The Mediterranean Diet
A Mediterranean diet is based on cuisines from a variety of countries surrounding the Mediterranean sea including France, Italy, Greece, Spain, Croatia and more.
Natural whole foods such as fruits, vegetables, fish, nuts, legumes, and olive oils play a large part in the diet.
Surprisingly, the Mediterranean diet doesn't look down at all fats and instead it is full of healthy omega-3 fatty acids and monounsaturated fats.
The Mediterranean Sea retrieved from Google maps 2017 (1).
The 2013 PREDIMED study shows that when compared to a low-fat diet, the Mediterranean diet will lower your risk of heart disease and stroke (2). After 3 months of the diet, oxidised low-density lipoprotein (LDL) levels decreased, a major risk factor for cardiovascular disease (3).
Type 2 diabetes
A Mediterranean diet also appears to be effective in preventing the development of type 2 diabetes by 52% in people at a higher cardiovascular risk (4).
One meta-analysis showed that by adhering to the Mediterranean diet, subjects were associated with a lower risk of all-cause cancer mortality, colorectal cancer, breast cancer, gastric cancer, prostate cancer, liver cancer, head and neck cancer, pancreatic cancer, and respiratory cancer (5).
In another systematic review, it has shown that the Mediterranean diet is associated with a better cognitive function, slower cognitive decline and reduced risk of developing Alzheimer disease (6). The MIND diet that prevents dementia and loss of brain function is actually based on both the Mediterranean diet and DASH diet.
The main feature of the Mediterranean diet is to focus on natural whole foods and shift away from unhealthy processed foods. Plus the good thing is, it's so easy to get started. Nothing radical, just ask those who live healthy lives along the Mediterranean Sea!
Oldways African Heritage Diet Pyramid © 2009 Oldways Preservation & Exchange Trust
This is not a typical weight loss diet but more of a set of habits inspired by the traditional eating habits of people living in the Mediterranean. The Mediterranean diet focuses on whole nutritionally dense foods:
1. Fresh whole foods rather than processed or refined foods
You won’t find many ready meals but instead freshly prepared pasta, bread, seasonal produce and home-cooked meals.
A variety of plant foods usually accompany most meals and provide good sources of vitamins, minerals, fibre and antioxidants. From the simple Italian Caprese salad drizzled with olive oil to aromatic soups and stews, creamy dips, pasta dishes served with countless bases, vegetables are an absolute must to the delicious flavours the Mediterranean diet. The flavours can be further enhanced with a pinch of fresh herbs and spices.
Italian Caprese salad made of sliced mozzarella, tomatoes, basil and seasoned with salt and olive oil.
2. Eat lots of fruits, vegetables and legumes
Goal: A variety of 3 or more servings of vegetables per day
Eat a wide variety of fruits from apples, apricots, and oranges to grapes, pomegranates, and passion fruits. Save sweets and cakes for a special treat or celebration.
3. Fresh fruit for dessert
Goal: A variety of 3 or more servings of fruits per day
4. Starchy foods
Starchy foods include potatoes, bread, pasta, and rice. These are nutritious as they contain fibre, calcium, iron and B vitamins. Just remember to stick to the right portion sizes and choose low glycaemic index (GI) starchy foods.
Goal: 3 to 6 servings a day or 1 to 2 servings per meal
Switch to whole grains. Whole grains are naturally higher in fibre, B vitamins and minerals which can keep you satisfied for hours. They ten to have a lower GI and hence, doesn’t give you a spike in insulin levels.
Goal: 3 servings per week of legumes (beans, peas, etc.)
Glycaemic Index (GI)
High > 70
Medium 55 - 69
Low < 55
Data retrieved from “International Tables of Glycemic Index and Glycemic Load Values: 2008” by Fiona S. Atkinson, Kaye Foster-Powell, and Jennie C. Brand-Miller (7).
Note: the glycaemic load is more accurate as it takes into account the amount of food consumed.
Vegetables: Artichokes, arugula, beets, broccoli, carrots, cucumbers, kale, onions, spinach, tomatoes, zucchini
Fruits: Apples, apricots, avocados, bananas, dates, figs, grapes, oranges, pears, strawberries, melons, peaches, pears, pomegranates
Legumes: Beans, chickpeas, lentils, peanuts, peas, pulses
Starchy foods: Potatoes, sweet potatoes, turnips, yams
Whole Grains: barley, buckwheat, bulgur, oats, rice (brown, black, red), whole grain bread, pasta
Herbs and Spices: basil, bay leaf, cinnamon, cumin, garlic, mint, nutmeg, oregano, parsley, pepper, rosemary, sage, tarragon, thyme
5. Use healthy oils and fats
These include olive oil, nuts, seeds, olives and avocados. Olive oil is frequently used in dishes instead of butter or other vegetable oils.
