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What is the Best Diet?

Columnist: Sal Iaquinta, M.D.
November, 2018 Issue

Sal Iaquinta, M.D.
All articles by columnist

The word “diet” doesn’t mean to lose weight anymore, diet simply means a selection of food and beverages that help you achieve a particular goal. There are a myriad of diets to choose from—diets to lose weight, diets to build muscle, diets to reduce cholesterol, diets to avoid allergens or animal products, diets to control diabetes. With such a wide range of diets, it’s nearly impossible to answer the question: What is the best diet? But that won’t stop me from trying.

Diets for the average person
First, we need to agree that the real question is: What’s the best diet for the average person? Meaning the average person doesn’t have allergies or intolerances and only wants to be as healthy as possible, but still enjoy eating.

We know a fair amount about the so-called “average person.” Most research projects are done on the average person. Medical scientists know that, on average, about 60 percent of people will die of heart disease, cancer, lung disease, Alzheimer’s, diabetes, stroke and kidney disease. A primary criteria for an ideal diet, is one that lowers the risk of death from these diseases.

The average American diet is the Western diet, which is rich in meat, fried foods and refined grains. Although tasty, it raises the risk of heart disease, stroke and type 2 diabetes. For those of us who eat large amounts of processed meats, there are studies that indicate these foods will increase your risk of lung cancer by 15 to 35 percent. (Sorry, but this diet isn’t in the running.)

A second criteria is that the diet supplies all the basic nutrients, vitamins and minerals the body needs. There should be no need for supplements. This includes fiber, which reduces the rate of sugar entering the bloodstream from the digestive tract. It also helps reduce cholesterol, and may even reduce your risk for cancer.

The third criteria is sustainability. Diets that are extremely limiting in their food selection get boring quickly. A diet must be filling and diverse. At one point, the Japanese Ministry of Health recommended that people consume 30 different foods daily for variety and nutrition. A diet has to fulfill our emotional needs—meaning it still has to have foods we truly enjoy, even crave. Though raw diets are popular, many people have a hard time even starting them because of the idea of giving up cooked or baked foods. This is a huge hurdle that limits its adoption and longevity.

Top diets in the world
The two top contenders for the World’s healthiest diets come from faraway places—the Okinawan diet and the Mediterranean diet. For many years, Okinawan population had of the longest life expectancies in the worlds—about nine years longer than the average American. In the past 20 years this has decreased somewhat since the islanders have more access to Western-style fast or processed food. In fact, the youngest generation has a much higher incidence of obesity as compared to the older generations.

Traditionally, the Okinawan diet is based on the Satsuma sweet potato. This may be shocking to you because so many diets eschew carbohydrates. However, the sweet potato shares more in name with white potatoes than anything else. In contrast to white “Irish” potatoes, the Okinawan sweet potato is high in fiber, digests slowly, has a low glycemic index, and is rich in antioxidants, potassium, iron and calcium. This potato, along with bitter melon, rice, grains, and other root vegetables account for around 80 percent of caloric intake. This is a much higher carbohydrate diet than any of the other popular diets out there.

The Okinawan diet has little meat in it, but does include some fish. This diet is rich in seaweed, tofu, and turmeric and low in sodium and cholesterol. What’s more, Okinawans have a lower prevalence of Alzheimer’s dementia than mainland Japanese and Americans.

The other well-studied, healthy diet is the Mediterranean diet. This diet differs from the Okinawan diet in that half as much of its calories come from carbohydrates. It has significantly more fat than the Okinawan diet. The Mediterranean diet is characterized by high consumption of fruits, vegetables cereals, legumes and olive oil. The Mediterranean diet includes moderate consumption of fish, poultry and wine. Surprisingly, about 40 percent of the diet’s calories come from fat, but fat that is monounsaturated such as olive oil.

This diet is proven to lower cardiovascular risk, cancer, neurodegenerative diseases, impotence, and mortality, compared to the Western diet.

These two diets are considerably different than each other, but what they have most in common is what they exclude. Neither diet has processed food. Both diets involve minimal amounts of red meat, and both are rich in adding flavor with herbs, spices and healthy oils.

So, I can’t tell you which diet is best for you. But I can tell you my top two choices —the Okinawan diet and the Mediterranean diet. And based on the number of Japanese and Mediterranean restaurants everywhere, there are plenty of options to choose from in the North Bay.

Salvatore Iaquinta, M.D., is a head-and-neck surgeon at Kaiser Permanente. He is also the author of The Year They Tried to Kill Me.



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