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What is the Mediterranean Diet?
Interviewer: You've probably heard it before: Try the Mediterranean diet. I mean, it shows up in heart health advice, cholesterol management, and even brain health. But what is the Mediterranean diet really, and why do doctors keep bringing it up?
Today, we're talking with Dr. Richmond Doxey. He's an internist and culinary medicine specialist at 麻豆学生精品版, and he is going to break it down.
So the first question is, when you talk to patients about the Mediterranean diet, how do you describe that in real-world terms?
Dr. Doxey: The Mediterranean diet is a diet that is high in intact whole grains, fresh fruits and vegetables, legumes, meaning beans, peas, peanuts, and chickpeas, some fish, and then, really, a limited amount of animal flesh, like meat and poultry and eggs, and a limited amount of dairy. And then the predominant fat source is from the grains, nuts, and seeds, and olive oil.
The Power of Whole Grains
Interviewer: So I've heard vegetables and fruits are good for me, nuts, olive oil, but whole grains, I kind of thought that we should avoid those sorts of things. If not, what are whole grains? What should we be shooting for there?
Dr. Doxey: So the data on whole grains, if you separate out refined flours from intact whole grains, think steamed brown rice, quinoa, barley in a soup, those whole grains will dramatically reduce your cholesterol and heart disease risk, actually improve blood sugar control, and they're good for your brain. They're excellent sources of B vitamins, of fiber, of good fatty acids, of iron, and other minerals. They're a powerhouse and really can go a long way in helping your health.
Nuts Should Be a Part of Your Diet
Interviewer: And I've also heard that nuts are something that most Americans really don't consume enough, and they're also kind of a health powerhouse. What kind of nuts are you focusing on?
Dr. Doxey: The key there is variety. With all these dietary things, variety is kind of the number one. So if you can get several different kinds of nuts, almonds, pecans, peanuts, which are technically legumes, pistachios, whatever you can get, I think is good. Keep in mind that you want to really limit those that are heavily oiled and salted.
Interviewer: The more natural, the better for all of these ingredients, really.
Dr. Doxey: Correct. Yep.
Legumes: Affordable and Nutrient-Dense
Interviewer: And then let's briefly talk about legumes before we move on. So you said that's basically beans. Can you give us some examples of other legumes?
Dr. Doxey: So common ones people think of are pinto beans, chickpeas, black beans, but there are others. One of my favorites to use and recommend to patients is lentils, because they cook very quickly. You cook them from dry, and boil them like pasta, and then they're ready to put in a dish, in a soup. And they have an excellent protein, carbohydrate, and fiber content. Again, full of B vitamins. And they're really inexpensive. They're quick, they're cheap, they're easy.
The Science Behind the Mediterranean Diet's Benefits
Interviewer: And why is the Mediterranean diet recommended so often? Eating these things that you talk about makes up the Mediterranean diet?
Dr. Doxey: Two big studies that I can think of off the top of my head. One was a Greek cohort that studied and published in 2003 in "The New England Journal of Medicine" that showed that those who followed the Mediterranean dietary pattern closely had a 25% reduction in all-cause mortality compared to those who didn't, and a 30% reduction in death from heart disease.
Even more impressive, in 1999, in the journal "Circulation," the Lyon Heart Study was published, and they took a few hundred patients who had had a heart attack and either put them in a group where they taught them to eat what was called the Step I diet at the time, kind of a low-fat diet, and then they put the other group and taught them how to eat the Mediterranean diet, and with several detailed sessions and follow-up. But it was just educational.
And then they watched them for over the course of about almost five years. Over the course of five years, those who followed the Mediterranean diet . . . First of all, those in that group were very adherent to the Mediterranean diet; they had a 70% lower risk of having a second heart attack. It cut the risk by 70%, which is dramatic. No medication we have does that.
Interviewer: And I've heard the Mediterranean diet, as far as diets go, is kind of the most researched diet out there. And it's also one of the most successful diets out there when it comes to any of the other eating plans you could subscribe to.
Dr. Doxey: Yeah, that is correct. There is a huge body of literature on the benefits of the Mediterranean diet for your heart, for your brain. There's even data that it improves autoimmune disease and risk for autoimmunity. It improves lung function. The Mediterranean diet can lower cholesterol. Anyway, yeah, there are multiple studies showing its benefits.
Mediterranean Diet Improves How You Feel
Interviewer: What about just making you feel better? Does it make you feel better? We know that it can reduce these health risks, but how does it make people feel when they switch to this?
Dr. Doxey: Yeah, they feel a lot better, mentally and physically. There have even been some randomized controlled trials looking at patients with depression and anxiety following the Mediterranean diet, and it gets better. But physically, you feel lighter, you feel like you have more energy. Patients tend to sleep better, breathe better, and think clearer. Yeah, there are just so many benefits.
Reducing Inflammation Through Food
Interviewer: And it can also reduce inflammation. How does that manifest in how I feel?
Dr. Doxey: In everything. So if you're eating a very inflammatory diet, high in refined sugars, saturated fats, and salt, then you're going to feel a little bit slower, a little more sluggish. Patients describe brain fog, less energy, breathing is harder, and exercise is harder. And when you switch to a Mediterranean diet, unprocessed foods, your energy improves, you feel lighter, your digestion tends to get better, and your mental clarity is much better.
