Mediterranean Diet

1. Mediterranean Diet Dr Hassan S Makki Phoenix Heart Center

2. Where does the Mediterranean diet originate? • American scientist, Ancel Keys pointed out the correlation between cardiovascular disease and diet in the 1950’s. • The poor population of small towns, of southern Italy was, much healthier than the wealthy citizens of New York, even compared to their own relatives who emigrated in earlier decades to the United States. • Keys suggested that this was diet dependant, by focusing his attention on foods that made up the diet of these populations. • Thus, he led the famous “Seven Countries Study” (conducted in Finland, Holland, Italy, United States, Greece, Japan and Yugoslavia), in order to document the relationship between lifestyles, nutrition and cardiovascular disease between different populations.

3. Seven Countries Study Mediterranean diet thought to be the cause!

4. What is a Mediterranean Diet? • High in fruits,vegetables, wholegrain bread, rice and pasta, potatoes, beans, nuts,and seeds • Olive oil as an important fat sourceand dairy products, fish, and poultry (consumed low- moderate amounts) • Eggs in moderate amounts, and low amounts of redmeat in low amounts • Wine is consumed in low to moderate amounts.

5. Mediterranean vs Traditional

6. Mediterranean diet guidlines Every main meal • 1-2 portions fruits, 2+ portions vegetables • 1-2 servings wholegrain bread/ rice/ pasta • Use olive oil as main cooking fat or as a dressing Every day • 2 servings dairy • 1-2 servings nuts Weekly • 2 servings poultry, 2+ servings oily fish, 2+ servings legumes • Less than 2 servings red meat, 1 or less serving processed meat • 0-4 servings Eggs • Less than 2 servings sweet foods • Optional: 1 glass wine/day(women), 2 glasses/day(men) most days

7. What are the key foods? • Eat more fruit & vegetables • Include oily fish (e.g. salmon, herring, sardines) 2-3 times/ week • Eat wholegrain bread and cereals instead of white/ low fibre • Use olive or rapeseed oils & spreads • Add more natural nuts into your diet (e.g. walnuts, almonds or hazelnuts) • Reduce red meat intake and eat poultry more often • Alcohol in moderation (optional)

8. What does a typical Mediterranean diet look like? • Breakfast • Fruit or small glass of unsweetened fruit juice • Wholegrain breakfast cereal/ oatmeal • Wholemeal bread/ toast with olive oil spread • Lunch • Soup and wholemeal bread • Small portion of chicken/ fish/ egg/ cheese • Salad • Wholemeal bread • Fruit and yoghurt • Evening meal • Small portion meat/ chicken/ fish/ egg • Plenty of salad/ vegetables • Potatoes, rice, pasta, other grains • Fruit for dessert • Glass of wine (optional) MENU Wholegrain bagel with olive oil spread +fresh fruit Lentil soup + wholegrain bread Mediterranean-style marinated fish or chicken Snacks: Fruit/ nuts

9. A Typical lunch recipe: Lentil soup Heat the olive oil in a saucepan and add the onion and garlic. Sauté gently for 5 minutes until softening Add the rest of the vegetables and cook for a further 4-5 minutes. Add the lentils and stock and bring to the boil. Simmer for 15-20 minutes. Season with pepper, blend until smooth. Pour the mixture back into the pan, reheat gently. Serve with wholemeal bread • 2 tbsp olive oil • 1 clove garlic, thinly sliced • 1 carrot, diced • 1 large onion, sliced • 1 celery stick, sliced • 1 medium potato, diced • 1-2 slices of turnip, diced • 100g (4oz) red lentils • 1L (1 ¾ pt) chicken or vegetable stock • (serves 4)

10. Marinated Fish or Chicken • 2 (100g/4oz) fish/chicken • 2 tbsp olive oil • 2 tsp red wine vinegar • ½ tsp ground black pepper • ½ dried basil or thyme • ¼ tsp garlic granules • 2 bay leaves • (serves 2) In a bowl, mix olive oil, vinegar, pepper, basil, thyme and garlic. Coat both sides of the fish/ chicken fillets. Break the bay leaves into 3-4 pieces, press onto both sides of fillets. Cover and refrigerate for at least an hour. Remove the bay leaves. Cook in a non-stick pan over a medium-high heat. Serve with potatoes, pasta, rice or another ‘grain’ such as couscous and vegetables

11. What are the proven health benefits of a Mediterranean diet? • PREDIMED study (7500 pts) • 30% reduction in risk of heart disease/stroke • 52% reduction in risk of diabetes • Results comparable to statins and metformin respectively • reduce the risk of Alzheimer's and Parkinson's disease • reduce the risk of death from or occurrence of Cancer

12. What are the studies showing the benefits of the Mediterranean diet? • PREDIMED Study-(wtloss, BP, BS control isbetter vs low fat diet) • StanfordStudy-(lowered CRP levels) • NorthwesternUniversity-(Oleicacidblocked cancer genes) • The Hale Project-(50% decreasedmortalityin Europeonelderly) • EmoryUniversityStudy • Second University of Naples • Federico II University- • Maris Study/WageningUniversity • University of Michigan • Walter Reed ArmyMedical Center

13. How does the Mediterranean diet lower risk? • Better blood pressure control • Weight loss; less metabolic syndrome • More favorable lipid profile; lowers LDL and increases HDL • Better glycemic levels • More antioxidants from more vegetable sources. • Lower markers of inflammation, ie…CRP

14. Where do we start!?

15. Where do we finish!?

16. Online resources • http://www.mediterraneanbook.com/the-mediterranean-diet/ • http://allrecipes.com/recipes/healthy-recipes/special-diets/mediterranean-diet/ • http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/in-depth/mediterranean-diet-recipes • Even Fox news is aware of it! (next to the article about how Hilary wearing glasses is a “warning sign”) • http://www.foxnews.com/health/2013/07/25/22-mediterranean-diet-recipes-to-improve-your-health/

17. Thank you • Questions??? • Answers !!??