Digging for Answers for The Common Root of Dysfunction

When the leaves of a plant start looking sick, wise gardeners will dig out the root to take a look. Even though it is buried in the soil, hidden from view, gardeners know they must go to the root to find where most plant diseases begin. It does not surprise them that it was far away from the root, on the leaves, that the first symptoms appeared. They know that for the leaves to be healthy, they must receive nutrients from the roots, where they are absorbed from the soil. I learned this as a kid, watching the gardeners in my own backyard.

As I looked for answers and solutions to my own health issues, my journey also changed me from Western-trained specialist to open-minded doctor. As I started studying other traditions of healing, one concept kept cropping up in many of them: health and disease start in the intestines. This concept, which initially I did not understand, held the key that unlocked the answer I was looking for. Hidden, just like roots, our intestines absorb nutrients from food, our soil. Intestinal health plays a huge role in whether we get well-nourished. Toxicity, depression, irritable bowel syndrome, nutrient depletion, mucus, acid­ity, serotonin production—all these loose pieces of the puzzle became connected in a multilevel matrix that answered my questions about how and why.

Most people underestimate the importance of intestinal health. Other organs, such as the heart (the “king of the organs”), tend to get center stage. Yet as I learned, information on this system proved to be the missing link between my irritable bowel syndrome and my depression.

The human gut is similar to the root of a plant: both are hidden, both absorb water and nutrients, and when sick, both can show symp­toms on organs far away, like the leaves and branches or the skin and hair. But hidden in this root is one of the most important systems for human life: a high-precision machine with abilities and functions that not only allow us to obtain the building blocks and chemicals that will make our bodies, but also detect who to trust in life. A machine so deli­cate, it needs a very specific set of conditions for balanced function. Nature is the designer of the machine and also provided the perfect conditions. When we departed from the ways of nature, the conditions for optimal gut function deteriorated. When the intestines are in dis­tress, nutrient deficiencies are likely. But also your intuition may suffer. Your “gut feelings” may get confused. Your seasonal allergies may come back with a vengeance. You may gain weight despite “not eating,” get depressed, or get constipated. You may start to react to foods that you never reacted to before. Every single organ or function in the body has a direct link to the intestines.

Toxicity often affects the gut before any other organ. The gut, as I refer to it here, is not a single organ. It is a system that performs impor­tant, diverse, and almost magical functions. A short description of the four major constituents of the gut system will help you understand how it can be the root of the problem for totally different diseases.

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.

Questions and Answers about Vegetables found in the Mediterranean Diet

If allium compounds are destroyed in the cooking pro­cess, what is the best way to include them in the diet? Raw onions and garlic?

To many people, raw onions and garlic are too strongly flavored to be palatable when eaten alone. However, minced or even thinly sliced raw onions make an aromatic addition to a salad, and minced fresh garlic tastes great in an olive oil vinaigrette salad dressing. Raw chives are another delicious addition to salads and make a crunchy garnish to other foods, from the traditional cottage cheese to grain-based dishes and pasta dishes. When you do cook onions and gar­lic, try to cook them for as short a time as possible. When making soups and stews, sprinkle a few chopped onions on top, and/or add the garlic (or half the garlic) toward the end of the cooking time.

Are the familiar herbs and spices used in Mediterranean cuisine of any nutritional value, or are they purely for fla­voring?

Herbs and spices are plant foods and are rich with nutri­ents and phytochemicals, just like vegetables, although re­search hasn’t focused its attention on herbs and spices the way it has on vegetables (at least partially due to the fact that these plant foods are consumed in much smaller amounts and so may have a less potent, although quite possibly cumula­tive, effect). Some plant foods such as garlic are often thought to be either an herb or a vegetable, and the distinc­tion is indeed blurry at times. The dictionary even defines vegetables as “a usually herbaceous plant cultivated for its edible parts.” Herbs are, technically, plants with fleshy rather than woody stems, and are also defined as “aromatic plants used in medicine or as seasoning.” Similarly, spices are “aromatic  or pungent plant substances used as flavoring.”

Yes. Just as a raisin is as nutritious as a grape, the sun-dried tomato is full of lycopene and contains all the nutrients of a vine-ripe tomato. The only element missing is the water. The sun-dried tomato also contains the same number of calories as a fresh tomato. However, because it is smaller, it is easier to eat more sun-dried tomatoes than fresh tomatoes. Of course, the calories in vegetables are minimal and these are calories with nutritional power, so there’s no need to limit yourself. Sun-dried tomatoes make a flavorful addition to many dishes and are even a tasty addition to homemade bread.

