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    Archive for the ‘Mediterranean Diet’ Category

    In The News: Seeking Health? Look to the Mediterranean

    The question of “ideal diets” is a hot topic in the nutrition field.

    Although many dietitians agree that a Mediterranean style of eating — ” rich in vegetables, fruits, legumes, cereals [mainly whole grains], fish, olive oil and, yes, a bit of red wine with meals” — is optimal, you are bound to run into individuals of the opinion that good health is achieved by eating liberal amounts of saturated fat and protein while shunning carbohydrates.

    The British Medical Journal is helping shed light on this cloudy matter with one of the largest meta-analysis studies ever conducted, compiling “a dozen of the most methodologically sound of these observational studies, which included over 1.5 million people followed for up to eighteen years, analyzing cardiovascular consequences and some other important health outcomes.”

    End result? The Mediterranean diet was found to have the lowest rate of cardiovascular disease, cancer, Parkinson’s, and Alzheimer’s.

    To quote directly from the study, “greater adherence to a Mediterranean diet is associated with a significant improvement in health status, as seen by a significant reduction in overall mortality (9%), mortality from cardiovascular diseases (9%), incidence of or mortality from cancer (6%), and incidence of Parkinson’s disease and Alzheimer’s disease (13%).”

    Although the Mediterranean Diet is no longer an accurate name (the younger generations in these countries are eating too much processed food and too many calories, as evidenced by rising rates of obesity and type 2 diabetes), this particular way of eating does many things correctly.

    Among them? Focusing on minimally processed foods high in fiber and phytonutrients, including heart-healthy fats (monounsaturated and Omega-3 polyunsaturated fats), and keeping added sugars to a minimum.

    Although this is termed a “Mediterranean” diet pattern, it contains many parallels to the diet of one of the healthiest countries — Japan.

    This bit of “news” simply confirms what dietitians have been recommending for decades: stick to a desirable caloric range while making sure to eat your fruits and vegetables, keeping an eye on saturated and trans fat intake, choosing healthy fats, and avoiding added sugars whenever possible.

    I am also of the belief that since this kind of eating pattern cuts down on empty calories, it makes sticking within a desired caloric range a little easier.


    You Ask, I Answer: Battle of the "Diets"

    Andy, are you going to blog about [the study that concluded that a low-carb diet was more successful at helping subjects achieve weight loss and healthier blood cholesterol profiles than Mediterranean or low-fat ones]?

    — Anonymous
    Via the blog

    I was most certainly planning on commenting on this study, mainly because of some very distracting flaws I noticed.

    Let’s begin with some basic information.

    The study — partially funded by the Robert and Veronica Atkins foundation (potential bias, anyone?) — took place over 2 years, during which 85% of the 322 participants stuck with their respectively assigned diets (low-fat, Mediterranean, and low-carb.)

    Now with some of my “uh, wait a minute” impressions.

    Firstly, when it came to weight loss, low-carb beat out low-fat by 4 pounds (10.3 lbs vs 6.3 lbs), but edged out a Mediterranean Diet (which includes higher carbohydrate consumption) only by 0.3 lbs.

    And although the low-carb diet resulted in the best blood cholesterol profiles, it’s important to note that for this study, researchers “urged [the] dieters [on the low-carb diet] to choose vegetarian sources of fat and protein.”

    In other words, although the low-carbers had the highest saturated fat intake out of the three groups, the majority of their fats came from plant sources.

    There isn’t anything groundbreaking here. Anyone keeping up with nutrition research knows that mono and polyunsaturated fats are recommended for heart health.

    Hence, this study calls into question the belief so many low-carb fanatics like Gary Taubes fervently hold on to — that saturated fat is the best for blood cholesterol levels.

    The study specifically mentions that the blood cholesterol levels of the low-carbers is due largely to the consumption of monounsaturated fats.

    Besides, I always wondered why low-carb enthusiasts even bother bragging about improved cholesterol profiles on their diets when, two seconds later, they turn around and say that the cholesterol-heart disease link is a lie and the result of “bad science.” Which is it?

