Implementing the Med Diet - Part One

09/16/22 • 9 min

Do you think you eat enough plants in your diet? How many plants do you eat in a week? Not refined grains, but plants. You can cook them, boil, bake, microwave, roast them or even eat them raw. How many? Further, it's not just eating more volume of plants, it's diversity.

Mediterranean Diet and Plants

Adherence to the Mediterranean diet depends more on plants.

Vegetables
Fruits, Tree Nuts, Seeds
Legumes
Whole Grains
Olive oil

When it comes to plants, more is better. But not just in quantity of plants, but also diversity.

Think about this: there is no one plant that can provide all the micronutrients and macronutrients a person needs. We tell vegetarians to use several plant sources for complete proteins, the same is true for any nutrient.

Gut Bugs and Plants

Your gut contains a trillion bugs. There are more of them than of us. But what do they eat? It turns out, most of what they eat are the things we don't. Gut bugs eat plant parts. Without them eating those plant parts, we would be far worse off. Thus, the gut microbiome is an exciting research field.

Guts break down fiber to chemicals shown to:

Decrease the risk of colon cancer
Lower cholesterol
Decrease blood sugar spikes
Decrease depression
Allow absorption of polyphenols

Fiber is an Essential Nutrient

Plants provide vitamins, minerals, macro and micronutrients. A single source of plants cannot provide the nutrients a person requires, which has been the main reason we recommend a diversified diet. Fiber is also a nutrient, an essential nutrient, one that humans cannot make, but without it there is clearly an increase in disease. While those on the extreme of low-carb diets will disagree, the literature is unambiguous.

Myth

Fiber supplements are not a substitute. Some are expensive, one selling for over $150 a month. But no supplement gives you the diversity of nutrients that you can get from your diet. Mother Nature gives you a better deal. So, eat your fiber, don't buy a supplement.

Now begin to chart your diversity

Today's assignment is simple: begin to chart the diversity in your diet, so that you increase the sources of your plants. One of my favorite dieticians, Dr. Megan Rossie, suggests a person has 30 plant-based foods per week. Sound impossible? Let's try it using the Meditereanean Diet.

Why 30?

It isn't that difficult to implement, but consider that you want to consume the vitamins, minerals, antioxidants, and other nutrients, and there is no one plant that does this. But many will.

Vegetables:

One Mediterranean diet point is achieved by consuming 9 ounces of vegetables per day. Run through the list of vegetables that you can add to your diet in any given week.

Asparagus
Beets
Bok Choi
Broccoli
Brussels Sprouts
Cabbage
Cauliflower
Carrots
Celery
Cucumbers
Eggplant
Jicama
Kale
Leeks
Lettuce
Onions
Parsnips
Peppers
Spinach
Squash
Tomatillos
Zucchini

Fruits:

Apples
Apricots
Avocado
Bananas
Blueberries
Cherries
Coconuts
Dates
Grapes
Grapefruit
Jackfruit
Kiwi
Lemon
Lime
Mangos
Melons
Nectarines
Peaches
Pears
Pineapple
Pomegranates
Plumbs
Prunes
Oranges
Tomato
Watermelon

Legumes:

Black beans
Butter beans
Chickpeas
Green beans
Kidney beans
Navy beans
Pinto beans
Navy beans
Lentils
Peanuts

Whole Grains:

Barley
Brown Rice
Buckwheat
Bulgur
Corn
Millet
Oatmeal
Whole wheat
Red rice

Nuts:

Acorns
Almonds
Brazil nuts
Cashews
Chesnuts
Hazelnuts
Macadamias
Pecans
Pine nuts
Pistachios
Walnuts

Seeds:

Chia
Flax seeds
Hemp
Pomegranate
Poppy seeds
Pumpkin
Sesame seeds
Squash seeds
Sunflower

These provide a diversity of micronutrients, macronutrients and fiber.

All of which provide a healthy diet.

But let's not forget one of the most important plants:

Perhaps the most important part of the Mediterranean Diet is this plant.

Breakfast ideas...

Implementing the Med Diet - Part One

Mediterranean Diet and Plants

Adherence to the Mediterranean diet depends more on plants.

Vegetables
Fruits, Tree Nuts, Seeds
Legumes
Whole Grains
Olive oil

When it comes to plants, more is better. But not just in quantity of plants, but also diversity.

Gut Bugs and Plants

Guts break down fiber to chemicals shown to:

Decrease the risk of colon cancer
Lower cholesterol
Decrease blood sugar spikes
Decrease depression
Allow absorption of polyphenols

Fiber is an Essential Nutrient

Myth

Now begin to chart your diversity

Why 30?

