We Need to Talk About Why the “Mediterranean Diet” Is Problematic

We Need to Talk About Why the “Mediterranean Diet” Is Problematic

YOU’VE NO DOUBT heard about the heart-healthy, disease-fighting, longevity-promoting virtues of the Mediterranean diet.

Health experts love it because it’s simple and flexible, unlike complex and restrictive diets like Whole30 and keto. On a Med diet, all you have to do is focus on eating lean proteins (especially seafood and poultry), with lots of fresh fruits and vegetables, whole grains, unsaturated fats, and a little wine if you’d like.

Even the name itself conjures images of lazily nibbling olives off a patio table behind a cliffside villa. This isn’t a diet—this is a lifestyle.

Except that some dietitians are now criticizing that very image. The Med diet is, and has always been, narrowly defined. And as any glance at a map will tell you, the region extends beyond Greece and Italy—it’s a vast swath of land consisting of 22 countries including Tunisia, Bosnia and Herzegovina, Slovenia, Syria, and so many more.

To exclude those cultures from our definition of the Med diet, even implicitly, discourages the consumption of a wide variety of incredible flavors from a world of cuisines.

So why limit yourself?

The Med Diet: An Origin Story

NO ONE PERSON or brand owns the diet, but one study did conceive it.

In 1950, heart disease was the leading cause of death in the U. S. and scientists wanted to know why. After a few years of initial research, they started connecting cardiovascular health to diet. This brought about the 1958 launch of the Seven Countries Study, a massive cross-cultural analysis of how food and lifestyle relate to heart health. Ancel Keys, Ph.D., a physiologist from the University of Minnesota, led the research.

is the mediterranean diet racist global eating diversity

Andrew B. Myers

Keys and his team studied cohorts from the U. S., Finland, the Netherlands, Italy, Greece, Yugoslavia, and Japan. What they found was revolutionary at the time: Lower saturated-fat intake was associated with lower rates of heart disease.

Keys determined that participants from southern Europe (specifically the Mediterranean countries) and Japan had lower rates of coronary heart disease. The study itself was groundbreaking—the first major epidemiological research to assess the relationship between diet and health, according to the official website dedicated to promoting its message.

The findings reverberated throughout the world, and Keys rose to scientific stardom, even appearing on the January 13, 1961, cover of Time.

While the Seven Countries Study was undeniably important from a research perspective, critics have since pointed to its limitations—namely that there were too few cohorts, there was a lack of complete dietary data, and the research subjects were primarily white and/or European middle-aged men.

During their work on the study, Keys and his wife, Margaret, a biochemist who led some of his lab work, wrote two best-selling books: How to Eat Well and Stay Well in 1959 and How to Eat Well and Stay Well the Mediterranean Way in 1975.

The recipes in each would not be out of place in a Mediterranean cookbook today: simple appetizers like honeydew melon and prosciutto, a “real” Spanish omelet, and Greek lentil soup.

The couple embraced the European lifestyle and even bought a second home in a small fishing village on the southern coast of Italy, where they lived and worked for more than three decades. And the diet and lifestyle undoubtedly agreed with them. He died shortly before his 101st birthday and she lived to 97.

Yet they might have lived just as well in Japan. The Seven Countries Study found that Japanese participants, who followed a much different dietary pattern than the Greeks and Italians, also had low rates of coronary heart disease.

The focus on a narrow Mediterranean diet has left little room for other traditional diets.

In the preface to How to Eat Well and Stay Well the Mediterranean Way, the authors explained their decision not to highlight the health benefits of the traditional Japanese diet in their writing. It was “fortunate,” they wrote, that the countries they studied included Italy and Greece.

If the research had centered on Japan, Korea, and Taiwan, “it would have been difficult to apply the findings to the well-being of Americans” because “their cuisines are simply too alien to the heritage of the Western world to be acceptable to most of us.”

By “most of us,” the two meant “the white Western world,” says Breana Lai Killeen, M.P.H., R.D., a Chinese and Jewish chef and dietitian. “This quote says to me that the Eastern world was too exotic to the Western world.”

The Med diet was the equivalent of an American traveling to Europe or Australia: different, but not so unfamiliar as to make “us” uncomfortable, she says.

The criticism about what qualifies—and what doesn’t—as a Med diet is relatively new, however. After the Seven Countries Study, the diet grew in popularity as one nonprofit in particular championed a specific structure around how to eat “Mediterranean.”

“Mediterranean Madness

FOR WHATEVER REASON, when it comes to explaining nutritional concepts, Americans love a good pyramid.

In 1993, just a year after the USDA introduced the Food Guide Pyramid, a nonprofit called Oldways debuted its own.

Oldways was the brainchild of politico/restaurateur/world traveler K. Dun Gifford, whose aim was to “research and promote a harmony of traditional food patterns, sustainable agriculture, and healthy eating and drinking,” according to its website.

The nonprofit has since published African, Latin American, and Asian diet pyramids, but it originally chose to focus on the Med diet because of its scientific backing, says current Oldways president Sara Baer-Sinnott.

a fork and knife on a map

Andrew B. Myers

Unlike the USDA’s, Oldways’ pyramid had a section for beans and legumes, separated fish from lean red meat, and included olive oil and olives in the “eat daily” category—and its representation isn’t far off from most Eurocentric depictions of the diet today.Above its pyramid, in fine print, it did mention that “variations of this optimal diet have traditionally existed” in other countries, including Morocco, Tunisia, Turkey, Lebanon, and Syria.