Olive oil is a big proponent of this diet which makes this diet higher in monosaturated fats and lower in saturated fats which helps in lowering LDL cholesterol (aka the bad cholesterol) and improves HDL cholesterol function (aka the good cholesterol). It is rich in polyphenols and antioxidants that also dampen chronic inflammation (8), the common cause of several chronic diseases and conditions including osteoarthritis, rheumatoid arthritis, IBS and Crohn’s disease (9).
Always aim to buy "Extra-virgin" and "virgin" olive oils as they contain the highest levels of the protective plant compounds that provide antioxidant effects. For cooking, it is often drizzled on rough chunks of whole-grain bread, mixed in salads and used in tomato sauces.
Goal: 1-4 tablespoon(s) per day (30-70mL/day)
Healthy Fats: Extra virgin olive oil, olives, avocados
Heart-healthy fats such as omega-3 fatty acids, monounsaturated fats and polyunsaturated fats are found in most nuts (10). Different nuts contain its own unique combination of nutrients as well – Cashews with iron, almonds with calcium and vitamin E and walnuts with alpha-linolenic acid (omega 3) and antioxidants.
Always keep nuts on hand for a quick snack whenever you are craving for sweets. Natural nut butters are good as well – just use it as a spread on your toast in the mornings.
Goal: 3 servings a week of raw, unsalted nuts
Nuts and seeds: Almonds, cashews, hazelnuts, Macadamia nuts, pistachios, pumpkin seeds, sesame, sunflower seeds, walnuts
7. Eat seafood at least twice a week
Fish such as tuna, herring, salmon, and sardines provide a good source of omega-3 fats which has been associated with lower risk of heart attacks and helps to moderate blood pressure. Shellfish including mussels, oysters and clams contain little fat and are high in protein, vitamins and minerals. You can add it to your salad like the French Nicoise Salad or simply steam mussels with white wine and garlic. Avoid battered and fried fish.
Niçoise salad with potatoes, boiled eggs, tomatoes, salty anchovies and of course tuna
Goal: 3 portions of fish per week, 2 of which should be oily
Fish: herring, mackerel, salmon, sardines, trout, tuna
Shellfish: shrimp, oysters, clams, crab, mussels
Eggs are a great source of high-quality protein and one of my favourite breakfast dishes is Shakshuka (baked eggs) originated from Tunisia made with tomatoes, paprika, onions, spices and of course, topped with eggs.
Have some Greek or plain yoghurt, and natural cheeses but in moderate amounts. To lower saturated fat intake, choose cheeses like cottage cheese, feta and mozzarella.
Shakshuka made of poached eggs in a spiced tomato stew with onions and garlic. Top it up with some spinach as well!
8. Moderate poultry, eggs and dairy portions daily to weekly
Goal: 3 servings per week. No limits on egg whites.
Poultry is a good source of lean protein, vitamins and minerals but it is best to remove the skin or any visible fat.
Goal: 3 servings (3 ounces each) per week.
Eggs: Chicken, quail, duck eggs
Dairy: Cheese, yoghurt, Greek yoghurt
Poultry: Chicken, duck, turkey
9. Eat meat less often
Red meat can be healthy as it is rich in vitamins, minerals (especially iron) and protein but also high in saturated fat so it is best to have it as a treat. You can have it in a stew with tons of vegetables so that you are consuming less meat overall. Avoid processed meats such as sausages and salami as it can increase your risk of cancer.
Goal: 2 or less portions per week
10. Enjoy some red wine
A glass of red wine goes great with Mediterranean meals. Red wine is rich in polyphenols especially resveratrol that possess antioxidant properties which may explain their protective effects on the cardiovascular system. In one study, middle-aged men and women who drank up to 7 drinks a week were associated with a lower risk of developing heart failure (11).
However, if you don’t normally drink, it is not advised to start. Grape juice is a perfect alternative for those who drink.
