Dr. MJ Bazos MD,
Patient
Handout
The
Mediterranean Diet Pyramid Q & A
The questions and answers below highlight some
of the important differences between the Mediterranean Diet Pyramid and the U.S.
Department of Agriculture's Food Guide Pyramid.
- Are the Mediterranean Diet and USDA Pyramids
both equally grounded in well-established
science?
The Mediterranean
Diet Pyramid is based on the well-documented, historical reality of the
traditional Mediterranean Diet, considered in the light of current scientific
research. The low rates of diet-linked chronic diseases and the high adult life
expectancy typical of much of the region in 1960 have been described repeatedly,
as have the food consumption patterns of the region at that time. The
Mediterranean Diet Pyramid that represents this diet has long stood the test of
time as being compatible with excellent health. The Mediterranean Diet Pyramid,
then, is not a theoretical construct -- it is a tested, proven cultural model
for healthy eating.
By contrast, the USDA Pyramid was constructed
against the backdrop of a national dietary pattern which is known to contribute
to heart disease, cancer and other chronic diseases which persist at high rates
in this country. Without the existence of a "home-grown" time-tested cultural
model of healthy eating on which to base the USDA Pyramid, this graphic is by
definition a more speculative document. Many commentators have suggested that
the USDA Pyramid represents a mix of well-supported findings, educated guesses,
out-dated approaches to grouping foods, and political compromises with powerful
economic interests such as the dairy and meat industries. Whatever are its
specific faults, however, it is the larger issue that should be of paramount
concern: the USDA Food Guide Pyramid has never been tested in a whole population
over a long period of time. The extent to which a diet based on the USDA Pyramid
will reduce chronic disease risk in comparison to other known and tested
cultural models for healthy eating, such as the Mediterranean, Asian, Latin
American, and vegetarian diets, is a matter that only future research can
resolve.
2. What is the basic message of the
Mediterranean Diet Pyramid and its accompanying text?
A. The basic nutrition message is this:
Emphasize a largely plant-based diet, low in saturated and trans fats. There is
an important culinary message here as well: by casting a wide net and searching
the world for various cultural models for healthy eating, it is possible to find
food traditions that don't compromise taste and sensory appeal in achieving
excellent health. The Mediterranean Diet is one such model -- a model in which
Americans have already shown great interest. This is good news for policy makers
and public health experts who worry whether Americans, even when confronted by
the now well-documented links between diet and chronic disease, will change
their food choices.
3. What are the plant foods that largely make
up the Mediterranean Diet?
A. Breads, potatoes and grains (pasta, couscous,
rice, polenta, bulgur and other grains), fruits and vegetables (in all their
wonderful variety), including herbs and wild, gathered greens, legumes
(chickpeas, lentils, peanuts, beans and peas), tree nuts (almonds, hazelnuts,
pistachios and walnuts), and seeds (principally sesame seeds). The principal
cooking oil -- indeed, far and away the principal source of fat in the diet --
is the juice of the fruit of the olive tree - olive oil. Finally, the juice of
another fruit -- in this case fermented -- was for centuries, along with water,
the region's principal mealtime beverage: the fermented juice of grapes, or
wine.
4. Is it necessary to eat this specific mix
of plant foods to enjoy the health benefits of the Mediterranean
Diet?
A. It is important to remember
that the Mediterranean Diet, which we now associate with excellent health and
longevity, evolved over centuries, and was shaped by a variety of factors
including climatic and geographical conditions, agricultural and trade
development patterns, economics and politics. In other words, Mediterranean
peoples never actively chose these foods as a health-promoting mix for their
dinner tables. It is likely that other combinations of plant-based diets would
be equally health-promoting. What seems to be of critical importance from the
perspective of current research and an analysis of other cultural models for
healthy eating -- especially those of Asia -- is the need to keep the ratio of
plant foods to animal foods at a high level. For Americans, this means a switch
from using foods from animal sources in moderation to using them, collectively,
on a reduced basis. However, scientists are far from certain exactly what parts
of the Mediterranean Diet are responsible for what percent of chronic disease
risk reduction. Thus, we should think principally of the entire diet as the
model, and not selected parts of it. We should especially refrain from pulling
pieces of the diet out and promoting them independent of the rest of the diet,
as we have often seen done in this country in other situations.
