APPENDIX A

Basic Snacks

Here is a list of snacks to incorporate into your daily routine while following the Mediterranean diet. These snacks do not require much preparation, and many can be purchased directly from the grocery store.

SNACKS UNDER 50 CALORIES:

•   1 small apple, sliced •   ½ small banana •   1 cup blueberries •   ½ cup fruit salad •   14 grapes •   1 sliced kiwi fruit •   1 small orange •   1 peach •   1 cup chopped watermelon •   ⅛ ounce sliced avocado •   1 cup sliced celery

•   1 sliced tomato with 1 tablespoon grated Parmesan cheese •   1 dark chocolate square •   3 cups air-popped popcorn •   4 whole-grain crackers •   1 tablespoon hummus with celery •   ½ cup plain nonfat Greek yogurt mixed with 1 teaspoon honey •   8 pitted kalamata olives •   ½ ounce dried turkey jerky

SNACKS UNDER 100 CALORIES:

•   1 sliced apple with 2 teaspoons peanut butter •   1 small baked apple with cinnamon •   1 cup unsweetened applesauce •   1 small banana •   3 peeled clementines •   3 tablespoons dried fruit •   1 cup chopped pineapple •   2 tablespoons hummus with 8 baby carrots •   1 scoop nonfat frozen yogurt

•   3 large carrots, peeled and sliced •   1 cup tomato soup •   3 dark chocolate squares •   6 cups microwave popcorn •   15 whole almonds •   30 shelled pistachios •   ¼ cup whole-grain granola •   2 tablespoons toasted chickpeas •   2 tablespoons toasted pumpkin seeds •   1 hard-boiled egg

APPENDIX B

Healthful Substitutions

When following a new diet, it can take time to get used to new restrictions. The great thing about the Mediterranean diet is that it isn’t focused on a prescribed calorie count, and the list of restrictions isn’t a mile long. In order to succeed in your new diet, focus not on what you can’t have but on what healthful alternatives you can enjoy. Here is a list of healthful substitutions for unhealthful foods that you can feel free to enjoy on the Mediterranean diet.

•   Substitute Greek yogurt for mayonnaise or sour cream to cut down on the fat and calories.

•   Use unsweetened applesauce in place of oil and butter in your recipes for baked goods—they will turn out moist and delicious.

•   If you don’t have any applesauce on hand, substitute an equal amount of mashed banana or avocado.

•   Rather than eating bread with your meal and croutons on your salad, try substituting a tablespoon or two of nuts as a salad-topper.

•   Use unbleached flour rather than all-purpose flour in your recipes. Unbleached flour does not go through chemical bleaching processes.

•   Rather than using skim milk in place of cream in thick soups, and as a result sacrificing texture, try substituting puréed potato instead.

•   Swap out your reduced-fat peanut butter for all-natural peanut butter. It doesn’t contain all the artificial additives and still contains healthful fats.

•   In several recipes you will see pitted dates as a key ingredient. Dates are a great substitute for sugar because they are naturally sweet.

•   Avoid using butter in your recipes, especially when browning meats and sautéing vegetables. Use olive oil instead.

•   If you are watching your cholesterol, substitute two egg whites for one whole egg in a recipe.

•   Throw away your iceberg lettuce and opt for nutrient-rich greens such as kale, spinach, and romaine lettuce.

CHAPTER ONE

What Is the Mediterranean Diet?

Embracing the Mediterranean diet is all about making some simple but profound changes in the way you eat today, tomorrow, and for the rest of your life.

—Oldways Preservation Trust, “Mediterranean Diet 101”

As stated in the introduction, there is no one “Mediterranean diet.” That is to say that all the countries bordering the Mediterranean Sea have their own unique cuisines and delicacies. Most Mediterranean cultures, however, follow similar dietary principles and habits, which is what the modern Mediterranean diet is based on. Before you can make the switch to the Mediterranean diet, you need to understand the basics: What are the benefits of this diet? Is it possible to lose weight on the Mediterranean diet? And which foods should be included and avoided on the diet?

There are many different diet plans available to choose from, and you might be overwhelmed by the sheer number of choices. The Mediterranean diet is just one of those choices, but you will soon see why it is superior to many other options. In this chapter you will learn everything you need to know in order to make an educated decision regarding whether the Mediterranean diet is the right choice for you. If it is, you can move on to the second chapter of this book, in which you will learn how to effectively utilize the tools and meal plans included in this book. Your journey in weight loss and health transformation begins here, so don’t be afraid to jump right in.

