Implementing a Mediterranean-Style Diet Outside the Mediterranean Region

Abstract

Purpose of Review

Populations surrounding the Mediterranean basin have traditionally reaped health benefits from a Mediterranean diet (MedDiet), which may benefit Westernized countries plagued by chronic disease. But is it feasible to implement beyond the Mediterranean? To answer this question, we present evidence from randomized controlled trials that achieved high dietary compliance rates with subsequent physical and mental health benefits.

Recent Findings

In the 1960s, the Seven Countries Study identified dietary qualities of Mediterranean populations associated with healthy aging and longevity. The PREDIMED study confirmed reductions in CVD-related mortality with a MedDiet; a meta-analysis in over 4.7 million people showed reduced mortality, CVD-related mortality, and reduced risk of Parkinson’s and Alzheimer’s disease. Continually emerging research supports the MedDiet’s benefits for chronic diseases including metabolic syndrome, cancers, liver disease, type 2 diabetes, depression, and anxiety.

Summary

We summarize components of studies outside the Mediterranean that achieved high compliance to a Med-style diet: dietitian led, dietary education, goal setting, mindfulness; recipe books, meal plans, and food checklists; food hampers; regular contact between volunteers and staff through regular cooking classes; clinic visits; and recipes that are simple, palatable, and affordable. The next step is testing the MedDiet’s feasibility in the community. Potential obstacles include access to dietetic/health care professionals, high meat intake, pervasive processed foods, and fast food outlets. For Western countries to promote a Med-style diet, collective support from government, key stakeholders and policy makers, food industry, retailers, and health professionals is needed to ensure the healthiest choice is the easiest choice.

Sample of popular HELFIMED recipes replacing meat with legumes

Chilli Beans

This simple, versatile Mexican-inspired dish has a tasty combination of flavours and textures with the cool creaminess of the avocado combined with the rich spiciness of the beans. Serve with rice or quinoa for extra boost of protein and nutrients. Also a delicious and nutritious topping for nachos, burritos or tacos.

Ingredients

• 1-2 tblsp extra virgin olive oil

• 1 red onion

• 2-4 cloves garlic

• 2-3 fresh chillies or ~1 tsp powdered chilli to taste

• 2 heaped tsp sweet paprika

• 1 tsp salt

• 1 can crushed tomatoes

• 1 can red kidney beans

• Grated mozzarella cheese

• Use all or any combination of the following vegetables

• Celery

• Carrot

• Eggplant

• Red capsicum

• Zucchini

• Sweet potato

Method

• 1. Finely chop all vegetables (except avocado)

• 2. Lightly heat olive oil in a saucepan then add onion, celery, carrot and eggplant

• 3. Cook until onion is clear; add garlic, fresh or dried chilli and paprika; cook for a few minutes, stirring occasionally

• 4. Add cans of tomatoes and kidney beans with remaining vegetables plus half a can of water and salt

• 5. Cook until simmering, stirring occasionally; lower heat and put the lid on

• 6. Cut avocado into slices

• 7. When the vegetables are soft, serve the chilli beans with grated cheese and avocado on top – can be eaten alone or with rice/quinoa, burritos, nachos or tacos.

Lentil Nut Burgers

These tasty meat-free burgers are high in protein and can be eaten with salad and home-made chips or on a bread roll with salad and sauce. Great for picnics and barbeques. Omit the breadcrumbs for a gluten-free version.

Ingredients

• 1 can lentils

• 1 potato

• 1 small sweet potato

• Handful of mushrooms, finely chopped or processed

• 1 cup chopped parsley

• 1 onion, finely chopped

• 2 cloves garlic, finely chopped

• ½-1 cup ground mixed nuts (e.g. almonds, walnuts, cashews)

• 1 egg

• Salt and pepper

• Chilli powder or cayenne pepper (optional)

• 1 tblsp soy sauce or tamari

• Breadcrumbs for coating

• Extra virgin olive oil for cooking

Method

• 1. Peel and dice the potato and sweet potato, boil in salted water and cook until just soft enough to mash (not too soft); mash and allow to cool.

• 2. Finely chop onion, garlic, parsley and mushroom.

• 3. Mix all ingredients apart from breadcrumbs and olive oil. Adjust ground nuts as needed for consistency firm enough to form patties.

• 4. Shake some breadcrumbs onto a plate, make patties from the lentil mixture and roll in the breadcrumbs to cover. (If desired, the burgers can be frozen in batches for other meals at this point).

• 5. Lightly heat olive oil in a frying pan and cook patties on both sides until golden brown.

Shepherd’s Pie with Lentils

A tasty, nutritious alternative to Shepherd’s Pie. This dish was especially popular with a person who didn’t previously like lentils – she started cooking it on a regular basis!

Ingredients

• 1 cup lentils and 4 cups water or stock (or 2 cans lentils)

• 1 onion, chopped

• 4 cloves garlic, chopped

• 1 large carrot, diced

• 1 large or two medium zucchini, diced

• 1 stalk celery, diced

• 1-2 cups mushrooms, chopped

• 2-3 bay leaves

• 1 tsp sea salt and black pepper

• 2 tblsp parsley, chopped

• 6 potatoes, chopped

• 2 cloves garlic, chopped

• ½ cup milk

• Extra virgin olive oil

• Grated mozzarella cheese (optional)

Method

• 1. If using whole lentils, place lentils and water or stock in a saucepan with bay leaves; bring to boil then simmer.

• 2. Lightly heat olive oil in saucepan, add chopped onions, carrot and celery and sauté until onions start to become clear and vegies soften.

• 3. Add chopped garlic, zucchini and mushrooms and cook until zucchini starts to soften.

• 4. Add lentils to the vegetables with cooking water (or canned lentils and bay leaves), with salt, pepper and parsley, and continue to cook until lentils are soft.

• 5. Meanwhile, boil some water, peel and chop potatoes. Cook in salted boiling water until soft and drain water out. (Pre-heat oven now to 180 degrees.)

• 6. Mash or blend cooked potatoes with salt, pepper, milk and a drizzle of olive oil.

• 7. Pour cooked lentil mixture into a casserole dish and gently spread the mashed potato over the top. If using grated cheese, sprinkle over the top. Bake until cheese melts and starts to brown (or top is golden if not using cheese); serve with a green salad.