5. How, then, is the Mediterranean Diet
Pyramid different from the USDA Food
Pyramid?
A. The USDA Pyramid is a big
step forward from the Four Food Groups, which placed an equal graphic emphasis
on foods from animal sources and foods from plant sources. To its credit, the
USDA Pyramid puts greater emphasis on the consumption of fruits, vegetables,
breads, and grains, reflecting the findings of current research. However, the
USDA Pyramid does not go far enough in emphasizing the role of plant foods in
maximizing chronic disease risk reduction. By way of analogy, this could be
compared to urging heavy smokers to cut down to a half-pack of cigarettes a day
in order to reduce one's risk of developing smoking-related chronic
diseases.
6. There is no "Meat Group" as such in the
Mediterranean Diet Pyramid as there is in the Department of Agriculture's
pyramid. Why is this? And what is the rationale behind where these foods have
been placed in the Mediterranean Diet Pyramid?
A. The answer to this question has
several elements:
- The "Meat Group" of the USDA Pyramid recommends
daily consumption of 2-3 servings of 2-3 ounces of red meat, poultry, fish,
beans or nuts. This grouping presents several problems. First, from the
perspective of impact on chronic disease risk, the foods in this group are not
equivalent, and in fact represent an unfortunate mix of animal protein and plant
protein in the same category. They do not belong together.
- Red meat consumption has been linked to an
increased risk for heart disease and several cancers, whereas no such links are
established for the consumption of legumes and nuts. Indeed, some research now
suggests that nuts may be not just neutral with respect to chronic diseases, but
a positive factor with respect to reduced heart disease and, possibly, the
control of diabetes.
- The USDA Pyramid suggests that the consumption of
up to 9 ounces of red meat can be associated with good health (following the
maximum numbers associated with the "Meat Group" in the Pyramid graphic: 3
ounces, 3 times per day). The text of some of the Department of Agriculture's
documents suggests a lower maximum figure; the Dietary Guidelines for Americans
suggest a maximum from this "Meat Group" of 6 ounces per day, all of which can
be consumed as red meat. Further, the implication is that these figures are a
"floor" and not a "ceiling" -- that is, that one must eat this much meat or its
equivalent to achieve good health. There is now ample scientific evidence to
indicate that these recommendations are outdated and are no longer consistent
with promoting maximum reduction of chronic disease risk. This position will be
reviewed during the USDA and the U.S. Department of Health and Human Services
review of the official dietary guidelines in 1999 and 2000.
- Although the traditional Mediterranean Diet was
not a vegetarian diet, it featured less meat -- indeed, less of all foods from
animal sources -- than the current American diet or even that recommended by the
USDA Food Guide Pyramid. In 1960, for example, when they enjoyed the highest
adult life expectancy in the world of all WHO reporting countries, the Greeks
ate red meat on average of once every week or two. In Crete in 1960, which
reported especially low levels of heart disease, total per capita consumption of
meat, poultry and fish combined averaged about 13 ounces per week. And their
heart disease rates were 90% lower than those measured in the U.S. Mediterranean
cooks had developed techniques over generations to add extra flavor to grains
and vegetable dishes with just an ounce or two of meat, maximizing the impact of
what little meat they did eat. In the Mediterranean-style diet, poultry and fish
are consumed somewhat more often: a few times per week.
7. With these reduced
amounts of meat and other foods from animal sources in the Mediterranean Diet
Pyramid, isn't there a concern about a deficiency in protein and such minerals
as iron?