BENEFITS OF THE DIET

In 2012, the American Heart Association (AHA) published an assessment of the Mediterranean diet and how well it adheres to the AHA’s standards for heart-healthy eating. The AHA found that the average Mediterranean diet is lower in saturated fat than the traditional American diet—in fact, the average consumption rate of saturated fat in Mediterranean cultures is well within the AHA dietary guidelines. Though the Mediterranean diet is high in dietary fat, more than half of the fat calories consumed in the Mediterranean diet come from monounsaturated fat. Monounsaturated fat, which comes from sources like olive oil and avocados, has a lesser effect on blood cholesterol levels than saturated fat, which comes from animal products such as meat, eggs, and dairy. The AHA also found that death rates and the incidence of heart disease were lower in Mediterranean countries, although the more active lifestyle of many Mediterranean cultures compared with the average American activity level is considered to be a significant factor in this statistic.

Though improved heart health and reduced risk for heart disease are two of the main benefits of the Mediterranean diet, they are not the only benefits. In the years following World War II, Dr. Ancel Keys, a Minnesota physiologist, helped pilot a study on the effects of the Mediterranean diet on overall health. This study involved more than twelve thousand middle-aged men from seven different countries, thus earning it the name the Seven Countries Study (Keys, 1966). The countries represented in this study include the United States, Italy, Japan, Greece, Finland, Yugoslavia, and the Netherlands. The study began in 1958, and the results were published in book form by Harvard University Press in 1980. The main focus of the study was to determine the preventability of heart disease and the effects of saturated fat consumption on heart health, but the results were just the tip of the iceberg in scientific research regarding the Mediterranean diet (Keys, 1966).

Following the findings of the Seven Countries Study, many other studies were conducted regarding the various health benefits of the Mediterranean diet. A study published in the British Medical Journal in 2008, for example, revealed that adherence to a Mediterranean diet was associated with a 9 percent reduction in overall mortality in test subjects as well as a 13 percent reduction in risk for neurodegenerative diseases such as Alzheimer’s and Parkinson’s disease (Sofi et al., 2008). In 2009, a study was published in the Journal of Nutrition regarding the effect of the Mediterranean diet on the risk for chronic disease. The results of this study suggest that an eating pattern high in plant foods and unsaturated fats, like the Mediterranean diet, can reduce the risk for lower abdominal obesity and coronary heart disease (Romaguera et al., 2009).

In addition to preventing heart disease, the Mediterranean diet has been linked in several studies to reduced risk for certain cancers. A study published in the American Journal of Epidemiology followed the eating habits of more than sixty-five thousand women and revealed that following the Mediterranean diet can reduce the risk for postmenopausal breast cancer (Cottet et al. 2009). A review of more than twenty thousand cases published in 2009 further revealed that increased consumption of fruits, vegetables, whole grains, and fish reduced the risk for epithelial cancer cell growth. The same review showed that monounsaturated fat consumption was inversely related to cancer risk at more than twenty different cancer sites (La Vecchia, 2009).

As is true of any diet, the health benefits associated with the Mediterranean diet can vary from one individual to another. Some of the other benefits followers of the Mediterranean diet have reported include reduced risk for diabetes, relief from rheumatoid arthritis, improved eye health, improved fertility, relief from depression and other mood disorders, improved brain function, and increased longevity. Following the Mediterranean diet can also help you lose weight and maintain a healthful body mass index (BMI). You will learn more about this in the next section.

LOSING WEIGHT ON THE MEDITERRANEAN DIET

It is possible to lose weight with nearly any diet as long as you follow the guidelines and burn more calories than you consume. The problem with many diets, however, is that the guidelines themselves are very strict or confusing, which makes it hard to stick to them. The Mediterranean diet, however, is a fairly easy concept to understand, and as long as you engage in healthful eating habits, you should have no trouble losing weight. In fact, several recent studies have shown that losing weight on the Mediterranean diet is a very likely outcome.

