Mediterranean Diet and Monounsaturated Fat

A very big caveat that goes along with suggesting Americans would do well to substitute monounsaturated fat for saturated is that such advice doesn't address the epidemic of obesity in our country. Each tablespoon of olive oil, or any cooking oil for that matter, consists of 120 calories of pure fat. And unlike carbohydrates, any fat we eat, whether saturated or mono-unsaturated, is stored very efficiently as body fat. In other words, the more fat in your diet, the fatter you are likely to end up with even when calorie consumption stays the same. And with excess body fat comes an increased risk of high blood pressure, which is considered a major risk factor for developing heart disease in and of itself.

Excess body fat also keeps down HDL-cholesterol, and much more dramatically than not eating olive oil. That is, body weight is a much more powerful regulator of HDL levels than monounsaturated fat in the diet. The less heavy a person is (the closer to healthy weight), the higher his HDL levels will be.

Another more powerful regulator of HDL-cholesterol than the amount of olive oil one eats is exercise. Vigorous physical activity helps maintain high HDL levels (in part because it can help keep off excess pounds).

These are extremely important considerations, since HDL levels are important for most Americans. People in the U.S. tend not to go on diets so low in fat that it doesn't matter whether or not artery-clearing HDL-cholesterol is present. Unfortunately, they also tend not to exercise, which is one reason obesity is so prevalent here.

Even if Americans did engage in a great deal of physical activity and manage as a whole to keep their weight at healthy levels (which not only maintains higher HDL- but also keeps down LDL-cholesterol), it is not at all clear that olive oil would be the dietary fat of choice for staving off heart disease. After all, canola oil is also high in mono-unsaturated fat. What's more, it has less than half the saturated fat of olive oil. Yes, olive oil contains some saturates; every cooking oil does. A particular one may be referred to as monounsaturated because monounsaturated fatty acids make up the bulk of its composition. But it is actually a combination of different types of fatty acids.

Other cooking oils that might do the job of keeping heart disease at bay are corn, safflower, and sunflower oils, all of which are high in poly- rather than mono-unsaturates. Indeed, when Harvard University nutritional biochemists recently reviewed hundreds of studies that addressed the effect of various oils on blood cholesterol levels, he found a pattern that indicated polyunsaturated fatty acids actively lower blood cholesterol, particularly LDL-cholesterol, while mono-unsaturates do not.

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Mediterranean Diet and Mediterranean Lifestyle

The Mediterranean diet, which includes olive oil and wine, may be a healthy diet, even though it obtains up to 40% of calories from fat. Not all researchers agree that this is a healthy diet. Lifestyle also may be a factor in the health of people living in the Mediterranean.

A Harvard University scientist arguing that a diet containing 35 to 40 percent of calories as fat--as much as 10 percent more than what health experts recommend--could be "very compatible with excellent health"? A member of the American Heart Association's Nutrition Committee saying it is possible to eat more fat than the Heart Association advises and still follows a heart-healthy eating plan? Are such things really happening?

Yes, even as Americans are being told to reduce their fat intake from 37 percent of calories to less than 30 percent in order to avoid the ravages of heart disease and various kinds of cancer, a handful of researchers believe it's possible to eat just as much fat as ever yet remain protected from the chronic diseases that plague so many Americans during the last 10 to 20 years of their lives. It's enough to make anyone struggling to stick to a low-fat diet break a pencil between his teeth.

The notion that how much fat one eats is not important for good health comes largely from research conducted some 35 to 40 years ago on the Greek island of Crete. Researchers found in the 1950s and early60s that while the farming community that populated the island took in close to 40 percent of calories as fat, mostly as olive (it is said that some men even drank a glass of olive oil in the morning), the rates of heart disease and various types of cancer there were among the lowest in the world, and the adult life expectancy was among the highest.

The residents of Crete in the 50s and 60s also drank much more wine than Americans do today--more than four times as much according to at least one estimate. And in southern Italy, where olive oil was also the principal dietary fat (total fat consumption hovered around 28 percent of calories rather than 35 to 40 percent), an estimated 14 times as much wine was drunk per person as in the present day United States--again, with lower rates of heart disease and cancer than in this country.

It certainly sounds like a diet many Americans would be more pleased to follow than the one that is currently recommended. After all, which would you rather eat, a U.S. Dietary Guidelines diet, with its "prim" instructions for choosing a diet low in fat and drinking alcoholic beverages in moderation if at all, or a Mediterranean diet that includes foods dripping with olive oil and a ready supply of wine?

