The USDA My Plate versus the Ikaria, Greece Diet:
Should you trust the government with your brain?
Dan Buettner’s quest to discover and understand pockets of the planet where humans live extraordinarily disease free and long lives has revealed many valuable lessons. Dan and his team search for and study “Blue Zones”, parts of the world that have a large proportion of centenarians, individuals at least one hundred years old. As a dietitian with a passion for longevity eating and living, and an aging one at that, I am reading his book1 The Blue Zones Solution: Eating and Living like the Worlds Healthiest People. I’m also perusing his website resources with great interest. Prior to his book, I have read many books about longevity lifestyle including those of the Okinawans and the Hunzans, other robust long-living populations. There is one blue zone that has especially drawn my attention, Ikaria, Greece.
I have recently spent many long hours studying the interventions that are succeeding in not only staving off Alzheimer’s disease, but reversing it, the Bredesen protocol and the functional medicine approach to neurodegenerative diseases. I have studied the food, the lifestyle and the supplement interventions. I have read journal articles and explored the underlying pathophysiological processes. A question came to my mind. “Where do people live long disease-free lives that also produce the lowest incidence of Alzheimer’s disease and neurodegenerative disease overall?” In other words, “Where are people getting it right for brain and nervous system health”? That appears to be the island of Ikaria off the coast of Greece. Between the book and the research published on diet and lifestyle of the Ikaria2 I have been able to piece together what they actually consume. I say “piece together” because the research excluded calories from wine, dairy and nuts, that all appear to be important parts of the cuisine and all have been linked to healthy brain and heart! There is a lesson here. Research is extraordinarily valuable but no better than the quality of the questions asked. Reading about the food of Ikaria, I learned that small amounts of wine, feta cheese and nuts appear at nearly every meal, occasionally even wine with breakfast.
As you might imagine, the people of Ikaria eat very differently than we do in the United States. But then again, we are told we eat quite differently than the ideal eating patterns recommended by the USDA in My Plate guidelines. Here I compare how we in the US eat on the average, USDA recommendations, and the Ikaria, Greece diet from a macronutrient perspective.
Macronutrient Distribution3,4,5,6,7: (Yes, ethanol is an energy source and should be counted!)
* Amount adjusted for age and sex of average population.
1. USDA total energy and macronutrients recommendations are not very different from what we eat but fiber is very different. Ironically, total energy intake and macronutrient distribution the typical American is eating is very close to the recommended amounts. The most significant difference is in grams of fiber, which is about 1/3 the amount recommended. The discrepancy between intake and recommendations is not so much how many carbs but “which carbs”. The quality and content of carbohydrates are very different from those recommended as I will show later.
2. People in Ikaria consume over 25% fewer calories than the US and nearly half of all calories are fat. Yes that’s right! The healthiest brains on the planet are getting half their calories from fat. Not just any fat, mind you. Half of the fat calories in the Ikarian diet comes from olive oil. Ikarians that consumed at least 12 teaspoons (average is 13 teaspoons) of olive oil per day had lower all-cause mortality. I also found that the USDA ideal recommendations for calories for the “ideal” US man and woman is 2240 kcal/day, about 1800 for women and 2700 for men. It is highly unlikely that the USDA recommendations will ever solve the obesity problem like this!
If you assess the Ikarian diet by USDA My Plate standards you get a story that would suggest severely substandard nutrient intake. I did just that and here is what I got:
3. Ikarians only consume one ounce equivalent of grains per day, only 14% of that recommended by the USDA. Vegetable and protein intakes are nearly ideal by USDA standards. Fruit is only about half and dairy is 1/5 that recommended. Yet they are among the longest living and healthiest populations on the planet and have the lowest level of Alzheimer’s disease of all people. Clearly, USDA My Plate is an incomplete assessment of a healthy diet pattern. To understand the differences in dietary patterns you have to dig deeper into exactly what they are eating. The following table does this.