Goal: 4-6 ounces a day with meal (optional)
ReferencesIrritable bowel syndrome [Online] Available at: https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/symptoms-causes/syc-20360016 [Accessed: 22 June 2018]. Saha, L. (2014). Irritable bowel syndrome: Pathogenesis, diagnosis, treatment, and evidence-based medicine. World Journal of Gastroenterology, 20(22), p.6759. D. Cashman, M., K. Martin, D., Dhillon, S. and R. Puli, S. (2016). Irritable Bowel Syndrome: A Clinical Review. Current Rheumatology Reviews, 12(1), pp.13-26. Guidelines--Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders. (2006). Journal of Gastrointestinal and Liver Diseases, 15(3), pp.307-12. Drossman, D. (2016). Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features, and Rome IV. Gastroenterology, 150(6), pp.1262-1279.e2. Ikechi, R., Fischer, B., DeSipio, J. and Phadtare, S. (2017). Irritable Bowel Syndrome: Clinical Manifestations, Dietary Influences, and Management. Healthcare, 5(2), p.21. Enck, P., Aziz, Q., Barbara, G., Farmer, A., Fukudo, S., Mayer, E., Niesler, B., Quigley, E., Rajilić-Stojanović, M., Schemann, M., Schwille-Kiuntke, J., Simren, M., Zipfel, S. and Spiller, R. (2016). Irritable bowel syndrome. Nature Reviews Disease Primers, 2, p.16014. Chey, W., Kurlander, J. and Eswaran, S. (2015). Irritable Bowel Syndrome. JAMA, 313(9), p.949. Hungin, A., Chang, L., Locke, G., Dennis, E. and Barghout, V. (2005). Irritable bowel syndrome in the United States: prevalence, symptom patterns and impact. Alimentary Pharmacology and Therapeutics, 21(11), pp.1365-1375. Gibson, P., Varney, J., Malakar, S. and Muir, J. (2015). Food Components and Irritable Bowel Syndrome. Gastroenterology, 148(6), pp.1158-1174.e4. Card, T., Canavan, C. and West, J. (2014). The epidemiology of irritable bowel syndrome. Clinical Epidemiology, p.71. Occhipinti, K. and Smith, J. (2012). Irritable Bowel Syndrome: A Review and Update. Clinics in Colon and Rectal Surgery, 25(01), pp.046-052. Chey, W., Kurlander, J. and Eswaran, S. (2015). Irritable Bowel Syndrome. JAMA, 313(9), p.949. Zhou, Q. and Verne, G. (2011). New insights into visceral hypersensitivity—clinical implications in IBS. Nature Reviews Gastroenterology & Hepatology, 8(6), pp.349-355. Ghoshal, U., Kumar, S., Mehrotra, M., Lakshmi, C. and Misra, A. (2010). Frequency of Small Intestinal Bacterial Overgrowth in Patients with Irritable Bowel Syndrome and Chronic Non-Specific Diarrhea. Journal of Neurogastroenterology and Motility, 16(1), pp.40-46. Ghoshal, U., Shukla, R. and Ghoshal, U. (2017). Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy. Gut and Liver, 11(2), pp.196-208. Ghoshal, U. (2014). Irritable bowel syndrome and small intestinal bacterial overgrowth: Meaningful association or unnecessary hype. World Journal of Gastroenterology, 20(10), p.2482. Marshall, J., Thabane, M., Garg, A., Clark, W., Moayyedi, P. and Collins, S. (2010). Eight year prognosis of postinfectious irritable bowel syndrome following waterborne bacterial dysentery. Gut, 59(5), pp.605-611. Marshall, J., Thabane, M., Garg, A., Clark, W., Salvadori, M. and Collins, S. (2006). Incidence and Epidemiology of Irritable Bowel Syndrome After a Large Waterborne Outbreak of Bacterial Dysentery. Gastroenterology, 131(2), pp.445-450. Spiller, R. and Campbell, E. (2006). Post-infectious irritable bowel syndrome. Current Opinion in Gastroenterology, 22(1), pp.13-17. Ericsson, C., Hatz, C. and DuPont, A. (2008). Postinfectious Irritable Bowel Syndrome. Clinical Infectious Diseases, 46(4), pp.594-599. Grenham, S., Clarke, G., Cryan, J. and Dinan, T. (2011). Brain?Gut?Microbe Communication in Health and Disease. Frontiers in Physiology, 2. The Brain-Gut Connection [Online] Available at: http://www.ibsclinic.org.au/causes.php?pageId=584&moduleId=186 [Accessed: 24 June 2018]. Folks, D. (2004). The interface of psychiatry and irritable bowel syndrome. Current Psychiatry Reports, 6(3), pp.210-215. Fichna, J. and Storr, M. (2012). Brain-Gut Interactions in IBS. Frontiers in Pharmacology, 3. El-Salhy, M. and Gundersen, D. (2015). Diet in irritable bowel syndrome. Nutrition Journal, 14(1). Irritable Bowel Syndrome - National Library of Medicine - PubMed Health [Online] Available at: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024780/ [Accessed: 24 June 2018]. Folks, D. (2004). The interface of psychiatry and irritable bowel syndrome. Current Psychiatry Reports, 