The Med-DASH eating plan may seem like it is going to be a challenge. Most Americans don’t eat lots of fruits and vegetables. We don’t consume enough dairy, and we might miss out on having enough fish in our diet. We need to make this plan fit into our real lives.
In order to make it easy to stay on track with the Med-DASH plan, you want to have the right foods on hand. Even if you don’t cook, you will find that it is so easy to make healthful meals and snacks when you can go to the fridge and find fresh fruits and veggies, a carton of yogurt, hard-boiled eggs, some sliced cheese, nuts, sliced meats, tuna salad, whole-wheat bread, lettuce… Even if you went looking for chocolate, perhaps some strawberries will call out to you instead. You have the urge for a snack, you open the fridge, and there is a fresh plum and a cup of yogurt. How much more appetizing than some junk snack that won’t truly satisfy your hunger.
The heart of the Med-DASH plan is plant-based foods: fruits, vegetables, olive oil, beans, nuts, seeds, and mostly whole grains, when you do have grains. Your diet automatically becomes high-fiber and full of antioxidants, vitamins, and minerals. Fortunately, if you consume dairy, meats, poultry, seafood, or beans, they are also rich in vitamins and minerals and high-quality protein. This is a super-nutritious food plan based mostly on whole foods, and is very easy to follow. Not just a few super-foods, but a complete super–diet plan based on great foods.
Life has become very confusing when it comes to buying groceries. Do you want organic, GMO-free? How about locally grown with sustainable agriculture? I am not going to preach to you. Costs and your personal health concerns can guide your choices. But we don’t need to reject foods that have so many health benefits.
I love farmers’ markets. I much prefer to buy food from individual growers. They often have the tastiest foods because the produce isn’t grown with the sole objective of being able to withstand long-distance transportation. They are grown for flavor! If you are up for it, grow your own. Home gardens produce the tastiest tomatoes, the most tender broccoli. What is the point of eating a tomato if it is mealy and tasteless? (If I can’t get to the farmers’ market and don’t have ripe tomatoes in my garden, I have discovered that heirloom tomatoes in season or grape tomatoes from the grocery store are flavorful and lovely.) The freshest sweet corn is the best tasting. Peaches from smaller farms are so much more delicious. In most areas of the country, you can find locally grown and raised foods, including beef and poultry, dairy, eggs, and seasonal fruits and vegetables. Depending on your budget, it is great to support local growers and to feel a little more connected to the people who produce your food. You and your family are more likely to eat fruits and vegetables when they are super-tasty, organic or not.
Key MUFA-rich oils include olive and canola. They are less susceptible to rancidity than PUFA oils, but can still become oxidized. You can slow this down dramatically by storing them in the refrigerator, where the cooler temperatures slow oxidation. Even though it is not as economical, I buy smaller bottles of oil to minimize the amount of time I store the opened bottles (and since rancid oil needs to be tossed out, perhaps it is more economical to buy oil in smaller quantities). Light will also speed oxidation of fats, so if not in the refrigerator, a dark, cool cupboard is the best place to store oil. This is especially true for olive oil: Since it will partially solidify in the refrigerator, I store it in the coolest, dark spot in my kitchen instead, and buy only small bottles.
Nuts and seeds should be refrigerated or kept in the freezer to stay fresh because they too can become rancid. Yes, they are high in fat. But surprise! They are super-nutritious and associated with lower cholesterol and reduced risk of heart attacks. Most nuts are rich in MUFA, as well as fiber, potassium, selenium, and other important minerals, and provide key benefits to both the DASH and Mediterranean diets. They may be particularly advantageous to help reduce the risk of type 2 diabetes, and are anti-inflammatory. Beans, of course, are very high in fiber, which may be protective in terms of supporting a good balance of bacteria in the gut. They are excellent sources of protein, especially for people trying to limit their intake of animal foods.
Beef and pork are much leaner today than they were twenty-five years ago. We do, however, want to limit our intake of red meat to two or three times per week. Newer information about the digestive end products of meat show that by-products can be formed that can increase your risk of heart disease. One such end product is trimethylamine (TMA), which can be converted to trimethylamine N-oxide (TMAO) in the liver. TMAO is associated with higher risk for CVD mortality and may increase the tendency of cholesterol to form plaques in arteries. The process of making TMAO seems to be related to an unhealthy balance of bacteria in your gut. The high amount of plant foods in the Med-DASH plan helps to nourish good bacteria and can minimize production of TMAO and the negative effects of including meat in your diet.
The best choices for beef and pork are cuts that have the words “loin,” “chop,” “chuck,” or “round” in their names. These meats are naturally low in saturated fats and calories. You do not need to go super-low fat with beef, since you’ll likely end up with tasteless, dry meat that no one will eat. Appendix A provides a listing of beef fat content for different cuts. Pork can also be a great choice. It tends to be raised to be much leaner than it was twenty-five years ago. For this reason, you really want to avoid overcooking pork, which will leave the meat dry and tough. You will find information on the nutrition content of pork in Appendix B. Both beef and pork are great sources of vitamins and minerals. In particular, they are rich in potassium, which appears to be a key part of how the DASH diet helps to lower blood pressure.
