Mediterranean Diet
Think of the Mediterranean and most of us conjure up images
of sun, sea, sand and sangria. But those aren’t the only
benefits of the Med way of life. Believe it or not, eating a
Mediterranean style diet can actually help to keep us healthy,
too. Weight Loss Resources dietitian Juliette Kellow reveals
all...
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A Taste of the Med
By WLR Dietitian
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Shirley Valentine didn’t just boost her love life when she
swapped her humdrum life in Liverpool for a holiday in Greece!
Replacing egg and chips with a glass of wine and plate of
traditional Greek food almost certainly gave her health a boost,
too.
Many health experts around the world agree there’s something
special about the Mediterranean way of eating that helps to keep
us healthy, particularly when it comes to reducing the risk of
heart disease.
This is good news considering that recent figures
from the British Heart Foundation reveal that diseases of the
heart and circulatory system – known as cardiovascular disease –
are still the main causes of death in the UK, with 38 percent of
people dying each year from this disease.
In contrast, the death rate from cardiovascular disease in
most countries surrounding the Mediterranean Sea is much lower.
What’s most surprising though is that many people living in
these countries have relatively high intakes of fat. In fact, as
many as 40 percent of calories can come from fat in a typical
Mediterranean-style diet – far more than the maximum of 33
percent of calories recommended by health experts in the UK. So
just why is the Mediterranean diet considered to be so healthy?
What is the Mediterranean diet?
The Mediterranean diet isn’t actually a specific diet like
the Atkins programme or the
F-plan diet. It’s simply a
collection of eating habits that are traditionally followed by
people living in Mediterranean countries. At least 16 countries
border the Mediterranean Sea including Spain, France, Italy,
Greece, Turkey, Morocco, Tunisia, Libya, Israel and Egypt.
Naturally, the culture, religion and lifestyles of people
living in these countries vary considerably. But, the eating
habits of people living in these countries tend to have a number
of common characteristics.
Mediterranean Diet Guidelines
Traditional Mediterranean diets tend to include lots of
fresh, natural foods and few processed foods.
In general, people
eat lots of fruit, vegetables, bread, pasta, rice, beans and
nuts and use lots of olive oil in cooking and as a salad
dressing. Fish tends to be eaten in good amounts and small
amounts of red wine are often consumed with meals.
Furthermore,
food tends to be flavoured with fresh herbs, garlic, black
pepper and red wine – although salt is still often added to many
dishes.
In contrast, intakes of red meat, eggs and full-fat
dairy products are usually only eaten in small amounts.
It’s thought that when combined, all these factors help to
keep the heart healthy and reduce the risk of cardiovascular
disease.
Is there any proof that the Med diet is healthy?
Since the
1950’s, scientific research has shown that people who follow
traditional Mediterranean diets have lower rates of heart
disease.
In 1958, Professor Ancel Keys launched the Seven
Countries Study and studied the diets, lifestyle and incidence
of coronary heart disease of almost 13,000 middle-aged men for
10 years from seven different countries. His research discovered
that heart disease was rare in Greece and Southern Italy, where
good amounts of veg, fruit, olive oil, grains, beans and fish
were eaten. In contrast, he discovered the incidence of heart
disease was much higher in America and Finland where large
amounts of foods rich in saturates were eaten.
Since then, many other studies have provided similar
findings, particularly in healthy people, but also in those at
risk of heart disease or following a heart attack.
Nevertheless,
some health experts still believe caution is needed before
recommending a Med-style diet that contains more fat.
The
American Heart Association – which recommends that diets provide
no more than 30 percent of calories from fat – believes further
research is needed to confirm the heart benefits of a
Mediterranean-style diet and to identify whether it’s the diet
itself or other lifestyle factors such as being more active that
account for fewer deaths from heart disease in Mediterranean
countries.
Why is a Mediterranean diet thought to protect against heart
disease?
Good intakes of olive oil and red wine are often cited
as two of the main reasons why a traditional Mediterranean diet
keeps the heart healthy. But most experts believe it’s more
likely to be the whole package that reduces the risk of heart
disease.
In general, Mediterranean meals are usually based on fresh,
natural ingredients rather than processed foods, which mean they
are more likely to contain plenty of
vitamins and minerals. For
example, pasta dishes are more likely to be served with a
homemade tomato sauce rather than a jar of sauce, fresh fruit is
more likely to be served as a desert than a ready-made chilled
pudding and seafood stews are made from fresh fish, stock and
vegetables.
Large amounts of vegetables – which are good sources of
fibre, vitamins, antioxidants and phytochemicals – tend to be
included in most savoury dishes like moussaka, spaghetti
Bolognese, kebabs and risotto. Salad is also usually served as
an integral part of a meal and is often eaten as a course on its
own – and there’s always a basket of bread on the table at meal
times.
