What is a fad diet?
The term conjures images of short-term starvation, compulsive calorie counting, and ‘lite’ salad dressings, focussed on shedding a few pounds of flab in the short term. Fads rise quickly, as their merits decay away just as fast.

But I’ve always been one to think of a “diet” as the foods we eat everyday; not a short-term departure from our fodder. There is one of these non-fad diets that has become a recurring headline (warningly like a fad diet), and more and more scientific research is revealing the positive health benefits of the Mediterranean Diet.
Since the ’60′s, the Mediterranean Diet has been drawing attention for the purported health benefits, and scientific investigation has been consistently expounding the nutritional and health value of this diet.
Proponents call it a “life-style”, characterized by:
- Getting plenty of exercise
- Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts
- Replacing butter with healthy fats such as olive oil and canola oil
- Using herbs and spices instead of salt to flavor foods
- Limiting red meat to no more than a few times a month
- Eating fish and poultry at least twice a week
- Drinking red wine in moderation (optional) (Source: MayoClinic)
An updated meta-analysis, published this week in the American Journal of Clinical Nutrition, has reiterated the positives of this diet. This study by Sofi et al. added another seven studies to their previous analysis published in 2008.
This meta-analysis of prospective, cohort studies included 18 trials including over 2 million subjects with follow-up times ranging from 4 to 20 years. The analysis was interesting because it used a scale of “adherence” to the diet and its effects on outcomes including: overall mortality, mortality and/or incidence from cardio- and cerebrovascular diseases, mortality and/or incidence from cancer, and incidence of neuro-degenerative diseases.
Results
The results corroborated the findings of the previous meta-analysis, reporting that with increasing adherence to the Mediterranean diet, as measured through Food Frequency Questionnaires or other survey methodologies, risk of all-cause mortality decreased.
A two-point increase in adherence was related to a ~10% decrease in cardiovascular death (CI: 0.87-0.93; p<0.00001) and a ~6% reduction in death due to cancer and other neoplastic diseases (CI: 0.94-0.96; p<0.0001). The authors also noted a 13% reduction in neurodegenerative conditions with increasing adherence to the diet.
Reservations
I’ve got a few “hold-it-right-there” reservations. First of all, the only thing that can be shown here is an association between morbidity and mortality and the Mediterranean diet, and this is because the analysis only included prospective cohort trials, not randomized, controlled interventions, and thus cannot show causation. With so many different components to the diet, which might be contributing most significantly to the health benefits?
Also, no biomarkers of nutritional status were collected and thus it was only through analysis of food frequency questionnaires and dietary diaries that data was collected. We have no idea what the actual biological health of these participants was!
From my experience, these methodologies are acceptable (and indispensable) for public health research, but have a decent level of error. When dealing with small risk reduction values like those reported here, reporting bias could potentially diminish these positive results.
However, the huge sample size included in this meta-analysis, one of the largest I have seen outside of other massive prospective cohorts like the Nurses Health Study, provides strength to the findings.
The Big Take Home

Interest in the Mediterranean Diet has been on the rise in recent years
Something that is not clear at all is how this translates into clinical practice. It is not feasible to expect that patients might be willing and able to dramatically switch their dietary practices, for a slight reduction in disease risk.
The results of this analysis appear to support the benefits on a population scale, but beyond providing kindling for the “eat more fruits and vegetables, less red meat, and more olive oil” camp, it’s hard to make concrete recommendations to individuals.
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