The Mediterranean Diet Score is a great way to daily score yourself from the Mediterranean Diet. This is a nine point system, and I started by the things that are important to it in the last blog Mediterranean Diet Score: Part One. Unlike many of the fad diets, adherence to the Mediterranean diet has been shown to mirror a decrease in death from heart diesease, cancer, and all cause mortality over the 44 months it was followed for over 22,000 people (Trichopoulou A, et al. Adherence to a Mediterranean Diet and Survival in a Greek Population. NEJM 2006. 348;26 2599-2608 link here).
For every two-point increment in the diet there was a decrease in deaths by 25%, and especially a decrease in death from heart disease (33% less ) and cancer (24% less).
So by eating better you can reduce your risk of dying over the next few months. Here were the nine categories – and today we will discuss the last few categories – Dairy, Meats, and Alcohol, because in this study more was not better. More vegetables, legumes, fruits and nuts, fish, and use of quality oils, as well as whole grains pretty much come under the banner of “more is better,” but not with these categories.
|Food Group||Daily Serving Size||Examples||More Examples|
|Vegetables||2-3 cups a day||1 c lunch, 2 c dinner||A good salad w your own dressing|
|Legumes||2 ounces a day||peanuts, beans, lentils, chickpeas||Lentil chili|
|Fruits and Nuts||9 oz men, 8 oz women||apples, oranges||Add an apple to your lunch|
|Fish||1 oz a day or 2 servings a week||salmon, tuna, trout, arctic char||mackerel, anchovies, sardines|
|Quality Oils/Fats||Unsaturated fats||Olive oil, canola oil||avocados, walnuts|
|Dairy||3/4 to 1 C a day||plain yogurt – add fruit, cheese||small bits of cheese|
|Meats||4 oz a day||Much less meat than most eat||less is more-|
|Whole Grains||2 – 3.5 cups per say||popcorn, steel cut oatmeal||make your own popcorn dressings|
|Alcohol||5 ounces of wine a day||red or white||limit is 2 glasses for men, 1 for women|
The Mediterranean diet emphasizes fermented dairy products, yogurt and cheese. Two major issues: yogurt in the Mediterranean areas is unlike yogurt found in the United States. Most yogurt in the United States, even those that are labeled as “Greek” yogurt have large amounts of added sugar. To get a point for dairy on the Mediterranean Diet Score it is best to use plain yogurt and add your own fruit (blueberries, strawberries) to it. As with many products it is always best to read the label of the yogurt to see if it has added sugar to it. My favorite brand of plain yogurt comes from Iceland, Siggi’s and you can purchase it at Safeway stores, as well as AJ’s. One other way is to make your own yogurt in an instant pot.
Other fermented products include cheese. Cheese is calorie dense, and like yogurt, it has limited amounts to get a point. My favorite cheese is still the Norwegian goat cheese that I grew up with as a child.
The key with dairy is that there is an upper limit. In this case about 3/4 to 1 cup per day. This allows some modest cheese and perhaps a bit of yogurt. In the Mediterranean they don’t have a lot of dairy. Some cheese is added as flavor. In the United States the Dairy Industry would have you believe you should be drinking a lot of milk and eating a lot of cheese. Limiting these, as they do in the Mediterranean Diet, provides you with cheese for some satisfaction but not so much that it increases caloric load. You will get plenty of calcium through your vegetables.
Still it is a point on the Mediterranean Diet Score and more points are not a bad thing. The key is that if you are having yogurt that has a lot of added sugar you will defeat yourself, and your mid-section. The studies were clear that yogurt and low fat milk had a reduced risk of metabolic syndrome but higher consumption of cheese did increase the risk of metabolic syndrome. (Babio N, et al. Consumption of Yogurt, Low-Fat Milk, and Other Low-Fat Dairy Products Is Associated with Lower Risk of Metabolic Syndrome Incidence in an Elderly. Mediterranean Population.J Nutr. 2015 Oct;145(10):2308-16. for link click here.)
There is no doubt that I am a lover of red meat. I really am. Lamb is probably my favorite, followed closely by steak. Those who live in the Mediterranean area didn’t eat that much red meat. The limit is 4 ounces per day. Not that this is a difficult thing to do, but to be fair, it is a point on the system. Four ounces of red meat can be quite satisfying.
If you slice the meat and display it out, as I did here – you get your four ounces. In the back is a lot of vegetables – in fact enough for a point on the Mediterranean Diet Score.
The difficulty is that many people like more red meat. This isn’t a debate about steak or red meat or its great benefit – this is about the score. Could you do this for dinner and be satisfied – yes. The studies thus far have shown that red meat consumption does not seem to be associated with shorter survival, but processed meats do (Bellavia A, et al. Differences in survival associated with processed and with nonprocessed red meat consumption. Am J Clin Nutr. 2014 Sept; 100(3):924-9 for link click here)
In this case the Mediterranean Diet Score typically uses red wine. For men this is two glasses of a five ounce pour per day, and one for women. Like my colleague, Dr Tim Harlan says – you cannot save this up for the weekend.
There are a lot of benefits from red wine – including anti-oxidants such as resveratrol, catechin, epicatechin, proanthocyanidins. Sadly resveratrol has been a part of one of the bigger frauds in weight loss schemes. If you heard the commercials touting “RM3” – it is a combination of one ingredient that doesn’t work for weight loss and resveratrol.
So a bit of wine is good for you – not a lot, just a bit. Drinking small amounts of red wine have been shown to decrease the risk of heart disease over non-drinkers. But more is not better. (Di Castelnuovo A, et al. Meta-analysis of wine and beer consumption in relation to vascular risk. Circulation. 2002 Jun 18; 105(24):2836-44 – link click here)
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Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate and graduate degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. He found he liked people more than petri dishes, and went to medical school. Dr. Simpson, a weight loss surgeon is an advocate of culinary medicine. The first surgeon to become certified in Culinary Medicine, he believes teaching people to improve their health through their food and in their kitchen. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcolm Baldrige award for healthcare in 2011 for the NUKA system of care in Alaska and in 2013 Dr Simpson won the National Indian Health Board Area Impact Award. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit www.terrysimpson.com.