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Mediterranean Diet Recipes - Lentil-Walnut Spread

Ingredients Required

3/4 cup lentils, rinsed
1/4 cup walnut halves
1 tablespoon olive oil
1 small clove garlic, peeled
1/2 teaspoon salt
1 cup finely minced arugula, spinach or watercress leaves
3 tablespoons vegetable broth
1/4 teaspoon ground cumin
1/8 teaspoon ground coriander

Procedure

In a small saucepan, combine lentils and 1 1/2 cups water and bring to a boil over high heat. Reduce heat to low, cover and simmer until lentils are tender and water is absorbed, 35 to 40 minutes. Drain well. Transfer to a small bowl.

In a small food processor or blender, process walnuts and oil to a smooth paste. With a rubber spatula, scrape mixture into bowl with lentils. With a fork, mash mixture into a paste.

Cut garlic in half; sprinkle with 1/4 teaspoon salt. With the flat side of a knife, mash together. Add to lentil-walnut mixture along with arugula, broth, cumin, coriander and remaining salt. Mix well. Cover and refrigerate up to 4 days.

Serve with French bread slices or stuff it into a whole-wheat pita with red onion and romaine lettuce. Makes 6 servings.

Nutritional information per serving

Calories, 83.16;
Protein, 3.718 grams;
Carbohydrates, 6.064 grams;
Total fat, 5.379 grams;
Cholesterol, 0;
Saturated fat, 0.509 grams;
Dietary fiber, 2.341 grams.

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Mediterranean Diet Recipe - Greek-Style Pita

Do not confuse extra-virgin olive oil with "pure" olive oil, which is an inferior grade. Never substitute pure olive oil for extra-virgin olive oil in a recipe.

Ingredients Required

1/2 cup chopped romaine lettuce
1/4 cup crumbled feta cheese
1/4 cup chopped ripe olives
2 tablespoons chopped, jarred, roasted red peppers
4 teaspoons low-fat dressing with olive oil
2 whole-wheat pita pockets, cut in half

Procedure

In a small bowl, combine lettuce, cheese, olives, peppers and dressing. Mix well. Spoon into pita halves. Makes 2 servings.

Nutritional information per serving

Calories, 395.5;
Protein, 11.52 grams;
Carbohydrates, 38.89 grams;
Total fat, 23.58 grams;
Cholesterol, 28.25 mg;
Saturated fat, 6.897 grams;
Dietary fiber, 5.269.

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Mediterranean Diet a Heart-Healthful Diet

While the Mediterranean diet can be heart-healthful, it's not just about a heart attack. Eating more fruits and vegetables, rich in vitamins and minerals, can make you feel better and look better, he said. The incidence of, and death rates from, heart disease in Mediterranean countries are lower than in the United States.

This may not be entirely due to the diet. Lifestyle factors such as meal patterns, more physical activity, social support systems and drinking wine in moderation with meals may also play a part, according to the Heart Association.

The Mediterranean diet includes a modest breakfast, a more substantial lunch followed by a siesta when possible, and smaller, lighter dinners. Mediterranean meals also are social events.

Meals traditionally are shared with family and friends in pleasant surroundings. Mealtime is not rushed; people usually relax at the table, sharing food and conversation. This helps to reduce stress and improve the body's ability to digest foods and absorb nutrients.

Americans eat in a hurry. They spend as little time on meals as any people in the world. I don't think people are satisfied. Their bellies may be full, but they go to the refrigerator an hour later because they haven't necessarily enjoyed their food.

A Mediterranean-style diet isn't for everyone. Because of the fat content of the Mediterranean diet, adopting it may increase the risk of obesity for some people, according to the Heart Association.

When deciding whether it's right for you, focus on the big picture and the diet's healthful benefits. Eat more grains, fruits, vegetables and legumes, and less meat. And follow the Mediterranean example of enjoying relaxing meals and incorporating exercise into your daily routine.

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Getting a Mediterranean Frame of Mind and Diet

Winter's history. Add some sunshine to your diet with the flavorful foods of the Mediterranean region.

Getting in a Mediterranean frame of mind also is a great way to eat more healthfully. A traditional Mediterranean diet, rich in olive oil as well as fruits, vegetables and grains, has been correlated with heart-healthful benefits, lowering cancer risk and other health advantages.

