Updated: Jan 12
It’s that time of year again when every other newspaper article seems to be either about the latest greatest diet or why the latest greatest diet, or indeed any diet, doesn’t work. To be honest it’s all a bit exhausting and it’s not unusual to want to know what actually does work.
The answer to that depends upon what you mean by “work”. You could be asking what diet is easiest to stick to and get results, and the answer to that is the one that works for you. In previous blogs I’ve looked at topics such as why we eat, what we can do about hunger and what to do when things go wrong. But there is little point in radically changing what you eat, even if you get rapid weight loss, if it doesn’t benefit your health and you can’t stick to long term.
So, for this blog I am going to look at what has the most evidence for improving health, and the Mediterranean Diet in particular. In recent years there has been increasing amounts of research showing that the Mediterranean Diet has many health benefits. Most research has been done on improved heart health, reduced cancer risk and the prevention and treatment of Type 2 diabetes but it is also likely to have benefits for many health conditions and healthy aging.
So, what is the Mediterranean Diet?
First of all, the bad news, the Mediterranean diet isn’t about eating lots of pasta and drinking red wine, no matter how much that appeals. The name describes the diet that was traditionally found in countries around the Mediterranean Sea, such as Greece, Italy and Spain and is linked to the good heart health that was traditionally found in those countries. Unfortunately, it is not as common as it once was due to more recent generations swapping to a more processed westernized diet and lifestyle. I find it quite heart-breaking that many of these countries now have the highest childhood obesity rates in Europe.
What is special about a Mediterranean Diet?
The traditional Mediterranean diet has a low intake of red meat, processed foods and salt and is high in a variety of different foods, particularly the following:
Vegetables and fruit,
Pulses such as peas, beans and lentils,
Nuts and seeds,
Seafood such as fish or shellfish and eggs,
Healthy fats such as olive oil,
Herbs and Spices.
It also has moderate intake of dairy products.
But it’s not just about foods it is also a lifestyle which includes taking time over preparing and eating food and sharing meals with family and friend, reduced stress, and being physically active
So, do I need to buy a Spanish/Greek/Italian cookery book?
You’ll notice that when we talk about what the Mediterranean diet is, we talk about the types of food rather than particular foods or recipes. For example, a vegetable tends to contain healthy fibre, vitamins and phytonutrients regardless of whether it is traditionally eaten in that part of the world. It’s not necessary to eat only Spanish, Italian or Greek recipes, any meal can be adapted to be more “Mediterranean” and I’ll give some examples below of how to adapt your favorite meals.
Can’t I just take supplements to get the healthy nutrients?
Whenever a certain way of eating is found to have benefits for health, it’s common for people to try to work out what makes it healthy. This might be scientists creating government healthy eating advice, food companies looking for foods to sell in their “healthy” products, health bloggers looking to recommend ‘superfoods’ or even supplement companies looking for individual nutrients that can be sold in tablet form. But what is often found that when you try to pull an individual nutrient or food out of a healthy way of eating, it just doesn’t have the same benefits.
You might hear about foods such as broccoli or blueberries called superfoods. These two were talked about a lot a few years back, so I thought in the name of an up-to-date blog I’d do an internet search to find out what the latest trends were. Apparently, there are between 1 and 25 of them depending upon who you believe. One or two I’d never heard of, but the majority of foods currently being touted as superfoods are also common in the Mediterranean diet, often fruits, vegetables or whole-grains. These are healthy foods and well worth eating, but they’re not magic, it’s much better to have a range of different healthy foods in the diet rather than just lots of one.
