The Mediterranean Diet Health Benefits Revisited

Three red tomatoes lycopene mediterranean diet prevents cancer

Three red tomatoes lycopene mediterranean diet prevents cancerPhotograph courtesy of

A recent study evaluated six different clinical trials involving 2650 overweight and obese patients around the world.  The Mediterranean Diet was found to be more effective in reducing weight, body mass index, blood pressure, fasting sugar and total cholesterol than a low fat diet.  

The Mediterranean Diet is known as a moderate fat diet, because a higher percentage of calories comes from fat than in a standard heart healthy diet where less than 30% of calories are from fat. However, the secret of the Mediterranean diet is not the percentage of fat but the type of fat consumed. Olive, canola, sunflower, safflower, soybean and peanut oil commonly eaten in the Mediterranean regions are all mono and poly unsaturated oils, which are healthier than saturated and trans (partially hydrogenated vegetable oils). Monounsaturated fatty acids (commonly abbreviated MUFA) are healthier than saturated fats, which are found in animal fat products such as butter and tropical oils.  Avocados are another source of MUFA.

Nuts, another integral food consumed in Mediterranean countries, provide heart-healthy omega 3 fatty acids.

Fish, a leaner protein than red meat, is a major component of the Mediterranean Diet.  Fatty fish like salmon, halibut, herring, black cod and sardines have high levels of omega 3 fatty acids, which support healthy memory and aging, and prevent heart disease. Interestingly, omega 3 fatty acids modestly increase LDL ( bad cholesterol), but they are beneficial in preventing heart disease and stroke because they prevent platelet stickiness and help lower blood triglyceride levels. Omega 3 fatty acids also reduce the risk of sudden death by preventing heart dangerous types of heart rhythm abnormalities.Mykonos Crete Mediterranean Diet Madelaine Bulkes Made B

Photograph Courtesy of Madelaine Bulkes

The Standard American Diet or SAD (pun intended) has large amounts of red meat, fried foods, processed grains, cured meats, and sugary sweets and beverages.  In contrast, the Mediterranean Diet is plant-based, with up to 10 servings of fruits and vegetables daily. 

Whole grains are another important feature of the Mediterranean Diet. Bread is eaten plain or dipped in olive oil.  Avoid butter, which has saturated fat, and margerine, which contains trans fat made by partially hydrogenating vegetable oils. Whole grains take longer to digest so they prevent sharp increases in blood sugar after meals. 

Americans more commonly eat processed grains, which have the outer covering of the grain removed.  Remember that whole wheat bread is not made of whole grain; instead it is made out of processed wheat flour (but still has more fiber than white bread). Whole grains have more fiber and are healthier for the colon than processed grains. A high fiber diet can reduce the risk of diverticulosis and colon cancer.  It takes more calories to digest whole grains than to digest processed grains.  A diet high in fiber can also lower blood  cholesterol levels. The Mediterranean Diet have high amounts of soluble (beans, legumes, cracked wheat)  and insoluble (fruits, vegetables, oat bran) fiber.

Substitute a whole wheat version of your favorite pasta, and remember to cook it al dente (not soft) in order to prevent increases in blood sugar after eating.

red wine mediterranean diet mark phillips Timba LimberRed wine in moderation is acceptable in the Mediterranean Diet. However, if more than 5 ounces per day in women or 10 ounces a day in men is consumed, the benefits of the red wine are lost.  Women at risk for breast cancer or breast cancer

Photograph courtesy of Mark Phillips/Timba Limber

recurrence should consider restricting alcohol intake since this factor has been associated with breast cancer occurrence.  It is believed that the benefits of red wine to the heart are through the antioxidant action of the phytonutrient resveratrol, which is found in the skins of grapes. So the same benefits of wine can be achieved by eating red grapes or drinking pure red grape juice. 

Dr. Ancel Keyes and his colleagues (including Dr. Paul Dudley White, who later served as President Eisenhower’s heart doctor) developed the Seven Countries Study after World War II to evaluate the health of almost thirteen thousand middle-aged men in the United States, Greece, Italy, the Netherlands, Finland, Yugoslavia and Japan.  They discovered that people who ate a diet high in vegetables, fruits, legumes (beans, lentils), fish and whole grains were the healthiest. The healthiest men were the residents of Crete, who lived longer and had less heart disease than Americans in the post World War II era.  Dr. Keyes and his  associates hypothesized that it was the Mediterranean diet that the Cretans ate which contributed to their longevity and good health. The residents of Crete ate up to 10 servings of fruits and vegetables daily!