The Oldways pyramid was a success, appearing in hundreds of newspapers, magazines, and nutrition textbooks, according to The Oldways Table, a 2007 book by Gifford and Baer-Sinnott.

As a result, by the mid-’90s, the Mediterranean-cookbook category was booming. (There are currently more than 10,000 titles on Amazon.) Between 1990 and 2012, olive-oil consumption tripled in the U. S. More Americans started saying wine was their favorite alcoholic drink. All this excitement for the diet was enough for The Washington Post to declare in a 1994 headline that Americans had reached a point of “Mediterranean Madness.”

Oldways’ mission then and now: to “inspire people to embrace the healthy, sustainable joys of the old ways of eating.” The Oldways Table mentions that the group also embraced the diet because it was “the healthiest eating pattern most familiar to Americans.”

Did “Americans” mean white Americans? “This is [almost] 30 years ago. And there’s a lot that has changed now. Culturally, societally, racially,” says Baer-Sinnott. “We believe that one size doesn’t fit all and that we are a nation of immigrants.”

Yet the continued marketing of many Mediterranean cookbooks and guides is misleading about the greater region. The 30-Minute Mediterranean Diet Cookbook, which has more than 7,500 Amazon reviews, pictures salmon, of which there are no wild species in the rivers flowing into the Mediterranean Sea. Numerous cookbooks have covers that include avocados, a fruit that originated in Central America. Plates of pasta are featured far more often than bowls of rice.

This drumbeat of familiarity has an effect. When U. S. News & World Report surveyed people in 2020 about their favorite Med-diet foods, Greek salad and tabbouleh ranked high.

Nowhere to be found—at least among the popular presentations of the diet or in polling data—was slata mechouia, a ubiquitous grilled-vegetable dish in Tunisia. Or bosanski lonac, the vegetable-heavy stew that is a staple in Bosnia and Herzegovina. Or ajdovi žganci, a traditional whole-grain buckwheat porridge eaten throughout Slovenia.

All of these dishes, each incredibly nutritious, would be right at home on the cover of a Med-diet cookbook and on your table, too. And their inclusion could have a huge effect on your health.

A More Diverse Plate

THE FOCUS ON a narrow Med diet has left little room for other traditional diets that are just as healthy.

“As a clinical dietitian, I had Mexican patients tell me, ‘Oh, do I have to eat like a white person?’ ” says Miguel Ángel López, Ph.D., R.D.N., of the Gretchen Swanson Center for Nutrition. “There is this stigma that their food is unhealthy, and to be healthy, you’re supposed to eat this other kind of food.”

Some major health groups, such as the American Heart Association, have moved toward a more inclusive approach called the Med-style diet, emphasizing core food groups (like “fish and seafood”) rather than culturally specific ingredients (salmon).

It’s a good step to steer the diet away from Keys’s original European focus, critics say, because the answer is not to toss out the Med diet or to crown another cultural diet as “best overall.” It’s to get rid of the crown. It’s to forget the title.

The answer is to broaden the definition of what a healthy diet looks like, to diversify it to include the many unique and delicious foods from around the world, and to know that what’s on your plate can and will change over time.

A limited diet also makes eating less fun. Dezi Abeyta, R.D.N., a Men’s Health nutrition advisor, sees diversifying your diet as an opportunity to add more nutrition—and more flavor. For example, instead of pasta or bread, the carbohydrate on your plate could be Japanese soba noodles, southern-style yams, Vietnamese broken rice, Nigerian fufu, or Mexican tortillas.

Abeyta even has a preferred method of expanding his diet: making new friends from other cultures, learning from them, and breaking bread together. “The way that you can diversify your plate is to diversify your community,” he says. And that may be the “overall best diet” advice, well, ever.

Eat the Whole Planet

Fill up on lots of lean proteins, a rainbow of fruits and vegetables, fiber-rich beans and grains, nuts, and healthy fats: These healthy-eating guidelines aren’t specific to any one country. Here are four global ways to broaden your diet. By Dezi Abeyta, R.D.N.

Lean Proteins
• Variety of fish and other seafood (salmon, tuna, mackerel, yellowtail)
• Tofu

Fruits & Vegetables
• Seaweed
• Mushrooms
• Japanese sweet potatoes
• Radishes
• Cucumbers

Whole Grains
• Rice
• Noodles

Legumes & Nuts
• Miso (fermented soybeans)
• Soybeans

Healthy Fats
• Salmon
• Mackerel

• Wasabi
• Ginger
• Sesame seeds

Dishes That Have Some of Each
•  Baked miso tofu rice bowl
•  Traditional Japanese breakfast: grilled fish, steamed rice, miso soup, and various side dishes

preview for NYC Chef and Break-Dancer Shares His Healthy High-Protein Meal | Weights & Plates | Men's Health
Headshot of Anjali Prasertong, M.P.H., R.D.

Anjali Prasertong, M.P.H., R.D., is a Denver-based registered dietitian who focuses on nutrition, racial equity, public health, and food systems. She writes the newsletter Antiracist Dietitian.

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