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

The symptoms of allergies (seasonal allergic rhinitis, aka “hay fever”) can often be confused with the common cold (aka viral upper respiratory infections).  There are some key differences which you should learn.

Here is a chart with some distinguishing features that can help you to find out which one you have.

We all have small bits of time waiting in line, standing in an elevator, being put on hold during a telephone call, waiting for your files to download from the internet, at the airport gate waiting for your flight, or watching commercials on TV.  These are otherwise wasted minutes unless you can turn them into mini workouts.  When I’m in an elevator alone, I do squats (bending the knees and going down and back up).  While it may seem like this wouldn’t amount to much, think about how many times you are “waiting” and the calories you burn can actually be significant.  Trust me, the calories can add up very quickly!  Be creative.  Here are some types of things you can do while waiting.

• At the grocery checkout line, do crunches with your shopping basket, handbag, or canned foods.  (lift them up and slowly lower your arm back down)
• Stretch with both arms above your head and pretend you’re arms are being pulled up to the ceiling, lengthen your spine.
• Do lunges while you are on hold during a phone call.  Put the call on speaker phone and each time the annoying recorded message or jingle repeats means you have to do another lunge.
• Turn commuting into a mini workout.  If you have an extra 5 minutes getting to work, take a different route, walk around the block, take the stairs to your office, or get off one subway train station earlier and walk the rest of the way.
• While surfing on the internet, lift your feet from the floor until your legs are horizontal.  This is a “leg lift”.  Repeat each time your computer takes time to download content from the internet.
• Walk brisk laps around the airport terminal.  This is a great exercise especially when your flight is delayed (which is quite often these days!) or you’re waiting for your connecting flight.  You will burn extra calories if you are carrying luggage.  I always wear sneakers whenever I go to the airport for this reason.
• Clean your house.  Cleaning can be a very vigorous exercise.  Scrubbing a bathtub, sweeping the floor, wiping down tables, and cleaning the windows are great ways to burn calories and your house will look beautiful.

We all eat for many reasons aside from providing the calories needed to maintain our metabolism.  Here are some other reasons:

• To be social.  You ate dinner, but are meeting up with friends just as they sit down to dinner.  It’s tough to not share food with them, even if its just dessert or some bread.
• For the enjoyment of eating.  You’re stuffed after Thanksgiving dinner and your mother brings out a delicious pie she baked that is your favorite.  Sure, your stomach is full of turkey, but you want to enjoy your favorite food.
• Pressure from others.  People (usually relatives) say you look skinny and need to put on more weight.
• Boredom.  You’re sitting in front of the TV and are watching many commercials with advertisements for foods.  The sight of food can trigger hunger, even if it’s just on a TV commercial.
• Thirst.  In many cases, your brain confuses your body’s thirst (mild dehydration) for hunger.  After all, many foods are primarily water and will satiate your thirst.
• To stay awake.  Many people who don’t get enough sleep will sometimes snack on sugary foods to provide “quick energy” much as they would drink coffee.
• Alcohol enhances the taste of food and increases your appetite.  In many European countries, people will start their meals with an aperitif, which is an alcoholic drink.

The next time you are hungry and it’s not near mealtime, ask yourself why you need to eat.  If it’s any of the above, avoid the temptation to eat.  If you don’t know the answer, I recommend drinking a glass of water and waiting 10 minutes.  Do something that requires full brain concentration like a puzzle or take a walk outside and get fresh air.  If you still feel hungry, you can eat a small amount of a snack containing protein such as unsalted nuts, boiled egg, or a non-fat yogurt.

When you have digestive issues such as diarrhea or nausea, you must be careful about what you eat.  Most infections cause the digestive system to lose cells that produce enzymes.  The most complicated of these enzymes digest milk/dairy, proteins such as meats, and oils.  Strongly flavored spices such as chilis or curry can also cause irritation to the intestines.  It is important to avoid these groups of food early on during an intestinal infection.

I once had a patient who had a gastrointestinal infection and decided to eat spicy Thai food for dinner.  The following day she reported that she felt much sicker.  The food irritated her intestines and caused more inflammation.  After eating a “bland” diet, she felt much better.

Foods to Avoid

• Dairy (milk does not “settle” the stomach)
• Alcohol
• Meats
• Fried Foods
• Spices
• Sour foods
• Green leafy vegetables
• Carbonated beverages
• Caffeinated beverages

As a rule of thumb, when you don’t feel well think about what foods you would give a baby to eat.  Infants have very premature digestive tracts, with an inability to digest complicated foods.  Here are some foods I recommend when you don’t feel like your body is digesting properly.  Some clinicians will include bread on this list, but I would leave it out as gluten is also difficult to digest.  In general, you want to stick with boiled foods and avoid foods fried in oil.

• Bananas contain potassium, which is essential to replenish following diarrhea
• Rice
• Applesauce
• Water
• Egg whites
• Sweet potatoes (baked)
• Clear broth (miso soup)
• Gatorade/Powerade diluted 50/50 with water (be careful if you have high blood pressure as this contains a lot of sodium)
• Ginger tea

As you are feeling better, you can start adding simple proteins such as chicken breast and yogurt.  This is called “advancing your diet”.  If you feel ill or experience diarrhea after adding these new foods, go back one step for the next meal.