Would the REAL Mediterranean Diet Please Stand

A place to get your questions answered from McDougall staff dietitian, Jeff Novick, MS, RDN.

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Would the REAL Mediterranean Diet Please Stand

Postby vgpedlr » Tue Oct 13, 2015 11:31 am

I was watching Dr. Greger's recent videos on Alzheimer's, and he referenced several studies that used the Med diet.

Which got me wondering, what IS the Med diet?

I've only seen it described in the vaguest terms. When researchers and other professionals (such as yourself) use the term, what is meant by it?

If was a member of the general public and I wanted to change my SAD diet to the Med diet to get the purported benefits, how would I know I was doing it right?

I believe you mentioned in a presentation that if took away the olive oil, and maybe the wine, what you'd be left with is the Asian diet. Didn't you write about that? Can you help me find it?

Thanks
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Re: Would the REAL Mediterranean Diet Please Stand

Postby JeffN » Tue Oct 13, 2015 12:01 pm

First, as with the WFPB diet, the MED diet is not a diet but a dietary pattern and the MED dietary pattern was based on studies in the 50's and 60's on several countries in the MED area. The majority of their calories came from fruits, vegetables, starchy vegetables, whole grains and legumes with the addition of some nuts, seeds and oil (mostly olive). Fish was consumed in moderation and meat, dairy and butter were more like condiments. This is a general pattern. Some used almost no olive oil and some used a little more, some drank almost no wine and some a little more. On the isle of Crete around 1960 (which is often cited as "the" MED Diet) they were using about 2 tbsp per day and their diet was about 30% fat and under 8% saturated fat.

Public Health Nutr. 2006 Feb;9(1):53-60.
Changes in food supply in Mediterranean countries from 1961 to 2001.
Garcia-Closas R1, Berenguer A, González CA.

Abstract

OBJECTIVE:
To describe geographical differences and time trends in the supply of the most important food components of the traditional Mediterranean diet.

DESIGN:
Food supply data collected from national food balance sheets for the period 1961-2001.

SETTING:
Selected Mediterranean countries: Spain, Italy, France, Greece, Algeria, Morocco, Tunisia and Turkey.

RESULTS:
Differences of almost 30-fold and five-fold were found in the supply of olive oil and fruits and vegetables, respectively, among the Mediterranean countries studied during the 1960s. A favourable increasing trend for the supply of fruit and vegetables was observed in most Mediterranean countries. However, an increase in the supply of meats and dairy products and a decrease in the supply of cereals and wine were observed in European Mediterranean countries from 1961 until 2001. Only in African and Asiatic Mediterranean countries were cereals the base of food supply. During the 1990s, Greece's food supply pattern was closest to the traditional Mediterranean diet, while Italy and Spain maintained a high availability of fruits, vegetables and olive oil, but were losing the other typical components. Among African and Asiatic Mediterranean countries, only Turkey presented a traditional Mediterranean dietary pattern except with respect to olive oil, the supply of which was very low. France showed a Western dietary pattern, with a high supply of animal products and a low supply of olive oil.

CONCLUSIONS:
Dietary supplies in the Mediterranean area were quite heterogeneous in the 1960s and have experienced a process of Westernization, especially in European Mediterranean countries.


Second, in 1999, I published an newsletter article entitled, "The French Paradox & The Mediterranean Mix-Up", explaining how these diets are promoted to the American public is a hoax. My presentations since, have expanded on this including much more data supporting my view.

The following article appeared in a leading medical journal on lipids supporting my view and may be the final "nail in the coffin."

It's about time!

Clinical Lipidology Roundtable Discussion
Discussion on dietary fat
Journal of Clinical Lipidology (2009) 3, 303–314

W. Virgil Brown, MD
- Editor–in–Chief, The Journal of Clinical Lipidology, Charles Howard Candler Professor of Internal Medicine Emory
University School of Medicine, 1670 Clairmont Road, Atlanta, GA 30033, USA

Wahida Karmally, RD, DrPH
- Associate Research Scientist and Director of Nutrition, Irving Center for Clinical Research, Columbia University, New York, NY, USA (Dr. Karmally);

Penny Kris-Etherton, PhD, RD
-Professor of Nutrition, Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, USA

Lawrence R. Rudel, PhD
- Clinical Researcher, Pathology Department, Lipid Sciences, Wake Forest University Medical School, Winston Salem, NC, USA

Quoting...

