Which Diet Is Best? Vegan? Paleo? Keto? Mediterranean? (Just Ask Your Great Grandmother)

Another article about optimal diet is just what you need right now, right? Well yes, actually. And there is a very specific reason why. There is perhaps nothing more rife with BS, politics, and misinformation than talk of proper diet. Most of the diet and nutrition space resembles identity politics. And that’s precisely why it’s important to have a look at this and to climb out of the rabbit hole. I wouldn’t write this if I didn’t feel I had something valuable to say. What I’m going to tell in you in answer to the question of whether you should go vegan, paleo, keto or Mediterranean is that, as far as actual physical health is concerned, it doesn’t really matter that much. And I’m going to tell you why. Politics and bias aside, the distinguishing factors in each of these dietary approaches are trivial in terms of actual impact on health. What’s more, focusing on their dietary restrictions and distinctions actually prevents us from understanding what and how we should be eating in order to be healthy.

Three Films
Last year I completed an arduous exercise. I watched three documentaries about diet and nutrition: Forks Over Knives, The Magic Pill, and Cooked. (I do not recommend doing this.) The exercise helped me to see what is truly important in understanding how diet affects health (and guess what… you already know what that is). It also helped me to understand how we are susceptible to persuasion and essentially unaware of bias towards or against dietary rules and how they may be influencing our beliefs. It became clear that our decision to follow a restrictive diet has far less to do with objective physical health than it does positioning ourselves on one side of the aisle or the other.

Both Forks Over Knives and The Magic Pill attempt to persuade the viewer about what to eat, whereas Cooked does not. Forks and Magic are both “advocacy films”. Advocacy films are “designed to influence public opinion and ultimately policy. They play an important role in the development of political and social systems.” Cooked was not an advocacy file and was by far the most persuasive of the three and the only one that had any kind of impact on me at all. And it had a big impact.

What I found most enlightening in watching these three films was that the first two, Forks Over Knives and The Magic Pill, followed VERY similar scripts even though the key dietary approaches ultimately advocated by each are about as different as can be. Forks Over Knives argues very persuasively for veganism, whereas The Magic Pill argues very persuasively for a low carbohydrate or “keto” diet. (Note: Although it’s used interchangeably with low carb, the term “keto” has a very specific meaning. “Keto” is short for “ketogenic”, which is the physiological state that occurs after you have eaten a very low carbohydrate diet for some time. Your liver produces ketone bodies in the absence of carbohydrates, which can be used for fuel and other things.)

The pattern in both Forks Over Knives and The Magic Pill was to introduce a cast of characters who are very sick. They are all of us. Their maladies range from obesity to diabetes to asthma to depression to hypertension to ….. They are old, they are young, they take multiple medications. They are our reality: chronic disease. Both films showed that the sufferers for the most part followed the SAD, or the Standard American Diet. SAD is limited mostly to processed convenient foods, sweets, empty calories, sugary beverages, low-nutrient snacks made largely of refined carbohydrates, and frequent eating. Each film then points to a main culprit behind the characters’ illnesses. But rather than to suggest that the health problems are due mainly to a lack of healthy food and surplus of unhealthy food in the diet, each film singles out a food group or a macro-nutrient group (the macro-nutrients are fat, carbohydrate, and protein) as the main source of the problem. In the case of Forks, the enemy is animal products, and in the cast of Magic, it’s carbohydrates. The characters are then put on a strict balanced diet which, in addition to restricting the food or macro-nutrient group believed to be the cause of all the problems, also removes the junk and replaces it with real food. So, in Forks, the participants moved from SAD to a diet full of fruit, vegetables, legumes, nuts, seeds and whole grains. Those in the Magic film ate meat, seafood, low carb vegetables, (to exclude starchy things like potatoes and roots), dairy, nuts and seeds, and low carb fruit (like berries).

Guess what? Meds were discarded, airways cleared, pants fit again, tears were shed. Everyone got better!

