Advanced Mediterranean Diet

I have been visiting the NutritionData website for several years.  I used it to analyze several of the recipes in my healthy lifestyle book, The Advanced Mediterranean Diet.  Please check out NutritionData.com if you are seriously interested in nutrition.  These are some of the most prominent features of the site:

1.  Dieting and Weight Loss Blog.  Written by four experts:  Monica Reinagel (nutritionist/chef/author), Stephen Cabral (fitness and personal training professional), Elaine Murphy (nutrition consultant), and Dana Lilienthal (dietitian and health educator).

2.  The ND Blog: Notes From the Nutritionista.  Written by Monica Reinagel, nutritionist, chef, and author.

3.  The Pantry.  Store and analyze your recipes.  Track your daily consumption.

4.  Easily find a huge amount of nutritional information on almost anything you eat.  For example, within seconds you can find that a medium raw apple with skin has 95 calories, 4 grams of fiber, 4 mcg of vitamin K (5% of Daily Value), 49 mcg of beta carotene, 11 mg of phenylalanine, plus amounts of about 30 other specific nutrients.

5.  Nutrition News.

6.  Extensive information on glycemic index and glycemic load.

7.  Nutritional effects of food processing (referring to freezing, drying, cooking, and reheating).

8.  Body mass index calculator and daily caloric needs calculator based on your age, sex, weight, and activity level.

9.  IF Rating System.  “Systemic inflammation” may play a role in several chonic conditions, such as allergies, joint pain, and premature aging.  One measure of such inflammation, for example, is a blood test called C-reactive protien (CRP).  Foods have various components that may either contibute to inflammation or fight inflammation (anti-inflammatory).  The Inflammation Factor (IF) Rating System was designed by Monica Reinagel to provide some idea of the potential for specific foods to cause or prevent systemic inflammation.  This is pretty cutting-edge stuff and Monica may be ahead of her time here.  We will know more in a few years.

10.  Healthy Recipes.

At NutritonData.com you will find very little, if any, commercial bias.  The information presented is mostly science-based.  And it’s all free.

Steve Parker, M.D., author of The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer    www.AdvancedMediterraneanDiet.com

Here is one of 42 recipes in my healthy lifestyle book, The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer.  Pasta e fagioli (pasta and beans) is a traditional Italian peasant dish.  My inspiration was the soup at The Olive Garden restaurant.  My wife and I experimented quite a bit before settling on this composition.  We hope you enjoy it.       

Pasta e Fagioli

4 tbsp olive oil
4 garlic cloves, minced
1½  cup chopped celery (about 3 stalks)
1 cup chopped red onion
3 carrots, large, julienned, 1½ inch-long strips
12 oz bulk sweet Italian sausage (or use link Italian
sausage after removal of the casing). Italian
sausage is fatty: 60–75 percent of calories are
from fat. Buy as lean as you can.
3 15-oz cans diced tomatoes, undrained
1 15-oz can cannellini beans, drained and rinsed
(alternatively, use white, navy, or great northern
beans)
1 15-oz can red kidney beans, drained and rinsed
5 cups Swanson lower sodium, fat-free chicken broth
1 tbsp red wine vinegar
1 tsp dried basil leaves
1 tsp white sugar
1 tsp salt
¼ tsp black pepper, freshly ground
8 oz (dry weight) ditalini or small shell pasta, whole
wheat if available
½  cup chopped fresh parsley (or 2 tbsp dried parsley)
6 tbsp grated parmesan cheese

     Heat olive oil over medium heat in a large stockpot. Choose a pot with a lid because you will cover and simmer this soup later. Add the minced garlic to the hot oil in the pot and cook, stirring, for about 30 seconds. Add the onions, carrots, and celery, and sauté over medium heat until the onions are transparent, about five minutes. Stir frequently. Remove this concoction to a bowl or plate. The carrots will finish cooking later.
Add the Italian sausage to the stockpot and cook over medium heat for about eight to 12 minutes until fully done, stirring frequently. As it cooks, break the sausage into small chunks using the edge of a rigid turner. A turner is what you would use to flip pancakes, for example.
To the cooked meat in the stockpot, add the sautéed concoction, tomatoes, beans, broth, basil, pepper, salt, vinegar, and sugar. Bring to a boil over high heat, then reduce heat to low and simmer, covered, for at least 20 minutes. An hour is better. Stir occasionally. Just before serving, add parsley to the pot, and stir once more. If the soup seems too thick, add extra chicken broth or water.
Fill a separate stockpot with water and bring to a boil. Add the pasta and cook according to directions on the box. Then drain the pasta. Mix 1/3 cup pasta and 1 cup soup in a serving bowl, then sprinkle with ½ tbsp grated parmesan cheese. You might enjoy something crunchy with this dish, such as crackers or toast.
Store leftover soup and pasta in separate containers in the refrigerator.  The soup tastes just as good, or better, over the next few days.  The pasta gets mushy if you mix it into the soup for storage. Add the pasta to the soup just before you eat.
Servings per batch: 13
Serving size: 1 cup soup and 1/3 cup cooked pasta (290 calories) 

Steve Parker, M.D., author of The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer   www.AdvancedMediterraneanDiet.com

Atherosclerosis is the formal term for “hardening of the arteries.”  Who cares how hard they are, as long as the arteries deliver blood to our organs, right?  Atherosclerosis in the arteries that supply blood to the heart - essentially a hollow muscle that pumps blood - is called coronary heart disease disease (CHD) or coronary artery disease (CAD).

