How exactly is the US interpretation of “the Mediterranean diet pyramid” misinformed? In an epic-fail kind of way.
For decades, beginning with its inspiration of the USDA’s first Dietary Guidelines, we’ve been led to believe in a model of this allegedly health-promoting “Mediterranean diet” that’s largely plant-based and rich in whole grains, but low in fat, saturated fat, salt, and animal protein.
This mainstream concept and faith in the Mediterranean diet persist despite several gaping holes in the science behind it. These gaping holes are especially critical when you consider that we’re being sold left and right on the alleged benefits of a “plant-based diet.”
In this article, I dish on the details about these holes.
But first, let’s examine exactly what the Mediterranean diet food pyramid is.
What Is the Mediterranean Diet Pyramid?
The Mediterranean diet pyramid is allegedly based on the foods consumed by Mediterranean cultures and/or regions, primarily Greece and Southern Italy.
The pyramid consists of five levels that indicate how often you should eat specific foods. Several versions of the Mediterranean diet pyramid exist, but most include the following levels:
- Foods to eat as the base of every meal: fruits, vegetables, grains (mostly whole), olive oil, beans, nuts, legumes, seeds, herbs, and spices.
- Foods to eat often (at least twice weekly): fish and seafood.
- Foods to eat in moderation (weekly): poultry, eggs, cheese, and yogurt
- Foods to eat rarely: red meat and sweets.
- Red wine is permitted in moderation and water is encouraged.
This Western interpretation of the Mediterranean diet discourages saturated fat and animal foods and minimizes salt, despite evidence of traditional salt-rich foods like:
- Feta cheese
The Mediterranean diet also advocates unsustainable food-sourcing. We already have a big overfishing problem. It’s simply not sustainable for everyone to eat fish all the time.
Plus, even wild sustainably-sourced fish can negatively affect your health because it often contain heavy metals.
On the other hand, pasture-raised eggs and meat are actually sustainable. Read more about sustainable food sourcing here: The Transition to Veganism: Is It Actually Good for the Planet?
The Claimed Benefits of the Mediterranean Diet
Advocates of the Mediterranean diet claim it helps
- Lower the risk of heart disease and high blood pressure
- Promote weight loss and healthy weight-maintenance
- Prevent and manage diabetes
- Prevent cognitive decline and dementia
- Reduce inflammation
- Lower cancer-risk.
Granted, research does exist that supports some of these touted benefits. For example, adoption of an alleged ”Mediterranean diet” would likely help you cut out problem-causing foods, like sugary and processed foods.
But that doesn’t change the flawed logic that underlies the Mediterranean diet pyramid.
The Gaping Holes in “the Mediterranean Diet”
I’ve observed four main holes in the logic behind the popular unquestioned concept of “the Mediterranean diet pyramid.” The current concept of the Mediterranean diet neglects:
- Changes in standard dietary practices since the introduction of Western and industrial foods to Mediterranean regions.1, 2, 3
- That traditional Mediterranean diets varied and vary greatly by region (the Mediterranean covers a huge hunk of land!).
- That traditional Mediterranean diets have not included as many grains as they have unprocessed animal-products, fats (usually animal-sourced), and oils.
- That cuisines in many regions actually include about 40 percent more sodium than the USDA tells us to eat (think of all those sodium-rich foods like olives, sardines, anchovies, prosciutto, parmesan, etc.).4, 5
Not surprisingly, the USDA’s first Dietary Guidelines, set forth in 1980 (which have remained mostly unchanged over the past 40 years even after multiple revisions) were written by political staffers, as opposed to scientists, nutritionists, and dietitians.
This will come as a shock to many: the USDA’s low-fat, grain-and-cereal-focused food recommendations (the old Food Pyramid and new MyPlate) weren’t evaluated for health benefits before they were put into effect.
It should come as no surprise that the health of the American population has only gotten worse, not better under the influence of these outdated and under-researched guidelines—which Americans have tried their darndest to follow.
Since the time the guidelines were installed, the number of obese people in America has more than doubled, and the number of those with type 2 diabetes has tripled.6, 7
The Ignored Cultural Differences
It’s worth noting the lifestyle differences between a centennial living in the Mediterranean and the average American. Because cultural health differences can’t be addressed through the diet alone.
Yes, advocates of “the Mediterranean diet” may assert that recommendations for family meals and physical activity are included in the pyramid. But an hour in the gym isn’t the same as natural movements, like walking to work, gardening, and working around the house.
Even modern conveniences that make your life easier, like robotic vacuums, take away from your physical activity throughout the week.
Now I’m not saying technological ingenuity shouldn’t make your life easier, but it’s worth comparing all the cultural and lifestyle differences between the U.S. and the Mediterranean region–not just food.
If you’re considering following dietary guidelines supposedly derived from another culture, you need to holistically examine that culture’s lifestyle. If you only consider a fraction of that culture’s practices, how can you expect the same health outcomes? You can’t.
