The Mediterranean Diet Myth - Vegetables, Fruit, Naturally Low Caloric Density, Hard Physical Work, Yes! Olive Oil, Nuts, Seeds, & Chocolate? I Don't Think So!

 

I Thought Those High HDL's Were My Ace in the Hole - Until I Read Dr. Lawrence Rudel's Research

 

The Green African monkeys metabolize fat in the same way as humans, so they're good stand-ins.. 

At the end of five years, their autopsies showed that the monkeys who were fed monounsaturated oil (olive) had higher HDLs (the good cholesterol) and lower LDLs (the bad cholesterol) than the ones fed the saturated fat diet.  The big surprise here:  Both groups had exactly the same amount of coronary artery disease.  The higher HDLs & lower LDLs of the olive oil group were meaningless.

 -Dr. Lawrence Rudel-

 

 

If you received this post via email, click here to get to the web version with all the links--and to post a comment.

One week until my Utah "Centenarian Strategies" presentation--and except for some minor tweaking, it's finished! 

After May 3rd I'll be back to blogging!  I've really missed it.  Posting on Facebook is just not the same.

I wanted to share a few slides that help explain why in spite of eating what I thought was a healthy diet--and exercising regularly--my weight continued to climb as I got older.

Maybe you've noticed the same thing yourself--& wondered why.

My weight continued to climb.

My cholesterol continued to climb.

My blood pressure continued to climb.

 

The Myth of the Mediterranean Diet - It Can Get You Fat

 

After seeing the Greek islands for myself last May, I understood why the Mediterranean Diet got its reputation for being heart healthy.  Steep hills, homegrown food, and isolation.

Imagine living on a craggy isolated Greek island, post-World War II.  You had to walk up and down steep hills everyday to tend to your garden and your animals.  There was no processed food coming onto the island. 

You lived off of what you could grow yourself--tomatoes, greens, vegetables, fruits, and the wild purslane (high in omega-3s) growing on the hillside.  Sure you had a little cheese, fish, wine & olive oil--and fava beans. 

You were heart-healthy because you worked hard, ate lots of plants, a little fish, and a little wine.  And that heart health came in spite of the olive oil--not because of it.

What's the real story behind the virtues of the Mediterranean Diet?

The authentic post-World War II Mediterranean diet of Crete--lots of physical labor coupled with lots of fruits, vegetables, legumes, and just a little bit of olive oil, wine, & fish.

Br J Nutr. 2004--when researchers went back to Crete to look at the health of the islanders 50 years later--the group with the highest olive oil (MUFA) consumption had the highest heart disease, and those with the lowest olive oil intake had the the lowest heart disease.  Click here and here for more about why olive oil & the monounsaturated fats aren't exactly health food.

The data on which the Mediterranean Diet is based came from the 1950's.

At that time the people on the Isle of Crete had the lowest all-cause mortality. It was post-WWII, they were poor, didn't have a lot to eat, ate mostly fresh fruits & veggies from their gardens, walked 9 miles a day, worked at hard physical labor and the highest consumption of oil was 3 TBS a day--and small amounts of fish. Big difference from how we live today.

 

 

Drs. Lawrence Rudel, Dean Ornish & Robert Vogel on Olive Oil

 

• Vogel:  Contrary to our hypothesis, our study found that omega-9 (oleic acid)--rich Olive Oil, impairs endothelial function after eating.  If you've been using olive oil because you think it's healthy, it's time to think again. The olive oil constricted blood flow by a whopping 31% after a meal in a Vogel's study.  Dr. Robert Vogel

• Rudel:  Rudel ran a five year study feeding olive oil and saturated fat to African Green monkeys.  The monkeys metabolize fat in the same way as humans, so they're good stand-ins.. At the end of five years, their autopsies showed that the monkeys who were fed olive oil had higher HDLs (the good cholesterol) and lower LDLs (the bad cholesterol) than the ones fed the saturated fat diet.  The big surprise here:  Both groups had exactly the same amount of coronary artery disease.  The higher HDLs & lower LDLs of the olive oil group were meaningless.  Rudel later repeated the study on rodents, and got the same results.  Dr. Lawrence Rudel

• Ornish:  It's 100% fat and 14% of it is saturated. At 120 calories a tablespoon it's very easy to eat too much of "a bad thing".  It won't raise your LDL as much as butter or other saturated fats will,  so it might look like it's reducing your cholesterol, but it's still raising it.  It's just not raising it as much other fats would!  It's the omega-3's that reduce inflammation and are "heart healthy", and olive oil has very little omega-3, maybe 1%. It's mostly omega-9, which has been shown to impair blood vessel function. 