Are frozen vegetables as nutritious as fresh vegetables?

Not always, but sometimes the frozen version of your fa­vorite veggie is actually more nutritious than the fresh ver­sion. Many vegetables are flash-frozen and bagged right in the field after picking, preserving many nutrients that might otherwise be destroyed by rough handling and extreme tem­peratures, not to mention too-long exposure to the air during the long transport to your local supermarket and finally to your refrigerator. Some nutrients are easily oxidized and de­pleted during this trek.

That’s not to say you shouldn’t seek out fresh produce! Seek out local produce stands or, better yet, grow your own vegetables. The trip from garden to dinner plate is much shorter, and you’ll be getting the best flavor and most nutri­tional value possible. When good fresh produce isn’t avail­able, however, you can rest assured that frozen and canned vegetables are a pretty close second when it comes to nutri­tional value. Be aware, however, that sodium may be added to frozen and canned vegetables. Briefly rinse these vegeta­bles with water before preparing to wash away the excess, should you be salt-sensitive or if your recipe doesn’t call for extra salt.

How much folacin is in different kinds of foods?

Many kinds of beans, vegetables, fruit, whole grains, nuts, and seeds contain folacin. All of these foods are rec­ommended to be consumed on a daily basis in the Mediter­ranean Diet Pyramid, making it easy to get adequate amounts of folacin. The recommended daily allowance for the average adult is 180 to 200 micrograms. Women in childbearing years, and those who are pregnant, are recom­mended to get 400 micrograms of folacin per day. Some re­searchers feel that folacin intakes should be from 400 to 800 micrograms per day to help prevent cancer. Below is a chart of some foods and their folacin content:

Food                                                         Folacin (micrograms)

Artichoke,

boiled (1 medium)                                             155

Asparagus,

boiled (1/2 cup, or 6 spears)                             130

Avocado,

raw (1 medium)                                                  160

Blackberries

(frozen, unsweetened, 1 cup)                             50

Boysenberries

(frozen, unsweetened, 1 cup)                             85

Broccoli,

raw (1/2 cup chopped)                                          30

Chickpeas (garbanzo beans),

boiled (1 cup)                                                     280

Orange juice

(8 ounces)                                                           110

Red kidney beans,

boiled (1 cup)                                                     230

Note: These figures are rounded numbers. Source: Jean Penning­ton, Bowes & Churches, Food Values of Portions Commonly Used (17 ed), Philadelphia: Lippincott, 1998.

The Mediterranean Diet – Questions and Answers about what you eat and drink

In general, what counts as a serving?

The Mediterranean Diet Pyramid lists serving sizes in each of its food categories. The USDA also publishes a list of serving sizes for a variety of food groups. In general, however, one serving from the grain group equals one slice of bread. Note that by “slice of bread,” we are referring to the standard 70-calorie portion size. If your whole-grain bread contains more calories per slice, adjust accordingly. For example, some prepackaged whole-grain breads contain 110 calories per slice, which would equal 11/2 Mediter­ranean Diet grain servings. A serving is also equal to 1 ounce of ready-to-eat cereal or 1/2 cup of cooked grains, in­cluding whole-grain rice, pasta, or cooked cereal.

This serv­ing is fairly small. Drop 1/2 cup of pasta on a plate and you’ll see what we mean. The small serving size (by American standards, where we have become accustomed to “super-sizing” our meals) puts the USDA’s six to eleven serving recommendation from the grain group in perspective. For the carb-concerned, six to eleven servings sounds out of control, and even eight servings sounds like a lot, but eat a cup of whole-grain, sugar-free cereal for breakfast (like hot oatmeal), one sandwich on two slices of whole-grain bread for lunch, and a cup of whole-grain pasta for dinner and you’re there. In general, whole-grain foods will not promote wide fluctuations in insulin levels.

For the vegetable group, 1 cup of raw leafy vegetables or 1/2 cup of chopped or cooked other vegetables or 3/4 cup of vegetable juice equals a serving. One medium piece of fruit or 1/2 cup of chopped or cooked fruit, or 1/2 to 3/4 cup of most fruit juices equals a fruit serving. In the dairy category, 1 cup of milk or yogurt or 11/2 ounces of cheese equals a serving, and in the protein group, 2 to 3 ounces of cooked lean meat equals a serving (that’s not very big, so take note). Note: One egg, 2 tablespoons of peanut butter, 1/ 3 cup of most nuts, or 1/2 cup of cooked lentils equals an ounce of meat.

Does the Mediterranean diet provide enough daily pro­tein for the average adult?

