all 144 comments

[–][deleted] 262 points263 points  (37 children)

The Standard American Diet is such a disaster that almost any other diet will outperform it.

[–]mveaMD-PhD-MBA | Clinical Professor/Medicine[S] 13 points14 points  (0 children)

Journal Reference:

Gotaro Kojima, Christina Avgerinou, Steve Iliffe, Kate Walters.

Adherence to Mediterranean Diet Reduces Incident Frailty Risk: Systematic Review and Meta-Analysis.

Journal of the American Geriatrics Society, 2018;

DOI: 10.1111/jgs.15251

Link: http://onlinelibrary.wiley.com/doi/10.1111/jgs.15251/full



To conduct a systematic review of the literature on prospective cohort studies examining associations between adherence to a Mediterranean diet and incident frailty and to perform a meta-analysis to synthesize the pooled risk estimates.


Systematic review and meta-analysis.


Embase, MEDLINE, CINAHL, PsycINFO, and Cochrane Library were systematically searched on September 14, 2017. We reviewed references of included studies and relevant review papers and performed forward citation tracking for additional studies. Corresponding authors were contacted for additional data necessary for a meta-analysis.


Community-dwelling older adults (mean age ≥60).


Incident frailty risk according to adherence to a Mediterranean diet.


Two reviewers independently screened the title, abstract, and full text to ascertain the eligibility of 125 studies that the systematic search of the literature identified, and four studies were included (5,789 older people with mean follow-up of 3.9 years). Two reviewers extracted data from the studies independently. All four studies provided adjusted odds ratios (ORs) of incident frailty risk according to three Mediterranean diet score (MDS) groups (0–3, 4–5, and 6–9). Greater adherence to a Mediterranean diet was associated with significantly lower incident frailty risk (pooled OR = 0.62, 95% CI = 0.47–0.82, P = .001 for MDS 4–5; pooled OR = 0.44, 95% CI = 0.31–0.64, P < .001 for MDS 6–9) than poorer adherence (MDS 0–3). Neither significant heterogeneity (I2 = 0–16%, P = .30) nor evidence of publication bias was observed.


Greater adherence to a Mediterranean diet is associated with significantly lower risk of incident frailty in community-dwelling older people. Future studies should confirm these findings and evaluate whether adherence to a Mediterranean diet can reduce the risk of frailty, including in non-Mediterranean populations.

[–]bravotipo 3 points4 points  (0 children)

Italian who visited USA two times and each time for three weeks in a row. Yes I love your country. As many pointed out the main difficulty in eating as I do at home (fresh fruit once a day and fresh vegetable two times a day) was finding the right options. We managed to do it in San Francisco and NY but it was pretty difficult in Nevada, Utah, Arizona and other remote areas. Let me also point out the HUGE portions. Many time I skipped dinner and split my order with my co traveller. In any case the lack of options of most menu is the main problem. Why having some simple grilled vegetables instead of fries is so difficult? Or a simple green salad with oil/salt/vinegar? I had to expressly ask for them as out of menu. I also noticed that in more expensive places vegetables were more available. Here in Italy also the cheapest place (except for fast food) have vegetables option for a very low cost. In any case I want to point out that I asked for these because I was grown up eating many veggies. And this bring back the problem to education and upbringing. Children eat what they parents eat (not what parents tell them). And of course in Italy is normal to spend a bit of time preparing meals at dinner (vegetables require a lot of time to prepare). So my guess is if American parents had more time for family maybe they could cook better and healthier. Just my anecdotal experience.

[–]asherrd 8 points9 points  (0 children)

tl;dr eating a well rounded diet is good for you. we've known this for decades. we just don't act on it.

[–]DingusMacLeod 1 point2 points  (0 children)

If everyone ate like that their whole lives we'd have sognificantly lower rates of obesity and obesity-related illnesses.

[–]catsalways 17 points18 points  (69 children)

Another study in support of a plant based diet.🙂

[–]CescQ 32 points33 points  (34 children)

However, a Mediterranean diet includes milk and its derivates, fish or meat.

