The Mediterranean Diet is widely regarded as the healthiest diet, yet it lacks a precise definition. Researchers observed remarkably low rates of heart disease and cancer in parts of the Mediterranean in the 1950s, long before the rise of ultra-processed foods. Notably, people in Crete had a heart disease rate that was one-twentieth that of the United States, as described in this video. These individuals primarily consumed whole plant foods and fish. Their Traditional Mediterranean Diet closely resembles a Whole Food Plant-Based Diet, as both prioritize plant-based foods while minimizing saturated fats and processed foods. While it is not feasible to conduct a Randomized Controlled Trial (RCT) on nutrition in the same manner as we do with pharmaceuticals, ample research confirms that Traditional Mediterranean and Whole Food Plant-Based diets are the most effective in promoting health and longevity. This website aims to present this growing body of evidence, which includes RCTs such as PREDIMED, case series published by Dr. Caldwell Esselstyn and others, large observational studies of Seventh-day Adventists in Loma Linda (who have a high percentage of vegetarian diets), and studies of the Blue Zones, where populations enjoy exceptionally long and healthy lives.
What is a Whole Food Plant-Based (WFPB) Diet?
A Whole Food Plant-Based (WFPB) diet is a vegan diet that excludes junk foods and refined carbohydrates, such as white bread. While many people think a WFPB diet is limited to salads and fruits, whole grains and legumes also play a crucial role in making this diet complete and sustainable.
| Standard American Diet (SAD) | Modern Mediterranean | Traditional Mediterranean | WFPB Diet | Comments | |
|---|---|---|---|---|---|
| Highly Processed & Junk Foods | Yes | No | No | No | Infused with sugar, salt, and fat, these foods can be addictive. |
| Processed Meat (sausage, sandwich meats…) | Yes | No | No | No | Increases the risk of heart disease and many types of cancers. |
| Red Meat | Yes | Little | No | No | Increases the risk of heart disease and has been associated with an increased risk of some cancers. See American Cancer Society Guidelines below the table for more details. |
| Refined Carbs (white bread, white rice, white pasta, etc) | Yes | Yes | No | No | High glycemic index causes spikes in blood glucose after eating. Processing removes fiber and other nutrients. |
| Whole Grains (oats, whole wheat bread, etc) | No | No | Yes | Yes | High in fiber and nutrients, health promoting. |
| Fruits & Vegetables | Little | Yes | Yes | Yes | High in fiber and nutrients, health promoting. |
| Legumes (beans, lentils, etc) | Little | Yes | Yes | Yes | High in fiber and nutrients, health promoting. |
| Dairy with fat | Yes | Yes | Little | No | High in saturated fat. Examples include cheese, ice cream, regular yogurt, low fat milk, and whole milk. |
| Nonfat Dairy | Yes | Yes | Little | No | Shown to be health- promoting in some areas and harmful in others. |
| White Meat (chicken, turkey) | Yes | Yes | Little | No | Generally lower in saturated fat than red meat, but it is healthier to avoid meat altogether. See information listed below this table. |
| Fish | Yes | Yes | Yes | No | Fish like salmon and tuna are high in omega 3 fats (essential fatty acids). Some raise concerns about toxin content including mercury and polychlorinated biphenyls. |
Per the 2020 American Cancer Society dietary guidelines
“Evidence that red and processed meats increase cancer risk has existed for decades, and many health organizations recommend limiting or avoiding these foods. In 2015, the International Agency for Research on Cancer (IARC) concluded that processed meat is in Group 1 (“carcinogenic [cancer-causing] to humans”) and that red meat is in Group 2A (“probably carcinogenic to humans”), based on evidence for increased risks of colorectal cancer. Recent studies also suggest a possible role of red and/or processed meats in increasing risk of breast cancer and certain forms of prostate cancer, although more research is needed. It is not known if there is a safe level of consumption for either red or processed meats.” https://www.cancer.org/cancer/risk-prevention/diet-physical-activity/acs-guidelines-nutrition-physical-activity-cancer-prevention/guidelines.html
Per the 2019 American College of Cardiology (ACC) guidelines
“A diet emphasizing intake of vegetables, fruits, legumes, nuts, whole grains, and fish is recommended to decrease cardiovascular disease risk factors.” This is a Class 1 recommendation, the strongest level of endorsement. The guidelines go into more detail supporting that minimizing animal products is associated with a substantial reduction in mortality rates: “Plant-based and Mediterranean diets, along with increased fruit, nut, vegetable, legume, and lean vegetable or animal protein (preferably fish) consumption, with the inherent soluble and insoluble vegetable fiber, have consistently been associated with lower risk of all-cause mortality than control or standard diets in observational studies. The PREDIMED (Prevención con Dieta Mediterránea) trial randomized participants to a Mediterranean diet supplemented with either extra-virgin olive oil or nuts and demonstrated 30% and 28% reductions, respectively, in the combined endpoint (MI, stroke, or cardiovascular mortality), but the improved outcome was driven largely by the reduction in stroke, with no significant improvement over the control diet for mortality or MI. When the PREDIMED cohort was reanalyzed post hoc for the “provegetarian” food pattern (more vegetable consumption versus animal, egg, fish, dairy, or meat product consumption), a significant mortality rate reduction (41%) was noted in the 2 quintiles with the highest vegetarian score. A comparison of plant and animal protein from the Adventist Health Study-2 cohort similarly indicated that using meat for protein was associated with a 61% increase in mortality rate, whereas replacing meat with nuts and seeds was associated with a 40% reduction in mortality rate. Similarly, the graded risk published by Song et al. indicated that lower mortality rate was associated with replacing animal protein of different origins with plant protein. The evidence is mixed with regard to the effectiveness of dairy intake to reduce ASCVD risk factors, which is why it is not included in the listed foods for this recommendation.” https://www.ahajournals.org/doi/10.1161/CIR.0000000000000678#d1e1862
FAQ
Medicine is a field that is usually slow to change. Medical students and young physicians tend to adhere to the teachings of their instructors and more experienced practitioners. This apprenticeship-like environment can discourage young professionals from thinking outside the box. This partly explains the 17-year gap between the publication of compelling studies and the widespread adoption of new practices by physicians as noted in this source.
- Medical schools teach very little about nutrition, this is slowly improving.
- Physicians are embracing the impact of a plant forward diet in larger numbers, hence the rapid growth in membership of the American College of Lifestyle Medicine.
Governmental and medical organization’s dietary recommendations have been slow to embrace the benefits of a WFPB diet because of the lobbying strength of the many parts of the food/agriculture industry. Such pressures were described eloquently in the China Study book.