LDL cholesterol is the “bad cholesterol” that is associated with atherosclerosis.  Generally, the higher the LDL, the worse the atherosclerotic complications: plaque build-up leads to poor circulation to vital organs, arterial blood clots, even death of tissue due to blocked arteries.  Oxidation of LDL cholesterol facilitates atherosclerosis.

People at high risk for coronary heart disease include type 2 diabetics, smokers, people with high blood pressure or cholesterol abnormalities, and people with a family history of coronary heart disease.  Advanced age is another strong risk factor.

The ongoing PREDIMED Study is designed to test the the effects of the traditional Mediterranean diet in primary prevention of coronary heart disease in a high risk population.  9000 study participants will be assigned to one of three diets:  1) low-fat, 2) Mediterranean plus extra olive oil, or 3) Mediterranean plus extra nuts.  The Mediterranean diet is moderate in percentage of calories derived from fat, and the main source of fat is olive oil.  Virgin olive oil has a particularly high content of antioxidant phenolic compounds.  Nuts are also a rich source of antioxidant phytochemicals.  These antioxidants can prevent the harmful transmogrification of plain LDL into oxidized LDL.

A group of 372 early study enrollees were randomly assigned to one of the three diet groups.  In both of the Mediterranean diet groups, researchers found reduced oxidized LDL, reduced blood pressures, lower total cholesterol, and lower total-HDL cholesterol ratios, more than in the low-fat diet group.

These observed changes would tend to reduce the incidence and severity of atherosclerotic complications.  When PREDIMED is completed, we will know whether the traditional Mediterranean diet, compared with a low-fat diet, is better at preventing death and disease from coronary heart disease.  That’s where the rubber meets the road.

Steve Parker, M.D., author of The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer    www.AdvancedMediterraneanDiet.com

References:

Montserrat, Fito, et al.  Effect of a Traditional Mediterranean Diet on Lipoprotein Oxidation: A Randomized Controlled Trial.  Archives of Internal Medicine, 167 (2007): 1,195-1,203.

Prevencion con Dieta Mediterranea Study (PREDIMED)  http://www.predimed.org

In my blog yesterday, I mentioned a statistic I read in a scientific journal article:

Every 2.2 pound (1 kg) loss of excess weight lowers the risk of developing type 2 diabetes by 16%.

That tidbit was embedded in another article with a focus on regain of lost weight over time.  The “16% per kilogram” number sounded too good to be true, and I had never heard it before.  So I did some digging and found the source of the statistic.  Ain’t the Internet wunnerful?

The origin of the 16% figure is the Diabetes Prevention Program Research Group.  Investigators enrolled 1,079 middle-aged (mean 50.6 years) study participants and followed them over 3 years, noting the effects of exercise, percentage of fat in the diet, and weight loss on the subsequent development of diabetes.  Average body mass index was 33.9.  (A 5-foor, 4-inch person weighing 197 pounds (89.5 kg) has a BMI of 33.9).  Sixty-eight percent of participants were women.  The investigators’ goal for this group of overweight people was for loss of 7% of body weight through diet, physical activity, and periodic counseling sessions.  Average weight loss over the course of three years was 9 pounds (4.1 kg).

None of the study participants had diabetes at the time of enrollment.  But, by design, they all had laboratory-proven “impaired glucose tolerance.”  Impaired glucose tolerance is a form of “pre-diabetes.”  It is determined by giving a  75-gram dose of glucose by mouth, then measuring blood glucose (sugar) 2 hours later.  A blood glucose level under 140 is normal.  If the level is 140-199, you have impaired glucose tolerance.

Having impaired glucose tolerance means that study participants’ glucose (sugar) metabolism was already abnormal.  They were at higher than average risk of developing diabetes, compared with both average-weight healthy people and overweight people without impaired glucose tolerance.  This is a great cohort to study for development of diabetes.  But the finding that “every 2.2 pounds of weight loss lowers the risk of diabetes by 16%” applies to this particular group with impaired glucose tolerance, not the general overweight population.

A total of 153 participants developed diabetes over the course of 3 years.  Loss of excess weight was by far the best predictor of lowered diabetes risk, compared with regular exercise and lowering percentage of dietary fat.

Yes, weight loss does prevent diabetes in some, probably many, overweight people.  The specific degree of reduced risk depends on numerous factors, such as age, sex, genetics, degree of weight loss, and pre-existing impaired glucose tolerance.

