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Nutrition and Fitness
From the first Olympiad in 776 BC to 393 AD
and the concept of positive health

By Artemis P. Simopoulos, MD

Since the earliest times athletics have been an integral part of man's life and culture. Originally a part of the basic requirements for survival either for gathering food or protecting oneself and family, eventually athletics developed into contests of speed, strength, and skill. With further passage of time, these contests were transformed into more complicated forms of exercise because of a lessening of the need for basic survival skills, the advent of more leisure time, and the ingenuity of man himself.

In antiquity many of the activities that we would today regard as sport were an intimate aspect of religious and cultic festivities. For example, in the Heraen Games women raced in honor of the goddess Hera, the acrobatic gymnastics of the Egyptian girls are believed to have cultic significance, and, of course, dance was an integral and essential aspect of religious rites and women played a great role in these.

In societies where the status of women was relatively high, such as the Egyptian, the Minoan and the Spartan societies, we see women participating extensively in a variety of physical activities. In classical Athens and in Mesopotamia the status of women was low and their participatory role was similarly low.

The role of women in sport was discussed in antiquity. In the chapter entitled "The Equality of Women" in Plato's Republic, Socrates raises the question of whether "females should guard the flock and hunt with males and take a share in all they do, or be kept within doors as fit for no more than bearing and feeding their children while all the hard work is left to the males." Socrates' brother Glaucon agreed that "women are expected to take their full share, except that we must treat them as not quite so strong." They were concerned that both men and women ought to receive the same upbringing and education. Such a system, Socrates remarked, would at first appear revolutionary but he reminded his friends that, "It is not so long since the Greeks thought it ridiculous as well as shameful for men to be seen naked in the gymnasium. When gymnastic exercises were first introduced in Crete and later in Sparta, the cynics had their chance to make fun of them." However, he observed, "A new attitude was soon adapted and it will be the same once women are given equal access to physical education." Plato was concerned with the education of an elite, a selected group of leaders of proven excellence of character, mind, and body. Thus, he argued logically that once the principle of selection is recognized and the wide scope of individual differences among men as well as women is accepted a distinction between the educational systems for boys and girls is no longer justified.

Fitness, sports, and olympism

All parts of the body which have a function, if used in moderation and exercised in labors in which each is accustomed, become thereby healthy, well developed, and age more slowly, but if unused and left idle they become liable to disease, defective in growth, and age quickly.

Hippocrates

Many of the sports known to us today are mentioned by Homer in both the Iliad and the Odyssey. In the Iliad Homer describes chariot races, wrestling matches, foot races, discus and javelin throwing, and archery using a live target, a poor pigeon tied to a mast.

In the Odyssey Homer refers to Ulysses as swimming, throwing the discus, boxing, and shooting an arrow. When Ulysses arrives in the land of Phaeacians, Nausical, the daughter of the king, plays a kind of handball another evidence of women in sports-and young boys compete against one another in footraces, wrestling, jumps, boxing, and discus throwing.

In fact, in his chapter "Olympism and Literature", Banciulescu considers Homer the patron of sports journalists and states, "The XXIII song of the Iliad describes with artistic mastery sports competitions held at a time which historians still find it difficult to reconstruct. Under the walls of Troy, which were still burning, the hero Achilles organized funeral games in honor of his dead friend Patroclus. These games were in fact magnificent sports competitions. Their description, forcefuland colorful, filled with picturesque elements and inventiveness, numerous details on the technique of events, the subtleties and rules used, by far exceeds the best olympic report presented by our special correspondents' today!"

Additional information about sports is obtained from archaelogical artifacts, illustrations in coins, shields, ornaments, vases, sculptures, and bas reliefs. Many of the sports we participate in today had their beginnings in the Greek culture and were closely associated with the arts.

From ancient times, sport in its most competitive form-that of the Olympic Games-has been regarded and practiced as a kind of art and has affected art in a special way. Sport, as noble emulation, stimulating continuous improvement of oneself and aiming at the best performance of the competing athlete beyond his limits, had inevitably an artistic aspect and inspired both the plastic arts, sculpture and painting, as well as poetry, music, and literature, which is artistic in itself. This aspect of sport is inevitable when practiced in the Olympic spirit, which does not concern only bodily movement and perfection but also and principally the whole of the human being as psychosomatic unit. Pierre de Coubertin, the founder of the Olympic games in 1896, attributed the inestimable prestige the games had enjoyed for so long to the fact that in ancient times writers and artists gathered together at Olympia to celebrate the games.