 

The Myth of High HDL's

 

There's no doubt about it.

Eat a lot of nuts & olive oil, drink alcohol & you'll raise your HDL's.  But, are all high HDL's created equal?

Turns out, there's good HDL & there's bad HDL.  Bet you didn't know that!

It's not about how high your HDL's are.  It's about how effective they are--and that's called "Efflux Capacity".

The HDL Catch-22:  HDL is altered in the presence of systemic inflammation and its ability to inhibit inflammation & transport LDL becomes compromised.

• Nuts are loaded with inflammatory omega-6s, that could impair HDL.
• Belly fat is an engine for inflammation, that could impair HDL.
• Olive oil is inflammatory, and may impair HDL.
• The typical Western DIet is inflammatory, and may impair HDL.
• A diet devoid of vegetables & fruit is inflammatory, and impair HDL.
• A diet where the omega-6s (found in oil, nuts, saturated fat, animal products, & processed foods) far exceeds the omega-3s (found in flax, chia, greens, vegetables, & fish) is inflammatory, and may impair HDL.
• Worry less about how high or low your HDL's are--and worry more about what you're eating that's inflaming your blood vessels.

Read more about HDL's & Efflux Capacity here.  A must read!

Read more about Olive Oil here.

 

 

Check Out the Omega-6 to Omega-3 Content of Nuts & Seeds

 

Chart Created by Joanne L. Mumola Williams, PhD, Foods for a Long Life

 

The ideal omega-6 to omega-3 ratio should be between 1:1 to 4:1, to prevent inflammation--and it's not so easy to do!  The typical Western diet has a ratio of 17:1.  

Oil, nuts, seeds, corn-fed animal products, trans-fats, & processed foods are the biggests sources of inflammatory omega-6's.

The more omega-6's you are eating, the harder it is for plant-based omega-3's like greens/flax/chia to convert into the kind of omega-3's you need to prevent inflammation!

But, if you cut out the oil & nuts--then the chia/flax/greens REALLY DO CONVERT into DHA and EPA--the kind of anti-inflammatory omega-3s we need for a healthy brain/arteries/body.   I had mine tested.  I know that plant-based no-added oil or nuts really works!

 

Why I Gained Weight & Inflammation on the Mediterranean Diet

 

Eating just a small 1/3 cup of almonds a day. 

Eating just a few squares of super-dark 85% cacao chocolate a day.

Eating just 3 TBS. of olive oil a day. I used it to cook with, to roast vegetables, in my salad dressings, & as a "dip" for my bread.  

I had no idea how much fat & calories were in these Mediterranean gems until I tracked them for this presentation slide.

 

846 extra calories a day from chocolate, nuts, & olive oil.

84% of those calories are from fat.

21% of those calories are from saturated fat.

I was consuming 84.3 grams of fat  (21.1 grams as saturated fat) just from nuts, olive oil & chocolate - and that's a conservative estimate.

 

 

 

The Veg-Heavy Green Smoothie Snack Compared to Handful of Almonds????  No Contest!!

 

 

 

Compare the Nutrients in the Green Smoothie to the Nuts?

 

For some perspective--those 5815 mgs of omega-6's from almonds are practically a day's worth--although it's relative to how many omega-3's you consume.  If you're also eating tahini, more nuts & seeds, oils, meat, & processed foods---you can only imagine what your omega-6 to omega-3 ratio looks like!

 

Anyone as surprised as I was from these statistics?  I'd love to hear your feedback!

Comments

[The Good Luck Duck]

Thank you for this break-down of the role of fats. Years ago, I got concerned when I read that we don't convert plant-source omega-3's very well, so I relented and started taking fish oil instead of my old, faithful flaxseed. I never knew that the omega-6's in my diet were blocking conversion.

And, those nuts!! Thanks for the chart; we truly had no idea.

Roxanne

[Emily H]

Can you share what your daily calorie requirements are to maintain your weight?

