“...the key dietary messages are stunningly simple: Eat less, move more, eat more fruits and vegetables, and don't eat too much junk food. It's no more complicated than that.” - Marion Nestle
There Is No Perfect Diet.
There are 8 billion people on the planet. So that means there are about 8 billion perfect diets.
So when someone says Keto is the best, or Vegetarian, or Paleo, or IIFYM or whatever, it’s probably because it has worked well for them. That’s good! Frankly, it’s hard to argue with results. Never would I dismiss reasonable self-experimentation when it comes to diet, in fact, I encourage it. You just have to keep in mind, that just because a diet has worked well for person A, doesn’t mean it will work well for person B.
So now what?
So the question becomes, which diet is going to work for most people? Where do we even start?
We all know that a sound diet leads to health and longevity. So naturally, we would want to go and search out the people that are healthy and living longer and find out what they’re eating. This will inevitably lead you to the ‘Blue Zones’.
The Blue Zones are well-documented regions around the globe where people live much longer than the average. Their locations and general dietary patterns are as follows:
Okinawa (Japan); sweet potatoes, green and yellow vegetables, fruit, soybean-based foods, marine foods, lean meats, tea, and moderate alcohol consumption [1].
Sardinia (Italy); high intake of olive oil, seasonal fruits and vegetables, a small amount of lean protein, and moderate alcohol consumption [2].
Nicoya (Costa Rica); fruits, vegetables, black beans, corn tortilla, white rice, a moderate amount of fresh dairy products. Low intakes of animal protein [3].
Icaria (Greece); fruits, vegetables, legumes, potatoes. Low to moderate amount of fish and other animal proteins. Low intakes of red meat and sweets [4].
Loma Linda, California (United States); a large population of Seventh-day Adventists who follow mostly a vegetarian diet. Some consume small amounts of egg, dairy, and fish [5].
The Mediterranean diet.
The dietary patterns of the Blue Zones strongly resemble the Mediterranean diet. There are many books and scientific articles written on the Mediterranean diet (MedDiet). There are slightly different variations of what constitutes the diet, but fundamentally it consists of the following:
Lots of fruits, vegetables, nuts, seeds, whole grains, and healthy fat (especially from olive oil).
Fish and seafood are ok.
A little less of dairy, eggs, poultry.
Red meat and sweets are eaten sparingly [6] [7].
A good resource and summary for the MedDiet can be found here…
The MedDiet has been studied for more than 50 years. Starting with Dr. Ancel Keys recognizing that individuals living in the Mediterranean region had a lower than normal occurrence of heart disease. After decades of research, it has become clear that the MedDiet is good for more than just the heart. It has been shown to improve the biological markers associated with: arthritis, high cholesterol, high blood pressure, diabetes, neurodegenerative diseases such as dementia, rheumatic diseases, etc... [8-13]
In their article (Eleftheriou et al., 2018) wrote, “Our meta-analyses confirm the inverse association of MedDiet with mortality.” Simply put, whatever could kill you, you’re less likely to die from it if you’re adhering to a Mediterranean diet.
There are always exceptions to the rule. One potential exception is cancer. Cancers may respond differently to different diets [15]. At this point, there’s simply not enough evidence to make claims about any one cancer-preventing diet. Nonetheless, even the American Cancer Association recommends, in general, a Mediterranean-style diet [16].
Miscellaneous.
Now, down the rabbit hole for a bit.
Yes, a healthy diet can be simple. But there’s a lot of misinformation on the subject, and it’s easy to miss the forest for the trees. So let’s knock down some trees.
Macronutrients
Macronutrients are largely what make up the food you eat and are classified as proteins, carbohydrates, and fats. Macronutrient composition in the diet doesn’t appear to matter all that much. For instance, the majority of the Okinawan diet is comprised of carbohydrates from sweet potatoes and vegetables, whereas the Mediterranean diet provides a substantial amount of calories from fat, mainly from olive oil.
With that being said, it’s important to know that there are essential amino acids (from protein), and essential fatty acids (from fat) that your body can’t make on its own, and you need to obtain from your diet. Roughly speaking, you should obtain a minimum of 20 percent of your calories from protein, and a minimum of 20 percent from fat [17]. If you want to set up your macronutrients based off of your individual goals, check out this article from Tiffani Bachus here.
You may have noticed there is no such thing as an essential carbohydrate. But carbohydrates from fruits and vegetables contain vitamins, minerals, fiber, and phytonutrients that serve important functions in the body and keep you healthy.
Grains
Grains may, or may not be, “bad”. About 1% of the population has gluten intolerance [18]. Some folks are gluten sensitive, and some have full-blown wheat allergies. If you’re none of the above, and you do consume grains, consume whole grains. Try to avoid heavily processed grains such as white bread, pasta, flour, pastries, etc… These grains have been stripped of fiber and nutrients, and practically function like pure sugar in your body when consumed.