Studies have shown that the Mediterranean Diet decreases the risk of heart attack, stroke, Parkinson’s disease, Alzheimer’s disease and death from all causes. Although there have not been any prospective randomized, double blind, placebo controlled trials (the gold standard for evidence based medicine) comparing the Mediterranean diet to the standard American diet or weight loss programs, a number of studies have shown that people who follow the Mediterranean diet are leaner than people who follow other diets.

Cruciferous vegetables (shaped like a cross when cut)  such as broccoli, cauliflower, kale, cabbage and Brussels sprouts have antioxidants which prevent several kinds of cancer including breast and prostate.  Tomatoes have lycopene, an  antioxidant similar to vitamin A, which  reduces the risk of cancers such as breast and prostate. Cooking tomatoes or cooking with olive oil, such as in tomato sauce, increases the lycopene content.

The low sodium Mediterranean diet combined with the high potassium content of fruits and vegetables such as various greens, legumes, potatoes and squash helps lower blood pressure.  Spinach, almonds, lentils, broccoli, pumpkin and sunflower seeds are good sources of magnesium, another element essential to maintain good blood pressure.

The high fiber content of fruits, vegetables and whole grains stabilizes blood sugar and prevents diabetes.  Another benefit of fiber in the diet is that it keeps maintains a feeling of fullness, decreasing the temptation for eating unhealthy snacks when ravished! Mono unsaturated fats from foods such as avocados, olive oil and nuts increase the body’s ability to use insulin, which also decreases the risk of diabetes. 

Although nuts have healthy omega 3 fatty acids, they are composed of fat, so no more than a handful a day is recommended. Avoid salted or honey roasted nuts. Almonds, walnuts, hazelnuts, pine nuts, cashews and pistachios can be eaten as part of the Mediterranean diet.

Lean protein in the form of chicken and other poultry and fish (healthy portion  is checkbook cover size) are important components of the Mediterranean diet, and are consumed weekly. Red meat and pork is rarely eaten, no more than a few times a month, and in small portions (about the size of a deck of cards). Food is prepared simply, using fresh ingredients, without  sauces or gravies. Rosemary, garlic, thyme, basil and parsley are herbs commonly used in Mediterranean cuisine, and have been shown to have beneficial health effects.

Studies show that garlic decreases blood pressure and reduces risk of cardiovascular disease. Remember to allow cut garlic to sit out for at least 5 minutes before cooking, in order to retain its health benefits.

In the Mediterranean region, sweets are consumed infrequently (no more than twice weekly), and are usually made of natural sugars such as honey.  Aiming for a 75 calorie dessert is ideal. Sorbets, fruit and dark chocolate are the best dessert choices.

Low fat Greek yogurt, feta cheese, sardines, beans, Brussels sprouts, broccoli, spinach and kale are good sources of calcium.

Lentils, spinach, almonds, and poultry are good sources of iron. Eating citrus fruit or peppers provides vitamin C, which helps the absorption of iron in a meal. Lentils and beans are also good sources of potassium, magnesium, folic acid and soluble fiber. Soak beans and change the soaking water several times in order to decrease the gas producing substances in beans. Remember that beans are not a complete protein, meaning they lack some essential amino acids that the body must get through the diet; adding lean poultry and eggs provides these essential amino acids.  Egg yolks should be eaten no more than once a week due to the saturated fat content, but there is no limit to the amount of egg whites that can be consumed.

At least 30 minutes daily exercise or movement is a recommended part of the Mediterranean diet.

Finally, a very important component of the Mediterranean lifestyle is sharing food with friends and family. Enjoy the Mediterranean lifestyle, have a zest for life and improve health all at the same time!

Allain J. Nordmann, Katja Suter-Zimmerman, Heiner C. Bucher, Iris Shai, Katherine R. Tuttle, Ramon Estruch, Matthias Briel. Meta-Analysis Comparing Mediterranean to Low-Fat Diets for Modification of Cardiovascular Risk Factors. The American Journal of Medicine Volume 124, Issue 9, Pages 841-851.e2, September 2011.

