A glug of olive oil, a load of veg and a slab of tuna or pecorino. That’s the Mediterranean diet that we all know and love… but it may not be the one that all the health benefits were actually linked to 50 years ago.
If there’s one thing most nutritionists and health experts agree on, it’s that many of us could benefit from eating in a more Mediterranean-style way. High in unsaturated fats, plants, grains and omega-3, we think of it as being grilled fish, bowls of rice, big bowls of salads. If you follow it to its Italian conclusion, perhaps it also means slices of margherita and creamy carbonara. After all, that’s what people eat in southern Italy, right?
Well, there’s evidence to suggest that we’re getting the Med diet slightly wrong, and it’s partly to do with the fact that many of us have far richer lives than those on whom the original studies into the nutritional health benefits were done.
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Back in the 1950s, researcher Ancel Keys and his colleagues discovered that poor people living in southern Italy and Crete were living longer, healthier lives than Americans – who, at that time, were thought to have an elite diet. Remember, this was post-war when things like eggs and meat were scarce, so it’s perhaps understandable that having free access to meat, dairy and eggs would seem like true health.
In any case, the researchers found that these poor Europeans were eating a largely meat-free diet, with Cretans eating a 93% plant-based diet centred on grains, beans, potatoes, olive oil, fruits and veg. Meat, fish, eggs and dairy accounted fora combined 7% of calories. Over in Italy, the staples were pasta, bread, beans, veg and the very occasional bit of fish or meat and a sprinkle of cheese. Pudding was always centered around fruit.
In 1995, a study was published in the American Journal of Clinical Nutrition, which claimed that the Med diet had been used as the original prototype for the 90s dietary guidelines in the USA. You don’t have to have been alive back then to know what the standard American diet consisted of: meat, fast food and dairy. In 2010, meat consumed in the US was still three times the global average, with red meat accounting for 58% of the meat eaten, with the average person eating 128g of meat a day. Since 1961, meat consumption in the US has increased by 40% – all while apparently following those “Med-based” guidelines.
Have we got the Med diet all wrong?
It’s no wonder that some dietitians, therefore, don’t believe the current idea of a Mediterranean diet is quite right. Cole Adam AKA the Eco Dietitian says that a true Med diet – ie one based on the original research – is up to 95% plant-based. It’s not fancy seafood and smoked meats from north London delis. It’s not expensive hard cheese or creamy truffle pastas. It’s a diet of the fields, packed with complex carbs, fresh fruit and veg, and olive oil.
“Unfortunately, the modern Mediterranean diet often recommended to people has been Americanized,” Adam claims in a recent IG post. “We overemphasize the things most people already like: fish, seafood, cheese/yoghurt, wine, poultry, pizza, and fatty pasta dishes. Yet we fail to realize that the health and longevity benefits attributed to this diet are mostly due to the abundance of plants.”
But Dr Federica Amati, chief nutrition scientist for Indi Supplements argues that while messaging around the ‘Med Diet’ may have been ‘Americanised’ by certain manufacturers, “the Med diet prescribed in clinical trials and for improved health has not”.
“The ‘Med diet’ that we talk about in nutrition research offers a clearly defined pattern of eating,” she tells Stylist. “This is made up almost entirely from plants, including vegetables, fruits, pulses, nuts, seeds, herbs, spices, beans and whole grains, with extra virgin olive oil on tap and the occasional small portion of meat, blue fish or dairy. Notably, dairy is also consumed almost entirely as fermented foods, such as cheese or yogurt and not as milk by the glass.”
In other words, her understanding of the Med diet is almost exactly the same as the original studies.
Can pizza be part of a healthy MEDITERRANEAN diet?
So, what does this mean for those of us who want to eat creamy pastas and pizzas as part of a Med diet? Dr Amati says that the key element of nutrition, whatever diet you follow, is to consider what you can add rather than take away. She believes that creamy pastas and pizzas can be part of a Mediterranean diet, but that they wouldn’t be a frequent staple of it. “It’s also important to differentiate between original clinical research (where participants adhere to a diet for weeks) and a dietary pattern in real life where people eat food every day of their lives for decades.
“Eating for life means enjoying birthday cakes, cheese fondues, takeaways with friends and snacks at the cinema, just as much as luscious salads, hearty kale and bean soups, roasted aubergines and seasonal fruit salads with kefir. There are no ‘bad’ foods but we do live in a food environment that makes better food choices difficult.”
Another important factor that she claims often gets overlooked is the quality of the food consumed: “A traditional Med diet, to this day, is made with seasonal fresh produce and is completely absent in ultra-processed foods like ready meals or prepared sauces.
“Pizza is slow leavened sourdough made with whole grain and topped with fresh tomatoes and herbs and pasta is of the high protein durum wheat variety served with plenty of vegetables, extra virgin olive oil and eaten sociably with family or friends. The Med diet is as much about quality as it is about the components of the diet themselves.”
In other words, we need to rethink what we believe these foods to be; eating a stuffed crust 12’’ pepperoni might be good for the soul but it’s a far cry from the real deal you’d eat in Italy.
And then we come onto the crux of the matter: the Med diet is all about eating more plants. Dr Amati says that while everyone needs to get to plant-based living at their own pace, “focusing on adding more plants, as opposed to taking away meat or fish, is likely to result in the same outcome. As plants are filling and nutritious, if you’re eating a delicious plant-rich plate at the start of your meal, you’re likely to be less hungry for a big steak.
“Research suggests we should aim for 30 different plants every week, from seasonal vegetables and fruits, as well as grains, legumes, spices, nuts and seeds. Although it looks pretty, preparing the same meal for lunch every day is not likely to help us achieve the ideal number of diverse plants every week.”
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