By the Mediterranean

Mediterranean Isn’t the Only Way to Eat Healthy

Defining healthy eating is somewhat like trying to define art. Everyone thinks they know it when they see it, but actually pinning it down in specific terms is not so easy. Nonetheless, we keep on trying and much of the focus from thoughtful people is on healthy patterns of eating, not individual foods. The exemplar for a healthy way to eat is the Mediterranean dietary pattern. Rigorous studies of it have had their ups and downs. But at the end of the day it holds up well in research.

Now, a new study in JAMA Internal Medicine brings us an important reminder. There are many healthy ways to eat and the Mediterranean diet is only one of them. In fact, Zhilei Shan and colleagues show that following any of four different definitions for a healthy diet can predict a lower risk of death.

More Slices of Data from Two Big Cohorts

This is another of a long line of studies that flow from big prospective observational studies. In this case, the data for women come from the Nurses Health Study and for men the data come from the Health Professionals Follow-up Study. So it comes with all the caveats that apply to observational research. These are self-reports of dietary intake, there are issues of unmeasured confounding, and generalizability is a problem.

Nonetheless, these researchers find good support for the notion that beyond the Mediterranean diet, there are at least three other ways to measure a healthy diet that will predict lower mortality.

Moving Beyond Paternalism

Popular conceptions of healthy eating can have problems with paternalism and diversity. Can one have a healthy diet if white rice is a big part of it? Some sources will quote studies to tell you that white rice is as bad as candy for habitual consumption. But in Japan, rice is a staple of healthy diets and its consumption predicts less cardiovascular disease mortality. Around the world and among different cultures, one size clearly does not fit all for a healthy dietary pattern.

In their new book, Healthy Eating Policy and Political Philosophy, Anne Barnhill and Matteo Bonotti suggest we move past old paternalistic debates about healthy eating. Instead, we should be paying more attention to issues related to diverse concepts of eating, health, and the public good. They call their proposal a “public reason approach.”

We welcome this more nuanced approach. Dietary triumphalists peddling their gospels of healthy eating are tiresome. And their central argument – this was good for me, so it must be good for you – is fundamentally flawed.

Click here for the new study from JAMA Internal Medicine, here and here for further reporting on it. For the book by Barnhill and Bonotti, click here.

By the Mediterranean, painting by Henri-Edmond Cross / WikiArt

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January 16, 2023