The Mediterranean Zone (5 page)

Your first thought might be, “I will starve to death on 1,200 to 1,500 calories per day.” I guarantee you will not. This is what I call the Zone Paradox: You will consume fewer calories with less hunger but more energy. Furthermore, you are still eating the typical protein intake of most Americans. Even though you are consuming fewer carbohydrates (but more of the colorful, non-starchy kind), they are still the primary source of calories in the Zone Diet. Since you always are consuming more grams of carbohydrate than protein, you can’t really describe the Zone as a high-protein, low-carbohydrate diet unless my definitions of high and low are significantly different from what is in the dictionary. Probably the best way to describe the Zone is as a moderate-protein, low-glycemic load diet.

Can you become too thin on the Mediterranean Zone? When you can see your abdominal muscles, it is time to start thinking about adding some additional monounsaturated fat (extra-virgin olive oil or almonds) to your diet. (So besides requiring a watch, you also might need a mirror to see if you are developing a six-pack.) This is what I do with the elite athletes (such as the twenty-five gold medal winners in the last five Olympics) who
follow the Zone. Their goal is optimal performance, not being on the cover of
Men’s Fitness
, and athletic performance depends on having a certain level of body fat. That fat provides the high-octane fuel needed for making the chemical energy needed for optimal performance.

The macronutrient balance of the Zone is not set in stone but represents a bell-shaped curve.

Why? Not everyone is genetically the same. Nonetheless, the more you increase carbohydrate intake (even adding moderate-glycemic ones such as fruits), the more you will increase insulin secretion. If that is combined with high amounts of omega-6 fatty acids in your diet, then you are going to create more inflammatory eicosanoids and more cellular inflammation. That’s going to make you fat, sick, and age faster. If you swing too much in the other direction and have too much protein and not enough carbohydrates (such as on the Atkins diet), you are going to cause the increased secretion of cortisol, which is a stress hormone. That hormone will make you fat, sick, and age faster.

So it is critical that you keep experimenting with the balance of food ingredients on your plate until you can maintain yourself in the Zone. How do you know when you get there? Use your watch. If you can go for five hours between meals without being hungry or losing peak mental focus, that’s your sign that your last meal put you into the Zone. The secret is keeping yourself in that Zone for a lifetime. The better you play this hormonal
balancing game using the Mediterranean Zone, the better and easier your life becomes.

The balance of protein, carbohydrates, and fat in the Mediterranean Zone is continually reinforced by ongoing research that has been published over the last fifteen years. The dietary recommendations of the Joslin Diabetes Center at Harvard Medical School for treating obesity and diabetes are essentially those of the Mediterranean Zone. Some of the more recent research comes from the EPIC study published in 2013 analyzing the diets of some twenty-two thousand Greeks, demonstrating those following a low-glycemic load diet with a total carbohydrate intake of about 40 percent of total calories had the least risk in developing diabetes. A 2010
British Journal of Nutrition
article estimated the diet composition of our Paleolithic ancestors was about 40 percent low-glycemic load carbohydrates, 30 percent protein, and 30 percent fat. It appears that health in the past, present, and future depends on having a balance of macronutrients. As soon as you start increasing one macronutrient in a diet, another has to decrease. Moving away from the basic Zone macronutrient balance creates very large hormonal changes that can disrupt your metabolism.

The most important research, however, is that which demonstrates the effectiveness of the Zone diet in reducing cellular inflammation. The published research leaves little doubt on this subject. Harvard Medical School demonstrated in 2004 that the Zone diet was nine times more effective in reducing inflammation compared to a control diet based on the USDA dietary recommendations, even though the weight loss was the same with both diets. Tufts University School of Medicine came to the same conclusion when comparing the Zone to the USDA dietary recommendations in treating diabetics. A study published in 2006 in the
American Journal of Clinical Nutrition
indicated that the Zone dramatically reduced cellular inflammation while simultaneously improving exercise endurance and mood levels when compared to the Atkins diet.

The reduction of diet-induced inflammation should be the real goal of any nutrition plan, as opposed to simple weight loss. It is only with the reduction of cellular inflammation that you begin to reverse chronic disease and slow down the aging process. Unfortunately, weight loss is not a good marker. This is because weight loss is made up of water loss, loss of muscle mass, and loss of excess body fat. Losing water and muscle is not
going to have any positive health benefits. However, losing excess body fat does because of its reduction of inflammation. In this regard, the Zone is the clear winner.

The power of science is that it helps predict the future. If you throw a rock into the air, you can be confident it will fall back to earth. That’s why gravity represents such strong science. Likewise, nutrition predictions have to come true if it is good science.

So here is what you can expect if you follow the Mediterranean Zone for a month.

If you like that list of benefits and want to maintain them, then just continue the Mediterranean Zone for a lifetime. If you have a hand, an eye, and a watch, that’s easy to do.

