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What does it take for Americans to adopt a Mediterranean-style diet?

A Mediterranean diet is abundant in fruits, vegetables, whole grains, legumes, nuts and olive oil.
A Mediterranean diet is abundant in fruits, vegetables, whole grains, legumes, nuts and olive oil. Centre Daily Times, file

With a reputation as the world’s healthiest diet, the Mediterranean diet is abundant in fruits, vegetables, whole grains, legumes, nuts and olive oil. It features moderate amounts of dairy (fermented cheese and yogurt) and lean protein (fish and poultry).

By comparison, the average American diet is high in refined carbohydrates, sugars and red meats. The 2015-20 Dietary Guidelines for Americans recommend the Mediterranean diet as a healthy way to eat for Americans to stay healthy or become healthy/healthier.

An observational study presented at the European Society of Cardiology conference in Rome in August looked at 1,200 Italians with a history of heart disease over a period of seven years. This study found that those who adhered more closely to a Mediterranean diet had a 37 percent lower risk of death compared with those who didn’t comply. This far exceeds the reduction rates observed with current medication therapies.

The Italian findings are consistent with previous research showing that people with heart problems will benefit from following a Mediterranean diet. Notably, even those on cholesterol-lowering statins experience enhanced effects. Cholesterol-lowering statins (as well as blood-pressure lowering medications) have long been considered the most effective way to treat heart disease, which kills almost 615,000 Americans annually.

On average, statins reduce the risk of heart problems by about 24 percent. Research suggests a Mediterranean diet could synergize with statins and result in patients requiring a lower dose of statins. Higher doses can be associated with adverse side effects, which in turn can cause patients to avoid taking the medication. Thus, for both statin users and non-statin users (as well as for users of blood-pressure lowering medications), adopting a Mediterranean diet is strongly recommended to achieve maximum cardiovascular benefits.

In contrast to most currently recommended dietary patterns, the Mediterranean diet is relatively high in dietary fat, albeit healthy unsaturated fats (i.e. olive oil, nuts, fatty fish). With an average of 42 percent of total calories from fat, many U.S. health organizations have noticed the success of the Mediterranean diet pattern and have shifted recommendations to consume moderate fat, instead of low-fat diets. Keep in mind, however, this shift is also designed to lower intake of saturated fat and refined carbohydrates, as the success of the Mediterranean diet is based upon the entire dietary pattern rather than any one single food or nutrient.

In a recent controlled, randomized clinical study, investigators measured the weight and waist circumference of 7,447 people who ate three different diets for five years. While the study was not designed to be a weight-loss trial, their findings suggest that a Mediterranean diet, high in dietary fat (versus a lower-fat diet), is more successful in helping individuals maintain or lose a little weight in the long term. This is true for older adults, as well as those who have Type 2 diabetes or are already obese or overweight.

Given that the Mediterranean diet has been credited with doing everything from helping to lose weight to living longer to improving brain health, why is it that Americans are not eating a Mediterranean diet? Is it too much of a leap to eliminate red meat, refined carbohydrates and sugar from the diet? While sugar and refined carbohydrates have indisputably earned their unfavorable reputations, there remains uncertainty regarding the role of lean red meat in the diet. As we and others have shown, lean beef can be included in a heart healthy dietary pattern that achieves reductions in both LDL-C (the bad cholesterol) and blood pressure. Furthermore, Americans enjoy consuming beef, and given the option to include it in a healthy diet helps with adherence to current food-based dietary recommendations.

Results from our previous study, beef as part of an Optimal Lean Diet, clearly demonstrate that current dietary recommendations to limit lean beef consumption are needlessly restrictive. Therefore, we are conducting a new study to demonstrate that lean beef can be included in a heart healthy Mediterranean-style dietary pattern that can be followed in the U.S.

For this study we will evaluate three levels of beef (0.5, 2.5, 5.5 oz. per day) in the context of a Mediterranean diet, compared to an average American diet. The Mediterranean diet used in this study will consist of meals made from scratch that are similar to those of a traditional Mediterranean diet, modified slightly to enhance acceptability by study participants. The key components, including high quantities of fruits, vegetables, legumes and nuts will be constant among diets, but you won’t be left asking, “Where’s the beef?”

We believe that our findings will show that individuals can enjoy lean beef and derive the expected cardiovascular benefits of a heart-healthy diet even with higher beef consumption than is typically consumed in the United States.

The study is currently enrolling participants. If you are interested in trying a taste of the Mediterranean while improving your heart health or would like further information, email psudiet@gmail.com or call 866-PSU-DIET and leave your name and contact information.

Jennifer Fleming is an instructor and clinical research coordinator in Penn State’s College of Health and Human Development.

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