Are you still dedicated to transitioning to the Mediterranean-style of eating? How are you doing? I hope well. Or are you new to the idea? The Mediterranean-style of eating is certainly not the latest fad diet, but it continues to amass a mound of statistical and epidemiological evidence that makes moving toward it worthy of your effort.  It’s not a new message; but it’s definitely promising, tasty and even exciting.

The Mediterranean diet is getting frequent news spots again since a big study was completed and recently published in Diabetes Care. It is s significant study because they used randomization and different eating groups, which is tied to proving cause and effect. (Most studies of diet are epidemiological research, which study populations, show relationships, but do not prove cause and effect.) Although the study found a 30 percent lower risk of cardiovascular events (mostly strokes) with the Mediterranean-style diets, than those on the low fat diet, it got a little messed up.  In reality, one of the groups was receiving free nuts and one of the groups was receiving free olive oil; both delivered to their homes. All three groups were told to eat fruits, vegetables, and fish; and cut back on commercial pastries, sweets, butter and/or margarine, and fatty red or processed meats. Unfortunately, in addition to the blurring of the groups, the ‘low-fat’ group consumed 37 percent of their calories from fat.  Note: Americans average 33 percent. So that ‘low fat’ label is somewhat misleading.

The conclusion is that especially for those genetically predisposed to diabetes and stroke, that risk can be reduced with the Mediterranean diet, especially diets that contain olive oil and nuts. Jose M. Ordovas, co-author of the new study said that the Mediterranean diet is not going to hurt anyone and this new study shows that it will help those people with risk factors. An important risk factor in these studies is a gene, named  TCF7L2-rs7903145 Polymorphism. This gene is associated with one’s susceptibility to type 2 diabetes and cardiovascular disease, as is a family history of these diseases (diabetes/stroke).  People with the gene variant, which are strongly linked with the development of type 2 diabetes, seem to be greatly benefited by eating the Mediterranean diet. This diet strongly interacts with the processes activated by their faulty gene, and this interaction reduces the risk of stroke.  Eating the Mediterranean diet seems to put those with the gene variant at the same risk as those who do not have the increased stroke susceptibility. Those who had two copies of the variant gene were three times as likely to have a stroke compared with people with one or no copies of the gene. Yet despite this, after eating the extra virgin olive oil and/or nuts their risk was reduced to the same level as those without the gene variant. That is very exciting. It goes beyond the correlations found in epidemiological studies and shows that eating these healthy foods actually makes a change in the body to reduce the chain of events that precipitates the diseases.

This study is exhilarating because it shows that making changes in the way we eat can significantly reduce risk for chronic disease. Certainly epidemiology has long suggested that our eating influences the outcome of risk for disease despite our genetics, but this study takes us a step closer to knowing that it does, and for whom.

Other valuable information was learned from this large randomized study, which is still valid despite less control than desired over how the groups ate.  The groups that received the nuts and olive oil were advised to eat as much olive oil and nuts as they wanted. One thing that was interesting is that they poured on the olive oil and ate all the nuts they wanted and still didn’t gain weight consuming these calorie-dense foods. The researchers need to do more studies to try to discover why that happened. Whatever the reason, it is great news that they did not gain weight. But the most important outcome is learning that genetic risk can be modified by diet –not gaining weight is a nice side benefit, probably intrinsically related because overweight is clearly associated with risk of diabetes and stroke.

In another study (DOI 10.1007/s00125-013-3013-y), published in Diabetologia, by Carlo La Vecchia et al; part of the European Prospective Investigation into Cancer and nutrition (EPIC) in Italy and Dr. Antonia Trichopoulou from the University of Athens, different diets were rated on a designed points scale. Their conclusion is that adherence to the Mediterranean diet and the availability of low glycemic carbohydrates (lots of vegetables and not much simple sugar and processed flour products) may reduce the incidence of type 2 diabetes.

What is, and is not, a Mediterranean Diet?