If you are carbohydrate sensitive but still want to stick closely to a MedDiet protocol, opt for the Spanish Ketogenic Mediterranean Diet [19].
For a really good article on this subject, read “Settling the Greate Grain Debate” by Brian St. Pierre, MS, RD over at https://www.precisionnutrition.com/grain-wheat-debate.
Dairy
Dairy can be an issue with some people as well. Like with grains, some individuals are lactose intolerant, and others are likely to be sensitive. Dairy isn’t necessary for good health, nor is it necessary for strong bones like you have been led to believe. You can easily get the recommended daily intake of calcium by eating more dark leafy greens such as mustard greens, tulip greens, kale, bok choy, swiss chard, etc…
However, a little bit of dairy, especially in the form of hard cheeses and yogurts is probably OK .
Grazing vs Gorging
Generally, gorging means eating one to three bigger meals per day, while grazing constitutes consuming more like five, all the way up to eight or nine smaller meals per day.
Some health experts and fitness enthusiasts recommend grazing on food as a means of increasing your metabolism, controlling hormonal fluctuations, lowering your body weight, and becoming overall healthier. Other professionals believe grazing rather than gorging is of no, or minimal, consequence. There is research available that backs up both sides of the argument.
One study found in The British Journal of Nutrition indicated that increasing meal frequency increased feelings of satiety (fullness) and also increased fat oxidation (burning fat for energy) [20]. In yet another study, increased meal frequency appeared to control blood sugar more effectively in type II diabetes patients [21].
On the contrary, there are alternative studies that show increased meal frequency does not promote greater body weight loss or improve health parameters. In a meta-analysis of the subject, Australian researchers found that there was no association between meal frequency and weight or health [22].
Intermittent Fasting
“Intermittent fasting is a broad term that encompasses a variety of programs that manipulate the timing of eating occasions by utilizing short-term fasts in order to improve body composition and overall health [23].”
Whereas some experts claim that eating small, more frequent meals is advantageous, some believe that intermittent fasts confer a health benefit. Unfortunately, the research doesn’t bear this out either [24 - 25]. It would seem that how much you eat, and what you eat, is far more important than when you eat it.
Supplements
Dietary supplements “include vitamins, minerals, amino acids, and herbs or botanicals, as well as other substances that can be used to supplement the diet [26].”
For healthy individuals without nutrient deficiencies, the research for most supplements is pretty weak. Arguments can be made for a multivitamin supplement [27]. It would be difficult to consistently get the recommended intake of all the vitamins and minerals through diet on a daily basis. A supplement such as a multivitamin could fill in the gaps.
You may be deficient in certain nutrients. The only way to know this is to get bloodwork done or do a self-analysis of your nutrition. Doing a self-analysis would be cheaper and possibly more effective than getting your blood work done. Simply log what food you eat for a couple of weeks. Most nutrition apps like MyFitnessPal include a micronutrient breakdown of the food you eat. Wherever there is a deficiency, you can add foods that address the deficiency, or supplement if it’s more convenient.
Here is an excellent article written by Wyatt Brown about who could benefit from taking vitamins over at https://examine.com/nutrition/do-you-need-a-multivitamin/.
Examine.com is an excellent resource for all things regarding supplements.
Summary
The fundamentals of a healthy diet are simple. With that being said, what works best for you will probably require some careful experimentation. The best way to approach this experimentation is to submit yourself to an elimination diet.
“Elimination diets pretty much do exactly what the name suggests: exclude certain foods for a short period of time—usually 3 weeks. Then you slowly reintroduce specific foods and monitor your symptoms for possible reactions [28].” There is an article at https://www.precisionnutrition.com/elimination-diet
written by Sarah Maughan that is the most thorough and informative description of the elimination diet that I have found.
Lastly, never underestimate the importance of how you ‘feel’ after a meal. If a food agrees with you, you should have more energy and improved mental clarity. The opposite of how you feel after a large fast-food meal.
You may have a health condition in which your diet needs to be professionally monitored. In this case, I encourage you to seek the care of a registered dietician or a doctor who is knowledgeable about nutrition. Otherwise, for most of us, a Mediterranean-style diet is a good place to start.
Additional Resources
Another good resource for a grain-free version of the Mediterranean diet, also called the Anti-inflammatory diet, can be found here. https://www.anaboliclabs.com/anti-inflammatorydiet.aspx
If you have time to spare, take a listen to what Prof. Eran Segal has to say about the ‘best diet’ (20 mins). https://www.youtube.com/watch?v=0z03xkwFbw4
Dr. Mike Evans presents a good, informative summary of healthy eating (15 mins). https://www.youtube.com/watch?v=fqhYBTg73fw
Dr. Mike Israetel presents an entertaining and educational lecture on the scientific landscape of healthy eating (15 mins).