[Terry]

I had exactly the same experience! I was eating a "healthy" vegetarian diet based on research, and exercising 5Xs/wk, but as I approached 60 my cholesterol kept going up and while not overweight, I felt dumpy. It wasn't until I started reading your posts and decided 16 months ago to try the no added fat diet (giving up my much loved dark chocolate, avocados, nuts, and salad dressing) that my body was transformed, dropping my cholesterol and triglycerides significantly and losing 8 pounds. I feel great and love the new way I eat, not missing any of it (except the dark chocolate :) Unfortunately, there is so much written about the "healthy" Mediterranean diet and the benefits of olive oil that it's hard to talk to friends and family about this truly healthy way of eating.
Thank you so much for keeping us posted about the latest research; you've changed my life in very positive ways!

[Anna SKinner]

Do you have any pointers to places to read about the impact of this diet on children and in pregnancy? We avoid refined oils but do have avocado, nuts, tahini and nut butters in our children's diet (and in smaller quantities in the adults' diet too). It makes sense to me to avoid the harbingers of poor health in childhood but I'm not sure I could get enough calories in without some dense foods like nuts or avocado.

[The Healthy Librarian]

@Anna: Kids need more fat--nuts, avocados & nut butters are fine. Dr. Esselstyn says avocados & walnuts are fine for those without heart disease. It's really important for babies, kids, & us to absolutely get B12 (& I mean taking a supplement, not just what's in fortified foods. For adults: 1000 mcg/day(, vitamin D, if you aren't out in the sun, & DHA (an omega-3) just for insurance. I also by fortified soy or almond milks---with all the added vitamins & mineral.
Look at Jack Norris' website--a vegan dietitian with info on proper nutrition for kids--also Dr. Joel Fuhrman has a book on the subject--but I think it hasn't been updated for years.

Here're some book suggestions & more guidance re pregnancy & kids from a reply I'd written to someone else.:

Check out this newest book http://www.amazon.com/Everything-Vegan-Pregnancy-Book-pregnancy/dp/144052551X/ref=sr_1_fkmr0_1?s=books&ie=UTF8&qid=1328896374&sr=1-1-fkmr0 --written by a registered dietitian and recommended by Ginny Messina, also a vegan RD--who isthe vegan resource for the American Dietetics assn.) Haven't seen it myself, though. Also, look at Julianne Hever's book http://www.amazon.com/Complete-Idiots-Guide-Plant-Based-Nutrition/dp/1615641017/ref=sr_1_fkmr0_1?s=books&ie=UTF8&qid=1328896638&sr=1-1-fkmr0 --another RD. Excellent resource. Absolutely take a B-12 supplement!! Can't overdue it. Baby needs it. I take 1000 mcg a day on advice from B-12 expert at the Cleveland Clinic--Dr Donald Jacobsen--but talk to your doc-a must for vegans!! Also, in addition to eating plant sources of omega-3 like chia, flax, & greens---take a DHA supplement---algal if you're strictly plant-based, or from fish oil if you don't care. But DHA is the baby brain builder. Of course, eating all the good high nutrient frutis & veggies, whole grain foods, beans & legumes, too. Use fortified non-dairy milk for yourself, like EdenSoy Extra to get the calcium---also, lots of highly digestible calcium in the dark leafy greens. Lots of beans & other plant sources for protein.

[Leland]

Thanks for the eye-opening information. I have always made sure that I have enough fat in my salads (in my dressing) or kale-based meals (nuts or bread with vegan spread) in order to maximize my body's ability to absorb all of the fat-soluble nutrients in my food. I recall learning that doing so is supposed to increase such absorption up to 10-fold.

In cutting out all nuts and oils, how much do you believe you are sacrificing on the nutrition side of the equation, and is it possible that there is a balance that should be struck between the omega-6 detriment and nutrient-absorbing benefit when considering whether to go "extreme" with respect to completely cutting out all nuts, seeds and oils?

[Chell Atchley]

What do you recommend for a good DHA supplement? And how much? I have concerns with fish oil due to the toxins present (Dr. Michael Greger strongly suggests to avoid all fish). Thanks so much!

[anna]

Jack Norris' website has some stuff about B12 - is sublingual a must? Should we chew a B12 tablet? Which type of B12 is best? What is your opinion? I'm getting so confused.

[anna]

Just found your post from 2010 on B12. SO it's: methylcobalamin, 1000mcg, sublingual is best, on an empty stomach. Thanks!

Any thoughts on Zinc? Dr Fuhrman recommends this as a supplement.

