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IN THIS CHAPTER

❯❯ Taking a close look at the powerful nutrients found in simple foods and functional foods

❯❯ Toasting to the health benefits of red wine

❯❯ Highlighting heart health research

❯❯ Looking and feeling your best with anti-aging tips

❯❯ Dealing with diabetes and cancer through a Mediterranean diet

The Mediterranean diet has long been touted for providing health benefits, such as reducing coronary artery disease and decreasing the risk of some cancers. Including fresh vegetables and fruits, legumes, and healthy fats into your diet can help improve your health in many ways. And in addition to the health benefits, you’re eating foods with full flavor. Thinking of bland or boring Greek or Italian food isn’t easy.

This chapter highlights why this diet is full of health benefits (focusing on heart disease, cancer, diabetes, and anti-aging) by looking at some of the main nutrients found in Mediterranean eating.

As you read this chapter, note that a healthy diet, exercise, and stress management can significantly reduce your risk of certain diseases, but nothing can bring a guarantee. Genetic components also play a role with chronic diseases. However, if you have family history of heart disease, diabetes, or cancer, incorporating these lifestyle and diet changes into your daily life can help you decrease those risks.

Highlighting the Main Nutrients of the Mediterranean Diet

A plant-based diet such as the Mediterranean diet offers a plethora of nutrients that can help your body stay healthy. These plant foods are loaded with vitamins, minerals, antioxidants, phytochemicals, and healthy fats. The following sections highlight some of these key nutrients found in the foods associated with the Mediterranean coast.

These nutrients don’t just benefit humans; the plant itself needs them so that it can grow and protect itself from the elements, bacteria, and other damage. Without nutrients, the plant can’t grow or protect itself from oxidative damage or bacteria.

Fighting free radicals with antioxidants

Antioxidants are a key component of many plant foods that help slow down the process of oxidation (when your body’s cells burn oxygen). This slowing decreases the amount of free radicals, or unstable molecules, that cause damage to your cells, tissues, and DNA. Antioxidants are a crucial part of your diet because you can’t avoid oxidation all together. Consider the many contaminants, such as car exhaust, sunlight, unhealthy foods, and air pollution, that you’re exposed to during a typical day. These types of exposures can cause free radicals to gain speed in your body, damaging everything in their path and leaving you at greater risk of chronic conditions like heart disease and cancer.

Think about slicing an apple. Before you know it, the exposed flesh turns from white to brown. This browning occurs because of oxidation. But adding orange juice or lemon juice to the apple right after you slice it keeps it whiter longer because the antioxidant vitamin C in the juice protects the flesh.

Eating a diet high in antioxidants such as vitamin C, vitamin E, and beta-carotene means better protection for your body and overall health (no, the benefits of antioxidants aren’t just for apples). The ATTICA study in the September 2005 issue of the American Journal of Clinical Nutrition measured the total antioxidant capacity of men and women in Greece. It found that the participants who followed a traditional Mediterranean diet had an 11 percent higher antioxidant capacity than those who didn’t adhere to a traditional diet. The findings also showed that the participants who followed the traditional diet the most had 19 percent lower oxidized LDL (bad cholesterol) concentrations showing a benefit in reducing heart disease.

You don’t have to look far or even cook that much to get antioxidants into your diet. You can find plenty of antioxidants in fruits and vegetables. If you’re only eating one to three servings of fruits and vegetables per day, you need to increase your intake to take advantage of the produce’s antioxidants. We challenge you to increase your intake of fresh fruits and vegetables to five to eight servings daily! Table 2-1 shows some common foods, including lots of fruits and veggies, that are rich in certain antioxidants.

TABLE 2-1 Antioxidant-Rich Foods

TO SUPPLEMENT OR NOT TO SUPPLEMENT? THAT’S STILL THE QUESTION

Although you’ve likely heard the news that antioxidants found in foods promote good health, scientists are still researching whether taking supplements such as beta-carotene, vitamin C, vitamin E, or other antioxidant blends can replace eating the real thing.

