Why a Mediterranean diet might not be as good as it seems
The Mediterranean diet was voted by a panel of 25 health and nutrition professionals as the best diet for 2020. Characterised by plant-based meals, the diet emphasises eating less red meat and dairy, and more fish and unsaturated fatty acids like olive oil. Red wine can be enjoyed in moderation.
Even if you are familiar with the Mediterranean diet, you may not know that it “involves a set of skills, knowledge, rituals, symbols and traditions concerning crops, harvesting, fishing, animal husbandry, conservation, processing, cooking and particularly the sharing and consumption of food,” as described by the Unesco. In 2013, Unesco added the diet to its list of the intangible cultural heritage of humanity.
The Mediterranean region and its food traditions
The Mediterranean area covers portions of Europe, Asia and Africa around the Mediterranean Sea. While many nations share that bio-geography and elements of the diet, only the nations of Cyprus, Croatia, Greece, Italy, Morocco, Portugal and Spain sponsored the diet’s addition to Unesco’s list.
Mediterranean food traditions have deep history, but different ingredients arrived at different times. Olives were first pressed for olive oil sometime before 2,500 years ago. Grapes were likely first enjoyed as wild harvests, but by 6,000 years ago full wine production was underway. Domesticated grains and legumes like wheat and lentils appeared between 9,000 and 10,000 years ago. Fish would have been one of the earliest resources, traded even into non-coastal areas.
In spite of the diet’s guidelines, various red meats and dairy products also enjoy a long history in the region. Domesticated herd animals such as sheep, goats, cattle and camels arrived on the scene at least 10,000 years ago, and dairying goes back at least 9,000 years in Europe. The prominence of red meat and dairy foods in daily meals may have varied regionally, but both are deeply rooted in Mediterranean history.
But these are just the ingredients. Defining a single Mediterranean diet is tricky business. The Mediterranean region encompasses hundreds of languages and cultures, culinary techniques and styles. The ancient past was equally diverse, with millennia of migration and trade across the region bringing new ingredients and culinary innovations. Ask someone in Lebanon if their food is the same as Spain’s, or someone in Morocco if their food traditions are identical to those in Greece.
And no one in the Mediterranean would agree that their diet is identical to that of their ancestors. The multinational group that nominated Mediterranean food traditions to UNESCO might agree on the broadest framework, but culturally each region in the Mediterranean is distinct.
What’s wrong with the Mediterranean diet?
We are anthropologists who study biological and cultural aspects of nutrition and past foodways as part of human gastro-heritage. And we are simultaneously excited and concerned about the Mediterranean diet in public health messaging.
1/17 Balkisa Zakow, 25, with her twins Hassan and Ousseni, Tombokiery village, Niger
At nine months’ pregnant with twins Balkisa Zakow, 25, feared she wouldn’t have the energy to give birth. A devastating drought made Balkisa’s harvests fail, made food prices soar, and then forced her family apart. Her husband migrated in search of work to earn money to provide for his young family, leaving her heavily pregnant and alone.
“Sometimes if my husband had money he sent it to me so I could eat. Sometimes the money just doesn’t come,” she said. “I was worried I wouldn’t have the energy to give birth.”
But seven-month-old twins Hassan and Ousseni are lucky, they were born the night after Red Cross support came to Tombokiery village, Niger. The Niger Red Cross provided the family with a small cash grant.
“A Niger Red Cross volunteer told me to go first because she saw how exhausted I was. I used the money to buy food, then I went back home to sleep feeling relieved. Before sunrise I had given birth to my twins.”
Yuki Sugiura/British Red Cross
2/17 Aissa Garba, 65, gazes out of the window of her home in Tombokiery village, southern Niger
Last year’s drought made Aissa’s crop fail, leaving the family with nothing to eat. In the Sahel rainfall has become erratic and wet seasons that people rely on are shrinking.
The Sahel has one of the driest climates in the world, people who live here have always been incredibly resilient, are now having to adapt and survive to ever harsher conditions.
The region is almost one degree hotter than in 1970 and could rise by several degrees by the end of the century. Record hot spells, desertification, loss of crops and increasingly unpredictable weather patterns are reducing people’s ability to feed themselves. Mothers are forced to eat just one meal a day so that their children can eat.
Yuki Sugiura/British Red Cross
3/17 Herbs dry in the entrance to Aissa’s home
“When we had enough we ate three times per day, but during the shortage we only had one meal a day. The children were always following us, crying because of their hunger but we had nothing to feed them,” said Aissa.
“But the Niger Red Cross brought us a cash grant. We bought millet and some rice, and with that we chased the hunger away.”
