Print Mediterranean Madness: FAQs About a Centuries-Old “Diet”

One of my colleagues is on a cruise of the Mediterranean right now. After the week I’ve had at work, I have to say I’m a little envious. Speaking of the Mediterranean, there’s been a flurry of information lately about what’s called the "Mediterranean diet." Have you heard of this? No, it’s not the latest fad diet to come along. In fact, this "diet," which is really a way of eating, has been around for hundreds of years.

What is the Mediterranean diet?
How many of you like fruits, vegetables, fish, olive oil, and wine? If you said “I do,” this diet just may be for you. The mainstay of this way of eating has its roots in Greece and southern Italy and focuses not only on foods prevalent in these regions, but the pleasure and sense of well-being that these cultures have taken in eating over many centuries.

Why is the Mediterranean diet so good for me?
Studies dating back to 50 years ago or so show that people who eat like the people who live in the Mediterranean region have a lower risk of death from heart disease and cancer. Eating this way can lower LDL (”bad”) cholesterol and blood pressure; reduce the risk of developing Type 2 diabetes, obesity, and lung disease; and even lower your chances of depression, and Parkinson and Alzheimer disease. And a recent study out of Israel showed that those subjects who followed a Mediterranean diet had better lipid and blood glucose control compared to those who followed a low-fat diet. What more could you ask of an eating plan?

What foods are included in the diet?
The good news for all you carb lovers: Fruits, vegetables, beans, and whole grains are staples of this eating plan. This means that bread, pasta, rice, and couscous can be part of your daily food choices, along with fresh produce like grapes, avocadoes, broccoli, and tomatoes. Fresh fruit, rather than a bowl of Ben and Jerry’s Chunky Monkey ice cream, is dessert.

As far as protein choices go, fish and poultry are emphasized, while red meat is recommended only a few times per month, with the maximum amount being 12 to 16 ounces per month. Up to four eggs per week are “allowed”. And some cheese and yogurt is okay to eat each day, preferably lower-fat versions.

Olive oil is the primary fat in the Mediterranean diet, and very little, if any, butter or margarine is consumed to keep your saturated fat intake down. Nuts and seeds are encouraged although they are high in calories, so moderation is important.

Wash it all down with a glass of red wine—one to two glasses per day for men, one glass per day for women—unless you have particular reasons or health concerns for not drinking alcohol.

What about physical activity?
You thought you could sit back, eat nuts and seeds, drink wine, and rest on your laurels? Not a chance. Physical activity, particularly walking, is an important part of the Mediterranean lifestyle, so think about ways to make this a regular part of your daily schedule.

What about calories?
Eating the Mediterranean way means eating slowly while savoring and taking pleasure in your food. By doing so, you eventually learn that you don’t need to eat as much as you once did, and that you become fuller sooner. You still need to watch portions of food, though, especially portions of olive oil, nuts, and seeds. If you’re interested in trying this eating style but need a little more structure, ask your dietitian to provide you with more guidance in terms of calories, portions, and/or carb grams.

How can I get started?
Easy ways to get started include: Eating more fish and less red meat, using olive or canola oil in cooking, and eating more fruits, vegetables, and whole grains rather than refined carbs like white bread, pasta, and sugary treats. For more information, check out these resources:

Comments:

i'm a 70 year old type II diabetic with a kidney transplant. managing carbs, glycemic index and insulin is really tough. seems to me the Mediterranean diet with all the wheat flour will speed up my demise!! the wine is great, the bread etc isn't .

Posted by: alynsach | Sep 17, 2008 02:29 PM

I would like to know how a diabetic could regulate blood sugar levels while drinking red wine. It is my understanding that once you have alcohol in your system your insulin cannot work. The alcohol is then not digested for 6-8 hs. So then you have high sugar levels from not metabolizing that wine sugars or any other carbs until the alcohol leaves your system. Why bother with the wine?

