Part 9: What About the Mediterranean Diet?

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Spoiler alert: At the end of the movie The Sixth Sense the main character, Dr. Malcolm Crowe, realizes that he is yet another dead person that Cole can see. Cole told him earlier in the movie that the dead people "only see what they want to see." Malcolm suddenly becomes aware of all the details he missed to indicate that he was no longer alive, such as his wife dining alone and not answering him. One set of events, but two points-of-view. Two different views that see the same event in different ways.

The Mediterranean Diet is very similar to this concept. The Mediterranean Diet is known popularly as the fish, olive oil, and red wine diet, because that is one viewpoint that has been taken with regards to the results of several medical studies on this diet. But the other viewpoint that is grossly overlooked is that the bulk of the actual Mediterranean Diet is a whole foods, plant-based diet with lots of physical activity. Because of these two drastically different view points, many myths have been perpetuated about the health benefits of consuming the Mediterranean Diet. In today's post, I hope to clear up some of these myths and point you to the truth.

Background:
The Mediterranean Diet originated from an American nutritionist, Ancel Keys, who led the "Seven Countries Study" in the late 1950s. The "Seven Countries Study" evaluated the health status, diet, and lifestyle factors of populations from seven different countries. One of these countries was the island of Crete. In the study, Keys learned that the population of Crete had significantly lower rates of heart disease than many other countries, including the United States. Now here is where "The Sixth Sense" dichotomy comes in...

At the time of the study, the population of Crete was primarily agricultural (high levels of physical activity) and ate a diet consisting of mostly whole grains, vegetables, and fruits, with some fish, red wine, about 3 Tbsp of olive oil per day, and limited amounts of meat and dairy.  One point-of-view is that the fish, olive oil, and red wine were the "super foods" that kept this population healthy. Another (my) point-of-view is that this population was healthy in spite of the small amounts of fish, oil, and red wine (and meat and dairy) that were consumed. In other words, their primarily whole foods, plant-based diet and physically active lifestyle protected their health from the detrimental habits of consuming little to moderate amounts of oil, fish, meat, and dairy. Not the other way around. In fact, as it pertains to heart disease, Dr. Caldwell Esselstyn has shown that the reversal of arterial blockages (i.e. a true cure to heart disease) is made possible on a whole foods, plant based diet that is very low in fat and excludes meat, dairy, and oil.

But this is not the news that people want to hear. As Dr. John McDougall says, "people like to hear good news about their bad habits." Hence, fish, olive oil, and red wine to the rescue!

What about the population of Crete today? They continue to consume fish, olive oil, and red wine, but have adopted a more Westernized diet (higher amounts of meat and dairy in the diet) and reduced the amount of physical activity since the country became more industrialized. The population's health has declined. This phenomenon has been observed in other populations as well, such as Hawaii.

However, the Mediterranean Diet continues to be very popular today. The non-profit company Oldways, founded by K. Dun Gifford, continues to provide information about how to adopt the Mediterranean Diet. Sadly but not surprisingly, K. Dun Gifford passed away in 2010 at age 71...from a heart attack. The sad part is that the man who created his company to promote healthy eating suffered from the effects of unhealthy eating. So let's discuss the benefits and detriments of eating the Mediterranean Diet according to the pyramid below.

Summary of Diet Recommendations:
Today's Mediterranean Diet consists primarily (base all your meals on these foods) of fruits, vegetables, mostly whole grains, legumes, nuts, seeds, herbs, spices, and olive oil. Fish and seafood is recommended at least two times per week. Poultry, eggs, cheese, and other dairy products are recommended in "moderate" amounts "daily to weekly." Red meats and sweets are recommended less often. Physical activity is also recommended, but no specific amounts are provided.

What's Good?
It's wonderful that the Mediterranean Diet consists largely of a whole foods, plant-based diet. Lots of whole grains, legumes, fruits, and vegetables are recommended. I love how they say to "base every meal on these foods," though I would omit the olive oil completely because all it does is add unnecessary fat to the diet (recall from Part 1:What About the Standard American Diet? that 2 Tbsp of olive oil per day produces 24 lbs body fat per year). An easy way to switch your thinking when adopting a plant-based diet is to plan your meals around a whole grain, starch, or legume as opposed to planning meals around a meat item.

