Blog | Friday, September 20, 2013

What foods are in the Mediterranean diet?


The Mediterranean diet is fresh on my mind, having recently returned from a trip to Turkey. During my trip I became a particular fan of Turkish vegetables: white beans with tomatoes and onions in olive oil, oven baked green beans or okra, eggplant stuffed with walnuts with a tomato ragout, to name a few. My husband commented that I must be a true fan of olives, as he surveyed my breakfast plate, which was chalk full of several varieties of olives, raw cucumbers, tomatoes, a few arugula leaves, fresh cheese and bread. During my travels I also enjoyed a variety of grilled fresh fish served with lemon, seaweed salad, pomegranate juice, freshly pressed at the side of road, and roasted chestnuts, also sold by street vendors.

I was elated to hear that a new study published in the New England Journal of Medicine in April of this year validated the health benefits of the Mediterranean diet. The study randomized 7,447 women and men with risk factors for cardiovascular disease to receive either a Mediterranean diet enriched with olive oil, a Mediterranean diet enriched with nuts, or a standard low fat diet for the control group. Participants assigned to the two Mediterranean diet arms were found to have a significantly reduced risk of adverse cardiovascular outcomes (heart attack, stroke, death from cardiovascular causes) compared with the control group. The study was terminated after a mean follow up time of 4.8 years.

Are you wondering how your diet matches up with the “Mediterranean Diet” as defined by the recent study? I was after I read these results.

Here are the criteria with answers qualifying for the Mediterranean Diet shown in bold.

1. Do you use olive oil as main culinary fat? Yes
2. How much olive oil do you consume in a given day (including oil used for frying, salads, out of house meals, etc.)? 4 or more tablespoons
3. How many vegetable servings do you consume per day? (1 serving = 200g - consider side dishes as 1/2 serving) 2 or more (at least 1 portion raw or as salad)
4. How many fruit units (including natural fruit juices) do you consume per day? 3 or more
5. How many servings of red meat, hamburger, or meat products (ham, sausage, etc.) do you consume per day? (1 serving = 100-150 g) Less than 1
6. How many servings of butter, margarine, or cream do you consume per day? (1 serving = 12 g) Less than 1
7. How many sweet/carbonated beverages do you drink per day? Less than 1
8. How much wine do you drink per week? 7 or more glasses
9. How many servings of legumes do you consume per week? (1 serving = 150 g) 3 or more
10. How many servings of fish or shellfish do you consume per week? (1 serving: 100-150 g fish, or 4-5 units or 200 g shellfish) 3 or more
11. How many times per week do you consume commercial sweets or pastries (not homemade), such as cakes, cookies, biscuits, or custard? Less than 3
12. How many servings of nuts (including peanuts) do you consume per week? (1 serving = 30 g) 3 or more
13. Do you preferentially consume chicken, turkey or rabbit meat instead of veal, pork, hamburger or sausage? Yes
14. How many times per week do you consume vegetables, pasta, rice, or other dishes seasoned with sofrito (sauce made with tomato and onion, leek, or garlic, simmered with olive oil)? 2 or more

*From Table in S1 in Supplement to: Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovasculardisease with a Mediterranean diet. N Engl J Med 2013.

Taking a closer look at the details of the study as described in the NEJM supplement, it seems to me that the particular factors of those listed above that really differentiated the Mediterranean groups from the control group were: the quantity of olive oil ingested, the increase in nuts consumed, and, somewhat less significantly, the amount of seafood consumed, legumes consumed, and sofrito sauce consumed.

In this study the particular kinds of nuts prescribed were walnuts, hazelnuts and almonds. However, there may be health benefits with other nuts as well. Here is some useful nutritional information from University of Michigan Health System (my alma mater) about nuts.

Personally, this study has changed my health practices. While I was already doing well with some of its components, since reading the specifics of the Mediterranean diet prescribed and found to be associated with reduced cardiovascular risk I’ve made greater attempts to incorporate legumes, nuts, and fish into my diet.

Juliet K. Mavromatis, MD, FACP, is a primary care physician in Atlanta, Ga. Previous to her primary care practice, she served on the general internal medicine faculty of Emory University, where she practiced clinical medicine and taught internal medicine residents for 12 years, and led initiatives to improve the quality of care for patients with diabetes. This work fostered an interest in innovative models of primary care delivery. Her blog, DrDialogue, acts as a conversation about health topics for patients and health professionals. This post originally appeared there.