A. For those who enjoy meat,
there is no question that it is a source of great culinary delight. However,
since all of the nutrients that meat provides can be obtained elsewhere, meat
need not be considered an essential food. Vegetarians, who eat no meat, enjoy
good health, and ample scientific evidence conclude that reasonably diverse
vegetarian diets are compatible with excellent health, resulting in neither
protein, vitamin nor mineral deficiency. Consequently, largely plant-based diets
such as the Mediterranean Diet easily cover most nutritional needs. There is no
evidence of adverse health risks due to micronutrient inadequacies in the
traditional diets of the Mediterranean.
8. Doesn't the push toward lean meat largely
address this concern about meat and chronic disease
risk?
A. It is not certain that the fat
component of meat is responsible for all or even most of the chronic disease
risk, especially cancer risk. Further, all foods from animal sources displace
foods from plant sources which are themselves great storehouses of vitally
important health-promoting micronutrients. A more detailed discussion of these
points, and an excellent technical discussion of the differences between the
Mediterranean Diet and the diet outlined by the USDA Pyramid appears in "Diet
and Health: What Should We Eat?" in the journal Science, April 22,1994,
by Walter Willett M.D., Dr.P.H., Chairman, Department of Nutrition, Harvard
School of Public Health.
9. How do dairy products fit into the
Mediterranean Diet Pyramid? Why are just cheese and yogurt mentioned? And why
aren't low- fat and nonfat dairy products
mentioned?
A. Dairy products,
principally cheese and yogurt, were consumed in the traditional Mediterranean
diet on a daily basis, but in low to moderate amounts. Milk was not included in
the Mediterranean Diet Pyramid for the simple reason that, historically, it was
only a minor component in the diet (milk goes sour quickly in hot, Mediterranean
climates, so early humans developed ways of preserving milk -- in the form of
cheese and yogurt). Dairy foods played a smaller role in the Mediterranean diet
than they do in either the current American diet or the diet outlined by the
USDA Pyramid (dairy foods occupy the top band in the daily portion of the
Mediterranean Diet Pyramid, whereas they are somewhat further down -- suggesting
greater use -- in the USDA Pyramid). Both the USDA Pyramid and the Mediterranean
Diet Pyramid mention, in the texts accompanying them, the desirability of
choosing low-fat and nonfat dairy products. Reduced-fat dairy products were
simply not part of the traditional Mediterranean diet; but from the perspective
of contemporary, health-conscious Americans, these products represent a
favorable innovation.
10. If the Mediterranean Diet was less
reliant on dairy products, would calcium be adequate for someone following this
diet?
A. Calcium is an essential
mineral for maintaining bone strength and for other health-related reasons.
There is no evidence of calcium deficiency among the peoples of the
Mediterranean. Indeed, studies have demonstrated low fracture rates among adults
in the region. Further nutritional analyses of the Mediterranean diet confirm
the adequacy of calcium for most people in the typical Mediterranean food
pattern. Dr. Willett, in the Science article mentioned above, observes
that as one looks around the world "adult populations with low fracture rates
generally consume few dairy products and have low calcium intakes. [Dairy foods]
contain a substantial amount of protein, which can enhance renal calcium loss."
For those particularly concerned about adequate calcium intakes and the
prevention of osteoporosis, calcium supplements and increased intakes of nonfat
dairy foods offer two approaches that have widespread, though not necessarily
overlapping, support within the scientific research community. Many Asian
populations are lactose-intolerant but do not suffer any calcium-deficiency
diseases by avoiding milk.
11. What other differences distinguish the
Mediterranean and USDA Pyramids?
A.
The USDA Food Guide Pyramid lumps all fats and oils together and adds the
warning to use these sparingly. Ignoring a large body of scientific evidence,
the USDA Pyramid doesn't acknowledge the differences in types of fat, and the
very different impacts these fats have on heart disease, cancers and other
chronic diseases. In sharp contrast, the Mediterranean Diet Pyramid does make
this distinction with its emphasis on non-hydrogenated plant oils, such as olive
oil and the oils found in nuts, both typical of the healthy Mediterranean diet
of the 1960s.