I also like how the "sweets" are recommended occasionally. I love my sweet treats, but they should be kept as treats, not a regularly consumed item.

It is also nice to see that the Mediterranean Diet recommends regular physical activity, though it would be nice to see some specific recommendations on frequency and intensity. I recommend at least 5 days per week, at least 45-minute sessions, aiming to keep your heart rate in your target zone (you're out of breath enough that you can still talk, but would rather not). I also recommend a variety of physical activity: weight-training, cardiovascular, and yoga/stretching.

What's Bad?
The recommendation to eat fish at least twice per week is misleading advice. I recommend eliminating all animal products, including fish, from your diet. Fish is commonly, but mistakenly, considered a health food or as one of those mythical "super foods" that surely everyone must need because of all the "good fats" and omega-3 fatty acids. Let's look at the real story about fish.

Fun Facts about Fish

In general, fish contain 1.5 to 2 times more cholesterol than chicken, pork, or beef.

Plants make all omega-3 and omega-6 fatty acids.
Fish, animals, and humans do not create omega-3 and omega-6 fats.
This means that fish get these fatty acids from eating plants.

Skip the middleman by eating plants directly, avoiding the harmful fat and cholesterol!

I also recommend avoiding dairy. That's why I think the recommendation to consume "moderate" portions of dairy products is very poor advice (it's also very vague). Dairy is not a healthy food to consume, even in small amounts. It's high in fat, cholesterol, sugar, estrogen, and concentrated animal protein.

The notion that olive oil is "the good kind of fat" is just plain silly. Yes, there are different forms of fat, but fat is fat (recall Fun Facts about Fat from Part 8: What About the Raw Foods Diet?). The human body creates, from other nutrients, all forms of fat needed except two: omega-3 and omega-6 which, as described above, are only created by plants. Plant foods and whole grains do contain small amounts of fat, more than enough for your bodily needs. There's simply no good reason to include extra fat in your diet.

You must also be aware that certain plant foods are unusually high in fat. Avocados, nuts, nut butters, seeds, and olives are examples of this. These higher fat plant foods still contain healthy nutrients, but also contain very high levels of fat. If seeking to lose weight, you should limit your intake of these foods to a couple times a week. Even if you are at your optimal weight, these higher fat plant foods should not be consumed every day.

Animal products of any kind are not beneficial to a person's health because of the high-fat content, cholesterol, and acid load it puts on the body from the excess protein consumption. The Mediterranean Diet would look perfect if it omitted the meat, fish, dairy, and olive oil, as opposed to making those items the "hero" of why the Crete population was healthy in the 1950s. It is such a shame to overlook the real hero of their former state of health: the whole foods, plant-based diet.

Bottom Line:
The original Mediterranean Diet (Crete population in the 1950s) consisted of a very physically active lifestyle and a primarily whole foods, plant-based diet with limited amounts of meat and dairy. The decreased health of this population as it adopted a more Westernized diet while continuing to consume fish, olive oil, and red wine supports the notion that it was not the fish, olive oil, and red wine that kept the population healthy -- it was the plant-based diet that had a protective effect. As it stands today, the popular Mediterranean Diet recommends consuming olive oil, fish, meat, and dairy -- all of which are unhealthy for you. A whole foods, plant-based diet is the key to better health, not added oils, fish, or red wine.

Here is an interesting video clip of Dr. Pam Popper (The Wellness Forum) speaking about the Mediterranean Diet myth.

Next -- Part 10: What About the Paleo Diet?
Previous -- Part 8: What About the Raw Foods Diet?
Introduction to the 10-Part Series

Part 8: What About the Raw Foods Diet?

The raw foods diet originates from Dr. Maximilian Bircher-Benner, who in the late 1800s discovered that he could cure his own jaundice by eating raw apples. The theory is that cooking foods removes all the nutrients and vitamins from it (but this claim has not been supported through scientific evidence).

Summary of Diet Recommendations:
The raw foods diet consists of uncooked (not heated above 115 degrees Fahrenheit) vegetables, fruit, sprouts, legumes, nuts, seeds, herbs, and cold-pressed oils. Although not shown in the above pyramid, a "raw foodist" may not necessarily be vegan, but may also consume raw fish, meat, unpasteurized milk, cheese, and other dairy products.

