The Mediterranean Diet Translated for You and Your Patients

May 17, 2011
Tim Harlan, MD (aka Dr. Gourmet)

MD Magazine®, Volume 2 Issue 1, Volume 2, Issue 1

In each issue, Dr. Gourmet will present great recipes for your patients with common conditions such as diabetes, obesity, or high cholesterol.

The Mediterranean diet…It sounds so exotic, so foreign. Most of your patients translate the concept as simply eating more olive oil and fish. They might think of dishes like Greek salad, spanakopita, or even hummus. Most Mediterranean diet cookbooks further this idea and are filled with recipes that are anything but familiar to most Americans.

Truthfully, the research simply looks at a style of eating. While the ingredients are important, how they are put together can very easily be translated to “Western” tastes. This approach can be very beneficial for patients looking to slim down due to health concerns such as diabetes, obesity, vascular disease, and gastrointestinal problems.

The reality is that the Mediterranean style diet is a basic set of principles that your patients can easily follow by making a few small adjustments in their regular diet. The seminal work reported by Antonia Trichopoulou and colleagues in 2003 analyzed the diet of over 22,000 Greeks and categorized it into nine basic components. Those nine categories—vegetables, fruit and nuts, legumes, dairy, oils, cereals and grains, meats, fish, and alcohol— made up the 9-point Mediterranean diet score on which the research is based.

A perfect Mediterranean diet score would be a 9, and the perfect Western, fast food diet would likely come in at or near zero.

The Trichopoulou study showed that small differences—say, an improvement from 5 to 7— had a profound effect on patients’ health, with a 25% reduction in mortality from vascular disease and cancers. The 9-point scale is a simple and easy way to approach eating healthier and helping your patients understand what really works.

What is your patient’s Mediterranean diet score? This quiz will help you guide your patients to small changes they can make in their daily life to improve their health.

1. If you are female, do you eat more than 9 ounces of vegetables per day (11 ounces for men)?

9 ounces is…

about two medium carrots

about 8 medium spears of asparagus

about 1 cup sliced yellow squash or zucchini

about one 3 inch beet about 11/4 cups chopped broccoli

Score:

1 point for more than 9/11 ounces

0 points for less than 9/11 ounces

Inside the Research: Why Vegetables Matter

Here are some great examples of the power behind eating more vegetables. Beyond Mediterranean diet research, other studies have shown that each additional serving of vegetables you eat per day reduces your risk of heart disease by 4%.

In another study of successful weight loss strategies, the five most common strategies included consuming more vegetables along with eating smaller portions, more fruits, fewer fatty foods, no sweetened beverages, reducing the amount of food eaten overall.

Taking vitamin pills instead of eating more vegetables doesn’t work very well. Supplementing your diet with antioxidants or B vitamins in pill form won’t have any effect on hardening of the arteries.

2. Do you eat more than 13/4 ounces of legumes per day (2 ounces for men)?

13/4 ounces is…

about 1/4 cup canned chick peas

about 3 tablespoons peanut butter

about 1/4 cup raw lentils

about 1/3 cup canned kidney beans

about 1/3 cup roasted soybeans

about 2/3 cup frozen peas

Score:

1 point for more than 13/4 / 2 ounces

Inside the Research: Why Legumes Are Important

In a study of 10,000 men, those eating legumes four times or more per week reduced their risk of heart disease by as much as 22%.

But the benefits don’t stop at reducing heart disease. In one study, of the top 25% of men surveyed, those eating the most beans had a 65% reduction in recurrence of colon polyps and almost a 50% reduction in more advanced colon tumors compared to those men who ate the fewest beans.

Eating legumes doesn’t mean just eating beans, however. Eating legumes means having a peanut butter sandwich, a side of black eyed peas, or some chili. Here’s a great, simple chili recipe to get you going:

3. Do you eat more than 8 ounces of fruit or nuts per day (9 ounces for men)?

8 ounces is…

1 large apple

2 medium bananas

1 cup walnuts, pecans, pistachios, or other nuts

Score:

1 point for more than 8/9 ounces

0 points for less than 8/9 ounces

Inside the Research: Fruit and Nuts

This is a good place for combination. An ounce of nuts contains somewhere in the range of 200 calories. Even though nuts and seeds are calorie dense, these are excellent quality calories in that they contain good quality fats and are high in minerals. Nuts help control cholesterol, and the health benefits extend to a lowered risk of sudden death.

In addition to being a great source of vitamins, eating fruit can be a tremendous help with weight control.

4. Do you eat less than 7 ounces of dairy per day (71/4 ounces for men)?

7 ounces is…

about a cup of yogurt

about a cup of sour cream

7 slices of cheese

Score:

1 point for less than 7/71/4 ounces

0 points for more than 7/71/4 ounces

What Type of Dairy Is Best?

Contrary to some of the hype, many studies have shown that eating more dairy products is not the perfect solution for weight control or weight loss. That said, consuming fermented dairy products, like cheese and yogurt, appears to be very beneficial. Likewise, using lower fat dairy products is key to getting the best quality calories from your foods.

5. Do you eat more than 9 ounces (4.5 servings) of cereals or grains per day (101/2 ounces, or about 5 servings, for men)?

