Mediterranean Diet

It isn’t what you may think….

 

In science, we don’t look to confirm what we know; we want to find out something that we don’t know. We love it when science proves us wrong.

 

If your doctor told you that you have heart disease, or were pre-diabetic, or said you should eat healthier they likely will tell you to follow the Mediterranean diet.

In spite of all the noise on the internet about low carb/keto, vegan, or other diets/lifestyles you will find that the Mediterranean Diet is consistently ranked as the number one or two diet for health in the United States.  That is based on many studies showing how the diet leads to a decrease in heart disease, improved hypertension, better control of diabetes, less strokes, and lowering risk of dementia.

The Mediterranean diet is neither low carbohydrate (it is about 50% carbohydrate) nor low fat (it is about 30% fat). It is not high protein (it is about 20% protein). Obsessively counting those macronutrients is unimportant in this diet. Adherence to this diet is more dependent on consuming the quantity of the foods and completely ignores counting macros (proteins, carbs, fats, and alcohol).

In spite of the diet being neither low fat, or high fat, not high protein or low protein, not low-carb or all carb – the combination of food has the most consistent long-term results for a decrease in heart disease, strokes, cancer, and increase in longevity of any diet published. In addition it is the most anti-inflammatory of all diets.

If you examine modern literature, numerous studies show for those who have diabetes, or are insulin resistant, that this diet is superior to others. Those who claim low-carbohydrate diets are the best for diabetes are often stunned that the Mediterranean diet, rich in whole grains and fruits, which can produce transient spikes in blood glucose levels, leads to better long term results than avoiding whole grains and fruits.

 

But what is that diet? When I introduce the Mediterranean Diet to my patients I get a response like this:

“Sounds great!  Who doesn’t love red wine, olive oil, and fresh Italian tomatoes?”

This is followed by asking for a recommendation of a book of recipes from the Mediterranean.

It seems to invoke sitting on a rooftop restaurant in Positano sipping wine while munching on fruit and waiting for pasta. Yes, the food and wine are all on the diet.

The assumption that the Mediterranean Diet is just what people in the Mediterranean eat. And the origin of that diet is from what ‘some’ people in the Mediterranean ate, but that isn’t what we (doctors, scientists, registered dieticians) mean today.   

Over the last fifty years over 150 foods have been studied to see their effect on humans, for better or for ill. Those foods have been divided into broad groups: vegetables, fruit and nuts, legumes, fish, meats, whole grains, dairy, fats and oils, and alcohol.

 Each one of those categories is worth a point, so you have a chance to get nine points total. For some categories you get a point for eating a given quantity of food (more for some, less for others). We determine adherence to the diet based on how many points a day a person gets on average. The closer to nine points a person has on a daily basis, we say the more that they are adherent to the diet.  

Vegetables:

The target is 9-10 ounces a day of vegetables. 

We count the pre-cooked weight of vegetables. If you bake 9 ounces of broccoli it will weigh about 4 ounces when cooked, but you still get credit for the 9  ounces. 

A medium carrot is 4 ounces - so two carrots a day gets you almost to your goal!

There is a long list of vegetables and recipes in here to add them, but in case you want a refresher:

Asparagus, Beets, Brussels Sprouts, Cabbage, Celery, Collard Greens, Cucumber

Eggplants, Peas, Leeks, Lettuce, Onions, Peppers, Shallots, Spinach, Squash, Zuchinni

and those are just a few of them. 

Don't think of vegetables as a side dish - think of how you can incorporate them. One of my favorite is to put in cabbage in fish tacos to give it a lot of crunch.

Add carrots, onions, peppers, celery to your tomato sauce for pasta. 

Add them to your chicken soup, or your dahl

Fruits and Nuts (not politicians):

Target is 8-9 ounces. A medium apple is 6 ounces. 

Fruits are portable, delicious, filled with fiber and a part of a great diet. 

The nuts in here are tree nuts (peanuts are a legume).

So how to get this in? Easy to have a handy fruit at lunch, some fruit in the morning, and even some for dessert.

While you know apples  - did you know there used to be over 14,000 variety of apples in the United States? Most common apples sold in most supermarkets are not that great, but I like Honey Crisp. My absolute favorite apple is the Knobby Russet - which is hard to find, unless you have someone with a tree.

