Whenever a list ends, we need to have an "and" there.
But there is not need to have 2 "ands". The only case when we have two ands at the end would be in the case, when the last element of the list is a compound one, which is not the case here.

Let's go One option at a time:

(A) and meat rarely
The second and is not allowed
(B) and meat was rare
The second and is not allowed
(C) with meat as rare
meat as rare is a wrong use of the word "as". We need to have a comparison here
(D) meat a rarity
We need to separate this from the last item of the list
(E) with meat as a rarity
The best choice, with no incorrect usage of "and" and also it separates this element from the last one.

Hi Optimus,

Thanks for you reply.

Can you please give me a example where two AND needed with explanation.

I dont understand the reason of option D. Please explain.

Thanks

j_shreyans wrote:The diet of the ordinary Greek in classical times was largely vegetarian--vegetables, fresh cheese, oatmeal,
and meal cakes, and meat rarely.

(A) and meat rarely
(B) and meat was rare
(C) with meat as rare
(D) meat a rarity
(E) with meat as a rarity

A and B: The diet of the ordinary Greek in classical times was largely vegetarian--vegetables, fresh cheese...and meat.
Here, the usage of and meat implies that meat is a VEGETARIAN food.
This meaning is nonsensical.
Eliminate A and B.

C: meat as rare
meat as rare AS WHAT?
Also, the usage of rare could imply RARE MEAT -- in other words, meat that is barely cooked.
Not the intended meaning.
Eliminate C.

An absolute phrase is a modifier composed of COMMA + NOUN + OTHER WORDS that serves to modify the entire preceding clause.
In an absolute phrase, the noun after the comma must refer to the PRECEDING SUBJECT.
SC108 in the OG for Verbal:
Sound can travel through water for enormous distances, its acoustic energy prevented from dissipating.
Here, the portion in red is an absolute phrase in which its acoustic energy (the noun after the comma) refers to sound (the preceding subject).

D: The diet of the ordinary Greek in classical times was largely vegetarian, meat a rarity.
Here, the portion in red seems to be an absolute phrase, but meat (the noun after the comma) does not refer to the diet (the preceding subject).
Eliminate D.

The correct answer is E.

Generally, COMMA + with at the end of a sentence serves as an ADVERB modifying the VERB in the preceding clause.
OA: The diet of the ordinary Greek in classical times WAS largely vegetarian -- vegetables, fresh cheese, oatmeal, and meal cakes, WITH meat as a rarity.
Here, the portion in red is an adverb modifying was -- the verb in the preceding clause -- expressing how the diet WAS largely vegetarian.
HOW was the diet largely vegetarian?
WITH meat as a rarity.