The Mediterranean Zone (6 page)

Unfortunately, while longevity and a lower risk of disease are among the benefits of a traditional Mediterranean diet, weight loss is not. The Mediterranean diet is still overloaded with carbohydrates; it still falls outside the dietary composition needed to reach the Zone. If you are eating too many carbohydrates (even if they are rich in polyphenols), and they are not balanced with low-fat protein, then you are not going to lose weight. That’s why I believe this book to be so essential. It’s the first time the longevity-enhancing science behind the Mediterranean diet has been further enhanced by the weight-loss and anti-inflammatory power gained when you reach the Zone.

Are there any intervention studies that suggest that the Mediterranean diet has health benefits compared to a control diet, such as the diet recommended by the American Heart Association? Actually there are. The results of the first of such studies, the Lyon Diet Heart Study, didn’t make the American Heart Association very happy. Started in 1988, this study split more than six hundred French patients who had recently suffered a heart attack into two groups. One group followed the American Heart Association diet guidelines, consisting of a low-saturated-fat, low-cholesterol diet, but the fat they did consume was relatively rich in omega-6 fatty acids (beloved by the AHA because they are shown to lower blood cholesterol). The other group followed an experimental diet similar to the Mediterranean diet, which included more fish, vegetables, and fruits and was low in omega-6 fatty acids. The researchers wanted their subjects to use olive oil. But because the French tend to prefer butter over olive oil, the researchers gave the subjects free margarine low in omega-6 fatty acids, but enriched with omega-3 fats and lots of trans fatty acids to hold it together. Trans fats!

They planned to follow the patients in both groups for the next five years, but the study was stopped after three and half years. Was it ended because those getting the experimental Mediterranean diet were dying like flies because of the trans fats in their diet? No, just the opposite. They were doing dramatically better (especially in terms of mortality) than the subjects following the American Heart Association recommendations. How much better? They had 70 percent fewer deaths overall and a complete elimination of sudden cardiac death (the primary reason you die from heart attack).

When researchers looked for clinical markers to explain these remarkable
differences in mortality, they found the blood cholesterol levels were the same in the two groups, as were the blood sugar and blood pressure levels. The only thing they found that was different was that those following the experimental Mediterranean diet had a 30 percent lower AA/EPA ratio in their blood. Since the AA/EPA ratio is one of the markers of cellular inflammation used to define the Zone, this would also suggest that the mortality differences may be a result of reductions in cellular inflammation and not the usual suspects such as elevated cholesterol and blood pressure.

Another recently published intervention study supposedly demonstrated the superiority of the traditional Mediterranean diet compared to a low-fat diet to prevent heart disease. This study was noble in design but flawed in execution (this is the continuing story of diet intervention studies). The researchers split the subjects into three separate groups. One group was given free nuts, including walnuts and almonds. The second group was given free extra-virgin olive oil. The third was told to change their current diet to a low-fat diet. Not surprisingly, the groups that got the free food eagerly consumed it. Since the free food consisted of items that increased their adherence to the Mediterranean way of eating, it was not surprising that their Mediterranean diet adherence scores also increased. And the group that was supposed to change their diet to a low-fat diet? They didn’t. So in the end the study compared people getting free food rich in polyphenols to a group that made virtually no changes to their current diet. Some controlled study! At the end of the study, those subjects getting either free nuts or free olive oil (foods rich in polyphenols) had fewer heart attacks. The media screamed this proved the Mediterranean diet prevents heart disease, when it really proved that people who consume free food rich in polyphenols seem to have fewer heart attacks. It also proved that it’s very difficult to change a person’s dietary habit if they don’t get free food.

Other more controlled intervention studies have indicated when you dramatically reduce the levels of carbohydrates in the Mediterranean diet (usually around 60 percent total calories) and simultaneously increase the protein content from about 15 percent of total calories to about 30 percent, there are significant improvements in blood sugar control and satiety. This would suggest that there is a lot of potential improvement in what is considered to be the Mediterranean diet.

The logical question might be this: Can the benefits of the Mediterranean
diet (decreased chronic disease, increased longevity, and decreased dementia) be taken to a still higher level using the Zone blueprint of balancing protein, carbohydrate, and fat in addition to providing the missing Holy Grail of weight loss at the same time?

The answer is an absolute yes, as I will explain in the next chapter.

I
f you take the composition of the Zone Diet that I described earlier and put it into a graphic form, it looks something like this:

The basis of your diet is a lot of non-starchy colorful vegetables with limited amounts of colorful fruits and legumes. You add moderate amounts of low-fat protein (such as chicken or fish) and a bit of monounsaturated
fat, such as extra-virgin olive oil or limited amounts of nuts, and keep the intake of omega-6 and saturated fats to a minimum. Finally, you eat as few grains and starches as possible (zero would be the optimum) and never put any white carbohydrates on the plate. Up to this point the Mediterranean Zone seems similar to the Mediterranean diet except for the reduction or elimination of grains and starches and adding far more colorful vegetables and fruits to your plate. But those two seemingly small dietary changes have dramatic hormonal implications. It turns a good diet (the Mediterranean diet) into a hormonally superior anti-inflammatory diet (the Mediterranean Zone). To get even better results, you keep reducing the levels of the fruits and increasing the levels of non-starchy vegetables. This significantly reduces the glycemic load of the diet and further enhances its anti-inflammatory performance.

