Healthy Cooking Columns

The Mediterranean Diet: Introduction

Over the last thirty years the media has disseminated literally thousands of columns on nutrition information and how to eat healthy. The problem is that there have been so many different (and often over-simplified) messages: avoid fat, avoid trans-fats, eat whole grains, avoid all carbohydrates, all meat is bad, all meat is good, sugar is bad, don’t eat anything white, only a vegan diet is healthy, we should eat like Neanderthals….

Some of that information is in fact mis-information: it comes from fad diets which are generally based on faulty science at best and much more often based on outright myth and pseudoscience. Add to the confusion the fact that nutrition science has been evolving in the last few years, and that health messages that are indeed founded on the best science available still do change over time. Between this and silly fad diets it can be hard to know what to believe.

That’s the bad news.

The good news is that there has been a tremendous amount of excellent research about diet and nutrition published in the last decade. We now have a great understanding of what works from studies of the Mediterranean style diet. “Mediterranean” simply refers to the people who live on the Mediterranean Sea, whose diets are higher in fruits and nuts, vegetables, legumes (beans and peas), and whole grains and cereals. They consume less red meats and poultry than we Americans do, and they eat more fish. They eat some dairy products, although much of the dairy is in the form of cultured products like cheeses and yogurt rather than drinking milk. That lower intake of poultry and red meats is coupled with a moderate consumption of alcohol, which is usually wine and drunk most often with meals. Olive oil is their main source of dietary fat, and they use far less of the more highly saturated fats like butter and lard.

The best way for you to think about this is to focus on these ingredients and that style or pattern of eating and not specific Mediterranean recipes. This style of eating and these ingredients have formed the basis for our recipes for years, and for the most part it adds up to fewer calories and better quality foods. That is, in essence, using the principles of the Mediterranean diet and applying them to the American kitchen by translating the recipes that you know and love into versions that taste just as good but are better for you. You’ll be surprised at how good healthier versions taste.

Before the year 2000 there had been a number of studies to suggest how healthy the Mediterranean Diet was, and in 2003 Antonia Trichopoulou and her colleagues reported on a large study that examined over 22,000 healthy adults in Greece. They found that those who more closely followed a Mediterranean-style diet had a significant reduction in their risk of death from heart disease and cancer. (NEJM 2003;348:2599-2608).

While there had been other studies, this was a much larger and more exhaustive look, with the researchers following participants over time. Dr. Trichopoulou and her colleagues analyzed the diets of those in the study for a year prior to the beginning of data collection. They then looked at nine dietary components of a Mediterranean diet. A value was assigned of either 1 or 0 for each dietary category: fruits and nuts, vegetables, legumes, whole grains and cereals, meat and poultry, fish, dairy, dietary fats, and alcohol. If a participant was found to have eaten a diet more favorably in each of the nine dietary components, they received a point in each of those categories. The maximum score for a perfect Mediterranean diet would be 9 and a score of 0 would indicate a more Western diet pattern. They also issued a lifestyle questionnaire that recorded physical activity.

The results were pretty amazing. Quite simply, those who had better scores lived longer and were healthier.

The best part is that small changes have a big effect. After analyzing the data, the researchers noted that a two point improvement (say from 5 to 7) in a Mediterranean Diet Score resulted in a 25% reduction in death from all causes. This would mean, for example, that by simply eating more vegetables and legumes you could markedly improve your health and live longer.

Your Mediterranean Diet Score

What about those 9 components of the Mediterranean diet? How has this been used in research and what does it mean for you?What makes up the Mediterranean diet score?

That study of over 22,000 Greeks determined a threshold amount for each component of the Mediterranean Diet. The following list details those thresholds and you can calculate your own diet score based on these amounts.

It is pretty simple. The scores have been adjusted for a 1,500 calorie per day diet for women and 2,000 calories for men. For instance, if you are a woman and consume more than 9 ounces of veggies by weight per day, on average over a week, you score one point. Eat less than that on average and you get zero. The best overall score is a 9 and the worst a zero.

Work through these 9 sections and see how you score. Keep track of your food intake for a week and score yourself on the average over the week. Even better, you’ll find that keeping a simple food diary can help you identify places where you can improve your score.

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

4 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 1 1/4 cups chopped broccoli

Score:
1 point for more than 9 ounces female / 11 ounces male
0 points for less than 9 ounces female / 11 ounces male

2. Do you eat more than 1 3/4 ounces of legumes per day (2 ounces for men)?

1 3/4 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
and 2 ounces is about 2/3 cup frozen peas

Score:
1 point for more than 1 3/4 ounces female / 2 ounces male

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

Score:
1 point for more than 8 ounces female / 9 ounces male
0 points for less than 8 ounces female / 9 ounces male

4. Do you eat less than 7 ounces of dairy per day (7 1/4 ounces for men)?

7 ounces is by weight and is about a cup of yogurt or a glass of milk

Score:
1 point for less than 7 ounces female / 7 1/4 ounces male
0 point for more than 7 ounces female / 7 1/4 ounces male

5. Do you eat more than 9 ounces of cereals or grains per day (10 1/2 ounces for men)?

2 ounces is about…
1 cup bite size shredded wheat
two slices of whole wheat bread (1 ounce/slice)
1/4 cup of uncooked brown rice
1/2 cup dry whole wheat pasta
1/3 cup uncooked quinoa

Score:
1 point for more than 9 ounces female / 10 1/2 ounces male
0 points for less than 9 ounces female / 10 1/2 ounces male

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

This is not very much, but the research looked at averages: 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 ounces female / 1 ounce per day male
0 point for less than 3/4 ounces female / 1 ounce per day male

7. Do you eat less than 3 1/4 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.

Score:
1 point for less than 3 1/4 ounces female / 4 ounces male
0 points for more than 3 1/4 ounces female / 4 ounces male

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 5 and 25 grams female / 10 and 50 grams male
0 point for less than 5 grams female / 10 grams male
Subtract 1 point for more than 25 grams female / 50 grams male

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.

Examples of healthy fats:
Olive oil
Canola oil
Grapeseed oil
Peanut oil
Soybean oil

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

Conclusion and Score
There is no passing or failing grade for this test, but the higher your score, the better. A perfect Mediterranean style diet would be a score of 9 and if you’re living on snack food and soda, it is likely your score will be closer to zero.