Note that in one film animal products are the source of the problem (reduced down to the very very bad macro-nutrient: saturated fat) and in the other they are central to a healthy diet. So each movie really is about vilifying a single macro-nutrient group, either fat (in animal products) or carbohydrates. If you are a history buff and are interested in this subject, then you will find that there is a long cyclical tradition of demonizing these two macro-nutrient groups. Interestingly, the third macro-nutrient, protein, has never really been the villain. This is due in large part to the prevailing, and incorrect, belief that more protein helps you build more muscle.

In my own lifetime I recall fat very much being the enemy for many of my earlier years and in the very difficult nutrition class that I took in college, until Dr. Atkins came along with his revolution. Suddenly fat is fine but carbohydrates are the enemy. But dig a little deeper and you’ll find William Banting advocating a low carb diet in 1863 in his “Letter on Corpulence to the Public”. Similarly, studies dating back to the 1940s linked dietary fat with heart disease, an idea that was etched in stone by the work of Ancel Keys, and certainly helped to bring us standards of today that are seldom questioned by many of us, such as cereal, toast, pancakes, and oatmeal for breakfast; standards, I hasten to add, that do NOT take our health into consideration in any way, shape or form.

I realized that the characters in Forks Over Knives and The Magic Pill who benefited from the dietary changes had FAR more in common than apart in terms of diet by simply replacing junk with real food. This taught me that either of these approaches can be fine and in fact, any diet can vastly improve physical health as long as it replaces junk with a wide range of real food most of the time. This is not to say that each diet doesn’t have individual merit beyond the removal of processed food. You may have ethical or religious objections to eating animal products or you may have certain medical conditions that would respond well to a low carb diet (such as diabetes, obesity, or some cancers). You may be one who easily gains weight, you may not tolerate gluten, or you may not be able to handle the idea that something died to give you your dinner. These are fine reasons for food group restrictions. But the value of the diet on overall health is not the food group or macro-nutrient restriction per se but rather the replacing of processed and junk food with real food. And this speaks volumes.

As far is diet is concerned, and I mean diet in the sense of Lose Weight, Get Healthy!, restriction (and suffering and will power) really seems to be important to our psyches. Obviously to lose weight SOMETHING has to be restricted. But the concept of transforming your health through changing your diet really has more to do with replacement than restriction, and maybe this is where our focus should be. But the idea that it has to hurt and you have to have will power seems to be required.

Paleo/Primal/Whole30
I first became interested in diet and nutrition when I, a former skinny guy who could eat anything, and did, had to grapple with mid-life unexplained weight gain. I’m not sure how I found it, but I read a book called The Primal Blueprint by Mark Sisson, and it really struck a cord with me. The approach advocated in this book extends and improves upon the very popular and enduring “Paleo Diet”, originally popularized by Robb Wolf in the book The Paleo Solution. The premise of The Primal Blueprint, and then Primal Health Coach program (of which I am a graduate) is that the preponderance of chronic health problems today result from the fact that our diets and behaviors do not match our genes. I’ll spare you the details but the gist is that our genetic blueprint was finalized sometime shortly after the paleolithic era when we were still hunter-gatherers and before the age of agriculture. As such, our genetics are more suited to pre-agricultural foods such as animals and the kinds of vegetables that grow in gardens but not to grains, legumes and other foods that are produced on a large scale via agriculture. These are the foods that are grown abundantly and cheaply in order to feed billions of people affordably. Therefore, the paleo diet excludes wheat, corn, rice, beans, peanuts, soy, oats, barley and any foods derived from these ingredients. This makes it one of the more restrictive diets out there. And in fact, the most restrictive version of the paleo diet is called Whole30. The Whole30 challenge eliminates all grains and legumes, alcohol, dairy, soy, non-essential medications, sugar, sweeteners such as honey and syrup and a variety of other things. This is the ultimate paleo elimination diet.

It is important to note that there are features of the Primal Blueprint that set it apart from healthy behaviors limited to food. The Primal Blueprint discusses factors such as sleep, sunlight, play and stress management.