The fundamental principal of Olympism is excellence, ie, the athlete has to excel over others and over his own capacities as realized to date. This basic principle thoroughly influenced the concept of beauty as being the essential element in esthetics. The ancient Greeks had no term directly expressing the beautiful as such. The word kalos used in this instance signifies beauty with goodness, as a handsome and virtuous person. This is why it was used together with agathos to denote the perfect human being as a whole, uniting within himself both esthetics and bodily existence. The athlete became one of the main sources of inspiration for the artists. The sculptors did not give individual characteristics to the statues but the athletic ideal, which was kalos-agathos (handsome and kind).

Prominent authors of the stature of a Homer, Pindar, Bacchylides, Simonides, Epictetus, Plato, Xenophon, Euripides, Plutarch, Theocritus, Virgil, Horace, Lucian, and so many others wrote about sports and fitness. They of course lived within a society and an environment where physical culture through exercise, or what we call sport today in general terms, was an important fundamental aspect of their lives. Physical education with all its apparent forms of play and Greek agonistics were part of the mentality of the time and had their place in the spirituality of the ancient city belonging to the intimate structure of man.

Basic dietary patterns

Information about prehistoric people's diets is based on archaeological evidence from remains of food, skeletal remains (teeth being the most important pointer to nature of diet), surviving artifacts (involved in food processing), and painted or sculptured representations of activities (milling, baking, and cooking).

The basic diet of both Greeks and Romans was strongly, though not exclusively, vegetarian, comprising a variety of cereals, vegetables (green and dried), and fruit (fresh and dried) with wine (diluted with various proportions of water) as the only drink apart from water. In Greece the commonest meat was that of goats; in Italy it was that of pigs in the form of pork or bacon. Beef might be eaten occasionally after a sacrifice but the cow, like the ox, was a working animal and milk was normally obtained from sheep and goats. Olive oil took the place of butter and soap and was the major source of domestic lighting. Fish (both fresh and salted) and poultry also were featured in the diet of both peoples.

By the end of the fourth century BC, wheat had achieved the dominant position among grains used for human food. Bread was a logical advance on porridge as an energy-producing cereal because bread is characterized by easy handling, transport, and durability. However, the arrival of bread did not cause porridges and pulses to disappear.

In the earliest writings of ancient Greece, food and cooking are frequently mentioned. There were many famous men who were quite proud of their culinary talent in those days: Thimbron of Athens and Soteriades practiced "fad cooking"-different foods for different moods!

The philosopher Archestratus was the author of Gastrology, which was considered a culinary masterpiece. He wrote for immortal Greece, presented his concepts with the zeal of a legislator, and travelled extensively to seek out new recipes and new treats to grace his table. The only thing that distressed him was the fact that he could not eat all the foods he liked all the months of the year. He would be very happy if he lived today because modern agriculture, refrigeration, and rapid-transportation facilities have eliminated these limitations. He therefore consoled himself by talking about all these delightful dishes all the year round. Many of his recipes, which are probably the oldest in the world (his writing took place around 350 BC), are reportedly still in use in Greece today.

The entire Western world actually owes much to Greek cooking for the Greeks gave us the art of dining. Many of the sauces in use today were developed by the Greeks.

When Greece was conquered by Rome, the Greek culture and culinary arts still triumphed in Rome. There are accounts of peacocks from Samos, crabs from Chios, cranes from Melos, and turkeys from Phrygia. Yet, although the Romans inherited all the luxury of Greece, they never erected as the Greeks did a temple to Addephagia, the Goddess of Good Cheer.

Spices and herbs were used for health and medicinal purposes. Hippocrates used over 400 different herbs in his cures and, of these, 200 are still in use today. Tansy was one: the name comes from the Greek word athanasia, which means immortality. White thyme, another herb, was known as a symbol of courage. Dill has been used for centuries. The Greeks would chew dill seeds during the never-ending political speeches and throughout long plays to keep themselves awake. The ancient Greeks believed that herbs improved one's mind and, therefore, included them in almost all their dishes.

The Greeks have always been fond of fish and it is a part of their staple diet. Greeks discovered the oyster as an edible fish. Legend has it that one day many centuries ago, a young Athenian boy was wandering along the beach in search of shells. Suddenly he saw an oyster in the act of yawning. Curiosity getting the better of him, he picked up the half-open shellfish and put his finger inside the shell. The oyster at once snapped the shell together, causing the boy to give a sharp cry of pain and to quickly withdraw the injured finger, which he at once popped into his mouth. The flavor was so delicious, however, that he broke open the shell and swallowed the unfortunate oyster. Since that fatal day the oyster has been a much harassed shellfish.

Vegetables have always held an important place in Greek cooking. In the days of Achilles and Ulysses most conspicuous dishes at state banquets were often those consisting of vegetables. Alexander the Great was extremely fond of vegetables for he was always finding new kinds, bringing them back to Greece. He found onions in Egypt, tasted them, and decided they were just the thing for increasing the zeal of his warriors. It was Alexander who discovered the haricot bean for Europe, which the Greeks have cultivated extensively. Both the Greeks and the Romans used cabbage as a remedy against drunkenness. Leeks were also popular and considered a remedy for many diseases. Other vegetables used in ancient times that are also in use today include beetroot, artichokes, turnips, radishes, etc.

