An article published in the New England Journal of Medicine, titled “Primary Prevention of Cardiovascular Disease with a Mediterranean Diet” created many waves in the world of nutrition.  The researchers from Spain who conducted the study had assigned two groups of people to a control group that ate a traditional “low fat” diet and an experimental group that ate a “Mediterranean” diet.  Some of the main differences include:  Encouragement to consume more than 4 tablespoons of olive oil per day, more nuts and beans in the Mediterranean group, Wine (no more than 1 glass/day) was allowed in the Mediterranean group, but none in the “low fat” group.

Though there was little observed weight loss in either group, the researchers saw dramatic reductions in heart attacks and strokes in the Mediterranean diet group.  In fact, the study was halted early because the researchers believed it was unethical to allow the control group (low fat) to continue because there was overwhelming evidence to show that the Mediterranean diet could make an impact on the participants’ health.

I believe the study reinforces many aspects of nutrition that we already know.  We know that olive oil, tree nuts (such as almonds and walnuts), red wine, and fish oils can raise HDL (“good”) cholesterol and that in turn has a cardioprotective benefit.  The diet also emphasized increasing intake of foods with antioxidants, such as fruits and vegetables.  I was a little surprised that weight was not as much of a factor.  Perhaps, it is the quality of the calories in the diet that makes a bigger difference.  However, I do think it is still important to maintain a good BMI.

The study also included a spice mixture called “sofrito” which is ubiquitous in Spanish cuisine.  It contains tomato, onion, garlic and olive oil. Previous studies have speculated that garlic can be helpful for lowering LDL (“Bad”) cholesterol and lower blood pressure.  Before you go out and buy that large bottle of olive oil, be sure that you purchase extra virgin olive oil, as use of the the refined variety (low in polyphenols) was discouraged.  Overall, I believe there is no downside to following the Mediterranean diet.  Many people have already adopted it or some aspects of the diet already. I am ectstatic to see that there is more evidence that diet can change your medical conditions and hope that one day a prescription for the “Mediterranean Diet” will be more commonplace than drugs for high cholesterol and high blood pressure.

Here are the actual daily recommendations for the Mediterranean diet group in the study:

Recommended

• More than 4 tablespoons of extra virgin olive oil
• 1 serving of nuts per day (30 grams total with 15g walnuts, 7.5g almonds, 7.5g hazelnuts)
• More than 3 servings of fresh fruit per day
• More than 2 servings of vegetable per day
• More than 3 servings of fish per week (fatty fish was recommended)
• More than 3 servings of legumes (beans) per week
• More than 2 servings of Sofrito (sauce made with olive oil, tomatoes, garlic, and onions)
• White meat instead of red meat
• 1 glass of wine with meals (optional, only for people who usually drink alcohol)

Discouraged

• Soda
• Commercial bakery goods, sweets, pastries
• Spread fats (i.e. butter)
• Red and processed meats

Want to improve your health and wellness this summer?  Pick up one of these books before you hit the beach!  (Don’t forget the sunscreen and sunglasses!)

The Miracle of Mindfulness: An Introduction to the Practice of Meditation
by Thich Nhat Hanh.  This is a wonderful book about how to incorporate meditation into your life and reduce stress.  Though the author is a Buddhist monk from Vietnam, his technique is universal.  One of the tips I learned from this book is to stop multitasking.  No one truly “multitasks” (try telling that to your boss someday!).  Instead, we “toggle” between tasks, shifting our attention from one focus to another.  Accordingly, we should focus on our attention on the people directly around us, and not be distracted by out electronic devices.  We all know it’s dangerous to drive and text, but it’s just as wise to put the phone away when you want to spend quality time with your loved ones. Live in the moment.

Forks Over Knives by Gene Stone.  This is the book that started an eating revolution and has many celebrity followers such as former President Bill Clinton.  While I have not moved over to a completely plant-based diet, I have seen many patients with cholesterol issues improve their numbers with this lifestyle.

Dropping Acid:  The Reflux Diet Cookbook by Dr. Jamie Kaufman and Jordan Stern.  A MUST for anyone with gastroesophageal reflux disease [aka, GERD, heartburn, reflux, LPR (laryngopharyngeal reflux), indigestion].  Learn what foods can cause your problems and avoid them.  I was surprised to learn that not apples are created equal!  Granny smith apples are very acidic and can make your heartburn unbearable but Fuji apples do not.

Being Mortal:  Medicine and What Matters in the End by Atul Gawande.  We will all grow old and die.  But does that mean we must suffer?  This is a must-read if you have aging parents.  It depicts the current crisis of the US healthcare system as it relates to end-of-life care.

Colon cancer is the second leading cause of cancer-related death in the United States.  For a long time, we have known that high fiber diets are not only good for lowering cholesterol but can also reduce your risk for colon cancer.  The New York Times recently reported about a published study in JAMA which showed a 21% reduced risk of colon cancer in vegetarians compared to people who ate meat.  The theory is that fiber which is indigestible moves food along in your intestines at a faster pace and picks up possible carcinogens (cancer-causing chemicals) from the intestinal wall along the way before they can be absorbed into your body.  You can think of fiber as a “scouring pad” and “sponge” for removing dirty things from the digestive tract.