The extent to which the paleo/primal/Whole30 approach improves health is not actually relevant to this article beyond the fact that it includes real food and excludes junk. To me, things like whole grains, legumes, dairy, and to some extent alcohol are gray areas that do not make or break a healthy diet necessarily. More importantly, the paleo/primal approach is very restrictive and based on assumptions that simply are not tractable for most people in the today’s world. It is very difficult to maintain the restrictions even 80% of the time (as the Primal Blueprint recommends). It’s very difficult to live like a hunter gatherer when there’s nothing much to hunt or gather. Furthermore, is it even possible to KNOW what the paleolithic humans really ate? This is what the main body of paleo diet criticism is based upon – “Paleo Fantasy” argues that we can’t know what paleolithic humans ate and even if we could, our food of today is vastly different. More importantly, it’s not the actual food types or categories (such as meat, vegetables, roots, fruit) that have been important throughout our evolution, but rather overall food availability. “From the standpoint of paleoecology, the Paleolithic diet is a myth,” Peter Ungar writes. “Food choice is as much about what is available to be eaten as it is about what a species evolved to eat.”

For present purposes the point here is that it’s really not worth speculating about what the diet of an ancient human consisted of in order to try and imitate it with foods available 12,000 years later. The paleo diet and particularly the primal diet improve health markedly, but again, it’s because of the vast contrast to SAD. Compliance is quite difficult, however, and whether or not whole grains and legumes are actually a problem for most of us pales in comparison to the extent to which sugar and processed wheat are. So you can try to be a knuckle-dragger if you want but know that it will be very difficult to maintain and may not be entirely necessary.

Take a look at the pictures below. They are graphic representations of the vegan, paleo, keto and Mediterranean diets. You can clearly see how they are virtually indistinguishable from one another and how much more they have in common than not. And it’s not very difficult to distinguish them from the last picture, which is, well, just SAD.

Vegan. Grains included but no meat, eggs or dairy.
Paleo. No grains, legumes or soy.
Keto. No high carb foods such as grains, root vegetables and most fruit.
Mediterranean. Includes whole grains and legumes, meat is eaten infrequently. No processed food.
Reminds me of college

Mediterranean Diet
If you were to take the paleo diet and add back in the foods that it restricts because they were developed after agriculture (things like grains, legumes and dairy), but not junk, you would roughly have what is today referred to as the Mediterranean Diet, which I think can serve as a good template for a healthy diet of today. According to the Mayo Clinic, “The Mediterranean diet is a way of eating based on the traditional cuisine of countries bordering the Mediterranean Sea. While there is no single definition of the Mediterranean diet, it is typically high in vegetables, fruits, whole grains, beans, nuts and seeds, and olive oil.” This sounds great. And it IS great. But what’s Mediterranean about this, really?

Here’s what I mean. I once belonged to a Facebook group for the Mediterranean Diet. I happily posted a picture to the Mediterranean Diet Facebook group of a wide range of fresh foods I had recently purchased and laid out on the kitchen counter, to include fruits, vegetables, olives, dried beans, pickles, canned fatty freshwater fish and freshly baked bread. I was excited about the post, but it was rejected by the Mediterranean Diet Facebook group moderators. It was rejected because the picture contained bread that was “likely made of white flower” (the words of the moderator). The Mediterranean Diet, they pointed out, only includes WHOLE grains. The funny thing was, the bread in my picture was baked at a Greek bakery in Astoria, NY (Greek town). And indeed it was very much like the bread I’ve enjoyed in Greece many times. The rest of the items were purchased at my regular grocery store. So the rejected item was the only thing in the picture that was actually Mediterranean. Health benefits or risks aside, the photo was rejected simply because it might have violated arbitrary rules about group membership. I quit the Facebook group.

Fortunately I got over the need to belong to a dietary group and realized I can happily benefit from the “Mediterranean Diet” without needing to call it that or believe that what I’m deciding to eat and not to eat has anything to do with those regions near a certain sea.