Don't forget the berries: blueberries, blackberries, salmon berries, Huckle berries.

This also includes seeds - and I love putting chia seeds into my overnight oats. Seeds have a lot of magnesium.

Nuts have more calories, but with their mono-unsaturated fats and fiber they make a  healthy portable snack. I like walnuts, as they are a great source of vitamin D.

If you have diabetes and notice that fruits will spike your blood glucose level you should know that in long-term studies people with diabetes who ate whole grains and fruits had lower Hemoglobin A1C than others. Short term glucose spikes are not as important as a healthy diet.

Legumes:

The target is 2 ounces a day.

Think beans, lentils, and even okra. In culinary medicine a legume is any plant that seeds are lined up in a pod, but if you talk to a botonist they will tell you how okra is not of the legume family. We will count okra here.

Chickpeas are my favorite snack - bake them in the oven or an airfryer and you have a great snack. Peanuts, in contrast to tree nuts, are a legume. 

Legumes are a great source of protein and fiber and low in fat. Did you know that people who eat legumes as a primary source of protein in meals at least four times a week have 22% less heart attacks?

Lentils are great, and my Dahl for a great soup is a wonderful filling dish. 

Green beans, like haricot verts, are a great side dish - I like mine with a dijon mustard and olive oil sauce.

Even peanut butter - a good legume.

Vegetarians often find that legumes are a major source of protein.

Cereals and Grains:

The target is 9-10 ounces a day.

Whole grains are associated with a decrease risk of heart disease, diabetes, and obesity. Refined grains (white four, white rice) is associated with an increased risk of heart disease, diabetes, and obesity. 

Breakfast is a place where I get a lot of my whole grains - I love overnight oats (made with rolled oats). But on the days when I forget to make then there are some great whole grain cereals like bran flakes, cheerios, life cereal. 

Whole wheat bread is an easy way to change things.

Let us not forget about whole wheat pasta. It is finally available everywhere, and provides a filling meal and is worth some points. I didn't like the spirlized vegetable substitute for pasta, I like pasta. 

Fish:

Target is 2 ounces a day and two meals a week.

The Mediterranean diet is more fish than meat or poultry. The reason is fish are high in Omega 3 fatty acids, which are missing in many traditional diets. 

Give fish a chance. A few fish tips about buying fish: never buy fish that smells fishy.

Worried about mercury - check to see that most sustainable fish are low in mercury. Buy the light tuna (yellow) instead of albecore. Or buy from a place like Oregon's Choice, where their mercury levels are low. 

Heart disease and risk of heart disease is greatly reduced by eating at least two meals a week in fish. The oil capsules do not have the same advantage. 

Check out my fish recipes.

Olive Oil and other fats:

Olive oil is life! It was the first form of light, electricity, and used for cosmetics in the ancient world. Olive oil is still used by some for an aftershave!

These are high in monounsaturated fat, and other oils that are just as healthy include Canola, Grapeseed (which I use for a lot of cooking) Sesame oil, Tahini, Peanut butter, and Safflower oil. Be careful of avocado oil as it is recommended because of a high smoke point, but often is contaminated with other oils -- food fraud. Know your sources. 

Did you know the highest purest standards for extra virgin olive oil are in the United States. You can argue about your favorite olive oil, but the high standards are met when the US growers submit their oils for testing.

I buy California and Arizona olive oil. I hear Georgia has some good olive oil also.

Before you get too upset, my favorite olive oil in the world is from Liguria in Italy.

The goal is to have over 60 percent of the food you cook come from monounsaturated fats.

Dairy:

Target is less than 7 ounces per day.

This means you use cheese for its flavor - sprinkle some great parmesan cheese and you can taste it. 

Yogurt is great, you can make your own or be careful about what you buy.

Meats:

The target is less than 4 ounces a day.

I know it doesn't seem like much, but the latest studies confirm that a little meat is ok, but the more meat you have the greater the risk of heart disease. 

Protein sources from fish, vegetables, and legumes are important - meat is more of an extra bit on the side.

Alcohol:

Target: one serving for women, two for men. A serving is 5 ounces of wine, 1 ounce of hard liquids, or one beer.

Toxicity is in the dose. Too much is bad, too little is ineffective - but wine has some great polyphenols in it and associated with a lot of health benefits. But too much is never a good thing.