Researchers Found a Problem with the Research Supporting the Mediterranean Diet - What Does This Mean For You?

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You may have seen articles in the news this week that a major study supporting the Mediterranean Diet has been retracted.  And you may have questions about what this means and whether or not you should consider following the Mediterranean Diet.

First of all, let's start with a little background.

Over 50 years ago, a research study by Ancel Keys, PhD, the Seven Countries Study, found that middle-aged men living in the Mediterranean region of the world, specifically the island of Crete, experienced lower cardiovascular disease rates than middle-aged men in other parts of the world.  This outcomes was attributed to their diet - specifically a traditional diet comprised of fruits, vegetables, whole grains, beans, and fish.

Subsequent studies found that people in the Mediterranean region following this diet experienced an array of health benefits, including increased lifespan, less obesity, lower cholesterol, lower rates of heart disease, stroke, and diabetes, improved brain function and lower rates of Alzheimer's disease.

In 2013, results from a landmark study called the PREDIMED trial were published in the prestigious New England Journal of Medicine.  This large multi-site trial was touted as a randomized study comparing the Mediterranean Diet against the low-fat diet promoted by the American Heart Association.  The results were impressive:  A Mediterranean diet that included nuts reduced the risk of cardiovascular disease by 30% and risk of stroke by 49% when compared to the American Heart Association low-fat diet.

This week, the researchers acknowledged that there were serious problems with their methodology in the PREDIMED study - specifically, not all of the supposedly randomized participants were, in fact, separated into groups randomly.  The researchers re-analyzed their results, retracted the original study, and replaced the study with the new results - which came to the same conclusion as the original study.

In other words, even though the original study design was flawed, once the data were corrected to account for the flaws, the results were the same.  The Mediterranean Diet does lower the risk of cardiovascular disease and stroke.  In addition to all the benefits noted in other studies of the diet.

So, if you follow, or are considering following, the Mediterranean Diet as your way of eating, should you throw it out?  Absolutely not!

The Mediterranean Diet with its emphasis on plant-based, locally sourced, whole and natural foods remains a very healthy way of eating with many health benefits. 

The Mediterranean Diet with its emphasis on plant-based, locally sourced, whole and natural foods remains a very healthy way of eating with many health benefits.  When you are eating the Mediterranean way, your diet will focus on a variety of fruits and vegetables, legumes, lean protein, nuts, healthy fats, and whole grains, all in moderation, and washed down with a bit of red wine if you so choose.  It is a diet that is loaded with the vitamins, minerals, phytochemicals, and antioxidants your body needs, with little of the highly processed, low-nutrition foods so common in the standard American diet.  And it is a way of eating that is reasonably easy to follow, filled as it is with a tasty variety of mostly easy to find foods.  So eat up with a clear conscience - and don't forget the red wine! 

National Nutrition Month

Welcome to March which is National Nutrition Month.  This month, I will be sharing tips for healthy eating.  And since we are just coming off of Heart Month in February, the first tip is to eat 10 fruits and vegetables a day for your heart.

Eating 5 servings of vegetables and 5 servings of fruit a day helps to lower your blood pressure.  Look for a variety of colorful fruits and vegetables for a great mix of vitamins and nutrients.


DASH Diet Challenge - Food Groups and Serving Sizes

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As I wrote in my DASH Diet Challenge Post, for the next 30 days, I will be following the DASH Diet.  

As with most diets, one must start by figuring out what you can eat.  The NIH National Heart, Lung and Blood Institute includes several charts to help us decide an appropriate calorie intake and servings of various food groups.  Based on the calorie chart, I should take in 1,600 - 1,800 calories a day.

It's the next step that often stumps people.  What exactly does that mean in terms of what I can eat?  According to the chart, I can have:

  • 6 servings of grains per day
  • 3-5 servings of vegetables per day
  • 4-5 servings of fruits per day
  • 2-3 servings of fat free or low-fat dairy products per day
  • 3-6 servings of lean meats, poultry or fish per day
  • 3-4 servings of nuts, seeds, and legumes per week
  • 2-3 servings of healthy fats and oils per day
  • 3-5 servings OR LESS of sweets per week
  • Maximum sodium intake of 2,300 mg per day

Hmm, sounds like a lot of food, right?  But now, I need to know just what a serving is for each type of food.  So, on to the next chart.

Grains.  In the grains category, a serving size is 1 slice of bread, an ounce of dry cereal, a 1/2 cup of cooked rice, pasta, or cereal.  The slice of bread is easy enough to visualize.  For the other items, I will have to use a measuring cup.  Accurate portion control is going to be important, especially for the grains, as they are high in carbohydrates.  For a visual reference, a 1/2 cup of rice is a lot less than you think - about the size of a half of a fist.