[–]beckaandbaylee 8 points9 points  (9 children)

While yes, it does, the Mayo Clinic explains:

The Mediterranean diet emphasizes eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts.


[–]Tinuz99 13 points14 points  (7 children)

And then right below it:

Eating fish and poultry at least twice a week

[–]temba_hisarmswide_ 7 points8 points  (1 child)

That's a big change from animal protein in every meal though. To defend the slightly smug vegetarian.

[–]Tinuz99 4 points5 points  (0 children)

He doesn't need defending, I just object to calling the Mediterranean diet plant based. Saying people could do with a little less meat... yeah, I can't object to that at all.

PS. Awesome name!

[–]SexyJamal77 2 points3 points  (0 children)

How is eating fish and poultry twice a week even remotely comparable to the amount of animal products people on the standard western diet eat?

[–]asherrd 4 points5 points  (3 children)

emphasizes eating primarily plant-based foods

They are not mutually exclusive. In fact, it is more in favor of plant based food than fish or poultry.

[–]Tinuz99 2 points3 points  (2 children)

But couldn't we say that of every diet? Every diet, with perhaps a very few exceptions, are mostly plant based.

I'm not saying that it doesn't advocate more plant based nutrition when compared to the average diet (American/Western European), but I feel that calling this diet plant based is something of a misrepresentation.

[–]imnotsospecial 1 point2 points  (0 children)

Anicdotal, but as a Mediterranean I eat meat almost everyday. The meat is not the main ingredient, but every vegitable/beans stew has meat cuts in it. Eggs and cheese are a staple breakfast foods, and fish is consumed regularly. Calorie wise rice/beans/vegetables/grains count for around 40-60 percent of the calories. Between meals people typically snack on fruits.

[–]wigg1es 7 points8 points  (0 children)

However, it's unclear whether people who followed a Mediterranean diet had other factors that may have helped prevent frailty. And the study did not prove that a Mediterranean diet actually caused frailty risk to drop, just that there was an association.

[–]FanOrWhatever 4 points5 points  (0 children)

No, another study in support of a varied, nutritious diet.

[–]James72090 7 points8 points  (27 children)

Except that the best predictors of mortality are: leanbody mass, leg strength, VO2 max, gait speed and grip strength.

[–]fsmpastafarianPhD | Clinical Psychology 16 points17 points  (15 children)

I'm not sure how any of that counters the claim about diet.

[–]knightmeirl 2 points3 points  (14 children)

It doesn't.

However, just like how you can destroy a chair using a fork or a sledgehammer, one tool is much faster and more effective in accomplishing your goal.

Resistance training significantly decreases your frailty in weeks, if not days, and does so to a degree that diet will never accomplish.

[–]StillOnlyCountsAsOne 11 points12 points  (1 child)

You still have to eat something while exercising. We shouldn't be looking for a silver bullet, but rather a combination of effective strategies like increasing exercise and maintaining a proper diet. The two are not mutually exclusive.

[–]knightmeirl 0 points1 point  (0 children)

That would be great as long as the strategies are promulgated in proportion to their effectiveness.

In my opinion the chance that a senior on a resistance training program would fail to achieve the appropriate bone density adaptation due to their diet is very low.

[–]fsmpastafarianPhD | Clinical Psychology 12 points13 points  (8 children)

Again, none of this counters the idea of a plant-based diet being healthy.

[–]ellipses1 1 point2 points  (0 children)

Is there a good study linking plant based diets to health? I’ve heard a lot of people saying that plant based diets did not show lower mortality than a healthy diet high in animal protein and fat.

[–]knightmeirl 0 points1 point  (1 child)

Did you miss that I acknowledged this in my previous comment or do you just have nothing to say?

[–]fsmpastafarianPhD | Clinical Psychology 1 point2 points  (0 children)

Of course I didn’t miss the initial part of your comment, but the rest of your comment goes on to cite seemingly irrelevant claims as if that rebutted the idea that a certain diet may be particularly healthy, so I thought it was good to point out again that it was irrelevant.