4. Ikarians eat six times the low glycemic vegetables that Americans do. Beyond that, almost half are leafy greens. Most grow their own vegetables or pick wild greens so they do not have chemicals on them, they are not genetically modified and they are fresh and local. They also use lots of fresh, locally grown herbs in their cooking that are powerfully loaded with phytonutrients. They get the added benefit of the physical activity required to grow, pick and forage them. Their consumption of high glycemic fruits and vegetables is modest. Produce is fresh, locally grown and varies seasonally. The total servings of fruits and vegetables is about 7, quite modest in quantity, but quality and nutrient density far surpasses that typical in the US.
5. Ikarians, Greeks in general, consume about 3 tablespoons of nuts every day. They use a lot of walnuts, almonds and pistachios and they are considered an important ingredient in desserts.
6. Speaking of dessert, the only added sweet that they consume is local raw honey, about 8 teaspoons per day. Compare this to the average adult in the United States that consumes 23 teaspoons, nearly ½ cup of added refined sugars every day. The research is clear on the toxicity of these levels of refined sugars on our brains and liver. Ikarians use honey in their herbal teas and in desserts. A particularly popular simple dessert is walnuts in honey. As I type this, I plan to try this treat. It sure doesn’t get simpler than that.
7. Of course, there is always fresh fruit in season on the table for everyday desserts. There is one fruit that is in and on everything, lemon. Not only do Ikarians sqeeze lemon juice on everything but they eat the whole fruit, rind too. I recently was curious about the nutrients I heard were in the rind of a lemon and I threw a half lemon in my smoothie, rind and seeds and all. It was delicious! How many years have I been throwing the lemon rinds in my garbage disposal as a natural deodorizer when I should have been eating them? Lemon juice not only is rich in vitamin C but the skin is rich in limonene that suppresses appetite, enhances gut health, is an anticancer agent and stimulates metabolism. Marinating meat with lemon juice also suppresses formation of Advanced Glycation End-Products that promote insulin resistance and oxidative stress (the subject of my published review article).
8. Dairy is goat and sheep cheese and yogurt, by nature pastured and organic. Both are fermented/cultured products that contain probiotics. According to Diane Kochilas, a Greek chef whose family came from Ikaria, feta cheese is a garnish with nearly every meal. (Please get lost on her website like I did: http://www.dianekochilas.com/greek-food-index/traditional-ingredients/ )
9. At only ½ cup per day, Ikarians eat 20 times the beans and legumes of the average person in the United States. In fact, beans and legumes are a universal staple in all blue zones. They are a very rich source of protein, fiber, folate and minerals. This is the one place where the Paleo diet falls apart. It excludes beans that are an essential part of the diet of the healthiest people on the planet!
More to the story…. There is a lot more to lifestyle and even food than statistics can reveal. Ikarians like strong Turkish coffee. They drink herbal tea with their local honey and value both for medicinal purposes. They place a high value on culinary skills and love to cook as a rule. Beyond food, they have a strong sense of community. Their jobs require being outdoors and walking, mostly shepherds. Emulating all that is Ikarian would certainly be a challenge for a Michigander like me as fall begins to set in and days get shorter and the air gets colder. But I believe there is much I can do to create my little Michiterranean. I can cultivate my own food when I can (I do!). I can also cultivate my friend circles, my spirituality and my sense of gratitude. I can make time for moving daily and exploring the very different dietary pattern that has proven to enhance a healthy body and healthy brain.
“Yamas” (To our health!)
1. Buettner, D. The Blue Zones Solution: Eating and Living Like the World’s Healthiest People. Washington, D.C.:National Geographic Society.2015.
2. Panagiotakos DB, Chrysohoou C, Siasos G, Zisimos K, Skoumas J, Pitsavos C, Stefanadis C. Sociodemographic and lifestyle statistics of oldest old people (>80 years) living in ikaria island: the ikaria study. Cardiol Res Pract. 2011 Feb 24;2011.
6. O’Neil CE, Keast DR, Fulgoni VL, Nicklas TA. Food sources of energy and nutrients among adults in the US: NHANES 2003–2006. Nutrients. 2012 Dec 19;4(12):2097-120.
7. Yannis Manios, George Moschonis, Christina Mavrogianni, Rolf Bos, and Cécile Singh-Povel. Micronutrient Intakes among Children and Adults in Greece: The Role of Age, Sex and Socio-Economic Status Nutrients. 2014 Oct; 6(10): 4073–4092. Published online 2014 Oct 3.