Vegetables.  The vegetables category is my favorite, since I especially like green, leafy vegetables and my lunch is usually a salad made from mixed lettuces and power greens.  A serving size of leafy vegetables is a cup (a good handful), or a half cup of cut up raw or cooked vegetables.  Starchy vegetables like potatoes should be eaten sparingly.

Fruits.  To be honest, I have not been eating a lot of fruit, since many are high in sugar, and I do seem to be very sugar sensitive.  However.  In the fruit category, a serving size would be a medium size fruit (think a medium size apple), or a 1/4 cup of dried fruit (about the size of an egg for visual reference - no scarfing down a whole bag of dried mangos!), or 1/2 cup of fresh, frozen, or canned fruit.  You may notice I haven't mentioned fruit or vegetable juice.  I don't particularly like either one, but if you do, a serving size would be 1/2 a cup.  I'll be going for lower sugar fruits such as berries and Granny Smith apples (delicious sliced and sprinkled with a bit of cinnamon).  

Dairy.  A serving size is 1 cup of milk or yogurt, or 1-1/2 oz of cheese.  People who are lactose intolerant (I am not) can drink lactose-free milk.  I've found that milk from grass fed cows seems to taste better, even when it's fat free, and I like Kroger's Simple Truth version.  If you are following this diet, or any others that allow dairy, be especially aware that Greek yogurts, although higher in protein, often have a lot of sugar in them. I've been choosing lower sugar yogurts like Siggis since I started eating breakfast every day.  You can also make your own yogurt so that you can control the sugar content.  For a visual reference for the cheese serving size, it would be the size of a 9 volt battery.

Lean Meats, Poultry, Fish.  A serving size is 1 oz of cooked meat, poultry or fish (for visual reference, 3 ounces is the size of a deck of cards or the palm of your hand).  One egg would also be a serving in this category.  That's way less meat than I am used to eating, so this will require me to manage my portions.

Nuts, Seeds, Legumes.  A serving size is 1/3 cup or 1-1/2 oz of nuts (much smaller portion than we are used to thinking about - I can easily scarf down a bag of pistachios at one go).  For nut butters, a serving size would be 2 tablespoons, and for seeds, the serving size is also 2 tablespoons or 1/2 ounce.  The serving size for cooked peas, lentils, legumes is 1/2 cup (the same as a serving size of rice).  Note that this category is 3-4 servings per week, not per day.

Fats and Oils.  A serving size is 1 tsp of margarine, butter, or oil, or a tablespoon of light mayonnaise or salad dressing.  (This one will be hard - I love my healthy fats!  But for the purposes of this challenge, I will do my best to follow the guidelines).  

Sweets and added sugars.  I'm pretty sure this category was added in so that people don't feel deprived by having to give up their sugar.  You are allowed a few servings a week of jelly or jam (1 tablespoon) or syrup, 1/2 cup sorbet or gelatin dessert, or a piece of hard candy.  

So that's the breakdown of what is allowed and how much.  Now, on to meal planning!

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Learn more about Women and Heart Health in my Love Your Heart series.

Sugar Traps and How to Avoid Them


Let's just call sugar what it is:  sweet crack.  Anyone who has been paying attention to diet news over the past few years knows that sugar is a villain in the fight against obesity and many chronic diseases.

But it is so yummy!  Sweet, delicious.  It's part of our traditions - who has a birthday without a cake?  A dinner party without dessert?  It's part of our daily lives - a supersize choco-mocha-soy latte with extra caramel whipped cream to get started for the day?  Yes, please.  Cookbooks, cooking shows, blogs are devoted to how we can use the white stuff in deliciously new and creative ways.  It's how we reward people (and ourselves)!  Just a little treat, right?  Sugar is socially accepted.  No one will look at you funny if you take a cupcake at a social.  And we start young - we give sweet treats, candy, sugar loaded cereals and juices to babies and toddlers everywhere.  

And it can be incredibly addictive.  Because sugar triggers the opiate receptors in our brain, it provides us with an "award" of dopamine, a neurotransmitter which makes us feel good.  That's why when we experience a breakup or other similarly sad experience, we turn to sugar - the "bucket of ice cream" - to make us feel better.  More sugar = more release of dopamine = we want more of that, and it takes more and more to keep us satisfied.  We get addicted to our sugar high.  In fact, sugar has similar addictive properties as nicotine, cocaine, methamphetamine, and opioids such as heroin.

