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Simple ways to follow a Mediterranean diet

A Mediterranean diet conjures up an image of fresh fish and colourful salads doused in olive oil, washed down with a glass of red wine - all while sitting in the sun of course. While we may not have reliable sunshine in the UK, we can certainly tap into the wide-ranging health benefits offered by the Mediterranean diet.

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Dr Simon Poole, author of the Real Mediterranean Diet and who co-wrote the Olive Oil Diet with Judy Ridgeway, says that if he were to pick one diet that combines nutrition, sustainability, taste, and healthy lifestyles, it would be the Mediterranean diet.

"Many of the diets advocated nowadays focus too much on single nutrients, such as fat or carbs, completely missing the point that food combinations are more important," he says.

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What is a Mediterranean diet?

The Mediterranean diet advises sticking to healthy food groups combined with lifestyle tips - such as together at the table, taking time to savour your food, enjoying regular exercise, and staying clear of junk foods.

Generally, it is based on around 5 to 7 portions of fruits and vegetables daily with wholegrain cereals, fish, eggs, dairy foods, olive oil, nuts, and seeds. Meat and poultry are eaten in small amounts.

But don't worry if you struggle to get anywhere close to your 5-a-day, as frozen, tinned, and dried fruits and vegetables all count just as much as fresh - but make sure the canned fruit doesn't have added sugar or syrup. The main point is eat a colourful variety of plant foods. You can also swap harder-to-buy Mediterranean options, such as aubergine, for typical British foods such as cabbage or kale.

Dietitian Dr Duane Mellor says: "There is some debate about whether it's best to try to mimic the Mediterranean diet in the UK, or to focus on foods that are more typical in the UK. These can provide similar nutrients to foods commonly used in Mediterranean countries."

Swaps could include having oats instead of spelt, salmon instead of shellfish, or lentils instead of chickpeas.

Unlike many diets promoted in books, in social media, or on celebrity websites, the Mediterranean diet is supported by many studies.

Poole says: "One of the biggest studies was PREDIMED - a multi-country study of nearly 7,500 older adults - which compared two variations of the Mediterranean diet with a typical low-fat 'healthy eating' plan."1

He explains that one Mediterranean diet group was given unsalted nuts as a snack, while the other group received olive oil. Over the next five years, both diet groups did so well health-wise that the trial had to be stopped so that everyone could benefit.

The results showed a staggering 30% reduction in the chance of dying from a stroke, heart attack, or breast cancer.

Mellor adds that as well as cardiovascular disease, a Mediterranean diet also appears to be beneficial for managing type 2 diabetes.

"A review of five clinical studies found that people who ate a Mediterranean-type diet improved their long-term glucose control compared with people who ate other types of diet," he says.2

But would you expect to pile on the pounds by adding higher-fat foods such as nuts, seeds, and olive oil into your diet?

"Not really," says Poole. "As these wholefoods help to fill us up, so we eat less at other meals."

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One downside to the Mediterranean diet may be the cost. Oily fish, nuts, seeds, and extra virgin olive oil can be expensive. However, you may save money by buying fewer sweets, confectionery, ready meals, and savoury snacks as these are not part of the Mediterranean plan. Eating seasonal fruits and vegetables that are on offer in supermarkets will also help keep costs down.

Watch your alcohol intake too though. Although red wine is included in the diet, it's important to stick within the guidelines of 14 units a week for men and women - spread over several days, and with at least a couple of alcohol-free days a week.

Mellor says that the benefits of red wine are overstated and that studies of the Mediterranean lifestyle often find that moderate alcohol consumption is associated with quality of life and reduced stress. However, that may be due more to the positive social environments than anything in the wine.

If you are more used to pie and chips than pimiento and chickpeas, read on.

Here are Poole's top ten tips to get started on the Mediterranean diet:

  • Vegetables - any types but ring the changes so you get lots of variety.

  • Extra virgin olive oil - use for cooking and salads. Dip your bread in it instead of spreading on butter or margarine.

  • Fruit - enjoy after meals instead of high-calorie desserts.

  • Snacks - choose unsalted nuts and seeds - a handful a day (around 30 grams) is enough.

  • Herbs and spices - these contain polyphenol compounds that act as natural antioxidants in the body. Try turmeric, basil, parsley, rosemary, oregano, sage, saffron, and freshly ground pepper.

  • Fish - each week, aim for one portion of white fish and one portion of oily fish, such as mackerel, salmon, tuna - fresh but not tinned tuna counts as an oily fish - or herring.

  • Dairy - try Greek yoghurt or cheese made from sheep or goat milk. The full-fat versions fit better with the Mediterranean lifestyle. Try fermented dairy products, for example, kefir.

  • Drinks - an occasional glass of red wine with a meal if you wish. Water or herbal teas are recommended.

  • Wholegrains - try a variety of grains, such as spelt, barley, buckwheat, bulgar, farro, millet, oats, polenta, and rice.

  • Beans and pulses - high in fibre, these can be added to soups and stews to bulk out beef, lamb, pork, and chicken.

A typical day on the Mediterranean diet

Breakfast:

  • Plain Greek yoghurt with added fruit - frozen is fine - and a teaspoon of honey.

  • Mug of rosehip or mountain tea.

Lunch:

  • Large salad with extra virgin olive oil, eggs, tinned tuna and chunks of wholegrain bread.

  • Fruit for dessert.

  • Mug of green tea.

Dinner:

  • Stew made with tomatoes, mixed beans - tinned or frozen are fine - diced pork, peppers, turmeric and parsley. Serve with kale and polenta.

  • Fruit for dessert.

  • A glass of red wine if desired - within safer drinking guidelines.

Snacks:

  • A handful of nuts, or a handful of pumpkin or sunflower seeds.

Further reading and references

  1. Guasch-Ferre M, Salas-Salvado J, Ros E, et al; The PREDIMED trial, Mediterranean diet and health outcomes: How strong is the evidence? Nutr Metab Cardiovasc Dis. 2017 Jul;27(7):624-632. doi: 10.1016/j.numecd.2017.05.004. Epub 2017 Jun 10.
  2. Esposito K, Giugliano D; Mediterranean diet and type 2 diabetes. Diabetes Metab Res Rev. 2014 Mar;30 Suppl 1:34-40. doi: 10.1002/dmrr.2516.

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