What is the Mediterranean diet?

The mediterranean dietToday we continually hear about the health benefits of following a Mediterranean diet. For example, a recent analysis of more than 50 published studies indicated that a Mediterranean diet would lead to a 30-percent reduction in metabolic syndrome (1). Since metabolic syndrome can be considered pre-diabetes, the public health implications are enormous. However, are we talking about the Spanish Mediterranean diet or the Italian, or the Moroccan, the Egyptian or the Lebanese versions? Here is the basic problem with all diets: Trying to define them correctly.

In order to compare one diet to another, each diet must ultimately be defined by its balance of the macronutrients (protein, carbohydrate and fat). This is because the macronutrient balance determines hormonal responses generated by that diet (2).

A Mediterranean diet can be considered to contain approximately 50 percent of the calories as carbohydrates, 20 percent of the calories as protein and 30 percent of the calories as fat. This is a higher protein-to-carbohydrate balance than is found in the usually recommended “healthy” diets for weight loss and cardiovascular health. As a result, this difference in the balance of the protein-to-carbohydrate ratio will generate different hormonal responses between the two types of diets, especially in terms of reducing insulin responses and controlling cellular inflammation.

This is important since it is excess insulin that makes you fat and keeps you fat, and it's cellular inflammation that makes you sick. Since insulin levels are determined by the protein-to-carbohydrate ratio, would more protein and less carbohydrate generate an even better response? Of course it would. That is why the Zone diet contains 40 percent of the calories as carbohydrates, 30 percent of the calories as protein, and 30 percent of the calories as fat. This improved protein-to-carbohydrate balance means lower insulin levels and less cellular inflammation.

Why stop there? Let's just continue reducing the carbohydrates. Now you get low-carbohydrate diets, like the Atkins diet. Unlike the Zone diet, carbohydrates are no longer the primary macronutrient in a true low-carbohydrate diet. Now the primary macronutrient is fat. Using these low-carbohydrate diets creates some real problems by generating an abnormal metabolic state known as ketosis. This occurs when you don't have enough carbohydrates (fewer than 20 percent of total calories) in the diet to metabolize fat completely to carbon dioxide and water. When that happens, your blood vessels lose their elastic nature, (3) increasing the risk of a heart attack (4). This is probably a consequence of lowering insulin too much as well as increasing inflammatory mediators (3). If you are trying to lose weight, increasing the likelihood of a heart attack is not a good idea. So it seems you need some carbohydrates, but not too few if your goal is to lose weight safely.

That's why people (as well as physicians and diet editors) get confused when they read articles in the New England Journal of Medicine talking about low-carbohydrate diets for weight loss when such diets actually contain 40 percent carbohydrates (5). To be correct, they should use the term “the Zone diet” instead of a “low-carbohydrate diet” to be correct. Despite the poor dietary description used in this article, the “low-carbohydrate” (aka the Zone) diet generated greater weight loss after two years, a greater reduction in the total cholesterol-to-HDL cholesterol (a marker of future cardiovascular risk), a greater decrease in triglycerides and a greater decrease in inflammatory markers when compared to a Mediterranean diet or the always-recommended low-fat diet (5). That's why you do controlled clinical trials instead of guessing what the best might be.

So if you want to lose weight and reduce your future heart disease risk, it seems prudent to follow the Zone diet and make most of your carbohydrates colorful ones (i.e., fruits and vegetables) and add olive oil and nuts for fat instead of using vegetable oils and saturated fats just as I recommended more than 15 years ago (2). Just call it the Mediterranean Zone diet. Now everyone is not only happy, but also they are finally using the proper diet terminology.