It isn't that difficult to implement, but consider that you want to consume the vitamins, minerals, antioxidants, and other nutrients, and there is no one plant that does this. But many will.

Vegetables:

One Mediterranean diet point is achieved by consuming 9 ounces of vegetables per day. Run through the list of vegetables that you can add to your diet in any given week.

Asparagus
Beets
Bok Choi
Broccoli
Brussels Sprouts
Cabbage
Cauliflower
Carrots
Celery
Cucumbers
Eggplant
Jicama
Kale
Leeks
Lettuce
Onions
Parsnips
Peppers
Spinach
Squash
Tomatillos
Zucchini

Fruits:

Apples
Apricots
Avocado
Bananas
Blueberries
Cherries
Coconuts
Dates
Grapes
Grapefruit
Jackfruit
Kiwi
Lemon
Lime
Mangos
Melons
Nectarines
Peaches
Pears
Pineapple
Pomegranates
Plumbs
Prunes
Oranges
Tomato
Watermelon

Legumes:

Black beans
Butter beans
Chickpeas
Green beans
Kidney beans
Navy beans
Pinto beans
Navy beans
Lentils
Peanuts

Whole Grains:

Barley
Brown Rice
Buckwheat
Bulgur
Corn
Millet
Oatmeal
Whole wheat
Red rice

Nuts:

Acorns
Almonds
Brazil nuts
Cashews
Chesnuts
Hazelnuts
Macadamias
Pecans
Pine nuts
Pistachios
Walnuts

Seeds:

Chia
Flax seeds
Hemp
Pomegranate
Poppy seeds
Pumpkin
Sesame seeds
Squash seeds
Sunflower

These provide a diversity of micronutrients, macronutrients and fiber.

All of which provide a healthy diet.

But let's not forget one of the most important plants:

Perhaps the most important part of the Mediterranean Diet is this plant.

Breakfast ideas...

Previous Episode

Mediterranean Diet - Fats

Perhaps the most important part of the Mediterranean Diet is this plant.

Olive oil is the single ingredient most associated with the Mediterranean Diet. It is the one single food substitution you can do that will improve your health immediately and have great consequences. But not all olive oil is the same.

Olive oil and your heart

There are many types of fat that you can find in your diet. Saturated fat will raise your LDL level, increasing your risk of heart disease and stroke. Olive oil, which is unsaturated, decreases the risk of heart disease.

Types of Fat

Fats are confusing. You will hear saturated, poly unsaturated, monounsaturated, and trans fats. First, we won't look at the chemical structure of fats. Second, we will look at the evidence that the food is associated with fat and how it influences our bodies. Finally, we will dismantle some bad arguments against certain fats.

Saturated Fats - it's the source, not the ingredient

Sources: butter, red meat, dairy.

What the Mediterranean Diet showed us what that the total diet mattered more than the individual ingredient. In spite of the revolutionary approach to using cohort studies with complete diets, many have insisted on pulling that apart to find out if one ingredient is "bad." For years, saturated fat was considered the "bad" part of what we ate. The American Heart Association recommended limiting saturated fat to just ten percent of what you eat. The AHA recommended changing from saturated fat to polyunsaturated fat or monounsaturated fat. There has never been a question about olive oil, but a few concerns have been raised about some polyunsaturated fat.

But it isn't as simple as the saturated fat molecule. We don't eat pure saturated fat, it turns out we eat food containing that fat. Depending on the food, it depends on how saturated fat affects you.

Dairy and Fish vs Red Meat

Adding more fish and dairy to your diet decreases the risk of heart disease. Adding more red meat to your diet increases your risk of heart disease. This study, from the EPIC group, was impressive in its size, and its ability to factor out other issues that might increase heart disease. Once again, cohort studies show it isn't as important.

Cheese

Besides heart disease, cheese decreased the risk of dementia among a cohort of Finnish men followed for 22 years.

Perhaps the greatest snack of all time (my opinion - not science).

Another cohort study found that cheese was associated with a lower risk of pre-diabetes. Other forms of dairy products did not have this same benefit. This flies in the face of some vegans, who insist diabetes comes from saturated fat.

Finally, non-dairy cheese is not a great source of nutrients. I know my fellow vegans want to find a good alternative for cheese, but there simply isn't one.

Proving again that the whole food is greater than its parts, fish.

Fatty fish have been shown to decrease not only cardiovascular mortality, but all causes of mortality. But not fish oil.

Who doesn't love a good salmon?

