The Mediterranean Diet Is a Healthy Eating Plan—But It’s Far From Universal
- January 17, 2021
There are some eating plans that have been controversial from the get-go, like the ketogenic diet, Whole30, and intermittent fasting. But the Mediterranean diet—an eating plan that advocates for lean proteins, whole grains, seafood, and plenty of vegetables along with the occasional glass of wine—has long been the least problematic of any eating plan, quick to be endorsed by doctors, dietitians, and other healthy eating experts.
It’s easy to see why. The Mediterranean diet is the most studied eating plan in the world, backed by decades of robust clinical research. Hundreds of studies have found it to be beneficial in many ways, from supporting brain and heart health to reducing inflammation and keeping the gut healthy. All these reasons and more are why U.S. News and World Report has named the Mediterranean diet the best eating plan three years in a row. These benefits are also why the eating plan has been extensively covered by Well+Good.
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But there’s a blaring problem with the Mediterranean diet that many have failed to see, including the editors and writers of this publication. “The Mediterranean diet is an eating plan that was created by Westerners, studied by Westerners, and is recommended to everyone,” says Gerry Bodeker, PhD, who has researched and taught in medical sciences at Oxford University for two decades and is an adjunct professor of epidemiology at Columbia University.
Dr. Bodeker works with private sectors, governments, and United Nations organizations, currently serving as senior advisor to a UN University project on Asian traditions of nutrition. He says that recommending the Mediterranean diet to all people not only ignores the foods and eating patterns of different cultural traditions but can also work against people nutritionally. “If you’re going to have a global health message, you need to make sure it fits every single culture,” Dr. Bodeker says. The Mediterranean diet, for all of its benefits, does not quite fit the bill.
The research gaps of the Mediterranean diet
The very first Mediterranean diet study was published in 1958 by an American physiologist named Ancel Keys. He called it the “seven countries study.” The study (which only included men) focused on the connection between dietary habits and heart disease rates in Greece, Italy, Spain, South Africa, Japan, and Finland. His study found that rates of heart disease were lowest in Greece, Italy, and Spain—regions bordering the Mediterranean Sea. The “Mediterranean diet,” as identified by this study, sparked decades of additional research into the lifestyle’s benefits for all aspects of health.
What has remained consistent in the following seven decades is how scientific researchers, doctors, and nutrition experts talk about the Mediterranean diet. While the plan’s benefits largely come from the consumption of specific nutrients (a specific balance of protein, healthy fats, fiber, and complex carbohydrates), the foods often recommended for achieving said benefits typically come from a list of foods (like olives, fish, and feta) traditionally eaten in Greece, Italy, and Spain—the three countries that were the focus of Keys’s research all those years ago.
The wide body of research on the Med diet has been used to support its preeminence in the health world. Yet here lies one of the biggest problems with the Med diet: The majority of researchers are white, and the studies they conduct are primarily on white people. Despite Congress passing the Revitalization Act in 1993, requiring the inclusion of women and people of color in federally funded studies, fewer than 6 percent of all clinical trials are funded by the National Institute of Health (the government body that provides billions of dollars in research grants each year)—meaning that many more studies (including those researching the Mediterranean diet) aren’t incentivized to include Black, Indigenous, and people of color (BIPOC) in their research. It also means that many conclusions drawn about the Mediterranean diet may not apply to BIPOC communities, since they are largely left out of studies.
Dr. Bodeker says the lack of racial diversity in Med diet studies is a huge shortcoming. “This the nutritional equivalent of white entitlement,” Dr. Bodeker says. “It’s the dominant group recommending their way to the world sending the message of ‘our way is the best way.’ It’s the same colonial messaging based on lack of interest and knowledge of history and suitability for other cultures.”
Using primarily white participants in Med diet studies also reveals an extremely selective view of what it means to be from the Mediterranean. The region doesn’t just consist of Greece and Italy; it also includes Tunisia, Turkey, Syria, and Lebanon. Yet these communities and their cuisines are typically not included in the research on the Mediterranean diet’s benefits.
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Why the Mediterranean diet is far from universal
In an effort to make the eating plan more inclusive, proponents of the Mediterranean diet often say that its macronutrient proportions, not the specific foods, explain the diet’s superior health and longevity benefits compared to all other plans. But that’s not necessarily true either. Dr. Bodeker says the Okinawa diet (which comes from the Blue Zone community of Okinawa, Japan) contrasts with the Mediterranean diet in several key ways, including higher carb consumption, more mono/polyunsaturated fats, fewer saturated fats, and zero dairy consumption. Yet despite these major differences in diet, Okinawans regularly live to be over 100 in good health.
It’s not that one diet is better or worse than the other—it’s that the Mediterranean diet, for all its merit, isn’t the only way to eat healthily, nor is it necessarily beneficial for all peoples. “[A large percentage] of the Mediterranean diet is cheese and yogurt, but 60 percent of East Asians are lactose intolerant,” Dr. Bodeker says as an example. “If people who are lactose intolerant eat dairy, it will have an inflammatory reaction in the gut.”
