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A skeptical look at popular diets: Thumbs up for Mediterranean

In the ninth and final post in the series A Skeptical Look at Popular Diets, physician Randall Stafford examines the Mediterranean diet.

This diet emphasizes a style of eating once common along the Mediterranean Sea. The main food sources are vegetables, fruit, whole grains, legumes, nuts, fish, poultry, olive oil, and dairy products such as yogurt and feta cheese. The diet generally limits eating butter and red meat.

The Mediterranean diet is the most scientifically tested eating pattern showing substantial health benefits. A broad range of comparisons with other diets indicates that the Mediterranean diet is associated with reductions in heart disease, diabetes, cancer, and total death rates.

The Mediterranean diet involves more than just selecting generally healthy foods; it also includes social meals with family members and plenty of physical activity as well.

Health rationale slogan: A healthy diet eaten by real people who live long, enjoyable lives.

Analysis: This style of eating has many things going for it, including:

  • Practicality: it’s relatively easy to sustain both at home and in restaurants.
  • Flexibility: very few foods are off the table, provided they are eaten in moderation.
  •  Science: well-proven to have significant health benefits.

The Mediterranean diet has similarities to several more extreme diets and can be thought of as a sensible compromise in place of more radical diets. For example, this diet is basically a relaxed vegetarian diet that allows some fish and chicken as well as infrequent intake of red meat. Likewise, a Mediterranean diet is similar to a paleo diet, but allows some older but post-Paleolithic food technologies into the kitchen, such as pasta, wine, reduced-fat dairy and whole grains. This allows eating a more satisfying variety of foods.

Easy to follow?: This diet is relatively easy to follow at home and in restaurants given the inclusion of fish and chicken and the flexibility around consuming many foods in moderation. Nonetheless, the diet requires a major shift from a typical American diet.

Dominant source of protein: Fish, chicken, beans/legumes, nuts and some dairy products.

Most common fats: Healthy fats from olive oil, fatty fish and nuts.

What about carbs?: Pasta and good carbs found in fibrous vegetables, beans/legumes and whole grains.

When it goes wrong: It is difficult to make this diet unhealthy. As with many generally healthy diets, though, over-consumption of calories can be a problem, so an overemphasis on carbohydrates, such as pasta and bread, can make this diet less healthy. Also, this diet can be oversimplified by making it mostly about olive oil without including all its other features.

To make it healthier: The Mediterranean diet allows for a fair amount of carbohydrate consumption. Reducing the intake of high-carb foods (like bread and pasta) leads to more weight loss and less chronic disease compared to the standard Mediterranean diet.

Variations: The Mediterranean diet has spawned numerous variations like the DASH diet (Dietary Approaches to Stop Hypertension), which emphasizes lean meat (rather than fish and poultry), and the Therapeutic Lifestyle Changes (TLC) diet (link to PDF), which limits intake of saturated fats and dietary cholesterol.  With few changes, a Mediterranean diet can be a healthy vegetarian diet.

Conclusion: The Mediterranean diet can be enthusiastically recommended. It has the scientific evidence to solidly back up its health claims, it is practical and flexible to put into practice, and the diet’s defining features are sound and logical. The only downside is this diet’s flexibility: With fewer hard and fast rules, it may be harder to keep this diet consistently healthy. But emphasizing the core foods of whole grains, beans/legumes, fruits and fibrous vegetables will result in one of the best diets available.

The last word, from my colleague, nutrition scientist Christopher Gardner, PhD: "This diet hits the savory spot of being healthy and great tasting for more people than for any other diet covered in this series."

This is the ninth and final post in a series called A Skeptical Look at Popular Diets. The series reviews the eight currently most prominent diets in America. 

Randall Stafford, MD, PhD, is a professor of medicine at Stanford. He practices primary care internal medicine and studies strategies for preventing chronic disease. Stanford professor and nutrition scientist Christopher Gardner, PhD, examines the impact of diet on health and disease. Sophia Xiao provided research assistance.

Photo by lukasbieri

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