Yuki Sugiura/British Red Cross
4/17 Rabi Chibkao, 56, and her granddaughter Aicka Danyabou, six months, at a Red Cross nutrition centre in the village of Kiéché, southern Niger
Six-month-old Aicka is struggling to gain weight. It’s been a month since her mother died and her grandmother Rabi has brought her to the Red Cross nutrition centre for help. The centre provides support to mothers and babies, weighing infants and measuring their upper arms for signs of malnutrition.
The pair are two in a long queue waiting for help but a shortage of the nutrition supplement plumpy nut means that Aicka is still not at a healthy weight.
Rabi said: “I had been feeding her cassava flour but I noticed didn’t help her much. When she has plumpy nut it helps a lot but sometimes there isn’t any. It has made my life very hard to bear. You can’t take care of a child properly if your own life is not good.”
Yuki Sugiura/British Red Cross
5/17 Ingredients for a Kuwo porridge with cassava
Ingredients for a Kuwo porridge with cassava, which are given to families of malnourished children visiting the Red Cross nutrition centre.
Yuki Sugiura/British Red Cross
6/17 Ai Naliguido, 40, and her son Aboul Aziz, four, in their village of Kiéché, southern Niger
Aboul, four, is small for his age because severe malnutrition left him physically stunted. Across the Sahel 1.5 million children are acutely malnourished, one in five will die before their fifth birthday.
“His body was very weak and he was so thin,” said his mother Ai Naliguido. “It was just Garri I was feeding him made with some corn-meal, or millet.”
“I took him to the hospital every week and they gave him plumpy nut. I’m so relieved that he got the help he needed to get stronger. He has gotten a lot better.” She said.
Niger Red Cross volunteers from the nutrition centre visit communities to show mothers how to get the most nourishment from millet flour and drought tolerant root vegetables like cassava, which helps to keep children healthy.
Yuki Sugiura/British Red Cross
7/17 Ali Naliguido’s empty bowl
Yuki Sugiura/British Red Cross
8/17 Hassi Seyni, 30, sits with her son, Mohamad Moufitaur, 15 months old – in Tombokiery village, southern Niger
First the drought made the harvests fail and then food prices inflated so high even the very basics became unaffordable for Hassi Seyni and her family. Her husband, like many others, was forced to leave to find work to earn enough money to feed the family.
“We got really fearful because many men fled and left the women on their own,” said Hassi. “When he (her husband) has some money he sends it to us. This is how we lived.”
“With support from the Red Cross we bought some bags of millet and corn. We bought some vegetables and some condiments. When your conscience is free from problems and you get to eat. Then you can think about the future.”
Yuki Sugiura/British Red Cross
9/17 Hassi Seyni eats couscous with baobab leaves
Yuki Sugiura/British Red Cross
10/17 Drought resistant millet and the different ways it can be used at the mill run by a women’s cooperative in the village of Gurguzu, southeast Niger
Millet is a drought resistant crop. Stems are stripped by hand and the grain pounded into flour which is slowly mixed with boiling water to make two, a thick white paste which is a staple across the region. Alternatively, water can be added to the flour to make porridge.
Millet is a good source of carbohydrate but eaten alone lacks the vital nutrients needed as part of a balanced diet. When it’s available sauces are added to give flavour – such as the leaves of the Baobab tree.
The mill is run by a women’s cooperative group and allows the whole village to buy grain at a cheaper price than in the market, it also helps to ensure the price is less volatile in the lean season.
Yuki Sugiura/British Red Cross
11/17 Millet being hand stripped
Yuki Sugiura/British Red Cross
12/17 Drought tolerant cassava grown at the Red Cross market garden
During the lean season a shortage in food forces the prices up to unaffordable amounts for many families. The market garden helps the local community to grow their own food and helps to stabilise prices during the lean season.
Yuki Sugiura/British Red Cross
13/17 34-year-old Ouma Azzika with goat she was given from the Niger Red Cross
Ouma Azzika has seven children to feed. She received this goat from the Red Cross as part of a project supporting women to provide enough food to feed their families during the lean season when food is most scare. As well as providing milk, the goat can be sold at the market to earn money to buy food.
Yuki Sugiura/British Red Cross
14/17 An empty bowl and spoon in Tombokiery village, Niger
Yuki Sugiura/British Red Cross
15/17 A child is weighed and arm measured at the Red Cross nutrition centre in the village of Kiéché, southern Niger
Yuki Sugiura/British Red Cross
16/17 A traditional cooking pot used to cook tuwo in Tombokiery village, Niger
Yuki Sugiura/British Red Cross
17/17 Niger Red Cross nutrition centre sign
Yuki Sugiura/British Red Cross
1/17 Balkisa Zakow, 25, with her twins Hassan and Ousseni, Tombokiery village, Niger
At nine months’ pregnant with twins Balkisa Zakow, 25, feared she wouldn’t have the energy to give birth. A devastating drought made Balkisa’s harvests fail, made food prices soar, and then forced her family apart. Her husband migrated in search of work to earn money to provide for his young family, leaving her heavily pregnant and alone.