What's Good?
Those that avoid consuming all animal products (vegan raw foodists) also avoid the over consumption of animal protein, which is very beneficial for a person's health.

Furthermore, eating a diet full of plant foods is very healthy, but a strictly raw foods diet lacks certain plant foods that are inedible in their raw state (i.e., rice, potatoes, beans). In other words, Michael and I eat raw foods some of the time, but we do not eat raw foods 100% of the time, because we know it's also important to consume whole grains and starches (which require cooking to become edible). I'll explain more about this shortly.

The raw foods diet is also low in processed and refined foods, which is a healthy trait.

What's Bad?
The main drawback to a raw foods diet is that it is extremely difficult to consume an adequate amount of calories from whole, plant-based foods because certain high-calorie plant foods are inedible in their raw state. Many whole grains and starches are automatically eliminated from a raw foods diet because no foods can be heated above 115 degrees.

This point brings up a common question or concern that I have heard from friends. I usually hear something like this: "But I have a friend who went vegan for a time and became so skinny/weak/emaciated that he/she had to stop." My response is usually, "I'm not surprised," which puzzles the person. I then go on to explain that it is entirely possible (and I would argue, common) to technically be vegan, but not eat a health-promoting diet. As I mentioned in Part 7: What About the Vegan Diet?, a vegan is commonly found in one of two ways: the junk food vegan or the starving vegan.

As I discussed in Part 7, a junk food vegan is common because there are so many convenient high-fat, highly-processed vegan food options that are available.

The starving vegan is the result of the person trying to live on vegetables and fruit alone. The problem with that is that vegetables contain about 200 calories per pound and fruit has about 300 calories per pound. Though these two food groups are very healthy and should be consumed often, they should not be the largest food group consumed because it is difficult to consume enough of them to get all the calories you need each day (recall from Part 7 that you would have to eat 10 lbs of vegetables and 6-7 lbs of fruit each day if you needed 2,000 calories per day to maintain your weight, and athletic/active individuals often require 2,500 or more calories). This is why I recommend that whole grains and starches make up the bulk of your diet, and then supplement with vegetables, fruit, and other plant-based foods.

I'm not surprised the person's friend "who went vegan" and tried to live on vegetables and fruit alone ended up so skinny, weak, and emaciated...because they slowly starved themselves into poor health. I usually end the conversation by posing the rhetorical question, "Do Michael or I look emaciated and sickly?" The answer is no, because we eat mostly whole grains and starches, coupled with vegetables and fruit.

A raw foods diet is essentially a starvation diet, unless the person intentionally eats higher-fat raw foods. But this is not a good solution either.

If the raw foodist consumes large amounts of high-fat raw foods in an attempt to consume enough calories each day, the person will eventually end up in an unhealthy state. The cold pressed oils, nuts, seeds, avocados, and olives are very high in fat, which would help a person avoid starvation, but is not beneficial for one's health in the long run.

Fun Facts about Fat

Our bodies store fat easily to ensure survival in times of famine.
But famine in the U.S. is not a reality,
so fat and more fat continues to be stored in the body.

Eating carbohydrates does not result in weight gain because your body
burns off excess through body heat and energy before storing as fat.

Only with extreme over-consumption will your body convert carbohydrates to fat,
but it is a very inefficient process that requires 30% of the calories
consumed just to complete that process.

But fat is easily stored by the body,
requiring only 3% of calories consumed to complete the process.
The fat you eat is literally the fat you wear!

The over consumption of fat can lead to obesity, type II diabetes, and arthritis.

80% of the calories in nuts and seeds are from fat.
1 oz of walnuts (a small handful) contains 183 calories, 153 from fat (84% fat content)
Eating just 1 oz of walnuts every day would result in consuming
5,490 calories -- or more than 1.5 pounds of body fat -- each month!