Posted by: blinggirl | Sep 17, 2008 02:43 PM

Hi alynsach,

Don't confuse the Mediterranean diet with a high carbohydrate diet. No matter what eating plan you're following, you'll need to watch your carbohydrate intake. The Mediterranean eating plan emphasizes unrefined, lower glycemic carbs, such as whole grain bread, brown rice and legumes. These foods have less of an impact on blood glucose levels than foods such as white bread, white pasta and white rice, so you might actually find managing your diabetes a little easier on this kind of eating plan. A dietitian could help you with the Mediterranean diet, if you're interested in trying it. You'd need to discuss the use of alcohol with your physician.

Posted by: acampbell | Sep 17, 2008 02:59 PM

Hi blinggirl,
Actually, drinking alcohol in moderation (such as one glass of wine or 12 oz. of light beer per day) has little effect on blood glucose control, and may actually help lower the risk for heart disease. However, for people who take insulin or certain types of diabetes pills, if they drink alcohol without eating food, there's a higher chance of having low blood glucose (hypoglycemia). Normally the liver can release glucose if blood glucose levels start to drop. Once alcohol is on board, the liver devotes its attention to "detoxifying" the alcohol, and tends to ignore what's going on with blood glucose levels. Also, it's not true that it takes 6-8 hours to digest alcohol. Alcohol can be digested fairly quickly, depending on whether food is consumed with it or not. On the other hand, alcohol is a source of calories, so it needs to be figured into one's eating plan. And some people shouldn't drink alcohol, including pregnant women, people with uncontrolled diabetes, and, of course, anyone with a history of alcohol abuse. Most people with diabetes can learn how to safely fit alcohol into their routine, if they so desire, without adverse effects.

Posted by: acampbell | Sep 17, 2008 03:08 PM

Dear Amy.

Could you please compare Canola oil vs Olive oil for us. Are they interchangeable? I used to eat about half and half but olive oil is getting to be prohibitive in cost.

The problem with alcohol is that the insulin still works very well and if you drink enough to poison the liver the blood sugar will go too low. The amount suggested in the Med diet is minimal and should not cause any problem. The extra calories without nutrients are a problem for people that gain weight.

Posted by: CalgaryDiabetic | Sep 17, 2008 03:46 PM

Excellent comments, Amy. With my personal patients who are overweight, I recommend generally avoiding or limiting the high glycemic index foods such as white bread and potatoes.

Otherwise I'm a huge advocate of the Mediterranean diet for people with type 2 diabetes. As you know, the diet is considered moderate in carb content (45-65% of calories from carbs). People with diabetes are prone to coronary heart disease. The Mediterranean diet lowers the risk and incidence of such heart disease. (Dr. Ornish's vegetarian program probably does, too.)

I put together a Mediterranean-style weight-loss program and posted it at my healthy lifestyle blog, but people need their doctor's and dietitian's approval before proceeding. For anyone interested, it's available at:
http://advancedmediterraneandiet.com/blog/?page_id=65

I need to re-visit the Oldways site to find out if they recommend whole grains rather than refined flours. The grain portion of their pyramid is a little confusing to me on that issue. I like the whole grains, for improved health. I assume the traditional Mediterranean diet of the mid-20th century featured whole grains, not refined/processed flours. Anyone here know for sure?

-Steve Parker, M.D.

Posted by: Steve Parker, M.D. | Sep 18, 2008 09:15 PM

Hi CalgaryDiabetic,

Both canola and olive oils are considered to be heart healthy, and both are rich in monounsaturated fat, the kind of fat that can lower LDL (bad) cholesterol and perhaps raise HDL (good) cholesterol. Canola oil has the least amount of saturated fat of all the vegetable oils at 7%, whereas olive oil contains 15% saturated fat. For reference, butter contains 68% saturated fat and coconut oil, 91% saturated fat. Either oil is a good choice, however. Canola oil is less expensive than olive oil, and has a milder flavor, which lends itself to baking, for example. It also holds up a little better to heat than olive oil, which makes it ideal for sauteing. Olive oil is more likely to smoke or burn at high temperatures. Remember that all oils have 120 calories and 14 grams of fat per tablespoon, so use prudently if weight loss is your goal.

Posted by: acampbell | Sep 19, 2008 08:14 AM

Dear Amy. Thanks for the comparaison. Will use mostly canola for the cooking with a little olive only when the strong flavor is needed.