Now, back to evaluating the holes in the evidence behind the Mediterranean diet pyramid. Let’s take a look at what experts have to say about low-fat diets.
The Experts Weigh In On Low-Fat Diets
Dr. Janet King, Chairwoman of the 2005 Dietary Guidelines Advisory Committee:
“[E]vidence has begun to accumulate suggesting that a lower intake of carbohydrate may be better for cardiovascular health [than a low-fat diet].” 8
The Institute of Medicine’s 2005 Dietary Reference Intakes Report:
“…low-fat, high-carbohydrate diets may modify the metabolic profile in ways that are considered to be unfavorable with respect to chronic diseases such as coronary heart disease and diabetes.” 9
The 2010 report, “In the face of contradictory evidence: Report of the Dietary Guidelines for Americans Committee” discusses the lack of
“sufficient evidence to conclude that increases in whole grain and fiber and decreases in dietary saturated fat, salt, and animal protein will lead to positive health outcomes.” 10
John P. Salerno, MD, board-certified family physician:
“Low-fat patients are my most unhealthy patients….The reason we are spiraling into diabetes and obesity is because of the low-fat concept developed by the U.S government decades ago. Low-fat diets have a low nutrient base, and phytonutrients in vegetables cannot be properly absorbed without fat.” 11
An article published in the Journal of the History of Medicine and Allied Sciences:
“Ironically, in the same decades that the low-fat approach assumed ideological status, Americans in the aggregate were getting fatter, leading to what many called an obesity epidemic. Nevertheless, the low-fat ideology had such a hold on Americans that skeptics were dismissed.” 12
Basically, fat is mega important for good health. Since we started nixing fat, including animal-sourced fats (what with our exaltation of “the Mediterranean diet pyramid”), we’ve been replacing it with things that aren’t good for us. 13
People Don’t Actually Lose Much Weight on a Low-Fat Diet
What’s the supposed logic behind low-fat diet recommendations for weight loss?
Basically, fat has 9 calories per gram, in comparison to carbohydrate’s and protein’s 4 calories per gram—factoids we’ve taken to mean that if you eat less fat, you’ll by default eat fewer calories and lose weight.
While that logic looks alright on paper, it doesn’t hold up so well in clinical tests.
Take, for example, the $100-million Women’s Health Initiative (WHI), a rigorously-controlled clinical trial in which the 50,000 women who enrolled were thoroughly counseled to eat lots of grains, fruits, and veggies, with no more than 20 percent of their daily calories from fat.
According to the WHI, after three years of this extremely low-fat diet, the women lost an average of one kilogram each—a little over two pounds.
Two pounds in three years! Talk about an epic fail.
In general, according to Gary Taubes, an expert on the dietary fat and cholesterol controversy, “the results of well-controlled clinical trials are consistent: people on low-fat diets initially lose a couple of kilograms, as they would on any diet, and then the weight tends to return. After 1 to 2 years, little has been achieved.”
So why exactly are low-fat diets and the Mediterranean diet pyramid so ineffective for weight loss, and how do they increase your chances of heart disease and diabetes?
To answer this question, we have to ask another: what nutrient replaces fat in a low-fat diet? Usually carbohydrates (as seen in the WHI study). Herein lies the problem.
Too Much Fat Isn’t The Problem, Too Many (and Poorly-Sourced) Carbohydrates Is
There are three kinds of carbs: sugar, starch, and fiber.
Fiber isn’t digestible, can help your body eliminate waste, and doesn’t spike blood sugar. Fiber is cool.
On the other hand, starch eventually breaks down into sugar in the body.
As sugar and starch consumption increase, the body makes more insulin to collect sugar from the blood and tells your body to store fat (exactly the opposite of what you want!), laying the foundation for weight gain, diabetes, and heart disease.
So even if you count every gram of fat that enters your mouth, throw out the yolks of your eggs, and avoid butter as if it was that ebola-monkey from the movie Outbreak, you’re not helping matters when it comes to weight loss. Frustrating much!
To make things worse, low-fat diets are hard to maintain because they tend to lack flavor and don’t satisfy.
Meals made up of mostly carbohydrates and very little fat are digested quickly, leading to blood sugar highs and lows that can make you seem like a cranky PMS-ing monster for no apparent reason or an insomniac zombie in the office at 2:00pm.
Unless you’re looking to not enjoy meals and walk around hungry and out of sorts, low-fat diets, including “the Mediterranean diet,” make for an unsustainable lifestyle.
Read more about this topic in my article Think You Know the Facts About Carbs? Don’t Be So Sure.
Research Demonstrates the Opposite of a Low-fat Diet Is Better for Your Health
On the other hand, the opposite of low-fat diets—higher fat and lower carb—have actually been shown to reduce the risk of
- Diabetes by decreasing fasting blood sugar and improving insulin sensitivity.
