Earlier this year, the "Mediterranean diet"
turned 15. Of course, for the people who actually live in the
Mediterranean region, that's an absurd notion. They have been eating
meals of fish, vegetables, and whole grains drizzled with olive oil,
then washing it all down with a glass or two of wine for generations.
What actually turned 15 is the Mediterranean Diet Pyramid, an attempt by nutrition experts to promote an alternative to the typical overprocessed, fat- and sugar-laden American diet.
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The
Mediterranean diet is believed to be responsible for the low rates of
chronic heart disease in the 16 countries bordering the Mediterranean
Sea.
That pyramid—like other recently devised dietary guides built on
age-old traditions—represents a way of looking at nutrition that's
gathering steam these days. Rather than reducing a diet to its
essential foods and then foods to their essential nutrients—vitamins,
minerals, and other chemicals—and trying to isolate those that may
contribute to good health, researchers are increasingly taking a step
back and correlating health with broader eating patterns. "What we're
talking about is the background diet," says Linda Van Horn, acting
chair of preventive medicine at Northwestern University's Feinberg
School of Medicine. "It's not the occasional hot fudge sundae or
brownie; rather, it's the day-to-day, meal-to-meal, bite-to-bite: What
is it that appears in your mouth?"
The focus is on finding the overall combination of foods that are
associated with better health, without necessarily pinpointing
individual elements of the diet that are responsible. That may involve
studying how people in different areas of the world eat or, here at
home, using statistics to study which foods the healthiest among us
consume. "You find out who's healthy, then ask what they're eating and
how much they exercise," says K. Dun Gifford, founder and president of
Oldways Preservation Trust, the Boston-based food issues think tank
that developed the Mediterranean Diet Pyramid. (More later on the exercise element, which often gets lost when people try to adopt a healthier diet.)
Oldways, which gets funding from food companies and trade
associations, among others, and developed its recommendations in
conjunction with the Harvard School of Public Health, has also created
food pyramids for a traditional healthful Asian diet, which emphasizes vegetables such as bok choy and chilies, noodles, and beans, as well as a traditional Latin American diet. The group has also cooked up a healthful vegetarian pyramid;
plant-based diets, when they include all the essential nutrients, are
associated with low rates of chronic diseases and longevity.
Not that people haven't tried. Consider the health
claims for various vitamins, minerals, and other nutrients over the
years. Vitamins A and C, which are antioxidants, and carotenoids like
beta carotene and lycopene were once touted as tools to fight chronic
diseases like cancer. It was a logical hypothesis; people who eat a lot
of fruits and veggies are healthier than those who don't. Shouldn't the
chemicals that are unique to these foods be responsible? As it turns
out, no. "The history has been that the first studies [to test
individual nutrients] show fabulous benefits, and then as they were
repeated with larger populations, better placebos, and better controls,
not only were they not helping, but in some cases they may hurt," says
Nestle. The poster child is beta carotene, which not only didn't stave
off lung cancer but actually appeared to increase rates of the disease among smokers. (A similar outcome was reported earlier this year with vitamin E.) Now we're back to where we started: Fruits and veggies appear to be protective, but we still don't know why.
Soy was also considered as a miracle food. When Japanese people move
to the West, for example, their rates of chronic diseases like diabetes
and heart disease go up. Researchers naturally wondered whether missing
dietary elements might be responsible. They realized that these
immigrants largely gave up soy for other protein sources, so the
researchers focused on isoflavonoids, a group of chemicals found mostly
in soy and suspected of guarding against chronic disease, says
Christopher Gardner, a nutrition scientist at the Stanford Prevention
Research Center. Again, a logical assumption didn't pan out in larger
studies.
But what if it's not a single chemical or food that traditionally
protected the Japanese, says Gardner, but how all components of their
diet interact? "Maybe it's not just the tofu but the tofu in the stir
fry with the sesame oil," he says. "The frustrating thing in nutrition
is that for the last couple of decades, so many studies have failed
because we've isolated one nutrient at a time, when probably the
benefit comes from the synergistic and additive effects of the whole
diet taken together."