12. Even if olive oil is better than, say,
butter in the diet, aren't all fats basically bad? Don't all fats - to a
greater or lesser degree - lead to an increased chronic disease risk, and
shouldn't they all therefore be curtailed?
A. Total fat reduction, along with a cessation
of smoking and increased physical activity, have become three of the leading
objectives of international health communities in recent years. Indeed, the
media in tandem with dietitians and public health specialists have helped to
create an anything-but-fat mentality among Americans in the last few years.
Unfortunately, this priority of total fat reduction at any cost and the image of
all fats as bad is not based on the reality of existing scientific research.
What is well documented is the need to limit saturated fats and trans-fatty
acids from partially hydrogenated vegetable fat in the diet. The text
accompanying the Mediterranean Diet Pyramid explicitly discusses the
desirability of limiting saturated fat in the diet to 7-8%, as was typical of
the diet of Greece in 1960. It further points out the absence of margarine in
the diet and the general lack of processing -- including hydrogenation -- in the
diet, which assured low levels of cholesterol-raising trans-fatty acids. The
USDA Pyramid and the Dietary Guidelines for Americans allow for saturated fat in
the diet to be as high as 10%, and make no mention of the need to sharply
curtail foods containing trans-fatty acids. This is not consistent with the
scientific understanding of what contributes to optimal nutrition
status.
By contrast, there is no evidence suggesting
that the monounsaturated fat found so abundantly in olive oil and some other
plant foods such as nuts and avocados needs to be curtailed in the diet, absent
concerns about obesity and activity levels. The Greeks that Ancel Keys and his
colleagues studied in the 1960's, in the Seven Countries Study, consumed up to a
third of their calories in olive oil -- typically olive oil cooked with
vegetables and legumes, which were the core of the diet. As stated above, their
heart disease rates were a fraction of what Americans experience, and rates of
other chronic diseases were similarly low.
13. If saturated fat and trans-fatty acids
are the real culprits here, how did this urgency about reducing total fat
arise?
A. The influential 1989 Diet and
Health Report of the National Academy of Sciences concluded that there was "no
link between heart disease and total fat per se," the only link being between
saturated fat and heart disease. However, the Report then recommended that
limiting total fat in the diet would be an effective strategy for limiting
saturated fat in the diet.
14. Does the Mediterranean Diet Pyramid then
suggest that we can abandon the 30% guideline as long as the fat is olive
oil?
A. The text accompanying the
Mediterranean Diet Pyramid indicates that "various levels of total fat (where
the fat was mostly olive oil) can be associated with the excellent health seen
in the region at that time (circa 1960)." More specifically, it suggests that
total fat -- if largely fat from plant sources -- can range from less than 25%
to over 35%, within the context of the Mediterranean Diet
Pyramid.
It cannot be overemphasized, however, that
Mediterranean populations in the early 1960s were highly active, and were much
leaner than their Western counterparts. Americans in the 1990s, by contrast, are
more sedentary and even more prone to weight gain. Indeed, obesity, which is
linked to various chronic diseases, is a major public health problem in the
United States. Therefore, the extent to which a higher fat Mediterranean diet --
as opposed to a lower or more moderate fat Mediterranean diet -- is appropriate
to a contemporary American setting must be considered with great
care.
To quote from the Mediterranean Diet Pyramid
notes: "Current scientific data does not tell us if a diet with over 35% fat
coming mainly from olive oil, and much of the rest of the diet being fruit,
vegetables and bread, promotes obesity in a sedentary population any more that a
diet with an equivalent level of energy (calories) from fat. Apparently, for an
active person with no weight problem, a traditional Mediterranean diet as
represented by Crete with over 35% of energy from fat is compatible with
excellent health."