Eating a diet that requires you to consume large amounts of high-fat foods to eventually maintain your weight is not sustainable in the long term. For example, if an overweight person needed to lose 20 lbs to reach their optimal weight, they could easily achieve that eating a raw foods diet by eating mostly raw fruits and vegetables and little to no high-fat raw foods. But after the person reaches their optimal weight, they would be required to consume more calories to prevent additional weight loss. By restricting themselves to raw foods only, they would be "forced" to consume high-fat raw foods to get more calories. It would be a bodily experiment on one's self to determine the exact amount of high-fat raw foods that must be consumed each day to maintain the person's weight. This is impractical and unnecessary. Why not eat a whole foods, plant-based diet consisting of naturally low-fat carbohydrates (whole grains and starches) and vegetables and fruit? Unlike nuts and seeds, whole grains and starches have lots of fiber that help a person regulate how much food to consume, without having to monitor how much body fat is constantly being accumulated. Isn't effortless weight loss and maintenance more appealing?

The final point I want to make is that food is meant to be enjoyed. If you choose the right kinds of food, then you should have the freedom to enjoy every bite to satiety. I think I would become miserable eating nothing but unseasoned, raw foods every day. Sure, I enjoy the occasional raw broccoli florets for a snack, but I do not want to only consume raw vegetables. Salads? Delicious, but I tend to get tired of salads if I eat them everyday. Fruit - that makes more sense to eat raw, but I still enjoy cooking fruit on occasion. For instance, this summer we discovered the simple, yet delicious dessert of sauteing some sliced peaches in water with cinnamon and oats. A raw foods diet seems very limited to me.

Bottom Line:
Though raw foods can be very healthy, eating a 100% raw foods diet is not. Whole grains, legumes, and starches, which are necessary for adequate calorie intake and proper weight maintenance, are inedible in their raw state. Eating an entirely raw foods diet either leads to starvation or too much fat intake in order to consume enough calories -- neither result is health-promoting or beneficial for losing/maintaining weight. A whole foods, plant-based diet (centered around cooked starches, legumes, and whole grains) is the most health-promoting and results in effortless weight loss and maintenance.

Next -- Part 9: What About the Mediterranean Diet?
Previous -- Part 7: What About the Vegan Diet?
Introduction to the 10-Part Series 

Part 7: What About the Vegan Diet?

Veganism is not only a way of eating, but a way of living. People who consider themselves "true vegans" avoid harming or taking anything away from animals in every way. Not only do they avoid consuming any form of animal products in their diet (no meat, fish, eggs, or dairy), they also refuse to purchase clothing, shoes, linens, household/beauty products, etc. that are made with animal products or tested on animals. There is some debate amongst vegans about whether it is or is not okay to consume honey. Sometimes vegans will boycott an entire company and its products if even one product is tested on animals or uses animal products. It's no wonder that vegans are often viewed as crazy hippies or aliens from another planet.


(Photo Source)

Summary of Diet Recommendations:
Similar to vegetarians, vegans likely feel good about no longer contributing to the negative environmental and ethical mistreatment impacts associated with the meat and dairy industries (read my Stewardship series to learn more about this).

In general, vegans avoid consuming any food or beverage or using any product that contains animal products or derivatives of any kind -- a few examples are no meat, fish, dairy, eggs, honey, beeswax, bones, gelatin, lard, lanolin, casein, and whey.

What's Good?
It's very good to eliminate animal products from your diet. I also like that vegans go the extra mile to ensure that no animal products are contained in packaged foods they consume. This is one of the most difficult aspects of eating opposite to most Americans, but the vegan's passion fuels them to ask questions about ingredients. Furthermore, it would likely be easier for a vegan to adopt a whole foods, plant-based diet because they are already committed to avoiding all animal products and investigating what is in the food they eat. Their decision to not contribute to the meat and dairy industry have a positive impact on the environment.

What's Bad?
The problem with a vegan diet is that it's defined by what to avoid rather than what foods to pursue. As I mentioned in Part 6: What About the Vegetarian Diet?, simply eliminating all animal products from the diet is only half the picture. In other words, eating a strict vegan diet does NOT necessarily mean that the person is eating a healthy diet. The end result is usually one of two outcomes: the junk food vegan (discussed in this post) and the starving vegan (I'll address this briefly in this post, but you should also read Part 8: What About the Raw Foods Diet?).

