What is the “Advanced” Mediterranean Diet?
Throughout my medical career, my overweight patients frequently asked me the best way to lose weight. I had seen them try all kinds of diets, such as Atkins, The Zone, Sugar Busters, South Beach, the grapefruit diet, the cabbage soup diet, Dr. Ornish’s Eat More-Weigh Less, NutriSystem, Jenny Craig, low-fat diets, low-carb diets, among many others. Many of these diets didn’t have any scientific evidence that they were safe and healthy, although it was clear that acute medical complications were uncommon.
Rarely, a diet had scientific studies demonstrating long-term effectiveness as well as evidence that the diet actually improved health and underlying chronic diseases. Dr. Ornish’s diet is a prime example. But his diet is vegetarian, and therefore, unacceptable to many people. No matter how healthy it is, they just aren’t going to do it.
Most of my patients who tried various diets did indeed lose weight, only to regain it after they got tired of the restrictions. The Atkins diet is a good example.
Around the turn of the century, I began to see a trickle of scientific journal articles that pointed me in the right direction in terms of what we should be eating if our goals are improved health and longevity, forgetting about weight loss. The eating pattern that eventually emerged included whole grains, vegetables, fruits, nuts, legumes, fish, olive oil and other beneficial fats, judicious amounts of wine, and minimal amounts of saturated and trans fats. [Saturated fats are mostly derived from animal products such as beef, chicken, and pork.] This dietary pattern had been in place in much of the Mediterranean region in the mid-20th century. The health and longevity benefits of this traditional Mediterranean diet and active lifestyle had been extensively documented by researcher Ancel Key and associates in the 1950s and 1960s. It made sense to me that I should recommed a Mediterranean-style diet to my overweight patients. Why not lose weight and improve your health and chances for a longer life at the same time?
Other than the general description of the traditional Mediterranean diet, there was no monolithic Mediterranean diet common to the entirety of the region in the mid-20th century. Local populations tended to eat what was readily available to them based on agricultural customs, local natural resources, and availability of transportation. For example, populations closer to the sea tended to eat more seafood, inland people ate less.
Scientific breakthroughs, mostly over the last decade, have allowed us to fine-tune the traditional Mediterranean diet, leading to greater improvements in health and longevity. How does my “advanced” program improve the Mediterranean diet? In two major ways. First off, the Advanced Mediterranean Diet is geared towards weight loss, not just health and longevity. Secondly, the Advanced Diet is quite specific compared to the general guidelines of the traditional Mediterranean diet.
Following the Advanced Mediterranean Diet will ensure that you get the optimal amount of various foods that have been clearly associated with lower rates of disease and improved longevity.
- How much fish? Two servings per week, to prevent sudden death and heart attacks.
- What kind of fish? Cold-water fatty fish (albacore tuna, salmon, mackerel, sardines, trout, sea bass, swordfish, herring, anchovies, halibut, pampano). Many of these fish were not available to the Mediterraneans of the mid-20th century.
- How many nuts? Three to five 1-ounce servings per week.
- How much olive oil? Aim for a minimum of seven to 14 tablespoons weekly.
- How much fruits and vegetables? At least 5 servings daily, to reduce risk of cancer, heart attacks, and stroke.
- How much legumes? Four servings per week, to prevent coronary artery disease.
- How much wine, for those who carefully weigh the risks and choose to drink? No more than one glass (4-5 ounces) daily for women and two glasses for men, to prolong lifespan and reduce coronary artery disease and dementia.
- How much whole grains? Three servings daily, to reduce risk of premature death, coronary artery disease, diabetes mellitus, and cancer.
- The traditional Mediterranean diet was generally high-fiber but how much fiber do we need? Twenty-five to 30 grams daily, to prevent diverticulosis, constipation, irritable bowel syndrome, and hemorrhoids.
- The Advanced Diet encourages usage of heart-protective omega-3 polyunsaturated fatty acids in vegetable oils, especially flaxseed, canola, and soybean oils. These were not significant contributors to the traditional diet.
- Full-fat versions of dairy products were the norm in the traditional diet. We know now that the saturated fats in them seem to contribute to hardening of the arteries (atherosclerosis), so the Advanced Diet favors the low-fat versions. For the same reason, the Advanced Diet favors leaner (lower fat) cuts of meat, poultry, and game.
The traditional Mediterraneans had physically active lifestyles that contributed to lower rates of disease and longer lifespans. But how much activity? Thirty minutes of brisk walking on most days of the week, for example, will win you the bulk of the health benefits.
Undoubtedly, we will all either die suddenly or develop diseases and then die. You can eat all the right things and exercise vigorously an hour daily, and still get run over by a truck tomorrow. Or you can play the odds, make some of the aforementioned changes in diet and lifestyle, and thereby forestall disease and death. It’s your choice.