How did Ephesus prosper and become the leading city in the world after Rome was sacked? The rise and fall of this iconic city offer important lessons to all us who take the advances of modern civilization for granted. The health of the population was due to hygiene advances and the Aegean diet, which has allowed some of the longest-lived populations on the planet to thrive.

Ephesus was considered the most important Greek city and the most important trading center in the Mediterranean region for much of its history. The city was founded roughly 3,000 years ago and grew rich because of a large harbor which gave access to the fertile lands and rich crops of Asia Minor. It was also closer than Istanbul and other northern ports to the rest of the Mediterranean, which made trade easier. After numerous civilizations controlled this region, Alexander the Great conquered Ephesus in 334 BC.

In addition to commerce, the Greeks worshipped gods and especially Artemis, goddess of hunters and the Moon and Apollo’s twin. To celebrate one of the most revered Greek deities, citizens erected the Temple of Artemis, which became one of the Seven Wonders of the Ancient World and was the Vatican of its era.

Their majestic amphitheater could seat 25,000 people. City planners would expect 10% of the population to attend events, so we can multiply this capacity tenfold to estimate a total city population of 250K. To keep this population in one place, they preserved public spaces (agoras), created a sophisticated sanitation system with public toilets and water, and even lit the city with torches’ light at night.

They also treasured diversity and brought Greeks, Romans, Egyptians, and Jews together and gave rights to women so they could all contribute to society. They built the Library of Celsus, the third largest library in the ancient world. They had a large medical school to help with contagious diseases and its hospital was known around the world as the “Place Death Was Not Allowed to Enter.” Ephesus also created the first psychiatric hospital, perhaps to address the challenges of crowding in an urban society. Without attention to the health of its citizens, Ephesus would not have maintained its dominant status for so many centuries.

However, the inhabitants of this region had another secret to longevity that only became apparent over the past 20 years with the discovery of Blue Zones. These unique regions around the world boast an inordinate number of centenarians and researchers identified the Mediterranean diet as a major driver. Experts have proven that the raw materials for living long and well are fresh produce combined with unsaturated fats like olive oil and small fish rich in omega-3 like anchovies and sardines. These are the foundation of meze dishes which adorn the region’s dinner tables, but the diversity arose because the Jewish, Greek, and Ottoman communities swapped recipes and created new dishes.

One local favorite is cigirtma with peppers and tomato sauce stuffed into eggplant and seasoned with garlic and pepper flakes. Its major competitor is the artichoke bottom which is often eaten as an alternative to salads. Both are rich in nutrients required to feed our microbiome and avoid common chronic ailments, which was of great value in the era prior to modern medicine.

Despite its residents’ excellent personal health, Ephesus was destroyed by the Goths in AD 262. Some restoration of the city took place, but it never regained its splendor. The accumulating silt in its harbor accelerated its decline, as the stagnant water gave rise to malaria which devastated the crowded city, a stark reminder that our environment always matters. Finally, earthquakes and invasions weakened the town so Ephesus was conquered by the Ottomans in the 1500s. By the end of that century, Ephesus was abandoned, and its legacy left to archaeologists, historians, and the thousands of visitors who flock to the region each year.  

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