Is there really a best diet?

Every few years one diet becomes the all talked about fashion as the new best diet. Paleo, keto, low carb, low fat all had their rotations. But these are all restrictive diets and mostly based on some expert or self claimed guru. For instance, Paleo diet was based on the assumption that as hunter gatheres we ate mostly meat and little carbs. But we now know that is not true. So, what is really the best diet?

That is a very hard question to ask. Mostly because it is very hard to do an evidence based, randomized trial of a pure diet. In addition, many diets also come with cultural and lifestyle differences that are hard to measure as a contributing factor to overall health. Some cultures are more physically active (Japanese), some are more relaxed (French and Spanish) and some are more outdoors and in tune with nature (Scandanavian). Those are all healthy attributes that can confound the effect of pure dietary changes. Same can be said about vegiterians (usualluy more active, calm yoga goers), Paleo (more body builder stereotypical).

Ok, enough nay saying. Obviously I do think there is a best overall diet, otherwise this whole blog would be a waste of time. If you were to choose a certain way of eating, then there is one diet that has trully withstood the test of time as being associated with better health outcomes and biomarkers such as cholesterol, blood sugar and inflammatory markers.

THE Mediterranean Diet:

Numerous populaiton, case control and some randomized studies have all shown the benefits of this diet:

• Lower blood sugar

• Better lipid profile (lower bad cholesterol)

• lower risk of cardiovascular disease and stroke

  • The strongest evidence comes from the PREDIMED trial involving 7,747 participanets at high cardiovascular risk. A Mediterranean diet rich in Olive oil demonstrated a 30% reduction in major cardiovascular events (heart attacks, stroke, or cardiovascular death) and a 42% reduction in stroke in high-risk individuals without prior cardiovascular disease.

  • The Lyon Diet Heart Study in secondary prevention (people who already have heart disease) showed that Mediterranean diet reduced cardiovascular mortality by 65% in patients with coronary heart disease over 46 months.

• Rcenet randomized trials have shown Mediterranean diet is an effective alternative to the very restrive LOW_FODMAP diet for patient with IBS.

• Numerous studies have shown significant reduction in inflammatory markers in Mediterranean diet vs all other diets including vegans, vegiterians and the DASH diet.

Now, do not get me wrong. I think true Mediterranean living is much more than the diet. People in that region are known for their laid back, low stress and rich social life. All attributes to a healthier living. But studies in populaitons outside of that region, where we work, sleep, and then work more, have persistently shown improved outcomes. So, besides their happy easy lifestyle, the Mediterranean diet alone seems to have significant health benefits.

In addition, the Mediterranean diet is not really a diet. It does not eliminate or prohibit any food category. It is rather a way of life which is much more practical and enjoyable than implementing a diet. It is something that anyone with any lifestyle can implement with few changes. As a primary care doctor, I never like to recommend a diet. It is punitive and implies that you are doing something wrong. It has been my experience that most people eventually give up their diet. So let's call this a lifestyle rather than a diet.

What is Mediterranean food:

As the name implies, it is the food of people in the Mediterranean countries, most notabley Greece, Southern Italy and Spain where olive oil is the main source of dietary fat. Main foods in a typical daily Mediterranean life are:

• Fresh Fruits and Vegetables, 3-4 servings per day.

• Tree nuts, main source of snacks.

• Legumes in most meals as source of carbohydrate and protein (as main source or a supplement).

• Whole grains such as farros, quinoa, brown rice.

• Fish 3 or more times a week.

• Poultry 2-3 times a week.

• Eggs 3-4 a week.

• Small amounts of fermented dairy products like yogurt, cottage or feta cheese.

• Wine in small amounts with a meal.

• Whole grain bread (consumed with olive oil) consumed with most meals.

Olive Oil: Olive oil is used as the main source of fat both for cooking and as a dressing. In fact Olive oil is the staple of Mediterranean diet and is used almost in every meal. There is good evidence that a lot of the cardio-protective effects of the Mediterranean diet comes from this high consumption of olive oil. However, the olive oil that is used in the Mediterranean region is a completely different product than what we buy in grocery stores, which for the most part lacks the benefits. To learn more about this, check out my seperate short blog on Olive oil.

What is missing on a regular basis in the Mediterranean diet is pork and red meat, consumed very occaiosnally and in special events only.

So, comparing this to a typical American diet, the most important changes will be:

• Absence of processed foods, specially procossed carbohydrates like white bread, white rice and processed pasta.

• Absence of red meat and pork.

• Absence of none fermented diary products like milk and butter.

• And of course as you all already know, absence of all those colorful boxed processed foods.

• Much higher consumtopn of fruits, vegetables, fish, tree nuts and high quality olive oil.

Here is a short simple sample of what a daily diet looks like:

• Breakfast:

  1. Greek yogurt with fruits, rolled oats and nuts

  2. 2 eggs with spinach and tomatoes using olive oil, side of fruits

  3. Oats with fruits, nuts and seeds

• Lunch:

  • Salad with beans or quinoa, sliced veggies, sliced fruits such as apple or tangerine, feta cheese, chicken or fish such as Salmon. Dressing is salt, pepper, olive oil, vinigear, fresh sqeezed lemon.

• Dinner:

  • Chciken or Fish with roasted potatoes, baked veggies using olive oil both as cooking oil and as a drizzle on cooked veggies.

  • Beans with baked veggies, whole grain such as brown rice or farrow, feta ceese or greek yogurt with a healthy sauce (fresh squezed lemon, riped crushed avocado, olive oil, garlic powder).

• Snacks:

  • Fresh fruits 2-3 servings through out the day.

  • Small amount of nuts

  • Veggies with hummus or greek yogurt dip.

  
  

As someone who has the priviledge of inheriting all the high quality genes for diabetes, high cholesterol and heart disease I personally have become much more interested in making evidence based changes in my lifestyle to prolong my days above the ground. And as the main cook in the house, I guess Megan and the kids can say goodby to Burgers with fries and say hellow to Salmon and baked veggies. And to set you on your new journey to a Mediterranean food exploration, here are a couple of websites with diverese easy to make recipes.

Mediterranean Living

A couple Cooks