Dr. Karmally: Because of the way the Mediterranean diet has been promoted, olive oil is in the center of that pyramid.

Dr. Brown: It’s viewed as healthful and as you pointed out, the Lyon Diet Heart Study really found that the one fat that correlated best with reduction in events was not monounsaturated oleic acid, the major fat of olive oil, it was linoleic acid. And so I’m afraid that this has become a great hoax applied to the American diet and that we have not paid as much attention to the data as we should have in order to make a better decision about the content of fat in our diet.

And, in regard to MONO fat...

"A recent study, published in 2008 from the ULSAM, Uppsala Longitudinal Study for Adult Men, in which in 1970 they started enrolling all men that turned age 50. They have studied about 3–4,000 individuals, following them for about 30 years, so they have many observations over a long period of time. In Sweden the diagnosis of cardiovascular death is better than in almost any other country in the world. At the end of the study, they had about 460 deaths from cardiovascular disease, and a significant predictor of this outcome was cholesteryl oleate and cholesteryl palmitate. Again, an inverse association was found with plasma cholesteryl linoleate. So, it appears that in humans, as well as in our monkeys and in our mice, increased cholesteryl oleate is not good—it predicts arteriosclerotic vascular disease We should be concerned that when you increase monounsaturated fats, you make more cholesteryl oleate in plasma, and this relates to earlier atherosclerotic disease. In the San Diego studies mentioned earlier, subjects fed a high monounsaturated fat-rich diet for 4 weeks had an increase in the percentage of cholesteryl oleate in plasma by about 20%. Plasma cholesterol oleate appears responsive in humans as it is in monkeys and mice. Cholesteryl oleate may be an underappreciated villain, that’s my term.

My original article..

The French Paradox & The Mediterranean Mix-Up.
Chef Jeff's Weekly Health Update
June 1, 1999

Many of us who follow a low fat, plant food diet are often confronted with the question, "but what about the French Paradox" or the "Mediterranean" diet. In France, mortality from heart disease is about a quarter of that in Britain and also less then that in the US. The major risk factors are no more favorable in France, and so this "French Paradox" exists, though it has not been satisfactorily explained yet.

Despite the difference in mortality from heart disease between these countries, similar levels of animal fat consumption, serum total cholesterol and high density lipoprotein cholesterol concentrations, blood pressure, and (in men) smoking exist.

So why the difference?

The French paradox is usually attributed to the higher consumption of alcohol in France, notably of wine, and some have suggested a specific effect of red wine. However, low levels of ischaemic heart disease in France is not due to drinking red wine, suggest researchers in last weeks British Medical Journal.

In their paper Dr Malcolm Law and Professor Nicholas Wald from the Wolfson Institute of Preventive Medicine in London present a new hypothesis to explain why the French population has experienced such a low incidence of heart disease and provide supporting evidence. The crux of their hypothesis is that animal fat consumption and serum cholesterol are a relatively new phenomena in France and that there is a time-lag in the effect they have on health which we haven't fully seen yet.

Animal fat consumption and serum cholesterol concentration have only increased in the French population in the last 15 years, say the authors. For decades up to 1970 France had lower animal fat consumption and serum cholesterol and only between 1970 and 1980 did French levels increase to those in Britain and the US.

Law and Wald explain that French mortality from ischaemic heart disease is nevertheless still only about a quarter of that in Britain and the US because of a "time lag" effect. They estimate that the time lag between an increase in fat consumption and its effect on heart disease is somewhere between 25 to 35 years and explain that the time lag is similar to that which is seen in relation to lung cancer risk and smoking.

The authors examine previous explanations of the "French paradox" including the under certification of heart disease deaths by French doctors (which they say could account for about 20 per cent of the difference in mortality rates); smoking; alcohol intake (especially red wine); the consumption of garlic and onions and the moderately warmer climate in France. They conclude that apart from smoking in women, these factors explain little of the difference and that the most important explanation lies in the time-lag hypothesis.

Law and Wald emphasize that the consumption of animal fat leads to a slow increase in the risk of mortality from heart disease, but, as with smoking and lung cancer, these risks decrease rapidly on cessation.

Also, despite the supposed protective effect of alcohol on heart disease amongst the French men, alcohol related deaths from other causes among French men almost nullifies this benefit. In comparison with Britain, the amount of alcohol related deaths in France is 3x that in Britain. So, any protective effect that alcohol may be offering in relation to heart disease is canceled out by other alcohol related deaths (including increased mortality from cancers of the mouth, pharynx, esophagus, liver, larynx and also alcohol related mortality
from cirrhosis and alcohol dependence). Mortality statistics from all causes, bears this truth out.