Last updated on January 18, 2012 by Dr. Vee  Photograph courtesy of

red raspberries frozen antioxidants

Leptin, the Body Fat Hormone

Photograph of Assorted Nuts Courtesy of Stephen Orsillo
Photograph of Citrus and Parsley Courtesy of Sandra Cunningham
Photograph of Man Exercising Courtesy of Suhendra Utet
Photograph of Measuring Tape Courtesy of Irma Marren

Leptin is a protein secreted by adipose (fat) tissue. It was named after the Greek word leptos, meaning “thin.” The more stored fat a person has, the more leptin is secreted. Of course we used to think that fat just sort of, well, grew around the midline and thighs, and was inert. Now scientists know that fat is actually an active organ and makes hormones such as leptin.

Leptin binds specific receptors in the body tissues and organs. High leptin levels also signal the brain to decrease appetite and food intake. Leptin also interacts with the areas of the brain that involves motivation to eat and reward for eating as well as the feeling of being full.

Overeating, high sugar levels, high insulin levels, internal steroids and estrogens all increase leptin levels in the bloodstream.

Losing weight, a lack of body fat such as in patients with anorexia, HIV related weight loss, fasting state, adrenaline, thyroid hormones, testosterone all decrease leptin levels in the body.

Many of us think we have a hormonal reason for being overweight. The truth is that leptin deficiency is exceedingly rare. Rare cases of leptin deficiency are seen in childhood when children eat tremendous amounts of food and become morbidly obese. Because of their leptin deficiency, these children do not enter puberty. It is essential in obese children to determine if leptin deficiency is playing a role. These children respond to pharmaceutical replacement with leptin.

So how about the rest of us? Can leptin injections help with weight loss? Well, the truth is, most people who are obese already have very high levels of circulating leptin. They should lose weight due to the effects of leptin on the appetite and satiety centers in the brain but they don’t! Unfortunately, most people’s brains become resistant to the effects of chronically elevated leptin levels, just like diabetics become resistant to the effects of high insulin in their bloodstream. The exact mechanisms for this leptin resistance is unknown.

So it turns out that leptin is not the magic weight loss drug we thought it could be. Early studies with high dose leptin admininstration did not lead to significant weight loss. Some researchers propose that the addition of a pancreatic hormone called amylin may sensitize the body’s response to leptin. Preliminary studies suggest that the addition of an analogue of amylin called pramlintide may help aid weight loss, although like most weight loss studies, the patient withdrawal rate in this study was high, making conclusions difficult to interpret.

Where leptin may play a role is in the maintenance of weight loss. It is hypothesized that decreasing leptin levels in people who have lost weight increases their appetite and reverses the weight loss they attained. Hence the yo-yo weight loss/weight gain cycle that is so familiar to many of us. So in the future, it may be possible to maintain that hard earned weight loss with the use of exogenous leptin. For right now though, eating healthy portions and exercising are the best way to maintain that weight loss!

Last updated by Dr. Vee on February 27, 2011

How to Begin a Bone and Muscle Strengthening Program Smartly

By Guest Blogger Kim Miller, ACE Certified Trainer and Wellness Coach. 904 501- 6002

Gain Bone Strength and Muscle Tone Even if You’ve Never Trained

It’s never too late to gain strength. Our bones and muscles have an innate capacity to respond to stimuli by growing in size, density and strength. Here’s how to begin. In the beginning stages of a weight training routine, it’s necessary to take 3-4 weeks to learn proper technique while keeping the weights light.

Think of this process as setting the stage for smart progressive gains in strength, muscle tone, and muscle density. Skipping these two factors of proper technique and light weight in the initial stage increases injury occurance which is the number one reason people stop training. Don’t let this be you.

Keep the weight light enough that you can practice good form without any struggle. The temptation to increase the weight amount will be looming, but realize it is the tendons and ligaments of the body that really need sensible conditioning in these opening weeks. Be patient. Be Smart.

To Hire a Trainer or Not ?