15. Until we are sure about the obesity
issue, aren't we better off all sticking with the 30% calories-from-fat
guideline?
A. This may not be much of
an issue. A startlingly large percentage of saturated and total fat in our diet
comes from meat and other foods from animal sources. In a Mediterranean Diet,
these foods are significantly reduced, "freeing up" space in what some have
termed a "fat budget" for more healthy fats, especially those high in
monounsaturated fat such as olive oil, nuts and avocados, or other liquid plant
oils. Dietary analyses have shown that it is very easy to construct a typical
four day Mediterranean food pattern where total fat represents 30% or less of
calories, if one so desires. This suggests that development of special,
so-called '"Mediterranean light" recipes and concepts are unnecessary, even if
policymakers retain the 30% fat guideline in future years.
One aspect gives some researchers pause: of all
the countries around the Mediterranean reporting food and health data to the
World Health Organization and the Food and Agriculture Organization in the early
1960s, and of all the countries studied by a variety of researchers at that
time, Greece, and particularly Crete, displayed the best health data. And, as
indicated above, Greece, and again, particularly Crete, had total fat levels
well in excess of 30%.
It may be possible that this higher fat level is
not simply non-toxic or neutral, but is actually more health-promoting than a
lower fat diet of a similar content. Low-fat Asian diets are associated with low
rates of coronary disease, but replacing fat calories with carbohydrate calories
in a typical American context may lead to a decrease in cardio-protective
HDL-cholesterol levels. Recent studies have confirmed that diets high in
monounsaturated fat are more effective in controlling diabetes than are diets
high in carbohydrates. In the meantime, researchers suggest that it is better to
exercise or simply walk more often than to spend time with a calculator worrying
about the exact number of grams of olive oil on our pasta in a healthy
Mediterranean-style diet.
Finally, no matter whether one adopts a higher-
or lower-fat Mediterranean diet, the olive oil and other high-fat foods, such as
nuts and olives, do indeed replace butter, cream and other sources of animal
fat. Olive oil added to the standard, unhealthy American diet with no
corresponding changes is apt to have little health benefit, and may indeed
further undermine good health.
16. To gain the benefits of the Mediterranean
Diet, must the principal fat be olive oil? Aren't other plant oils just as
good?
A. To the extent that the health
benefits of olive oil are entirely contained in its high percent of
monounsaturated fat, other excellent traditional sources of monounsaturated fat
should also be highlighted, such as nuts, peanuts, avocados and olives. Seed oil
producers, in cooperation with biogenetic engineers, have been working hard in
recent years to bring a greater number of oils high in monounsaturated fat to
market. Canola oil is an example of this effort. Promising though it is, the
extent to which canola oil is an effective substitute for olive oil is a
question for future research to resolve; it is a refined and not a natural oil
and therefore may not contain as many antioxidants.
As nutrition research has progressed in recent
years, seemingly innocuous changes to a product can produce adverse health
consequences. Such was the case with the hydrogenation of liquid vegetable oils:
some margarines are now found to be more unhealthful than butter. Newly invented
and engineered foods should stand the test of time before they are regarded as
fully safe.
Further, the reductionist nature of modern
science often leads researchers, public health experts and much of the general
public to think that science has successfully singled out the bioactive
components -- positive or negative -- in various foods and beverages, when this
may or may not be the case. The positive contributions of fruits and vegetables
get lost when reduced to fiber and a handful of antioxidants; or, meat gets
reduced to saturated fat in terms of its apparent chronic disease-promoting
effects.
New research is highlighting the fallacy of this
approach. It is not yet fully known what it is about fruits and vegetables that
are health-promoting. In the same way, to the extent that olive oil is
health-promoting and not just health-neutral, it is premature to say that
scientists have isolated all of the health-promoting aspects of the oil,
particularly when it is in its most unrefined state and represents one element
of a healthy diet's micronutrients.
