Eating the Mediterranean Way

Donna L. Weihofen, RD,

MS

Senior NutritionistUW Hospital & Clinics

Seven Countries StudyAncel Keys - 1958

• Studied diet, lifestyle, and cholesterol -• 12,000 healthy middle-aged men• 7 countries

• Finland• Greece - Crete• Italy• Japan• Netherlands• Yugoslavia• United States

Ancel Keys• The 1st research physician to

recognize that it was not the total fat in your diet that promoted heart disease but it was the saturated fat that was bad

• He noted that a high fat diet with olive did not increase risk of heart disease.

– Keys died in 2004 at the age of 100.

Mediterranean Diet & 2nd Heart Attack1999 Study

• 600 people who have had heart attacks– ½ followed Mediterranean diet

(30% fat, 8% saturated fat)

– ½ followed Western diet (34% fat, 12% saturated fat)

– Followed for 4 years• Mediterranean group had 50% lower risk

of repeat heart attacks compared to Western diet

Mediterranean diet reduces death from major chronic diseases –

2008 study

• Researchers assessed 12 international studies which collectively included 1.5 million participants whose dietary habits and health were tracked for periods ranging from 3 – 18 years.

• All studies used a numerical score to estimate how much people stuck to the diet, called an “adherence score”

What did they find?

• People who stuck strictly to a Mediterranean diet had significant improvements in their health

– 9% drop in overall mortality from CV disease

– 13% drop in Parkinson & Alzheimer’s disease

– 5% drop in cancer» British Medical Journal, Sept 12, 2008

Diet affects colon cancer survival• “Western diet pattern” – high amounts

of red meat, fat, and refined grains

• Mediterranean diet – high amounts of fruits, vegetables, fish and poultry

• Individuals with colon cancer who had undergone surgery and chemotherapy had significantly higher risk of recurrence if they followed a predominantly Western diet pattern.

– J. Meyerhardt, presentation at ASCO, June 2007.

'Western' Diet Not the Way to Age Well (April 15, 2013)

• A new British study provides further evidence that eating a so-called "Western" diet may not be good for you in the long run.

• People who eat this kind of diet -- which includes fried and sweet foods, processed and red meat, refined grains and high-fat dairy products -- are at increased risk for premature death. And those who do make it to old age are less likely to be in good health when they get there, the researchers said. The American Journal of Medicine, news release, April 15, 2013

Ray’s Western Breakfast Donna’s Mediterranean Breakfast

• The results show how real people,

• eating real food,

• in their own homes, can significantly

lessen their chances of dying of

cardiovascular disease and cancer.

And it will be a good life!

• People following the Mediterranean diet had a 40% lower risk of developing Alzheimer’s than those who ate the conventional American diet.

• Annals of Neurology, April 2006

– Those who followed a Mediterranean diet more closely had less cognitive decline over time.

– Amer J Clin Nutrition, Dec 2010

Mediterranean Diet & Rheumatoid Arthritis

• Arthritic persons living in Sweden began following Mediterranean diet for 3 months

– decrease in pain, inflammation, and fewer swollen joints

– Annals of Rheumatic Disease 2003

Why??• Olive oil has anti-inflammatory

properties.

• It is rich in oleic acid, which when metabolized to eicosapentaenoic (EPA) acid, has anti-inflammatory properties

• Vegetables contain a variety of antioxidants thought to help decrease inflammation

One more major benefit

Mediterranean Diet & Weight Loss

2001 study (International J Obesity)

• 101 overweight people instructed to follow low-fat diet or moderate fat Mediterranean-style diet– Only 20% could stick to low fat diet– More than 50% could stick to moderate fat diet– Both groups lost an average of 11 pounds the

first year

– However, the moderate fat group kept off a significant amount at 2 ½ year follow-up but low fat group had regained their weight.

A Fusion of Flavor & Health

“Motivation and adherence are very hard to sustain in any with loss program, but the results from this study suggest that the tastier the food, the greater overall success of the diet plan - even if it does include moderate amounts of fat.”