If there was ever a time to hire a trainer it’s in the opening weeks of a weight training routine. A good trainer will show you what machines to use, how to set them up, and what weight to start with. A really good trainer will help you in those opening weeks to make sense of a routine suitable for you. This should involve asking many questions about your lifestyle, how much time you can commit to exercise, what type of job you have, past injuries, health status, motivation levels, reasons for initiating a strength program and other pertinent information that willhelp develop a plan that is suited for you and you’ll likely implement consistently.

A really good trainer will also add perspective on how best to adhere to the program and will transition you through various aspects of learning to strength train. A good trainer is well worth the money as making sense of the implementation of a strength routine is paramount when considering that most people do not continue a strengthening program for longer than a few weeks.

Going It Alone? If, for some reason you need to begin a strength program on your own, most gyms have attendants that can show you how to use the machines. There should be no cost for them to show you how to set up each machine. If you never strength trained before in your life, and you will be training on your own, have the gym’s attendant or preferably a personal trainer show you these five exercises.

Getting Started On Your Own

Leg Press- press through the heels and keep head back.

Latissimus Dorsi Pull Down-keep chest upright throughout and lean slightly back.

Chest Press- keep head back and engage chest muscles to press.

Seated Shoulder Press With Dumbells – back supported and palms facing in.

Standing Bicep Curl Against Wall- knees slightly bent and stand against wall for support.

Repetitions and Sets

Practice 15 repetitions of each exercise in the order as desribed above. Repeat this cycle one more time. Practice slowly and deliberately and use a light enough weight that 15 repetitions are not a strain.

How Often

Practice this routine 2-3 times a week for the first three weeks preferably having a day or two off in between. Increase the weights by no more than 15% each week. Remember, your goal in the opening weeks is to practice good form and allow your tendons and ligaments to get adjusted to the increased workload to come.

When you leave the gym you should feel like you could easily continued doing more. Don’t be tempted to increase your weights, repetitions or sets. This is a mistake that will ultimately increase the likelihood that you will dread going to the gym your next session. We are not just training our bodies, but we are also training our minds. It’s a process of adjustment and by honoring this you’ll increase the likelihood of making strength training a lifelong habit.

Look for part II of this series on smartly beginning a weight training routine for bone strength and increased muscle tone. Until then, keep in mind that our true wealth is in your health. Best of luck to you!

E-mail or call me for any questions you may have. I will be happy to help!

Kim Miller, Ace Certified Trainer and Wellness Coach. 904 501- 6002

Last updated April 1, 2010

Health Benefits of the Mediterranean Diet

Greeks who live on the Island of Crete have significantly less heart disease and cancer than Americans.  Research studies suggest it is the Mediterranean diet that may give Cretans their health advantage.

The Mediterranean diet is rich in fruits, vegetables, whole grains, fish and nuts such as almonds and walnuts.  It has been associated with lower risk of recurrent heart attacks than people who followed the traditional low fat, low cholesterol Step I American Heart Association diet, in which fat intake is less than 30% of daily calories. 

The Mediterranean diet is low in the animal fat of red meat as well as the  hydrogenated fats found in margarine and processed food. Instead, monounsaturated oils such as olive oil, canola oil and peanut oil are used. The diet does recommend limiting fat in general in people trying to lose weight.

The Mediterranean diet also includes up to one glass of red wine for women and up to two glasses per day in men.  However, if you do not already drink red wine, you should not start drinking just to get the benefits to the heart.  Remember that alcohol is addictive, and that the health benefits are lost when more than recommended amounts of alcohol are  consumed.

You may be able to get the same health benefits by drinking purple/red grape juice.  Purple grapes contain Oligomeric Proantho Cyannidins (OPCs) which neutralize free radicals in the body.  This may help prevent cancer and heart disease.

Low fat dairy, including yogurt, is consumed by Greeks in the Mediterranean.  However, like most healthy diets, sweets and processed foods (including tropical oils) are limited.

Nuts are an important part of the Mediterranean Diet because they provide heart healthy omega 3 fatty acids. Remember that because they are high in fat, no more than a handful of nuts should be eaten daily.

