The Mediterranean Diet Health Benefits Revisited


Three red tomatoes lycopene mediterranean diet prevents cancerPhotograph courtesy of epSos.de

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 epSos.de

red raspberries frozen antioxidants

Super Fruits for Health (Or Why Purple is the New Green)


Photographs Courtesy of Albaflickr/J.Jorge

Super Fruits are fruits that are packed with nutrients and antioxidants.

Free radicals are toxic molecules created naturally in the body when food is digested and energy is utilized by the body. Antioxidants are ingredients in fruits that fight damage created by free radicals. Cancer, heart disease, Alzheimer’s disease and eye problems can develop if free radicals aren’t neutralized by antioxidants in the body. Super Fruits have antioxidants which scavenge free radicals and decrease inflammation in the body. Antioxidants also boost the immune system to help fight infections. Many fruits have high levels of potassium, which helps prevent high blood pressure.

1.Blackberries–Purple berries have the highest antioxidant content of any food, so when it comes to fruits and vegetables, purple is the new green! Anthocyanins are the antioxidants in blackberries (and black currants) that give berries their deep purple color and protect against heart disease and cancer. Blackberries also have high levels of vitamin C, which help boost the immune system. Blueberries, raspberries, strawberries and cranberries also have high levels of antioxidants. Cranberries may help prevent bladder infections.

2. Tomatoes–(fruit though we think of as vegetable). Red fruit such as tomatoes have an antioxidant called lycopene which helps prevent heart disease and certain types of cancer. Cooking tomatoes increases antioxidant levels. Tomatoes contain high levels of Vitamin E, vitamin C and iron.

3. Avocado–also known as an alligator pear. Contains more protein than in a steak! Avocados have essential amino acids (can only eat in the food, not made naturally in the body) to build muscle. They contain heart healthy omega 3 fatty acids. The monosaturated oil in avacodos help lower bad cholesterol levels. Contains lutein, which helps preserve eyesight. The antioxidants in avocados are great for the skin when applied as a masque.

4. Red grapes and grape juice–Contains the same heart healthy antioxidant resveratrol found in red wine. Resveratrol is felt to help prevent heart disease and blood clots. The skin of red grapes are packed with polyphenol antioxidants so eat the grapes with the peels on!

5. Pomegranates–one of the earliest cultivated fruits. High in fiber, vitamin C and potassium. Contains antioxidants called polyphenols (tannins, anthocyanins, and ellagic acid) that help prevent heart disease.

6. Kiwi–Can be mashed and spread on meat as a natural tenderizer. Good source of fiber, vitamin C, potassium and vitamin E. Has antioxidants to help vision and prevent heart disease. Mild flavor so kids will enjoy. One study showed kiwi fruit helped reduce the inflammation of asthma in children.

7. Chili Peppers–All peppers have seeds so are considered fruit (though we often cook them like vegetables). Contain antioxidant called capsaicin, which treats inflammation pain due to osteoarthritis. It is also used as a natural remedy for nasal congestion. Also increases endorphins in the brain so may help improve mood. Peppers contain more vitamin C than oranges! They also have high levels of the antioxidants beta carotene (to help prevent cancer) and lutein (to preserve vision).

8. Figs–Contain lutein that helps maintain good vision. High in iron, fiber, potassium and calcium. Contain polyphenol antioxidants.

9. Oranges–high in fiber and vitamin C, which helps boost immune system. May be helpful in reducing the inflammation associated with asthma and rheumatoid arthritis. Vitamin C helps the absorption of iron from the stomach.

10. Apples–Contains pectin, a soluble fiber that lowers cholesterol and blood sugar levels. Pectin binds heavy metals like lead and mercury to help the body get rid of these toxins. Contain high levels of vitamin K which helps with clotting function, and vitamin C which helps make healthy connective tissue. Trace mineral selenium helps body’s natural antioxidant system. Antioxidants in apples help preserve brain and memory function. Lots of nutrients in the peel of apples. Consider splurging for organic apples to avoid possible pesticide exposure.