Also, there have been some recent media reports stating that a new study from Lyon, France showed that people who ate a "Mediterranean Diet" had fewer heart attacks then those who ate a "low-fat" diet. There are some problems associated with these reports. First, there is no clear cut definition of what exactly the "Mediterranean Diet is. And, the so-called "Mediterranean Diet" that has been touted for its health benefits, doesn't exist anymore, (not even in the "Mediterranean) if it even ever did.

The information that has been translated into the "Mediterranean Diet" came from a study that found low rates of heart disease amongst those living on the Isle of Crete in the late 1950's. While this people did consume olives, avocados, olive oil and other monunsaturated fats, their diets were predominately fresh fruits, vegetables, whole grains, and legumes with small amounts of animal protein.

Part of the reason for this was the community was very economically depressed as they were recovering from a recent time of war. Additionally, they were very active, walking an average of 9 miles a day.

This dietary and exercise pattern, that was evident on the Isle of Crete in the late 50's, no longer exist there (nor anywhere else in the Mediterranean). Rates of obesity and heart disease on the Isle of Crete have risen since the original study, as their diet and fitness patterns have changed.

Second, in the above mentioned study from Lyon, France (Circulation, 99: 733, 779, 1999) the so-called "low-fat" diet actually had more fat and saturated fat in it, then the so-called "Mediterranean" diet. To this date, no study has pitted a "Mediterranean" style diet against a truly healthy version of a low-fat" diet.

Many reports have attempted to show that the "French" or "Mediterranean" diets may be more healthful then a low-fat diet. And, many of us may have been swayed by these reports in an attempt to do what is most healthful.

Well, for those of you who may have been (or are being) swayed by the reports in the news of the "Mediterranean" diet and/or the "French Paradox", you can sit back and relax and know that the best advice for your health hasn't changed. You can't fool Mother Nature. Stick to a whole foods plant based (or plant exclusive) diet based on whole unrefined, unprocessed foods. Choose small amounts of the good fats that we have discussed, and get adequate amounts of physical activity and exercise.

Remember, Your "Health" Is Your Greatest Wealth!

In Health,
Chef Jeff
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Re: Would the REAL Mediterranean Diet Please Stand

Postby JeffN » Tue Oct 13, 2015 12:11 pm

A few more, from another "private" blog I write..

1) Cleaning Up The Olive Oil Spill
Jeff Novick, MS, RDN

Because of the popularity of Mediterranean style diets, olive oil went from being a high calorie, high fat condiment, to a health food and in some circles, a super food.

This is unfortunate, as the true benefits of the Mediterranean style diets was not because of any one specific food, let alone olive oil, but because of a highly active lifestyle and a prudent diet that occurred in the region during the late 1950's and early 1960's. Their dietary pattern at the time was based on a high intake of fruits, vegetables, starchy vegetables, whole grains and legumes, a moderate intake of fish, and where meat and dairy were little more than condiments. While olive oil was used in certain part of the Mediterranean, it was not a staple for many, let alone used by all.

In 2003, when the Mediterranean diet was becoming popular, Dr. Alice Lichtenstein, one of the nation’s top nutrition scientists who is the senior scientist and director of the Cardiovascular Nutrition Laboratory at Tufts University, cautioned Americans:

"If the main message that Americans get is to just increase their olive or canola oil consumption that’s unfortunate because they will increase their caloric intake and they are already getting too many calories. What they need to do is eat more fruits, vegetables, and legumes and fewer foods rich In saturated fats”

Unfortunately, this caution has not been heeded and since 1998, the average intake per person of olive and other salad oils has more than doubled. While I know we would all like to believe olive oil is the key to the benefit of the Mediterranean diet, let's take a minute to take a closer look at olive oil, and put it in perspective.

Olive oil, like all oils, is the most calorie dense food there is. One tablespoon is 120 calories. Like any dietary oil, it is 100% pure fat and has no fiber, protein, or minerals and has virtually no vitamins except for a small amount of vitamins E and K.

