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The Mediterranean diet isn't just about what you eat – it's also about how you eat it

Focus on cooking meals with fresh, minimally processed ingredients to bring you closer to a Mediterranean style of eating.


Health Advisor is a column where contributors share their knowledge in fields ranging from fitness to psychology, pediatrics to aging.

Diet. When most people hear this word they think of restricting calories to lose weight. However, the real meaning of "diet" comes from the Greek word dieta, which means "a way of life."

If we follow this definition, then whatever "diet" we choose needs to be one we can live with for the long term. This is a conversation I often have with my clients, who are troubled by the conflicting messages out there on food and nutrition. Contrary to what the diet industry would have us believe, most "diets" are not sustainable.

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An exception is the Mediterranean diet. Extensively studied and known for its cardiovascular benefits, the complete description of this way of eating is in keeping with the true meaning of the word diet. The Mediterranean diet encompasses an attitudinal, cultural and lifestyle approach to eating, that in addition to what is eaten, considers how and where we eat.

It largely focuses on plant-based foods without being vegetarian. It also focuses on the experience of eating. Taking time to prepare food and sitting down at a meal with others to enjoy the experience of eating that food are key features of this dietary approach. And yes, red wine is included in this mix, albeit in moderation and usually with meals.

Studies have shown that the Mediterranean pattern of eating reduces cardiovascular risk factors such as high blood pressure, Type 2 diabetes and metabolic syndrome. Most of the randomized controlled trials looking at the effects of a Mediterranean diet on health have been done in secondary prevention, the area in which I work. Secondary prevention means the diet is studied among individuals who have experienced a heart attack, bypass surgery or angioplasty and are at a higher risk of dying.

For instance, the Lyon Diet Heart Study was a randomized controlled trial that looked at the incidence of cardiovascular death and heart attack in those following a Mediterranean diet compared with a low-fat diet among people who had had a heart attack. The results were compelling. Those on the Mediterranean diet experienced 73-per-cent fewer deaths and heart attacks compared with the low-fat group.

Beneficial results were also experienced in the PREDIMED study, which was a randomized control trial that looked at the benefits of a Mediterranean diet in people at high risk for heart disease (primary prevention). This study showed how following a Mediterranean-diet pattern reduced cardiovascular risk and death by 30 per cent. Other studies have shown protective effects of a Mediterranean diet against other chronic diseases such as cancer.

Interested in making the shift to this dietary way of life? The following are key elements that are included in a Mediterranean style of eating:

Plant foods

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This diet emphasizes vegetables and fruit, as well as legumes, whole grains, nuts and seeds. A variety of nuts are included, walnuts being the main source. Walnuts are a plant-based source of omega-3 fatty acids that are associated with many heart-health benefits. Whole-grain breads in a Mediterranean diet are high in fibre and nutrient-rich. Plant proteins such as legumes are used in large amounts and provide high amounts of fibre that aid in lowering cholesterol and blood-glucose levels.

Olive oil

Because olives are readily available in the Mediterranean,

olive oil is used as the main source of fat in this diet for cooking and as an additive to dishes such as salads.

Protein sources

Fatty fish is a great source of omega-3 fatty acids. Intake of meat is low and includes lean sources of rabbit, poultry, beef and pork. Dairy is included, mostly as fermented sources such as cheese and yogurt.

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Limited processed foods and sugar

Generally, meals are prepared from scratch and sugars and sweets are consumed in smaller amounts and in moderation. This doesn't mean you have to make your own yogurt or soak your beans overnight. I encourage my clients to start slowly, take shortcuts where possible and gradually make those changes over time. For example, no-salt-added canned beans and other goods are available in many grocery stores. Just rinse them and add to salads or soups for a source of plant-based protein, while increasing your fibre at the same time.

Being familiar with the core principles of a Mediterranean diet is an important first step. Integrating these principles into your lifestyle would be next.

Start by taking note of what you eat each day. Instead of focusing on individual nutrients such as saturated fat, sugar or sodium, focus on food and cooking meals with fresh, minimally processed ingredients to bring you closer to a Mediterranean style of eating. And remember to enjoy your meals.

Maria Ricupero is a registered dietitian, certified diabetes educator and spokesperson for Dietitians of Canada. She currently works at the UHN Cardiovascular Prevention and Rehabilitation Program in Toronto.

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