Skinless chicken is one of the champions of low-fat meats. Chicken thighs are having a resurgence in popularity, but you might want to make them more of an occasional choice instead of a several times a week option, since they are a little higher in saturated fat. Let your personal taste preference be your guide.
For quick meals and sandwiches (with or without bread), you can buy sliced low-sodium meats at the deli counter. If you would like to have even less processing, though, you can roast your own beef, chicken, or turkey and slice it as thick or thin as you like. The primary health concerns with red meat involve processed meats, so roasting your own is a great way to take charge of your health. Minimize the amount of sausages, bacon, and ham you eat, limiting them to maybe once a month. These foods are fine as an occasional addition to your diet, but take a pass on overconsumption.
The very best fish sources of the beneficial fatty acids DHA and EPA are cold-water fatty ocean fish. Great choices include tuna, mackerel, herring, sardines, halibut, salmon, and anchovies. You may not like all of them, but depending on your personal tastes, I’m sure you will find the right ones to enjoy! If you think you don’t like fish, perhaps start with species that taste meatier. I learned to eat fish by trying swordfish, which has a meaty flavor and meaty texture. Then it was on to tuna steaks. Same benefit. Now I love fish, especially salmon.
Just because we specifically want to include fish with omega-3 fats doesn’t mean other types of fish and seafood aren’t good or should be excluded. Lower-fat fish can also be very healthy, as they are lean, protein-rich foods. You have lots of fabulous choices, including tilapia, whitefish, mahimahi, crustaceans like shrimp and lobster, and mollusks like oysters, clams, and scallops.
Fruits and vegetables are the core promoters of good health on the Med-DASH plan. They are chock-full of antioxidants, fiber, vitamins, and minerals, and can be super delicious, along with having the side benefit of being very filling. The more different colors you choose, the more health benefits you will reap. You can choose fresh, frozen, or canned (preferably fruits in low-sugar syrup, or low-salt vegetables), if that fits better into your budget. Berries are especially wonderful. Those intense reds and blues are associated with the very powerful antioxidant anthocyanin. Stone fruits (peaches, plums, apricots, cherries, pluots) are very rich in soluble fiber, which slows your absorption of fructose (the fruit sugar) and nourishes good bacteria in your gut; these fruits also contain anthocyanin. Citrus fruits are rich in carotenoids, along with vitamin C. As mentioned earlier, grapefruit can react with some medications in your body, so talk to your physician to see if you should limit grapefruit in your diet (see here for more information). Even though we don’t want to overdo them, both sweet potatoes and regular potatoes are rich in potassium and vitamin C. Orange-yellow fruits and vegetables have lots of beta-carotene, along with other powerful antioxidants. Green leafy vegetables also contain lots of the carotenoids, although they are hidden by green chlorophyll. Tomatoes, red bell peppers, and watermelon are rich in lycopene.
Since we want to choose foods that are naturally filling and satisfying, it’s best to limit dried fruits like raisins and dried cranberries. Without the water content you’d find in their fresh form, they aren’t as filling, so it is easy to overeat them and not become full as fast as you would if you were eating the whole, fresh fruit. It’s also better to eat your fruit than drink it, so most often, choose a juicy piece of fruit over fruit juice or fruit smoothies for the most filling way to enjoy fruit. And the most delicious.
Although we know that fiber from whole foods is associated with healthier weight, we have been caught up in a trend that actually reduces fiber from fruits and vegetables: smoothies! Even if your juicer or blender leaves the fiber in, the processing of the smoothies pulverizes the fiber and makes it ineffective. So… enough with the smoothies! You want the fiber. The whole, intact fiber. That is a prime benefit of produce. Eat the fruits and vegetables, don’t drink them! It’s more filling and helps slow the absorption of sugar, which in turn helps you avoid a sugar rush.
It has been found that the intestinal tracts of vegetarians have a different mix of bacteria than those of non-vegetarians. In general, this mix helps vegetarians stay leaner and avoid becoming overweight, and fiber is one of the key elements of this intestinal good health. It is also a key factor in the health benefits of the DASH diet and the Mediterranean diet.
Dairy is important for providing all the blood pressure benefits of the DASH diet. In general, we would like to mostly choose nonfat or reduced-fat dairy. You may think this runs contrary to the “keep the fat in the diet” message of the Med-DASH plan. However, we do want to limit saturated fats, which are associated not only with heart-health concerns but also increased risk for insulin resistance (a precursor to type 2 diabetes), perhaps lower bone density in women, and some kinds of cancer, including prostate cancer. (It should be noted that for men, intake of 2 or more cups of milk per day is associated with an increased risk for prostate cancer, so lower intake may be beneficial.) Calcium and magnesium also reduce the absorption of saturated fats.