    The study wasn’t entirely a “low carb diets RULE!” piece, either.

    For instance, the Mediterranean Diet — which was highest in fiber — proved to be the most effective at managing blood glucose levels.

    Yet again, this goes against traditional low-carb beliefs (and, once again, those Gary Taubes loves to pontificate) that the research on fiber is “inconclusive at best” and that there is no need to have it in the diet.

    Before anyone jumps down my throat about whether or not I read Good Calories, Bad Calories, Gary Taubes himself said at his New York University talk in March of this year that he didn’t think high-fiber grains were any healthier than refined ones.

    Speaking of fiber, I noticed that the low-fat group was only asked to consume “low-fat grains.”

    This struck me as odd, mainly because it is hard to find grains high in fat — they are all low-fat.

    Additionally, it’s hard to overlook some bias.

    The study does not urge low-fat dieters to consume the healthiest grains (whole grains), yet specifically requests that low-carb dieters eat the healthiest fats.

    I also found it strange that for the majority of this study the low-carb group was consuming 120 grams of carbs a day. This is definitely higher than the much lower levels recommended by most low-carb advocates.

    Atkins, for instance, usually calls for no more than 100 grams of carbohydrates per day during the maintenance phase.

    Finally, take a look at the numbers and you see that although the low-carb group was not calorie-restricted, their caloric intake was lower compared to their pre-study diet.

    So, as always, we are talking about weight loss as a result of reduced caloric intake.


    In The News: Three Cheers for the Mediterranean Medley

    A recent study published in the British Medical Journal offers great news for those of you who mainly adhere to a Mediterranean “Diet” like the one pictured at right — it appears to be quite effective at lowering your risk of diabetes.

    The New York Times reports that the study, which “followed 13,380 healthy Spanish university graduates for an average of four and a half years, tracking their dietary habits and confirming new cases of diabetes through medical records” determined that “higher adherence to a Mediterranean diet rich in olive oil, plant based foods (fruits, vegetables, and legumes) and fiber but low in meats was inversely associated with incidence of Type 2 diabetes among initially healthy participants.

    I’m personally a huge fan of The Mediterranean way of eating (I hate the term “Mediterranean Diet”).

    I consider it not only delicious, but also a beautiful — and healthy — array of protein, fats, and carbohydrates.

    It is not about hunting down ice cream made with Splenda, chowing down on egg and bacon breakfasts, or munching on convenience snacks low in fat but loaded with sugar.

    Instead, you base your meals on mainly unprocessed food: nuts, seeds, whole grains, fruits, vegetables, fish, low-fat dairy, and olive oil, all with a healthy dose of portion control.

    Sounds — and tastes — good to me.

    Pyramid image © 2000 Oldways Preservation & Exchange Trust. Visit their website (http://www.oldwayspt.org) for a wealth of educational materials relating to the Mediterranean Pyramid and other current nutrition topics.


    Nutrition Highs and Lows

    People regularly throw out the terms “low-fat”, “low-carb”, “high fiber” and “reduced sugar” liberally — and often times inaccurately.

    Although the terms “high” and “low”can be subjective (a 15-story building in Manhattan is relatively low compared to the surrounding skyscrapers), they are mostly defined by clear-cut boundaries in the world of nutrition.

    When in doubt, here is a handy guide.

    If you’re talking fats, a “very low fat diet” gets no more than 15 percent of total calories from fat.

    A traditional low-fat diet, meanwhile, consists of no more than 30 percent of calories from fat.

    Keep in mind this is a rather wide spectrum.

    In reality, 16 to 25 percent is truly considered “low fat”. By the time you get to the 25 – 30 percent range, you are crossing into more moderate territory.

    Hence, the latest mainstream recommendations for 30 – 35 percent of calories from fat can not be casted off as “low-fat” dogma.

    The heart-healthy Mediterranean Diet, for instance — which no one would ever describe as “low fat” due to the prevalence of olive oil, nuts, and fatty fish — consists of approximately 30 – 35 percent of calories from fat.