[Karen]

Very interesting. What are your current cholesterol levels? Karen

[Anna SKinner]

Thanks for your advice. We do fortified foods and have Dr Fuhrman's book and also the Physicians Committee for Responsible Medicine book about diet for children. I don't give the kids a B12 supplement because they get 400% of the recommended amount in Nutritional Yeast on a daily basis and that's where I get mine from and my blood levels have not been low. We do vegan DHA when I remember and I take vit D since last year when I got a stress fracture running in the winter and measured my levels and found them pretty poor despite lots of outside time. For omega 3s I try to get an ounce of walnuts and a tablespoon of chia into everyone every day, but with the avocado and nut butters I got a bit worried about our omega 6 intake. Got to be better than the average processed food diet though, so we'll just keep at it!

[Penny]

I've read the NY Times articles on "Is Veganism for Everyone?" Nina Planck's,"A Choice With Definite Risks," is especially misleading. It is rife with nutritional misinformation for adults and children. Ginny Messina has written a very effective response. http://www.theveganrd.com/2012/04/the-new-york-times-nina-planck-and-safety-of-vegan-diets.html
This piece is certainly not top-tier journalism! Take a look.

[The Healthy Librarian]

@Penny: Thanks for the excellent link to Ginny Messina's rebuttal to Nina Planck. I totally missed that whole piece in the NYT's. The experts that the NYT's picked were the furthest thing from nutrition or medical experts--although I value Rip Esselstyn's opinion.

[Jack]

Might Leland, above, be misreading your take on nuts, seeds, and oils? It doesn't seem to me that you forgo them entirely, or urge that-- but that you use a limited amount of mostly chia seeds and walnuts (for example, in your recent chia/soymilk salad dressings). That's about what we do at our house, too. However, I'd love to see you address Leland's general question on balance between fat for absorption of micronutrients and overconsumption of omega 6 fats. Dr Greger strongly pushes the fats-with-greens-for-absorption idea, and some of us are reading him, too(!) Dr. Esselstyn endorses walnuts for people w/o heart disease; on the other hand, at least males over sixty with experience of standard western diet (two of us in this household) can be presumed to have significant cardiovascular disease.

[The Healthy Librarian]

@Jack:

I actually get plenty of fat from naturally occurring fat in the foods I eat--even oats have fat. I also get fat from chia, soy milk, flax, & a couple of walnuts.

Turns out we actually need less fat than you'd expect to absorb the fat soluble vitamins--and the fat doesn't have to be eaten at the exact same time as the vitamin-A or D rich foods. (although I do take my D with my biggest meal)
How much dietary fat do we need to absorb vitamin A from carotene-rich yellow and green leafy vegetables?

"In summary, only a small amount of dietary fat (just 2.4 grams/meal--or 21 grams eaten throughout the day) is needed for optimal utilization of plant provitamin A carotenoids.

Data from the present study indicate that is is possible to improve the total-body vitamin A pool size and restore low liver vitamin A concentrations to normal concentrations by eating sufficient amounts of carotene-rich yellow and green leafy vegetables and minimal amounts of fat."

--Judy D. Ribaya-Mercado, Jeffrey B. Blumberg et al, "Carotene-rich plant foods ingested with minimal dietary fat enhance the total-body vitamin A pool size in Filipino schoolchildren as assessed by stable-isotope-dilution methodology," American Journal of Clinical Nutrition 2007;85:1041-9 http://www.ajcn.org/content/85/4/1041.long

Read the whole post:

"Tufts University/Jean Mayer USDA Research Center: How Much Fat Do You Need to Absorb the Vitamins in Your Vegetables? Less Than You Think" http://www.happyhealthylonglife.com/happy_healthy_long_life/2011/03/vitamin-a-.html

[old lady]

Thanks for the info...it is so hard to get everything right...good fats, bad fats, omega3, omega6. The brain/body needs fat! My brain is swirling! I am not a regular meat eater...but do salmon, sardine, tuna weekly.
Well, I do incorporate nuts/oil olive in my diet, I know, gasp! I only use it sparely, probably about 1 tbsp a day if that...then there are the nuts, sunflower seeds/raw almonds/sometimes cashews. Probably 1/4 cup each day. My skin & hair respond to what I take into my body.

This is information is good and worthwhile to know, what you put into your body. Gotta find that balance of what works for your body. With this program, all my levels cholesterol, hdl, and ldl, and BMI are under the danger range.

[Ninufar]

Great to hear about balance (thanks "old lady"!)... I'm really glad I got to read this post and get more info on fats. I'm also a little amazed to see 3 Tbsp of oil listed for a day's food intake (if I understood), which just underscores how helpful it is to see these details and not just talk in generalities.

