Mediterranean Diet…The Best Diet Ever? Not So Fast!

Last week, the New England Journal of Medicine published a study which, according to the fawning mainstream press, proved “conclusively” that the best diet in the world was the Mediterranean diet, that it protected everyone from heart disease and stroke, and that everyone in the world should be on it.

Except the study showed no such thing.

Now, don’t get me wrong. I’m a big fan of the concept of Mediterranean eating, even though I’ve never seen anyone definitively define what “The Mediterranean Diet” actually is. (Check the definitions: most are squishy and vague with phrases like “higher in vegetables” or “lower in dairy”.) We do know that in all styles of Mediterranean eating there is way less sugar. And there’s lots of olive oil, nuts and other good stuff.

We also know that Mediterranean folks eat their big meal of the day in the middle of afternoon. And that they take naps. And that the men talk about their feelings. (A lot.) And they get lots of sun. And that all of these things have a great deal of impact, though that’s not what gets mentioned when the press talks about “The Mediterranean Diet”.

But I digress.

Back to the study. What the researchers actually did was create three groups of people. Group one ate what is generally thought of as a Mediterranean-type diet, but supplemented with lots of extra-virgin olive oil. Group two ate the same diet, but supplemented with lots of nuts. And group three ate the standard, American, low-fat high-carb diet that the diet dictocrats have been pushing on us for decades. The one recommended by such groups as the American Heart Association and the god-awful moribund American Dietetic Association (or whatever it is they’re calling themselves these days to try to reinvent themselves as contemporary. Good luck with that.)

Here’s what the results showed with laser-sharp clarity: The low-fat diet is a complete and utter failure.

Both “Mediterranean diet” groups did well on measures of cardiovascular health, and there wasn’t much difference between the two groups. But the low-fat group did horribly. In fact, they did so badly that in the middle of the study, the researchers intervened, and tried to give the low-fat group more instruction and attention to bring them up to speed. Didn’t matter. They bombed anyway.

Side note that was missed in all the media reporting: The researchers clearly state that they believe the excellent results achieved by both “Mediterranean” groups were largely driven by the supplemental nuts and the supplemental extra-virgin olive oil. Not necessarily the “diet” itself.

So what have we learned, class?

We’ve learned that the American, low-fat diet stinks. And that nuts and olive oil are extremely healthy foods.

As far as the Mediterranean diet being the “best” diet ever, that’s still up for grabs. This study certainly didn’t show that, as it didn’t pit the “Mediterranean diet” against any other diet but the low-fat one; there was no group doing a “paleo” diet, or a “high-protein” diet or a “raw foods” diet.

And we still don’t have a good definition of the Mediterranean diet. (As my mentor, the great Robert Crayhon once quipped, “People think the “Mediterranean Diet” means adding a bunch of olive oil to your corn flakes”.) And we still don’t know which aspects of the so-called Mediterranean lifestyle are the ones that really produce the results. Is it the olive oil? The nuts? The vegetables? The low level of red meat? The fact that they eat slowly and in the middle of the day? Maybe it’s all of those things, maybe it’s just some of them… this study certainly didn’t address that question, so we can’t say for sure.

What we can say is this: No diet, ever, in the history of the world, has been higher in sugar and processed carbohydrate junk foods than the one that most people in America consume on a daily basis.

And no diet is better designed to produce the epidemic of obesity, diabetes and heart disease we are currently witnessing.

My own personal opinion is you could design a dozen diet studies showing the superiority of a dozen different diets (from Atkins to Ornish to Zone) as long as you compare each of them to the crap we’re eating now.

With a bar that low, almost any diet is going to look like a superstar.




  1. Leslie

    Jonny, you are so irreverant in the most pleasing of ways; always love to hear that sarcasm when it hits completely on target. Yes, we are subject to more idiots in the world of nutrition than can be counted. We are blessed that you are diligent in the pursuit of bringing truth into the foray. I mean, seriously, these idiots that do these studies would not make it into high school biology class without having to make excuses for their lack of practicing ‘real’ science. Honestly. Thank you for being the rogue that you are!

  2. Chris

    Well, the early (like 3,000 years ago) Greek diet was a diet high in all kinds of fats (natural of course). Bet they wouldn’t like to hear that.

  3. Phil McGee

    Thank you, JB. Excellent, informative and refreshing. Cannot wait for your next book.

  4. jim healthy

    Hi, Jonny… Re: Your comment: “And we still don’t have a good definition of the Mediterranean diet.” The study was very specific about what the reserachers fed the Med Diet group:

    The “Mediterranean diet” was defined very specifically:
    • Fruits – 3 servings daily
    • Vegetables – 2 servings daily
    • Fish – 3 or more servings weekly; preferably fatty fish
    • Beans – 3 or more servings weekly
    • Sofrito – 2 or more servings weekly
    • Poultry (in place of habitual red meat)
    • Extra virgin olive oil (EVOO) – 4 tbsp daily or Nuts – 3 servings weekly (walnuts, almonds, and hazelnuts)
    • Glass of wine at dinner (optional, and only if previously habitual)
    My question is: Why did they need to run this study at all? For one thing, we have the results of the Lyons Heart Disease Study of 1988 which showed the same results. As your body Dr. Stephen Sinatra and I wrote in our book The Healing Kitchen (Bottom Line Books, 2010): “The Lyons Study showed that heart attack survivors who follow the Mediterranean diet with the fat content of 30-40% were 70% less likely to experience a second heart attack or other cardiac problems compared to patients who followed the typical low-fat diet recommended by the American Heart Association. The heart healing effects of the Mediterranean diet could be observed in patients within the first two months. And the study was halted years early to protect the health of the patients in the low-fat diet group.”
    As you know Jonny, Lyons wasn’t the first study to prove the failings of the low fat diet. As I cite in my upcoming book, The 30-Day Blood Pressure Cure (written with Roy Heilbron, MD, co-creator of the South Beach Diet: “… we’ve repeatedly been told for nearly 50 years that a low-fat diet is good for us. This has become a cultural belief, although there is no credible research to support it. In fact, when researchers finally got around to testing this, the results demonstrated no benefit from a low-fat diet. This should have sent shockwaves through the medical community and changed public health policy. Unfortunately, it didn’t.
    “Several such clinical studies have been conducted in the last ten years, comparing the low-fat diet still recommended to this day by the AHA and the British Heart Foundation to those high in fat — and especially saturated fat. These trials are considered the best ever done on the effect of eating high-fat, high-saturated-fat diets on risk factors for heart disease and diabetes. In each of these trials, participants were instructed to eat as much fat and protein foods as they wanted — including meat, fish, and poultry — but to restrict carbohydrates to no more than 50 grams. Their results were compared to subjects who ate fewer overall calories and avoided fat and saturated fat. Results were remarkably consistent across all studies.
    “Here’s what happened to those who ate mostly saturated fat and protein:
    1. Their HDL cholesterol went up.
    2. Their triglycerides went way down.
    3. Their blood pressure went down.
    4. Their total cholesterol remained about the same.
    5. Their LDL cholesterol went up slightly.
    6. They lost about the same amount of weight as the low-fat group
    7. Their risk of having a heart attack decreased significantly. “
    Hundreds of millions of dollars have been spent trying to stubbornly demonstrate any health benefits for the low-fat diet. All have failed. Indeed, the official low-fat dietary advice from doctors has been responsible for our current epidemics of Type 2 diabetes, cardiovascular disease and obesity. This “fat is bad” advice has frightened consumers into devouring more refined carbohydrates – with devastating consequences. Jim Healthy,

    1 Gannon et al. Nutrition & Metabolism 2010, 7:64
    2 Ibid.

  5. Rukhsana Shanbhag

    As a Registered Dietitian, who has had training in a functional approach to nutrition, I would like to say that not all of us agree with our organization. I am in private practice and hope to see a change in the focus of AND( association of Nutrition and Dietetics). We are nutritionists, most with a graduate degree and we become Registered Dietitians by qualifying to sit for the credentialing exam. We need to maintain education credits , both at state and National level. I am not alone, and we are working on getting rid of some of the relationships with corporations that make unhealthy foods. Trashing all RDs is not fair.

  6. Rachelle

    As much as I appreciate the information posted (and I do,I do!), I also have to admit that Jonny’s slightly caustic sense of humor as he points out the flaws in the dogma always brings a big giggle to my day!

  7. Jeff

    Jonny, you forgot to say that almost nobody was able to stay on the low fat diet, so it wasn’t even a comparison to that diet. It did show that low fat is very difficult to stay with, though.

  8. andrea

    You’re great Jonny – love the candor.

  9. Bob

    From looking at the details of the study, the control was not the standard American diet, rather it was the standard Spanish diet with the addition of a flyer that said to cut back on fat. As table S6 in the original document shows, all 3 diets were very similar in amounts of vegetables, fruits, cereals, refined cereals, pasteries, and dairy products. As Jonny points out, the interpretation of this as a recommendation of “Mediterranean diet” is a real stretch!

  10. Dr. Jonny Bowden

    Hi Rukhsana,

    I never intended to trash all dietitians. Some of my most respected colleagues– Esther Blum, for example, or Linda Lizotte (president of Designs for Health) are RDs… but i remain convinced that the ORGANIZATION is horrible. They engage in all kinds of behind-the-scenes litigation and lobbying to “protect” their members from competition, they were birthed in the days when nurses gave up their seats to doctors in the hospital cafeteria and they have never waved from this kind of subservience to the medical profession, they refuse to question even the most ridiculous reactionary positions of conventional pharmaceutical medicine, they parrot the “party line” on every issue and have never had an original thought in their collective head. Sorry. Individual dietitians can be wonderful, forward thinking, revolutionary, and all the rest. The ADA? Not so much.

  11. Dolly Ann

    I read that it was the Greek coffee that was the ‘good guy’.
    Well ?

  12. Chris

    I heard it was the Ouzo

  13. Jannah

    I grew up in the Meditteranean, and it is a myth that people there don’t eat a lot of red meat. Goat and lamb are both red meats, and they are regularly consumed very frequently. The thing is that there is a lot of fish and poultry consumed too, so that they all balance out. But those meats are still eaten in fairly even proportions to one another. It’s beef that might not be eaten quite as frequently – but that depends on the region, too. They do eat more fruits and veggies than we do in the U.S. But olive oil, as good as it is, does contribute to weight gain, given that it is in the line of being a LCFA. The other thing people miss is that butter and dairy actually are consumed quite regularly in the Mediterranean. It’s just milk consumption that isn’t as high with all adults. But there is regular consumption of butter, cheese, and yogurt – quite a bit of it, actually. – Especially in the Middle Eastern, Greek, north African, and French parts of the Mediterranean. In Turkey, a special drink call Ayran is a slightly salty, tart yogurt drink that is drunk regularly for the hot summer months. So, maybe people need to pay a little more attention before they start assuming Mediterraneans eat little red meat or dairy.

  14. Dr. Jonny Bowden

    I really thank you for this post. It’s good to hear from someone who actually lived there.. we tend to believe our own mythologies too much!