On the other hand, meats are thought to contain many carcinogens.  These could result from hormones, antibiotics, chemicals and environmental pollutants which work their way into the animals we eat.  Another source is the cooking technique.  Meat that is grilled and charred contains known carcinogens called polycyclic aromatic hydrocarbons (PAH) and heterocyclic amines (HCA).  The bottom line is that moderation is the key, and reducing our animal protein intake is important.

Here are some tips on how to incorporate the study findings into your lifestyle:

• Not every meal you have needs to have meat.  Many of us have grown up with the idea that a meal is not a meal without meat.  Try substituting meat with tofu, grilled eggplant, beans, or chickpeas. Go vegetarian for lunch two or three times per week.  Try my recipe for tofu caprese salad or healthy veggie wrap, they’re delicious!
• Eat a serving of fruit everyday.  I keep a fruit bowl on my counter at home and keep it stocked each week with beautiful and colorful fruit.  I take one fruit each day and bring it to work where it sits on my desk.  Throughout the day, I stare at the fruit and it stares back at me.  At some point, I’m going to feel hungry, and the fruit will be there for me to eat.  If you don’t crave fruit usually, you will develop a craving over time if you do this.
• Buy organic fruits, especially for fruits where you eat the skin.  Thin-skinned fruits such as apples and peaches can have higher levels of pesticides and chemicals.  It is definitely worthwhile to buy the organic versions of these.
• Find out the fiber content of fruits and vegetables.  Many of my patients say they eat bananas each day to increase their fiber intake. Unfortunately, bananas are quite low in fiber and high in calories (an average sized banana has about 160 calories, almost as much a can of soda!).  Fruits with seeds such as blackberries, raspberries, or blueberries have much more fiber and are less sweet.  I often tell people, if it gets stuck in your teeth like the strings when you eat celery, it’s got a lot of fiber.  Typically we should all aim for over 25 grams of insoluble fiber each day.  This roughly amounts to 5 servings of fruits or vegetables per day.
• Sprinkle chia seeds or flax seeds in your salads, yogurt, or oatmeal.
• Juices do not provide adequate fiber!  Eat the whole fruit instead.
• Limit your intake of charred or grilled blackened meats.  Before cooking meat on the grill, microwave it for a few minutes so that you reduce time on the grill.
• Get your colonoscopy starting at age 50, or earlier if you have a family history of colon cancer!  Screenings save lives!

Did you ever wonder why we eat the way we eat now?  Breakfast for most people is a light meal, lunch a bit heavier, and dinner is chock full of calories and heavy in meat protein.  Our eating habits are remnants of the agricultural life led by our ancestors.  Imagine a farmer who gets up just before dawn and does physical labor in the morning before the heat sets in.  Then he or she may rest around noontime when it was too hot to work and resume working in the 2-3 hours before sunset.  The meals that most of us eat currently would be perfect for this type of lifestyle.  The problem is, most of us sit at desks all day long and are just as sedentary after we get home.  I would argue that our society is becoming more obese because we are not adapting our diets for the (lack of) level of physical exertion that has become part of our daily lives.  Your body is a like a bank for calories.

I understand that meals are means of social bonding and are ingrained in our daily routine.  I would recommend trying to make a few adjustments.

• Eat a heavier lunch than dinner.  Most times after dinner we sit around and watch TV, or use electronic devices such as tablets.  These activities barely burn any calories.
• Increase protein and calories for breakfast.  Many studies have shown that the body likes to start the day off with protein.  Try adding some fat-free Greek yogurt or egg white omelet to your breakfast, and you will notice you will be less hungry at lunchtime.
• Reduce the amount of carbohydrates at dinner time.  Complex carbohydrates such as breads, noodles, potatoes and rice are the body’s ideal food to store up energy.  Taken too late at nighttime, this can lead to weight gain.
• Eat dinner earlier.  By eating earlier, you increase the chances that you will be able to burn off some calories eaten at dinner.  Late night eating can also lead to reflux (GERD) and for poor sleep.
• Try the Mediterranean Diet.  It not only is delicious, but can reduce your risk of heart disease and diabetes.

If you’ve ever read the nutrition label on a jar of pickles, you’d probably be shocked to see that the sodium content is astronomical.  High sodium diets can worsen high blood pressure.  There are also many chemical preservatives added to keep pickles green.  As an alternative, you can make your own pickles with no preservatives and add just the right amount of salt.  It is the perfect healthy and refreshing accompaniment to any meal.

Ingredients:

• 6 Kirby cucumbers (or 2 typical cucumbers)
• 1 Clove garlic
• 2 Tablespoons chopped fresh dill (or 3 tablespoons dried dill)
• 1/4 Cup vinegar
• Salt and pepper to taste

Clean and wash cucumbers and cut lengthwise and into spears.  Place in a glass bowl.  Chop up the garlic and dill and add to bowl.  Pour vinegar over the cucumbers and mix well.  Add salt and pepper to taste.  Cover tightly and place in refrigerator.  They are ready to eat in an hour.  For stronger flavors, leave in the refrigerator overnight.