Last updated on March 15, 2011 by Dr. Vee

Statins and Beta Blockers Deplete CoQ10


 

Coenzyme Q10 is a natural substance found in abudance in cells of the body that provides energy to the body and helps the immune system.  CoQ10 also acts as an antioxidant in the body.  Antioxidants are substances that attack and remove free radicals, dangerous substances which cause damage to cells and can eventually result in cancer, aging or cell death.  CoQ10 protect cells from stress from environmental toxins (e.g. cigarette smoke) or aging.  It is in this way that Coenzyme Q10 is believed to help the body fight cancer, prevent heart disease, and combat aging. 

CoQ10 is found in mitochondria, the parts of cells that generate energy. CoQ10 is involved in the generation of energy called adenosine triphosphate (ATP) in cells.  ATP is the energy currency that allows cells to carry out all their myriad functions, including muscle contraction, protein synthesis and other vital cell functions.

Two forms of CoQ10 exist. The more common form is called ubiquinone. The active or oxidized form of CoQ10 is called ubiquinol.  Young people convert ubiquinone to the active component ubiquinol quite readily.  However, ubiquinone is less easily converted to ubiquinol as people get older.  Until recently, ubiquinol was unstable and could not be manufactured as a supplement.  Now ubiquinol is available, but is typically more expensive than the ubiquinone form.

CoQ10 are found in large numbers in the power centers of the body, the liver and heart.  In the liver, CoQ10 is made in a pathway similar to the way cholesterol is made.  So when a person is on a statin, which inhibits an important enzyme that makes cholesterol, the CoQ10 pathway is also impaired.  It is believed that two important classes of medications, the statins (simvastatin, atorvastatin, pravastatin, lovastatin) and beta blockers (atenolol, metoprolol) decrease (up to 40 %) the production of CoQ10 in the body.

Eating antioxidants in Super Foods such as pomegranate juice is a good way to replenish CoQ10 in the body. Some experts feel that older patients on statins or beta blockers should take CoQ10 supplements to replace the reduced levels of CoQ10 in cells.  Some experts feel that people who have high blood pressure should consider supplementation with CoQ10 as well as Vitamin D3.  Athletes (and wannabe athletes) may want to consider adding CoQ10 supplementation to optimized exercise endurance and muscle recovery.

Last updated March 19, 2010 by Dr. Vee

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 Oldwayspt.org.

Last updated January 15, 2012 by Dr. Vee

Treatment of Influenza A H1N1 “Swine Flu” with Anti-Viral Medicines in High Risk Groups


Blue Swine Influenza Molecules from CDC

 

Electron MicrographView of Influenza A H1N1 Virions 

 

Two classes of antiviral drugs are available for the prevention and treatment of influenza: neuraminidase inhibitors and adamantanes, which inhibit a viral protein called M2. Influenza A H1N1, formerly known as swine flu, has been found to be resistant to adamantanes (amantadine and rimantadine). Oseltamivir (Tamiflu) and zanamivir (Relenza) are the two neuraminidase inhibitors currently available by prescription. These drugs reduce the median duration of symptoms by approximately one day and reduce the chance of contracting influenza by 70 to 90 percent when used for known influenza exposure.

 

zanamivir moleculeWho Should be Treated with Neuraminidase Inhibitors if they Contract Swine Flu?

High risk groups for the development of H1N1 influenza A, formerly known as swine flu, include children and adolescents who are on longterm aspirin therapy (which puts them at risk for the brain abnormality Reye’s Syndrome if they contract influenza), children under the age of five and pregnant women. Adults and children with chronic lung disease, cancer, heart disease, kidney dysfunction, diabetes, sickle cell anemia, HIV infection and transplant recipients are also considered high risk for complications for influenza, and should be treated with antiviral agents.

Adults and children with brain abnormalities which result in decreased ability to clear respiratory secretions should also be treated with oseltamivir or zanamivir in the event they contract or are exposed to Influena A H1N1.  Patients with cerebral palsy, Lou Gehrig’s disease, seizure disorders and spinal cord injuries would be considered at higher risk for serious complications if they were to contract influenza. Elderly patients, especially those who live in Nursing Homes are also at high risk for developing complications of influenza.

