Comprehensive Guide to the Pesco Mediterranean Diet?

The Main Points

Before noting health benefits or weight loss success of the Pesco Mediterranean, here is a summary of the key components:

• It is a plant-rich diet (lifestyle)
• It is rich in tree nuts
• Fish and seafood are the principle source of animal food
• The principle fat source is extra-virgin olive oil (EVOO), but it does allow for moderate amounts of dairy (particularly yogurt and cheese) and eggs;
• Modest amounts of alcohol consumption is compliant with the diet (ideally red wine with the evening meal)
• Very few red and/or processed meats are included
• Intermittent fasting is a key component, both for weight loss and from a health standpoint

How it is Different from a Regular Mediterranean Diet?

The traditional Mediterranean diet has been endorsed for heart health in many, many academic or research publications. Recently, the 2020 U.S. News & World Report ranked it #1 for overall health.

This ranking was based upon it being nutritious, safe, relatively easy to follow, protective against cardio vascular disease and diabetes, as well as effective for weight loss.

The primary difference between a Pesco Mediterranean diet and the classic Mediterranean diet is the intermittent fasting component.

The emphasis on fish and seafood is the other key variant. These may seem like small differences, but they are important distinctions.

Is it Good for Weight Loss?

The classic Mediterranean diet has long been established as a healthy diet that “can be” effective for weight loss. I think it’s longevity has resulted in boredom for many people. It is sometimes far more sexy to follow a trendy diet promoted by “influencers”.

The other reason I believe people may not have achieved weight loss with a classic Mediterranean diet is that it involves whole foods, which often means cooking or preparing food.

Americans seem to have lost some of the art of cooking and preparing whole foods, as life became busy and processed food became abundant, inexpensive and quick.

Two Key Concepts to Help with Weight Loss

1. The addition of intermittent fasting to the diet should help, but it is not a given that it will result in weight loss without learning how to accomodate whole foods into your lifestyle.
2. Cooking compliant meals is even more tricky with a Pesco Mediterranean lifestyle, because fish is one of the more intimidating and expensive things for people to cook (at least in America).

What kind of Intermittent Fasting is Needed for Weight Loss?

Intermittent fasting (aka time-restricted eating) is essentially limiting the eating window of your day. The most frequently cited form of intermittent fasting related to weight loss is 16/8 (16 hours of daily fasting and an 8-hour eating window).

This typically means skipping breakfast, but some prefer to skip dinner instead. I have not found any research that shows a preference to the time of day of the eating window.

For weight loss benefits, a 18-6 intermittent fasting regime (18 hours of fasting to a 6-hour eating window) seems to be even more beneficial.

Of course this makes sense from a calorie standpoint. The less time you eat in a day most often relates to few calories, given you are on a particular diet or lifestyle that doesn’t include an overload of sugar and processed food.

Some studies have promoted intermittent fasting as a method to achieve “fat loss” rather than just “weight loss”, and I wholeheartedly agree with this concept.

The idea is that intermittent fasting promotes glucose metabolism. After a 12-hour overnight fast, insulin levels are typically low, and glycogen stores have been depleted. This means when you wake up and your body is looking for energy, you will mobilize fat for energy rather than glucose.

There are a range of documented health benefits to intermittent fasting (insulin sensitivity, lower blood pressure, etc.) that are relevant to people not trying to lose weight, but the weight loss benefit is meaningful to many people looking for a healthy lifestyle.

Caveat from the ACC: “The evidence regarding time-restricted eating is mostly based on animal models and observational human studies. The most popular form of time-restricted eating involves eating two rather than three meals and compressing the calorie-consumption window.

No head-to-head studies have been performed to assess the optimal time window.”

Is it a Healthy Diet Plan?

This is a quote from the authors of a American College of Cardiology (ACC) study comparing the health of popular diets:

“Humans are evolutionarily adapted to obtain calories and nutrients from both plant and animal food sources. Many people overconsume animal products, often-processed meats high in saturated fats and chemical additives.

In contrast, while strict veganism has gained popularity for many reasons and has value in certain groups, it can cause nutritional deficiencies (vitamin B₁₂, high-quality proteins, iron, zinc, omega-3 fatty acid, vitamin D, and calcium), and predispose to osteopenia, loss of muscle mass, and anemia.

This is not true of a lacto-ovo vegetarian diet, which allows no animal-based food except for eggs and dairy.

A 6-year study of 73,308 North American Adventists reported a decreased incidence of all-cause mortality when comparing vegetarians with nonvegetarians.

However, when the vegetarians were stratified into vegans, lacto-ovo vegetarians, pesco-vegetarians, and semi-vegetarians, the pesco-vegetarians had lowest risks for all-cause mortality, cardiovascular disease (CVD) mortality, and mortality from other causes.”

