Fad diets are a persistent quirk of American culture, but the last decade in particular has offered a highly confusing array of mandates about what we should and shouldn't be eating. Doctors and dietitians--along with the revised US Department of Agriculture (USDA) food pyramid--have told us to avoid fatty foods and base our diet on complex carbohydrates, fruits and vegetables, and low-fat proteins. Then Dr. Barry Sears, author of The Zone, told us to eat high-protein foods and avoid carbohydrates. And last year, Dr. Atkins claimed in Dr. Atkin's New Diet Revolution that we could eat all the fat we wanted as long as we avoided carbohydrates completely. Meanwhile, Americans are gaining more weight than ever. That's because "low-fat diets as commonly conceived do not work, can be medically harmful, and do not represent the best diet for many people--especially if they want to lose weight and keep it off," according to Dr. Kevin Vigilante's book, Low Fat Lies, High Fat Frauds and the Healthiest Diet in the World (Life Line Press, 1999). Moreover, Dr. Vigilante maintains that high-protein, high-fat, low-carbohydrate diet theories are just as flawed, and can be downright dangerous.
Dr. Vigilante, a clinical associate professor of medicine at Brown University, teamed up with nutritionist Mary Flynn, PhD, to educate the public about the "healthiest diet in the world, or at least the western world": the Mediterranean diet. Low Fat Lies heralds, in an engaging and highly readable style, the benefits of the plant-based, olive-oil-rich Mediterranean diet, which consists of 40% fat. At the same time, Dr. Vigilante and Flynn expose what they say are the main hazards of the most common fad diets of the day. Here, Dr. Vigilante (KV) talks to CBSHealthWatch by Medscape (HW) about some of the central themes of Low Fat Lies.
HW: Your book emphasizes the lifelong health benefits of the Mediterranean diet over its effect on weight loss. The chapter on weight loss in your book is actually quite "slim." I also noticed that you referred many times to the fact that calories--not fat--cause weight gain, which implies that losing weight requires eating less and exercising more--an unpopular message in today's diet industry. How do you think readers will respond?
KV: The truth will set you free! My first concern is to give accurate information, not to do slick marketing in order to sell diet books. The truth is that you have to consume fewer calories or exercise more if you want to lose weight. It is best to do both. The evidence shows that anyone who says differently is either a liar, a fraud, or a fool. But eating fewer calories doesn't mean you have to feel hungry or deprived. Our research showed the higher fat content of the Mediterranean diet enables you to consume fewer calories yet feel completely satisfied. If anyone has lost weight on Atkins, Zone, Pritikin, or Ornish diets it is because they consumed fewer calories.
HW: In Low Fat Lies, you thoroughly addressed the hazards of several current fad diets and diet books such as the ones you just mentioned. Can you sum up what you see as the most dangerous diet advice being given to today's bombarded diet consumer?
KV: The most dangerous advice is: One, meat is risk-free: Eat as much as you want.
In fact, excess consumption of red meat has been very convincingly tied to cancer and heart disease in many studies. Two, calories don't count, and it is, A, fat that causes weight gain, or, B, carbs that cause weight gain. In fact, calories do count, and whether they come from too many carbs or too much fat, they cause weight gain.
HW: Americans are known around the world for our enormous portion sizes. What general, simple advice about portion size would you give to someone wanting to adopt the Mediterranean diet in hopes of better long-term health and gradual weight loss, without a great deal of calorie counting?
KV: Pasta is a great food but you need to limit the amount you eat. So learn what two or three ounces of pasta looks like on your plate, and try to limit your serving size to that amount. A cup of dry pasta is about 2 ounces.
Bottom line is that you have to develop an eye for your own appropriate portion size based on your current weight and how much you want to lose. This is a lot easier than actually counting calories. So in Low Fat Lies we try to teach people how to develop an eye for the critical elements of the diet--olive oil, pasta, white meats, and fish. They can have as much fruit and vegetables as they want. The vegetables are prepared in the Mediterranean style so they are a delight to eat and very filling. They are the key to weight loss on this very healthy diet.
For folks who want ongoing personalized coaching Mary Flynn, my co-author, and I offer an Internet weight loss program called meddiet.com. We use the Mediterranean diet and the principles put forth in the book to help people lose weight. It has been very successful.
We are also offering a cooking and nutrition course in a 16th-century Tuscan Villa this summer--just 12 miles outside Siena. The villa is on a working organic farm. Here we will personally show people how to use the Mediterranean diet for health and weight loss.