Yes! The Recommended Daily Allowance (RDA) for pro­tein for the average adult male (age twenty-five and up) is 63 grams. For the average adult female (age twenty-five and up and who is not pregnant or lactating), the RDA for protein is 50 grams. If you eat the minimum daily Mediterranean Diet recommendation of 1 cup of legumes (such as chickpeas and red kidney beans) per day, you’ll be eating roughly 14 grams of protein. Add in 1/3 cup of nuts (such as walnuts) and you’ll be consuming 7 grams more. Consume at least three servings of vegetables (such as green beans and carrots), and you are adding about 3 more grams of protein. Two cups of low-fat soy milk equals roughly 16 grams of protein. Eat at least eight servings of whole grains (such as whole-grain bread and couscous), and you are adding about 24 grams of protein. This already puts us up to 63 grams of protein, and we haven’t even left the minimum recommendations of the daily food section of the Mediterranean Diet Pyramid. Toss in an ounce of fish (such as tuna) and you’ll be getting about 7 more grams of protein.

Can a vegetarian eat a Mediterranean diet?

The traditional Mediterranean diet is almost a lacto-ovo vegetarian diet. While both Mediterranean diet pyramids list meat, poultry, and fish to be consumed anywhere from weekly to a few times per month, these items are not, by any means, required. The traditional Mediterranean diet centers around plant foods, with small amounts of cheese and yo­gurt (depending on the country of a recipe’s origin). Many people living in the Mediterranean during the 1950s and 1960s probably were vegetarian by necessity.

Even a vegan (someone who consumes no animal prod­ucts at all) can follow the traditional Mediterranean diet. Al­though cheese, yogurt, and milk, can be added in moderation to a heart-healthy eating plan, they aren’t required. Soy cheeses and milks make delicious substitutes, or try almond milk. Vegans must be careful to eat food from a wide variety of sources, to ensure that all the nutritional bases are cov­ered. Vegans might also consider taking supplements, par­ticularly of vitamin B12, which is most available from animal sources. We strongly recommend that anyone plan­ning to eliminate an entire food group from his or her diet should seek the counsel of a registered dietitian to ensure that the proportions of food eaten are sufficient to meet all nutrient and caloric needs.

Is the Mediterranean Diet Pyramid appropriate for children? What about pregnant or breastfeeding women? What about teenagers?

Yes to all! The Mediterranean diet, when eaten in correct proportions and sufficient amounts, is nutritionally adequate for anyone. Again, however, we recommend that you con­tact a registered dietitian if you have any special nutritional and/or caloric needs such as those of a growing child or a pregnant or breastfeeding woman.

Can someone with a chronic disease such as diabetes or kidney disease safely eat a Mediterranean diet?

People with chronic diseases have unique nutritional and/or caloric needs, so again, we recommend contacting a registered dietitian about the diet that is right for the individ­ual. Certain food items or groups may be prohibited for you. Although you may have to customize certain elements ac­cording to your needs, in general, a Mediterranean diet is a healthy, nutrient-dense diet appropriate for anyone able to eat it.

Are vitamin, mineral, or other dietary supplements nec­essary or beneficial while following the traditional Mediterranean diet?

No, the nutrient-dense Mediterranean diet provides all es­sential nutrients when eaten in sufficient quantities (as de­picted in the Mediterranean Diet Pyramid). If you suspect you aren’t deriving adequate nutrition from your diet or if you have special nutritional needs, seek the advice of a reg­istered dietitian.

Why does the American Heart Association recommend averaging percentages, such as the 30-percent-of-calories­from-fat rule, over a few days or a week rather than on a daily basis?

This concept works for both the AHA-recommended diet and the Mediterranean diet. In the words of the AHA, “Ap­plying the 30 percent standard to single foods greatly limits the variety of foods in the diet and can be misleading. The only way to maintain balance, variety and enjoyment of the AHA eating plan is to interpret the guideline with emphasis on the words ‘total calories.’ ” In other words, occasionally it makes sense to have a day where calories from fat will ex­ceed 30 percent. If days like this are balanced with days where total calories from fat fall below 30 percent, this is more conducive to a varied (and interesting) diet.

Can flaxseed be consumed on a Mediterranean diet?