Fermented dairy foods, whether Greek yogurt or mozzarella cheese, are very familiar parts of the Mediterranean diet and are easy for most people to digest. The lactose in yogurt or cheese is converted into lactic acid, which is what provides the thickening. The straining process that concentrates Greek yogurt reduces its lactose content even further. Many people even find that their tolerance for dairy improves if they consume more yogurt. In cheesemaking, almost all residual lactose gets removed when the liquid whey portion is separated from the solid curds. There are so many important nutrients, such as high-quality protein, calcium, potassium, magnesium, and vitamin D, in dairy foods, so please include them if they agree with you.
Some people, especially as we get older, have blood pressure that is very sensitive to salt. Sodium is added to speed cheese ripening, as well as for flavor and as a preservative. But many types of cheeses are naturally low in sodium, such as Swiss (Emmental), Monterey Jack, mozzarella, ricotta, and cream cheese.
Some people consider nonfat (skim) milk to be a highly processed and unnatural food. Really? For eons, humans have allowed the cream to rise on a container of milk to get the butterfat. I wouldn’t really call that “processed.” The separation happens all by itself. The question of whether we need to drink skim or reduced-fat milk, however, is a little murkier than originally thought. Several recent studies have shown that drinking whole milk has little effect on blood cholesterol levels.
Eggs were once considered to be absolutely forbidden on a heart-healthy diet. Today we are less concerned with dietary cholesterol than we are with the cholesterol the body makes from saturated fats. We normally consume 100 times more saturated fat than cholesterol every day. Our own internal production of cholesterol greatly outdoes the amount we eat. The American Heart Association (AHA) advises that eggs can be part of a heart-healthy diet again. To be very specific, the new lifestyle recommendations state that there is no evidence that lowering intake of cholesterol from foods does anything to help to lower LDL (“bad”) cholesterol levels.1
Eggs are extraordinarily packed with nutrients. Lutein and zeaxanthin are two powerful antioxidants from the carotenoid family. They are very important for eye health, helping to reduce the likelihood of age-related macular degeneration and the development of cataracts. Choline is needed in all body cells and is especially important during fetal development to support brain health. Eggs have the highest-quality protein, which means that it is the most efficiently used form of protein for growth and maintenance of the human body. Additional key vitamins and minerals include vitamin D, iron, selenium, and riboflavin. Most of the nutrients are in the yolk, so don’t throw it away!
Eggs make a wonderful breakfast food, because their protein content helps keep you satisfied longer than sugary breakfast cereals or other high-starch foods.
Grains are all high in starch. In the ’90s, starch was called a complex carbohydrate and labeled as slower to digest. In reality, starch is very easy to digest, with the process starting while chewing. It easily is turned into glucose—in fact, it converts 100 percent into glucose. The fiber from whole grains is beneficial for staying regular and may have some antioxidant properties. Oats and barley are particularly rich in soluble fiber, which can help lower LDL (“bad”) cholesterol and triglyceride levels and slow the absorption of glucose into your bloodstream, as compared with refined grains. Even though we tend to eat sweet corn as if it were a vegetable, in reality, it is a grain, and a whole grain at that. One of the problems with breads is that they are low in water, which makes them relatively non-filling. Rice and pasta will be a little more filling, but are still easily digested. By the weight of food consumed, carbs such as these grains are relatively high in calories, so you may want to limit them, especially if you are trying to get to a healthier weight. I personally like to use vegetables in some of the dishes where I would normally use grains so that I can still enjoy my favorites, but with much lower calories. So there you have it. Grains: healthy if they are mostly whole grains, but best to eat in moderation.
Throughout history, herbs and spices have been used to increase the flavor of foods. Who knew that they also had important health effects? One interesting point is that many spices have antibacterial properties. Those hot, spicy flavorings, which are used in traditional dishes in tropical areas, have mild preservative properties. Spices and herbs are also rich in antioxidants and other bioactive chemicals. Whether it is turmeric for anti-inflammatory properties, or cinnamon for lowering blood sugar, or cancer protection by garlic, there are a host of health-promoting benefits of herbs and spices. The Mediterranean recipes in this book will introduce you to a new world of flavors by incorporating spice palettes from all around the Mediterranean region.
Chocolate is super-rich in antioxidant polyphenols. Studies in several countries have shown that people who have a cup of hot chocolate daily are less likely to have issues with heart disease and blood pressure. Observational studies of people all over the world, including in the United States, Sweden, Holland, the Kuna Indians in Panama, and elsewhere, have shown cardioprotective benefits for people who have moderate chocolate intake. Polyphenol-rich chocolate has been shown to lower blood pressure, improve vascular function, have a vasodilatory effect, reduce oxidative stress, increase mitochondrial function (associated with the capacity to burn off excess energy), reduce platelet stickiness (associated with blood clots), and improve the ability to respond to insulin and metabolize glucose properly.2 Choose mostly really good dark chocolate, in smallish portions, and enjoy!