Fat in the Mediterranean diet - questions and answers

How many Americans have high blood cholesterol levels?

Too many! Approximately half of all Americans have high or borderline-high total blood cholesterol levels. Since blood cholesterol is, in many cases, controllable through di­etary changes, you needn’t be one of those 50 percent. Try to follow the guidelines of the Mediterranean Diet Pyramid to help keep your diet heart-friendly.

Can blood cholesterol levels be controlled through other methods besides diet?

Yes. One of the most effective ways to keep total blood cholesterol levels down, as well as increasing “good” or HDL cholesterol levels, is to include lots of physical activity in your life. Exercise can help keep your blood cholesterol profile, as well as your muscles and heart, in great shape. Traditionally, the people in the Mediterranean had highly active lifestyles, probably a contributing factor to their ex­cellent heart health.

Smoking has also been linked to increased blood choles­terol levels, so quitting the tobacco habit is an obvious way to help control blood cholesterol levels. Also, obesity tends to raise blood cholesterol, so achieving and maintaining a healthy weight is an effective way for many people to keep blood cholesterol levels in check.

How many Americans die from coronary heart disease?

Too many again. Heart disease is the number one cause of death in America for both men and women. About 25 percent of the 275 million people in America suffer from car­diovascular disease, and over 42 percent of the deaths each year in the United States are due to cardiovascular disease. This includes heart attacks and strokes, both the result of blockages to the blood vessels.

How much fat should I include in my diet?

Your total food choices over the course of a few days should average about 30 percent of calories from fat. But, more importantly, only 10 percent (one-third or less of the fat calories) should be from saturated fat. Foods that are high in saturated fat, such as fatty meats, need to be limited as much as possible. Eating in a pattern as described by the Mediterranean Diet Pyramid will help to keep saturated fat, as well as total fat and trans-fatty acids, within desired levels.

Most packaged food items have the amount of fat and sat­urated fat grams per serving, as well as fat calories per serv­ing, on the Nutrition Facts label. If you want to know the percentage of calories from fat and/or saturated fat on any individual food item, you can make the following calcula­tion:

Multiply the number of fat or saturated fat grams in a serving by 9 to get the number of calories from fat or saturated fat. (Eliminate this step if you al­ready know the fat calories per serving.)Divide the number of calories from fat or saturated fat by the total number of calories per serving.The resulting number is the percentage of calories from fat or saturated fat per serving.

For example, if you want to eat a cup of plain, low-fat yo­gurt that has 230 calories and 2 grams of fat, multiply 2 grams of fat by 9 to get 18 calories from fat. Then divide 18 by 230 to get approximately .08, or a total of about 8 percent of calories from fat. To find the amount of saturated fat in the yogurt, look for the grams of saturated fat beneath the to­tal fat grams. If 1 gram of saturated fat is listed, multiply 1 by 9 to get 9 calories from saturated fat. Then, divide by 230 to get approximately .04, or 4 percent of calories from satu­rated fat—a good choice, especially if you mix in some fresh fruit.

If you wish to calculate the amount of total and saturated fat you eat for any given day, use the following example as a guide. Let’s say you require 2,000 calories per day. Then 30 percent of that number is 600 calories; 10 percent is 200 calories. Again, fat has 9 calories per gram, so 600 divided by 9 equals 67 grams from total fat, and 200 divided by 9 equals 22 grams from saturated fat. Remember, it may be more realistic to think of your fat intake over the course of a few days rather than on a day-to-day basis. You may eat more fat on one day and less on the next, which is fine and in keeping with heart-healthy guidelines.

What about “fat-free” or “low-fat” foods? How do they fit in with a Mediterranean-inspired eating pattern?

Most prepackaged “fat-free” or “low-fat” foods are often high in sugar and/or artificial ingredients, fillers, gums, and other ingredients meant to simulate the taste and texture fat would have provided. These products are often high in calo­ries, expensive, and devoid of nutrients. In addition, many prepackaged low-fat foods are deceiving because they con­tain trans-fatty acids. To eat in a true traditional Mediter­ranean way, limit the use of these foods as much as possible and opt for foods closer to their natural state. Dried fruit, nuts and seeds, and whole-grain crackers (those without partially hydrogenated oils—read the ingredients) are as convenient to grab on the go as prepackaged snacks. The Mediterranean way of eating is focused on whole, fresh foods.

When eating out, what words suggest lower-fat or higher-fat food preparation?