Surprisingly, most patients to date who have contracted Influenza A H1N1, formerly known as swine flu, are younger, healthier patients. Use of Neuraminadase Inhibitors in Infants Under the Age of One Treatment should be considered for infants (down to one day of age) and children with moderate to severe influenza, and those at high risk of complications, including children younger than 5 years of age. While antiviral treatment earlier in the course of infection is likely to have a greater impact on decreasing clinical illness, treatment can be started even if the duration of illness is greater than 48 hours.

 

 

virion2

Who Should Receive Preventative Treatment with Neuraminidase Inhibitors?

 

The Centers for DIsease Control (CDC) recommends consideration of antiviral prophylactic (preventive) treatment with medications in patients who have had known or probable exposure to swine flu and are at high risk for developing complications if they were to contract influenza H1N1. Pregnant women, patients over the age of 65, and patients who have the above described chronic medical conditions and who are household contacts of a suspected or confirmed case of swine flu should receive treatment with antiviral medications. A patient is believed to be infectious from one day prior to seven days after symptoms of swine flu start.

Children in daycare and school children who are at high risk for complications of swine flu and who have had close contact with someone diagnosed with swine flu is eligible for prophylactic treatment with neuraminidase inhibitors.

Travelers to Mexico who are at high risk of influenza complications should also receive preventive treatment. Prophylactic treatment with antiviral agents is available to babies under the age of three months, but is only recommended if the infant is critically ill.

Ambulance personnel, emergency medical service providers, first responders, emergency room personnel and other health care workers who are working in areas of confirmed swine flu, and who are at risk of serious influenza related complications may receive antiviral medications to prevent influenza. People who are required to have contact with others in high risk situations such as hospitals or in areas with numerous documented cases of influenza A H1N1 cases should use N95 respirators  to prevent infection.

 

 

Virion Particle

Viral Strains Resistant to Anti-Viral Medications are on the Rise

Antiviral resistance can develop to adamantanes such as rimantadine and amantadine after just two to three days of therapy with the class of antiviral agents called adamantanes. Amantadine is an example of this class of drug.

Resistance to oseltamivir, a neuraminidase inhibitor, can also form in two to three days of therapy. Resistance to neuraminidase inhibitors is being seen in some countries. It is expected that strains resistant to oseltamivir and zanamavir will be resistant to peramivir, another medication in the same class, which is currently in development.

Treatment with oseltamivir in infants under the age of one is based on age, not weight. Dosing of children between age one and twelve is based on weight. Zanamavir, which is an inhaled medication, should not be used in patients with asthma or chronic obstructive pulmonary disease (COPD) because it may cause wheezing or shortness of breath.

There have been rare reports of self-harming behavior that may be associated with neuraminidase inhibitor treatment, primarily in Japanese children. Therefore the risks and benefits of treatment with these anti-viral agents should be taken into account before they are used. Treatment or prevention with anti-viral agents does not negate the need for simple infection control measures such as hand washing to prevent the spread influenza H1 N1 infection.

 

 

Legal Disclaimer: This article is for informational purposes only and should not substitute for medical advice from your health care provider. The author is not providing personal medical opinion, diagnosis or course of treatment. Do not delay or substitute this information for medical treatment.

Last updated August 28, 2009 by Dr. Vee

Anti-Viral Treatment of Novel Influenza A H1N1, Formerly Known as Swine Flu


Read my article on Suite101:

Anti-Viral Medicines (Oseltamivir and Zanamivir) for the Treatment and Prevention of Swine Flu (Influenza A H1N1)

Medical Students Learn to Wear Face Masks and Sit Two Seats Apart,  in Preparation for Volunteer Work in Mexico City

Medical Students Wear Face Masks and Sit Two Seats Apart, in Preparation for Volunteer Work in Mexico City

Influenza A Virion

Influenza A VirionHemagglutin (H) and Neuraminidase (N) Particles on Surface of Influenza A Virion