Amid the swirling shifts in views about what does and does not constitute healthy eating, the Mediterranean diet has held its own for decades as a balanced approach that combines great tasting food with positive healthy outcomes.

While the message that the Mediterranean diet is a healthy one has been clear and consistent for many years the place in the diet of wheat-based foods produced from white flour has been far murkier. Part of this confusion in the United States may be because Oldways, a longtime advocate of the Mediterranean diet, also was the force behind the creation of the Whole Grains Council. The Mediterranean diet recently attracted positive attention when the New England Journal of Medicine published results of a study in which subjects at “high cardiovascular risk” following the Mediterranean diet supplemented with olive oil and nuts were less likely to have a heart attack or stroke than a control group, with risk reduced by 30%.
Missing within the study or the media coverage, though, was much discussion about grains and what kind of grains were consumed by subjects. The term “whole grains” does not appear once in the body of the study. So exactly what kinds of grain-based foods were the subjects eating?

A 34-page appendix notes subjects on the Mediterranean diet were allowed limitless amounts of “whole grain cereal” when counseled by dieticians. When surveyed about what they actually consumed, though, the Mediterranean diet that yielded the successful cardiovascular results featured consumption of products from enriched grains versus whole grains at a ratio of 6.6 to 1. The proportion was the same at baseline as after the intervention.

For wheat-based foods, the study has many valuable takeaways — that enriched grains remain a central part of the Mediterranean diet, increasing intake of whole grains remains a challenge (despite the whole grains encouragement, intake actually fell very slightly) and that good cardiovascular outcomes are compatible with diets featuring generous amounts of enriched grains. Successfully communicating these messages remains a herculean challenge for the wheat foods industry.