- Heart disease by improving cholesterol and triglyceride values and lowering inflammation.
Read more about the myriad health benefits of not just fat, but saturated fat in my article Is Saturated Fat Bad for You? No!
And learn more about how important it is to source protein from animal foods–despite what “the Mediterranean diet pyramid” espouses–in my article Plant Protein vs. Animal Protein: The Myths and Facts.
Why then do some people swear by a low-fat diet? Most likely because when people keep tabs on fat, they also become more conscious of their eating habits on the whole, thereby nixing processed food or at least excessive amounts of it.
That said, while some people may stay on track with their weight by paying attention to numbers, nit-picky calorie-counting isn’t informed or healthy. Why? Because not all calories are created equal (more on this soon).
If you simply can’t resist the urge to number-crunch labels (you know who you are), check out the grams of sugar per serving. Doing so will give you an idea of how truly “fattening” your food choices are.
The Bad Guy That Ends Up On Your Hips and Thighs
See, sugar is the bad guy that ends up on your hips and thighs.
While it is true not just sugar, but also excess starchy carbohydrates can do this, sugar is more addictive and leads to overeating because it tweaks insulin levels in funky ways.
Even the nutritionally-conservative American Heart Association recommends a maximum intake of 25 grams of added sugar per day–though this message gets little media attention.
Yikes! That’s just 6 teaspoons of sugar or 2/3 of a 12-ounce can of soda. Sweet crap adds up quickly!
One thing remains clear though: the body responds to different macronutrients differently when it comes to storing their associated calories as body fat.
So a new question arises: are calories even a reliable tool of measurement for weight management?
While calories are clearly one way to quantify energy provided by food, research indicates human biology responds to calories from different sources, well, differently. (Read more about this in my article: Tired Of The Calories In Calories Out Weight Loss Method? Try This Instead.)
The Dangers of a Low-Fat Diet
Still not convinced about the dangers of a low-fat diet, as exalted in “the Mediterranean diet pyramid?” If you just can’t seem to shake your fat-fearing mindset, consider the following things a low-fat diet might predispose you to:
- Infertility and menstrual disorders
- Heart disease
- Lowered immunity.
In fact, researchers have never been able to find a culture in the history of the world that was able to continue its line on a diet devoid of fat-rich animal foods (I talk about this in my book).
There’s a simple, obvious reason: your body needs fat.
Don’t Buy Into All That Non-Fat Greek Yogurt Hype
And don’t let all the non-fat Greek yogurt that flies off grocery store shelves fool you.
Traditionally, cultures (Greek, Icelandic, etc.) removed fat from yogurt not in an attempt to avoid fat, but in an effort to eat it in/as other foods, like butter. The non-fat yogurt was just a byproduct. Unlike our modern practices in the US, traditional cultures didn’t let much food go to waste.
In fact, in some Scandinavian countries, it was recommended people eat what most Americans would consider ghastly amounts of butter per week during the frigid winter months. Such recommendations certainly weren’t made because fat was considered unhealthy.
Nope, fat was and still is a prized giver of health.
On the other hand, the American interpretation of “the Mediterranean diet pyramid” is not.
What About Those High-Salt Traditional Mediterranean Foods?
Salt isn’t the health-ruiner it’s made out to be and most regional populations in the Mediterranean eat significantly more salt than the USDA guidelines recommend.
You might be wondering, how can it be that Mediterranean populations eat nearly 40% more sodium and still have a lower risk of high blood pressure and heart disease?
Could it be that salt isn’t nearly as bad for your health as you’ve been told? That’s right, the amount of salt you eat is not the cause of high blood pressure.
In fact, for most people, changing the amount of salt they eat minimally impacts their blood pressure. You can read more about this in my article What Happens If You Eat Too Much Salt?
- The biggest takeaway from all this should be: don’t be afraid to question everything you hear–even government guidelines.
- The mainstream so-called ultimate answer to health problems changes every few years—from low-fat crazes to the Mediterranean diet pyramid to all manner of alleged superfoods—as the mainstream diet industry quests for the right one-size-fits-all approach. It’ll never find one though. Why? Because
- The diet industry is an industry and it thrives on novelty–fads, quick-fixes, new-new-new.
- There is no one-size-fits-all approach when it comes to your health.
- The foundation of health isn’t one specific diet or behavior. It’s the drive and commitment to question everything, even if doing so makes you or the people around you feel uncomfortable. You’ll never level up if you don’t face and grow your edge. And remember you’re never alone. Seeking community and connecting with others—even reading this article right now—is how you grow your edge. See, you’re doing it right now.
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Feature image and two outtake feature images copyright Erika Herman. “Nutritional Food Diet Pyramid Products” illustration by yupiramos. “Empty NO symbol, prohibition or forbidden sign; crossed out red circle” graphic by Michiru13.