Mediterranean Diet Foods
Here’s the lowdown on how the different foods typically eaten
in a Mediterranean diet can help to keep the heart healthy:
Fruit and vegetables
Fresh fruits and veggies including
aubergines, courgettes, avocado, tomatoes, peppers, onions,
melons, oranges and peaches are an important part of the
Mediterranean diet. This is good news as most fruit and veg are
low in fat and high in fibre – both of which are important for a
healthy heart and helping you to lose weight if necessary.
Fruit and veg are also good sources of antioxidant vitamins
such as beta-carotene and vitamins C and E, which ‘mop up’
harmful free radicals – molecules that can cause oxidation of
LDL or bad cholesterol, which potentially speeds up the process
of the narrowing of arteries.
Furthermore, many fruit and veggies are good sources of
naturally occurring plant chemicals such as flavonoids, which
act as powerful antioxidants.
Tomatoes in particular have come
under scrutiny because they feature so heavily in Mediterranean
dishes. These are a good source of the antioxidant lycopene,
which may be important for a healthy heart, as well as reducing
the risk of some cancers. Better still, cooking tomatoes helps
the body to absorb lycopene more easily, with the result that
tomato-based pasta dishes and pizzas are good choices.
For good
health, it’s important to eat five servings of different
fruit
and veg every day.
Bread, rice, pasta and couscous
It’s unlikely the Atkins
diet ever caught on in Mediterranean countries, as starchy foods
tend to form the basis of most meals!
Starchy foods have the benefit of being filling and contain
good amounts of nutrients and naturally-occurring
disease-fighting chemicals called phytochemicals, particularly
if wholegrain varieties are chosen, such as wholewheat pasta,
granary bread and brown rice. Unfortunately, when grains are
refined, for example to make white flour or white rice, the
outer bran and germ layers of the grain are stripped away – also
removing the fibre, nutrients and phytochemicals, which are
concentrated in these areas.
In particular, wholegrain starchy
foods help to keep the heart healthy – research suggests that
people who eat at least three servings of wholegrains each day
are less likely to suffer from heart disease, and
type 2
diabetes and certain types of cancer.
Other research suggests wholegrains may play a role in
treating and preventing obesity because they are more filing
than their refined counterparts. Indeed, a study of American
nurses found that those who ate a diet high in fibre and
wholegrains were least likely to be overweight.
Olive oil
Olive oil is used liberally in many Mediterranean
dishes and is also poured onto salads, mixed with pasta and used
with bread instead of butter. As a result, Mediterranean diets
tend to be higher in monounsaturates and lower in saturates and
trans fats than typical diets in the UK.
Eating fewer saturates
and trans fats and boosting intakes of monounsaturates is
particularly important when it comes to keeping the heart
healthy. This is because saturates and trans fats increase
levels of LDL or bad cholesterol – the type that can be
chemically changed (a process called oxidation) and taken up by
the cells in the artery walls, causing them to become narrower.
In contrast, monounsaturates lower LDL or ‘bad’ cholesterol but
help to maintain levels of HDL or ‘good’ cholesterol, the type
that carries excess cholesterol away from the arteries to the
liver, where the body gets rid of it.
Fish
Fresh fish is usually in abundance in most
Mediterranean countries due to the proximity to the sea – and
there are usually plenty of varieties to choose from including
white fish such as monkfish, octopus, squid and snapper,
shellfish like crab, mussels, prawns, crayfish and lobster and
oily fish like sardines, mackerel, anchovies and fresh tuna.
This is good news as all fish is packed with protein and
contains plenty of vitamins and minerals. White fish and
shellfish are also low in fat making them a great choice for slimmers.
But the true heart heroes from the ocean tend to be oily
fish.
Despite recent reports to the contrary, most health
experts still believe omega-3 fats, a type of polyunsaturated
fat found in oily fish, have an important part to play in
keeping the heart healthy. As well as reducing the stickiness of
blood, making it less likely to clot, omega-3s help to keep the
heart beating regularly and protect the small arteries, which
carry blood to the heart, from damage. They also help to lower
levels of another type of fat found in the blood called
triglycerides, high levels of which are linked with heart
disease.
For good health, the Food Standards Agency recommends
we should eat at least two servings of fish each week, one of
which should be an oily fish.
Nuts
Forget crisps, biscuits and chocolate. In
Mediterranean countries, unsalted nuts are far more likely to be
eaten as a snack. But that’s not all.
Nuts are often included in
savoury dishes and deserts – think pine nuts in homemade pesto,
walnuts in bread and pistachio ice cream! Like olive oil, nuts
are a good source of monounsaturates. Plus they’re packed with
fibre and protein and contain a range of vitamins and minerals.