"Heart disease is among the leading causes of death in the United States, and despite all the advances in treatment, it's still better if we can prevent the disease. One of the best ways to prevent heart disease is through diet and exercise," said dean of the University of South Carolina's School of Public Health.

But, because diet modification is difficult for many people, a Mediterranean-style diet may offer a healthful, more palatable option. He favors the Mediterranean diet over other traditional ethnic diets that show promise in preventing chronic disease because he believes it is easier to sustain than very low-fat diets. In addition, many of the foods are more familiar and easier to find.

There is no single, typical Mediterranean diet. Diets vary not only from country to country in the Mediterranean area, but also among regions within countries. However, there is a consensus among health professionals that a traditional Mediterranean-style diet is more healthful than the American diet because it includes more grains, such as pasta and couscous, fruits, vegetables, legumes, nuts and olive oil. It is a diet high in soluble fiber, antioxidants and other important nutrients.

The greatest difference is that red meat is much less important in the Mediterranean diet, with cheese and yogurt, along with eggs, poultry and fish constituting the predominant sources of protein. The American Heart Association, while noting health benefits that are correlated with a Mediterranean diet, recommends a diet with fewer calories coming from fat. And the Mediterranean-style diet is not a low-fat regimen.

About 30 to 40 percent of calories in a Mediterranean diet come from fat, about the same as in the typical American diet. The difference is that because of the emphasis on fruits, vegetables, grains and olive oil -- a monounsaturated fat-- saturated fat accounts for only 8 percent of calories in the Mediterranean diet. This level of saturated fat is lower than the average in the American diet and is within the Heart Association's dietary guidelines.

A low-fat diet can help prevent heart disease, but people tend not to remain on a low-fat diet.

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Cooking Oil in Mediterranean Diet

Aside from which cooking oil(s) might be most appropriate here in the Mediterranean diet, what needs to be considered is that although olive oil may not be harmful for lean and active populations that do not mean more is better. While the people on Crete ate enough olive oil to bring their fat consumption to 40 percent of their total calories, those in southern Italy, who enjoyed similarly low rates of heart disease and various forms of cancer, ate only 28 percent of their calories as fat. Perhaps if they had eaten less olive oil, their rates of chronic disease would have been even lower. Indeed, many researchers believe that for the purpose of avoiding breast cancer, the optimal amount of fat in the diet falls somewhere around 20 percent of total calories. That hypothesis is supported by the fact that in Japan, where fat intake has traditionally been quite low, breast cancer incidence is even lower than it was in 1960 Greece--and life expectancy for both women and men today is just about the highest in the world, certainly higher than in Greece and Italy.

An abundance of olive oil is just one part of the Mediterranean diet that may not travel well. But even from a fat-loving American's viewpoint that might not be a bad thing. As much as some people in this country enjoy olive oil's rich taste and smooth mouth feel, they still may not want to eat as much of it as did the folks in Greece or Italy, who averaged, per person, somewhere on the order of two to three tablespoons of the stuff a day. We currently average about three tablespoons of olive oil per person every four months or so! To make the switch we'd probably have to start eating it in all kinds of dishes at almost every single meal--a shift many would find not just monotonous but also expensive. Olive oil costs a lot more than other cooking oils.

Contrarily, a lot of Americans might not mind making the switch to the greater wine consumption of the Mediterranean. Many people really enjoy the taste of wine and above and beyond that, the calm, relaxed mood it tends to create. Currently, Americans drink very little wine, which in moderate amounts raises HDL-cholesterol levels and has consistently been associated with a reduced risk of heart disease. Consumption here averages less than an ounce per person per day, however, whereas in Greece it averaged three ounces a day and in Italy, an estimated 10 ounces, or two five-ounce glasses. Of course, in those areas people grew up learning to drink wine as an integral part of meals in a family setting; it was not used, as alcohol often is here, away from the table as a recreational drug.

But the issue of drinking more wine in the U.S. is a sticky one just because of our lack of "familiarity" with it. A good deal of strong evidence indicates that as increased wine consumption decreases the risk for heart disease, it increases the risk for breast cancer in women. Thus, the benefit to women who start to drink more wine is murky, as it is for anyone who has a family history of alcoholism or who must operate potentially dangerous machinery or drive a car during the workday. It should be noted, too, that alcohol increases the risk for liver disease as well as the risk of falls and other accidents.


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