Trying to pull out individual nutrients to make a supplement is harder still. For example, a vegetable such as broccoli contains lots of different nutrients. There is lots of fibre and fluid, small amounts of carbohydrate, protein and minerals such as calcium and iron, a good amount of vitamin C and some vitamin A and B6. There are also some chemicals known as phytonutrients that aren’t essential to keep you alive but have antioxidant and anti-inflammatory benefits and are believed to help keep you healthy. However, the health properties of these only seem to work well as part of the food they are contained in, or better still as part of a varied diet. So, while there is plenty of evidence for example that a diet rich in fruit and vegetables lowers rates of cancers, studies of supplementing a single nutrient commonly found in these have often been disappointing. There have even been studies, most notably one where vitamin E supplements were given to patients at high-risk of lung cancer, where high dose supplements have actually increased risk.
The bottom line here is that a diet rich in lots of different kinds of plant foods and healthy fat and protein containing foods is best for the health.
Can the Mediterranean Diet Help me lose weight?
If you look back at my blog on finding out how to manage hunger, I talk about which foods are more likely to fill you up. These tend to be bulky, high fibre and low energy density foods such as vegetables, wholegrains and pulses, and low-fat protein foods such as poultry, fish eggs and dairy. Unsurprisingly, these are also common foods in the Mediterranean diet. In addition behaviours around eating found in this lifestyle, such taking time preparing and eating meals, reducing stress and being physically active can also help to reduce hunger and snacking and burn more calories.
So, the Mediterranean way of eating can help to reduce appetite and control weight, but only if you eat less calories than you burn in a day. If you eat large portions, snack frequently when you are not hungry or add large amounts of even healthy fat to your food then you may even gain weight.
Equally, if you are too restrictive and eat too few calories and deprive yourself completely of foods you love and things you enjoy doing that involve food, you are very unlikely to keep it up for too long. In a previous blog post I also discuss why it is so challenging for health professionals to just tell you what you should and shouldn’t eat.
I keep hearing about reducing processed foods – what are they?
Highly processed foods are sometimes called hyper-palatable foods because they are easy to eat in large amounts. Food companies have spent a great deal of money finding out what foods we enjoy so that we buy, eat and buy more of their products. They tend to be quite low in things that are good for us like fibre, vitamins and minerals, and high in things that aren’t such as salt, sugar and processed fats.
Processed foods usually can be recognised by having something taken out (such as fibre or water) or added (such as fat sugar, salt and other food additives). Often, they come in boxes with long ingredient lists that include things you wouldn’t use if you were cooking yourself. Think fast food, ready meals and jar sauces, white bread and cereals, commercially made cakes, sweets, crisps and processed meats such as pies, pasties, tinned meat and sausages.
Diets high in these foods are linked to poorer health. But notice the use of the term 'diets high in these foods' - they don't need to be banned from a healthy diet or labelled as bad. As long as they aren't pushing all foods rich in nutrients out of the diet they can still be included. Having "Pie Friday" isn't going to destroy the health benefits of how you've been eating the rest of the week.
To find out a bit more about processed foods and why we enjoy them so much see my blog about why we eat.
It seems quite daunting to make big changes to my diet. What should I do first?
It’s quite difficult to just change everything about your diet all at once. If you enjoy cooking and trying new things, then it can be fun to get some Mediterranean cookbooks and have a go. However, as I mentioned above, it is not necessary to do this if it’s not your thing. You can make small changes to all of your favourite meals to make them more Mediterranean. It is well worth investigating what works for you, rather than following diet plans made for you by other people. I feel a new term coming on. . .
Mediterraneanise your Meals.
First of all, have a think about what meals and snacks you really enjoy? You might want to write down some of the things that you have eaten over the last week. Often, we don’t remember exactly what we have eaten so having a go at a food diary for a week or so can be really worthwhile.
Record things such as: what you ate, where and with who, why you ate it and how much you enjoyed it. I’ve uploaded a sheet (not entirely sure about that name mind) that you can print out below, but many people just like to use a notebook which is easier to carry.
This is similar the food diary discussed in my previous blog why we eat – it’s not just about hunger part 2, where I look at why we eat. It might be worth visiting that blog if you aren’t familiar with the idea of food diaries.