In The Deipnosophistae, a second century BC cookbook written by Athenaeus of Naucratis, we find many references to the sweet creations of that period. It seems that one of the most popular desserts was none other than cheesecake. Forty-seven types of differently named cheesecakes are described: cheesecakes made of cheese and cheesecakes made of everything but cheese, cheesecakes boiled in oil and dipped in honey, cheesecakes devoted to Olympian goddesses surrounded with figures of lighted torches, and wedding cheesecakes baked over an open ftre and drenched with honey, which were given by the bride to the bridegroom to be eaten by the bridegroom's friends.

The diet of the athlete

Trainers of athletes occupied an important place in Greek society. They prepared their charges both physically and psychologically, taught skills, and supervised exercise and diet. In early days there was a simple regimen of porridge, cheese, figs, and meal cakes.

Meat was only eaten occasionally. Towards the middle of the fifth century BC, a meat diet was introduced by Slymphalos, an exathlete who had won two Olympic victories in the long-distance race. According to legend the philosopher Pythagoras of Croton was the instigator of the meat diet consumed by Eurymenes of Samos, an athlete he is said to have trained.

Some athletes are reported to have consumed enormous quantities of meat. Milo of Croton (a town famous for its athletes), who is reputed to have consumed 9 kg of meat, 9 kg of bread, and 8.5 L of wine in a day, was the most renowned of all the Greek wrestlers. Milo won five successive Olympic crowns from 536 to 520 BC. In addition to these victories he won many others at Delphi, Corinth, and Nemea.

At the original Olympic games held in Olympia, Greece for over 1000 years, the victorious athletes received more than meals. They were rewarded with pieces of ravani, spicy sweet cakes that are still eaten today. Honey, flour, and fruit were offered to the gods and are early indications of the traditional custom of Greek hospitality.

It is of great interest indeed that the award or prize of the first six Olympic Games was the golden apple. Was it supposed to signify the nutritional importance or was it simply the golden apple that was given by Paris, the prince of Troy, to the goddess Aphrodite? In any event this golden apple award was replaced by a wreath from a branch of the sacred olive tree at the recommendation of the Delphic Oracle and became a moral reward devoid of any material value.

The concept of positive health

The history of Greek medical thought and practice is an important part of the general history of science. Within the Greek achievement, medicine is second only to mathematics, and the Hippocratic writings have strong links with Ionian nature philosophers. These philosophers developed concepts of a pre-Aristotelian biology, which Democritus (fifth century BC outlined as a forerunner of Aristotle. Anaxagoras of Clazomenae (500-428 BC in Ionia developed a cosmological theory which has an important bearing on his view of physiology, particularly of nutrition: how out of bread or other foods so different from the tissues of the body, the body tissues could none the less be built up or replenished.

It was indeed no accident that scientific medicine among the Greeks began in the age of the nature philosophers who swept away the magic and superstition that hindered its growth in other societies. Nature philosophy was for the Hippocratics and others what general science is today for modern medicine. The beginnings of professional medicine and the Hippocratic Corpus were established in the fifth century BC. A physician of that period wrote that medicine is mainly a matter of regimen, particularly of diet (diet here means lifestyle: not just food but includes nutrition and exercise), discovered by man under stress of necessity and continually improved. Cooking has contributed much to the advance of man from a brutish condition in which he lived insecurely on strong and indigestible foods to a state of civilization in which cooking was one of the necessary arts. Medicine of that time understood man in relation to what he ate and drank.

The first evidence of the importance of food and exercise in health appears in the Hippocratic Corpus in the description about fever. The physicians of that period considered fever as a form of disease that was associated with other diseases. They believed that in individuals fever could arise from an excessive amount of food without exercise.

Among the Greeks, the concept of positive health was important and occupied much of their thinking. Those who had the means and the leisure applied themselves to maintaining positive health, which they often conceived esthetically, and to this end put themselves into the hands of trainers who subjected them to regimen. Training for war and athletic competition was of course well known among them. Health was an excellence in its own right, the physical counterpart and condition of mental activation. The details of regimen practiced for health were an important part of Greek medicine.

Hippocrates in regimen I said that positive health requires a knowledge of man's primary constitution (what today we would call genetics) and of the powers of various foods, both those natural to them and those resulting from human skill (today's processed food). However eating alone is not enough for health. There must also be exercise, of which the effects must likewise be known. The combination of these two things makes regimen when proper attention is given to the season of the year, the changes of the winds, the age of the individual, and the situation of his home. If there is any deficiency in food or exercise the body will fall sick. This advice of 2500 years ago is consistent with today's knowledge about genetics, nutrition, and physical fitness and their contribution to health.