Absolutely! There has been a lot of exciting news sur­rounding flaxseed and flaxseed products. Flaxseed is an ex­cellent source of health-promoting omega-3 fatty acids, as well as phytochemicals. Although not traditionally a part of the Mediterranean diet, it can definitely be incorporated in a healthy Mediterranean style of eating. Several whole-food manufacturers have started incorporating flaxseed in won­derful breads and ready-to-eat cereals. You, too, can incor­porate flaxseed, or flaxseed meal (which is similar to wheat germ, and can be purchased in most whole foods markets) as part of your daily nut or seed consumption. Sprinkle flaxseed meal in your cereal, yogurt, quick bread and muffin mixtures, and so forth. Another source of flaxseed is flaxseed oil, which can be quite expensive and, like all oils, high in calories. You can try using flaxseed oil as a substitute for olive or canola oil in cooking from time to time, or driz­zle a little on a salad. Keep flaxseed oil in the refrigerator.

Which dairy products besides nonfat or low-fat milk are a sensible addition to a low-saturated-fat diet?

Try some of the many low-fat and nonfat plain yogurts. Stir in some fresh fruit for sweetness. Also, while some cheeses contain a lot of fat, others are relatively low in fat. Check the labels, or look for cheeses made from skim milk (such as mozzarella made with part-skim milk). Pretty much all the cheeses come in reduced or nonfat versions. Cottage cheese, ricotta, feta, gouda, Cheddar—the list seems end­less—are now offered in reduced-fat or nonfat varieties. We recommend organic cheeses, or cheese imported from the Mediterranean region. They may cost a little more, but the taste is so intensely delicious that a little goes a long way.

Where does high-fat cheese fit into the Mediterranean Diet Pyramid?

High-fat cheeses (such as Gruyère, muenster, blue) are full of flavor, so as we mention above, a little goes a long way. Although a dairy product, high-fat cheese is more ap­propriately located with high-fat meats as a high-fat protein source. If you like them, consume high-fat cheese only every month or so and in small amounts.

q Canned beans are much easier to prepare than dried beans. Are they just as healthy?

Yes. For those who are salt-sensitive, however, be careful about the excess sodium. Rinse canned beans in a colander to wash away the salt. Rinsing will also wash away some of the starchy liquid, making your dishes more attractive, as well as reducing the likelihood of developing intestinal gas after bean consumption. If the recipe in which you are using canned beans calls for added salt (not often the case with tra­ditional Mediterranean recipes), you might consider adjust­ing the added salt accordingly.

q Are certain nuts and seeds better than others?

From a nutritional point of view, all nuts and seeds are nutrient-dense plant foods. Some are lower in fat than oth­ers, however, and consequently lower in calories, so these nuts and seeds might be more appropriate for people who are attempting to control their weight. Chestnuts are actually a low-fat food. A 1-ounce serving of roasted (European) chest­nuts (about three and a half nuts) contains less than 1 gram of fat, all unsaturated, and about 70 calories. On the opposite end of the scale, 1 ounce of dry-roasted cashews contains about 13 grams of fat and 163 calories, and 1 ounce of toasted or roasted sesame seeds contains about 14 grams of fat and 160 calories. The key is to get a variety of nuts and seeds to benefit most from the varied nutrients and phyto­chemicals (more on this later). The more variety, the healthier the diet really is. Of course, eating that variety in moder­ation is important, too.

Coconuts are a rare exception to the heart-healthy plant food rule. Coconuts are high in saturated fat and are best avoided most of the time.

The Mediterranean Diet Pyramid lists “four or fewer” eggs at the “weekly” level. Is it okay to eat more eggs if only the whites are consumed?

Yes, by all means. Egg whites do not contain cholesterol, which is found only in the yolks. They are a good source of protein and can be used to cut fat in egg dishes and baked dishes as well. Also, research supports the notion that con­sumption of saturated fat, not dietary cholesterol (some­times called preformed cholesterol), has the most impact on blood cholesterol levels. While some people are very sensi­tive to dietary cholesterol and should limit egg consump­tion, the general population need not be overly concerned about dietary cholesterol. The “four or fewer per week” egg rule is just a general guideline for a Mediterranean-inspired (or any nutritionally sound) eating program, due to the satu­rated fat element in whole eggs.

How can someone lose weight putting olive oil on every­thing?

We certainly don’t recommend putting olive oil on every­thing! Olive oil is fat, and fat in excess contributes to obe­sity, which in turn contributes to many health problems. One common misconception about the Mediterranean diet is that adding olive oil to an already high-fat diet will “fix” the fat problem. On the contrary, olive oil should substitute for other types of fat, not be added to them. Overall fat intake from all sources, including olive oil, should be lower than is typical for Americans. This is why we recommend “driz­zling” olive oil, not pouring it, over our visual representa­tion of a healthy Mediterranean-inspired diet. A little goes a long way.