When it comes to heart health, several large-scale studies have
shown that people who eat nuts are less likely to suffer with
coronary artery disease.
Better still, research also shows that
people who follow diets containing moderate amounts of nuts are
more likely to maintain their weight after dieting than people
who don’t eat nuts. This is thought to be because slimmers find
it easier to stick to diets that contain moderate amounts of
fat, rather than diets that drastically restrict fat.
Red wine
Binge drinking is far less common in Mediterranean
countries than in the UK. Instead, most people drink small
amounts of alcohol with meals.
As red wine is frequently consumed in the Med, much research
has been carried out looking at the specific heart benefits of
this alcoholic drink. In particular, red wine contains
antioxidants called flavonoids, which may prevent the build-up
of fatty deposits within the wall of the arteries.
However, while some research has suggested red wine is the
most beneficial alcoholic tipple for heart health, this is still
not conclusive. Indeed, it’s thought that small amounts of any
alcohol – that’s no more than one or two units of alcohol a day
– are associated with a lower risk of heart disease. Sadly
though, these beneficial effects are only seen in men over the
age of 40 and postmenopausal women! In particular, alcohol
raises HDL or ‘good’ cholesterol and may reduce the stickiness
of the blood.
In contrast, people who persistently exceed sensible drinking
limits – that’s a maximum of three units a day for women and
four units a day for men – are more likely to suffer from risk
factors associated with heart disease such as high blood
pressure. Binge drinking can also cause abnormal heart rhythms
and regular heavy drinking may lead to an enlargement of the
heart.
Alcohol contains calories but little else in the way of
nutrients so drinking large amounts can lead to obesity, which
in itself is a risk factor for heart disease!
As a result, most health experts agree that eating a healthy
diet, stopping smoking and being more active are likely to have
a far greater benefit to heart health than drinking small
amounts of alcohol. And if you do drink, stick to the
recommended maximum limits.
Garlic and herbs
Garlic and herbs are used in abundance in
Mediterranean dishes and undoubtedly help food to taste
fabulous.
In particular, it’s been suggested that adding garlic
to food may help to keep the heart healthy. However, according
to the British Heart Foundation, there’s currently not enough
evidence to suggest that it can protect us from heart disease.
Nevertheless, together with fresh herbs, garlic is a great way
to flavour food without the need to add salt – and cutting down
on salt can help to lower blood pressure, which is a risk factor
for heart disease.
Dairy products
In general, full-fat dairy products like
whole milk and cheese tend to be eaten in smaller amounts in
Mediterranean countries, helping to keep intakes of saturates
down, which in turn is associated with a reduced risk of heart
disease.
Furthermore, traditional cheeses like feta or goats cheese
tend to be lower in fat than traditional hard cheeses like
Cheddar or Red Leicester. Nevertheless, they’re often just as
high in salt, if not higher. For example, 100g of feta cheese
contains 3.6g salt compared to 1.7g salt in 100g of Cheddar.
Furthermore, yogurt tends to be eaten more frequently, for
example, in the form of tzatziki, as a desert mixed with honey
and fruit, or stirred into savoury dishes to add a creamy
texture.
Red meat
Red meat tends to be eaten in smaller amounts in
Mediterranean countries and this is thought to contribute to the
lower rates of heart disease. Indeed, some studies have shown a
slight increase in the risk of cardiovascular disease in meat
eaters compared with those who don’t eat meat. However, just as
many other studies have shown that eating lean red meat doesn’t
increase cholesterol and may even reduce levels of ‘bad’ or LDL
cholesterol, possibly because lean red meat contains
monounsaturates, omega-3 fats, B vitamins and selenium, all of
which help to keep the heart healthy. As a result, the British
Nutrition Foundation says it’s fine to eat lean red meat as part
of a diet for a healthy heart.
Are the health benefits simply due to diet?
Even as far back
as the 1950’s, Professor Ancel Keys – one of the first
scientists to link the Mediterranean diet with low rates of
heart disease – recognised that lifestyle factors as well as
diet probably play a role in keeping the heart healthy.
In
Mediterranean regions, people tend to be more physically active
– they walk rather than using a car and often have more
physically demanding jobs. The pace of life is also often more
leisurely and family ties are frequently strong with a greater
emphasis put on families cooking and eating together and taking
their time over meals – a far cry from microwaved ready meals
eaten hurriedly on your own in front of the TV!
How does the Mediterranean diet differ to a typical UK diet?
In many respects, the diet doesn’t differ greatly from the
healthy eating guidelines recommended by health experts in the
UK, where the emphasis is on eating more fruit, vegetables and
high-fibre, starchy foods and fewer processed foods and those
rich in saturates and trans fats.