Hippocratic medicine was rational medicine and lived side by side with the cult of Asclepius that was faith healing. There was no rivalry or controversy between the two such as there has been in more recent times between science and religion but the two existed in a form of honorable rivalry, not intolerance.

Herodotus (fifth century BC) remarked on the Egyptian habit of purging for 3 days every month. He said that the Egyptians pursued health by purges and emetics and believed that all human disease arises from food. Perhaps the most important Egyptian notion found in papyri was that disease was due to putrefying residues of food carried in the bowels and giving off gases that permeated the body. Hence the continual use of purges in Egypt, a practice that the Greeks followed.

Plutarch's (46-120 AD) view on emetics and catharties appears to be opposed to the current thinking of his time or at least to current practice. He believed that emetics and cathartics ought not to be introduced (into the regimen) except under pressure of great necessity. He used to say that most people fill up their bodies for the sake of emptying them and then empty them for the sake of filling them up again, thus running counter to nature's principles. He was particularly severe in condemning emetics as promoting an insatiable greed in the patient. Plutarch's statements are applicable today for patients with anorexia and bulimia. He had definite views on how to keep in good health. Plutarch emphasized the importance of good dietary habits when one is well and recommended avoiding overeating at parties. He felt that by remaining hungry one gets more enjoyment from food and advised appetite control and avoidance of lavish recipes.

Plutarch offered a list of nourishing foods. These included meat, cheese, dried figs, and boiled eggs. He recommended sticking to light, thin foods like garden produce, birds, and fish with little fat. He believed that this type of diet gratified the appetite without burdening the digestion. He recommended avoiding meat on top of other foods and that milk to be taken not as a beverage (ie, as an accompaniment to other food) but as a food possessing solid powers of nourishment.

The history of physical education shows sports and medicine to have a long-standing and close relationship from antiquity to today. Indeed if one takes into account the participation of doctors of medicine in national teams and the sporting reputations of some hospitals and medical faculties, a sympathy for sport seems to be almost a tradition of the medical profession. All we need to do is to insist that today's medicine emphasize the concept of positive health.

The concept of positive health developed by the physicians of the Hippocratic era is unique to Greek medicine. In most cultures medicine was and is still considered today by most people in a negative way-as a profession that is here to handle sick people through techniques, drugs, and other kinds of remedies. Even the terms prevention and preventive medicine have negative overtones. The concept of positive health is not population dependent but is specific to the individual.

The Hippocratic physicians distinguished among the various regimens (which they called diet) to achieve health. As indicated earlier, diet did not refer simply to food but to the whole lifestyle including nutrition and exercise. Their concept of positive health depended on knowledge of man's primary constitution (genetics), food, and exercise. The combination of food and exercise constituted regimen. In developing a regimen they distinguished regimens for laymen from those for professional athletes and paid particular attention to changing regimens for different seasons. Furthermore the regimens differed in accordance with the physique of the individual. They believed that special physiques needed special diets.

Hippocrates was the first to note the association of obesity with reduced life expectancy and said, "Sudden death is more common in those who are naturally fat than in the lean". It is rather interesting to read the Hippocratic physicians' recommendations about weight loss: "Fat people wishing to grow thin should always take exertion on an empty stomach: they should take their food while they are panting and before they are cooled they must have known about increased metabolic rate], their meat should be rich so that they will be satisfied with a minimum [they must have known the importance of fat in inducing satiety], and they should have only one square meal a day. Thin people wishing to be fat should do the opposite of these things, particularly avoiding exertion on an empty stomach". Of particular interest is the observation that athletes run a serious risk of diarrhea in training, an observation well known today. They had noticed that untrained people suffer from fatigue and recommended that the pains must be reduced by vapor baths and by hot baths and gentle walks.

Today, towards the end of the 20th century, we find ourselves at the brink of determining the human genome, which will lead to the definition of the genetic profile of individuals, and by means of recombinant DNA technology and biotechnology we are changing the genetics of plants and animals for the production of better food for man. Medical science will identify the individual at risk for developing illness or disease. This is the time to put into practice the concepts of positive health and develop regimens suited to the individual, taking into consideration the season of the year, whether the individual is a layperson or an athlete, and the individual's physique.

In the near future, research will enable us to write prescriptions specifying the type and quantity of exercise and the type of food on the basis of the genetic profile, the physique, and the type of work of the individual and environment and season of the year. We should aim to develop a world where kalos-agathos describe human beings in all cultures and where artists, writers, and philosophers write, sing, and praise the concepts of positive health.
 

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