I’ve used these online companies to order my supplements for over a decade. Good prices and reliable service.
Glossary
Diet: the food that a person or animal usually eats.
Biological: of or relating to biology or to life and living things.
Marker: something that shows the presence or existence of something.
Metaanalysis - examination of data from a number of independent studies of the same subject, in order to determine overall trends.
Macronutrients - nutrients that provide calories or energy and are required in large amounts to maintain body functions and carry out the activities of daily life. There are three broad classes of macronutrients: proteins, carbohydrates, and fats.
Phytonutrients - substances found in certain plants which are believed to be beneficial to human health and help prevent various diseases.
Works Cited
1. Willcox, Donald Craig, et al. “Healthy Aging Diets Other than the Mediterranean: A Focus on the Okinawan Diet.” Mechanisms of Ageing and Development, vol. 136-137, Mar. 2014, pp. 148–162, 10.1016/j.mad.2014.01.002. Accessed 6 Dec. 2019.
2. Pes, Giovanni Mario, et al. “Evolution of the Dietary Patterns across Nutrition Transition in the Sardinian Longevity Blue Zone and Association with Health Indicators in the Oldest Old.” Nutrients, vol. 13, no. 5, 28 Apr. 2021, p. 1495, 10.3390/nu13051495. Accessed 9 June 2021.
3. Nieddu, Alessandra, et al. “Dietary Habits, Anthropometric Features and Daily Performance in Two Independent Long-Lived Populations from Nicoya Peninsula (Costa Rica) and Ogliastra (Sardinia).” Nutrients, vol. 12, no. 6, 1 June 2020, p. 1621, 10.3390/nu12061621. Accessed 16 Aug. 2020.
4. Panagiotakos, Demosthenes B., et al. “Sociodemographic and Lifestyle Statistics of Oldest Old People (>80 Years) Living in Ikaria Island: The Ikaria Study.” Cardiology Research and Practice, vol. 2011, 2011, pp. 1–7, 10.4061/2011/679187
5. Orlich, Michael J., et al. “Vegetarian Dietary Patterns and Mortality in Adventist Health Study 2.” JAMA Internal Medicine, vol. 173, no. 13, 8 July 2013, p. 1230, www.ncbi.nlm.nih.gov/pmc/articles/PMC4191896/, 10.1001/jamainternmed.2013.6473.
6. Bach-Faig, Anna, et al. “Mediterranean Diet Pyramid Today. Science and Cultural Updates.” Public Health Nutrition, vol. 14, no. 12A, 13 Dec. 2011, pp. 2274–2284, www.cambridge.org/core/journals/public-health-nutrition/article/mediterranean-diet-pyramid-today-science-and-cultural-updates/70359644D12A038AC003B935AA04E120, 10.1017/s1368980011002515.
7. Serra-Majem, Lluís, et al. “Scientific Evidence of Interventions Using the Mediterranean Diet: A Systematic Review.” Nutrition Reviews, vol. 64, no. 2, 1 Feb. 2006, pp. 27–47, onlinelibrary.wiley.com/doi/pdf/10.1111/j.1753-4887.2006.tb00232.x, 10.1301/nr.2006.feb.s27-s47. Accessed 5 June 2019.
8. Veronese, Nicola, et al. “Adherence to a Mediterranean Diet Is Associated with Lower Prevalence of Osteoarthritis: Data from the Osteoarthritis Initiative.” Clinical Nutrition (Edinburgh, Scotland), vol. 36, no. 6, 1 Dec. 2017, pp. 1609–1614, pubmed.ncbi.nlm.nih.gov/27769781/, 10.1016/j.clnu.2016.09.035. Accessed 2 Dec. 2020
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10. Domenech, M, et al. “EFFECT of the MEDITERRANEAN DIET on BLOOD PRESSURE: THE AMBULATORY BLOOD PRESSURE SUBSTUDY (PREDIMED-ABPM): PP.23.423.” Journal of Hypertension, vol. 28, June 2010, p. e373, 10.1097/01.hjh.0000379349.42484.74.
11. Schwingshackl, Lukas, et al. “Adherence to a Mediterranean Diet and Risk of Diabetes: A Systematic Review and Meta-Analysis.” Public Health Nutrition, vol. 18, no. 07, 22 Aug. 2014, pp. 1292–1299, 10.1017/s1368980014001542. Accessed 1 Apr. 2019.
12. Petersson, Sara, and Elena Philippou. “The Effects of Mediterranean Diet on Cognitive Function and Dementia: Systematic Review of the Evidence.” Clinical Nutrition ESPEN, vol. 13, June 2016, p. e67, 10.1016/j.clnesp.2016.03.052.