Diet Works! 2013

• 7,500 residents in Spain were put on one of 3 diets and tracked for 5 years:– Low-fat diet– Mediterranean diet with nuts

(almonds, walnuts, and hazelnuts)– Mediterranean diet with at least 4

tablespoons of olive oil• Participants were allowed to have up to

7 glasses of wine a week

Benefits of good real food

• The 2 groups on the Mediterranean diets had a 30% reduction of cardiovascular problems

• The study was stopped early because data were so overwhelmingly clear. – New England J Med 2/2/13

Advice from Hippocrates

• Obese people … should perform hard work…eat only once a day, take no baths, sleep on a hard bed, and walk naked as long as possible

The Mediterranean Facts • F Flavorful

• A Aromatic

• C Colorful

• T Tasty• S Sensory

Pleasure

E

• Enjoy fruits & vegetables

at every meal

Mediterranean

Quercetin• Quercetin is a flavonoid

which has powerful cancer fighting properties

• Found in: apples, cranberries, raspberries, blackberries, black currants, lingonberries

• Also in onions, tea, and red wine

An Apple a Day

• Rats with breast cancer were fed the human equivalent of 1, 3, or 6 apples/ day (Cornell University study)

• Tumor was reduced by 25, 25, and 61 percent in rats fed respectively 1, 3, or 6 apples

• J. Agriculture and Food Chemistry, online Jan. 2005

Go for Color

Cruciferous Vegetables

• Cabbage, Broccoli, Brussels sprouts, Kale, & Cauliflower.

• Sulforaphane & isothiocyanates = potential active compound

The Humble Cabbage

• SAUERKRAUT – Fermenting cabbage produces

isothiocyanates – a class of cancer fighting compounds

– Fermentation process also produces organic acids such as lactic acid which makes cabbage easier to digest.

» J. Agricultural and Food Chemistry, Oct. 2002

Eat fruits & vegetables throughout the day

How many should I eat??

• More than you are eating now!

Mediterranean

• Decrease saturated fats

D

Mediterranean

–Increase monounsaturated fats

I

Virgin olive oil is special

• Virgin olive oil is more than fat because it is real juice with other healthful micronutrients.

• Olive oil is a natural juice, pressed from the olives.

– J American College of Cardiology, Nov 2005.

Olive Oil & Breast Cancer

• Greek Study

– Women who eat olive oil more than once a day have a 35% lower rate of breast cancer than Greek women who eat olive oil less frequently.

FAT or OIL % Monunsat

% Polyunsat

% Saturated

Olive oil 77 9 14

Canola oil 62 32 6

Peanut oil 49 33 18

Veg. Shortening

45 26 25

Corn oil 25 62 13

Soybean oil 24 61 15

Safflower oil 13 77 10

Lard 47 12 41

Butter 30 4 66

Avocados – “the good fat”

• Good sources– Vitamin E– Vitamin C– Vitamin B6– Folate– Potassium– Soluble fiber– Phytonutrients –

lutein

Mediterranean

• Target your taste buds with grains

• Breads, pasta, rice, couscous, bulgur

T

Benefits of high fiber for diabetes

• Reduces speed of glucose absorption

• Improves blood sugar levels

• Lowers cholesterol and triglyceride levels

• Helps control appetite

Whole grain cereals reduced heart failure risk

• Eating whole grain breakfast cereals was associated lower risk of heart failure in Physician’s Health Study

– Decreased 28% if eating whole grain cereal 7 times a week

– Decreased by 22% if eating whole grain cereal 2 – 6 times a week

– Decreased by 14% if eating whole grain cereal at least 1 time per week

• LucDjousse, Presentation at American Assoc 47th Conference on CVD, March 2007

Pasta

• ½ cup cooked pasta = 100 calories

• Choose pasta shapes for its ability to hold and support the sauce. e.g. Tubes shapes for thick sauce; flat, long shapes for thin, smooth sauce

Pasta

• Orecchiette = little ears

• Eliche = propellers

• Ditali = thimbles

• Conchiglie = conch shells

• Linguine = little tongues

• Vermicelle = little worms

Pasta

• Name ends in–-ricee = wavy edge

– -nidi = formed into nests– -rigate = ridged– -lisce = smooth surface– -ine = smaller form– -ette = smaller form

Mediterranean• Eat more fishE

Fish Safety

• Health benefits of consuming seafood far out weigh any risk due to trace amounts of mercury in fish.

• Fish low in mercury and high in omega-3 fats– Salmon, tuna, sardines, herring

• Only 4 species of fish are significantly high in mercury:– Shark, swordfish, king mackerel, tilefish

• Harvard Center for Risk Analysis, American J Preventive Medicine, Nov 2005.

Omega 3 Fatty Acid

H H H H H H H H H H H H H H H

H C C C = C C C = C C C =C C C C C C=O

H H H H H H H H

Omega 6 Fatty Acid

H H H H H H H H H H H H H H H

H C C C C C C = C C C = C C C C C C=O

H H H H H H H H H H

Approximate Omega-3 Composition of Sea Food

Seafood – 3 ounce Omega–3 (mg.)

Anchovy 1,800

Halibut 400

Salmon 1,000 – 2,000

Scallops 300

Shrimp 300

Swordfish 700

Trout 800

Tuna (albacore) 700JAMA, 296, 1885 – 1899, 2006.

