Is the Healthiest Diet More or Less?

More apples and fewer french fries. Most dietary advice is a variation on that theme: eat more of this and less of that. And of course, both sides are important and we really never have to choose.

But did you ever wonder, even as a thought experiment, which deserves stronger emphasis—eating more healthful food or less junk?

It’s really more than a theoretical question. People in need of more extensive dietary changes can easily become overwhelmed by a long list of recommendations. I always advise moving one step at a time, based on joint decision making and readiness to change.

And of course, as a preventive cardiologist, I want it all for everyone. But since that’s not realistic, at least not for everyone all the time, the question remains: which makes a bigger difference, the number of healthy items you eat or the number of bad choices?

What the Data Says

An interesting new study shed some light on that question. A group of over 15,000 people  with heart disease were asked about their diet using two scoring systems:

• Mediterranean diet score that measured “healthy” foods including vegetables, fruit, beans, whole grains, fish, and some alcohol (but too much zapped points away!)
• “Western” diet score that measured the “bad” stuff, including refined grains, sweets, deserts, sugary drinks, and fried foods.

The study then followed participants for almost 4 years, during which time 1,588 people had a heart attack or stroke. They then asked this question: What predicted a better outcome—the amount of good food consumed (Mediterranean diet score) or the bad (“Western” diet score)?

A drum roll for the results…..

The good won out! Controlling for the other variables, eating more of the Mediterranean diet foods led to a better outcome, but the number of unhealthy “Western” diet foods did not. I don’t think that’s a call to eat more donuts…but it does perhaps offer some helpful insights.

Why More of a Good Thing is Helpful

For one, most of the healthier choices measured in the Mediterranean diet score are loaded with fiber, and tend to fill you up. Eating more of these fiber-filled foods leaves less room for the junk food.

And what junk food does get eaten may not do as much damage, because the fiber in the good stuff tends to cut the absorption of excess sugar. It is also conceivable that nutrients in healthier choices may help neutralize at least some of the harmful stuff in junk food. Eating lots of fruit and vegetables, loaded with potassium, has been shown to offset, at least partially, the blood pressure raising effects of sodium found in many processed foods.

Returning to the person in need of a complete dietary overhaul: it might be easier (and possibly more successful) to focus on one theme at a time: say eating 1-2 servings of vegetables and fruit with every meal, instead of diverting mental energy on what to avoid. At least to start with.

Keep in mind that this study wasn’t randomized and didn’t have a control group, so there’s definitely a chance that the results were distorted in ways that are hard to unravel. But still, it’s an interesting glimpse into a diet question that gets very little attention.

By the way, I still advocate having it all: a diet packed with delicious, healthy stuff, and as little of the other as possible (except for those celebratory moments!). However, this study, showing the disproportionate benefits of emphasizing the positive, might point to the best way to get there.

Reference: Impact of Mediterranean and Western Diet Choices