    It is worth pointing out that the Mediterranean Diet is high in monounsaturated fat and very low in saturated fats.

    Mainstream dietitians have no qualms in recommending daily intake of heart-healthy foods like almonds, walnuts, olive oil, salmon, avocado, and flaxseed.

    Although there is no true definition of what a “low carb” diet is, two numbers keep popping up in the literature.

    Many clinical research trials define “low carb” as no more than 60 grams of carbohydrates per day.

    More intense low-carb advocates, however, bring the number down to no more than 30 grams a day (as much as one large apple or one standard slice of bread.)

    Food labels also have to abide by certain protocols (established by the Food & Drug Association) to make “high” and “low” claims.

    In order for a product to be labeled “low fat”, for instance, it must contain no more than 3 grams of fat per serving.

    The term “reduced calories” can only be used on a product that provides at least 25 percent fewer calories than the regular variety.

    Similarly, any product describing itself as “reduced” sugar must offer at least 25 percent less sugar than the regular variety.

    The statement “high in fiber” may only be used on products offering at least 5 grams of fiber per serving.

    As for the term “good source of fiber” – you need at least 2.9 grams per serving to qualify.

    Lastly, another interesting one: “light” can be used to describe a product that offers either at least 50% less fat, 33% less calories, or 50% less sodium than the regular variety


    In The News: Corrupted Virginity

    Extra virgin olive oil is considered the champion of all oils thanks to its high amounts of polyphenols, antioxidants, and monounsaturated fats.

    This powerful combination has been shown to decrease risks of heart disease (by lowering ‘bad cholesterol’), high blood pressure, and even breast cancer, according to some promising research from the Canary Islands.

    Sounds great, doesn’t it?

    Well, here’s a reality check you might not be too keen on cashing — that “extra virgin” olive oil you have been buying might be anything but!

    Reader Chris Davis notified me of a lengthy article published by The New Yorker earlier this year which spotlights worldwide olive oil fraud, a market laden with corruption and political scandals that can produce as much money as cocaine trafficking.

    Since reading the article, I have done a bit more research and want to share the not too uplifting news with you.

    A lot of supposed extra-virgin olive oil is really soy or hazelnut oil that has been adulterated.

    Unfortunately, the words “imported from Italy” do not necessarily mean what you think.

    If low-quality oils from North Africa are shipped to Italy, where they are then tampered with and bottled, the packaging can legally claim that oil is an Italian import.

    You might take that to mean that Tuscan olives from a small farm are made into extra virgin olive oil. Wrong!

    The Food and Drug Administration does not test oils coming into the United States for adulteration.

    Although a group known as the North American Olive Oil Association takes care of that — and they have discovered several distributors selling inferior quality oils as extra virgin — their testing is nowhere near as rigorous as that f the International Olive Oil Council.

    There are currently several proactive anti-fraud ideas being floated around.

    One would require all bottles of extra virgin olive oil to list the acidity of their contents (to be considered extra virgin, olive oil must contain an acidity of no more than 0.8%).

    Of course, who is to say that these figures can’t be doctored with the exchange of cold hard cash?

    One interesting solution to this problem comes from the region of Andalucia in Spain (one of the world’s largest manufacturers of olive oil). There are talks of using molecular cell technology to determine if olive oil labeled as extra virgin matches the structure of the authetic product.

    In the meantime, what can you do as a consumer? From a label standpoint, look for any bottles bearing the International Olive Oil Council (IOOC) stamp of approval.

    If this is absent, see if the label lists the acidity figures for the supposed extra virgin olive oil. Look for an acidity level of 0.8% or less.

    No luck? Look at the price tag. A liter of olive oil at $7.99 is highly unlikely to be extra virgin.

    For more information, check out the International Olive Oil Council’s website.


    Speaking With…: Lisa Sasson

    Lisa Sasson has been a clinical assistant professor at New York University’s Department of Nutrition, Food Studies, and Public Health for 15 years, and has almost twenty years’ experience counseling clients in New York City with their weight management goals.