I have personally followed low carb, slow carb, and keto diet plans and have seen weight loss (and fat loss) with all of them. With respect to overall health parameters, they each have their pros and cons.

I believe the main problem with these low carb approaches is that:

1. They involve excluding certain food groups. Elimination of an entire food group “may” result in nutritional deficiencies;
2. More importantly however is sustainability. Keto, in particular, does not seem to be sustainable for many, many people over the long run.
3. I found a lot of “weight loss” success with slow carb, but the high protein nature of it is difficult to achieve without red meat. Much of the current research favors plant-based diets over diets heavy in red meat if the goal is “health”.

Why are these Foods Important to the Diet?

The Case for EVOO

Extra Virgin Olive Oil (EVOO) is the oil of choice in the classic Mediterranean diet, as well as the Pesco Mediterranean diet. EVOO is used for cooking vegetables, in salads (with vinegar) and in sautéing fish.

It is important to note, however that olive oil quality is crucial, which makes it expensive. It is also important to note that EVOO has a low smoke point and can quickly turn rancid if used in high heat cooking.

The reason EVOO is so crucial to health aspects of a Mediterranean diet is it retains components of olives which are believed to underlie many of EVOO’s heart-healthy benefits (such as reduced LDL-C cholesterol and increased HDL-C cholesterol and a lower diabetes risk. (Source: American College of Cardiology)

Why are Nuts and Legumes important to a Pesco Mediterranean Diet?

Nuts are typically high in fat and calories and they are the main preventative for me in losing weight on the Pesco Mediterranean diet. That is not to say they aren’t healthy however!

Nuts and legumes are two of the food components that are common to the diet of the five regions of the “Blue Zones”, a world-wide study that analyzed the criteria for healthy longevity.

Although the ACC study states that generous intake of nuts and/or legumes does not promote weight gain because of increased satiety and incomplete digestion, I have not found that to be true anecdotally.

Nuts were the main culprit in preventing weight loss for me personally, but also for many of my previous clients I coached as a diet and health coach.

No doubt nuts are healthy however, and if you are choosing this type of lifestyle for health rather than weight loss, generous helpings of tree nuts can be beneficial.

Legumes can be a healthy protein substitute for red meat and processed meats, especially if you do not like to cook fish. Consumption of legumes has been linked to improvements in blood glucose, cholesterol, blood pressure, and body weight.

Dairy and Eggs

There doesn’t seem to be a clear consensus in the nutrition field on the benefits of dairy products to overall health.

They are allowed in the Pesco Mediterranean diet, with an emphasis on fermented versions of dairy like yogurt and soft cheeses.

Eggs are allowed in the Pesco-Mediterranean diet; egg whites are unlimited and preferably no more than 5 yolks/week.

The Relevance of Whole Grains

In contrast to most of the popular low carb diets, whole grains, such as barley, whole oats, rye, corn, buckwheat, brown rice, and quinoa, are an integral part of the traditional Mediterranean diet.

Most of the low carb and keto diet approaches do not allow grains of any sort, based around causing an insulin response. I have followed a low carb and keto approach for many years now, so this idea of eating grains is anxiety-producing to me.

I am being quite cautious while experimenting with the Pesco Mediterranean diet, and keeping grains, even whole grains to a minimum.

Even if the grains do not result in weight gain, there are many people today that must eat gluten free. The inclusion of grains as an “allowed food” in the Pesco Mediterranean diet doesn’t mean it is a necessity by any means.

I would say the same for dairy, if you have a problem with dairy. A great meal plan of fish, legumes, plant-based foods and EVOO, accompanied by intermittent fasting is a perfectly sustainable (and delicious) lifestyle.

The ACC explains the inclusion of grains like this:

“Pasta is an example of a starchy food that has a low glycemic index despite being a refined carbohydrate. In the context of a low glycemic index dietary pattern such as the Mediterranean diet, pasta does not adversely affect adiposity and may even help reduce body weight and there is no evidence that pasta promotes cardiometabolic risk factors.

White rice is associated with type 2 diabetes mellitus in Asians but not in Western cohorts, possibly because it is cooked and served plain in Asia and in Western cultures cooked in mixed dishes with vegetables and vegetable oil including EVOO.”

Beverages Compliant with a Pesco Mediterranean Diet

The standard for beverages on any weight loss or health lifestyle seems to be consistent across the board:

• water, which can be flavored but not sweetened
• tea or coffee (unsweetened)
• dry red wine daily: 6 oz for women and 6-12 oz for men, consumed with meals

Pesco Mediterranean Dinner Recipes

As noted earlier, cooking fish can be intimidating to many people, particularly Americans. Here are a few simple fish dinner recipes that fit this diet and are quick to prepare:

Seared Tuna with White Bean Side Dish

Cioppino (or Bouillabaisse or Fish Stew)

Plum Sauce for Salmon or Fish Dinners

Mediterranean Fish Veracruz