By the way my wife invented (this had nothing to do with diabetes) canola-butter years ago. Which is an emulsion of real(salted or un-salted) butter and canola blended in a kitchen aid mixer. Her ratio is about 60% w/w canola and 40% butter. You pour it into a rubbermaid container and it hardens in the fridge to about margarine consistency. The kids love it and even our Dog "Lordship" who is accoustumed to eat filet mignon fed to him from a fork accepts this over real butter.

This invention is a win win win, cheaper, better for you, tastes great and is workable strait out of the fridge. Somewhat labour intensive but his Lordship helps by pre-diswhashering all the kitchen aid utensils needed by liking off every last molecule.

Posted by: CalgaryDiabetic | Sep 19, 2008 07:16 PM

What about us Type I's? Can the Med Diet benefit us? I'm a 58-yr old male, diabetic for 9 years, and a prostate cancer survivor. I use a pump, and consider myself fairly well-controlled.

Posted by: bblakely | Sep 21, 2008 12:09 PM

I would only comment to say that although I love canola oil, I have read studies that say that canola oil heated up is a cancer-causer (but then again, what isn't these days??) So I would suggest olive oil for cooking, and canola for cold things (dressing, etc.) Not 100% sure on this, they may have changed their minds by now, but look it up and check it out just to be sure :)

Posted by: Jamie | Sep 22, 2008 11:41 AM

Hi bblakely,

Following the Mediterranean diet can certainly help people with type 1 diabetes. Many of the foods consumed as part of thie way of eating have a lower glycemic index (as long as one chooses unrefined, whole grain products), which, in turn may help improve both glucose and A1C levels. In addition, since people with type 1 diabetes also have a higher risk of heart disease compared to people without diabetes, this diet can help lower blood pressure and blood lipid levels, therefore, lowering your chances of having a heart attack or stroke.

Posted by: acampbell | Sep 22, 2008 01:52 PM

Hi Jamie,
Actually, the canola oil of years ago was actually called "rapeseed oil", derived from the rapeseed plant. This oil was unrefined and contained a high amount of erucic acid, a substance thought to perhaps increase the risk of lung cancer, as well as cause heart lesions in lab animals. In the early 1970s, a low erucic acid strain of rapeseed plant was developed, which substituted the erucic acid with oleic acid, a type of monounsaturated fatty acid which is a heart healthy substance. At that time, the name of the oil was changed to "canola" oil (since a large amount of canola oil comes from Canada). So, the information about canola oil being harmful is really an urban legend and is no longer true. This oil is safe to use, even for cooking and baking.

Posted by: acampbell | Sep 22, 2008 01:59 PM

Dear Amy. Could you comment on the polyunsaturated fats like corn oil. I read in an older issue of prevention that polyunsaturated fats are good in keeping down H. Pilori responsable for a good part of ulcers. Since my wife and I tend to suffer this affliction on occaision you wonder if a teaspoon of corn oil a day would be a good thing. On the other hand I remember reading that polyunsaturated fats where no longer deemed to be good because they depress the immune system. The two sources seem contradictory.

Posted by: CalgaryDiabetic | Sep 23, 2008 02:21 PM

Hi CalgaryDiabetic,
Polyunsaturated fats, such as corn, sunflower and safflower oils, are deemed to be heart healthy. I wasn't aware of this kind of fat being linked with H. pylori (a bacterium that can cause ulcers). The research I saw on this was mostly dated from the mid 1990s, and seemed to be conducted in the lab, rather than in humans. I'm not sure that this is a widely-used way to prevent H. pylori growth at this point in time. However, the typical Westernized diet tends to be too high in omega-6 fatty acids (vegetable oils), and too low in omega-3 fatty acids (fish oil, flax seed oil, canola oil). Both omega-6 and omega-3 oils are polyunsaturated. Too much omega-6 is linked with inflammation, insulin resistance and possibly an increased risk for prostate cancer. But it's not that omega-6s are all bad and omega-3s are all good - it's more the balance in which we consume them.

Posted by: acampbell | Sep 24, 2008 08:38 AM

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