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JUNE 14, 2018
The PREDIMED study, ﬁrst published in The New England Journal of Medicine in 2013, was a landmark clinical trial demonstrating the Mediterranean diet’s role in major cardiovascular events (like stroke or myocardial infarction). The republished PREDIMED data, which has stronger randomization protocols in place, further strengthens the evidence base on the health beneﬁts of a Mediterranean diet.
Despite the imperfections of the original PREDIMED study, its results continue to withstand scrutiny. The republished analysis, which excludes 1,588 of the original 7,447 participants due to randomization protocol, comes to the same ﬁndings as the original PREDIMED study, with an approximately 30% lower risk of major cardiovascular events. The participants that were omitted from the republished study were excluded because they shared a household with a previously enrolled participant and were therefore assigned the same diet without randomization, and because one of the eleven study sites assigned participants to diets by clinic, rather than individually. Even without these participants included, the sample size of PREDIMED remains large compared with other randomized controlled trials of diets and adds to the large body of literature demonstrating the health beneﬁts of a Mediterranean diet.
Dietary beliefs should not be shaped on one single paper. Leading nutrition researchers across the full spectrum of dietary philosophies emphasized at Oldways Finding Common Ground Conference that “representations of new diet studies to the public should be made in the context of the prevailing consensus,” and that “new evidence should be added to what was known before, not substituted for it sequentially.”
But here again, the Mediterranean Diet has science on its side. The PREDIMED study is hardly the only time researchers have made links between the Mediterranean Diet and good health. The Mediterranean diet is one of the most well-researched eating patterns in the world, with more than 5 decades of epidemiological and clinical research supporting its beneﬁts. The evidence supporting the Mediterranean Diet is so robust, that even the Dietary Guidelines for Americans recommend a Mediterranean style diet.
It’s easy to get caught up in the chaos when reputable journal like the New England Journal of Medicine retracts and republishes a study. But read beyond the headlines and you’ll ﬁnd that the beneﬁts of a Mediterranean diet are just as promising as researchers suspected, perhaps even more so. As PREDIMED study author Miguel A. Martínez-González tells the Washington Post, “no previous trial has undergone such intense scrutiny.”
Response to Recent Guardian Articles on the Status of the Mediterranean Diet in the Mediterranean Region
MAY 29, 2018
The recent Guardian article titled, “’People just have less time now’: is the Mediterranean diet dying out?” doesn’t accurately reﬂect the data in WHO’s own Childhood Obesity Surveillance Initiative. The 2018 COSI report actually says that, comparing initial 2007 COSI data with the most recent 2017 data, “a signiﬁcant decrease in the prevalence of both overweight and obesity was recorded in Greece, Italy, Portugal and Slovenia…[and] a decreasing tendency was also observed in…Spain.”
Yes, children in countries around the Mediterranean are eating more fast food and highly processed food, just as American children have done, and are thereby becoming more overweight and less healthy, like their American cousins. Educating kids (and their parents) about healthy food choices (and how to put them on the table quickly) is essential. Many traditional Mediterranean meals – such as pasta topped with vegetables and beans or a little ﬁsh – take less time to prepare than visiting the mall food court or picking up takeout, while saving money too.
While the WHO report is an important reminder of the stakes involved in instilling good eating habits in our children, the actual WHO data show that perhaps an important corner is being turned as countries that have traditionally followed a Mediterranean Diet and lifestyle are beginning to wake up to the importance of turning back to the old ways of eating. As Antonia Trichopoulou, Europe’s pre-eminent expert on the Mediterranean Diet, said to the Guardian reporter:
I am optimistic that the Mediterranean diet will not die in the next generation,” she said. “There has been a lot of movement in recent years to rediscover traditional foods in Greece, with people moving to villages and producing local food. The Mediterranean diet is seen as sustainable and good for the environment. It can be recovered.”
Since more solid, peer-reviewed data support the health beneﬁts of the Mediterranean Diet than any other way of eating, Guardian readers should be aware that this healthy eating pattern is not on its last legs.
Response to the interim ﬁnal rule, “Child Nutrition Programs: Flexibilities for Milk, Whole Grains, and Sodium Requirements”
NOVEMBER 30, 2017
We are disappointed by the recent USDA rule to relax school nutrition standards. This move is an unnecessary threat to children’s health, given that widespread evidence indicates that healthier school meals have actually reduced plate waste without reducing school meal participation in many districts. Despite Secretary Perdue’s comments to the contrary, students today are eating, and enjoying, whole grain foods. Relaxing nutrition guidelines that are already being met is a pointless exercise, and September 2016 data from the USDA show that the vast majority of school districts are certiﬁed as complying with the school nutrition standards. This includes 100% certiﬁcation in states such as Alabama, Kentucky, and Mississippi — states that often don’t receive acknowledgement for meeting nutritional guidelines.
This announcement comes at a particularly troubling time, as a Harvard study published today in the New England Journal of Medicine estimates that 57% of today’s children will be obese by age 35. Our lunchrooms are a place to nurture students’ appetites for healthy food and properly fuel their growing brains and bodies. Thus, we urge policy makers to prioritize the health and wellbeing of the next generation, and to not backpedal on existing successes.
Response to the National Academies’ reports, Redesigning the Process for Establishing the Dietary Guidelines for Americans (September 2017), and Optimizing the Process for Establishing the Dietary Guidelines for Americans: The Selection Process (February 2017)
SEPTEMBER 22, 2017
We wholeheartedly support the National Academies’ suggestions to enhance transparency, manage biases, and promote sound science. That said, we feel it’s important to clarify that the widespread critiques of the DGA do not translate to a critique of the DGSAC (Dietary Guidelines Scientiﬁc Advisory Committee). The 2015 DGSAC report was met with widespread support from those immersed in nutrition research, as well as respected organizations including the Academy of Nutrition and Dietetics, the National WIC Association, the Union of Concerned Scientists, and the Center for Science in the Public Interest. Scientists from vegan to Paleo, and from low-fat to Mediterranean, pushed aside personal interests and lent strong, collective support to the DGSAC report at Oldways’ Finding Common Ground conference.
The National Academies reports devote numerous pages to the need for DGSAC to be free of bias, yet it is the translation from science to policy that deserves the most scrutiny. Although the DGSAC report is intended to serve as the scientiﬁc basis for the DGA, the translation from DGSAC report to DGA has repeatedly watered down the integrity of the ﬁnal report, as the policy writers, more so than the scientists, are subject to the most bias from industry stakeholders. We concur with the National Academies, that “If the DGA omits or only accepts parts of the conclusions in the DGSAC report, a clear explanation has to be given as to why.”
JANUARY 26, 2017
We believe strongly that overall diet determines health, rather than individual foods or speciﬁc nutrients. No matter what combination of nutrient criteria FDA might mandate as healthy, it’s inevitable that a reductionist approach will result in eﬀorts to “game” the system with fortiﬁed manufactured foods, while some whole, natural foods may fail to qualify. For instance, under the “current thinking” outlined in FDA’s September 2016 guidance, brown rice wouldn’t qualify to be labeled healthy – while the highest fat hamburger meat commonly sold (70% lean/30% fat) would qualify, as would the bun typically eaten with it.
In our comments, we advised FDA to follow either of two paths: 1) Don’t allow the use of “healthy” at all on packaging, or 2) Allow it only on whole plant foods. If FDA does allow use of the word “healthy,” Oldways recommends using it to highlight whole or minimally processed plant foods, which are especially encouraged in the 2015-2020 Dietary Guidelines for Americans – instead of tying use of the word “healthy” to a formula of nutrients.