Unlike being on most fad diets, it’s an eating plan that leaves you satisfied psychologically (here I’m thinking of the Stuffed Peppers that we had this evening for dinner (stuffing of: shallots, onions, garlic, fresh basil, Italian herbs, brown rice, tomatoes, tomato paste, tomato sauce, zucchini, chopped peppers, Portobello mushrooms, salt and pepper; parboiled large meaty green peppers with fresh mozzarella cheese in the bottom, filled with stuffing and topped with Parmesan cheese.) The meal was quite yummy and definitely not painful to consume. I think you can catch the flavor of my focus by going back to a blog that I posted on January 25, 2010 – Why Decide upon a Mediterranean-Style of Eating?

The idea of eating flavorful whole foods is positive; not the torturous deprivation so often associated with going on a diet. This idea is to adopt progressively a style of eating and living. The idea is definitely not to go on a deprivation diet for a time, then return to bad eating habits after a weight goal is met.  This usually leads to a yo-yo rebound of weight. Unlike this, the Mediterranean style of eating is to eat enough to attain happy satisfaction and in so doing, making a permanent change of life style – eating and exercising.  Then the weight will stay off year after year.

Some of my friends think that Mediterranean food is American pizza (loaded with cheese, fatty meats and often huge thick white flour crusts) or a big pile of spaghetti with giant meatballs and some tomato sauce. So we should probably describe what the researchers are really meaning when they talk about Mediterranean-style eating.

The Mediterranean diet emphasizes olive oil, nuts, vegetables, fruit, beans, and seeds. It deemphasizes fatty meat, processed meat, fatty dairy products, processed grains and simple sweets. When the landmark research was done a half century ago, the Mediterranean peoples consumed whole grains – so when you do eat bread, pasta, and flour products, choose whole grains and moderate portion size.

One of my fond memories of our trip to Italy was gelato. Yes, I’m sure it had real sugar in it. Gelato has about 4 to 8 percent butterfat compared with American ice cream, with about 20 percent butterfat. Also, it had lots of fruit. But what I love about this memory was the serving size; it was less than a fourth of a cup. It was a nice treat without a huge load of fat and sugar.

Real Mediterranean meals:

• Pasta in a small to moderate portion (remember to use whole grain) loaded up with generous portions of vegetables.
• Making salads a main dish. Include fish (think salmon, tuna, shrimp); beans, fruits, nuts, avocado, tomatoes, herbs and veggies, veggies, veggies.
• Stir-fries and casseroles lend themselves nicely to Mediterranean-style meals.
• Skip the bread if you’re having pasta. Or give yourself a limit.
• Most all cuisines, no matter where they originate can emphasize vegetables and de-emphasize meats, cheeses and simple carbohydrates. So you can make your favorite flavors and cuisines move toward a Mediterranean-style of eating.
• Consider switching nuts for candy servings; and add nuts and seeds to your favorite recipes. Sprinkle them on salads or in dressings. A few that come to mind are hummus and pesto (contain pine nuts), and walnut, or pecan vinaigrette.

Just yesterday, we found ourselves in downtown Salt Lake City, hungry and not knowing where to go for a meal. We were bumbling along 200 East walking past a donut shop (not an option for us) when a kind young woman said she over heard our plight of searching for a meal. She told us about a new restaurant; Lumi Bistro that had just opened a couple of months ago; and said it was quite good. We followed her advice and were happy that we did. The owner of the establishment, Evan Sherow, waited on us; she shared that she is striving to serve whole foods, ideally locally grown. I say hooray! I’m not just happy for our delicious, duck; tomato and ginger soup; her ½ and ½ sandwich of brie with apples and fig almond jam on one half and thyme roasted mushrooms and balsamic 4-onion marmalade on the other side; but in addition it made me feel hopeful. The food was wonderful, tasty and satisfying; but more important; I assume that the demand for whole food is rising. Maybe people are beginning to realize, that what we eat really does matter.