The Mediterranean Diet Pyramid evolved from a conference held in Cambridge, Massachusetts, early in 1993, called “Traditional Diets of the Mediterranean.” Jointly organized by Oldways Preservation & Exchange Trust, a Boston-based nonprofit organization (of which I was then a founding director) with an interest in food issues, and the Harvard School of Public Health, the conference brought together a distinguished group of scientists, public health officials, scholars, and experts on diet and health from around the globe to consider the traditional Mediterranean diet and the health benefits that might derive from it.
There was a considerable and cohesive body of research to examine, and in the years since, the consensus has grown that the traditional diets of the Mediterranean, as described by Dr. Antonia Trichopoulou and Dr. Dimitrios Trichopoulos in Appendix I, “The Mediterranean Diet and Health,” represented a way of eating that is most likely a major factor in the generally excellent health profiles of the people who follow it. As the Trichopouloses explain, this sense of the traditional diet is based primarily on research that began with the highly commended Seven Countries Study in the late 1950s and early 1960s. (It is not to say that this traditional diet has been followed by all Mediterranean peoples at all times in their long history, but rather that there are certain common threads, particularly the overall reliance on fresh vegetables, legumes, seafood, wheat as the basic carbohydrate, and, above all, olive oil as the principal fat. But obviously, at many times and in many places, people ate very different things, some equally good for you and some not so great.)
At the time of the first Mediterranean Diet conference—there have been at least three since then—it was thought useful to offer a pyramid of dietary recommendations to counter the U.S. Department of Agriculture’s own pyramid representing USDA’s Dietary Guidelines for Americans. In its latest incarnation, the USDA pyramid has been revised slightly but still includes the startling recommendation that two to three servings daily of 2 to 3 ounces from the group labeled “meat, poultry, fish, dry beans, eggs & nuts” could be considered healthful. It doesn’t take a mathematician to work out that 3 ounces three times a day could well mean 9 ounces of red meat daily, hardly wise counsel for optimum health. (You can see a copy of this pyramid at nal.usda.gov/fnic/Fpyr/pmap.htm.)
The Mediterranean Diet Pyramid, which was copyrighted by Oldways Preservation & Exchange Trust, is shown in its current version, with thanks to Oldways for permission to publish it, on this page. It does not rely on serving sizes but stresses instead the relationships among various food groups with suggestions as to how frequently they should be consumed. Most radically, the very tiptop of the pyramid, a place for food to be consumed monthly rather than daily or weekly, is reserved for what looks unmistakeably like a sizable beef steak (maybe even a 9-ounce steak), while the place of extra-virgin olive oil in a healthful diet is graphically illustrated by including it with cheese and yogurt, fruits, vegetables, beans and legumes, and carbohydrates, all recommended for consumption every day. Oldways has gone on to develop diet pyramids for Asians, Latin Americans, and vegetarians, but its focus has remained the Mediterranean and the nonprofit organization now offers a “Med Mark program,” for food and drink products that fulfill what the organization believes to be the parameters of a traditional Mediterranean diet. On its web site (oldwayspt.org) Oldways describes this as a way both to move people toward more healthful diets and to boost appropriate companies’ bottom lines.
The Harvard School of Public Health, the other partner in that 1993 conference, not to be outdone by Oldways or USDA, now has its own pyramid, called the Healthy Eating Pyramid, which includes the advice that a plant-based diet is healthiest of all, and advises against the consumption of red meat, refined grains, potatoes, sugary drinks, and salty snacks—all aspects of the traditional American diet, the web site says, that are “really unhealthy.” HSPH further takes USDA to task for promoting recommendations that “have often been based on out-of-date science and influenced by people with business interests in their messages.”
If readers detect a note of skepticism in my tone, it’s because I am not especially impressed with any of these pyramid schemes. While initially attractive graphics, they are not really useful or in the long run at all meaningful. I find it hard to accept that the American public is so subliterate that the message about dietary change can only come from a colorful illustration. This is not to say that any of these organizations are mistaken or misguided in their advice—although USDA’s recommendation to eat plenty of meat and not much olive oil is a little off track—rather that the method they’ve chosen to get their message out simply, to my mind, misses the mark.