References

  1. Kastorini C-M, Milionis HJ, Esposito K, Giuglian D, Goudevnos JA, and Panagiotakos DB. “The effect of Mediterranean diet on metabolic syndrome and its components.” J Am Coll Cardiol 57: 1299-1313 (2011)
  2. Sears B. “The Zone.” Regan Books. New York, NY (1995)
  3. Buscemi S, Verga S, Tranchina MR, Cottone S, and Cerasola G. “Effects of hypocaloric very-low-carbohydrate diet vs. Mediterranean diet on endothelial function in obese women.” Eur J Clin Invest 39: 339-347 (2009)
  4. Yeboah J, Crouse JR, Hsu FC, Burke GL, and Herrington DM. “Brachial flow-mediated dilation predicts incident cardiovascular events in older adults.” J Am Coll Cardio 51: 997-1002 (2008)
  5. Shai I, Schwarzfuchs D, Henkin Y, Shahaar DR, Witkow S, Greenberg I, Golan R, Fraser D, boltin A, Vardi H, Tangi-Roxental O, Zuk-Ramot R, Sarusi B, Fricner D, Schwartz Z, Sheiner E, Marko R, Katorza E, Thiery J, Fielder GM, Bluher M, Stumvoll M and Stamper MJ. “Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet.” N Engl J Med 359: 229-241 (2008)

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.

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This entry was posted in Zone Diet and tagged , , , , by Dr. Barry Sears. Bookmark the permalink.

About Dr. Barry Sears

Dr. Barry Sears is a leading authority on the impact of the diet on hormonal response, genetic expression, and inflammation. A former research scientist at the Boston University School of Medicine and the Massachusetts Institute of Technology, Dr. Sears has dedicated his research efforts over the past 30 years to the study of lipids. He has published more than 30 scientific articles and holds 13 U.S. patents in the areas of intravenous drug delivery systems and hormonal regulation for the treatment of cardiovascular disease. He has also written 13 books, including the New York Times #1 best-seller "The Zone". These books have sold more than 5 million copies in the U.S. and have been translated into 22 different languages.

22 thoughts on “What is the Mediterranean diet?

  1. I have never thought of the Mediterranean Diet in terms of its macronutrient distribution. Rather, I think of it in terms of food selection. One thing that makes this diet good is the use of monounsaturated fats. I bet most people living in the Mediterranean belt are not counting calories or balancing their macronutrients!

    I believe that the Zone is more about “intuitive” eating: paying attention to the foods that we select, listening to our bodies and keeping hunger at bay. For some, 40% carbohydrate is just right. Others may need to drop to 30% carb, and some can tolerate a bit more carbohydrate (“the lucky ones”). But, to me, the Zone is not an exact spot. No one needs to worry so much about macronutrient distribution as long as we use those “intuitive” skills.

    The Zone Diet is not really a diet in and of itself. I can “zone” any diet! Whether it be paleo, mediterranean, or other diet, the food “type” determines the diet in many cases. The Zone just defines the appropriate macronutrient balance needed to keep one “in the Zone”. Not to mention the other healthy aspects of living the Zone lifestyle!

    • It is the rates of entry of digested amino acids, sugars, and fatty acids that determine the hormonal responses of meal. That’s why it is best to define a diet in terms of macronutrient composition. On the other hand, the food ingredients used in that macronutrient composition will greatly influence the inflammation induced by any particular diet. Because no one is genetically identical there is a bell-shaped curve for both the macronutrient composition and range of food ingredients used in a dietary program. You need a little experimentation with both to find a sustainable dietary program that controls cellular inflammation.

      • Absolutely! Just because one “balances” their diet with the appropriate macronutrient composition, does not make the diet a good one. For instance, if I ate a 40-30-30 balance of a meal comprised of foods found on the Zone “unfavorable” list, I may be “balanced”, but probably not “in the Zone”.

  2. I’m Italian and some days ago on tv they said that Italian people don’t know what the Mediterranean diet is. Here we eat pasta, spaghetti, maccaroni and a lot of bread and we know they’re carbohydrates; however there’s here in Italy a big misunderstanding on the definition of what carbohydrates are. Fruit and vegetables are considered to be just fruit and vegetables (and the advice is: ‘at least 5 portions a day’!) with no distinction between their different types as in the Zone. A lot has to be done here in Italy and our children and teenagers are getting fatter and fatter. I think that the idea of a “Mediterranean Zone diet” is wonderful and that it will bring a lot of health to our population!

