The Myth of the Mediterranean Diet

Monday Jun 1 | BY |
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If there is one diet myth I am so tired of hearing, it is the so-called health benefits of a Mediterranean diet.

It might sound a bit outrageous at first, but please hear me out on this. I don’t think that Mediterranean diet is a very healthy diet.

Let me explain…

The so-called Mediterranean diet is is not an ideal diet for health.

It is a little bit healthier than many other diets, including a standard American diet, but it is not the type of diet that will create radical and positive changes in your health. It’s a great diet for people with few health problems to begin with — but it’s not the diet that will lead you to the best positive outcomes in most people who need a more effective approach. Sadly, the Mediterranean diet is promoted as the healthiest alternative to the Standard American Diet.

Mediterranean Diet Healthier Than Low Fat Diet?

1101110912_400A study was published in The New England Journal of Medicine on April 4, 2013 called “Primary Prevention of Cardiovascular Disease with a Mediterranean Diet.” The entire study is available for free on their website.

This study made a lot of headlines because the main results were that a Mediterranean diet is healthier than a low-fat diet, a low-fat diet does not lead to any health benefits and that the Mediterranean diet reduces risk of heart disease.

All of these conclusions are pretty much mistaken if you actually read the study.

The study was interesting because it’s based on a control group, and two groups eating a Mediterranean diet.

Almost 7,000 people were randomly assigned to one of the three groups, and they were followed over a period of five years. The ultimate result is that people in the group eating the Mediterranean diet had fewer cardiovascular events, but mainly the only difference was the risk of stroke being reduced. No other major differences were found.

In each group, cardiovascular disease got worse on average.

In the Mediterranean diet with nuts, there were 83 cardiovascular events. In the Mediterranean diet with extra virgin olive oil, there were 96 events. In the control group—the so-called low-fat group—there were 109 events.

Let’s take a closer look.

First of all, what was the control diet group eating in this trial? If you look at the extra material from the study, there’s a complete breakdown of the total energy consumption in each group.

Roughly everybody started out eating the same amount of fat: about 39% of total calories. Total saturated fat consumption was about the same in every group. Cholesterol consumption was also roughly the same in every group by the end of the trial.

The controlled diet people were told to essentially follow a low-fat diet, but they were not truly following a low-fat diet. They were told to buy low-fat foods, to remove the skin from chicken and duck, to cook with less fat and avoid oil and butter. However, from the results that they got, they ultimately did not achieve a low-fat diet by any means.

The Mediterranean diet groups were divided into two.

One received a weekly supply of olive oil (1L per week), and the other group received a weekly allowance of walnuts (2kg every three months) and hazelnuts (1kg).

The guidelines given to the Mediterranean diet group were to consume abundant olive oil, vegetables, at least three servings of legumes a week, at least three servings of fish and seafood a week, one serving of nuts and seeds per week, and to eat white meat instead of red meat. They were also told they could have one glass of red wine daily.

Ultimately, the results were that risk of strokes were slightly lower in the Mediterranean diet groups, but in every group there was no significant reversal of heart disease. The authors of the study did not say necessarily which elements of the diet caused these benefits.

They wrote, “Perhaps there is a synergy among the nutrient-rich foods included in the Mediterranean diet that fosters favorable changes in intermediate pathways of cardio metabolism risks such as blood lipids, insulin sensitivity, resistance to oxidation, inflammation and vessel reactivity.”

Dr. John McDougall writes about the study that, “I believe the reason this New England Journal of Medicine study shows benefits is because the people in the Mediterranean diet group reduce their intake of meat and dairy foods and increase their intake of starches, cereals and legumes, vegetables and fruits. The inclusion of olive oil and nuts was not a magic pill that spared their ailing arteries from forkful of bacon and eggs.”

In the period of the study, which was only conducted on roughly less than 8,000 people in each group, there were a number of deaths from cardiovascular causes. In the Mediterranean diet groups with olive oil, there were 26 deaths. In the Mediterranean diet group with nuts, it was 31. In the control diet group, it was 30  deaths. In every group people died from heart disease.

On the other hand, the study done by T. Colin Campbell showed that in a rural province in China, over a three year period examination of over 250,000 death certificates, not one death was attributable to cardiovascular disease. If those rural Chinese were eating a Mediterranean diet, they would have experienced hundreds of deaths by comparison.

Don’t get me wrong: I’m not saying that it’s not worth it to make some improvements in our diets, but clearly the Mediterranean diet is not as healthy as we’ve been led to believe. It is only marginally healthier than standard diet advice. If we look at obesity rates throughout the world, we can clearly see that the countries that are considered to be eating in line with Mediterranean diets have higher obesity rates than countries in Asia where the diet is based on rice and vegetables.