[–]James72090 0 points1 point  (4 children)

It's not a counter, I'm stating that there are better predictors of health and those metrics should be focused on over diet. While diet can influence lean body mass, a larger influence is resistance training which most Americans do not perform. So my purpose of my comment is focus on what is a major influence over a minor with regards to health.

[–]Arduininoob 0 points1 point  (3 children)

Most of what you said is actually irrelevant. Of course the human body the way it is designed, has a lot of strength contained within the pelvic region. So somebody who is in a healthful condition more likely than not has better leg conditioning then somebody in a state that is more prone to end in death. For example someone with type 2 diabetes I imagine does not have the leg strength of somebody in a similar age who has mostly normal biomarkers of Health. You are looking at the results of an event, in this case mortality and trying to draw conclusions without understanding the underlying system that creates the data that you're looking at. The very idea that you could be 80 years old and survived on a diet high in saturated animal fat and animal proteins, with no reliable or consistent way to get vitamins minerals, antioxidants, and other phytonutrients that are mostly contained within plants. A hunk of steak is most likely not going to contain any Miracle compounds like broccoli. So why you are acting so smug seems a little bit unnecessary considering that the conclusions of your argument are absurd.

[–]James72090 0 points1 point  (2 children)

Conclusions such as? I have no made an argument I have only stated there are better predictors of mortality that have a greater influence diet in and of itself. Even if you talk about the Okinawain diet the biggest factor was not the diet but that the people were farmers.

[–]Arduininoob 0 points1 point  (1 child)

You are wrong. The fact that you think people cannot look back at your previous post, the one I respond to it see that you are doing nothing but making wild leaves and while grasping at straws just goes to show that some people aren't interested in discussion, they're interested in trying to be right. The sad thing for you though it is is that you are very very wrong. The Oaken now when's natural long jevity is similar to those found at Seventh-day Adventist. Are Seventh-day Adventist all Farmers? You just do not know what you're talking about and you need to stop spreading so much bad information or people are going to think that you had some sort of vested interest in topics about plant-based or majority plant-based diets it has nothing to do with science, but with some other personal motivation.

[–]James72090 0 points1 point  (0 children)

I know people can look at my pasts posts, do you think I do not know that given the age of my account? I am asking you what absurd conclusions are drawn by saying, 'the best predictors of mortality are: VO2 max, lbm, leg strength, gait speed and grip strength'. To add you approached in an aggressive fashion, it seems more that you are looking to assert and defend an ideological position instead of having a discussion. To add we are talking about preventing fraility and not centarians, the seventh day Adventists have a large community and support system, I don't think you could discount the power of community at relieving stress. To add how would you explain non-seventhday Adventist vegetarians not having an increased lifespan when measuring diet alone?

[–]BeowulfShaeffer 2 points3 points  (5 children)

I am familiar with some of those being predictors (v02 being the biggest) but not others - gait speed and grip strength?

Where can I go to learn more about these?

[–]sub-hunter 1 point2 points  (3 children)

grip strength and gait speed has to do with injury from falling. as you fall, if you can move your feet fast enough to catch yourself, or grab onto something preventing the fall, you will have a longer life as broken hips seems to be a life ending injury due to complications for many.

[–]BeowulfShaeffer 2 points3 points  (0 children)

Got it. So it's not so much "are you strong or super-strong?" but "are you getting really feeble?".

[–]knightmeirl 0 points1 point  (1 child)

grab onto something preventing the fall

Do you have a source for this? My assumption was that grip strength is simply a metric for overall muscle strength.

Stronger muscles = more load shared by soft tissue in a fall.

[–]sub-hunter 0 points1 point  (0 children)

just memory of something i read.

[–]James72090 0 points1 point  (0 children)

I can't pull up the studies but I was introduced to these through [Andy Galpin](www.andygalpin.com) and his writings. I could pull out his text 'unplugged' but that's too much effort for an internet comment.

