likely, mechanisms — by which the Mediterranean diet works,” Nicastro says. “This is something many research groups are tackling right now. It likely involves multiple pathways. For example, extra virgin olive oil is rich in monounsaturated fatty acids and in polyphenolic compounds that give it its characteristic color, flavor, and odor,” which are linked to weight loss, reduced risk of heart disease and decreased inflammation.

The diversity of foods within the Mediterranean Diet may also be protective. “The multiple potential mechanisms highlight how important it is to follow an overall healthy dietary pattern and not just focus on one or two ‘magic bullets’ to eat more of,” she says. “It is likely the combination of healthy foods and their various nutrients and components, as well as the lower levels of detrimental components like saturated fats and added sugars, that work together to lower one’s risk for cardiovascular disease.”

During our mountain hike, my husband and I encountered a single person on a street in the hamlet of Celso, a vigorous but toothless old man — if not one of the local centenarians, then certainly in the same generation. He directed us to the sole open bar, where we stocked up on water, then kept walking, now downward toward Acciarioli.

On the way downhill, we passed a woman walking uphill on the other side of the road. She was, I would estimate, well into her eighties. The road was steep, almost vertical, really, and there was no dwelling between the village below at sea level below and the houses nestled in the hilltop town above. The distance from sea level to town was at least two miles. She walked on steadily, like a metronome.

The promise of the Mediterranean Diet is not eternal life, but a healthier old age. And that’s as good as it gets. Why would you want to live to 100 if you lost the ability to walk unaided at 85?

Back in New York, our family doctor told my husband that she’s not a fan of the Mediterranean Diet. It has too much caffeine. Too much wine, she says. Certainly, that’s how we approached it. A glass of red wine was nice, but a whole bottle at dinner was even better, especially since one of the miracles of Italian wine consumed in Italy is that it doesn’t produce hangovers.

At the Mediterranean Diet Museum in Pioppi, I talked to a man in his thirties who asked not to be named. Confidentially, he told me, the Diet is not the secret to longevity. No one in his generation of Cilentani, he expected, would live to be 100 like the old folks in the piazza. The 100-year-olds got there because when they were young the land and sea were unpolluted and cleaner than now, he says. Unregulated toxic waste dumping by the Mafia in the water nearby has been widely reported. Cruise ships along the Amalfi Coast are also believed to have dumped waste in the sea. Besides that, when Keys arrived in devastated post-war Cilento, people were poor. Cars were scarce, televisions and smartphones a long way off. Young and old had to move, to exercise, simply to stay alive.

Experts who study the Diet and aging agreed with that assessment: “Very likely the younger generation in the same region will live shorter lives [than previously studied generations] because the traditional Mediterranean diet is being lost, physical activity has decreased and screen time is large,” says Dr. Walter C. Willett, professor of epidemiology at Harvard. “This is happening all around the Mediterranean region. People are getting fatter, and we know that this will have many adverse effects over the coming decades. Of course, these trends are not inevitable and we should do all we can to change them.”

Italy’s great poet Dante opens his epic poem, The Divine Comedy, with a middle-aged man “in the middle of life’s journey” spiritually lost in a selva oscura, a dark wood. I have occasionally thought of that metaphor as the psychic and physical disorientation of middle age crept up on me. What happened to the sure path I trod for so many decades, bearing children, producing work, cooking meals, loved and loving? Where am I? And what lies beyond these dark woods?

I still see that old woman walking up the hill from the sea. I can visualize her face, the focused eyes, her fierce and determined posture. She is old, truly old, older than I am or have yet imagined being, a beacon of some kind. She climbs and climbs, the bees buzzing, the sunset at her back, facing the indigo night at the top of the mountain. Life is a glorious, gorgeous mountain: She must climb it daily.

I didn’t stop to ask if she ate extra virgin olive oil and nuts every single day of her life. It could not be otherwise.