But this time we’re trying to find out from this is what meals you really enjoy, what you would be happy to adapt or swap for something else, and what you really would like to keep in your diet. The biggest wins are always adding things in rather than removing them, so you don’t feel deprived.
The sort of changes you might want to try are:
Adding extra vegetables, pulses or fruit to a meal,
Choosing wholegrain bread, rice, pasta and cereals, trying different wholegrains,
Having nuts and seeds in the diet,
Using seafood, eggs and white meat rather than red or processed meat,
Changing to healthier fats such as olive or nut oils,
Replacing salt with herbs and spices.
Here is an example of the start of a diary:
You’ll notice not everything needs to be changed. The author decided that they enjoyed their biscuits, but that it might be better to have some alternative snacks around and avoid being too hungry between meals. They were happy to adapt meals to make them reflect the Mediterranean diet, but without compromising the things that they enjoy.
There are some ideas are below for things that you might want to try changing – remember you don’t have to change everything at once and don’t feel guilty about having you favourite foods on occasion even if they are on the list of things to have less often.
When you are cooking for a whole family then there may need to be a bit of negotiation around how much gets changed, so looking for changes that can be made to one plate, such as adding extra vegetables, can be easier than changing a whole meal.
Try wholegrain cereals: look at the ingredients and choose one that says wholegrains, wholewheat, or whole oats. If there’s sugar, syrup or salt added, can you find one that doesn’t have this? You can always add your own honey, fruit, yoghurt, chopped nuts or seeds if you want it a bit more interesting.
Choose bread where the main ingredient is 100% wholewheat or wholegrain flour. Grains, seeds and oats in a bread are good, but check they aren’t just a white loaf with these added. The main ingredient in a white bread will be wheat flour without the wholegrain. Try different type of bread such as rye, spelt, pumpernickel, sprouted grain or sourdough or even cook your own.
Eggs make a good, filling breakfast boiled, scrambled or if you like them fried us a spray of olive oil on a good non-stick pan. Add vegetables such as mushrooms, peppers and tomatoes. Or have seafood such as kippers, haddock, smoked salmon or mackerel.
Yoghurt – choose natural yoghurt and add your own fruit, honey, nuts and seeds or oats.
If you have a microwave available, an easy lunch is to take an extra portion of the previous night’s dinner in a cool bag
Make sandwiches using wholegrain bread or rolls as discussed above – choose fish, eggs, white meat, hummus or low-fat cheese. Avoid processed and tinned meats such as processed ham or corned beef.
Aim to double the thickness of the sandwich with salad such as cucumber, tomato, green leaves, grated carrot, sweetcorn. Or have a salad on the side or add a piece of fruit or natural yoghurt.
Increase the amount and different types of vegetables on the plate – aim for at least 3 different types and try new ones.
Choose white meat, fish or eggs more often than red meat and keep processed meats such as pies, pasties and sausages to a minimum. Oily fish such as salmon, trout, mackerel, pilchards, sardines and fresh tuna and seafood such as mussels, squid and crab are particularly good for the heart. Vegetarian protein choices include nuts, beans, seeds, dairy, eggs, tofu, and high-protein whole-grains such as quinoa.
Keep skins on potatoes and try alternatives such as sweet potatoes or add this or carrot to mash. Roast vegetables or potatoes with a spray of olive oil or use a dry fryer.
Choose wholegrain or wild rice, wholegrain pasta or different grains such as quinoa, couscous, buckwheat, polenta and bulghur.
In dishes such as casseroles, stews, curries, bolognaise add extra chopped or frozen vegetables to these dishes. Beans, chickpeas or lentils can also be added. Tinned without added salt or sugar are an easy way to do this. Lentils tend to break down when cooked and make an excellent thickener.
Use herbs and spices rather than salt to flavour dishes and try to cook from scratch rather than using ready-made sauces.