We start to think that foods without added sugar just aren't as good.  Food producers are well aware of our cravings for sugar, and they are more than happy to oblige our addiction.  One of the reasons processed foods are so bad for us is that so many of them contain added sugar.  I took a quick inventory of foods with sugar in my kitchen cabinets and refrigerator.  Ketchup - of course!  Barbecue sauce, marinades, tomato sauce - yep.  Yogurt - yes.  Green chile enchilada sauce and organic chicken bone broth - yes and yes - who knew?  

I fully expected to find sugar (or its alter egos, corn syrup and molasses) in ketchup, jarred sauces, and marinades - but I did not expect it to be in bone broth.  And that's just how sneaky food processors can be.  There's no good reason to add sugar to many of the products it is in - but there it is anyway.

And just as with other addictions, the consequences of all this added sugar in just about everything we eat aren't pretty:  cravings, binging, and withdrawal symptoms when we try to eliminate it from our diets.  We can get a sugar rush when we consume a food that is high in sugar, and a subsequent sugar low when our bodies produce extra insulin that burns up the sugar quickly, leaving us feeling shaky and wiped out.  A continuous "diet" of these sugar highs and lows can cause us to develop insulin insensitivity, so that our bodies have to produce more and more insulin, eventually wearing out the insulin producing cells in the pancreas. And the longer term consequences add up to chronic health problems from headaches, hormone imbalances, and weight gain, to morbid obesity, heart disease, type 2 diabetes, and obesity-related cancers.

With a little thought, we can avoid the obvious sugar traps - the ones in plain sight.  We can add less sugar in our coffee, choose not to eat the cupcake at the office party, avoid the candy rack at the checkout.  It's the hidden sugar traps that can sabotage our way of eating and undo all the hard work we are putting in to improve our health.  A recent survey from found that most consumers don't know how much sugar is in their foods and are confused about how to read food labels and how to cut out added sugar.  The American Heart Association recommends that women consume no more than 100 calories a day in the form of added sugars.

Below are some of the food products that are hiding added sugar, and how you can avoid them by making a smarter choice.  Of course, always read food labels (see the infographic below for a list of common sugar synonyms used on food labels).  The higher up an ingredient is on the ingredient list on the label, the more of that ingredient there is in the product.  Some producers try to hide just how much sugar they have added by breaking it up into different sugar ingredients and listing them separately in the ingredient list, so read carefully.

1 teaspoon of sugar = 4 grams

Note:  Beginning in 2020, manufacturers of packaged foods will have to include the percentage of added sugars in a product as a separate line item.

Source:  Food and Drug Administration

Source:  Food and Drug Administration

Food Sources of Hidden Sugar

Beverages.  The average American consumes 14% of their daily calories in added sugars, and a lot of those sugars come in the form of sugary beverages - drinking our calories, as it were.  From so-called "healthy juices" and energy drinks, to sugar laden coffee to soda to sweet tea to alcoholic beverages, our drinks are all-too-often loaded with sugar.  Even smoothies can be sugar traps when purchased at a commercial smoothie shop or hiding under the label of a "healthy" bottled beverage product.  The best thirst quencher of all - plain water.  If you can't stand the taste of plain water, add a bit of lemon, lime, or other fruits to infuse and flavor it.  You can do the same with coffee and tea.  Make healthy smoothies at home, limiting sweeteners to the fruit in the smoothie or a bit of stevia leaf.  

Yogurt.  On its own, yogurt is a very healthy food.  But we want it sweetened - with fruits, sauces, honey, granola, or just sweetened vanilla.  A favorite strawberry-flavored yogurt from a major manufacturer has 24 grams of sugar in a single serving size - that's almost the full daily allowance for a woman!  Instead, choose a plain, unsweetened yogurt or kefir and add fresh or frozen fruit or a dash of vanilla extract.  If you simply must have it sweetened, try adding a bit of stevia or choose a yogurt with lower sugar content.

Instant oatmeal.  Here again, we have a product that, by itself, is a nutritious food, but manufacturers create a product with a lot of added sugar.  Instead of resorting to instant oatmeal for a quick breakfast, make refrigerator oats overnight and add a bit of fresh fruit in the morning.

Bread, pasta, bagels, crackers.  You think your whole grain bread or pasta is safe.  But even these products have added sugar to help them taste better.  Try a sprouted grain Ezekiel bread instead - and skip the bagels and crackers.  If you need something to scoop up your dip, try carrot and celery sticks instead.  Oh, and speaking of that dip...

Dips.  Yes, that delicious honey mustard dip has sugar.  So does the ranch dip and the french onion dip.  Even the commercial salsas have added sugar.  Better choices:  homemade salsa, hummus, guacamole, tzatziki, or baba ghanoush.