Make Small, Sustainable Changes for a Healthier Diet
Interviewer: All right. So changing your eating habits for one's self and also for one's family can be really challenging. So what does this look like? For somebody who's used to a typical American diet, what might it look like to shift towards a Mediterranean pattern? How do you help people make that transition?
Dr. Doxey: I ask patients what they typically eat, and then I say, "Okay, what is one..." We can call it a congruent. "What is one congruent dietary change you can make?"
So if you're used to eating, say, a cold-cut sandwich on white bread with a slice of cheese, mayo, and ham, I say, "Well, can you switch to whole wheat bread? Now, can you add a tomato to that? Can you add some lettuce to that? Okay, what about adding a slice of avocado? Now what about adding some vegetables, like some carrots and hummus, on the side instead of chips?" And over time, you can transform what was once a pretty nutrient-poor meal into something that's very nutrient-dense and is really good for you.
Interviewer: But I get to keep the ham or the roast beef if I want to.
Dr. Doxey: If you absolutely want to, but over time, we can add things. And as you kind of point out, it's about adding things. It's about eating the good stuff. And the data supports this, too. I care much more about what you eat than what you avoid.
Interviewer: All right. I'm going to give a little tip. So one of the things I wanted to try to do was to eat more nuts. So what I found is that for breakfast, I'll have Greek yogurt, which I hope is okay, and then I'll have some fruit, like blueberries or blackberries with that. And then I'll just sprinkle some non-salted, non-roasted pumpkin seeds on there, or I like walnuts. Those are pretty good. Or maybe I'll just grab a handful of almonds. Does that sound pretty good? Am I making some good swaps there?
Dr. Doxey: Yeah, absolutely. That's a great way to go. And I often start my morning in a similar way, with a bowl of oatmeal, with a handful of nuts, chia seeds, flax seeds, walnuts, pumpkin seeds, whatever I've got.
Interviewer: And something I've been trying to eat more of is beans. I don't really eat a lot of beans, legumes. And I think sometimes we think in order to get the health benefits of these things, we have to eat a ton of them. But I just try to add... if I have a salad with some vegetables in it, I just try to add just a handful of beans. I have some cooked up in the fridge ready to go, and I just kind of throw them in there.
Dr. Doxey: Yeah, you bring up two really good points. One, if you've got it, yeah, add it to your salad, add it to your soup, add it to the dish. And then the other point that you bring up that's really important is you have it on hand, whether it's preparing a thing of lentils or beans that you put in the fridge for the week, whether it's having some canned beans you can then rinse off and add to a salad or a soup. Yeah, if you're prepared and have some stuff ready, then it becomes much easier.
Myths and Misconceptions About the Mediterranean Diet
Interviewer: Let's move on to common misconceptions. Are there any myths or misunderstandings that you run into when you bring up the Mediterranean diet? Like, "Great, I get to just eat pasta and drink wine," or, "It's expensive," or, "It sounds like it's too strict." What do you run into?
Dr. Doxey: When we talk about the Mediterranean diet, what we're really saying is there's a pattern here. And if you can eat more fruits, more vegetables, more legumes, more intact whole grains, some fish, and reduce your intake of dairy and animal protein, then you're going to do better.
So it's not just pasta and wine. In fact, alcohol in small amounts might be okay. Some data suggests that maybe even that's questionable, but certainly it's about the pattern and not just one particular food or meal.
I run into the question of cost all the time. I looked at the data several years ago, and I've actually looked at some data since then. And when they do studies looking at those who shift from the standard Western diet to the Mediterranean diet, it may cost them $1 to $2 more per week.
And in those who plan their meals and plan what they're going to do, their food costs actually go down when they shift to the Mediterranean diet, partly because you're eating less processed food and you're eating less animal products, which are actually probably some of the most expensive things we buy.
Easy First Steps to Get Started on the Mediterranean Diet
Interviewer: You already kind of mentioned some first steps. Start making some swaps. Think additive, not subtractive, like, "How can I start doing more fruits, more vegetables? How can I add some avocado to my ham sandwich if I decide that I want to continue to have that?" I would like to come up with some other first steps.
So if somebody's like, "All right, Dr. Doxey, I'm on board. I'd like to try eating more Mediterranean-style this week," what's a simple change they could start with, and then add to?
Dr. Doxey: A couple of things. One, look at how you're snacking and start making swaps and doing more nuts and seeds and dried fruit rather than processed, high-fat, high-salt snacks.
Another thing you can do is make a switch so you're using less dairy, particularly less fluid milk and maybe even a little bit less cheese, and less yogurt, and that kind of thing. And depending on what you're eating, you just kind of reduce it, or maybe you may have to swap it out.
Interviewer: For my wrap-up question, what are some common challenges that you see people face when they are trying to make this change to the Mediterranean diet that you can maybe help prevent them from running into?
Dr. Doxey: You'll be most successful if you have someone doing it with you. And so whether that's a friend, whether that's a sibling or a partner, or whomever, find someone that you can do this with, and it will increase your chances of success in the long run exponentially.
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