Mediterranean Diet Pyramid is provided courtesy of

Last updated January 15, 2012 by Dr. Vee

One Small Step toward Weight Loss, One Big Step toward Better Health


I am frequently asked by my patients, “What is the best weight loss diet?” (Followed by the question, “What pill can you give me to lose weight?” which is the topic of another article!) My answer is, “Whatever diet works for you.” THERE IS NO SUCH THING AS “THE DIET.” Many diets promote weight loss and improve overall health.

For example, the Ornish diet is the traditional low fat/high vegetable diet. The Mediterranean diet includes significant intake of fish, occasional red wine in some cases, olive oil and mixed nuts. The DASH diet, Dietary Approaches to Stop Hypertension, includes whole grains, some meats and no more than 2/3 tsp salt daily. The DASH diet helps prevent hypertension. Patients who follow high protein, low carbohydrate Atkins or Zone diets also successfully lose weight. Similar to the low carbohydrate diets are the low glycemic diets, such as the South Beach diet, which emphasize carbohydrates that avoid rapid increases in blood glucose after being eaten.  The Pritkin diet is a VERY low fat diet.

Food and supplement replacement diets (Nutrisystem, Optifast, Slimfast) also work, as do group programs such as Weight Watchers that emphasize support systems and group weigh-ins. Confused yet?

The problem with every diet system is that the weight is regained unless the dietary changes become a permanent part of one’s eating routine. So if you can’t eat high protein and fat, or low fat and vegetables, or protein shakes for the rest of your life, you will regain the weight.

What I suggest is small changes that can be a permanent part of your life. Remember, obesity is a lifelong condition, just like allergies or arthritis. If you stop treatment, weight gain, just like other chronic illnesses, will recur.

Here are some strategies to start before going on a radical diet. They are healthy first steps to improving your overall health. I challenge you to do (consistently) just ONE of the following strategies as the first step toward weight loss, health and fitness:

1) Eat a small, healthy protein/fruit rich breakfast.

2) Skip second helpings.

3) Decrease portion size of meats (3 oz, the size of a deck of cards)

4) Increase your activity. Start with five minutes of leisurely walking three times a week to simply incorporate exercise into your weekly routine. If you actually make the initial effort to set aside a small amount of time for exercise several days a week, you will slowly notice that you naturally increase your exercise exertion and endurance without significant effort. Of course, it is ESSENTIAL that you consult with your primary care physician first before starting any exercise program.

5) Stop telling yourself (and your doctor) that your stressful life/job/family responsibilities/joint limitations prevent you from finding time to exercise. The president of the United States exercises. Neurosurgeons and Fortune 500 company CEOs and carpool Moms exercise. Is your life more demanding than theirs? You can’t find five minutes three days a week to go window shopping? (Remember window shopping is the START, not the ultimate GOAL of your exercise program!)

6) Skip second helpings (worth mentioning again).

7) Consider eating six small meals a day instead of three large meals, and make dinner your smallest meal.

 8) Add more fiber, naturally, through whole grains (unless you have celiac disease), or fiber supplements. This is important for better colon health and to help serum cholesterol.

9) Cut out sodas and other sugary drinks.

10) Cut out alcohol.

11) Make a DETAILED food diary.

12) Decrease or eliminate sweets (Don’t buy them for your home, especially if you have children—you want them to develop healthy eating habits at a young age).

13) Cut out fast foods.

14) Walk across the parking lot to your job or up the stairs—this is the starting point, not the ultimate goal, of your exercise program.

15) Incorporate calcium sources into your diet

16) No food from vending machines!

17) No snacks after 7 PM.

18) Think about loving your body with all it’s imperfections. Concentrate on improving your health and well being rather than looking like a movie star.

19) Decrease TV time (and hence “snack time”)

20) Everyone in the family eat together for as many meals as possible, especially dinner. You and your teenagers are more likely to eat healthy meals, rather than fast food, this way.

21) Try to eat at least five fruit and vegetable servings a day.

Even if you don’t follow a “name” diet perfectly, incorporating ONE or more of the above measures is a great starting point, and will give you a sense of mastery and accomplishment. I ask patients to accomplish that FIRST SMALL step in their lifelong odyssey toward a healthy weight, decreased susceptibility to illness and most importantly, feeling energetic and happy!

Last edited by Dr.Vee on April 7, 2009