The Mediterranean Diet - How to make the switch to this healthier eating pattern
The Mediterranean diet (Med diet) is likely the most researched diet for its health benefits, especially in relation to cardiovascular disease (CVD) risk. The popularity of the Med diet has come about after observation in the 1960s of low rates of mortality from CVD in the Mediterranean regions. Since then, there has been a myriad of adaptations to the diet reflective of regional and seasonal availability of produce. While some individual studies have found a reduced CVD risk for the Med Diet, a large-scale review in 2019 found that there is still uncertainty around the effects of the Med diet on CVD occurrence and risk factors. The benefits of the Med diet are largely thought to occur from the high amount of antioxidants present in the food abundant in this eating pattern, such as vegetables, fruit and nuts. A major review of vegetable and fruit consumption found that increased intake is associated with a lower risk of chronic diseases such as CVD and some cancers. While research in the field of nutrition is ever evolving, there are certainly some take home lessons from the Med diet that can be applied to anyone looking to improve their health with this style of eating.
The word ‘diet’ can initiate feelings of restriction, so it should be noted here that the Med diet is more of a healthy eating pattern and not a strict diet. In general, a Mediterranean eating pattern includes plenty of vegetables, fruits, whole grains, monounsaturated fats (like olive oil, nuts and seeds), seafood, legumes, and moderate consumption of alcohol, dairy and eggs. When considering health boosting properties of food, it is important to remember that we do not eat food or nutrients in isolation, but rather as a whole package. For example, incorporating more olive oil into your current (Western-style diet) diet would not be sufficient to gain the health benefits associated with the Med diet in its entirety.
In fact, the Med diet derives 39-42% of daily calories from fat, compared to the current Australian guidelines of just 20-35%. Given fat is the most calorie dense macronutrient, we must be careful not to overconsume fat without consideration to our overall daily energy intake, which if left in excess over time contributes to weight gain, a known risk factor for CVD. Despite this, the Med diet does align well with the overall theme of the Australian Guide to Healthy Eating (AGHE) – plenty of vegetables, legumes, wholegrains, fruit, moderate amounts of lean meats, poultry, fish and dairy and minimal processed foods. Eating plenty of vegetables is a major component of the Med diet and Australia is failing miserably in this department, with only 7% of adults and 5% of children meeting our current guidelines. Fruit consumption is better with 50% of adults and 68% of children reaching the targets. So, it looks like we could all do with a little more Med and a little less of our current habits.
Transitioning to a more Med diet pattern of eating can provide numerous health benefits. Here are some top tips to make the transition
· Swap out saturated fats (such as butter or coconut oil) for olive oil in cooking and in salad dressings. Consume a serve of nuts (approximately 30g) at least three times a week. Be mindful of serving sizes. A single tablespoon (20mL) of olive oil contains a 680kJ or 165 calories – same amount of energy found in 770g of raw strawberries.
· Eat more vegetables. Australia’s current guidelines suggest 5 serves of vegetables for adult women and 6 for adult men per day. A serve is about 75g (1 medium tomato, ½ cup cooked orange or green vegetables). Try incorporating vegetables into each meal. For breakfast, add in some baby spinach, capsicum and mushroom to an omelette. For lunch, try a bowl of homemade minestrone soup or grilled/baked vegetables like capsicum or pumpkin in a wrap or toastie. Dinner is usually the easiest meal to consume vegetables but be sure to eat the rainbow for the full spectrum of health benefits. Try snacking on some carrot and cherry tomatoes with a dip like hummus.
· Eat more legumes. Try building up to 3 serves a week. Legumes are a tasty and cheap nutritional powerhouse which can be used in a variety of dishes. Replace a couple of your weeknight dinners with a legume-based meal such as dhal, a veggie burger or lentil Bolognese.
· Eat more fish. Having 2 to 3 serves a week is ideal. If fresh isn’t available, use tinned salmon or tuna to make an easy tuna pasta bake or fish cakes. Try to incorporate a serve of oily fish (such as salmon) once a week. Canned fish is an inexpensive great source of protein and an essential pantry staple to have on hand for a quick meal. Tuna and tomato on some Ryvitas for a quick snack? Too easy.