Are some vegetables better choices than others? What about fruits?

All fruits and vegetables have their “star” qualities. Also, every type of plant food has a unique combination of nutrients and phy­tochemicals. That’s why a variety of plant foods is more im­portant than choosing a few “right” plant foods and eating only those. The more variety in your diet, the more nutri­tionally complete your diet will be.

What about table sugar? Is sugar an acceptable addition to a healthy, Mediterranean diet?

The sugar controversy rages on. Some people proclaim refined sugar as among the worst possible additions to your diet. Others say that, as long as a person maintains a healthy weight and consumes sufficient nutrients, sugar is fine. The truth probably lies somewhere in the middle. Whenever you eat a high-sugar product, you are filling up with empty calo­ries when you could have eaten something more nutrient-dense instead. If you are getting enough to eat but add sugar, you may have trouble maintaining that ideal weight. But, if consumed occasionally in moderation, as part of a healthy diet, sugar is probably just fine—and pretty hard to avoid these days.

What about coffee and tea?

Although not listed on either Mediterranean food pyramid, coffee and/or tea are both integral—albeit nonnutritive— parts of the diets in many Mediterranean countries. In fact, it would be difficult to discuss the Mediterranean region with­out mentioning the infamous Italian espresso, not to mention the thick, sweet, sludgy concoction known as Turkish coffee. Tea is also widely consumed in many Mediterranean coun­tries. However, we suggest that if you enjoy coffee and/or tea, you consume them in moderation like anything else, and not at the expense of more nutritionally complete foods. Re­cent research has linked green and even black tea with cancer prevention, as teas contain antioxidants and other phyto­chemicals that could bolster the body’s immune system and fight cancer-causing free radicals. Of course, caffeine-free herbal teas are a great way to relax with a hot beverage free of caffeine. If you are caffeine-sensitive, we recommend dis­cussing the use of caffeine with your physician.

Is canola oil just as good as olive oil?

Canola oil is, by necessity, more processed than olive oil. Therefore, it loses many of the vital phytochemical compo­nents still present in extra virgin olive oil. However, it is a good source of monounsaturated fat and it is generally cheaper than olive oil.

Can the Mediterranean Diet Pyramid be used as a guide for non-Mediterranean types of cuisine?

Yes! The idea is to apply the Mediterranean concept, not necessarily the particular food ingredients, to all your food choices. You need not limit yourself to pasta primavera, for example. Instead, base your diet around plant foods, focusing on vegetables, whole grains, fruit, primarily beans for pro­tein, fish, and animal meat in moderation. This goal works for just about any cuisine. In fact, bar-and-grill-type Ameri­can restaurants often have grilled vegetable entrées. Most restaurants have salads with small amounts of meat such as grilled chicken or salmon on top. Ask for olive oil and vine­gar as a dressing and you’ve got a great Mediterranean ­inspired meal!

Asian cuisine is right in line with the principles of tradi­tional Mediterranean cuisine. Many foods unique to this cui­sine have distinctive health benefits, such as soy foods like tofu. Rice and vegetables with protein from small amounts of meat or tofu or nuts and seeds (peanut sauce, walnuts, al­monds, cashews, and peanuts are common Asian additions) make an exceptionally healthy meal.

Even an American home barbecue can fit in with the Mediterranean concept if you fill up on green salad, baked beans, coleslaw made with vinaigrette instead of mayon­naise, grilled or raw vegetables, and fruit such as water­melon and fresh fruit salad. You probably won’t even miss the burger and hot dogs!

The Mediterranean Diet Pyramid seems to require a lot of food be consumed, especially in the daily food section. Will I gain weight?

No, not very likely, especially if you incorporate daily ac­tivity into your schedule. If you consume the minimum re­quirement of each of the recommended daily food groups, you will be consuming about 1,385 calories. Add in a table­spoon of olive oil, and you are still talking about only (roughly) 1,500 calories. Factor in a 3-ounce cooked portion of fish, such as salmon, and you’re adding around 200 calories, for a total of 1,700 calories for the day. The average adult can easily maintain weight on such a diet. In fact, many people will lose weight on any diet below 1,800 calo­ries, especially those who are moderately active.

The Mediterranean diet really should not be about num­bers. Rather, the culinary spirit of the traditional Mediter­ranean region should be celebrated and enjoyed for the many benefits it possesses. Again, if your health requires you to gain or lose weight, you should seek the guidance of a registered dietitian or other qualified health care provider for your individual needs. Our pyramid should act only as a general guide to shape your eating habits to closely resem­ble the healthy traditional Mediterranean diet.