In 2003, the Philippines had a 4% obesity rate compared to 23% in Greece. That’s a huge difference. Across the board, we see that the Mediterranean countries have much higher obesity rates than Asian countries.

Let’s Rethink Olive Oil

The idea of olive oil as a healthy food comes from research that’s been done on Mediterranean countries, like France and Greece.

In the 70s and 80s, a lot of research went into trying to answer a mysterious paradox:

Why are some countries consuming a lot of fat, yet experiencing less heart disease than other countries that eat more fat?

It was the beginning of the French paradox.

So there began the Lyon Health Study, the biggest of its kind at the time, that studied over 16 countries in the Mediterranean and found that the island of Crete was the one that experienced the best health at the time (this was before major industrialization took place on that island).

What the Lyon Health Study did was to compare a “Mediterranean-type” diet, inspired from the data available, to a control study that they labelled a “Low Fat Diet”

They put people in two separate groups. One was to eat the “Mediterranean Diet,” and one the “Low Fat Diet”.

Mediterranean Group: They were instructed to eat more bread, more root vegetables, more fish, more fruit, but reduce red meat, use margarine instead of butter, and olive oil on salad. Wine in moderation.

Low Fat Diet: The so-called “low fat diet” still consumed over 34% of their calories from fat! In my book, that’s not a low fat diet. On the other-hand, the “Mediterranean” group ate 30% fat, and much less cholesterol. The Low Fat Diet was higher in fat than the Mediterranean diet!

What they found is that people in the “Mediterranean” group experienced a dramatic reduction in cardiac death following that diet (50-70% less). So they even had to stop the study, fearing for the health of the control group on their so-called “Low Fat” diet.

What’s interesting is that all of the benefits from the “Mediterranean” diet can easily be explained by the slightly better choices they made: eat more vegetables and fruit, eat less meat, etc.

Here’s where it gets interesting:

– This study, and others like it, never proved that olive oil is healthy food in itself
– They only proved that replacing other fats (like butter) with olive oil and margarine is slightly better
– The main message from the study is to eat more fiber, whole grains, fruits, vegetables and exercise

The truth is that inhabitants of the island of Crete used to be very healthy because:

– Ate lots of fresh produce and some coarse (whole grain) bread
– They ate beans and fish instead of refined foods and fatty meats
– Yes, they added some olive oil to their diet (2 tablespoons a day), but burned it off by walking and hiking on average 9 miles a day!

Journalists are lazy and don’t really bother actually reading the studies that they’re talking about, and then they just love to make easy claims that people love to hear. For example, “olive oil protects you from strokes and a low-fat diet is found to be not healthy or not beneficial compared to a Mediterranean diet.” As we can see, this was not true and I could show you many more examples of the falsehood of the Mediterranean diet, but that will be for another article.

For your information, I visited the island of Crete in 2010. Now 60% of the population there is overweight. They continue to consume olive oil, but have thrown all of their other health habits out the window.

We’ve been told that the best diet we could eat is a Mediterranean diet. The research clearly shows that it is not the healthiest diet. It is only a little bit healthier than a typical diet. So, what is the healthiest diet?

The healthiest diet would look different than a Mediterranean diet. I will cover it in my next articles.

Frederic Patenaude

Frederic Patenaude has been an important influence in the raw food and natural health movement since he started writing and publishing in 1998, first by being the editor of Just Eat an Apple magazine. He is the author of over 20 books, including The Raw Secrets, the Sunfood Cuisine and Raw Food Controversies. Since 2013 he’s been the Editor-in-Chief of Renegade Health.

Frederic loves to relentlessly debunk nutritional myths. He advocates a low-fat, plant-based diet and has had over 10 years of experience with raw vegan diets. He lives in Montreal, Canada.

19 COMMENTS ON THIS POST

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  1. Thank you for this information. It seems clear to me (I am a Registered Dietitian) who teaches the McDougall program, that we have a lot of work to do. A study is only helpful if we can get people to make dietary change. I believe that even getting people to eat 3 to 4 servings of vegetables a day would make a huge difference in health. What about if people cooked their own meals? Now that’s a concept.

    t is shocking that on the Mediterranean diet they got a liter of olive oil a day. That is about a lifetime supply for me.

    The answer is “real” food not processed food, just like people used to do all over the world. there was NO choice.

    Thank you again for making this very clear. We need change to be healthier.

    • suzanne says:

      You meant to say a liter of olive oil a week, as the article says, not a day. Still too much though.