The main difference relates to
the overall fat content of the diet. In general, people eating a
traditional Mediterranean style diet get more of their calories
from fat – often up to 40 percent. But they tend to eat less
saturated fat. In fact, intakes of saturates are well within our
dietary guidelines. Instead, more than half of the calories in a
Mediterranean diet come from monounsaturated fats.
However,
because the fat content of Mediterranean diets is higher, diets
are also often higher in calories and this is thought to be
contributing to the rapidly expanding rates of obesity in
Mediterranean countries. In fact, statistics from the
International Obesity Task Force reveal that there are more
overweight and obese adults in Greece than there are in the UK,
while Spain is following hotly on the heels of the UK, where 66
percent of men and 60 percent of women are either overweight or
obese.
So will a Mediterranean diet help me lose weight?
Not necessarily!
Mediterranean dishes are often packed with calories due to
the large amounts of oil used and may, in fact, be higher in
calories than a standard UK diet. Dressing on salads, olive oil
drizzled over food before serving, fried foods, pasta mixed with
olive oil and oily pasta sauces soon tot up the calories. Plus
all that bread served in addition to pasta or rice simply adds
more calories. Red wine is also packed with calories – a small
150ml glass still contains 100 calories. Bottom line: if you
want to follow a Med-style diet, you’ll still need to stick to
your daily calorie allowance as recommended by Weight Loss
Resources if you want to shift those pounds. And ultimately,
that will probably mean going easy on the olive oil, bread and
red wine!
Having said this, a small American study has shown that
following a calorie-restricted Med-style diet may actually help
you to keep the weight off once you’ve lost those pounds. In the
study, 61 overweight adults followed either a standard low-fat
diet or a Med-style diet – both containing the same number of
calories. After six months, both groups had lost the same amount
of weight but a big difference was seen in how well they kept
the weight off. After a year, many of the people who followed
the Med-style diet had stuck with the diet and maintained their
weight loss, whereas those who followed the low-fat diet found
it difficult to stick to and regained all those lost pounds,
plus a few more!
Are there any negatives?
As well as being potentially high in
calories, many Mediterranean dishes also contain a lot of salt
and then more salt is often added at the table.
It’s easy to get into the habit of gradually drinking more
and more red wine – before you know it, one small glass has
become half a bottle every night and that’s a lot of calories –
and more than the maximum amount recommended for good health.
Low intakes of dairy products may mean that calcium intakes
are low and this can increase the risk of
osteoporosis (weakened
bones) in later life. Furthermore, research shows that the
calcium in low-fat dairy products can aid weight loss,
particularly fat around the midriff – so skipping dairy means
you’re also potentially skipping a slimming benefit.
Similarly, low intakes of red meat and eggs can make it hard
for women to meet their requirements for iron, a mineral that
keeps the blood healthy and prevents a condition called anaemia.
This is a worry as currently, a quarter of females aged 19 to 64
years in the UK have iron intakes below the minimum amount
needed to stay healthy.
Dietitian’s verdict
The Mediterranean diet is as much about
a way of life as it is about the food that’s eaten. This means
food is seen as a pleasure rather than a pain – every part of
the process from shopping for ingredients and preparing them to
cooking delicious meals and enjoying them with your family is
considered to be enjoyable.
It’s hard to find fault with a diet that promotes fresh,
natural foods and more fruit, veg and filling, high-fibre foods.
It’s also nice to see an eating plan that isn’t based on lots of
unpleasant restrictions. This is good news as most people find
it easier to stick to a more moderate eating plan.
I would suggest using the basic rules of a Med-style diet for
everyday eating – for example, choosing foods rich in
monounsaturates over saturates, eating more fruit and veg,
basing meals on starchy foods, and eating more fish and beans
and fewer processed foods. But you’ll still need to count those
calories if you want to lose weight – and ultimately, that will
mean watching portion sizes, not going mad with olive oil,
enjoying small amounts of red wine and having either pasta or
bread – but not both!
In the meantime, why not start to incorporate the Med way of
life into your own daily routine? Okay, you might not be able to
take a daily siesta, but you can start to get more creative in
the kitchen, encourage the family to eat together around the
table and now summer is here, even enjoy meals outside.
Further information
Visit the British Heart
Foundation’s website,
www.bhf.org.uk
H.E.A.R.T. - The Cholesterol Charity
HEART UK supports all those at risk of inherited high
cholesterol and cardiovascular disease.
www.heartuk.org.uk
You can use the tools and resources of WLR to keep a calorie
counted Mediterranean diet. Try
it free for 24 hours.
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