The Mediterranean Diet

Of all the ‘diets’ that have the strongest evidence base for positive health changes across a range of conditions is the Mediterranean diet. The Mediterranean diet has been shown to reduce the burden, or even prevent the development, of cardiovascular disease, breast cancer, depression, colorectal cancer, diabetes, obesity, asthma, erectile dysfunction, and cognitive decline1.

What is the Mediterranean Diet?

The Mediterranean Diet stems from the eating patterns in Crete, the rest of Greece and Southern Italy in the 1960s, where adult life expectancy was among the highest in the world and rates of coronary heart disease, certain cancers, and other diet-related chronic diseases were amongst the lowest2.

The diet consists of fish, monounsaturated fats from olive oil, fruits, vegetables, whole grains, legumes/nuts, and moderate alcohol consumption. The key nutrients it provides are Omega-3 fatty acids, fibre, vitamins and minerals.

Key concepts of the Mediterranean Diet

Plant based foods

Fruit & vegetable stall

The use of plant based foods as core elements of the daily diet provide essential vitamins and minerals and fibre. Plant based foods include fruit & vegetables, wholegrain cereals, beans and pulses and nuts and seeds.

The use of minimally processed ingredients is encouraged and meat sources can be included such as lean meat, chicken & fish.

The Mediterranean diet is not a vegetarian diet.

Aiming to get your 5 a day of fruit and vegetables is a good way to increase your intake of vitamins, minerals and fibre. Examples of what counts as a portion of fruit and vegetables include:

2 plums/satsumas

1 apple/pear/banana

1 slice of melon

1/2 grapefruit

2 broccoli spears

8 cauliflower florets

7 cherry tomatoes

3 heaped tablespoons of beans or pulses – these only count as a maximum of 1 portion per day

All sources of fruit and vegetables count towards your 5 a day, including frozen and tinned.

Oily Fish

Tray of fresh salmon fillets

Oily fish such as salmon, mackerel and pilchards are a great source of Omega-3 fatty acids. Omega-3 fatty acids which are a type of polyunsaturated fat have been shown to protect the heart and blood vessels from disease.

It is recommended that we eat 2 portions of fish per week, with one being an oily fish.

Olive oil

olive oil poured into bowl

Olive oil is a source of polyunsaturated fat which has been shown to be beneficial in protecting against heart disease.

Olive oil can be used a salad dressing or instead of putting butter or margarine on bread, try dipping it in olive oil. Olive oil can be infused with herbs and spices to create different flavours.

Wholegrain foods

wholegrain cereals in jars and pots

Wholegrain cereals such as oats, bread, pasta and rice are high in fibre, which provides a protective effect against cardiovascular and are important for good gut health are a key component of a Mediterranean diet.

Ensure your meals contain a source of wholegrain and try swapping white rice and pasta for wholemeal rice or pasta.

Wholegrains are also a good source of B vitamins which are involved in metabolism helping to give us energy.

Choosing wholegrains increases our fibre intake which is good for keeping us full and keeping our bowel healthy.

Nuts and legumes

legumes in pots

There are numerous studies which shows evidence that the Mediterranean diet supplemented with nuts offers primary cardiovascular disease prevention benefits1.

Legumes such as beans and pulses are a great source of protein and fibre and are a staple part of the Mediterranean diet.

Legumes can be used to bulk out meals so that you use less meat.

How to achieve a mediterranean diet?

  1. Swap out some of your meat for fish
  2. Switch out your butter in favour of olive oil
  3. Eat plenty of fruit & vegetables – aim for a minimum of 5 portions per day
  4. Choose wholegrain cereals such as porridge oats, wholemeal pasta and rice
  5. Cook from scratch using fresh ingredients

References

  1. Widmer RJ, Flammer AJ, Lerman LO, Lerman A. The Mediterranean diet, its components, and cardiovascular disease. Am J Med. 2015 Mar;128(3):229-38
  2. W C Willett, F Sacks, A Trichopoulou, G Drescher, A Ferro-Luzzi, E Helsing, D Trichopoulos, Mediterranean diet pyramid: a cultural model for healthy eating, The American Journal of Clinical Nutrition, Volume 61, Issue 6, June 1995, Pages 1402S–1406S

Food & Mood: What is the best diet?

Food is not just about nutrition and fuel.  It provides pleasure and enjoyment, balance, and also has social aspects such as eating out for celebrations and eating as a family.