Research has provided a great deal of information about many individual nutrients and their impacts on health, but researchers still don’t have the answers to many questions, such as how much of a supplement is enough and whether supplemented antioxidants have the same effect working on their own as the natural ones do working with accompanying nutrients. For instance, many fruits are high in vitamin C, so you may think that you can get the same vitamin C effects from taking a supplement if you don’t eat a lot of fruit. However, the vitamin C in an orange may work with the phytochemicals in the orange to more significantly affect your health than the vitamin C supplement does by itself. Even supplements made from fruits and vegetables may not contain the other nutrients.

Another supplement concern is that taking high doses of antioxidants may actually cause the antioxidants to work as pro-oxidants that promote rather than neutralize oxidation. And in some cases, you actually want free radicals to attack harmful cells such as bacteria and cancer cells. High doses of antioxidant supplements may interfere with this natural process.

The bottom line is that eating whole foods is still your best bet to combat diseases and live your healthiest life. As we note throughout the book, folks in the Mediterranean eat scads of produce, and this type of food intake is one of the reasons you see more longevity in people who live in this region.

Understanding phytochemicals

Besides vitamins and minerals, plants also contain phytochemicals. Don’t be scared by the big word. Phytochemicals are simply healthy chemicals that offer your body healthful benefits. As we say repeatedly throughout this book, a plant-based diet high in fruits, vegetables, and legumes can provide you with an increased amount and variety of phytochemicals, helping to promote heart health and working to prevent certain cancers.

Research in this area is relatively new and is uncovering a whole side of previously unknown health benefits. To date, certain phytochemicals have been shown to work as antioxidants (see the previous section), contain anti-inflammatory properties, and promote heart health.

Phytochemicals provide the pigment to your fruits and vegetables, so you can literally know which class of phytochemicals you’re consuming simply by noting the color you’re eating. Table 2-2 shows a few specific health benefits found in each color.

TABLE 2-2 Potential Health Benefits of Foods by Color

Vitamin D: Getting a little of the sunshine vitamin

Your body gets vitamin D, otherwise known as the sunshine vitamin, both from food sources and from exposure to sunlight. You want to make sure you get the appropriate amount of vitamin D; people in the Mediterranean may be healthier because they have strong levels of the vitamin.

The scientific community has been buzzing in the last ten years about the health benefits of vitamin D. Research shows this vitamin can help

❯❯ Protect against osteoporosis

❯❯ Reduce the risk of coronary artery disease

❯❯ Decrease the risk of certain cancers

❯❯ Lower the risk of infectious diseases such as the common flu

One theory suggests that the people of the Mediterranean coast are healthier because they’re exposed to more sunlight – specifically, the ultraviolet B rays that are responsible for producing vitamin D – because of their location near the equator and because they’re outside more often walking, gardening, working, or enjoying family and friends.

To produce vitamin D, you want exposure to sunlight for 15 minutes each day with no sunscreen (sunscreen blocks up to 90 percent of vitamin D production). Of course, unprotected sun exposure increases the risk of skin cancer, so you have to weigh the good with the bad. Note that many people don’t make enough vitamin D from the sun, including those who have darker skin tones, are overweight, are older, or live in northern climates.

In addition to the sun, you can get vitamin D from a few foods, such as fish, fortified cereals, and fortified milk. Food sources are limited, so you mostly need to depend on sun exposure to get the proper amounts.

Researchers agree that people’s vitamin D levels need to increase, although the level of increase is still up for debate. In 2010, the Institute of Medicine released a report recommending the following daily intake of vitamin D:

❯❯ People ages 1 to 70 should take 600 IU (international units) a day.

❯❯ People over the age of 70 should take 800 IU (international units) a day.