Fish consumption has been associated with a lower risk of heart disease. Further, fatty fish decreases the risk of all-cause mortality.

Fatty fish contain high quantities of omega-3 fatty acids. Our body cannot make these fats, we must get them from our diet. Here are the fish that are high in omega-3 fatty acids:

salmon
sardines
mackerel
herring
lake trout
canned light tuna

Even tilapia has some omega-3 fatty acids, in fact, it has about four times as much omega-3 fatty acids as grass-fed beef. However, tilapia has ten times less omega-3 fatty acid as salmon. Some have discouraged the consumption of

Next Episode

Mediterranean Diet After Weight Loss Surgery

Mediterranean Diet after weight loss surgery

Success after weight loss surgery doesn't end with an operation. It just gets started.

The most recalcitrant people to diets are those who undergo weight loss surgery. Weight loss surgery patients were on multiple diets prior to surgical intervention. The Mediterranean Diet is the best post-operative diet one can have.

Weight Loss and the Mediterranean Diet

The Med Diet is favorable for health. Multiple studies have shown decreased risk of cardiovascular disease, cancer, and autoimmune disease. What about weight loss? Systematic reviews have shown the Med Diet is equal or superior to other diets for weight loss. However, we found no post-operative program to adopt the Med Diet after weight loss surgery.

Preoperative Med Diet

We began coaching patients with the Med Diet before surgery. Many insurance companies require a preoperative, physician-supervised diet. In 2010, we began to use the Mediterranean Diet as a template for our patients using the 9-point scale. Contrary to weight loss plans, our emphasis was learning the Med Diet.

Weight Loss Surgery Protocol Liquid Phase

The immediate post-operative diet emphasized soups and smoothies rich in legumes, vegetables, and fruits. Modular, unflavored protein supplements (whey or pea-based) were used to augment the protein content during this time, as were standard chewable vitamins. Thus, the beginning of the post-operative plan was already a rich Mediterranean-style diet.

Early Solid Food Phase

Legumes and fish were emphasized during the early solid food phase, which were universally easy to digest. One of the favorite Mediterranean-style foods were tacos. Contrary to popular belief, the Med Diet is not foods commonly eaten in the Mediterranean. Instead, it consists of foods rich in whole grains (corn tacos), fruits (homemade salsa), legumes (lentils), some dairy products (cheese), and fish.

We noted lettuce was problematic for some in the early phase, but spinach was easy to digest. Thus salads were based upon spinach rather than lettuce.

Later Solid Food Phase

As the stomach continued to heal, we stressed the increase in food with multiple fiber types. We de-emphasized red meats, cautioned against excess alcohol, and worked on olive oil as the primary source for fats.

Follow up

Cooking classes were a constant feature of our support group, often bringing in guest chefs from the area and the Food Network. We emphasized the importance of patients learning to cook. Many of our patients believed that cooking was the most important aspect of their postoperative care. We found that those who learned to cook their meals had better weight loss than those who did not.

Validated Food Frequency Questionnaires (FFQ) were used to follow a group of patients. The FFQ were validated using dietary logs during follow-up with patients.

Getting in that quantity of food

Stomach capacity after weight loss surgery is limited. How, then, does one get in the required amount of food? It is not difficult.

All food is measured pre-cooked. Take broccoli. If you take nine ounces of broccoli and bake it, you end up with a small amount of volume but still have the one Mediterranean Diet point.

The increase of vegetables in the diet is one way to reduce inflammation.

Food increases over time

Food volume increases over time with both the Gastric Sleeve, Lap-Band, and RNY gastric bypass. The answer is not to eat less or take more protein shakes. The answer is to eat better. To have a balanced diet.

Putting someone on yet another low-carb plan does not provide a healthy long-term solution.

Protein Deficiency

Since meat is not emphasized in the Mediterranean Diet, some patients were concerned about protein intake. Lab tests did not show any patient with protein deficiency.

The Study

Over 220 patients agreed to long-term follow-up with FFQ, but we obtained consistent data on 134 patients after surgery, with a minimum seven-year follow-up.

The FFQ were converted to the nine-point Med Diet, and the results were analyzed.

Of the 134 patients, there were 65 which had scores of 5-9 Mediterranean Diet points. They showed an absolute reduction of weight of 54% total weight loss. Those patients who scored 0-3 points had a total weight loss of 32%.

What About Poor Adherence to Med Diet

Of the patients studied, 74 had the Lap-Band, 50 had the Vertical Sleeve Gastrectomy, and ten had the RNY gastric bypass. There was no weight loss difference regarding the type of weight loss surgery.

Alcohol

Those patients who did not ...