Nuts, seeds, olives, yoghurt, fruit, vegetable sticks and hummus are healthier snacks, You don't need to cut out your favourite snack foods that aren't on the healthier list, but be honest with yourself about whether you are eating because it's something you really want and will enjoy, or for other reasons like boredom or to distract yourself from something unpleasant,
Note for those with Type 2 Diabetes: the Mediterranean Diet has been shown to be one of the healthiest for people with Type 2 Diabetes but take care with your portions of carbohydrate foods as these are the ones that turn into glucose in your blood. However unprocessed carbohydrates such as wholegrain bread, brown rice, oats, quinoa, beans and fruit contain essential nutrients and fibre and release glucose more slowly into the blood (low GI) and are best not cut out of the diet all together.
Where can I look for more help?
It would be reinventing the wheel to create a comprehensive guide to adapting recipes. A search the internet will bring up many choices for healthier versions of your favourite meals – for an example, searching for ‘healthy shepherd’s pie’ or ‘Mediterranean diet lunches’.
When looking at recipes, or recipe books avoid ones that require many complicated steps or use small amounts of unusual ingredients that you won’t use again. Recipes that can be cooked in bulk and extra portions frozen for later are always useful. In my experience the best recipe books come with shopping lists of store cupboard essentials at the front.
If you are watching your weight be a little aware of how much fat is in a recipe. Try not to be too afraid of fat, some fats are essential such as omega-3 and omega-6 fats from oily fish, nuts and seeds and add taste and texture to food. But even if it is a healthy fat such as olive oils, nuts, seed and olives, they do contain a lot of calories.
Here are some websites to have a look at:
More information on the Mediterranean Diet at Oldways.
Hang on what about my red wine?
You’ll notice that I haven’t discussed alcohol yet and it’s something that always makes my heart drop as drinking red wine is often quoted as part of the Mediterranean diet. This can lead to thinking that more is better, but sadly that isn't the case.
There were some studies that found that drinking moderate amounts could have benefits for heart health (although possibility only in women over 45), but what is 'moderate drinking'? What is meant by it here is 1-2 units a day (a unit is half a pint of 3.8% beer or half a 175ml glass of wine),
We’re not sure why it might be beneficial. It could be due to reducing blood clotting, increasing good (HDL) cholesterol or the antioxidants called flavonoids contained in red wine. However, people that drink red wine tend to eat a healthier diet, lead healthier lifestyles, exercise more and smoke less and so there is disagreement about whether the benefits are real. Above 1-2 units a day alcohol increases the risk of heart disease along with a number of other health problems. We’re also becoming aware that any alcohol at all increases the risk of some cancers.
So, while having a small glass of red wine at dinner is unlikely to be harmful to your heart health, it is far from a healthy living panacea.
For more information on alcohol and the heart see the drinkaware site.
What about lifestyle?
The Mediterranean Diet isn’t just about food, it is also about lifestyle. Unfortunately, these days we all seem to be busier and busier so it can be challenging to live in a slower, lower stress way. But it is also very easy to spend a lot of time in front of a screen, which isn’t great for physical and mental health. So, perhaps we can all find a little more time to spend over cooking and eating, becoming a little more active and perhaps taking time to learn a creative hobby.
What can a dietitian do for me?
You could hire a dietitian to create you complete custom Mediterranean meal plan, complete with shopping lists, based on your personal medical history, social situation, likes and dislikes. But personally, I would recommend taking the time to learn how to adapt your own meals and snacks so that you are able to create and adapt new ones in the future. A dietitian can help support you to do this, provide ideas and answer any questions you might have.
A consultation with a Dietitian can also be helpful as they are trained to understand the reasons people eat and strategies to avoid overeating. Dietitians translate the scientific evidence on diet and lifestyle into straightforward, practical advice that works and support you to make healthy changes.
Dietetic advice can be valuable if you have a medical condition, such as diabetes, that benefits from dietary changes or you take medication that affects what you can eat.
If you are exhausted by a cycle of dieting and regaining weight, I can also support those wanting to try out non-diet approaches, working to improve their health without worrying about what the scales say.
More about what services I offer can be found here.