Finally, there is every reason to believe that
other plant oils high in polyunsaturated fat can play an important role in good
health. The use of various other plant oils in the diets of Asia, and research
on tree nuts, peanuts, and avocados suggests that foods containing
polyunsaturated fats in their liquid state (non-hydrogenated) may indeed be
health-promoting. The results of what effectively represents a long-term,
large-scale natural experiment in the Mediterranean region on the health impacts
of a diet high in monounsaturated-rich olive oil are clear. But there is no such
equivalent large-scale population-based experience with diets high in
polyunsaturated fat.
17. What about fish and the Mediterranean
Diet?
A. The Mediterranean Diet
Pyramid ranks fish ahead of poultry, eggs and red meat as a health-promoting
food choice, with the suggestion that it be consumed a few times per week. The
diets of the Mediterranean region have been shaped in large part by various
factors that can be tied to the Mediterranean Sea. At least for coastal
residents, fish was a significant part of the diet. However, available data on
the food consumption patterns of Greece and southern Italy in the early 1960s do
not show a particularly large contribution to the diet from fish. This may
simply indicate a lack of good data, because those things that were so abundant
in the backyards of Mediterranean peoples -- fruits, vegetables, olives and
olive oil -- may not have been properly accounted for by national governments
reporting to the World Health Organization and Food and Agriculture
Organization.
As the Mediterranean Diet Pyramid document
discusses, the experiences of Spain, Portugal and Japan suggest that moderate
levels of fish can be part of a healthy diet. If a broad, research-based
consensus emerges that regular fish consumption contributes positively to
maximum chronic disease risk reduction, the Mediterranean Diet Pyramid's
recommendation to eat fish a "few times per week" will be reviewed.
18. The Mediterranean Diet Pyramid shows a
glass of wine next to the pyramid graphic, suggesting the healthfulness of wine
in moderation. Is this really a good idea given all the ills caused by
alcohol?
A. Historically, a trinity of foods have defined
the Mediterranean Diet -- wheat, wine and olive oil. They are the foundation of
the family table and they figure prominently in the religious and cultural
practices of all of the Mediterranean countries, except those whose populations
are Islamic. With all that is now known about the cardioprotective effects of
moderate wine consumption and the centrality of its role on the Mediterranean
table, leaving wine out of any graphic depicting the health-promoting
characteristics of the Mediterranean Diet would distort the evidence.
The current (1995) edition of the Dietary
Guidelines for Americans correctly points out that alcohol should be restricted
for children and adolescents, individuals who cannot restrict their drinking to
moderate levels, pregnant women, individuals using prescription and
over-the-counter drugs, and those planning to drive.
These Guidelines also recognize that alcohol has
been used throughout history to enhance the enjoyment of meals, and that current
evidence suggests a positive association between moderate drinking and reduced
risk for coronary heart disease in some individuals. The mention of these two
benefits represents a great improvement over the government's 1990 Guidelines
for Americans (which acknowledged no such health benefits from alcohol
consumption). But the Guidelines still remain more cautionary than celebratory,
in spite of rapidly growing evidence supporting the health benefits of moderate
consumption. It should also be noted that the current USDA Food Guide Pyramid,
intended to graphically represent what the Guidelines for Americans promotes,
contains no mention or iconic symbol of moderate alcohol consumption, in either
text or graphics.
The Mediterranean Diet Pyramid, on the other
hand, does carry the graphic of a wine glass, along with the words "wine in
moderation." There is no mention of alcoholic beverages other than wine. In the
notes accompanying the pyramid, there is cautionary language similar to that
used by the USDA -- specifically that wine "should be considered optional and
avoided whenever consumption would put the individual or others at risk,
including during pregnancy and before driving" and that researchers have
observed a slightly increased risk for breast cancer even at moderate levels of
wine consumption. But the notes go further than the USDA regarding the benefits
of moderate wine consumption, pointing out that it also reduces overall
mortality in men, and that its benefits apply to both men and women (a
distinction increasingly acknowledged as important in heart studies and other
health research).