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Global health dietitian Megan Faletra, RDN, says that many cultures, in fact, have naturally healthy ways of eating that were fundamentally altered by European colonialism. “We don’t have a strong food culture here in the U.S., so we try to commodify, or white-wash, many global food cultures,” she says. For example, traditional Mexican food consists of plant-based staples, such as corn, beans, and rice. “Our Indigenous ancestors didn’t drink milk or consume dairy, and they weren’t necessarily vegan, but they didn’t eat as much animal products as is in our diets now,” food activist and Food Empowerment Project founder Lauren Ornelas previously told Well+Good. It was European influence that led to the rise in cattle herding across Latin America, which changed meat from a “special occasion” food to one that one served at every meal. Yet another example is Samoans living in Hawaii. “They traditionally ate fish, fruit, and vegetables,” Dr. Bodeker says. White settlers later introduced meat, flour, sugar, and alcohol into their lives. Now, they are 80 percent more likely to be obese than white Americans.
Interestingly, both of these cultures follow similar basic macronutrient principles as the Mediterranean diet—a focus on vegetables and fruit and lean animal proteins. Yet only one cultural-specific way of eating has been celebrated in the health world as the end-all, be-all of nutrition: the Euro-centric Mediterranean diet.
The consequences of valorizing one diet over others
To be perfectly clear, the Mediterranean diet isn’t unhealthy. The health benefits researchers have found are real—at least when applied to the people included in their studies. “The Mediterranean diet offers a healthy eating model that promotes variety, moderation, and predominance of plant foods over animal foods…As a proponent of the Mediterranean diet, I advocate its core principles to my patients and community,” says Shahzadi Devje, RD, a registered dietitian who has written about race discrimination in nutrition. “However, the challenge lies in translating these principles into specific foods and meals that are culturally appropriate. It is not a simple ‘plug and play’ model—neither should it be.”
Championing one culture’s way of eating over all others isn’t just a matter of semantics; it has consequences for the health of BIPOC communities who aren’t part of that specific cultural tradition. Devje says trying to impose the Mediterranean diet on everyone can create a barrier for some people to live their healthiest lives. “The selective foods characteristic of traditional Mediterranean diets such as nuts, fruits, bread, olive oil, and wine are not staples in other cultures. At least not in mine,” she says. Requiring someone to adopt those foods in order to be “healthy” might make it harder for them to comply with the eating plan.
“Building cultural competence is vital in supporting dietary change for patients and communities alike,” Devje adds. “Our nutritional recommendations must not conflict with cultural values. Rather, they must be culturally compatible. Only then will they be practical, sustainable, and enjoyable.”
Expecting a healthy diet to look like the Mediterranean diet also ignores the many systemic reasons that impact what and how people eat, adds Devje. “People from ethnic minorities struggle with many standard measures of health and quality of life: financial means, satisfactory living environment, sense of independence, health, education, and support,” she says—all of which impact their overall health and well-being, including their ability to eat healthfully. The relationship between food systems, race, and health is complicated, she says, and we need a new model to better reflect the needs of the communities most at risk of diet-related diseases.
“The reality is, the mainstream dietary messages we see endorsed in public health policy, research, guidelines, and media target affluent white consumers—undeniably excluding ethnic groups, who do not identify with such narratives. Why are we surprised then by the state of health disparities,” Devje says.
Faletra adds that when doctors and dietitians talk about the Mediterranean diet, they often focus solely on its nutritional qualities, removing the cultural aspects such as physical activity and spending time with loved ones that also contribute to the health and longevity of Mediterranean peoples. “It’s important to look at eating in the context of culture,” she says. “Who are you enjoying the food with? What is the lifestyle like?” But she says those critical questions are often ignored in mainstream discussions about the Mediterranean diet’s benefits.
A more effective way to give nutritional guidance
While it’s important that doctors and dietitians keep their patients’ and clients’ cultures in mind when recommending healthy eating plans, many Americans’ heritage consists of numerous cultures, not just one. Beyond that, being inspired by foods from a wide range of cultures makes meals more enjoyable. These factors are also important to consider.
“One question I often recommend dietitians ask clients is, ‘What foods make you feel good?'” Faletra says. She agrees with Devje that it’s important to think about what foods are accessible to a person as well as what foods are native to the region someone lives. This will ensure that the recommended food choices are sustainable, too.
Faletra adds that unprocessed whole foods were originally the staples of nearly every single food culture around the globe. The specific types of whole foods may differ depending on where you’re from, but it’s a commonality that spans eating cultures around the globe. “Guiding people to help figure out the whole foods that make them feel good is one way to make healthy eating more intuitive and fun,” Faletra says, while making room for the foods important to one’s cultural background and context.
Devje says it’s also important that there are more communities equitably represented in policy, education, and research to make nutritional recommendations truly appropriate for all people, not just some. “We must also tackle race discrimination by engaging with people from ethnic minorities to understand the factors that influence people of color differently and disproportionately. They must have a voice and be represented at all levels,” she says. Only then, she says, will health providers and researchers be able to truly understand the cultural influences on patient values and behaviors.
It bears repeating that the Mediterranean diet can be a healthy eating plan; it’s just not the only one. “We need way more cultural competency and inclusivity in the way that we talk about food and health,” Faletra says. “That’s the only way we’re going to serve more people and enable them to be seen.”
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