Everywhere you turn, someone is pushing a new diet. There’s low-carb, plant-based, vegan, vegetarian, lacto-ovo, paleo, raw, eating for your blood type, the Zone, South Beach, and the list goes on and on.
But the one diet that has stuck around isn’t even really a “diet” per se. It’s more of a way of eating that has been around for centuries: the Mediterranean diet.
The core of the diet focuses on fruits and vegetables, fish, legumes, whole grains, nuts, olives and olive oil, small amounts of dairy, and red wine. It also emphasizes exercise and encourages a happy, enjoyable ritual surrounding meal times.
And the Mediterranean diet has been linked to decreased risk of heart disease, obesity and diabetes.
But, let’s face it. We’re human. We like what we like, and we don’t always like to eat healthy. Moreover, we don’t always follow a great food plan all day every day.
If only someone could take our current eating habits and tweak them to fit the Mediterranean diet. For that, we head to Marseille, France.
When it comes to eating healthfully, you could go one of two routes. You can eat according to one of the myriad programs out there, or you can determine which nutrients you need and create a diet around those. And French researchers used a computer program to create a hybrid of the two.
Breaking Down Their Process
Based by the notion that people consume food, not individual nutrients per se, researchers set out to tweak known dietary choices to more closely fit the traditional Mediterranean diet. Their goal? To “translate nutrient recommendations into combinations of real food choices while taking into consideration the individual variability of eating patterns in a given population.”
To do so, they used a 1999 cross-sectional dietary survey that captured week-long food records of more than 1,100 French adults. While they did not include alcoholic beverages (including red wine, which is a staple of the Mediterranean diet) or even tea or coffee consumption, they did break the remaining foods into seven groups and 20 categories.
For example, vegetables, fruits and fruit juices, and unsalted nuts were all separate categories, but they fell under the “fruits and vegetables” group. (Why nuts were included in this, I have no idea.)
They took all of these dietary records and used a computer program to determine if that person needed to add or subtract any particular nutrients and/or food types from their diet. They specifically looked at four key elements:
- Total fats
- Total carbohydrates
- Monounsaturated fats
Next, taking these elements into account, they worked to create a new dietary plan that met three main objectives:
1. Ideally choose foods already listed on the person’s food records.
2. Try to minimize cutting foods already being eaten.
3. Introduce as infrequently as possible food not on the person’s list and try to include foods that are frequently enjoyed by others in the French population at large.
Additionally, there were some constraints put in place. The first included a maximum consumption for each particular food, each food category, and each food group.
They also used a combination of criteria from the World Health Organization (WHO), Nordic Nutrient Recommendations, and French recommendations to establish minimums for a variety of specific nutrients, including:
- Linoleic acid
- Alpha-linolenic acid
- DHA and EPA (essential fatty acids)
- Total omega-3 fatty acids
- Total polyunsaturated fatty acids
- Saturated fats
- Free sugars
- Ten vitamins (B vitamins; vitamins A, C, and E; vitamin D; etc.)
- Nine minerals (zinc, selenium, calcium, magnesium, iron, potassium, etc.)
Next, they worked to create ranges of macronutrients that would serve as a baseline. They called this the BASAL model. It included 20 percent to 35 percent of calories coming from total fats, and 50 percent to 75 percent of calories coming from total carbohydrates.
Finally, they used this BASAL model to create a total of eight different models to test based on restraints for fats, carbs and/or cholesterol, as well as adding in monounsaturated fats (MUFA). These included:
- The BASAL model
- BASAL minus fats
- BASAL minus carbs
- BASAL minus cholesterol
- BASAL minus fats, carbs and cholesterol
- BASAL plus MUFA
- BASAL plus MUFA, minus fats and carbs
- BASAL plus MUFA, minus fats, carbs and cholesterol
Phew! That’s a lot to digest (pun intended). Now the question remains, was all that work and categorizing of food plans worth the effort?
Small Tweaks Garner Great Results
Using the BASAL model as their baseline, researchers ensured that they started from a common point, which included no more than 35 percent of calories coming from fat, 50 percent or more of calories from carbs, and no more than 300 mg of cholesterol a day.
They found that removing the fats constraints had no effect on total fat distribution. Removing the carbs constraint decreased overall carb content from 50 percent of total calories to 45 percent. Conversely, removing the cholesterol constraint increased total cholesterol intake from 300 mg to 530 mg a day.