[–]shotgunlewis 4 points5 points  (4 children)

You can get all of those things with a plant based diet. Happy to elaborate if you or anyone else would like

[–]James72090 -4 points-3 points  (3 children)

You're correct I'm asserting that a plant based diet isn't a worth while metric by which to judge senor fraility as we have better metrics.

[–]knightmeirl 1 point2 points  (2 children)

I don't think metric is the word you're looking for here. The study is showing an association that suggests a causal relationship between a plant based diet and frailty.

[–]James72090 0 points1 point  (1 child)

Wouldn't 'fragility' and 'plant based diets' be the metrics and the study is measuring the relationship between the two?

[–]knightmeirl 0 points1 point  (0 children)

They're data which may or may not be the cause and effect of each other.

Researchers use metrics to reach a quantitative data point. In the case of frailty and plant based diet they might use something like 'hip fractures per year' or 'grams of plant based food eaten per day / grams of non-plant based food eaten per day' as metrics, respectively.

[–]afrogirl44 3 points4 points  (8 children)

It's such a great healthy diet. It can also help you live longer!! If anyone wants more info on it I wrote a 5 page paper on it a couple of months ago.

[–]APimpNamedAPimpNamed 2 points3 points  (4 children)

Mind posting the paper or a link to it?

[–]afrogirl44 0 points1 point  (0 children)

I posted it, and have all of my citations.

[–]afrogirl44 -1 points0 points  (2 children)

I wrote it for my Anatomy & Physiology class, and also got an A. I was very proud of this. I'll have to copy and paste unfortunately.

Today, I will be discussing the Mediterranean diet, which is one of the most popular diets. It’s known as the healthiest, and has many amazing benefits such as a better health, and even a longer life span. This diet is based off eating a large amount of nuts, vegetables, legumes, seeds, fruits, olive oil, spices, fruits, and herbs; a moderate amount of fish and seafood; a small amount of cheese, yogurts, and eggs; and a very small amount of meats and sweets. Carbohydrates are consumed through whole grain pasta and breads, and many plant products like cereal, rice, and wheat. “The diet has [also] been associated with a lower level of oxidized low-density lipoprotein (LDL) cholesterol – the ‘bad’ cholesterol that’s more likely to build up deposits in your arteries (Mayo Clinic Staff) are many types of this diet, but all are very similar to each other, with the main variation being drinking a moderate amount of wine.

The people that this diet is based off of, are the dwellers of the island Crete. Scientists noticed that many people of this island, and the rest of the Mediterranean countries, had “reduced rates of heart disease, Alzheimer’s disease, cancer, diabetes, and other serious health problems” (Ravn). These facts have been proved by many scientific studies, and there are currently even more studies going on. The first hard evidence of these benefits, was from a 1970 study called the seven countries study. The studies findings showed that Greece had lower rates of cardiovascular disease and cancer than Italy, Finland, Japan, Yugoslavia, the U.S. and the Netherlands. Another benefit of this diet, is that “women who the Mediterranean diet with extra-virgin olive oil and mixed nuts may have a reduced risk of breast cancer” (Mayo Clinic Staff).

[–]afrogirl44 -1 points0 points  (1 child)

The things that are involved with this plan is eating few carbohydrates, and a large amount of vegetables, fruits, legumes, and oils. Meat and sweets are also eaten in very minute

amounts. Many whole grains such as oats, barley, buckwheat, brown rice and corn should be eaten. This diet consists of many oils, such as olive oils, which account for the main source of dietary fat. Avocados and olives are also sources of dietary fats. Normally the only meat eaten is fish and seafood. This diet though isn’t just about al change, but also incorporates physical activity and mealtime sociability. This a whole lifestyle change that can amazing benefits in the long run. The added physical activity makes this diet good for possible weight loss, even though that’s not what the diet is meant for. What can make this diet difficult though, is that there is no one Mediterranean diet. The many variations can make it difficult in choosing what to eat, and how much of it to eat. For this plan to be effective, you have to stick to the diet. Doing it one day, but not the next will have no health effects.