Lower-fat dishes are often described as baked, broiled, roasted, sautéed, stir-fried, and grilled. Many restaurants will also accommodate your specific cooking suggestions. For example, you may be able to request that olive oil be used in preparing your food, or that your food be cooked with little or no oil. Avoid fried foods and dishes described as creamy, rich, or containing butter- or cream-based sauces, signaling high-saturated-fat preparation. Again, remember the Mediterranean Diet Pyramid. Butter, margarine, and high-fat dairy foods sit on the top, which means they are best consumed only on rare occasions.

Olive oil has a strong taste. Is it versatile? How can I re-place the fats in my diet with olive oil if I don’t care for the taste, or if the dish I am preparing would not taste good with olive oil?

Olive oil can be an acquired taste, although some people love it on first try. If you are not immediately charmed, rest assured that in cooking, the strong taste is neutralized. Also, some brands of olive oil taste lighter than others. You can even start with a “light” olive oil, although these are more processed. In general, the lighter in color the olive oil, the lighter in taste. As you get used to the taste of olive oil, you can move on to the darker, richer, more flavorful (and more nutrient-rich) oils.

If you are not yet used to the taste of olive oil, use it when it will be heated to minimize the taste. In salads and other dishes where oil is not cooked, use canola oil, which is relatively tasteless. You will not receive the same petrochemical benefits, but you will receive the benefits of a monounsaturated fat source. Then gradually introduce olive oil into your diet more often.

Experiment with olive oil in dishes you might not have considered, and you may find you are pleasantly surprised at the result. Olive oil in baking imparts a luscious flavor (the baking minimizes the strong olive taste, but leaves just a hint of fruitiness). Quick bread and pastries become more distinctive with olive oil. Stir a tablespoon into a ho-hum soup to boost its taste and texture. Leave the butter in the refrigerator (or best, at the store) and drizzle a little olive oil on your bread instead. The possibilities are endless.

Is it true that oils contain more than one kind of fatty acid?

Yes. When we say that olive oil is a monounsaturated fat, we mean that it consists primarily of monounsaturated fatty acids. However, olive oil also contains some polyun-saturated fatty acids, and even some saturated fat. All oils contain at least some saturated fat, although in differing amounts. However, the following chart compares a variety of common oils, and as you can see, olive oil and canola oil are the best sources of monounsaturated fat, that type of fat that has been found to promote “good” HDLs in the blood.

Saturated           Monounsaturated

This chart is adapted from the ADA’s complete Food and Nutrition Guide by Roberta Larsun Duyft, Minneapolis: Chronimed, 1996, p. 57.

Is olive oil expensive? How long does it stay fresh? Should it be refrigerated?

The extra virgin olive oil on your grocery store shelf is probably the highest quality and least processed of all the oils commonly available, but you will find that a modest bottle often costs quite a bit more than a large bottle of highly refined corn, safflower, sunflower, or canola oil (however, a little olive oil goes a long way). Most oil will last longer if kept in a cool, dark place, preferably in an opaque bottle. The refrigerator is a fine option, and even if it causes your olive oil to congeal or cloud, the oil will return to its clear state when allowed to sit at room temperature. If stored properly, olive oil should last for at least a year. Ex-posed to light and heat, however, it can quickly turn rancid, like most oils.

How much olive oil can I eat?

Olive oil is “drizzled” over the top of our Mediterranean Diet Pyramid to indicate that olive oil should be enjoyed as a highlight to a Mediterranean way of eating, but not to drown out the other healthy benefits. We did not specify ac­tual amounts of oil to be consumed because the amount should really be based on individual calorie needs. Calorie needs are determined from your height, weight, activity level, and state of health. As you can imagine, this can vary greatly from person to person. We strongly suggest consult­ing with a registered dietitian or other health care provider for guidelines on your individual needs. In general, how­ever, fat should be used in moderation (no need to limit fat intake for children under the age of four, as infants and tod­dlers need fat for their growth requirements, yet we would suggest avoiding trans fats for children).

And remember how many other spectacular and delicious foods are integral to a traditional Mediterranean diet. Just take a look at the Mediterranean Diet Pyramid if you need a reminder. If too many of the calories in your diet come from olive oil, you won’t have room in your calorie allowance for the other good stuff—the whole grains, vegetables, fruits, nuts, beans, and so on—that make up such an important part of a healthy diet.

Olive oil is certainly one of the highlights of the tradi­tional Mediterranean diet and the Mediterranean Diet Pyra­mid, but it is not the only element. To get maximum health benefits that the traditional Mediterranean diet has to offer, enjoy olive oil in moderation.