Perhaps most importantly, the Mediterranean Diet
Pyramid text suggests that moderate wine drinking with meals is part of a
healthy overall lifestyle rather than an isolated act of consumption or simply
part of an eating regimen. The notes describe the pleasurable circumstances
under which wine was traditionally consumed: "in moderation and normally with
meals and typically within a family context." This incorporates wine more fully
into the act of gathering with family and friends at the dinner table, itself
part of a healthy lifestyle.
While the 1995 USDA Guidelines for Americans are
an improvement over the 1990 version, there continues to be a mismatch between
the growing body of alcohol research and extant alcohol policy in the United
States. Public health experts will have to weigh how best to communicate what is
essentially good news to the majority of Americans who drink moderately and
responsibly, without causing further harm to individuals who can't or won't
drink responsibly and those they may in turn harm. This will not be an easy
task. Long-time alcohol researcher Arthur Klatsky, MD., Chief of Cardiology at
Oakland's Kaiser Permanente Medical Center, summarized the challenge this way at
the 1994 Changing American Appetites conference session on "Wine's Place at a
Healthy Table":
"There is an optimal amount of alcohol use
for longevity. It is easier for health professionals to counsel individuals than
to formulate general public health pronouncements. The overwhelming evidence of
the medical and social harm caused by heavier drinking makes it evident that
many persons including those with a history of special risk of a drinking
problem should not drink at all. The threshold for harmful effects of alcohol is
not known and varies from person to person. However, most persons in Western
society are light-to-moderate drinkers. Such persons can be reassured that their
drinking custom may place them in the most favorable risk category for
longevity."
19. The Mediterranean Diet Pyramid includes
two figures engaged in physical activity to the left of the pyramid? Why was
this included?
A. For Mediterranean
peoples of the 1960s, work in the fields or the kitchens resulted in a lifestyle
that included regular physical activity; this was associated with far less
obesity than is now observed in the United States. Further, a substantial number
of studies now confirm the vital, health-promoting role that physical activity
plays. The Mediterranean Diet Pyramid, therefore, includes a male and a female
figure to represent the importance of physical activity for healthy lifestyles.
Active people engaged in regular exercise lower their risk of obesity, and make
the counting of calories and grams of fat less necessary. Oldways has urged the
USDA to include figures depicting physical activity when it next revises its
Food Guide Pyramid.
20. Why doesn't the Mediterranean Diet
Pyramid specify number and size of recommended servings?
A. The Pyramid is intended to provide
an overall impression of healthy food choices rather than to define recommended
weights of certain foods or proportions of energy obtained from them. Where the
Pyramid does indicate relative frequencies, they are intentionally nonspecific
since good health has been associated with considerable variation within the
overall pattern. Further, Oldways believes it is important to reduce the average
individual's need to resort to math and calculators to achieve a healthy
diet.
21. Is Oldways recommending that the USDA
scrap its Food Guide Pyramid and adopt the Mediterranean Diet
Pyramid?
A. The Mediterranean Diet
constitutes a centuries-old tradition that contributes to excellent health,
provides a sense of pleasure and well-being, and forms a vital part of the
world's collective cultural heritage. For Americans and others who wish to
improve their diets, the Mediterranean Diet Pyramid describes a dietary pattern
that is attractive for its famous palatability as well as for its health
benefits, one that can be adopted in its entirety or in conjunction with meals
inspired by other healthful dietary traditions from cultures throughout the
world.
The Mediterranean Pyramid, therefore, is not
meant to replace the USDA Food Pyramid. As a culturally diverse country, the
United States needs an official food guide pyramid that accommodates many
approaches to healthy eating. Oldways intends that the Mediterranean Pyramid
will stimulate extensive dialogue within the American and international public
health communities as to what constitutes optimal human
nutrition.