[–]afrogirl44 0 points1 point  (0 children)

Some misconceptions about the diet, is that it’s only the diet change that makes this diet so healthy, when really, if you don’t change your lifestyle at the same time, there might be a huge change in health. “We need to redefine the Mediterranean diet,” Dr. Malhotra said. “The truth is that it’s a lifestyle. It’s the whole approach. It’s the food. It’s the social interaction. It’s getting the right kind of exercise. It’s being outside. It’s getting sunlight and sunshine” (O’Connor). The Mediterranean’s spend a large amount of time outside in the sun. One vital vitamin that they’re bodies produce when in the sun is vitamin D. This vitamin can help ward off the flu, prevent cancer, and is a vital part of keeping your bones healthy. Another misconception is that all grains are created equal, any grain will work. This isn’t true. The grains that the Mediterranean’s eat are a different type than the ones that Americans eat. Dr. Malhotra, a doctor trying to address misconceptions about this diet, stated that “simple changes can make a dramatic change to their health and vitality in a short space of time” (O’Connor). Even the

slightest change, like adding in more exercise, and eating more fruits and vegetables, will affect your health greatly in a small amount time. A third misconception, is that pasta is fattening and unhealthy. In a recent study that focused on the correlation of pasta intake to lower BMI, smaller wrist circumference, and smaller hip-to-waist ratio, it found that people who had a higher pasta consumption had a smaller wrist circumference, a lower BMI, and a smaller hip-to-waist ratio. This study was conducted on 14,402 men and women of all different ages. Pasta actually helps keep people leaner, and healthy.

Some health risks of the diet, is that calcium intake can be low. This diet doesn’t contain many dairy products other than yogurt and cheese. A lack of calcium in the body can cause the bones to be more susceptible to fractures, osteoporosis, confusion, memory loss, hallucinations, and many other things. If left untreated, this can be fatal. The amount of wine consumed also needs to be watched. Just because one glass is healthy, doesn’t mean that three are. If alcohol is consumed in copious amounts, the risk of esophageal, oral, liver, and laryngeal cancers is increased. The amount of fat that is consumed needs to be watched too. Even though the amount of saturated fats ingested in this diet are considered heart-healthy, you could still be consuming too much fat in your diet. Too much fat intake can cause a higher risk of heart disease. This diet also requires you to be able to cook. Pre-processed foods won’t meet the requirements of carbohydrate, fat, oils, and other essential foods in this diet.

New research has shown that this diet can be beneficial to children. Some studies have shown that children eating the Mediterranean diet are at a lower risk for asthma and allergy symptoms. Another study showed that obese children would be a suitable candidate for this diet.

A study conducted in Mexico where twenty-four of them were assigned to eat a Mediterranean-style diet and twenty-five were assigned a normal diet of junk food, and a high amount of saturated fats for sixteen weeks. The results showed that children on the Mediterranean diet lost weight and started to become healthier, whereas the children on the normal did not. Getting the children to eat the diet can be challenging though. Most children don’t like vegetables and refuse to eat them. Dr. Carolina Vidal stated that the best way to get children to eat them, is to "Slowly introduce fruits and vegetables, and present them consistently with the other foods they eat. Cutting out sugars and fast food meals and make those sporadic as opposed to a regular meal or snack is very helpful” (Howard). There are also some restrictions that go along with giving this diet to children. Wine is a factor in it, and children cannot have wine. The American Academy of Pediatrics recommends that children under the age of four not be fed nuts, as they are a choking hazard, and children under the age of two, only be given whole milk instead of skim milk.

