2It can be confusing and frustrating determining the optimum dietary intake for our patients and ourselves. However, it is increasingly clear that the best approach is a Mediterranean diet (MedDiet). Although the precise content of such a diet varies in different studies, the principles rely on eating a broad selection of plant-rich, whole foods, complemented by fresh fish, lean meat and extra virgin olive oil.
This approach has been well recognised for many years and is solidly validated, but the plethora of articles, books, websites, celebrity experts, bloggers, personal trainers (practically anyone who eats) extolling the virtues of the latest, greatest diet is a constant distraction.
Good health is, of course, not just about what you eat. Obtaining adequate sleep, exercise and coping with stress are all crucial aspects of maintaining optimum health.
A recent comprehensive sleep survey of Australians showed that up to 45% of people don’t get enough sleep, increasing the risk of chronic diseases (e.g. CVD, diabetes, mental health problems) and weight gain. Prolonged sitting (over eight hours daily) is established as a significant risk factor for chronic disease and is not fully offset by achieving the recommended amounts of daily exercise. Exercise also improves sleep, can reduce stress, and encourages neurogenesis and synapse formation in the brain, potentially leading to improved cognitive functioning.
Regimented programs of specific macro- and micronutrient intake and fasting attract interest (e.g. intermittent fasting, the 5:2 diet, fast 800, ketogenic, and paleo diets). They can lead to short-term weight loss but are not generally sound long-term strategies for good health.
Long term, sustainable healthy eating programs need to be easily assimilated into daily living especially for families eating together. It is not practical when different family members pursue radically different eating patterns. Simplicity is key to the sustainability of any long-term eating strategy.
Adhering to a MedDiet, which includes plant-rich whole foods, naturally leads to a low intake of highly processed foods, refined carbohydrates and sugars, whilst ensuring an adequate intake of fibre. Whilst various ‘superfoods’ are frequently highlighted as shortcuts to health and vitality, the real key is selecting a broad range of healthy foods.
The MedDiet is probably the most widely evaluated dietary regime in the scientific literature. Typically, it is characterised by a high intake of vegetables (e.g. tomatoes, eggplant, onion, garlic, green vegetables), legumes (chickpeas, lentils, beans), fruit, nuts, and wholegrains eaten in conjunction with seafoods, lean meat and extra virgin olive oil.
Suggested mechanisms underlying the beneficial effects of the MedDiet include reduction of blood lipids, inflammatory and oxidative stress markers, improvement in insulin sensitivity, enhancement of endothelial function, and antithrombotic effects. These changes are likely attributable to bioactive ingredients such as polyphenols, monounsaturated and polyunsaturated fatty acids, and fibre.
In practice, recommending five different plant-based foods each day, which are varied over the week, is a simple starting point. Although this sounds daunting to many patients, a dietitian can assist in recommending different salad ingredients, vegetables, grains, nuts, and seeds tailored to the patient’s preferences and income, so that this can be easily achieved. ‘Superfoods’ (some of which are nutrient rich with high levels antioxidants or protective plant compounds) are unlikely to have a significant effect on overall health or weight loss if the rest of the diet is poor.
One of the most exciting emerging areas of research is the link between diet, the gut microbiome, the brain, and health. Even a few years ago, suggestions that bacteria and other gut microorganisms could influence brain function and health would have been ridiculed. Positive effects on the human microbiome have been demonstrated in those following a MedDiet. This is due, at least in part, to ingested plant foods rich in fibre that are fermented by gut bugs, producing a range of bioactive compounds beneficial to health.
Nutritional science evolves, but it has become increasingly clear that a predominately plant-based food plan, supplemented with oily fish and lean meat, such as the MedDiet, is the best starting point. Optimum health also requires consideration of broader lifestyle factors, including sleep and activity.
Key messages
- Keep it simple
- Promote a Mediterranean style diet
- Get an accredited practising dietitian to assist with your patients’ individual requirements.
– References available on request
Author competing interests – nil