Steve Parker, M.D., author of The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer    http://AdvancedMediterraneanDiet.com

Reference: Hamman, Richard, et al.  Effect of Weight Loss With Lifestyle Intervention on Risk of Diabetes.  Diabetes Care, 29, (2006): 2,102-2,107.

I often hear from the general public, and even my physician colleagues, that losing weight and keeping it off is a hopeless goal.  So, why try?

Because it’s not hopeless.

The March 12, 2008, edition of the Journal of the American Medical Association includes an article from the Weight Loss Maintenance Collaborative Research Group.  Researchers identified a group of 1,032 overweight or obese adults who lost at least 8.8 pounds (4 kg) during a 6-month weight loss program.  These adults had high blood pressure, blood lipid abnormalities, or both.  38% were African American and 63% were women.

Average weight of the group before losing weight was 213 pounds (96.7 kg).  The weight-loss program consisted of 20 weekly group sessions, exercise goal of 180 minutes per week (26 minutes per day, usually walking), reduced caloric intake, and adoption of the Dietary Approaches to Stop Hypertension eating pattern.  The goal rate of weight loss was 1 or 2 pounds per week (0.45 to 0.91 kg per week).  Study subjects were taught how to keep records of their caloric intake and physical activity.

Except for the weekly group sessions, this program is similar to the Advanced Mediterranean Diet.

So each of these folks lost at least 8.8 pounds on this program.  Researchers followed them over the next 30 months to see how much weight would be regained.  Average weight loss for the entire group actually was 19 pounds (8.6 kg).  As expected, many people did regain weight over the next 30 months, between 6 and 9 pounds on average.  Of course, some individuals lost much more weight initially, and didn’t gain any back.  Some regained all of the lost weight, plus extra.

Overall, 42% of participants “maintained at least 4 kg [8.8 pounds] of weight loss compared with entry weight…” over the 30 months of follow-up.  37% remained at least 5% below their initial weight.

The “5%” figure stands out, for me, because we see improvement in obesity-related medical problems with loss of just 5 to 10% of body weight.

The authors cite studies indicating that “each kilogram [2.2 pounds] of weight loss is associated with a decrease in systolic blood pressure of 1.0 to 2.4 mmHg and a reduction of incident diabetes of 16%.”

To summarize the weight changes:  Study participants weighed 213 pounds before the behavioral weight-loss program.  Average weight loss was 19 pounds, down to 194 pounds.  Average weight regain over 30 months was in the range of 6 to 9 pounds.  Participants were still pretty big, but 37% of them probably saw some improvement in their medical status.

A huge amount of effort went into this study, on the part of both researchers and study participants.  Nevertheless, average results are relatively modest.  Keep in mind, however, that the numbers are averages, and you are not average.  I’m sure some of the participants went from 220 pounds down to 150 pounds and stayed there.  That could be you.

Steve Parker, M.D., author of The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer    www.AdvancedMediterraneanDiet.com

Reference: Svetkey, Laura et al.  Comparison of Strategies for Sustaining Weight Loss: The Weigth Loss Maintenance Randomized Controlled Trial.  Journal of the American Medical Association, 299 (2008): 1,139-1,148.

Researchers recently studied 24,444 Swedish women over the course of 6.2 years, analyzing dietary patterns, healthy lifestyle choices, and body weight.  Information on the women was obtained mostly by surveys at the start and end of the study.  The women were aged 48 to 83 at the start of the study and were free of diabetes mellitus, cardiovascular disease, cancer, and coronary artery disease.

Heart attacks in the study cohort were identified in the Swedish Hospital Discharge Registry and the Cause of Death Registry.  Over the course of six years there were 308 heart attacks.

The study authors noted a greatly reduced incidence of heart attacks in women with the following characteristics:

1. high consumption of fruits, vegetables, whole grains, legumes, and fish
2. moderate consumption of alcohol
3. avoidance of overweight, especially abdominal fat (waist-hip ratio < 0.85)
4. physically active (at least 40 minutes daily of walking or bicycling and 1 hour weekly of leisure-time exercise
5. non-smokers

Women meeting these criteria had a 92% lower risk of having a heart attack!  Such women were only 5% of the cohort, however.  I suspect the physical activity criterion knocked a lot of women out of the super heart-healthy subset.

The authors conclude that “most [heart attacks] in women may be preventable by consuming a healthy diet and moderate amounts of alcohol, being physically active, not smoking, and maintaining a healthy weight.”

I see little reason to doubt that these findings apply to the typical woman in the U.S. or Europe, and not just to Swedes.  The traditional Mediterranean diet of the mid-20th century fulfills the dietary prescription for a healthy heart.  The Advanced Mediterranean Diet incorporates these healthy diet and lifestyle choices while simultaneously working to control weight.

Steve Parker, M.D., author of The Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer    www.AdvancedMediterraneanDiet.com

Reference:  Akesson, Agneta, et al.  Combined Effect of Low-Risk Dietary and Lifestyle Behaviors in Primary Prevention of Myocardial Infarction in Women.  Archives of Internal Medicine, 167 (2007): 2,122-2,127.