You can easily get your vitamin D levels checked with a simple blood test at your annual physical. Just let your primary care provider know if you have concerns about your level. Many people need to add a supplement to ensure they’re getting the daily dose they need, but don’t try to guess how much you need; taking too much vitamin D can have harmful consequences. Check out Vitamin D For Dummies by Alan L. Rubin, MD, (John Wiley & Sons, Inc.) for more information.

Choosing healthy fats

The Mediterranean diet is lower in omega-6 polyunsaturated fats (or fatty acids) and saturated fats than most people’s diets are; it’s also higher in healthy fats, such as monounsaturated fats and omega-3 polyunsaturated fats. (For reference, you find monounsaturated fats in foods such as olive oil, avocadoes, and certain nuts. Polyunsaturated fatty acids are in corn, safflower, soybean, sesame, and sunflower oils and seafood. Saturated fatty acids appear in animal-based foods such as meat, poultry, butter, and dairy products, as well as in coconut and palm oils.) The higher percentage of monounsaturated fats found in the Mediterranean diet is associated with

❯❯ A lower risk of heart disease

❯❯ Lower cholesterol levels

❯❯ Decreased inflammation in the body

❯❯ Better insulin function and blood sugar control

Omega-3 fatty acids are one of the big contributors to the health benefits of the Mediterranean diet, and many people don’t get enough of them. Research shows that omega-3s help reduce inflammation, which is specifically important for those with inflammatory diseases such as arthritis, cardiovascular disease, or inflammatory bowel disease. These fats are also shown to be helpful for weight management, immune system function, behavioral issues such as attention deficit (hyperactivity) disorder, mood disorders such as depression, and prevention of Alzheimer’s disease.

Omega-6 fatty acids occur abundantly in the diet through sources such as grains, nuts, and legumes as well as sunflower, safflower, sesame, and corn oils. Omega-6 fats lower cholesterol, help keep the blood from clotting, and support skin health. Both omega-3 and omega-6 fats are considered essential, which means your body doesn’t make them and needs to get them from your diet.

The big trouble begins when omega-3s aren’t balanced appropriately with omega-6s. A diet too high in omega-6 fatty acids and too low in omega-3 fatty acids can promote conditions of chronic inflammation, including atherosclerosis, arthritis, and inflammatory bowel disease. Preliminary research also shows a possible connection to obesity, depression, dyslexia, and hyperactivity. This out-of-balance fat intake is very common in the American diet (with a ratio of 15 to 20 omega-6s to 1 omega-3) and less common in a Mediterranean style diet. Experts say to shoot for balance with a ratio closer to 1 part omega-6 and 1 to 2 parts omega-3.

Rebalance your diet by incorporating more sources of omega-3s, such as fresh herbs, canola oil, walnuts, flaxseeds, chia seeds, and cold-water fish (such as salmon, herring, and sturgeon), into your meals. You can also find products (such as eggs) fortified with omega 3s. Limit other sources of animal proteins (such as beef, poultry, unfortified eggs, and pork) by reducing your portion sizes to two to three ounces.

You can also repair the balance by replacing your cooking oils with olive oil, which is high in a third fat called omega-9 fatty acids. Your body can make omega-9s on its own, but adding more of them to your diet can help you lower your omega-6 intake.

Boosting your fiber intake

“Eat more fiber.” You’ve probably seen this message in advertisements and the media. You can get all the fiber you need by eating the Mediterranean way, focusing on fruits, vegetables, whole grains, and legumes.

Fiber is what you may call the “roughage” found in plants. Your body doesn’t digest fiber like it does nutrients; fiber goes through your gastrointestinal tract intact. This process has a bigger impact on health than you may think; its very important roles include the following:

❯❯ Helps maintain a healthy gastrointestinal tract by decreasing constipation and reducing your risk of diverticulosis, or small pouches that form in your colon.

❯❯ Lowers total cholesterol and bad cholesterol levels, helping to keep your heart healthy. This is the role played by the soluble fiber found in foods such as oat bran, beans, and flaxseeds.