“Sometimes if my husband had money he sent it to me so I could eat. Sometimes the money just doesn’t come,” she said. “I was worried I wouldn’t have the energy to give birth.”
But seven-month-old twins Hassan and Ousseni are lucky, they were born the night after Red Cross support came to Tombokiery village, Niger. The Niger Red Cross provided the family with a small cash grant.
“A Niger Red Cross volunteer told me to go first because she saw how exhausted I was. I used the money to buy food, then I went back home to sleep feeling relieved. Before sunrise I had given birth to my twins.”
Yuki Sugiura/British Red Cross
2/17 Aissa Garba, 65, gazes out of the window of her home in Tombokiery village, southern Niger
Last year’s drought made Aissa’s crop fail, leaving the family with nothing to eat. In the Sahel rainfall has become erratic and wet seasons that people rely on are shrinking.
The Sahel has one of the driest climates in the world, people who live here have always been incredibly resilient, are now having to adapt and survive to ever harsher conditions.
The region is almost one degree hotter than in 1970 and could rise by several degrees by the end of the century. Record hot spells, desertification, loss of crops and increasingly unpredictable weather patterns are reducing people’s ability to feed themselves. Mothers are forced to eat just one meal a day so that their children can eat.
Yuki Sugiura/British Red Cross
3/17 Herbs dry in the entrance to Aissa’s home
“When we had enough we ate three times per day, but during the shortage we only had one meal a day. The children were always following us, crying because of their hunger but we had nothing to feed them,” said Aissa.
“But the Niger Red Cross brought us a cash grant. We bought millet and some rice, and with that we chased the hunger away.”
Yuki Sugiura/British Red Cross
4/17 Rabi Chibkao, 56, and her granddaughter Aicka Danyabou, six months, at a Red Cross nutrition centre in the village of Kiéché, southern Niger
Six-month-old Aicka is struggling to gain weight. It’s been a month since her mother died and her grandmother Rabi has brought her to the Red Cross nutrition centre for help. The centre provides support to mothers and babies, weighing infants and measuring their upper arms for signs of malnutrition.
The pair are two in a long queue waiting for help but a shortage of the nutrition supplement plumpy nut means that Aicka is still not at a healthy weight.
Rabi said: “I had been feeding her cassava flour but I noticed didn’t help her much. When she has plumpy nut it helps a lot but sometimes there isn’t any. It has made my life very hard to bear. You can’t take care of a child properly if your own life is not good.”
Yuki Sugiura/British Red Cross
5/17 Ingredients for a Kuwo porridge with cassava
Ingredients for a Kuwo porridge with cassava, which are given to families of malnourished children visiting the Red Cross nutrition centre.
Yuki Sugiura/British Red Cross
6/17 Ai Naliguido, 40, and her son Aboul Aziz, four, in their village of Kiéché, southern Niger
Aboul, four, is small for his age because severe malnutrition left him physically stunted. Across the Sahel 1.5 million children are acutely malnourished, one in five will die before their fifth birthday.
“His body was very weak and he was so thin,” said his mother Ai Naliguido. “It was just Garri I was feeding him made with some corn-meal, or millet.”
“I took him to the hospital every week and they gave him plumpy nut. I’m so relieved that he got the help he needed to get stronger. He has gotten a lot better.” She said.
Niger Red Cross volunteers from the nutrition centre visit communities to show mothers how to get the most nourishment from millet flour and drought tolerant root vegetables like cassava, which helps to keep children healthy.
Yuki Sugiura/British Red Cross
7/17 Ali Naliguido’s empty bowl
Yuki Sugiura/British Red Cross
8/17 Hassi Seyni, 30, sits with her son, Mohamad Moufitaur, 15 months old – in Tombokiery village, southern Niger
First the drought made the harvests fail and then food prices inflated so high even the very basics became unaffordable for Hassi Seyni and her family. Her husband, like many others, was forced to leave to find work to earn enough money to feed the family.
“We got really fearful because many men fled and left the women on their own,” said Hassi. “When he (her husband) has some money he sends it to us. This is how we lived.”
“With support from the Red Cross we bought some bags of millet and corn. We bought some vegetables and some condiments. When your conscience is free from problems and you get to eat. Then you can think about the future.”
Yuki Sugiura/British Red Cross
9/17 Hassi Seyni eats couscous with baobab leaves
Yuki Sugiura/British Red Cross
10/17 Drought resistant millet and the different ways it can be used at the mill run by a women’s cooperative in the village of Gurguzu, southeast Niger
Millet is a drought resistant crop. Stems are stripped by hand and the grain pounded into flour which is slowly mixed with boiling water to make two, a thick white paste which is a staple across the region. Alternatively, water can be added to the flour to make porridge.