Ultimately nutrition has to be treated as science. So what are some of those clinical markers that are indicative of being in the Zone? Although I will discuss these markers in greater detail in Appendix E, here is a quick summary.

Two of these tests (HbA
₁
c and TG/HDL) will usually come from bloodwork issued for your annual physical. The AA/EPA ratio is a more specialized test used routinely in medical research, but not in standard blood tests given by your physician. See Appendix F for resources that will do such testing using only a drop of blood coming from a finger stick (similar to testing for blood glucose). Once you have these test numbers, you can tell if you are in the Zone, close to the Zone, or need lots of work to get to the Zone using the following chart.

This is not a multiple-choice test. Either all three clinical markers are in the correct ranges, or you can’t be considered healthy no matter how good you look in a swimsuit. Getting into the Zone remains the best medicine if your goal is the reduction of cellular inflammation leading to the reversal of chronic disease and better quality of life. Following the Mediterranean Zone is the easiest way to get to the Zone.

So what percentage of Americans might currently be in the Zone based on these clinical markers? The best evidence indicates less than 1 percent. Maybe 4 percent of the U.S. population is close to the Zone, and definitely more than 95 percent of Americans are out of the Zone by eating in a way
that is increasing their chances of chronic disease and premature death. Is it any wonder that health-care costs are out of control?

I really don’t care what diet you follow as long as you are never hungry for five hours after every meal, and your blood markers indicate you are in the Zone. However, if you follow my simple dietary rules, you are quite likely to feel the effects of improved hormonal control with your first meal, and within thirty days those blood markers that define the Zone will start to change for the better. Stay in the Zone for a lifetime, and you have your best chance of a longer and healthier life.

T
oday we hear a lot about the Mediterranean diet. UNESCO, the cultural arm of the United Nations, has proclaimed the Mediterranean diet one of civilization’s great treasures.

But which Mediterranean diet? There are sixteen countries that border the Mediterranean Sea. I have been to most of them for extended periods of time, and I can tell you that there is no single Mediterranean diet. What is eaten in Spain is very different from that eaten in Italy, and what is consumed in Italy is distinct from the diet in Greece, not to mention the other thirteen countries in the region.

If you ask most Americans for their definition of the Mediterranean diet, the response is usually eating pasta (and pizza), drinking red wine, using a little olive oil, drinking espresso, and adding some Parmesan cheese to their meals. But that American version doesn’t look anything like the real Mediterranean diet.

The distinguishing feature of the diets in virtually every region that borders the Mediterranean Sea is not pasta but vegetables and fruits (colorful carbohydrates rich in polyphenols). We finally have enough scientific sophistication to realize that the high levels of polyphenols make the Mediterranean diet unique.

There is no definitive caloric composition that makes up the Mediterranean diet. The best that researchers can do is to estimate adherence of their subjects in the consumption of those food groups they think should be in the Mediterranean diet. These food groups include separate categories such as vegetables, fruits and nuts, legumes, olive oil, fish, and cereals (bread, pasta, rice, and so on), drinking red wine, and not eating much meat or dairy products. Based on this definition, a good guess might be that about 60 percent of the calories in the Mediterranean diet are consumed as carbohydrates, 15 percent as protein, and about 35 percent as fat, which would make the Mediterranean diet close in macronutrient composition to the current American diet. So why is it seemingly so much healthier? It’s the polyphenols.

If you look at the Mediterranean food groups carefully, they usually fall into two broad categories: those rich in polyphenols (fruits, vegetables, wine) eaten in large quantities and those, such as red meat, chicken, and eggs, that are not great sources of polyphenols—and are eaten far less frequently. Furthermore, it is implicit that the fat in the Mediterranean diet is generally rich in monounsaturated fats (from olive oil and nuts), moderate in omega-3 fats (coming from fish), and low in omega-6 and saturated fats (from corn oil and red meat). Foods rich in polyphenols, monounsaturated fats, and omega-3 fatty acids and low in omega-6 and saturated fats may well explain why, despite having a similar ratio of carbohydrates, protein, and fat as the current American diet, the Mediterranean diet is so much more effective at preventing disease and promoting longevity.

Most of the research around the Mediterranean diet comes from epidemiological studies, which observe large groups of individuals to determine whether those more closely adhering to a dietary ingredient regimen have any improved health outcomes over those who are not. Better adherence to a Mediterranean diet (meaning probably eating more polyphenols) appears to reduce the incidence of diabetes and heart disease. Just as important, adherence to the Mediterranean diet also appears to preserve the mind and slow the rate of aging. Since diabetes, heart disease, and dementia are caused by cellular inflammation, this would strongly suggest that a Mediterranean diet really is an anti-inflammatory diet. However, remember that these benefits only come from a lifetime of eating a Mediterranean diet, reinforcing the ancient Greek origins of the word
diet,
which means “way of life.”