We’ve been around for millions of years and we’re still trying to figure out what to eat!
The 2014 Integrative Healthcare Symposium was a great meeting of the minds several of the leaders and innovators in the areas of integrative and functional medicine, and one of the most anticipated events was a panel discussion discussing the merits of vegan, paleo, and Mediterranean diets. Because of the amount of dogma and personal conviction people tend to hold regarding diet philosophies, these discussions can often become heated. This particular discussion, however, was structured to allow each presenter to highlight the merits of their approach, as opposed to debating about which one is best. After all, the goal is to help everyone become healthier, not to win an argument!
Dr. Michael Greger (Vegan diet), Dr. Colin Champ (Paleo diet), Dr. David Perlmutter (Paleo/Modified Ketogenic diet), and Dr. Stephen Sinatra (Mediterranean diet) were the speakers. You can read more about them here if you are interested.
I’ve divided up this overview of the discussion by topic so you can compare and contrast the differing philosophies of the individuals who were proponents of each diet. The purpose of this article is not to outline the entire philosophy of each diet, as that would take several books worth of writing to do. I simply hope to highlight many of the similarities and differences among the diets (through the point of view of an individual health practitioner) so that you can make an informed decision for yourself. Although I personally adhere to what I would call a modified paleo diet (Paleo + rice and occasionally gluten-free oats), I still kept an open mind and I certainly learned something from each of the presenters. Just to be clear, the opinions of the individuals may not reflect the strict guidelines of whichever diet they adhere to, as they make modifications based on their clinical experience and the needs of the populations that they serve.
Fruits & Vegetables
Vegan: We should all be eating a plant based diet and the health benefits of fruits and vegetables outweigh the risks of pesticide and fungicide contamination.
Paleo: Vegetables should be one third of the diet and we should be eating more greens and cruciferous vegetables. The diet should not be fruit heavy, but a fruit like an avocado could be a more regular part of the diet. About 50g fiber/day.
Mediterranean: Basically the same as Paleo, except with a greater emphasis on high fiber intake (about 100g fiber/day).
Meat & Fish
Vegan: Most livestock are raised in unhealthy conditions, and the water supply is too contaminated to eat most fish without being exposed to numerous toxins. Complete protein can be obtained from a varitey of plant sources instead.
Paleo: Meat and fish are healthful foods. Studies that show increased disease risk from eating meat don’t take into account meat quality. Favor grass-fed meats and smaller fish (sardines, anchovies) due to less contamination. It is best to get to know your source of meat because some livestock may be raised in accordance with “certified organic” standards, but the farmers are simply not willing or able to pay for that designation. About 30% of the calories in a diet should come from protein.
Mediterranean: Basically the same sentiment as the Paleo with a slightly lower protein intake overall. About 20% of the calories in a diet should come from protein.
Vegan: Not recommended. Milk is for babies.
Paleo: Not generally recommended but limited amounts of unpasteurized cream are ok.
Mediterranean:Hard Cheese and aged cheese provide Vitamin K2 which is a chelator of calcium. This is important for cardiovascular and bone health.
Vegan: Alcohol should be mostly avoided. The health benefits of drinking wine are not correlated to people already eating a healthy diet.
Paleo: Small amounts of alcohol have been shown to increase longevity, but some studies expousing the benefits of red wine had falsified data. Use in moderation
Mediterranean: The French, who tend to be heavy wine drinkers, have a low rate of cardiovascular disease but a high rate of cirrhosis. Should have in moderation.
Vegan: Green tea has more significant health benefits than coffee, but coffee is not necessarily harmful to drink.
Paleo: There is not a clear consensus on the long term benefits of coffee, but they personally drink it on a regular basis. Alcohol prevents the clearing of caffeine, so alcohol and coffee should not be combined
Mediterranean: Basically the same as Paleo. Coffee is an Nrf2 activator.which is an antioxidant pathway.
Vegan: Most nutrients should be obtained from the diet, but Vitamin D supplementation is recommded if needed. Algae is a preferable source of Omega-3 fatty acids than fish oil.
Paleo: The bulk of the diet should be solid foods with supplements plating a small complementary role. CoQ10, ribose, carnitine, and Magnesium are good supplements for mitochondrial health.
Mediterranean: Supplementary fiber is recommended, but most other supplements should be used only when indicated. Squid oil is a good source of omega-3’s
Vegan: Nuts are recommended as a healthy food.
Paleo: Nuts (especially macadamia nuts and walnut) are recommended. Peanuts and cashews are legumes, not nuts.
Mediterranean: Same as Paleo and Vegan.
Fat and Oils
Vegan: It’s better to obtain fats and oils from whole food sources such as nuts, and avocados as opposed to extracted oils. Some studies show enhanced cardiovascular risk with increased cholesterol levels.
Paleo: Butter form grass-fed cows, olive oil, macadamia nut oil, avocado oil, are all good choices. 60-70% of calories in the diet should come from fat. Cholesterol is essential for brain AND heart health. Some neurological disorders are related to cholesterol deficiency.
Mediterranean: Very big proponent of olive oil produced in America, as it is less likely to be adulterated with cheaper vegetable oils like corn oil or soy oil. 50% of the calories in the diet should come from fat. Dietary cholesterol is safe to eat.
Vegan: Carbs should make up the majority of the diet with refined grains being avoided.
Paleo: Grains should be avoided and carbs overall should be kept low. 60g-80g of carbs or lower, to treat patients with neurological disorders. A ketogenic diet (very low carb) and fasting have similar benefits as they will both upregulate mitochondrial biogenesis.
Mediteranean: 30% of calories should come from carbs. The higher the meat intake, the greater the need for fiber in the diet.
Wrapping it Up
As you can see there are many areas of differing opinions, and a few areas of agreement among the diets. I personally recommend eating meat, as high a quality as you can find, but its up to you to decide if your body responds well to that type of diet. Your carb needs will vary based on activity level, muscle mass, and environment, so that is a flexible variable as well. The bottom line is that the name you attach to your diet is rather arbitrary. The important factor to consider is the health outcomes that result from eating in a particular way and to find the particular style that keeps you healthy, energetic and also appeals to your taste buds.