Throughout the world, obesity is becoming a bigger and bigger problem. Dr. Michalis Stagourakis has said that “the usual sniffles and stomachaches of childhood are now interspersed with far more serious conditions: diabetes, high blood pressure, high cholesterol” (Rosenthal). This drastic change has been caused by the change of diet in people. They now eat more saturated fats, carbohydrates, and sweets, instead of fruits, vegetables, and nuts. These foods, which used to be consumed on a daily basis, are now consumed only occasionally. If more people would be eating the Mediterranean diet, many of these diseases would not be occurring in childhood. Many children now have a shorter estimated lifespan than their parents. Obesity is linked to a higher rate of heart disease, diabetes, liver disease, and many other diseases.

There have been many studies where the scientists have modified the diet by adding foods, or taking some out. One example is the PREDIMED study where 7447 individuals were put on one of three diets: a low-fat control group diet, the regular Mediterranean diet with added extra virgin olive oil, and the Mediterranean diet with added nuts. The participants weren’t told to change their calorie intake or to increase physical activity. The study went on for almost five years, and the results found that the diet reduced the risk of coronary heart disease by fifty-to-seventy percent. In a 1999 study where men and women who have suffered heart attacks, where one group was given a Mediterranean-type diet with an Omega-3 rich margarine, and one group a normal Western diet and followed for four years, found that that the individuals on the Mediterranean type diet were seventy-two percent less likely to have gotten another heart attack or die from heart disease.

I found researching this diet very interesting, and thought provoking about how we eat now. It made me realize how unhealthy I as a person eat. I learned a lot about the correlation of what we eat and our health. What we eat truly does have an effect on our health, and can determine how long you live. I found that very interesting, because it isn’t really something that I have never thought about before. I would like to learn more about how this diet effects diabetic individuals, and if it could help improve their diabetes drastically. I was surprised at how many things about your health that switching to this diet could help with. I thought that it would be only a minute amount, but I turned out to be very wrong.


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[–]asherrd 1 point2 points  (2 children)

It's such a great healthy diet. It can also help you live longer!!

Got any studies on that that last a significant amount of time. I have no doubt you feel better having followed the diet. But you can't really say what you would feel like if you had not been on the diet.

And I'm 100% sure there are no real scientific studies that would ever claim this diet would help you live longer. No real scientist would ever make that claim. They'd use more reserved language like "could potentially lead to a longer life." Only a huckster, that is trying to sell you something, would make such a bold claim. They would never say "this diet will definitely make you live longer" unless they are getting a cut of what is being sold.

[–]PhoenixDeveloper 0 points1 point  (0 children)

If it's healthy and reduces cardiovascular disease etc., it'll obviously reduce deaths from heart attacks etc. and increase the average lifespan.

Other plant based diets like the Okinawan diet or DASH diet have been shown to reduce cardiovascular disease, too, at least compared to the standard American diet.

But then again, fat based ketogenic diets that aren't necessarily plant based have been linked to improvements in cardiovascular disease, occurence of cancer etc. in several studies, too. There's a huge variety of dietetic approaches that are vastly superior to the processed food crap that is the SAD.

[–]MediterraneanLiving 0 points1 point  (1 child)

When you go to the Mediterranean you see people in their 90's who are getting around like 50 year olds from America. They are incredibly active and alive. As a dietitian who has also lost 40 pounds eating Mediterranean and feel better than every, I highly recommend the diet. If you are interested in lots of traditional recipes go to www.mediterraneanliving.com or check out this cookbook from the Greek island of Crete where they have the highest longevity rates in the world: Foods of Crete: traditional recipes from the healthiest people in the world by Koula Barydakis, a chef from Crete and Bill Bradley (me), Registered Dietitian.

[–]MediterraneanLiving 0 points1 point  (0 children)

This is why you see people in the Mediterranean who are in their 90's (and above) strong and healthy. They are doing things that many people in their 60's here cannot do. They are also still working the land, picking olives, grapes and other foods. They are quite active. For traditional Mediterranean Diet recipes check out www.mediterraneanliving.com.

[–]Danimally -3 points-2 points  (0 children)

Un buen plato de lentejas, puchero, pasta un par de veces por semana, pescado una vez y en fin de semana lo que quieras.