The key to the Mediterranean Zone is keeping your body in constant hormonal balance using food ingredients primarily found in the Mediterranean region. You do this with the understanding of how those food ingredients can interact hormonally and genetically to reduce diet-induced inflammation.

Unlike the relatively unstructured dietary parameters of the Mediterranean diet, the Mediterranean Zone provides a defined structure, and that is the key to generating superior results. Since the primary benefits of the traditional Mediterranean diet are better cognition and a longer life, then what can you expect by following the Mediterranean Zone? You will be smarter, happier, live a longer life with better health, and, unlike the results with the Mediterranean diet, you will also lose weight. Not a bad deal.

I’ve already talked in general terms about the balance of the foods that should fill your plate, but what food ingredients should you eat on the Mediterranean Zone? Let me give you a short historical overview of the changes that have taken place in the foods of the Mediterranean region, and this will give you some clues about how to make the Mediterranean Zone work optimally for you.

Protein-based foods during this era would have included eggs, fish, and red meat from wild game. The only carbohydrates consumed were fruits and vegetables (although cross-breeding and hybridization have changed
these plants substantially since then), and the only fats were nuts, or organs (such as the brain) from wild game. Fish, vegetables, fruits, and nuts are still mainstays of the Mediterranean diet regardless of how it is defined.

The advent of agriculture introduced new types of carbohydrates into the Mediterranean diet, including whole grains. There was a greater variety of protein sources available then, including dairy, legumes, and poultry, as well as new sources of fat, such as olive oil, that were rich in polyphenols. Also biotechnology (that is, fermentation) was being used to make foods such as yogurt and garum (a fermented sauce from fish intestines that was the ketchup of Roman times). Of course, the biggest breakthrough in biotechnology during this time period was the discovery and development of wine, produced by the yeast-mediated fermentation of the carbohydrates in the grapes. The alcohol produced by the fermentation extracted even greater amounts of polyphenols from grape skins. Many of these biotechnology-generated foods (except for garum) still remain in the Mediterranean diet.

The next infusion of new ingredients came during medieval times. Although urban legend has Marco Polo bringing pasta back to Italy from China, various forms of crude pasta already existed in Italy before his journey. The discovery of the Americas brought tomatoes, potatoes, and chocolate into the Mediterranean diet. Coffee came from Arabia. While tomatoes, unsweetened chocolate, and coffee are all rich in polyphenols, white potatoes are not.

And let’s not forgot the introduction of refined alcohol thanks to the Benedictine monks, who learned how to distill wine to increase its alcohol content. Unfortunately, this removed the vast majority of polyphenols from the wine during the distillation process.

The newest additions to the Mediterranean diet come from the new refining technologies, which both increase the shelf life of food and also reduce its cost. These include refined carbohydrates, devoid of polyphenols, such as white pasta, white bread, and white rice in addition to refined white sugar.

Another American import is refined vegetable oil (primarily corn and soy), rich in omega-6 fats. These fats were virtually unknown in all human diets until the last one hundred years. Finally, more advanced biotechnologies provided trans fats, derived from refined vegetable oils, and high-fructose corn syrup that was even cheaper than refined sugar. The last two food ingredients, coupled with cheap refined carbohydrates, became the backbone of the processed food industry.

It doesn’t take a rocket (or even a nutritional) scientist to quickly figure out that the more you stick with food ingredients used in the Paleolithic and pre-Christianity Mediterranean times, the better you are going to control diet-induced inflammation as well as lose weight. As soon as you add more of the post-Christianity and the modern industrial ingredients to the diet, your chances of reaching the Zone tumble dramatically as you increase the levels of diet-induced inflammation.

The key to maintaining the health benefits of the Mediterranean Zone is controlling cellular inflammation. Since the hormonal effects of a meal last only about five hours, this means you are eating about five times per day: three Mediterranean Zone meals and two Mediterranean Zone snacks. The secret is to never let more than five hours go by without an appropriate balanced meal or snack. For example, you should always consume a Mediterranean Zone meal within one hour after waking. Breakfast is the most important meal of the day because your body is on empty due to overnight fasting. If you eat breakfast at 7 a.m., this means you should have your next meal no later than noon. Since most Americans eat dinner around 7 p.m., that’s more than five hours from lunch. So in the late afternoon, have a Mediterranean Zone snack to keep your hormones in the Zone until dinner. Finally, before you go to bed, have another Mediterranean Zone snack. Even though you are going to sleep, your brain isn’t, and this late-night snack provides the hormonal touch-up you need so you aren’t groping for that cup of coffee the next morning to try to get you started.

The beauty of the Mediterranean Zone is that there is no guilt. If you mess up with one meal that takes you out of the Zone, your next meal can put you right back where you want to be hormonally.