In regard to the types of fat, olive oil is 14% saturated fat, which makes it ineligible to meet the industry standard to be considered a food low in saturated fat. (Remember, the goal is to keep our intake of saturated fat to less than 7% of total calories). Two tablespoons of olive oil actually have 3x the amount of saturated fat as a 3.5 oz serving of lean chicken.

In regard to the essential fat omega 3's, a 1 tablespoon serving of olive oil has .1 gram, which would be considered a poor source by industry standards. In addition, it has an omega 6/3 ratio of 11/1 which is almost 2x the upper limit of the recommended ratio.

To get enough omega 3's from olive oil, one would need to consume 8 oz, which would also be 1900 calories and 42 grams of saturated fat.


2) The Mythological Mediterranean Diet
Jeff Novick, MS, RDN

The "mythological" Mediterranean diet does not even exist in the Mediterranean anymore and hasn't in several decades. The reason is, they adapted our "Western" sedentary lifestyle and diet and as a result, their rates of obesity, diabetes and heart disease are rising rapidly.

A study published just yesterday confirms this.

The study looked at over 2,000 adults in Spain, aged 18 to 80 with equal amounts of males and females. Over 60 per cent of the subjects were overweight or obese and 77 per cent did not meet the minimum recommendations for exercise. Around 33 per cent had high blood pressure, 65 per cent had high cholesterol levels and about 30 per cent had three or more cardiovascular risk factors that could be modified by changes to their lifestyle or diet.

In regard to the study, Dr Ricardo Gómez-Huelgas from the Internal Medicine Department at Hospital Carlos Haya, Malaga said, "The prevalence of obesity, diabetes, high blood pressure and high cholesterol in Spain have all risen at an alarming rate over the last 20 years and this is likely to cause future increases in bad health and death due to cardiovascular disease.”

Dr Anthony Wierzbicki, a London-based Consultant in Metabolic Medicine said, "The myth that the Mediterranean diet and lifestyle is so healthy is based on 40-year old data from rural areas and so much has changed during those four decades."

In addition, in 2009, in an article on dietary fat that was published in the Journal of Clinical Lipidology, Dr Virgil Brown, MD, who is the Editor–in–Chief of The Journal of Clinical Lipidology, and the Charles Howard Candler Professor of Internal Medicine at Emory University School of Medicine said in regard to the way the Mediterranean diet and olive oil have been promoted in the USA,

"I’m afraid that this has become a great hoax applied to the American diet and that we have not paid as much attention to the data as we should have in order to make a better decision about the content of fat in our diet."

We need to move beyond the cultural myths of the Mediterranean diet and the misguided marketing and advertising of olive oil as a health food, to a truly healthy lifestyle and eating pattern that is simple, easy and based on sound science.


3) What Mediterannean Diet?
Jeff Novick, MS, RDN

My recent discussions and blogs on Olive Oil and the Mediterranean diet, have sparked some interesting conversations.

A recent article in the NY Times confirms many of the points I make.

The article is called, "Does the Mediterranean Diet Even Exist?"

http://www.nytimes.com/2011/04/03/magaz ... .html?_r=0

Some of the key points the article makes are:

- In Europe and the United States, the so-called Mediterranean diet — rich in olive oil, whole grains, fish, fruits and vegetables and wine — is a multibillion-dollar global brand, encompassing everything from hummus to package trips to Italy, where “enogastronomic tourism” rakes in as much as five billion euros a year.

- According to data from the United Nations Food and Agriculture Organization, Mediterranean people have some of the worst diets in Europe, and the Greeks are the fattest: about 75 percent of the Greek population is overweight.

- Before there was a Mediterranean diet, there was WWII and the food shortages that went along with it. When the fighting was over, Haqvin Mamrol, a researcher in Sweden, showed that mortality from coronary disease declined in Northern European countries during the war. This was, he believed, the result of wartime restrictions on milk, butter, eggs and meat

- At about the same time, a Minnesota scientist named Ancel Keys, who had been studying the effects of starvation on a group of volunteer subjects, moved on to study the diets of Midwestern businessmen. He found that these well-fed Americans were more prone to heart disease than were men in war-deprived Northern Europe

- “There is no such thing called the Mediterranean diet; there are Mediterranean diets,” says Rami Zurayk, an agriculture professor at the American University in Beirut. “They share some commonalities — there is a lot of fruits and vegetables, there is a lot of fresh produce in them, they are eaten in small dishes, there is less meat in them. These are common characteristics, but there are many different Mediterranean diets.”