❯❯ Slows the absorption of sugars you consume from carbohydrate foods, which helps keep blood sugar stable. This function is important for those who have insulin resistance diseases, such as diabetes or PCOS, and helps people manage their weights more effectively.

❯❯ Acts as a natural appetite suppressant, helping you to feel full and satisfied after a meal. No need to buy those diet pills that are supposed to suppress your appetite. Save your money and try eating more fresh produce, beans, and whole grains with every meal.

Filling Up with Functional Foods

Functional foods are foods that provide a function other than basic nutrition, offering either specific health benefits or disease prevention. Often, these foods are high in phytochemicals, antioxidants, or good bacteria that can decrease your risk of disease.

You don’t need to get caught up in buying expensive packaged foods that promise you a cure-all; just focus on eating common Mediterranean cuisine. Easy! The following sections highlight some of the more common functional foods included in Mediterranean eating.

Functional foods aren’t exotic product you have to spend loads of money on. They’re simple, whole foods that you can keep stored on a regular basis. Table 2-3 is a quick guide to some great functional foods to keep in your pantry or refrigerator.

TABLE 2-3 Functional Foods

Bring on the bacteria: Embracing fermented foods

As you read this book, you have trillions of little creatures working hard inside your body to keep you healthy. These creatures, better known as your gut bacteria, are what scientists call your second brain.

Your gut bacteria change and shift depending on what you eat. Emerging research shows that a microbe balance more heavily populated with good bacteria can improve your immune system, help keep your mood in check, improve digestion, and even help you manage your weight more effectively. When the balance is off and you’re not supporting the good bacteria, it can affect your body in a negative way. Chronic gas, bloating, and indigestion are signs that your gut bacteria may be out of whack. On a bigger scale, your bacteria may indicate your risk of chronic disease. Your gut bacteria have many important roles, such as building vitamins during digestion and signaling your immune system. Research is beginning to show people with chronic diseases like diabetes may have a different mix of bacteria than healthy individuals. This is a new and exciting field that needs more exploration, but for now it’s wise to feed and expand your good bacteria.

Fermented food is full of healthy bacteria sometimes called probiotics and is quite popular in Mediterranean cooking. Fermentation is the process where the sugars and starches from fruits and vegetables are converted to lactic acid, which in return preserves food without refrigeration or canning. The most common fermented foods in Mediterranean meals are yogurt, cheese, wine, sourdough bread, and brined foods like olives, capers, artichokes, and peppers. Whether you snack on some peppers or have a slice of sourdough toast in the morning, you’ll be making your gut happy and healthy.

Getting nutty

You’d be hard pressed to find a Mediterranean cookbook that doesn’t offer recipes using nuts and seeds. A traditional Mediterranean diet was a poor person’s cuisine, so people ate what they could readily grow, including many varieties of tree nuts.

Nuts are made up of fat and protein, making them a perfect snack or meal component to help you feel full and satisfied. As a functional food, many nuts contain omega-3 fatty acids and/or monounsaturated fatty acids shown to help with heart health and decreasing inflammation. Nuts are also a great source of vitamin E, an antioxidant shown to protect the artery walls from forming plaque. According to a 2016 systemic review posted in the British Journal of Nutrition, higher nut consumption is associated with a decreased risk of coronary artery disease and mortality.

Nuts are also high in magnesium, a nutrient many people are lacking in the typical American diet. Mild magnesium deficiency is difficult to diagnose but may be more common than you think. Symptoms include insomnia, muscle cramps, headaches, and nausea.

Having an ounce of nuts (around 23 almonds or 14 walnuts) as a snack or on a salad can go a long way in keeping you healthy and feeling good, not to mention giving you great flavor for little work!