    She is also co-director of NYU’s Food, Nutrition and Culture summer study abroad program in Florence, Italy. It’s only appropriate, then, that one of her specialties is The Mediterranean Diet.

    Her knowledge of nutrition and outspoken, affable personality led to appearances on Queer Eye for the Straight Guy and A& E as well as a one-on-one nutrition counseling session with supermodel Claudia Schiffer in 2004.

    Ms. Sasson is currently Nickelodeon’s nutrition consultant and has been featured in The New York Times, Reader’s Digest, Self, Time, Fitness, and was Allure Magazine’s nutrition makeover coach in 2005 and 2006.

    I sat down with Ms. Sasson and picked her brain regarding the latest fad diets. The result was a candid and insightful chat.

    Small Bites: How have diet fads evolved over the past few decades?

    Lisa Sasson: Nutrition reminds me of fashion. If you wait long enough, a certain diet will be in vogue again.

    For instance, when you look back 25 years ago, you see low-carb, high protein diets like Atkins and Scarsdale being advocated. These exact same diets resurfaced in 2003.

    Then, in the 90’s, diets were advocating counting grams of fat and eliminating it from your diet. In turn, people ate lots of carbs.

    Well, carbs, like all nutrients, have calories. Fat-free does not mean calorie-free.

    So, people ate lots of carbs and gained a lot of weight.

    SB: What themes do the most recent diet books have in common?

    LS: The glycemic index is back, and so is this idea of “good” versus “bad” carbs. Whole grains are also a focus of the newest diet books.

    Luckily, fat is becoming a component of most weight loss diets. Instead of calling for its elimination, the current books suggest eating healthy fats like olive oil, salmon, avocados, and nuts, which is a good push.

    SB: What’s your take on “good” versus “bad” carbs?

    LS: The problem I have with it is that there is no good scientific research demonstrating the importance of the glycemic index and “good” or “bad” carbs. So many factors affect the glycemic index of a food as it is. For example, the glycemic index of a potato varies depending on what you ate before, what you are eating with it, and how you prepare it.

    People take it out of context. A lot of these books focus on it because it’s a catch. It makes people think, “Oh! If I eat this I am going to lose weight.” It is a great way to draw someone into believing your book is special.

    SB: Which would you say is the best of the current diets?

    LS: Walter Willett’s book (Eat, Drink, and Weigh Less: A Flexible and Delicious Way to Shrink Your Waist Without Going Hungry) is one of the better ones.

    I liked it because he has a realistic approach. I wish he wasn’t so fixated on whole grains and the glycemic index, but he allows other carbs that may not be whole grains or “good” in the glycemic index to be incorporated.

    He also recommends healthy fats, and the meals featured in the book are simple to prepare.

    I liked Bob Greene’s book (The Best Life Diet) in the sense that it is done in increments and he goes into the psychological implications behind weight management.

    He also stresses the importance of exercise and being more physically active.

    You can’t talk about weight loss and not mention being more physically active. Not necessarily lifting weights, but just moving more. That’s the key to a healthy lifestyle.

    Exercising allows you to eat more, utilize glucose better, have more muscle mass and lose weight more quickly.

    SB: Are there any new diet books you aren’t too fond of?

    LS: Yes, The Sonoma Diet! The woman who wrote it, Connie Guttersen, is a registered dietitian. She should be ashamed! Do you know what her first “rule” is? “Throw out anything in your house that has white flour or sugar in it”!

    I mean, she takes pride in the fact that her diet mimics the Mediterranean Diet and then has the audacity to say, “Never eat pasta.”

    And then she has all these phases, or “waves”, as she refers to them. The first wave is VERY restricted. There is a whole list of foods you can’t have. You can only have certain veggies, certain nuts, and certain grains.

    There are also all these recipes that are so complicated. I was leafing through it and thinking, “Is someone really going to get home after a busy day and make these dishes?”

    The author also makes some outrageous statements. For example, she says you can’t eat fruit during phase one because of “the carbs”.