A study published in the Journal of Nutrition in 2008 studied the effect of Mediterranean-style eating patterns on the modification of food habits. The results of the study showed that the Mediterranean diet not only helps modify eating habits, but can also reduce the over-caloric density of one’s diet (Goulet, Lamarche, and Lemieux, 2008). Other studies have shown that the Mediterranean diet can be an excellent alternative to a low-fat, high-carb diet. Though the average Mediterranean diet includes 20 percent or more calories from fat, those calories are derived from heart-healthy monounsaturated fats, not the saturated fats that are thought to contribute to obesity.

Now that you know a little bit about the Mediterranean diet and its potential to help you lose weight, you may be wondering just how it works. As has already been mentioned, you can lose weight on almost any diet, so what makes the Mediterranean diet different? One component of the Mediterranean diet involves eating more fruits and vegetables. Fruits and vegetables are nutrient-dense foods, which means they have a high proportion of nutrients to calories; these foods are much lower in calories than many processed snack foods. Whole grains, another component of the Mediterranean diet, are also richer in nutrients than refined and processed grains like white rice, bleached flour, and processed bread. By eating more nutrient-rich foods like these, which are also high in fiber, you will feel fuller longer on fewer calories.

The Mediterranean diet also helps you lose weight by encouraging healthful food swaps—that is, substituting healthier options for high-fat and high-calorie foods. For example, the traditional American diet often incorporates butter as a cooking fat. In the Mediterranean diet, however, olive oil and canola oil are recommended; these options are a good source of monounsaturated, as opposed to saturated, fats. The type of protein you eat when following the Mediterranean diet will also play a role in helping you achieve your weight-loss goals. While many diets are based on fried foods and red meat, the Mediterranean diet focuses on lean protein sources such as fish and poultry, limiting red meat to a few portions per month.

The key to losing weight while following the Mediterranean diet is to make healthful eating choices. Many of the foods included in the diet are naturally lower in calories or fat than many of the foods that make up the staples of the modern Western diet. Of course you do still need to be mindful of how much you are eating. The Mediterranean diet does not prescribe specific calorie counts, but you should pay attention to proper portion sizes and make an effort not to overeat. Drinking plenty of water and rounding out your meals with low-calorie side dishes like salads and steamed vegetables will help fill you up while keeping your daily calorie count down. Later in this book, you will receive additional tips for losing weight while following the Mediterranean diet.

FOODS TO INCLUDE AND AVOID

Now that you understand the basics of the Mediterranean diet, you may be ready to get into the details—what can you eat? Because the Mediterranean diet is all about healthful eating habits and enjoying the food you eat, you should try not to think of these guidelines in terms of what you cannot eat. Too many diets place heavy restrictions on the foods you can eat, which leave people feeling dissatisfied. The foods included in the Mediterranean diet are full of natural flavor, and there are many ways to dress up your meals, so you should never feel deprived.

The main foods included in the Mediterranean diet are as follows:

•   Extra-virgin olive oil

•   Fresh fish and seafood

•   Fresh, frozen, and canned fruits

•   Fresh, frozen, and canned vegetables

•   Fresh herbs and spices

•   Nonfat Greek yogurt

•   Nuts and seeds

•   Olives and avocados

•   Part-skim milk cheese

•   Potatoes and legumes

•   Poultry (chicken, turkey, etc.)

•   Skim milk

•   Whole-grain bread and pasta

•   Whole grains (brown rice, cereal grains, etc.)

Foods to limit on the Mediterranean diet include:

•   High-fat dairy products (whole or 2 percent milk, ice cream, etc.)

•   Natural sweeteners (raw sugar, honey, maple syrup, stevia, etc.)

•   Red meat (three to four servings per month)

•   Wine (one glass per day with meals)

Foods you should avoid when possible are as follows:

•   Fatty cuts of meat

•   Fried foods and fast food

•   Processed snacks and prepared foods

•   Refined sugar and flour

•   Saturated fats (butter, margarine, etc.)

•   Sugary desserts and candy

LOOKING AHEAD

In this chapter you learned the basics of the Mediterranean diet, including its origins, the associated health benefits, and its potential to help you meet your weight-loss goals. You also received an overview of the foods that should be included, limited, and avoided while following the diet. In the next chapter you will receive information and actionable steps regarding forming and following your Mediterranean diet meal plan. You will also receive a collection of cooking tips and steps for success in switching to the Mediterranean diet.