Just Ask Your Great Grandmother
And of course your great grandmother knew all the things I’m saying here without knowing them. That’s why a good rule of thumb for whether or not something is a healthy food is whether or not your great grandmother would recognize it as food. Imagine being granted an other-worldly sit-down with your long lost great grandmother and when she asks you what you’re eating for dinner, you tell her about your calculated macro-nutrient ratios which you’re tracking in an app, and how you’re keeping your carbohydrate intake under 50 grams a day in order to prevent excessive insulin release and fat storage and how you start each day with a whey protein shake with MCT (medium chain triglyceride) oil and you like to take your fish in pill form. You tell her that strawberries, kale, avocado, arugula and honeydew are just fine but apples, potatoes, carrots and oranges are the devil’s work. Or maybe you tell her that saturated fat is inflammatory, that all your meals are prepared by people you’ve never met and come delivered by UPS every week, and you think you might be lactose intolerant. Tell her you do all your food preparation in a blender or the microwave. Or maybe you tell her that you’re making bread out of almond and coconut flour or that you like burgers made of “Water, Pea Protein*, Expeller-Pressed Canola Oil, Refined Coconut Oil, Rice Protein, Natural Flavors, Cocoa Butter, Mung Bean Protein, Methylcellulose, Potato Starch, Apple Extract, Pomegranate Extract, Salt, Potassium Chloride, Vinegar, Lemon Juice Concentrate, Sunflower Lecithin, Beet Juice Extract (for color).” (Beyond Beef ingredients.) At best she’d look at you like you were speaking in tongues and then she’d give you a stern thimble to the forehead. And you’d deserve it.

The Politics of Food
One side of the aisle has persuaded us that X in and of itself is bad for us. Let’s say X is beef (from cows). Never mind the fact that the human genome is based largely on a few million years of evolution where such a food item was central, and also that beef from cows today might be bad for things other than our health, such as the planet’s health while trying to sustain 7 billion people. Also never mind the fact that beef from cows raised humanely and fed appropriate diets is vastly more healthy than beef from cows raised in feed lots that are given antibiotics, hormones, and food designed to fatten them up as quickly as possible. The sustainability argument doesn’t land a punch so you must be persuaded that beef itself is bad for YOUR health despite your evolutionary history, and is in fact why you are overweight and have high blood pressure (it’s not).

BUT, we love burgers. We’re Americans and burgers are fundamental to being an American. So we must keep this food that identifies us and that we have grown up eating and loving, but we must take the one thing in it that makes it itself (the beef) and throw it away because it’s unhealthy. And in its place we must fashion a burger golem that sort of looks and (maybe) smells like the real thing but is actually made largely of laboratory ingredients and bleeds beet juice. And we have decided that THIS is healthy. Again, planet-sparing? Maybe. Healthy? … (thimble to the forehead.)

Vegan burgers

And of course, the other side of aisle has no problem with the beef from cows, but sees the bun as the problem. It really is ridiculous.

Keto burger. The bun has been replaced by lettuce. And paper.

Let’s go down this rabbit hole for a second. How about the the tofu turkey?

So succulent

How about a nice keto rye?

Can also be used to build a bookshelf

Cooked
There’s something else your great grandmother knew, and it is seldom mentioned in books or articles about improving your health by eating a certain way. And that is the real meaning of food and eating, beyond body-fat percentage, tribal affiliation, and chronic diseases of affluenza. There’s a really good reason why they used to ring bells at dinner time and the dining room table was the centerpiece of the family and the household. Enter Cooked by Michael Pollan.

In Cooked, Michael Pollan does not tell us what to eat, but rather Why. Not Why in the physiological sense, but Why in the social, emotional and psychological sense. This is why Cooked is so compelling.

There is so much to Cooked beyond healthy eating, but for the present discussion, Pollan points out that the healthiest foods in the grocery store are those on the perimeter. The closer you get to the center aisles, the less healthy the foods are. Produce, meat, seafood and other fresh foods exist on the perimeter of the store, whereas processed and packaged foods are found at the center.

