Why one-size-fits-all recommendations—including the Mediterranean diet—often fall short
Recently I had the pleasure of speaking at the Rhode Island Academy of Nutrition and Dietetics Spring Conference (on none other than IBD nutrition, of course 🙂).
One of the best perks of speaking at conferences is that you get a free pass to watch the other presentations.
While this meeting wasn’t focused specifically on GI nutrition, I still walked away with some very practical ideas I plan to use with my patients.
One talk in particular stood out: “Culturally Inclusive Care, Heritage Foods & Food Sovereignty” by dietitian Maya Feller.
As I was listening, I kept thinking about conversations I often have with people with IBD.
Many meet with me having been told to follow a Mediterranean-style diet.
Which, in theory, is reasonable advice.
Even the American Gastroenterological Association advises clinicians:
Unless there is a contraindication, all patients with IBD should be advised to follow a Mediterranean diet rich in a variety of fresh fruits and vegetables, monounsaturated fats, complex carbohydrates, and lean proteins and low in ultraprocessed foods, added sugar, and salt.
But when people hear this recommendation, they’re often left wondering:
What does that actually mean?
After all, most of them don’t live in the Mediterranean.
Nor is Mediterranean cuisine necessarily part of their cultural food traditions.
And to be honest, when many people hear Mediterranean diet, they picture Italian or Greek food — olive oil, olives, fresh fish, and tomatoes.
But the Mediterranean region includes dozens of countries across Europe, the Middle East, and North Africa, each with their own traditions, ingredients, and flavor profiles.
In other words, even within the Mediterranean, there isn’t a single “Mediterranean diet.”
And of course, each of us brings our own food traditions to the table.
This is where Maya’s talk felt especially relevant.
One point she emphasized was the importance of understanding someone’s cultural food patterns before making recommendations.
That might mean asking questions like:
- What meals feel the most comforting or familiar to you?
- Are there foods that feel especially important in your culture?
- What are your go-to herbs and spices?
- Are there any favorite foods (maybe even traditional foods) you’ve stopped eating because of your IBD?
These kinds of questions can open the door to far more helpful conversations than jumping straight into a list of foods to add or avoid — or a blanket recommendation to follow a “Mediterranean diet.”
I remember learning this lesson early in my career as an intern at the Bronx VA.
Many of the patients I worked with regularly ate white rice and beans — a staple in so many cuisines around the world.
At the time, I thought I was supposed to encourage them to switch to brown rice.
Technically, that aligned with the nutrition education I was receiving.
But it never felt quite right.
It ignored the cultural significance of foods like white rice and overlooked the fact that many of these meals were already nutritionally balanced.
(And honestly, some dishes just taste better with white rice.)
Over time, I realized that instead of replacing traditional foods, we might do better to focus on things like:
- Portion sizes
- Eating patterns and behaviors
- Reducing sodium and added sugar
- Gradually increasing fruits and vegetables (I have a fun “rule” here to help)
Emphasizing a wide variety of mostly whole, minimally processed foods — as the Mediterranean diet does — is a good framework.
But often the most sustainable (and enjoyable) nutrition changes come from building on the foods and traditions people already know and love.