    • Liz says:

      Hi Jill and everyone, I read it as 1 litre of olive oil per week , not day. Surely no one could imbibe 1 litre a day? Anyway, very interesting article Fred. All the posts up to date have pinpointed the shortcomings of the studies. I often think they do these sorts of studies just to employ people. When you read the parameters of the studies sometimes their bases are simply nonsensical and the methods flawed.

      Liz

  2. Lalitha says:

    We have been on low nuts, no oil, high greens & veggies (including fair amount of avocados and olives), fruits and very moderate whole grain diet ever since my husband’s heart attack. He left the hospital with a fist full of medications and was told he needs to be on them for the rest of his life.
    It has been 3 years and no medications and everyone of his tests comes out stellar and his doctor sees no indication of heart disease in him.

  3. jane says:

    thorough research. excellent article teasing apart what studies really mean. I look forward to next article.

  4. Steve says:

    I think the comparison between The Phillipines and Greece is a good one…Greece is firmly westernised now and obesity is a glaring problem (I live there)….give The Phillipines some time, they will catch up.
    Not sure about the margarine versus butter at all.
    I know the main focus of what I skim read was heart disease but the issues need refining.
    Soils every where are depleted, animals every where are mass produced, butter is rarely from a grass fed source and there is no body of water left on the planet that isn’t polluted.
    Plus it is very common knowledge that our genetic history, what our forefathers ate and where they lived, iis paramount in any dietary discussion.
    Therein lies the problem continually, sweeping generalisations.

    • Angie says:

      I agree with Steve. However, I’m sure that Frederic will have specifics in his upcoming articles on this subject.

  5. grh says:

    It’s not just diet but lifestyle and mental outlook too.
    people in the Med tend to be less stressed out and take a different attitude than say American city types. Health is not just about diet, it’s a holistic thing, mind, body and spirit; how you view others, your thoughts and intentions.

  6. Jason says:

    Thank you for this article. Great insight & careful analysis of this so-called “scientific study”. Funny how after the study the researchers could still only make an “educational” guess as to the reasons for the results. I suspect scientists often forget that the modern scientific method is really a big guessing game.

    Scientists need a greater appreciation for nature’s precision & fine-tuning. Studies need to be designed with far greater attention to the details and far greater controls than is generally the norm. Otherwise the results will only contradict those of other studies, confuse the researchers, and generate further questions…leading to more confusion, more studies, more questions, and further derailment from the bigger picture. And isn’t this what we’re seeing today?

  7. Arthur Sturm says:

    Excellent article. This is exactly the research we need. Please do more Frederic. I am doing my own research in several other fields and I do not have time to do this type of research. Thank you.

  8. Tasos V says:

    Hi Frederic

    About the Myth I’m not sure what you are talking about. Mediterranean diet is by far the best diet if:

    1. You make your vegetables in your Garden (tomato, cucumber, aubergines)
    2. You produce your own cold-pressed olive oil and not the cheap-stuff olive oil you get in US mixed with i don’t know what.
    3. You don’t eat meat (red meat only 2 times a month)
    4. By mistake people confuse mediterranean diet with Crete.. This is not correct. In fact the longest living people in Greece with true mediterranean cuisine are people from Ikaria island not Crete! They live without problems till they are 105-110yrs old.. But they eat mediterranean fish 4 times a week! (http://www.ikaria.gr)
    5. People from Crete are obese but very active they eat ALOT of meat (goats.lambs,) and their speciality is a cheese like butter-cheese called staka which is tasty but very unhealthy. They spread it on cheese..omfg

    So next time do a bit more research when you say something about mediterranean diet.. And go to Ikaria island to see for yourself! You will be amazed..
    Also you forgot to mention that austerity measures have made Greek people much poorer and this causes malnutrition = fast-food (souvlaki) which is not healthy at all..

    Feel free to visit my island to offer you true greek olive oil from my garden to experience the bitterness in your throat from the excessive vitamin E once you extract it its amazing!

    Anastasios
    Pharmacist Msc Bradford UK
    Community Pharmacist in Greece
    South Evvia

  9. So true! I am so tired of all the wrong claims. Cant wait to read your next article.
    Thanks, Elaine

  10. Ilse says:

    thanks for this article! there is still (to much) information that we should eat a high fat diet, low in carbs… What do you think about cutting out all (good) carbs (fruit etc) when you have cancer? Do you know Ty Bollinger and his “Truth about Cancer search”? Could you do an article about that (or podcast – I LOVE the podcasts of you and Kevin!!!); One thing is sure : if you want to be or stay slim : eat (healthy)carbs and be a vegan ! Love from Belgium x

  11. David says:

    Great post, look forward to your description of the healthiest diet.

  12. Mary says:

    What do you think about Dr. Perlmutter’s books? Grain Brain, etc.?

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