Millet is a good source of carbohydrate but eaten alone lacks the vital nutrients needed as part of a balanced diet. When it’s available sauces are added to give flavour – such as the leaves of the Baobab tree.
The mill is run by a women’s cooperative group and allows the whole village to buy grain at a cheaper price than in the market, it also helps to ensure the price is less volatile in the lean season.
Yuki Sugiura/British Red Cross
11/17 Millet being hand stripped
Yuki Sugiura/British Red Cross
12/17 Drought tolerant cassava grown at the Red Cross market garden
During the lean season a shortage in food forces the prices up to unaffordable amounts for many families. The market garden helps the local community to grow their own food and helps to stabilise prices during the lean season.
Yuki Sugiura/British Red Cross
13/17 34-year-old Ouma Azzika with goat she was given from the Niger Red Cross
Ouma Azzika has seven children to feed. She received this goat from the Red Cross as part of a project supporting women to provide enough food to feed their families during the lean season when food is most scare. As well as providing milk, the goat can be sold at the market to earn money to buy food.
Yuki Sugiura/British Red Cross
14/17 An empty bowl and spoon in Tombokiery village, Niger
Yuki Sugiura/British Red Cross
15/17 A child is weighed and arm measured at the Red Cross nutrition centre in the village of Kiéché, southern Niger
Yuki Sugiura/British Red Cross
16/17 A traditional cooking pot used to cook tuwo in Tombokiery village, Niger
Yuki Sugiura/British Red Cross
17/17 Niger Red Cross nutrition centre sign
Yuki Sugiura/British Red Cross
Health professionals should focus on food traditions rather than just nutrients, and it worries us when one cultural food tradition is held up as superior to others — especially one that has been associated with a history of Western political and cultural imperialism.
Historian Harvey Levenstein writes that the Mediterranean diet was created by physiologist Ancel Keys and his biochemist wife, Margaret Keys. In 1952, the Keys travelled to Italy and Spain and conducted some quasi-experimental surveys of blood pressure, blood cholesterol and diet.
A brief history of Ancel Keys, the physiologist who, along with his wife, popularized the Mediterranean diet.
Many epidemiological studies later, the couple promoted the Mediterranean diet in their popular diet book How to Eat Well, later repackaged as How to Eat Well and Stay Well the Mediterranean Way.
In the 1990s, the International Olive Oil Council promoted olive oil as a key ingredient in the diet, and the Harvard School of Public Health built the Mediterranean Diet Pyramid.
Promoting the value of all food heritage
The promotion of the Mediterranean diet is an example of what anthropologist Andrea Wiley calls bio-ethnocentrism. Wiley’s study of milk argues that although milk has been promoted as a healthy and nutritious food for all, only a segment of the human species — predominantly those whose ancestry comes from Europe, where there is a long history of dairying — are able to digest the primary sugar in milk (lactose).
Bolstering one region’s diet as universally ideal ignores the long evolution of social, biological and environmental human food traditions through the development and conservation of regional and local cuisines. This includes, as found in UNESCO’s description of the Mediterranean diet, the production, preparation and consumption of food through human skills, knowledge, and social and cultural practices.
In a globalized world with increasing migration, retaining traditional cuisines may seem meaningless. But in fact, it may be more important than ever. Anthropological research shows that migrants work hard to maintain their traditional cuisines as part of their ethnic identity and to support their health and well-being. When a health-care provider suggests to their patient that they adopt a Mediterranean diet, there are several things that can go wrong. Unless the diet is explained in detail, a patient may have a very different idea of what constitutes the Mediterranean diet. More harmfully, if a patient believes that their own cultural food traditions are bad for their health, they may give those up to adopt a diet seen as medically approved.
Syrian women help prepare a typical Syrian meal at the Newcomer Kitchen Project, an initiative for recent Syrian migrant women, held in 2016 at the Depanneur restaurant in Toronto. THE CANADIAN PRESS/Christopher Katsarov
A survey of global food shows that the core principles of the Mediterranean diet can be found in the traditional cuisines and food traditions of many people. In Mexico, for example, the combination of corn tortillas and beans — accompanied by foods like squash and tomato salsas — has yielded complete plant-based proteins that provide a nutritious and sustainable diet. Research on soy-derived and fermented foods found in traditional Chinese cuisines shows they are high in bioactive peptides that can provide protection against disease.
In a world where we are rapidly losing diverse biological and cultural heritage, we should be celebrating the plurality and unique qualities of traditional foods rather than attempting to promote and universalize one regional diet over another. Diverse traditional diets can and should be promoted through public health messaging that is culturally sensitive and inclusive.
Tina Moffat is associate professor, department of anthropology, McMaster University, Shanti Morell-Hart is assistant professor of anthropology, McMaster University. This article was first published on The Conversation (theconversation.com)