Mediterranean diet
The Mediterranean diet is what every dietitian thinks of as the "holy grail" of diets. It basically adheres to the USDA Food Pyra- um, I mean MyPlate, and sticks to all the politically correct dietary dogmas of the day. Eat very little meat, some fish, lots and lots and lots of whole grains, vegetables and legumes, olive oil and as much red wine as you can possible manage to fit into the completely subjective term "moderate."

So it's no real surprise that when a bunch of mainstream doctors, researchers and dietitians get together to pick out the "Best Diets for Healthy Eating," as they do annually at U.S. News & World Report, they consistently pick the Mediterranean diet as number one (actually, this year it tied for number one with the DASH diet, which conforms even more closely to the government recommendations, adds in calorie-counting and misguidedly has you limit salt). It's also no surprise that 'health journalists' across the mediascape then dutifully report on these findings, talking about how great the diet is and offering advice on how to convert your eating regime to be more in line with what we're told Mediterranean people ate, like, half a century ago.

Yet another non-surprise is that this body of 'experts' consistently rank the Paleo and Ketogenic diets close to the bottom of their list (Keto is dead last this year), even above a number of diets you've probably never heard of - like, what the hell is the Spark Solution Diet? Or the Nutritarian Diet? They take points off anything that restricts carbohydrates because, "These diets provide fewer carbs than is recommended by government guidelines." They should actually rename the list "Best Authoritarian Diets for Government-Approved Eating to Make You a Good Citizen for 2018." Accurate and catchy. (You can use that one for free, guys.)

What they're ranking the diets on is half the problem, following the same old dogma about what's 'heart-healthy', what's good for weight loss (calorie-counting, anyone?) and giving creds for being low-sodium. You really can't give a lot of clout to a list that puts the Ornish Diet in it's Top Ten, unless it's a list of the "Best Diets for Ruining Your Health and Making You Miserable for 2018." (You can use that one for free too). What the list is not is an actual test of the effectiveness of the diets based on some kind of comparison testing. If it were, and they managed to check their biases, they might find the Paleo Diet to be superior on a number of fronts. The list is essentially the opinion of experts, which is to say, those who have been deemed experts due to how successfully they've been able to internalize the prevailing dietary ideology.
mediterranean diet food pyramid

There appears to be a speck of red meat at the tip of the Mediterranean Food Pyramid. A trigger warning would have been nice.
The Mediterranean Diet isn't the Mediterranean Diet

The main issue with the Mediterranean diet is that it has absolutely nothing to do with what people ate in the Mediterranean at the time of its creation. The diet was created by Ancel Keys - yes that Ancel Keys. It seems that after investing so highly in his own hypothesis that saturated fats caused heart disease, Keys published a biased study to 'prove' he was right, then went on to promote the diet he apparently witnessed people eating when he was in the Mediterranean region, because it conformed so well to what he believed people should be eating.

Keys had visited Naples with his wife in the 1950s and witnessed people eating a simple diet of pizza and pasta, mostly vegetarian, low in fat except for olive oil sprinkled on greens, fruit for dessert. After doing some tests and finding the population was relatively healthy, he assumed the diet he witnessed them eating was what contributed to their health. This worked all the better since it happened to fall in line with Keys' own hypothesis.