13. Pacini, Greta, et al. “Mediterranean Diet and Rheumatic Diseases.” Beyond Rheumatology, vol. 1, no. 2, 20 Dec. 2019, pp. 72–73, 10.4081/br.2019.19. Accessed 10 June 2021.
14. Eleftheriou, Dimitra, et al. “Mediterranean Diet and Its Components in Relation to All-Cause Mortality: Meta-Analysis.” British Journal of Nutrition, vol. 120, no. 10, 7 Nov. 2018, pp. 1081–1097, www.cambridge.org/core/journals/british-journal-of-nutrition/article/mediterranean-diet-and-its-components-in-relation-to-allcause-mortality-metaanalysis
15. Key, Timothy J., et al. “Diet, Nutrition, and Cancer Risk: What Do We Know and What Is the Way Forward?” BMJ, vol. 368, 5 Mar. 2020, www.bmj.com/content/368/bmj.m511, 10.1136/bmj.m511.
16. Cancer.org, American Cancer Society, 2012, www.cancer.org/healthy/eat-healthy-get-active/acs-guidelines-nutrition-physical-activity-cancer-prevention/guidelines.html.
17. Elmadfa, I., and M. Kornsteiner. “Fats and Fatty Acid Requirements for Adults.” Annals of Nutrition and Metabolism, vol. 55, no. 1-3, 2009, pp. 56–75, 10.1159/000228996. Accessed 17 May 2020.
18. Di Sabatino, Antonio, and Gino Roberto Corazza. “Nonceliac Gluten Sensitivity: Sense or Sensibility?” Annals of Internal Medicine, vol. 156, no. 4, 21 Feb. 2012, p. 309, 10.7326/0003-4819-156-4-201202210-00010. Accessed 4 Aug. 2019.
19. Pérez-Guisado, Joaquín, et al. “Spanish Ketogenic Mediterranean Diet: A Healthy Cardiovascular Diet for Weight Loss.” Nutrition Journal, vol. 7, no. 1, 26 Oct. 2008, 10.1186/1475-2891-7-30. Accessed 12 Nov. 2019.
20. Smeets, Astrid J., and Margriet S. Westerterp-Plantenga. “Acute Effects on Metabolism and Appetite Profile of One Meal Difference in the Lower Range of Meal Frequency.” British Journal of Nutrition, vol. 99, no. 6, 1 June 2008, pp. 1316–1321, www.cambridge.org/core/journals/british-journal-of-nutrition/article/acute-effects-on-metabolism-and-appetite-profile-of-one-meal-difference-in-the-lower-range-of-meal-frequency/4AE8C3FC32CE7E456B9606F1AF963E76, 10.1017/S0007114507877646. Accessed 2 Apr. 2021.
21. Bertelsen, J., et al. “Effect of Meal Frequency on Blood Glucose, Insulin, and Free Fatty Acids in NIDDM Subjects.” Diabetes Care, vol. 16, no. 1, 1 Jan. 1993, pp. 4–7, 10.2337/diacare.16.1.4. Accessed 19 May 2021.
22. Palmer, Michelle A, et al. “Association between Eating Frequency, Weight, and Health.” Nutrition Reviews, vol. 67, no. 7, July 2009, pp. 379–390, 10.1111/j.1753-4887.2009.00204.x. Accessed 24 Mar. 2020.
23. Tinsley, Grant M., and Paul M. La Bounty. “Effects of Intermittent Fasting on Body Composition and Clinical Health Markers in Humans.” Nutrition Reviews, vol. 73, no. 10, 15 Sept. 2015, pp. 661–674, 10.1093/nutrit/nuv041.
24. Al-Islam” Faris, Mo’ez, et al. “A Systematic Review, Meta-Analysis, and Meta-Regression of the Impact of Diurnal Intermittent Fasting during Ramadan on Glucometabolic Markers in Healthy Subjects.” Diabetes Research and Clinical Practice, May 2020, p. 108226, 10.1016/j.diabres.2020.108226. Accessed 11 June 2020.
25. Jane, Louisa, et al. “Intermittent Fasting Interventions for the Treatment of Overweight and Obesity in Adults Aged 18 Years and Over: A Systematic Review Protocol.” JBI Database of Systematic Reviews and Implementation Reports, vol. 13, no. 10, Oct. 2015, pp. 60–68, 10.11124/jbisrir-2015-2363. Accessed 4 Aug. 2019.
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28. Maughan, Sarah. “Food Sensitivities and Intolerances: How and Why to Do an Elimination Diet | Precision Nutrition.” Precision Nutrition, Precision Nutrition, 3 Jan. 2019, www.precisionnutrition.com/elimination-diet.
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