The Advanced Mediterranean Diet

Why the Mediterranean Diet?

     Observational and clinical studies have clearly shown that the traditional Mediterranean diet is associated with overall greater health and longevity, lower incidence of dementia and cancer (of the colon, breast, prostate, and uterus), and lower incidence of cardiovascular disease, including coronary heart disease that causes heart attacks. Furthermore, recent studies indicate that such a diet may improve asthma and prevent type 2 diabetes mellitus and chronic obstructive pulmonary disease.

What is the Traditional Mediterranean Diet?

     There is no monolithic, immutable, traditional Mediterranean diet. But there are similarities among many of the regional countries that tend to unite them, gastronomically speaking. Greece and southern Italy are particularly influential in this context.  Here are the general characteristics of the traditional, healthy Mediterranean diet:

• It maximizes natural whole foods and minimizes highly processed ones
• Small amounts of red meat. Meat is used more as a garnish than as the
  centerpiece of the meal
• Less than four eggs per week
• Low to moderate amounts of poultry and fish
• Daily fresh fruit
• Seasonal locally grown foods with minimal processing
• Concentrated sugars only a few times per week
• Wine in low to moderate amounts, and usually taken at mealtimes
• Milk products - mainly cheese and yogurt - in low to moderate amounts
• Olive oil as the predominant fat
• Abundance of foods from plants: vegetables, fruits, beans, potatoes, nuts,
  seeds, breads and other whole grain products

Oldways Preservation and Exchange Trust, in Boston, MA, has done great work promoting the traditional Mediterranean diet.  Oldways has a similar definition of the Mediterranean diet and has graciously allowed me to reproduced their traditional Mediterranean diet pyramid of 2000:  

     Scientific breakthroughs, mostly over the last decade, should allow us to fine-tune the traditional Mediterranean diet, leading to greater improvements in health and longevity.  Specific modifications to the traditional Mediterranean diet will ensure that you get the optimal amount of various foods that have been clearly associated with lower rates of disease and longer lifespan.  Please consider the following modifications—which we’ll call the Advanced Mediterranean Diet—as you eat Mediterranean-style:

• 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 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.  Before taking up the wine habit, carefully consider the pros and cons.
• How much whole grain?  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 now believe that the saturated fats in them 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.

What’s Next? 

     First, review the disclaimer at the end of this document.  It’s a good idea to get medical clearance from your personal physician before you begin any diet or exercise program.  You may have an underlying illness causing your excess weight, or medical conditions that dangerously complicate the weight-loss process.
     Unfortunately, the Mediterranean diet does not magically lead to weight loss.  Make no mistake about it: you can become massively obese eating Mediterranean-style.  To lose weight, you need to determine the level of calorie intake that will allow you to convert your excess fat into weightless energy.  It really does come down to calories in versus calories out.  “Calories in” is the food you put in your body.  “Calories out” is the energy you need to move about, and the energy needed to run basic metabolic processes in your body.  Mild caloric restriction coupled with a mild-to-moderate exercise program usually is the best route to successful weight loss.  Let’s assume you have been sedentary but will start a walking program (eventully walking at 3-4 miles per hour) for 30 minutes on most days of the week.  To lose weight, your appropriate calorie intake level is based on your sex and weight:

• Overweight women between 130 and 210 pounds should reduce calories to about 1,500 calories per day.
• Women 210 to 300 pounds reduce to 1,900 calories.
• Overweight men between 150 and 220 pounds reduce to 1,900 calories daily.
• Men 220 to 350 pounds reduce to 2,300 calories.

     Women over 300 and men over 350 pounds who have tried and failed many different diets should consider bariatric surgery, or reduce caloric intake to 1,900 (women) or 2,300 (men).  
     If you just won’t exercise regularly, reduce the above suggested daily calorie intake levels by 200-300. 
     If you exercise but fail to lose one to one-and-a-half pounds per week, reduce daily calorie intake by 200-300 and see what happens over the next week.  Many people lose two to four pounds in the first week.  If that happens the second week, you aren’t eating enough, so increase your calories!  You can adjust your daily caloric intake on a weekly basis until it’s clear how much you can eat but still lose one to one-and-a-half pounds per week.  One pound per week is more realistic and sustainable over the long run. 
     While actively losing weight, take a multivitamin daily and consider a calcium supplement, “just in case.” 
     For physical activity instruction and information, visit Shape Up America!, Physical Activity for Everyone, or Growing Stronger: Strength Training for Older Adults. 
     If you like to be part of a supportive online community while dealing with weight issues, visit SparkPeople, 3 Fat Chicks on a Diet, or Calorie Count Plus.  All are free. 
     Now the fun begins!  You start eating Mediterranean-style, following the aforementioned food guidelines and keeping track of daily caloric intake and exercise in a journal or Daily Log.  You can find caloric value of most foods at NutritionData or Calorie Count Plus.  Advanced Mediterranean dieters shop from a grocery list that you may find helpful. 

     After you reach your weight goal, add 200-300 calories back into your eating program.  For example, if you lost a pound a week on 1500 calories daily, increase to 1700 or 1800 calories.  You don’t need additional milk products or meat, so add back fruits, vegetables, nuts, whole grains, and healthy oils such as olive oil.  Keep exercising. 
     Remember: aim for at least 7-14 tablespoons of olive oil weekly, at least two servings of fish per week, and 3 to 5 1-ounce servings of nuts per week.  Favor fish and poultry over red meat.  Cold-water fatty fish - e.g., trout, salmon, albacore tuna, sardines, herring - are probably healthier than fried catfish.  The rest is up to you.