Coleslaw.  At the restaurant, you might get the coleslaw because you think you are getting the healthiest option on the menu.  But it is probably has too much sugar to be really healthy.  Try a side salad instead.  And at home, make your own low sugar slaw.

Soups and broths.  I was surprised to see sugar as a key ingredient in my organic cream of chicken soup and in my organic chicken bone broth.  We often purchase these products to make our lives easier, but it's relatively easy to make soups and bone broth in the crockpot and then freeze in individual portion sizes for use later.  When we make it ourselves, we control what does and doesn't go into our recipe. 

Sauces and marinades.  Just about any sauce or marinade you can purchase in the grocery store will have added sugar.  Many sauces are simple enough to make at home using fresh ingredients, and you can leave out the sugar.  

Chinese food.  I'm not talking about a simple stir fry you make yourself.  Rather, just about all the favorites at your local Chinese buffet are guaranteed to have sugar in the sauces.  Do yourself a favor and make your stir fry at home.

Frozen dinners and prepackaged frozen meals.  A popular product in recent years is a frozen meal that you prepare in your kitchen, often combining meat, vegetables, pasta or rice, and - sugar heavy sauces.  I know we are all busy so we try to choose foods that will be convenient and still healthy, and many of these meals are marketed as a healthy alternative.  But read the labels carefully for added sugar.  You can create your own frozen meal-in-a-bag alternatives, given some planning and a few hours on a weekend afternoon.

Processed meats.  Often, processed meats such as sausages, pepperoni, salami, and deli meats are cured with salt and sugar and other preservatives.  Sugar is often added as flavoring as well.  Even some bacon (such as maple glazed bacon) may have added sugar. Check the ingredients list on your lunch meat package and you may see some form of sugar, such as corn syrup, or evaporated cane syrup, or even multiple forms of sugar.  At the deli case in your local supermarket, check your meats for added sugars before ordering.  You can also get meats from local butchers or farmers, or try your hand at learning the art of charcuterie to make your own. 

Energy bars, snack bars, and protein bars.  They are marketed as a healthy fuel source for the health conscious who exercise.  With added sugar, they are anything but healthy.  Instead of opting for an energy bar pre- or post-workout, choose nuts, a boiled egg, sweet potato, or fruit.

Salad dressing.  You might be tempted by low-fat salad dressings thinking they are healthier.  Instead, manufacturers have added sugar to make them taste better.  Try vinegar with olive oil and a spritz of lemon juice to keep your salad on the healthy side.

Condiments.  What makes ketchup so delicious?  Sugar, and lots of it.  Mayo?  Sugar.  Barbecue sauce?  Sugar.  Just about the only condiment without added sugar is mustard.  Try substituting a homemade salsa instead.

Seasonings and rubs.  Who doesn't love a good seasoning mix rub on a pork roast?  The problem is that most of the commercial seasoning and rub mixes have loads of sugar added in.  Ditch the sugar and add more flavor by making your own seasoning mix using a variety of herbs and spices.

The best way to avoid added sugar is to prepare your own meals using whole foods and minimally processed ingredients.

If you think you are seeing a trend here on how to avoid added sugar in your diet, you are right!  The best way to avoid added sugar is to prepare your own meals using whole foods and minimally processed ingredients.  Of course, with our busy lifestyles, that is not always possible, but every little bit we can do will help to cut down the amount of sugar we eat on a daily basis.  Always read the label, and look for products with low or no sugar.

If you want to know how much sugar is in the products you commonly buy, here is a great resource.

So what about fruits?  Of course, fruits contain sugar as well.  Sugar is sugar is sugar, no matter what form it takes.  But fruits include a lot of fiber that slows down the absorption of sugar and fruits are loaded with vitamins and nutrients that our bodies need.  Fructose, the naturally occurring sugar in fruit, is often present in lower levels than you would expect.  For example, in a cup of blueberries, fructose only accounts for 30 calories.  Fruit can be enjoyed as a healthy alternative to cookies, cakes and candy, and in fact, the American Heart Association recommends daily fruit consumption as part of a healthy diet.  To lower the impact of sugar, choose fruits that have a high glycemic index such as berries, apples, or grapefruit.

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You Don't Have to Clean Your Plate

Photo by  Hermes Rivera  on  Unsplash

"You don't have to clean your plate."

I was sitting across a table from my husband in our favorite Mexican restaurant, finishing dinner.  He had finished before me.  After eating half his food, he had set his plate aside.  

Because I had been talking, I had been eating more slowly. 