    That’s ridiculous because fruits are chock full of nutrients and fiber. Besides, they are delicious and sweet. There is absolutely no reason why people should not be allowed to eat fruit.

    Should you have limits? Of course. But to restrict a natural food makes no sense. I can’t accept that anything as natural as fruit should be eliminated from a diet.

    For someone to say, “I can’t eat an apple, I’m on a diet,” is just laughable.

    Oh, and throughout the whole diet you can only have Barilla Plus multigrain pasta, but not regular pasta. What bothers me is that Italians aren’t eating whole grain pasta.

    What matters more is what they’re putting on their pasta.

    SB: What do you mean?

    LS: In Italy, pasta has very little sauce on it. It’s eaten with beans and lots of vegetables, and it’s usually a side dish, not a huge meal. It is not a huge portion.

    SB: What would you say to someone who critiques nutritionists as being too objective when analyzing diets? It’s easy to look at the science, but what about the personal experience?

    LS: Funny you should ask that. I was looking at all these diets and thought to myself, “What does it feel like to go on these diets?” I wanted to really experience it “from the other side”, so to speak, so I decided to go on South Beach for 2 weeks. I followed it very strictly.

    The good thing was that while I was on it, I had very little freedom, so I was not tempted to just pick or snack mindlessly.

    So, it was easy in the sense that there wasn’t much choice. I was so hungry that whatever I ate, I enjoyed.

    The bad thing is that, while dieting, I continued living my normal life. It was very difficult to exercise during these two weeks. Yoga was particularly taxing.

    I was so low on carbs that I was glycogen-deprived, and glycogen is the main source of fuel. I felt light-headed, had terrible headaches, and was very moody.

    It was also hard for me to look forward to the social aspect of a meal. The joy and pleasure of food was taken out.

    After five days I couldn’t look at another egg because every morning I had one for breakfast. I also found it frustrating that I couldn’t just have a glass of wine with dinner.

    SB: So, psychologically, it was difficult.

    LS: Yeah, and what I hate about all these diet books is that none acknowledge that losing weight is not always easy.

    They talk about how delicious their recipes are and all the variety they offer and how you wake up and get to eat delicious things like ricotta cheese with Sweet and Low and Cocoa powder, which, ugh, I don’t know how anyone can find that tasty. It’s disgusting.

    And, again, none of these books mention fatigue or boredom. They dismiss it. All they talk about is how you’re going to lose all this weight in two weeks, and how you have so much choice, and how with each phase you can eat more. Please. I wanted to search the index for “headaches” and “moodiness” to make sure I wasn’t going crazy.

    SB: What about food shopping?

    LS: Oh, God! I would go to the supermarket and put all these artificial food products into my cart. I had diet gellatin, diet popsicles, diet ice cream, and all these products with fifty ingredients.

    Diet Jello became my best friend because I would make 2 boxes a day and make it when I was hungry. I would eat eggs, diet Jello, sugar-free pops, sugar free this, sugar free that. Meanwhile, I’m thinking, “This is expensive and I can’t have fresh fruits in my cart!”

    SB: What are some common pitfalls dieters make?

    LS: Setting unrealistic expectations. Rather than think of this as a change of their lifestyle, people just think of it as “I need to lose 40 pounds by my birthday.”

    Healthy eating goes hand in hand with living healthfully. So, apart from eating well, people should exercise and sleep enough. All these things affect your eating habits.

    Don’t look at weight loss as “I need to eat more blueberries and less salmon” or some mathematical equation.

    Also, learn to listen to your body. It lets you know when you are hungry, full, or satisfied. A lot of times people can’t differentiate between hunger and boredom. You shouldn’t feel stuffed after you eat.

    Also, it’s a good idea to eat BEFORE you feel famished. This will reduce your chances of overeating or choosing unhealthy foods to immediately curb hunger.

    SB: How should people who want to lose weight prepare themselves psychologically?

    LS: First of all, have realistic expectations. Healthy weight loss is approximately 1 pound a week. So, for twenty pounds, you are looking at four to five months.