We all know which foods are better choices from an overall nutrition perspective.  However, it is important to remember that some foods may not be the best choice nutritionally but are providing other benefits in our diet such as pleasure and enjoyment.  I believe that we should follow a diet that is balanced and in moderation.  Allowing ourselves to eat those foods that bring us enjoyment beyond any nutritional benefit is fine as long as it doesn’t become all we eat.  The 80:20 rule is a good way to look at your food choices i.e.  80% of the time you eat foods that are nutrient rich and balanced and 20% of the time you can have the food that you may class as ‘treats’ such as chocolate, cake.  It about eating those foods that are less nutritionally beneficially mindfully and in moderation.

Can what we eat affect our mood?

Yes – however, it’s not necessarily about labelling foods that are ‘good’ and foods that are ‘bad’, but more about understanding how our overall food intake may influence our mood.

Improving your diet may help to:

  • Improve your mood
  • Give you more energy
  • Help you think more clearly

What is the best diet for food and mood?

There is not one set diet for food and mood but looking at the overall pattern of our food choices, eating pattern and the variety of food in the diet.

Here are some key points and tips to improve your diet to help give you more energy and improve your mood.

  1. Eating regularly – eating regular meals throughout the day and choosing foods that release energy slowly and gradually which help to keep your blood sugar levels steady.  Keeping your blood sugar levels steady helps to prevent you from feeling tired, irritable and low in mood.  Choosing foods such as wholegrain breads and cereals, pasta, rice, oats and nuts and seeds.
  2. Staying hydrated – It is advised that we aim for 6-8 glasses of fluid per day.  These don’t necessarily need to be water, but tea, coffee, juices and smoothies all count.  However, I would suggest you avoid sugary drinks to prevent them negatively impacting upon your blood sugar levels.
  3. Manage your caffeine intake – caffeine is a stimulant which can make you feel anxious & disturb your sleep.  Caffeine is found in tea, coffee, chocolate and cola drinks.  It is important to watch the number of caffeinated drinks and potentially limit the number you have throughout the day or switch to decaffeinated drinks, particularly if this is the main source of your fluid intake.  Watch out for caffeine withdrawal if your stop suddenly.
  4. Diet variety particularly fruit & veg, oily fish & nuts (source of omega 3 & 6 fatty acids for brain health).  Getting your 5 a day of fruits and vegetables helps to ensure you that you get mix of all vitamins, minerals and fibre that help to keep us healthy.    Oily fish and nuts are an excellent source of fatty acids, particularly, Omega 3 and Omega 6, which are important for brain health.  Sources of Omega 3 and Omega 6 fatty acids are oily fish (examples includes salmon, mackerel and trout), nuts (particularly walnuts and almonds), avocados and eggs

Should I take a vitamin and mineral supplement?

If you are eating a variety of different nutrient rich foods, your body should be receiving adequate amounts of vitamins and minerals therefore you do not need to take a nutritional supplement unless you have been advised by a healthcare professional.  However, if you don’t eat enough nutrient rich foods, it is important to try to incorporate more of the foods into your diet so that you become deficient.  Nutritional deficiencies can impact on your energy, mood and brain function.  The following vitamins and minerals have been shown to have a relationship with our energy, mood and brain function.

  1. Iron – low intake is associated with anaemia – low energy which can impact upon mood.  Iron food sources include red meat, beans and pulses and fortified cereals.
  2. B vitamins – low intake is associated with tiredness and fatigue – food sources include wholegrain cereals and animal protein foods
  3. Folate – important in older people – food sources include liver, green vegetables, beans and fortified foods
  4. Selenium – low levels can increase feelings of depression or other negative mood states – foods include brazil nuts, meat, fish, seeds and wholemeal bread

Summary

The way food makes us feel isn’t purely about the nutrition content of the food but also the experience from eating that food such as for pleasure or comfort or for social reasons.  However, it is important that our diet contain a wide variety of different nutrient rich foods that support our bodies to keep us healthy.  Nutrient rich foods include fruits and vegetables, wholegrain cereals, oily fish and protein food sources.

Looking for help with your diet?

If you want help or guidance on improving your diet and food choices to achieve a healthy diet, please feel free to contact me for a FREE 15 minute discovery call.

What does a dietitian do?