Omega – 3 Fatty AcidsFish Oils

• Acts as an anti-inflammatory agent• Reduced heart disease

– Reduces blood clot formation– Contains triglyceride-lowering properties– Lowers blood pressure– Promotes arterial relaxation– Inhibits growth of plaque– Reduces susceptibility to arrhythmias

• Reduced cancer risks

Omega- 3 fats may be of benefit in:• Asthma• Arthritis• Diabetes• Mood disorders• Cognitive function• Pregnancy

Pre-eclampsia Gestational diabetes Fetal growth Offspring cognition

Mediterranean

• Reduce amount of meat

R

Mediterranean

• Rediscover legumes and bean

R

Mediterranean

• Add a little cheese

A

Mediterranean

• Nibble on nuts

N

Walnuts – Source of Omega-3s

Walnuts added to diet :

- Significantly decreased total cholesterol and LDL cholesterol

• Bajaram, Experimental Biology, 2006

– Improved bone strength• Griel, Nutrition Journal, Jan 2007

Walnuts protect persons with Type II Diabetes

• Eating a handful of walnuts every day can help persons with Type II diabetes achieve recommended intakes for omega-3 fats which are critical to protecting the heart.

• J. American Dietetic Assoc. July 2005

Almonds source of antioxidants, vitamin E, protein, fiber,

potassium, calcium, monounsaturated fats One ounce serving of

almonds contain same amount of flavonoid-class of antioxidants as one ounce serving of broccoli.

• Milbury, P. J Agric Food Chem, July12, 2006.

Mediterranean

• Enjoy eating out

• Enjoy wine in moderation

E

How about coffee?

Coffee may protect against DNA damage!!

• Drinking a cup of coffee may reduce the oxidation damage to DNA by 12%

• According to a European study – in 2010.(Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis, Misik, C,

online Sept 2010)

Coffee and Colon Cancer

• Harvard School of Public Health analyzed 17 studies on coffee drinkers and found a lower risk of colon and rectal cancer is associated with higher levels of coffee consumption.

• More recent studies compared high versus low coffee consumption groups and it found no significant association between coffee consumption and colorectal cancer risk.

• Review of 12 studies with 646,848 participants and 5,403 with colon cancer– International Journal Cancer, April 2009

Caffeine decreases skin cancer risk

• Large observational study 113,000 men & women

• Those consuming the most caffeine were significantly less likely to develop basal cell cancers

Coffee may boost prostate health

• Study of 50,000 men found that increased intake of coffee may reduce risk of lethal and advanced prostate cancers by 60%.

• Regular coffee has effects on insulin and glucose metabolism as well as sex hormone levels, all of which play a role in prostate cancer.

• American Assoc Cancer Research conference Dec 2009

Coffee linked to lower ovarian and uterine cancer risk

• Drinking 3 or more cups of coffee per day may reduce the risk of ovarian and uterine cancer by over 20%

• The benefits appeared to be related to the caffeine content of the coffee. No benefits were observed from decaffeinated coffee.– Tworoger S, Cancer; published online Jan 22, 2008.

Print issue date: March 1, 2008– International J Cancer, April 1, 2009– Internaitonal J. Cancer, Nov 15, 2009

Mediterranean

• Active lifetime activities

A

A Norwegian

Exercising

Mediterranean

• Nourish your body with wonderful healthy food.

N

www. CHANNEL3000.comunder the “Home” tab & “Recipe” tab

Click on Donna’s Recipes

What are the characteristics of Mediterranean Diet?

• Above average consumption of vegetables, fruits, nuts, legumes, grains, and fish

• Below average consumption of meat and high fat dairy products.

• Greater that average proportion of monounsaturated vs saturated fat consumption

The Mediterranean Way

• Simple ingredients

• Bold flavors

• Uncomplicated recipes

• And it is healthy too!!

Donna L. Weihofen

Nutritionist

donnaweihofen@gmail.com

Life should NOT be a journey to the grave with the intention of arriving safely in an attractive and well preserved body,

but rather to skid in sideways,

chocolate in one hand, wine in the other

body thoroughly used up,

totally worn out and screaming,

“Wow – what a ride!”

A Norwegian

Exercising

Watch what you eat! The real truth.

• Japanese eat very little fat and suffer fewer heart attacks than Americans.

• Mexicans eat a lot of fat and suffer fewer heart attacks than Americans

• Germans drink a lot of beer and eat lots of sausages and suffer fewer heart attacks than Americans.

• Norwegians eat old dry fish and suffer fewer heart attach than Americans

CONCLUSION

•Eat and drink what you like.

•Speaking English is apparently what kills you!