Captain Krunch is right in the middle of the store, next to the candy aisle.

Pollan shows that those center-aisle foods are the ones making the most health claims (“heart healthy whole grains in Cheerios!”, “now with added vitamin D!”, “highest in anti-oxidants!”). Have you ever seen an anti-oxidant? Do you know why it might be good for you?

The foods on the perimeter of the store are very quiet. In fact, they make no health claims whatsoever. But they DO require cooking for the most part, and cooking is, in fact, what the documentary is about. Pollan connects with food and therefore with our reasons for eating that are beyond biological, through cooking. Cooked “becomes an investigation of how cooking involves us in a web of social and ecological relationships. Cooking, above all, connects us.”

“The effects of not cooking are .. far reaching. Relying upon corporations to process our food means we consume large quantities of fat, sugar, and salt; disrupt an essential link to the natural world; and weaken our relationships with family and friends. In fact, Cooked argues, taking back control of cooking may be the single most important step anyone can take to help make the American food system healthier and more sustainable. Reclaiming cooking as an act of enjoyment and self-reliance, learning to perform the magic of these everyday transformations, opens the door to a more nourishing life.” This improves the health of all of us.

What To Do and What Not To Do
I’m trivializing the question of whether it would be best to go vegan, paleo, Mediterranean, keto, or any other of the many fad diets currently or recently in vogue because I think that the real value behind those diets are what they have in common rather than their differences. Let’s be clear. I do not want to insult my vegan, paleo, keto and Mediterranean diet-following friends. And I certainly would not minimize anyone’s successes with the diets. I just don’t think these different “ways of eating” offer anything of true value when it comes to improving or maintaining the individual health of the average person beyond what simply getting away from the SAD diet would do. Rather, what these “Ways Of Eating” offer is dogma, partisanship, and distinctions without meaningful differences. If they offer you a sense of belonging and motivation to continue eating healthy real food, then great. But understand where the health improvements are coming from.

The Blue Zones help to make my point. The Blue Zones are pockets throughout the world containing disproportionately high numbers of centenarians, or people living 100 or more years. Blue zones are found in Greece, Italy, Japan, South America, and California, among other places. The diets of the blue zone inhabitants are markedly different from one another. Tofu, fish and sea vegetables are staples in one, dairy and fruit in another, and corn in a third. Most of them eat animals, but not often, although some eat fish every day. The Blue Zone inhabitants in California are Seventh Day Adventists and as such are largely vegan. Alcohol is consumed daily in some Blue Zones and never in other Blue Zones. Carbs are plentiful in most Blue Zones. Processed food, however, is not. People in the Blue Zones are not concerned much about how healthy their food may be and do not have calorie goals. Importantly, although the diets may vary greatly in the Blue Zones, the lifestyles do not. In the Blue Zones, the individual foods do not matter as much as the fact that they are real, are available and grown or raised locally, are enjoyed in moderation and with family and friends, and fuel a life full of natural movement, adequate rest, hard work, and social activity.

If you are really interested in this stuff and want to make informed choices, I think it’s best to follow science. Which dietary principles are actually backed by research? Take a look at the book called A Grain of Salt: The Science and Pseudoscience of What We Eat, Real Clear Science, and the nutrition section of Science Based Medicine.

At the end of the day you need to be motivated and confident about the dietary choices that you are making and they need to make sense and fall in line with your own history and your culture and the preferences and values of your family and your ancestors. They also need to respect the times in which you are living. Reclaim diet from the TV and social media and the test tube and put it back in the kitchen and on the dining room table. You need to eat real food (most of the time) that multiple generations of humans, especially your family, would recognize as real food. And you should probably learn how to cook it and serve it. You shouldn’t think too much about it and you really don’t need to measure it or track it or photograph it unless it helps you to help yourself and others and to earn a living.

Your Great Grandma would approve.

Published by FormIsEverything

Primal health and fitness coach http://www.formiseverything.com

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