The biggest misconception of what a dietitian does is that we only see people who need to lose weight. For some dietitians this is true but for others, it may be the complete opposite and they may be supporting people who need to gain weight.

In the field of nutrition there are a number of different roles alongside dietitians such as nutritionists and nutritional therapists, but what’s the difference?

What are dietitians, nutritionists and nutritional therapists?

Registered Dietitians (RDs) are the only qualified health professionals that assess, diagnose and treat dietary and nutritional problems at an individual and wider public health level. They work with both healthy and sick people. They working in a variety of settings including the NHS, the food/medical industry, education and private practice.

Dietitians are the only nutrition professionals to be regulated by law, and are governed by an ethical code to ensure that they always work to the highest standard. Dietitians are regulated by the Healthcare and Professional Council (HCPC). Registered professionals must keep up-to-date through compulsory Continuing Professional Development (CPD). See my blog post here about CPD.

The following qualifications are required: Minimum requirement is a BSc Hons in Dietetics, or a related science degree with a postgraduate diploma or higher degree in Dietetics.

The British Dietetic Association is the professional body and Trade Union for dietitians and is also responsible for designing the curriculum for the profession. For further information, you can visit the BDA website here.

Nutritionists provide evidence-based information and guidance about the impacts of food and nutrition on health and wellbeing, at an individual or population level. They work in a variety of sectors including the food industry, education and public health.

Unlike dietitians, the title nutritionist is not protected so anyone can call themselves a nutritionist, however only registrants with the UK Voluntary Register of Nutritionists (UKVRN) can call themselves a Registered Nutritionist (RNutrs). To check the register, please visit here.

In order to be on the voluntary register as a Registered Nutritionist, they must have completed a nutrition course that is accredited by the Association for Nutrition (AfN).

Registered nutritionists are also expected to keep up-to-date through Continuing Professional Development (CPD).

Nutritional Therapists provide recommendations for diet and lifestyle in order to alleviate or prevent illness and use complementary medicine.

They are not regulated by law and some training is offered by the Institute of Optimum Nutrition.

Nutritional therapists provide private consultations. However, they use treatments such as high dose vitamins, detox, and food avoidance for which there is little robust scientific evidence.

My role as a freelance dietitian

As a UK registered dietitian with over 10 year experience I offer freelance services as a nutrition consultant to the food and medical nutrition industry, health writing and as a private dietitian for 1-1 consultations.

If you are looking for a private dietitian to help you with making dietary changes, I can help. I have experience in a broad range of medical conditions where diet can play a key role.

If you want to lose weight, I can help!

This blog post on behaviour change may be useful to help you understand how to overcome barriers to losing weight

If you want to gain weight, I can help!

You can read my blog post on treating malnutrition here

If you want to improve your gut health, I can help!

You can read my blog post on gut health and pre and probiotics here

If you want to manage your IBS symptoms, I can help!

You can read my blog post on IBS and diet here

If you have pre-diabetes/diabetes and want to look at making dietary changes, I can help!

How to say I WANT to change my diet rather than I SHOULD change my diet?

Have you ever wondered why you can’t make the dietary changes that you set yourself stick? Are you not able to create new habits that are long lasting? Do you find it difficult to make a long lasting change to your diet?

If you answered YES to all these questions and are thinking “this is me, why?”, I’m here to help explain why sometimes making changes to our diet can prove easier said than done.

Change comes about because we have chosen to make a change and are motivated to make it happen. More often that not, we believe we SHOULD make changes rather than WANTING too. This can lead to changes that are short lived or fail after a few weeks.

With regards to our diets, we are all aware of habits and food choices that are beneficial to health. Somehow though, implementing these habits and food choices into our diets can be difficult. One reason for this can be put down to behaviour change and where we are in the cycle of change.

What is behaviour change?

Behaviour change can be simply described as a 5 step cycle:

We can simply define each stage as the following:

Pre-contemplation: at the this stage there is no intention to change behaviour in the foreseeable future

Contemplation: aware that a problem exists but have not committed to taking action yet

Preparation: information gathering and planning stage

Action: modification of behaviour to overcome problems

Maintenance: prevention of relapse

Depending where you are on this cycle will determine the action you will or will not take to make change.