HW: Let's move on to some of the benefits of the Mediterranean diet that extend beyond weight loss. You say the Mediterranean diet promotes heart health and longevity and reduces the risk of several kinds of cancer. The Japanese diet gets a lot of publicity for its potential protection against breast cancer, based on the low incidence of that disease among women in Japan. Does the Mediterranean diet seem to offer similar protection?
KV: Breast cancer is complex because many factors influence it including genetics, age upon reproduction, obesity, and of course, dietary factors. The phytoestrogens [plant compounds that act like hormones in humans] from soy in the Japanese diet seem to be protective (though may be harmful if someone is on tamoxifen for breast cancer therapy). Elements of the Mediterranean diet seem to confer protections as well. Certainly the phytochemicals in fruits, vegetables, and olive oil confer protection from cancer in general. But there is experimental evidence that olive oil confers specific protection for breast cancer when compared to polyunsaturated fats. There are at least four studies that have shown that olive oil--the cornerstone of the Mediterranean diet--was associated with lower rates of breast cancer when it replaced or was used instead of polyunsaturated fats like corn oil.
HW: Your notion of the seven elements required for a successful diet was really interesting. Especially unique was your thinking on "harmony" in a diet. Most people probably don't think much about dietary harmony, but maybe they should. Will you explain the concept?
KV: Dietary harmony is critical to a diet's success. Harmony can occur on many levels-- from the practical to the transcendent. A diet may be harmonious so that patterns of eating are seamlessly woven into our way of life. This is certainly true with cuisines that arise from certain climates and environments and are embedded in a culture. It may be harmonious with spiritual beliefs, as with kosher food. On a practical level, the ingredients of a diet may be harmonious with each other. In Low Fat Lies we talk about the natural harmony of the Mediterranean diet. Tomatoes, basil, olive oil, wine, and many of the other foods seem to be made for each other. Choosing a cuisine that is internally harmonious in this way simplifies shopping and preparation of food. We always know what we need in stock and how to cook it. Harmonious foods go naturally together so it is hard to make something that doesn't taste good.
HW: Does the Mediterranean diet offer Americans benefits that the Japanese diet does not, other than increased simplicity and harmony?
KV: Absolutely. The traditional Japanese diet is woefully lacking in fruit, and of course the Japanese don't consume olive oil or red wine, which are very important in disease prevention.
HW: You write about the importance of olive oil in a Mediterranean diet and call it "nature's healthiest oil." Could you sum up the benefits olive oil has to offer? I'm also curious about types of olive oil. At my co-op, cold-pressed olive oil that has been processed without heat is a lot more expensive, but supposedly better for my family and me.
KV: Olive oil has numerous benefits. First, it is primarily a monounsaturated fat so that it enables you to lower LDL ["bad" cholesterol] and maintain or raise your HDL ["good" cholesterol] when you replace saturated fat with it. Also, unlike polyunsaturated fats, it is very resistant to oxidation and free radical production--real problems in disease initiation. It contains hundreds, perhaps thousands of phytochemicals which, among other things, are powerful antioxidants. Lastly, it permits the absorption of carotenes. These potent phytochemicals are important in disease prevention, but require some fat to be absorbed. No fat in your diet, and you flush them down the toilet. Literally.
And you always want to buy virgin or extra-virgin olive oil because it has not been processed or refined and probably is richer in disease-fighting phytochemicals.
HW: Can the Mediterranean diet be successfully adapted for vegetarians? It seems as simple as adding a few more legumes. Is there more to it?
KV: The Mediterranean diet is a plant-centered diet. Meat is more of a condiment or accent. The leap to vegetarianism is easy, as you say--use more beans. In fact, Italian Jews often had a hard time getting kosher meats, so they have even less meat in their version of the Mediterranean diet.
HW: Finally, tell me more about your take on Ronald McDonald. You say he is as dangerous as Joe Camel--and that's a powerful statement. Can "happy meals" really be as harmful as cigarettes?
KV: In some ways, Ronald McDonald is more dangerous, because the effect is more insidious and he is overtly marketing to kids. He is seen as a positive image and Joe Camel has been exposed as a negative one. While there are few habits as bad as smoking, eating a lifetime of McDonald's burgers and fries will guarantee you a shorter life. I think training an entire generation of kids to eat that way is reprehensible.
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