What’s the Best Diet: Mediterranean, Paleo or Vegetarian?

I attended an awesome meeting this past week in San Francisco. This nutrition conference was hosted by the Institute of Function Medicine-my 21^st annual meeting with this organization over the last 23 years. Even my wife, Nicole, attended, which was lovely for me as I usually have to attend these medical meetings alone and great for her clinical knowledge, too.

They had an incredible debate/presentation comparing a Mediterranean diet, a Paleo diet, and Vegetarian diet. The best part of this discussion was that the moderator pushed them to find what they could all agree on, and I love the results.

Here is what they all agreed on:

1. Everyone should have at least 30% of their calorie intake from vegetables and fruits, especially those with a low glycemic load.
   1. Since produce is so low in calories, this means 50% of the food we eat should come from vegetables and fruits. (Low glycemic load examples include beans, berries, green leafy vegetables, broccoli, and beets.

2. Everyone should have at least 1-2 handfuls of nuts daily; nuts and seeds are great for our health.

3. If you eat animal protein, it should be clean animal protein.
   1. If you eat seafood, it should be wild caught fish. Examples of clean animal protein are organic, free-range poultry, and grass-fed, grass-finished beef—clearly not hormone, antibiotic, and pesticide enriched animal protein produced in many commercial factories.
   2. For the sake of the planet, it is also better to eat low on the food chain, such as rabbit and poultry over beef and pork.

4. Nobody should be eating low fat. But fats need to come from healthy sources—hormone and pesticide free.

5. Everyone should avoid high glycemic load foods that have been processed, such as bread, crackers, rice and potato products, and anything made with flour.

6. And with the best of eating, we still need a supplement to get our key nutrients, like vitamin D, omega 3 fats, and other key nutrients.

Here is where they disagreed. They didn’t find common ground on sources and quantities of protein, or regarding beans and whole grains:

For legumes, the Paleo plan recommended none, as they have a few compounds that block nutrient absorption. The trouble with this is that beans are super high in nutrients and fiber, and blood test findings have noted that consuming beans has powerful and beneficial effects. The vegetarian and Mediterranean diet proponents truly made the point that we would benefit from eating beans daily. So yes, beans should stay on the menu

For whole grains, the Paleo plan recommended none, because of their glycemic load (blood sugar jump). Both the vegetarian and Mediterranean diet proponents accepted small quantities of whole grains, but not nearly as much as consumed by most Americans today.  Everyone agreed that if you have a gluten intolerance, you need to totally avoid all gluten products (wheat, rye, barley).

For protein, no surprises here:

1. With Paleo, 30% of the diet comes from animal protein.

2. With Mediterranean, no fixed amount of protein, but it comes from a mixture of lean animal protein and beans.

3. With Vegetarian, more beans, soy, and protein powders.

They all agreed that the most challenging part is that many, if not most Americans trying to following these diets, are doing it wrong.

1. The Paleo followers are poisoning themselves with dirty protein and animal fat—eating commercial sources loaded with hormones and chemicals, and they are clearly not getting the 5-7 cups of vegetables and fruits daily required to benefit from this type of eating plan.

2. The Mediterranean followers are eating far too much bread and pasta. If you are a farmer and physically active 6-8 hours per day, clearly you need more calories, and whole grains, even in the form of flour, can provide these nutrients. But for most people struggling to exercise for 7-10 hours per week, they can’t handle this high glycemic (sugar) load.

3. The Vegetarian followers are eating too many refined carbs and processed foods. To benefit, they need to stick to unprocessed food. They also have to ensure they get their protein from beans, soy, and protein powders, omega-3 fats from seaweed or a supplement, and enough vitamin B 12.

The bottom line is all these eating plans can lead to optimal health, but only if followed properly. You just have to find which diet you can follow best!

I wish you the best of health!

Steven Masley, MD, FAHA, FACN, FAAFP