The action stage will arise when you are ready to commit to active modification of behaviour to achieve the desired change. In a weight loss example, the action stage may arise as a result of active engagement with a dietitian and setting clear, defined and agreed goals to deliver the change. The difference here to making changes when you are in the pre-contemplation stage are that you are MOTIVATED to make the change and are driving the change rather than being instructed by someone else.

Relapse can occur during any stage of the behaviour change cycle and it is important that the cause of the relapse is identified so that the commitment to change can be re-established.

Motivation to change arises when you know what problems are caused by a particular behaviour and you are concerned about these problems. In addition to this, self esteem and competence are also important to allow change to happen.

How do dietitians use behaviour change techniques in their practice?

The role of the dietitian is to translate scientific and medical knowledge relating to food and health into everyday language by educating and giving practical, personalised advice to clients, patients, carers and colleagues. Nutrition education does not focus purely on what change to make but how to help people make behavioural changes.

Dietitians use behaviour change techniques in their practice to support individuals under their care to make the necessary and desired changes beneficial to health. As healthcare professionals understanding the importance of behaviour change and being able to identify where a person is in the cycle of change is so beneficial to providing patient centred care and supporting dietary change. Success of dietary changes is the result of the dietitian and patient working together to identify the reason for change, the motivation for change and to agree realistic goals that can result in behaviour change. However, the behaviour change journey does not end here. Following the action stage it is important that the maintenance stage is not overlooked. The maintenance stage is taking into account how the behaviour change will be sustained.

Setting behavioural goals is key to achieving a successful outcome. This is where the dietitian and client will work in collaboration to set SMART goals. The acronym SMART is defined as:

Specific e.g. I will reduce the amount of sugar I take in my hot drinks

Measurable e.g. I will reduced the number of sugars in my hot drinks from 1 to none

Achievable. Setting realistic and achievable goals is key to success and this may mean a gradual approach e.g. reduce the number of sugars in hot drinks gradually to allow for the adjustment to taste

Relevant to the goal of treatment i.e. I want to reduce my sugar intake as I’m pre-diabetic

Time specific i.e. defining and agreeing a time frame for the goal

Several behaviour change goals may be set depending on the overall goal of nutritional treatment. These smaller, specific goals can help with motivation and personal sense of achievement.

What next?

If you have decided you want to make some dietary changes and want the support of a dietitian, I offer 1-1 online video consultations. Please contact me here to arrange a free 15 minute call to discuss how I could help you.

Treating malnutrition

This is the 2nd blog post in support of Malnutrition Awareness Week 2020 and aims to provide more information about the treatment of malnutrition and some practical tips to follow if you or a loved one is experiencing malnutrition.

As we get older there can be the expectation that losing weight is normal and part of the ageing process. This is not true. Any unintentional weight loss should be taken seriously.

It is not uncommon for our appetites to change as we get older therefore it is important to manage these changes so that it does not result in an inadequate nutritional intake and unintentional weight loss.

10 tips that can help to address a small appetite

  1. Introduce small snacks in-between your meals such as cheese and crackers
  2. Choose higher fat containing foods such as full fat milk, butter, as these will provide more energy
  3. Add butter, cream or cheese to meals and sauces as this will increase the energy content without increasing the volume of food
  4. Have a nourishing drink before bed such as a hot chocolate made with full fat milk
  5. Have regular meals and snacks – aim for 6 small meals and snacks instead of 3 big meals a day
  6. Don’t forget about fluid – aim to have 6-8 drinks a day. This can include tea and coffee, glasses of milk and fruit juice.
  7. Avoid not eating at all, even if its only something small
  8. Don’t be afraid to ask for help with cooking and food shopping
  9. Tinned foods such as rice pudding or tinned fruit are useful staple cupboard foods
  10. If you continue to struggle with your appetite and are losing weight, please discuss with your GP or a healthcare professional

This advice is intended to provide general advice on treating malnutrition. If you are concerned about yourself or a loved one in regards to unintentional weight loss and changes in appetite, please speak with a healthcare professional.

Dietitians play a key role in the identification, management and treatment of malnutrition. Following specialist nutritional assessment, a tailored nutritional care plan will be provided. Ongoing monitoring of the care plan will ensure that the intervention is working and whether any adjustments to the plan are required. Dietitians will work with the wider multidisciplinary team to ensure implementation of the nutritional care plan.

I provide 1-1 online video consultations. Please click here if you would like to arrange a free call with me to see how I could help you.