2 ounces (one serving) is…

about 1 cup bite-size shredded wheat

two slices of whole wheat bread

1/4 cup of brown rice

1/2 cup dry whole wheat pasta

1/3 cup uncooked quinoa

Score:

1 point for more than 9/101/2 ounces

0 points for less than 9/101/2 ounces

Inside the Research: Whole Grains are Great

Many studies show the benefits of whole grains. Good-quality cereals and grains have been shown to help with lowering cholesterol, controlling diabetes and high blood pressure, and best of all, weight control. The best part is that it doesn’t take much. Consuming as little as 2 slices of whole wheat bread instead of white bread is enough to have a significant reduction in the risk of heart disease.

Start the day with a great-quality cereal or oatmeal, take a sandwich with whole wheat bread for lunch, and choose brown rice instead of white rice. Simple changes are the easiest. Here are a few recipes that can help you make changes:

Healthy Toasted Oatmeal

Shrimp Fried Rice

Pasta Carbonara

Whole Wheat Pizza Dough

6. Do you eat more than 3/4 ounces of fish per day (1 ounce for men)?

This is not much fish, and the research looked at averages, so that’s why it seems to be so little. This really means about two or

more 4 ounce servings per week.

Score:

1 point for more than 3/4/1 ounces per day

0 point for less than 3/4/1 ounces per day

Recipe Book: Something Fishy for You

There are a lot of reasons that consuming fish is good for you. Fatty fish like salmon, tuna, halibut, grouper, and sardines are high in Omega-3 fats and have clearly been linked to lower rates of heart disease, stroke, and high blood pressure.

Fish Tacos

Shrimp Jambalaya

7. Do you eat less than 31/4 ounces of meat per day (4 ounces for men)?

Most people think that a serving of meat is much larger than it should be. Four ounces of beef, chicken, pork or lamb is about the size of a deck of cards. Take time to look at the package, or better yet, ask the butcher to cut your choices to the right portion size. Choose lean meats whenever possible. Avoid processed meats like hot dogs, bologna, and sausage.

Score:

1 point for less than 31/4/4 ounces

0 points for more than 31/4/4 ounces

Inside the Research: Something To Sink Your Teeth Into

We now know that the problem isn’t as much eating red meat at all, but an issue of the quality of meat you choose. Select fresh meats and avoid or minimize highly processed meats.

We also know that eating less meat is linked to better weight control.

Recipe Book: Combination of legumes, vegetables, and lean beef with delicious spices

Asian Lettuce Wraps are delicious, and these use brown rice, veggies, and chicken.

8. Do you drink between 5 and 25 grams of alcohol per day (10 and 50 grams for men)?

25 grams is the equivalent of about one drink:

One twelve ounce beer

One 5 ounce glass of wine

One 1 ounce shot of spirits

Score:

1 point for between than 5 & 25/10 & 50 grams

0 point for less than 5/10 grams

0 point for more than 25/50 grams

Reminder for Your Patients: Moderation Is Key

Drinking alcohol has been shown to be beneficial, but too much is clearly a problem. In Mediterranean diet studies, most alcohol consumed is at meal times. It is clear that binge drinking is a major problem, so saving all of your drinks up for Saturday night isn’t a good idea. Those men who drank one-half to two drinks per day had the lowest risk for heart attack of all the participants in the Health Professionals Follow-up Study.

9. The ratio of the type of fat you consume is important. Do you eat more healthy oils? The optimal ratio is 1.6 portions of healthy fat to 1 portion of less healthy fats per day.

Healthy fats include:

Olive oil, canola oil, grapeseed oil, peanut oil, soybean oil

Less healthy fats include:

Hydrogenated vegetable oil, stick or hard margarines, butter, lard, vegetable shortening

Score:

1 point for greater than the optimum ratio of greater than 1.6 to 1 for healthy fatsless healthy fats.

0 point for less than the optimum ratio of greater than 1.6 to 1 for healthy fatsless healthy fats.

Low Fat Has Been Debunked!

For a long time there was a feeling that all fats were bad. We now know that this is wrong. Low-fat diets turned out to be almost as silly as low-carbohydrate diets. The key is good-quality fats. In Mediterranean diet studies, it’s clear that the main fat used is olive oil (and you thought that the French only used butter). Using olive oils in cooking is well documented to be good for you, and it doesn’t take much to see that benefit in your health. Studies have shown that even taking oil as a supplement will work.

Fill your cupboard with really great-quality fats like olive and canola oil. Use butter sparingly for great flavor and texture.

Final Score

There is no passing or failing grade for this test. The higher you or your patients score, the better. A “perfect” Mediterranean-style diet would be a score of 9. The impact of improving your score can be dramatic.

What About Eggs?

Interestingly, the Trichopoulou study did look at egg consumption but only to control for it as a continuous variable. Their conclusion was that no “association is evident for egg consumption.” There have been, however, numerous studies that indicate egg consumption is not the problem that it was once thought to be.

The exception to this appears to be in those with diabetes. There may be an increased risk in that population with frequent consumption of eggs associated with higher rates of heart disease. The Mediterranean diet is the American diet. Careful choice of ingredients; more plant-based foods, including high quality fats; more fish, lean meat, and dairy; and moderate alcohol consumption are the keys. You can find out more about Mediterranean diet along with recipes that suit your patients’ lives at DrGourmet.com.

Tim Harlan, MD, is currently the Medical Director at Tulane University School of Medicine and an assistant professor of medicine. He writes extensively on diet and health on his website DrGourmet. com, the easy-to-use resource to navigate complex nutrition and wellness info translated for the American kitchen. He is also the author of Just Tell Me What to Eat!