However, when the couple returned again years later, they found that people weren't eating the "Mediterranean Diet" anymore! Sally Fallon Morrel quotes him as saying:
"The restaurants are increasingly popular but the food they serve is commonly far from the Mediterranean pattern. . . Everything has to be loaded with butter or margarine and ground meat. Serving only fruit for dessert is not common; ice cream or pie is customary. Whereas Italian restaurants brag about the healthy Mediterranean diet, they serve a travesty of it."
...the "Mediterranean pattern" being what he saw people eating when he was there. How exactly he felt he could deem his own limited observations to a "pattern" is not clear. It wasn't exactly based on a rigorous investigation. As Fallon points out:
The question that the believers haven't asked themselves is this: Was the lean, so-called Mediterranean diet they observed after the war the true Mediterranean diet? Or were they observing the tail end of deprivation engendered by half a decade of conflict? Were the inhabitants of Crevalcore and Montegiorgio abandoning the traditional Mediterranean diet, or were they taking it up again? And did Keys miss the sight of Italians enjoying rich food in the early 1950s because Italians had never done such a shameful thing, or was the visiting professor too poor at the time to afford anything more than plain pizza in a sidewalk cafe?'s Dr. Gabriela Segura puts it this way:
Promoters of the highly-touted Mediterranean diet, with its olive oil and 'low animal fat', fail to mention the fact that there are still fat-loaded recipes that were passed from generation to generation among the Mediterranean people. Lardo di Colonnata with its cured strips of fatback and herbs and spices; Greek barbecue which often involves an entire lamb roasted on a spit; or the kokoretsi which is made from the internal organs of the lamb - liver, spleen, heart, glands - threaded onto skewers along with the fatty membrane from the lamb intestines, all of these are foods of the long-lived Mediterranean people. Yet the 'American-style Mediterranean Diet' selectively picks foods from the diet of the Mediterranean people to give the picture they desire. Ironically, many of the Mediterranean people have adopted this Americanized version of the 'Mediterranean Diet'.
Ancel Keys
© Time Magazine
Ancel Keys is the one on the left. We think.
In other words, Keys' "Mediterranean Diet" never actually existed. It was based on the observations of one person in a particular place at a particular moment in history and likely had little to do with how the population actually ate. The Mediterranean people have always eaten high fat and lots of meat (see this Weston A. Price link again for a look at what has historically constituted the traditional cuisine of the region). The glowing health of the people Keys saw in Italy was likely despite their sparse diet which, as Fallon points out, was likely temporary. So the way North Americans view the "Mediterranean Diet" is really a complete fantasy. It's based on nothing - there is no historical precedence for what is now being promulgated in the media every year when researchers once again announce that the diet is "the best".

This is, more or less, what the entire dietary guidelines pushed by governments are based on. Keys was instrumental in convincing the population of the dangers of animal foods, an idea so persistent it still informs all dietary advice proffered by authorities. If you were subjected to egg-white omelets, margarine and boneless skinless chicken breasts for the entirety of the 80s and 90s, blame Ancel Keys. The fact that there was never any scientific basis for the diet to be recommended apparently mattered little.

Sally Fallon Morrel again quotes Keys:
"Unhappily," writes Keys, "the current changes in Mediterranean countries tend to destroy the health virtues of the diet as we saw them forty years ago. Efforts are needed to reverse this change. Education is important. We should concentrate on the medical profession and the schools. It is not enough that doctors measure serum cholesterol and tell patients with high values to avoid butter and fatty meat. They also should emphasize prevention by targeting the general public."
Kinda creepy there, Keys. 'How can we force people to change their diets to be more in line with what I think they should be eating? It's vitally important to educate the poor misguided plebes to indoctrinate them into consuming the American version of the diet I assumed they were eating when I visited there once.' In reality, the best advice the people of the Mediterranean could be given is to ignore any advice coming from pompous American lab-coat-wearing authorities, and eat the way they've always eaten.

If you conduct an intervention whereby you remove all the crap associated with the Standard American Diet (SAD), you're guaranteed health improvements. And this is exactly what we see when various studies come out showing the Mediterranean diet's benefits. But this doesn't prove the healthiness of the Mediterranean diet so much as it condemns the SAD.

All the diets that make it into the upper echelons of authority-accepted diets essentially revolve around the same things, and those things don't deviate far from the ultimate authority of the government-dictated guidelines. In other words, it's essentially the same diet that has been promoted for the last half-century plus: high carb/high sugar, low fat/low nutrition. And it's not really working out for us.

If you want to get what you've always got, do what you've always done. If you want to improve, try a new strategy.