6(3), pp.210-215. Ikechi, R., Fischer, B., DeSipio, J. and Phadtare, S. (2017). Irritable Bowel Syndrome: Clinical Manifestations, Dietary Influences, and Management. Healthcare, 5(2), p.21. Rao, S., Yu, S. and Fedewa, A. (2015). Systematic review: dietary fibre and FODMAP-restricted diet in the management of constipation and irritable bowel syndrome. Alimentary Pharmacology & Therapeutics, 41(12), pp.1256-1270. Moayyedi, P., Quigley, E., Lacy, B., Lembo, A., Saito, Y., Schiller, L., Soffer, E., Spiegel, B. and Ford, A. (2014). The Effect of Fiber Supplementation on Irritable Bowel Syndrome: A Systematic Review and Meta-analysis. The American Journal of Gastroenterology, 109(9), pp.1367-1374. FRANCIS, C. (1994). Bran and irritable bowel syndrome: time for reappraisal. The Lancet, 344(8914), pp.39-40. Vazquez–Roque, M., Camilleri, M., Smyrk, T., Murray, J., Marietta, E., O'Neill, J., Carlson, P., Lamsam, J., Janzow, D., Eckert, D., Burton, D. and Zinsmeister, A. (2013). A Controlled Trial of Gluten-Free Diet in Patients With Irritable Bowel Syndrome-Diarrhea: Effects on Bowel Frequency and Intestinal Function. Gastroenterology, 144(5), pp.903-911.e3. Ford, A., Quigley, E., Lacy, B., Lembo, A., Saito, Y., Schiller, L., Soffer, E., Spiegel, B. and Moayyedi, P. (2014). Efficacy of Prebiotics, Probiotics and Synbiotics in Irritable Bowel Syndrome and Chronic Idiopathic Constipation: Systematic Review and Meta-analysis. The American Journal of Gastroenterology, 109(10), pp.1547-1561. Basturk, A., Artan, R. and Yilmaz, A. (2016). Efficacy of synbiotic, probiotic, and prebiotic treatments for irritable bowel syndrome in children: A randomized controlled trial. The Turkish Journal of Gastroenterology, 27(5), pp.439-443. Zhang, Y., Li, L., Guo, C., Mu, D., Feng, B., Zuo, X. and Li, Y. (2016). Effects of probiotic type, dose and treatment duration on irritable bowel syndrome diagnosed by Rome III criteria: a meta-analysis. BMC Gastroenterology, 16(1). Guandalini, S., Magazzù, G., Chiaro, A., La Balestra, V., Di Nardo, G., Gopalan, S., Sibal, A., Romano, C., Canani, R., Lionetti, P. and Setty, M. (2010). VSL#3 Improves Symptoms in Children With Irritable Bowel Syndrome: A Multicenter, Randomized, Placebo-Controlled, Double-Blind, Crossover Study. Journal of Pediatric Gastroenterology and Nutrition, 51(1), pp.24-30. Paineau, D., Payen, F., Panserieu, S., Coulombier, G., Sobaszek, A., Lartigau, I., Brabet, M., Galmiche, J., Tripodi, D., Sacher-Huvelin, S., Chapalain, V., Zourabichvili, O., Respondek, F., Wagner, A. and Bornet, F. (2007). The effects of regular consumption of short-chain fructo-oligosaccharides on digestive comfort of subjects with minor functional bowel disorders. British Journal of Nutrition, 99(02). Khanna, R., MacDonald, J. and Levesque, B. (2013). Peppermint Oil for the Treatment of Irritable Bowel Syndrome. Journal of Clinical Gastroenterology, p.1. Peppermint Oil for IBS: Does it Work? [Online] Available at: https://www.webmd.com/ibs/peppermint-oil-works [Accessed: 24 June 2018]. Grigoleit, H. and Grigoleit, P. (2005). Peppermint oil in irritable bowel syndrome. Phytomedicine, 12(8), pp.601-606. Khanna, R., MacDonald, J. and Levesque, B. (2013). Peppermint Oil for the Treatment of Irritable Bowel Syndrome. Journal of Clinical Gastroenterology, p.1. IBS Diet: What to Do and What to Avoid [Online] Available at: https://www.aboutibs.org/ibs-diet/ibs-diet-what-to-do-and-what-to-avoid.html [Accessed: 24 June 2018]. Johannesson, E., Simrén, M., Strid, H., Bajor, A. and Sadik, R. (2011). Physical Activity Improves Symptoms in Irritable Bowel Syndrome: A Randomized Controlled Trial. The American Journal of Gastroenterology, 106(5), pp.915-922.
The Mediterranean diet is actually a lifestyle. Not only you have to change the food you eat, you have to change your mindset and appreciate life more. Enjoy your meals with family instead of munching that plate of food in under 10 minutes in front of that TV screen. Life may be stressful sometimes but learn to relieve stress with meditation and exercise. The Mediterranean lifestyle includes:
Exercise - early morning runs are excellent to start the day or take a stroll after dinner
Enjoy meals with family and friends – electronics shouldn’t be at the dinner table
Take it easy – we all have stressful days but learn techniques to relieve it
Be well connected – socialise with those you love and care about instead of just texting on your phone