    The key is to think of this as lifestyle changes. You want to lose this weight forever, not just so you
    can show off your body at the beach and then not worry about it because in the winter you hide under baggy sweaters and jackets.

    When you lose weight quickly and go on these ridiculous restricted diets, you slowly start breaking the rules and then ease into your normal eating habits. So, what you need to change is your eating habits, and that’s going to take time.

    When you make long term commitment, you will forever have a healthier relationship with food. Weight loss will not be at the forefront, it’s going to be changing the way you eat. Eating healthfully, physical activity.

    It doesn’t – and shouldn’t — mean you can’t have desserts two times a week or pepperoni pizza a few times a month. The idea is that these foods should play less of a role. Healthy eating is not about one meal or one food, it’s about dietary patterns.

    People don’t succeed on overly restrictive diets because they focus on specific nutrients instead of changing their lifestyle. People get stuck on eating less of this, more of that, and it becomes difficult to sustain socially, culturally, physically, and emotionally.

    SB: Say someone is reading this and wants to start losing weight today. What would you recommend as a good starting point?

    LS: The first thing I tell my clients is to get rid of liquid calories. Liquids do not satiate the way food does, so it ultimately leaves room to consume more calories.

    Also, these can easily be substituted with lower calorie healthy beverages. So I would begin by replacing sodas, juices, high fat milk, beer, alcoholic beverages, cocktails, and sugary iced teas with flavored sparkling water, diluted juices, unsweetened teas, and low or non-fat milk.

    Then, each day try to do more physical movement than what you currently do. It can just be an extra ten minutes of walking every day. Then, two or three weeks later, add ten more minutes. Build it up slowly.

    Don’t focus on how little you are doing. Whatever you do — even if it’s a five minute jog — is positive.

    People just see the long-term goal and lose sight of the small steps in between. They say, “I can’t get to the gym tonight. I might as well eat a whole pizza.” Well, if you can’t go to the gym, walk for 10 or 15 minutes in your neighborhood.

    Also, pay attention to what you feel when you eat. Before you put something in your mouth, ask yourself, “am I hungry? Or bored?” Rate your hunger. When you feel satisfied, try to stop.

    Don’t buy things that make you feel vulnerable. If potato chips are irresistible, don’t have them in your house. If you have to buy them for other family members, put them somewhere out of your way so you have some time to think before reaching for them.

    Focus on fresh fruits and vegetables. Don’t get hung up on this fruit, this vegetable. If you eat close to nature, if you are eating less processed food, you are already doing a really good job. Don’t think about eliminating plums and then eating watermelon only after the third week. Fruit is healthy!

    SB: How can people spot a well-rounded “diet” book versus one that is unrealistic to follow?

    LS: I don’t like books that tell you, “throw out everything that has white flour or sugar! Don’t eat these foods for six weeks!” It’s so ridiculous. Telling someone to ban 30 different foods does not mean they will stick to it or lose weight.

    Also, these super strict rules are unnecessary. You don’t have to subsist on whole grain pasta or brown rice to lose weight. It’s OK to eat normal pasta as long as it is cooked healthily and you aren’t having three cups of it for dinner.

    If you don’t like whole grain pasta, it’s OK. It’s not the magic weight loss solution. If you’re drowing your pasta in alfredo sauce, it doesn’t matter if it’s whole grain or not.

    I like books that talk about making healthy changes rather than eliminate foods.

    I like books that aren’t about just seeing the top of the mountain, but rather about the steps you need to take to get there. Looking at that tall mountain can seem overwhelming and defeating. People should be encouraged to concentrate on small, continuous steps. That’s a much healthier, more realistic approach.

    I also think a good plan incorporates cultural sensitivity. Not everyone drinks milk, so to tell people to get calcium from dairy, that’s very shallow. Some cultures don’t drink milk and their calcium intake is just fine.

    Thanks again to Lisa Sasson for a fun and thorough interview!

    Over the next few weeks, Ms. Sasson will be analyzing some of today’s hottest diets. Come back to find out which ones make the honor roll and which make the hall of shame.


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