The starving vegan usually exists because the vegan consumes most of their calories from vegetables and fruit, rather than whole grains and starches. Vegetables contain about 200 calories per pound; fruit contains about 300 calories per pound. I don't recommend counting calories, but hypothetically, if you need 2,000 calories per day to maintain your weight, do you realistically think you could eat 10 lbs of vegetables or 6-7 lbs of fruit every day? That would be pretty difficult.

The junk food vegan is also very common because they eat a diet full of fat and processed foods.  Technically, the food I choose to eat is vegan (no animal foods), but I would not want to consume many of the popular vegan commercial foods because they are very processed and high in fat.

There are many "vegan junk foods" on the market today, making it very easy and convenient to continue eating processed and high-fat foods after adopting a vegan diet. Tofurkey, vegan cheeses, Oreos, soda drinks, french fries, potato chips, and much more are technically vegan friendly foods. But are these foods healthy for you in the long run if consumed regularly? No!

Fun Facts about Vegan Junk Foods

You may notice the rightmost column "Isolated Soy Protein," and wonder what that is. Many vegan junk foods use de-fatted soy as an ingredient to help replicate meat. But using these isolated soy proteins is very harmful for your health, and leads to the same diseases as the animal foods diet. You can recognize isolated soy protein if you see anything like soy (or pea or peanut or whatever plant food) "defatted soy flour," "textured soy flour," "textured vegetable protein," "soy protein concentrates," or "soy concentrates." These fake soy foods have been stripped of their original nutrient makeup and design, which should naturally include fiber, carbohydrates, protein, fat, vitamins, minerals, and phytochemicals. Isolating the protein and removing all the other beneficial "stuff" creates a fake food product, which can harm your liver, kidneys, and bone health similar to high amounts of animal protein. Just to be clear, natural forms of soy like soybeans, edamame, soy milk, soybean sprouts, soy sauce, soy flour, tempeh, tofu, and miso are okay because they have not been made such that the protein has been isolated. The Clif Builder's Bar in the table above is the best example of what to AVOID because its ingredients list says:

"Soy Protein Isolate, Beet Juice Concentrate, Organic Brown Rice Syrup, Organic Dried Cane Syrup, Palm Kernel Oil, Organic Rolled Oats, Unsweetened Chocolate, Cocoa, Organic Soy Protein Concentrate, Vegetable Glycerin, Natural Flavors, Organic Almonds, Rice Starch, Cocoa Butter, Inulin (Chicory Extract), Organic Flaxseed, Organic Oat Fiber, Organic Sunflower Oil, Soy Lecithin, Salt."

It's important to watch out for how much processed, high-sugar, high-fat foods you consume. Oils are unnecessary and 100% fat. Refined sugar can easily be over-consumed if not careful. Preservatives and chemicals are prevalent in many packaged foods. Highly processed and enriched foods have been stripped of their nutrients. Always look at the entirety of the diet instead of simply the elimination of a few foods. And always read every ingredient label carefully!

Instead of only focusing on avoiding all animal products (avoiding them is good, but incomplete), focus on pursuing whole, plant-based foods. Try new whole grains you might never knew existed (quinoa, millet, buckwheat). Embrace a newfound love for starches and complex carbs -- let the potato be your new best friend, just don't melt vegan cheese and crumble gimme lean on it. And of course enjoy lots of vegetables and fruit.

The vegan has already won a huge battle by voluntarily giving up all animal products and passionately questioning what ingredients are in food and other products. So take the next step by actively pursuing whole, plant-based foods without any added oils.

For additional reading, Dr. John McDougall has a great article about the unhealthy vegan.

Bottom Line:
Eliminating all animal products from the diet is a wonderful step in the right direction, but it is only half the picture. A vegan diet is not the same thing as a whole foods, plant-based diet because many processed/junk foods are technically vegan, but are not health-promoting. But the vegan is already much closer to a plant-based diet than the average American, so I encourage all vegans to switch your thinking towards pursuing whole, plant-based foods rather than focusing solely on avoiding all animal products. A whole foods, plant-based diet trumps a vegan diet any day of the week.

Next -- Part 8: What About the Raw Foods Diet?
Previous -- Part 6: What About the Vegetarian Diet?
Introduction to the 10-Part Series 

Part 6: What About the Vegetarian Diet?

