I interviewed the author, Dario Giugliano, M.D., Ph.D, professor of Metabolic Diseases at the Second University of Naples, Italy
The Fat Contradiction
Wendy: Many people are going on low fat diets, yet the traditional Mediterranean diet is high in fat. Can people still lose or maintain weight on a Mediterranean diet?
Dr. Guigliano: For decades epidemiologists studying the dietary habits of the Mediterranean region were asking the same question: How can the peoples of a country like Crete enjoy an excellent state of health when 40% of their daily energetic requirements are met through the intake of fats?
A high fat diet is also typical of Finland, but in comparison the country maintains a high rate of coronary heart disease. It, therefore, appears that besides quantity, the quality of fats in the diet plays a determining role in one's state of health. The unifying feature of most Mediterranean populations is the broad use of olive oil as a main source of fat. This substitutes for the saturated animal fats so typical in northern European cuisine.
Saturated fats and dietary cholesterol tend to increase the levels of blood cholesterol, the polyunsaturated vegetable oils and fish oils tend to lower cholesterol, while the monounsaturated oils (olive oil) are neutral.
Additionally, as with other diets, calories must be taken into consideration. People can lose or maintain weight while on a Mediterranean diet given that the amount of calories is adjusted to reach or maintain a desirable weight.
How The Mediterranean Diet Is Different
Wendy: What makes the Mediterranean diet different from the common American diet?
Dr. Giugliano: The dietary pattern characteristic of the Mediterranean-style diet is high in fruits, vegetables, bread and other forms of cereals, potatoes, beans, nuts and seeds. It includes olive oil as an important fat source and dairy products, fish and poultry consumed in low to moderate levels; eggs consumed zero to four times weekly, and little red meat. This is not the obvious American-style diet.
It is interesting to point out that the American Heart Association recently issued a scientific advisory that a Mediterranean-style diet demonstrates impressive effects on cardiovascular disease, and that they may soon be changing the AHA Dietary Guidelines to reflect the Mediterranean diet.
Wendy:What has research pointed to as the reason why people in the Mediterranean have lower heart disease?
Dr. Giugliano: There are several factors why peoples in these regions enjoy a lower level of heart disease than, say, the United States. Diet is one of the more influencing factors.
We should abandon the reductionistic approach that concentrates upon any single element or food in the diet, and embrace a holistic approach that considers dietary practices as a whole. It is not by chance that the American Heart Association admits the benefits of a Mediterranean-style diet on cardiovascular disease beyond the cholesterol reduction aspect.
The Exercise FactorWendy:How does exercise, walking, and physical activity enter into the "recipe" for the Mediterranean diet and health?
Dr. Giugliano: Physical activity is an important component of the "recipe" too. Consider that the dietary pattern we are alluding to is based on food patterns typical in many regions in Greece and southern Italy in the early 1960s, within the frame of a lifestyle that mirrored social and cultural habits of a very physically active people. The Mediterranean diet seems to connote a particularly healthy lifestyle rather than a dietary inclination.
One of the Thirteen Commandments of the Mediterranean Diet, from my book, The Mediterranean Diet, Origins and Mythsis to be physically active and adopt an active lifestyle. Should your job increase a sedentary lifestyle, take a daily walk for about an hour or take up an activity equal to at least one hour of exercise per week that uses the whole body.
Wendy:High protein diets are very popular now. How do these differ from the Mediterranean diet?
Dr. Giugliano: The nutrient profile of the Mediterranean-style diet includes little protein, about 15% of daily caloric intake. This percentage is similar to that sponsored by the American Heart Association in the Step 1 and Step II diets recommended for a healthy population. Recent studies also indicate that the Mediterranean diet provides additional benefits and reduced risks of heart disease. This is the reason the AHA is reviewing Step I of their dietary recommendations towards the Mediterranean-style diet.
Wendy: I love a good red wine. How has wine figured into the Mediterranean diet? How much per day is recommended?
Dr. Giugliano: While alcohol should be avoided, particularly in excess, for those who are enjoy wine, 5% of the calories for men and 2.5% for woman are sufficient. This insures that wine is consumed in low to moderate amounts. Two glasses of a good red wine for men and one glass for women is sufficient.
One final note: For a healthy lifestyle, we should not miss the possible opportunity to lower cardiovascular risk in the population by adopting a Mediterranean dietary pattern that includes fruits, root vegetables (turnips, potatoes, carrots, onions, radishes), leafy green vegetables, break and cereals, fish, olive oil, and foods high in a-linolenic acid (an omega-3 acid), such as vegetable oils (flexseed, canola), nuts and seeds (walnuts).