I have not yet tried doing absolutely-no-added-oil for more than a day or two, but my current intake is less than 1 tsp/day, usu more like 1/2 tsp/day. I'm being much more careful about quantites on my walnuts and seeds, which is good, I just know I never want to go back to the fear I had of oils and fats back in my body dysmorphia days. (and I am grateful to report thus-far very good blood pressure and blood lipid results, and I have no heart disease sfaik.)

[Jennifer Vajda]

Three tablespoons of oil is more than I put in most entree recipes and 23 almonds, one oz, is a serving. Five ounces of nuts per week has been found in to reduce cardiovascular risks. Moderation and variety is key. The body's needs and metabolic rate change with age so what worked ten years ago will not work ten years into the future (ignoring the nasty additives for a moment).
I love your website but have come to realize that any absolutes in the food business is too many. Humans don't process things the same as each other. My personal guinea pig experiences are only helpful to individuals who genetically and environmentally are similar. I was making too broad assumptions about what worked for me possibly working for more people but sweeping assumptions are also being made by many of the physicians and government.

Some bodies may need more fat than other bodies but really three tablespoons of oil is a lot. A 1200 calorie weight loss diet with 30% of its calories from fat grams would only allow 40 grams/360 calories from fat for the whole day. One teaspoon of olive oil with lemon juice and herbs on a salad, (~5 grams/45 fat calories) and 1/2 oz chopped walnuts on cereal,(9 grams/81 calories) would leave room for the chocolate and a few grams to leave as hidden - from the small amounts in everything else vegan (I would leave more for a meat/dairy eater).

The big problem with the low grade hypothyroidism symptoms common in our nation is that with that even 1200 calories could be a weight gain diet with that as untreated problem. Untreated hypothyroidism or polycystic ovarian syndrome can make weight loss very difficult even with regular exercise and reduced intake. The changing balance of hormones during perimenopause also make abdominal weight gain more of a risk.

Thanks for sharing your wonderfully thorough and organized work.

[Johannes Gutwald]

Thank you for your interesting information. May I inform you about my initiative "angel sugars are multicolored" for all-natural, multicolored angel sugars such as fruit, vegetables, legumes or nuts for kids. You find more information on http://en.zabi.info. Kind regards Johannes Gutwald, Phd, Master of Science in Preventive Medicine, Gars am Inn and Vienna

[Health Librarian]

@Johannes: Took me a couple minutes to realize exactly what "angel sugars are! Great site--worthy initiative & I wish you much success spreading the word. I really like your approach to parents & grandparents---how that one little treat just keeps adding up.

I highly recommend Dr. Gutwald's site--worth exploring it.

[Norman]

Great article!

I was eating a plant based diet with no oils in cooking. However I was eating tons of nuts after hearing from Dr Greger how good they were for you.
I was also using tahini in dressings and eating nut butters on toast. I stated to getting chest pains. With vigorous exercise they were severe. In 3 weeks with no nuts, no oil , no tahini, no avocados my chest pains have completely disappeared. I am walking 1 hr a day on the treadmill with no problem. When I started, I got chest pains after 10 minutes. I take 1 heaping table spoon of flaxseed a day. It has far more omega 3s and much less omega 6 and less calories then and an oz of nuts. We don't need nuts or oil beyond a table spoon of flaxseed. There is enough oil in whole foods to provide 10 to 12 percent fat to our diet.

[The Healthy Librarian]

@Norman: Thanks for sharing your experience with nuts & tahini. It's been Dr. Esselstyn's experience as well--after personally seeing & hearing from many heart disease patients. The so-called benefits of nuts aren't all they're "cracked up to be". With all due respect to Dr. Greger--he's just citing the research from the epidemiologic studies mostly from the 7th Day Adventists, & some of the shorter running nut studies--and they looked at body weight, blood pressure, & some lipid values. These don't necessarily relate to what is going on inside someone's arteries.

[debbie]

Hi, I have been taking spoonfuls of EVOO because I deal with chronic constipation and it helps lubricate my BM's (From experience, I really need fats to do this). I would take flaxseed but my body has started to react to it when I take it. Is there any other oil/oil food source you'd recommend to take?

Also, I would love to do green smoothies (and especially love Kale) but I have hypothyroidism and have to avoid eating too much uncooked brassica vegetables. Do you know any alternatives for green smoothies? Thanks so much for this post and your blog. I'm currently in school to become an RD and reading research about food is so interesting to me and gets me excited about my future career!