You may be surprised to learn that there are a variety of vegetarian diets. The table below shows the five basic types of vegetarians and what they will or will not eat, although this table is not exhaustive because I'm sure there are individuals who are combinations of these types.



Summary of Diet Recommendations:
The basic component of a vegetarian diet is the avoidance of animal flesh. As shown above, there are various types of vegetarians who may also choose to avoid fish, eggs, or dairy products. Semi-vegetarians are the least restrictive and are simply defined as people who make an effort to consume less animal products. Vegans are considered the most restrictive and are covered in more detail in Part 7: What About the Vegan Diet. People who decide to become a vegetarian usually do so based on ethical, environmental, and/or health concerns. But since the vegetarian diet is not an organized or commercially advertised diet like the previous five diets, there are no standardized dietary recommendations to discuss here. Nonetheless, I will discuss the good and bad consequences of eating a vegetarian diet.

What's Good?
By eliminating land animal flesh from the diet, the vegetarian is on the right track in terms of  reducing the amount of protein that many humans over-consume (humans only need enough protein to comprise 5% daily caloric intake).

Eliminating fish in addition to land animal flesh is another step in the right direction, and also reduces the person's fat intake and chances of mercury poisoning. In general, fish has 1.5 to 2 times more cholesterol than animal flesh. Furthermore, plants make all omega-3 and omega-6 fatty acids...not fish! More on this in Part 9: What About the Mediterranean Diet.

Also avoiding the consumption of eggs is a great step because eggs are very high in cholesterol and fat, in addition to being high in animal protein.

Fun Facts about Eggs

One large egg contains 185 mg cholesterol and has 64% fat content
The USDA recommends consuming no more than 300 mg cholesterol per day

In other words, if you consume TWO EGGS per day,
you have already exceeded the 300 mg cholesterol limit
2 eggs for breakfast = No more meat or dairy for the rest of the day!

Even if you consume one egg for breakfast,
you must not forget that eggs are used in many packaged foods such as:
breads, pastas, cookies, cakes, mayonnaise, salad dressings, soups, sauces, etc.

It should be called the terrible egg!

Avoiding dairy is a wonderful step in the right direction, because dairy is especially concentrated in animal protein and is high in cholesterol, sugar, fat, estrogen, and antibiotics that lead to antibiotic resistant bacteria (recall Part 4's Fun Facts About Milk).

Beyond the health benefits that some vegetarians may realize, vegetarian diets also help reduce the negative environmental impacts associated with the meat and dairy industries. Vegetarians may also feel better about not contributing to the death or mistreatment of animals for their food. To hear more about these types of issues, you can read my Stewardship series.

What's Bad?
As described above, being a type of vegetarian that still consumes animal flesh, fish, eggs, and/or dairy products is a step backwards. The over-consumption of animal products in general (meat, fish, eggs, dairy) lead to an excess of protein, which puts strain on your liver and kidneys and increases the acid load on your body. The increased acid load results in weaker bone health over time. That over-consumption also leads to increased fat and cholesterol intake, which promote heart disease, diabetes, and obesity. I recommend that all dairy, meat, and fish be eliminated from your diet.

Perhaps the most important point of today's post: just because you avoid animal products in your diet does not mean you are consuming a healthy diet. Animal products are one type of food that should be eliminated, but it is not the only type of food that determines your overall state of health.

Does the vegetarian still consume oils? Processed and enriched foods? Are they avoiding carbs? Are whole grains missing from the diet? If the answer is yes, then the vegetarian is off track. As I have mentioned before, moderation is not the answer - you must look at the entirety of your diet. Simply following a vegetarian diet is only half the picture.

Bottom Line:
Although eliminating some forms of animal products from your diet is a step in the right direction, it does not necessarily mean that you are consuming a healthy diet. Dairy should not be consumed by any human being, so the lacto vegetarian is severely off track. Animal flesh, fish, and eggs are best avoided as well. The healthiest diet is a whole foods, plant-based diet.

Next -- Part 7: What About the Vegan Diet? 
Previous -- Part 5: What About the Weight Watchers Diet?
Introduction to the 10-Part Series