Friday, May 20, 2011

The Roseto Paradox - A Diet Based Outlier?

Photo attributed to explorativeapproach
This week I started an interesting book called Outliers by Malcolm Gladwell.  This is a book about what makes successful people and has nothing to do with food.  However, the introduction to this book should grab any real foodie's attention.  The entire introduction can be read online here.

Gladwell describes a small Italian community that immigrated in the late 1800s to Pennsylvania from Roseto Italy, seeking better opportunity of course.   They named this new town Roseto after their abandoned village back in Italy.

In the 1950s this little town had gained the attention of a medical physician, Stewart Wolf, because Rosetans appeared to be only dying of old age.  This  was a phenomenon because heart attacks and heart disease were becoming an epidemic in the US at this time.  Wolf was determined to discover why the town of Roseto was beating all odds. 

Wolf studied the current residents of Roseto and the town's old death records and found that
...virtually no one under 55 died of a heart attack, or showed any signs of heart disease. For men over 65, the death rate from heart disease in Roseto was roughly half that of the United States as a whole. The death rate from all causes in Roseto, in fact, was something like thirty or thirty-five percent lower than it should have been.

He studied their ancestors  and their old region back in Italy to see if there could be a genetic link.  And then he studied all the nearby towns in PA to see if there could be an environmental link.  These were both dead ends.   

Naturally, Wolf first studied their diet to see if the Rosetans were eating "healthier" than most other Americans.  His conclusion; they actually ate worse!  But wait!  Let's see what was recorded about their diet.
Wolf's first thought was that the Rosetans must have held on to some dietary practices from the old world that left them healthier than other Americans. But he quickly realized that wasn't true. The Rosetans were cooking with lard, instead of the much healthier olive oil they used back in Italy. Pizza in Italy was a thin crust with salt, oil, and perhaps some tomatoes, anchovies or onions. Pizza in Pennsylvania was bread dough plus sausage, pepperoni, salami, ham and sometimes eggs. Sweets like biscotti and taralli used to be reserved for Christmas and Easter; now they were eaten all year round. When Wolf had dieticians analyze the typical Rosetan's eating habits, he found that a whopping 41 percent of their calories came from fat.

Conventional knowledge is that this diet is awful and unhealthy, but thanks to the works of Weston A. Price, Gary Taubes, and much more, we now know this to be an unfortunate misunderstanding.  Wolf did find many Rosetans to be obese and I would guess this has more to do with all the baked goods and sweets they were also eating.  But even though Rosetans tended to be overweight they did not seem to succumb to heart disease and heart attacks. 

Here's another important excerpt to note about the town of Roseto's diet.
In 1896, a dynamic young priest-Father Pasquale de Nisco-took over at Our Lady of Mount Carmel.
He encouraged the townsfolk to clear the land, and plant onions, beans, potatoes, melons and fruit trees in the long backyards behind their houses. He gave out seeds and bulbs. The town came to life. The Rosetans began raising pigs in their backyard, and growing grapes for homemade wine.

So Roseto was greatly involved in growing their own food (local and seasonal), cooked from scratch, and did not shy away from using the "forbidden" fats.  Unfortunately, medical and nutritional science at this time could not see this evidence as means to maybe question their conventional views on diet.  They automatically attributed the Rosetan's diet to being as bad, if not worse, than the standard American diet and continued to look elsewhere to find answers to the Roseto paradox.

Wolf finally concluded that the reason for Roseto being an outlier to the rest of the US was because of their strong values placed in family and community.  As many as three generations in a family would live under one roof and the community willingly chose to live humble and simple lives.

I don't mean to discredit or devalue Wolfs findings because I do believe social aspects of family, community, and simplicity in life style, do indeed lead to lower stress levels and happier people.  In fact, the goal of this blog is to promote simple lives and community of family and friends, just as much as it is to promote a diet of real food.  I just think that there was more to be investigated with the diet of Rosetans and, if paid attention to, could have helped to caution against the low-fat and highly processed food craze that remains today. 

It should also be noted that Wolf followed up with his research with a report 25 years later.  It appears the health of Rosetans no longer remains an outlier.  Heart and other chronic disease has caught up with the town of Roseto.  Again, this is attributed to the fact that Roseto's community no longer remains as socially tight knit as standard American values have crept in.  New generations no longer stick around past childhood, fancy cars now cruise the streets, and swimming pools have popped up in back yards.  However, in Wolf's 25 year review he does note that Roseto began consuming less animal fat.  I would bet on the fact that if one were to closely look at the Rosetan diet of today it would look much more like the standard American diet (processed, imported and vegetable-based fats), in stark contrast with their more traditional way of cooking during the 1950s and earlier.

** This post was linked at Real Food Wednesdays at Kelly the Kitchen Kop and Simple Lives Thursday at GNOWFGLINS **


  1. interesting research, and i really agree with the diet trend you picked up. i have been reading a lot about the effect of stress and general attitude to life as a very important aspect of health though, perhaps even more so than diet!

  2. There is increasing evidence for viral infections (especially from enteroviruses) precipitating heart attacks. Enteroviruses are respiratory viruses, which can be caught through kissing or close social contact.

    The Roseto Italians lived in a traditional close-knit community with probably lower levels of contact with outsiders, and most likely with lower levels of sexual and amorous promiscuity than the average American. This behavior may well have protected the Roseto Italians from picking up viral infections, thereby reducing their heart attack risk.

    There are around 460,000 fatal heart attacks per year in the US, with 40% of these (184,000 deaths) linked to enterovirus infections (reference here:

    So any lifestyle that can prevent the spread of enteroviruses in a community will likely result in lower rates of heart attacks.

    This is not to say that good food and and a supportive family network don't play a role in reducing heart attacks as well; but the fact is that enteroviral infections are likely the major mechanism of precipitating heart attacks.