Understanding the Importance of Wine

Drinking more red wine, like many people on the Mediterranean coast do, may be one reason you’re excited about switching to a Mediterranean diet. Red wine has certain properties that research has shown are beneficial for heart health. If you drink alcohol in moderation, add a little red wine in place of other alcoholic beverages. (If you’re not a fan of red wine, drinking grape juice made from Concord grapes and eating purple grapes also provide similar heart-health benefits.)

The cardio protection red wine provides is attributed to the antioxidants from flavonoids found in the skin of the grapes. The flavonoids reduce your risk of heart disease by lowering bad cholesterol, increasing good cholesterol, and reducing blood clotting. A specific flavonoid called reservatol may have additional benefits, including inhibiting tumor development in certain cancers, but that research is still in early stages.

Although red wine can indeed be part of a healthy lifestyle, a fine line determines what amount is considered healthy. If you consume alcohol, you should do so in moderation: one drink per day for women and two drinks per day for men. Excessive drinking can become unhealthy and is linked to high blood pressure, cardiovascular conditions, and extra calories.

You also need to be in good health to enjoy this perk of the Mediterranean diet. If you have high blood pressure, high triglycerides, pancreatitis, liver disease, or congestive heart failure, drinking even moderate amounts of alcohol may worsen your condition. Also, if you take aspirin regularly for heart health, you want to slow down on the drinking. Talk to your health care provider to see what’s right for you.

GETTING THE FACTS ABOUT SULFITES IN WINE

Sulfites are used as preservatives in many food products and also occur naturally in foods. Many people have sensitivities and allergies to sulfites, causing asthma-like symptoms, hives, and swelling. The headache that commonly results from drinking wine may be due to sulfite sensitivity, but it’s more likely a question of overindulgence, dehydration, or lack of food in your stomach while drinking. If your headaches aren’t consistent when you drink wine, you can’t blame the sulfites (sorry). The best way to determine whether you have an allergy is to get yourself tested by an allergist, especially if you already suffer from asthma.

Sadly, you won’t have much luck finding a sulfite-free wine; grape skins themselves are high in sulfites, and more are added in winemaking to give your wine a long shelf life. Without added sulfites, you get vinegar in a few months. Despite popular belief, European wines don’t have fewer sulfites; in some cases, they have more!

Looking at the Mediterranean Diet’s Effect on Heart Disease

The Mediterranean diet is most noticed in the scientific community for its effect on heart health. Heart disease is the number one cause of death in the United States, even though a few lifestyle changes make it easily preventable. Genetics still play a strong role, of course, but making small changes to your diet and exercising make a big difference.

The first research focused on the Mediterranean diet started with a scientist named Ancel Keys and the Seven Countries Study. This study found that southern Europe had far fewer coronary deaths than northern Europe and the United States did, even when factoring in age, smoking, blood pressure, and physical activity. These results made researchers look more closely at the differences in dietary habits. This study is still important today because more people in the Mediterranean regions studied no longer eat in their traditional way, and those regions show higher occurrences of heart disease.

Recent research continues to show a correlation between a traditional Mediterranean diet and lower incidence of heart disease. According to a 2011 review of several studies covering 535,000 people that was published in the Journal of the American College of Cardiology, a traditional Mediterranean diet is associated with lower blood pressure, blood sugar, and triglyceride levels.

Another study published in the New England Journal of Medicine in 2013 observed more than 7,400 individuals who were already at high risk of heart disease. The participants were assigned a Mediterranean diet with olive oil, a Mediterranean diet supplemented with nuts, or a traditional Westernized lowfat diet. After following the participants for five years, the study found the folks following either Mediterranean style diet had a 30 percent reduction in cardiac events. This study highlights that a lowfat diet isn’t necessarily the answer for reducing cardiac events; the type of fats eaten, primarily nuts and olive oil, are more important.

Many more studies have shown the heart health protection of a diet high in fruits, vegetables, legumes, wine, and seafood, which support the idea that the Mediterranean diet is a healthy lifestyle. We’re sure you’ll continue to see more and more research on this topic in the future.