Why read a book when I have this wonderful document?

     The book I know the best is my own award-winning Advanced Mediterranean Diet.  Advantages of the book include:

• much more information is contained in the 304-page book, including solutions for all the usual dieting problems 
• extensive understandable information on nutrition and physiology
• explanation of the all-important Energy Balance Equation
• comprehensive exercise instruction, even if you have never exercised a day in your life, no matter what your current weight
• inspirational success stories stories from my patients
• adaptation of the program for people with type 2 diabetes mellitus
• learn about weight-loss pills and supplements
• learn all about bariatric (weight-loss) surgery, including complication and death rates
• list of numerous supportive, reliable Internet resources
• citations for 200 scientific journal articles that support my recommendations
• learn the two critical factors to prevent regain of lost weight
  
• Daily Logs that ensure you eat the proper proportions of grains, vegetables, fruits, fats, milk products, and proteins based on your total caloric intake (1100, 1500, 1900, or 2300 calories)
• easy, tasty recipes for breakfast, lunch, and dinner from the Parker Compound Test Kitchen
• less expensive than a single consultation with a dietitian or nutritionist
• less expensive than most popular diet programs
• less expensive than monthly fees for Internet-based weight-loss programs
• overall effect of the book is enhanced motivation, commitment, discipline, adherence, and success

     If a new book breaks your budget, borrow one from a friend or library, or see if Amazon.com offers a used book at a discount.

Advanced Mediterranean Diet Blog.  Ruminations on weight loss, health, and longevity via the Mediterranean diet.  Many blog posts are inspired by the latest published scientific research.  The most up-to-date and reliable Mediterranean diet information in the world.

Books on Mediterranean eating and cooking:

• The Essential Mediterranean : How Regional Cooks Transform Key Ingredients into the World’s Favorite Cuisines by Nancy Harmon Jenkins
• The Mediterranean Kitchen by Joyce Goldstein
• Mediterranean Diet Cookbook: A Delicious Alternative for Lifelong Health by Nancy Harmon Jenkins
• The Cooking of the Eastern Mediterranean : 215 Healthy, Vibrant, and Inspired Recipes by Paula Wolfert
• The Mediterranean Diet by Marissa Cloutier and Eve Adamson
• The Mediterranean Heart Diet: How It Works and How to Reap the Health Benefits, with Recipes to Get You Started by Helen Fisher with Cynthia Thompson and Kaja LeWinn

The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer book website.  Click here for book and program description.

Allrecipes.com.  Over 30,000 free recipes with detailed nutritional analysis, including calories per serving.  Numerous Mediterranean-style dishes (enter search word “Mediterranean”).  Also check out the “healthy living collection.”  You’ll find more than recipes here, such as tips on selecting and cooking fresh fish.

ArabicNews.com.  See Food and Recipes under “Resources” heading.

Gourmed.  Hundreds, if not thousands, of authentic Mediterranean recipes, sortable by country of origini, andy of 22 main ingredients, and by dish (e.g., salad, soup, main dish).

NutritionData.  In addition to nutrient content of foods, this site has a combined body mass index calculator and “calories burned calculator,” which predicts calories you will burn in most types  of exercise, accounting for your weight, age, and sex.  Another calculator allows you to determine nutrient content of your own recipes.  Also find nutritional analysis of menu items at many fast food restaurants.

Recipezaar.  200,000 recipes.  Need a recipe for whole wheat pancakes?  You’ll find several here, rated by website users who have prepared the dishes submitted for publication by other users.  200,000 recipes, usually accompanied by nutritional analysis per serving: calories, amounts of various fats, cholesterol, total carbohydrates, several vitamins and minerals.

The Whole Grains Council.  Many recipes here, plus links to hundreds of recipes at other websites.

Weight-Control Information Network.  A service of the (U.S.) National Institute of Diabetes and Digestive and Kidney Diseases.  Information for the public and healthcare professionals on obesity, weight control, related nutritional matters, and physical activity.

Finally… 

     Don’t be discouraged by admonitions that “diets don’t work.” They require discipline and willpower, but many diets do indeed work. Losing excess weight and adopting a Mediterranean diet will be well worth the effort over the long run. Why not get started now?

     Best wishes, and best of health to you!

Steve Parker, M.D.

Email: steveparkermd@gmail.com

DISCLAIMER
These ideas and suggestions written by Steve Parker, M.D., are provided as general educational information only and should not be construed as medical advice or care.  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physican before making any dietary or exercise changes.  Steve Parker, M.D., and Vanguard Press disclaim any liability or warranties of any kind arising directly or indirectly from use of this information.  If any medical problems develop, always consult your personal physician.  Only your physician can provide you medical advice.

Throughout this document are links to external sites.  These external sites contain information created and maintained by other individuals and organizations and are provided for the user’s convenience.  Steve Parker, M.D., and Vanguard Press do not control nor can they guarantee the accuracy, relevance, timeliness, or completeness of this information.  Neither is it intended to endorse any view expressed nor reflect its importance by inclusion in this site.