Removing all three constraints simultaneously garnered the following:
- Increased total fats from 35 percent to 37 percent
- Decreased total carbs from 50 percent to 44 percent
- Increased total cholesterol intake from 300 mg/day to 520 mg/day
When MUFAs were added in, the results got interesting. First, the MUFA constraint dictated that 15 percent of calories had to come from monounsaturated fatty acids. This includes foods such as olives, olive oil, avocados, almonds, etc.
Researchers found that if the MUFA constraint was not included, the intake of the healthy fats was always reduced. However, they discovered that the BASAL plus MUFA model was totally unrealistic. (Oddly, they didn’t indicate why.)
They did find that there was more flexibility when you added in the MUFA constraint but removed the total fat and carb ones. They noted that it allowed more variability in the diet.
However, they found the same trend when they also removed the cholesterol constraint, with total cholesterol intake going from 300 mg/day to 520 mg daily.
When it came to using specific foods to create these tweaks to the models, a few things stood out:
- An increase in unsalted nuts was noted across the board.
- Several food categories were also increased in all cases, though to varying degrees. These included:
- Whole grains
- Fresh dairy products
- Vegetable oils
- Refined grains and potatoes were either decreased or unchanged and were at a moderate consumption level.
- Poultry, salted snacks, eggs, sweets and red meat were either decreased or unchanged and were at a moderate to low consumption level.
- Cheese, deli meats and animal fats were always decreased and in the lowest consumption levels.
- When it came to adding in MUFAs, they had to increase intake of vegetable oils.
After examining all eight models, researchers felt that one in particular stood out: the BASAL plus MUFA model, with the constraints removed for total fats and carbs. The reason for this was that without the addition of the MUFAs, people simply were not eating enough of these good fats.
Of the three models that included MUFAs, the one with just the BASAL and MUFAs was too restrictive, while the model that removed all three constraints had an unacceptable level of cholesterol. Therefore, researchers concluded that the ideal (or selected model) was the BASAL plus MUFAs without restraints on total fats and carbs.
Making the Selections
In order to make the necessary tweaks to the original 1,100-plus food plans to achieve this ideal model, researchers made the following changes to the diets:
- They added more fish to all plans.
- They added more fruit, fresh dairy products and unsalted nuts to most plans (more than 75 percent).
- They increased intake of whole grains, legumes, poultry and cheese to 17 percent to 30 percent of the plans.
- Animal fats were almost totally removed.
After these changes, researchers found that each new diet plan included (on average per day):
- 540 grams of fruits and vegetables
- 260 grams of fresh dairy products
- 60 grams of fish
- 70 grams of red meat
- 140 grams of sweets, casseroles, and/or sandwiches
- Less than 25 grams each of unsalted nuts, whole grains and legumes
Given all this, researchers concluded, “The Mediterranean diet pyramid should be interpreted as a goal showing the right direction rather than a strict model to apply.” They go on to say, “Healthy diets can include more foods with an unfavorable nutrient profile than is generally recommended if foods with a favorable nutrient profile are also present in sufficient amounts.”
Which is to say, you can include the occasional indulgence — even daily — if you are eating mostly healthy foods the rest of the time.
Turning Data Into Dinner
So, as an average Joe or Joanne, what should you make of all this? After all, it seems like a lot of configuring and number crunching and less actual consumption and meal planning.
To me, the takeaway is, first and foremost, going Mediterranean is not a trend. It’s a good model to follow for optimal health.
You can then use this study to further refine your meal plan. Be sure to include good, healthy, monounsaturated fats from olives, unsalted nuts and vegetable oils. Next, include a plant-strong diet of fruits, vegetables, whole grains and legumes. Finally, think water not land when it comes to protein.
And don’t forget to leave room for a bit of red wine and your favorite sweet treat. It’s your reward for eating right the majority of the time.
 Sofi, F et al. Adherence to Mediterranean diet and health status: meta-analysis. BMJ. 2008;337:a1344.
 Maillot, M et al. The shortest way to reach nutritional goals is to adopt Mediterranean food choices: evidence from computer-generated personalized diets. Am J Clin Nutr. 2011 Sep 7. [Epub ahead of print.]