I continued to talk and eat, waving my fork in the air to punctuate my sentences, while mindlessly scooping food into my mouth.

It wasn't a completely unhealthy meal.  Carne asada, rice, beans, guacamole.  Oh, and the three flour tortillas that come with it.  And cheese dip.  And tostada chips.  It was a big meal.

I was down to the last few bites.  

"You don't have to clean your plate," Joe said quietly.

My loaded fork, on its way to my mouth, paused in midair.  My first reaction was hurt.  My brain raced around a few thoughts:  "Seriously?"  "Are you saying I'm a pig?"  "How could you say that?!"  "How rude!" I thought to myself in indignation.

Fortunately, in that little pause, the cognitive part of my brain took control over the emotional part that wanted to lash out.

Calmly, I set my fork down, and pushed my plate aside.

"You're right," I said.  "I don't have to clean my plate.  That's just my programming."

"I know," he said.  "You can stop eating when you feel full.  You don't have to clean your plate.  I love you."

See, he knows that I've been focusing on portion control lately.  He knows that most of the time, I eat healthy, but the portions I eat are too large.  

I grew up in a "clean your plate" household.  "Clean your plate - there are starving children in China," my mom told me.  Or Africa.  Or Russia.  Or wherever the starving children happened to be that night.

Even as a small child, I knew her argument didn't make sense.  How would my cleaning my plate help those poor starving children?  A few times, I dared to say, "Well, then, how about you take this food and send it to them?"  But over the years, my mother's programming took hold in my brain and stuck there, as mom programming usually does.  Having grown up poor, the thought of wasting any food was abhorrent to my mother.  So she passed that mindset to me.

As a young mother myself, I found myself using the same arguments with my children.  Of course, they also asked why I didn't just send the food to the starving children in Africa.  "Because!  Now clean your plate!"  The same answer my mother gave me.

I often eat mindlessly, while working on some other task or talking or watching television or reading.  I barely taste the food.  I mindlessly clean my plate because that's my childhood programming.  

My husband's quiet reminder to me was that I can break with my programming.  Just because that's the program my brain has been following all these years, doesn't mean I can't change the program to a better one - a program that makes sense, that isn't borne from a lifetime of scarcity.  

You, too, may have been brought up with the "Clean Your Plate" fallacy.  You, too, may have found yourself mindlessly cleaning your plate because that's what you grew up with and it feels somehow "wrong" to waste food.  If so, here are some tips to change the program, or trick the program if you just must clean the plate.

1.  Practice eating mindfully. 

In other words, when you are eating, focus on eating.  Not on reading, watching TV, playing computer games, or all the other things we do when we are eating (but do engage in conversation with family and friends if you are eating in a social group - we don't want to be anti-social!)  Actually taste the food you are eating, pay attention to how much you are eating, and how you feel as you eat.

2.  Stop When You Are Full

It sounds so simple, right?  Just stop and push the plate aside.  This technique does take mindfulness and willpower.  First, you must learn to recognize when you are full.  Not so full that if you take another bite, you will explode like the fellow on the Monty Python skit who ate "just a thin mint."  No.  Just comfortably full.  You have to learn when you've eaten enough that you feel nourished and comfortable for the next several hours.  And then, you need to not pay attention to the uneaten food on the plate.  When you have grown up with the "clean your plate" mentality, it is hard to see food left on a plate and wasted.  It disturbs you.  It distracts you.  It calls to you - "Eat me!"  Don't listen to the siren song - remove the plate from the table, and dispose of the food.  Either throw it away (it gets easier) or put it in the fridge for the next meal if you can't stand to see it go to waste.  Remind yourself that it's okay not to eat it.

3.  If You Absolutely Must Clean Your Plate

If you're programming is so strong that you just must clean your plate, no matter what, then we have to trick the programming.  There are two ways to do just that.  The first way is to use a smaller plate.  Downsizing your plate will automatically downsize your portion size.  Use a saucer, instead of a full-size plate, and do not go back for seconds.  The other way to trick your programming is to change what you put on your plate.  Load a larger portion of your plate with green leafy vegetables which will add bulk and fiber and many fewer calories.  Add a healthy protein, a healthy fat, and if your diet allows, and healthy carbohydrate such as a bit of sweet potato.  Consider using the Healthy Eating Plate created by the Harvard School of Public Health and the Harvard School of Medicine as a guide for choosing your foods.


Remember, we do not have to be slaves to our childhood programming.  We have the power to choose ways of eating that help us to be healthy.

Do you have any tips to overcome the Clean Your Plate mentality?  Share them in the comments below.