Having in a sense returned to the drawing board, researchers are
increasingly looking at those conventional patterns of eating as models
for healthful eating. Dietary patterns are most easily described by
their ethnic origins. "Low-carb or low-fat diets are a man-made
phenomenon," says Van Horn. "Instead, what we're talking about is the
more cultural, traditional, historical eating pattern—like the
Mediterranean diet."
That's the dietary tradition with the most evidence behind it; scientists have been studying Mediterranean eating patterns
and their impact on health since after World War II, when diet was
suspected to account for the remarkable health of people living on
Crete. Since then, research has associated the Mediterranean way of
eating with a host of health benefits, including protection against
diabetes, cancer, and heart disease.
So some nutritionists are taking a stab at more
precisely describing dietary patterns, using statistical analysis to
measure what foods tend to cluster together in the diets of healthy (or
not healthy) people. For example, a "prudent" eating pattern is
characterized by higher intakes of fruit, vegetables, whole grains,
legumes, and fish, says Teresa Fung, a nutritionist at Simmons College
in Boston. That pattern has been shown to be associated with a lower
risk of coronary heart disease, type 2 diabetes, and colorectal cancer, as well as lower body mass index.
The prudent diet has some key similarities with most of the ethnic
eating patterns. "A better diet, however you define it, almost always
includes more fruits and vegetables, less processed meat, more whole
grains, fish, nuts, and low-fat dairy," says Katherine Tucker, a
nutritional epidemiologist at Tufts University's Friedman School of
Nutrition Science and Policy.
The beauty of the pattern approach is that it's not necessary to
know exactly what mechanism is leading to better health. "It could be
one thing or multiple things," says Fung. For example, research
recently suggested that the higher amounts of choline, an essential
nutrient in the vitamin B family, and another nutrient called
betaine—both of which are abundant in a Mediterranean diet—reduce
inflammation, which may contribute to a host of diseases, says Steven
Zeisel, director of the Nutrition Research Institute at Kannapolis, a
branch of the UNC Chapel Hill School of Public Health. "But the truth
is, I'd be foolish to rush out and eat those nutrients. I can eat
closer to that pattern—less red meat, more olive oil—and not worry
about which is the active ingredient," he says. In fact, it's not even
clear that these patterns are healthier because of what's in them—it
may be what's absent. "As soon as you eat the Mediterranean diet,
you're eating less steak," says Gardner. "Maybe it had nothing to do
with that. What we know is that if you eat that way, you're healthier."
So, is it that easy: We all just have to eat like the Greeks (or the
Vietnamese, or the ancient Maya)? Well, yes and no. First, most of the
evidence comes from observation, not rigorous scientific trials, so it
doesn't prove cause and effect. But there's enough observational data
to convince most researchers, and there is some experimental evidence:
Trials showed that eating a low-sodium diet based on whole grains,
poultry, fish, and nuts and lighter on the red meat, fats, and sweets
lowered blood pressure.
And if you're watching your weight—and who isn't?—calories really do
count. The key is replacing less healthful foods with healthier ones,
not just adding tofu to your bologna sandwich or nuts to your sundae.
As Pollan says, "Eat food. Not too much. Mostly plants." That doesn't
mean eschewing all indulgences, but it does mean keeping an eye on
day-to-day intake. "It's about the pattern over the long term," says
Oldways' Gifford. "Do you think people in the Mediterranean get drunk
after church on Sunday? Sure, they do! We're human, and you have to
take the pressure off the pressure cooker."
Even with occasional excesses, adopting a sound dietary pattern may
be both simpler and more wholesome than chasing down the latest
superfood or nutritional supplement. "Finally, the field has come
around to realize that it won't be a single nutrient," says Tucker.
"We're back to old-fashioned advice: Eat a variety of good-quality
whole foods. That's the way to stay optimally healthy."