- The healthy versions of these diets do have one other thing in common: they are what the Italians called “cucina povera,” the “food of the poor.” In Ancel Keys’s day, Mediterraneans ate lentils instead of meat because they had no choice. “A lot of it is to do with poverty, not geography,” says Sami Zubaida, a leading scholar on food and culture.

- The diet that Keys and his colleagues invented bore little resemblance to what Mediterraneans actually wanted to eat.

- Today, more than half the populations of Italy, Portugal and Spain are overweight. In Eastern Mediterranean countries like Lebanon, obesity is growing.

Don't be fooled by the marketing and advertising that is being fostered upon us by the food industry. The real MED diet existed at a time of post war recovery and was a diet of poverty, limited resources and food restriction.

Olive oil was at best a condiment as was meat, dairy and butter. Fish was consumed in moderation and they consumed large amounts of fruits, veggies, starchy veggies, whole grains and legumes that they prepared fresh. They were also highly active and engaged in hard physical labor.

This diet does not exist anywhere in the world today, including anywhere in the Mediterranean.

So, for your best health, put down the olive oil and skip the hype about the Mediterannean diet. Instead, follow the time honored and proven principles of healthy living and eating.

In Health
Jeff

PS, Here is a fairly decent analysis of the traditonal MED diet of Greece, Crete and Italy

The Mediterranean Diet Secret: Olive Oil or Low Fat Plant-Based 200 Days A Year?
http://donmatesz.blogspot.com/2012/12/t ... l.html?m=1
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Re: Would the REAL Mediterranean Diet Please Stand

Postby JeffN » Sat Jul 21, 2018 2:53 pm

In The NY Times Opinion Section today, an article, “How to Get America on the Mediterranean Diet” by Paul Greenberg says,

https://www.nytimes.com/2018/07/19/opin ... -loss.html

“Weight-loss fads and eating trends come and go, but the so-called Mediterranean diet has stood fast. “Among all diets,” Dr. Walter Willett of Harvard’s T.H. Chan School of Public Health concluded in an email, “the traditional Mediterranean diet is most strongly supported for delivering long term health and wellbeing.”

However, in 2011, as I posted above, The NY Times published an article, “Does the MED Diet Even Exist?”

https://www.nytimes.com/2011/04/03/maga ... ere-t.html

Some of the key points the 2011 article makes are:

- In Europe and the United States, the so-called Mediterranean diet — rich in olive oil, whole grains, fish, fruits and vegetables and wine — is a multibillion-dollar global brand, encompassing everything from hummus to package trips to Italy, where “enogastronomic tourism” rakes in as much as five billion euros a year.

- According to data from the United Nations Food and Agriculture Organization, Mediterranean people have some of the worst diets in Europe, and the Greeks are the fattest: about 75 percent of the Greek population is overweight.

- Before there was a Mediterranean diet, there was WWII and the food shortages that went along with it. When the fighting was over, Haqvin Mamrol, a researcher in Sweden, showed that mortality from coronary disease declined in Northern European countries during the war. This was, he believed, the result of wartime restrictions on milk, butter, eggs and meat

- At about the same time, a Minnesota scientist named Ancel Keys, who had been studying the effects of starvation on a group of volunteer subjects, moved on to study the diets of Midwestern businessmen. He found that these well-fed Americans were more prone to heart disease than were men in war-deprived Northern Europe

- “There is no such thing called the Mediterranean diet; there are Mediterranean diets,” says Rami Zurayk, an agriculture professor at the American University in Beirut. “They share some commonalities — there is a lot of fruits and vegetables, there is a lot of fresh produce in them, they are eaten in small dishes, there is less meat in them. These are common characteristics, but there are many different Mediterranean diets.”

- The healthy versions of these diets do have one other thing in common: they are what the Italians called “cucina povera,” the “food of the poor.” In Ancel Keys’s day, Mediterraneans ate lentils instead of meat because they had no choice. “A lot of it is to do with poverty, not geography,” says Sami Zubaida, a leading scholar on food and culture.

- The diet that Keys and his colleagues invented bore little resemblance to what Mediterraneans actually wanted to eat.

- Today, more than half the populations of Italy, Portugal and Spain are overweight. In Eastern Mediterranean countries like Lebanon, obesity is growing.

So, is this “food of the poor” MED diet the MED diet that NY Times Paul Greenberg wants us to go on?

I hope so. At least that will be closer to the truth :)

In Health
Jeff
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