    • The Zone diet is very popular in Italy since unlike in the United States they still eat vegetables and fruits. Nonetheless the confusion about carbohydrates is world-wide. The Japanese consider fruits and vegetables as a separate food group than bread or rice. In reality they are all carbohydrates.

  3. A link in my email today brought me here to this discussion and I am wondering why Dr. Sears never mentions the diet by Michael Montignac introduced ‘a decade’ before the Sears diet which seems to have been tweaked by Dr. Sears in that Montignac blames insulin on obesity and promotes the glycemic index of foods as the cure and Montignac does not believe calorie restriction is important as Sears does. If you read the diet by Michael Montignac, it sure looks like the Sears diet in most respects but Dr. Sears seems to criticize the obviously flawed diets of the world and never give credit to the credible diets.

    • Montignac discussed the glycemic index first discussed by David Jenkins i 1981, whose work is throughly mentioned in many books. No where in any of Montignac books (I think he only wrote one) did he discuss the need for balancing the glycemic index (and really the glycemic load) at every meal with an necessary amount of protein to balance insulin and glucagon responses. Furthermore, he never discussed the role of excess insulin in the generation of inflammatory eicosanoids by increasing the production of arachidonic acid. If you can find such references on arachidonic acid, eicosanoids, inflammation and the role of inflammation in chronic disease in his book, please let me know.

      I wrote an entire book on calorie restriction (The Anti-Aging Zone). You simply can’t eat unlimited number of calories.

      • I guess ol’ Jockobono cant produce the goods. Sorry jocko its not the seriousness of the charge, but the evidence that matters!

  4. Hi Rita,
    I am a health coach in the United States. I just read your question about the Mediterranean Zone Diet. It seems to be a general consensus that 5 portions of fruits and vegetables per day is an important number in terms of good health. Fruits and vegetables both have carbohydrates (carbs). Fruits in general have more carbs than vegetables. It is important though to understand some fruits and vegetables have a lot more carbs than others. Fruits and vegetables are considered “good” carbohydrates because they tend to digest slower which keeps your insulin levels from spiking and helps your body regulate blood sugar more normally. The Mediterranean Zone diet refers to the percentage ratio of carbs to fats to protein on your plate….

  5. Comments on the HCG diet plan per optimalhcgdiet.com?

    I have lost weight on the zone and easily lost 30 lbs on hcg in a little over a month.

    • The HCG diet has been around for near is based on 500 calories per day. You will lose weight (a lot of retained water, a lot of muscle mass, and even some fat). There have never been any published clinical research that supports the idea that injections of HCG suppresses hunger. It’s been around for nearly 50 years.

      A diet is a food strategy you follow for a lifetime to hopefully maintain your wellness. The HCG diet definitely doesn’t fit that definition.

      • Hi, Dr Sears:
        I am a great fan of yours and believe in your program. I improved a great deal when your book, the Zone, was released. I had a difficult time continuing thru the years. Now I am 67 years old and had quite a bit of stubborn fat. January I lost about 10 lbs on Atkins and switched to hCG injections. I lost an additional 40 lbs in 2 months maintaining my water and muscle mass. My weight loss was in the problem areas and at 220 lbs wear size 35 jeans. I have 25 lbs to go at which time I will once again follow your program for life. My blood pressure is normal now and though my fasting sugar was 128, it is now about 91 and below 100 all day long. I expect to maintain at about 10% body fat following your protocol.
        Just a side note. A lot of people have changed their lives and many have lost more than 100 lbs while maintaining their strength. I suggest you read Pounds & Inches and then see on youtube literally hundreds of satisfied people with strong bodies and tight skin. No hunger, only normal urges to snack. The Zone didn’t stop nitrites or address candida for cravings but I know it kept evolving with the glycemic index and Omega 3′s, etc..

        Again, thank you for your research. I would have diabetes like all of my relatives had it not been for your protocol.

  6. Hi dr.Sears i am from croatia and i am your biggest fan but i hawe got 1 question for you.On the botlle of omega 3 faty acids stands that optimal doze per day is one capsul but you are talking that appropiate dose is 5 capsuls.Im little bit confused.PS.Sorry for my bad english.

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