Fighting Cancer

Another area research on the Mediterranean diet has focused on is the diet’s effects on preventing and managing cancer. Specific staples of the diet have been shown to provide cancer-preventing and cancer-fighting benefits:

❯❯ Plant foods: A diet high in plant foods such as fruits, vegetables, legumes, and nuts may provide cancer protection. The high amounts of phytochemicals in these foods provide unique properties that can help inhibit or slow tumor growth or simply protect your cells. Head to the earlier section “Understanding phytochemicals” for details on these powerhouses.

❯❯ Meat: Beginning in 1976, researchers from the Harvard School of Public Health followed 88,000 healthy women and found that the risk of colon cancer was 2.5 times higher in women who ate beef, pork, or lamb daily compared with those who ate those meats once a month or less. They also found that the risk of getting colon cancer was directly correlated to the amount of meat eaten. Additionally, a 2011 report illustrated a link between eating red meat or processed meats and a greatly increased risk of bowel cancer. Its recommendation to consume less than 500 grams (roughly 1 pound of cooked red meats) per week actually aligns with the consumption across the Mediterranean.

❯❯ Olive oil: A study of 26,000 Greek people published in the British Journal of Cancer showed that using more olive oil cut cancer risk by 9 percent.

In addition to these ingredient-specific studies, the diet as a whole has some promising research. A 2008 study review published in the British Medical Journal showed that following a traditional Mediterranean diet reduced the risk of dying from cancer by 9 percent. That same year, the American Journal of Clinical Nutrition published a study that showed that among post menopausal women, those who followed a traditional Mediterranean diet were 22 percent less likely to develop breast cancer. The EPIC study has also published papers on the association between the Mediterranean diet and cancer risk. (Head to the nearby sidebar “Taking in the evidence with the EPIC cohort study” for more on the EPIC study.) A 2011 study published in the British Journal of Nutrition found that those who adhered more closely to a Mediterranean diet had a decreased rate of cancer. Although more research is needed in this area, you can enjoy a Mediterranean diet and know that you’re helping increase your odds against cancer.

TAKING IN THE EVIDENCE WITH THE EPIC COHORT STUDY

The European Prospective Investigation into Cancer and Nutrition (EPIC) study is one of the largest cohort studies in the world looking into the connection between diet, nutritional status, and lifestyle with the incidence of cancer and other chronic diseases. The study includes more than half a million participants who were followed for nearly 15 years, providing valuable information on diet interactions and wellness.

One of the highlights of this study is a close look at the health benefits of the Mediterranean diet and how this dietary pattern affects disease prevention. Through several published papers, the EPIC investigators have found that those who closely adhere to the Mediterranean dietary pattern have decreased overall mortality and decreased incidence of cardiovascular disease and cancer.

Of course, other factors that are out of your control (such as genetics) can influence whether you get certain diseases, but the evidence is clear from the EPIC study. You can help yourself prevent some of these chronic conditions by following a Mediterranean diet and lifestyle.

Battling Diabetes

The foods in a Mediterranean diet make perfect sense for a person with type 2 diabetes because the food choices lean toward being low-glycemic. The glycemic index is a measurement given to carbohydrate-containing foods that shows how quickly they turn into blood sugar. High-glycemic foods create a quick, high blood sugar spike, while low-glycemic foods offer a slow blood sugar rise. A diet that provides this slow rise in blood sugar is best for diabetics, who can’t manage a large influx of sugar normally. Most vegetables, fruits, whole grains, and legumes (hallmarks of the Mediterranean diet) provide a much slower blood sugar response compared to white bread, white pasta, or sugary snacks. A 2009 study from the Second University of Naples in Italy published in the Annals of Internal Medicine, found that diabetics who followed a Mediterranean diet instead of a lowfat diet had better glycemic control and were less likely to need diabetes medication.