· Eat more fruit. While more Australian’s are meeting fruit intake guidelines than vegetables, a lot of us still fall short. It may seem obvious, but an easy way to add more into your day is to snack on fruit. An orange and 10 almonds are a great nutritious boost to your day. Don’t forget you can add fruit into porridge, cereals, salads and even some main meals, think apricot chicken or a homemade sweet and sour sauce with pineapple. A serve of fruit is about 150g (a medium apple or banana).
· Eat less red meat. While red meat contains important minerals (such as iron) many of us consume more than is recommended. The Australian Cancer Council suggests consuming a maximum of 455g per week of cooked lean red meat and avoiding processed meats. If you’re making a Bolognese, try swapping half the meat out for red lentils to decrease red meat consumption and increase your legume intake.
· Choose wholegrains. Wholegrains are well known for their increased health profile compared to their white counterparts. Increased fibre, minerals and vitamins are just some of the reasons to select wholegrain products. Swap out your usual jasmine rice, white pasta or bread for a wholegrain option. Perhaps even try some legume pasta, made from lentil or chickpea flour which is now available in all major supermarkets.
· Sit down, enjoy your meal with family and friends and really savour your meal, eat mindfully. A large part of the Med diet revolves around the cultural aspect of eating together and enjoying your food. Eating more mindfully gives your brain time to register its satiety signals which may prevent you from mindlessly overeating.
Don’t feel as if you need to do everything at once if you’re considering making the switch to a more Med style diet. Focus instead on one or two changes at a time, such as including more legumes in your weekly meal plan, and once you’ve nailed that it might be time to get in those 5 serves of vegetables most of us aren’t getting. In no time at all, you’ll be eating a more Med style diet and reaping the health benefits.
References
Aune, D., Giovannucci, E., Boffetta, P. et al. (2017). Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality-a systematic review and dose-response meta-analysis of prospective studies. Int J Epidemiol. 2017;46(3):1029‐1056. doi:10.1093/ije/dyw319
Australian Institute of Health and Welfare. (2018). Australia’s Health 2018. Retrieved from https://www.aihw.gov.au/reports/australias-health/australias-health-2018/contents/indicators-of-australias-health/fruit-and-vegetable-intake
El-Sabban, F. (2014). The antioxidant advantage of the Mediterranean diet in cardiovascular disease. Nutrition And Dietary Supplements, 35. doi: 10.2147/nds.s59848
Estruch, R., Ros, E., Salas-Salvadó, J., Covas, M., Corella, D., & Arós, F. et al. (2018). Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. New England Journal Of Medicine, 378(25), e34. doi: 10.1056/nejmoa1800389
FSANZ. (2019). Australian Food Composition Database. Retrieved from https://www.foodstandards.gov.au/science/monitoringnutrients/afcd/Pages/default.aspx
Diet Review: Mediterranean Diet. (2020). Retrieved 29 May 2020, from https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/mediterranean-diet/
George, E., Kucianski, T., Mayr, H., Moschonis, G., Tierney, A., & Itsiopoulos, C. (2018). A Mediterranean Diet Model in Australia: Strategies for Translating the Traditional Mediterranean Diet into a Multicultural Setting. Nutrients, 10(4), 465. doi: 10.3390/nu10040465
Liyanage, T., Ninomiya, T., Wang, A., Neal, B., Jun, M., & Wong, M. et al. (2016). Effects of the Mediterranean Diet on Cardiovascular Outcomes—A Systematic Review and Meta-Analysis. PLOS ONE, 11(8), e0159252. doi: 10.1371/journal.pone.0159252
Nutrition Australia. (n.d.). Australian Dietary Guidelines: Recommended daily intakes. Retrieved from https://nutritionaustralia.org/fact-sheets/australian-dietary-guidelines-recommended-daily-intakes/
Rees, K., Takeda, A., Martin, N., Ellis, L., Wijesekara, D., & Vepa, A. et al. (2019). Mediterranean-style diet for the primary and secondary prevention of cardiovascular disease. Cochrane Database Of Systematic Reviews. doi: 10.1002/14651858.cd009825.pub3
