Mediterranean Diet and Workplace Health -- The Evidence Behind the Recommendations

One final post about the the Mediterranean Diet and Workplace Health Conference at the Harvard School of Public Health. The conference organizers prepared the review paper below. It clearly indicates the health benefits of following a Mediterranean diet and the evidence that supports the recommendation. I particularly like this chart at the top of page three that provides clear instruction for following a Mediterranean diet. Please take a few minutes to peruse the paper. 

  Mediterranean Diet and Workplace Health Promotion

Mediterranean Diet and Workplace Health -- Best Practices from the Field

2014 Initiative for Productivity and Health Management Conference at the Harvard School of Public Health

I came back from the Mediterranean Diet and Workplace Health Conference at the Harvard School of Public Health with so many notes, I decided to break them up into two posts. You can read my earlier post about Day 1 where they defined a Mediterranean diet and shared the scientific evidence about the health benefits. Day 2 focused on effective real world initiatives to help people eat a Mediterranean diet. Here’s some of what stood out to me…

Chef Psilakis is a big proponent of teaching kids to cook. That was actually a theme that was thread throughout the two days. Dr. Gianluca Tognon talked about how they improved the diet of school children in Sweden. They empowered children by involving students in the meal planning and offering them choices. They exchanged information by inviting school chefs into the classrooms. And, they evaluated the effects of what they were doing by keeping track of foods that were not well accepted and collecting feedback from students and teachers. He suggested food tastings, having specially themed food days, creating "smarter lunchrooms" by carefully considering food placement and having school gardens as ways to improve dietary habits of children. Dr. Tognon has a free e-book that I look forward to reading. 

UMass shared what they did at the university level and it really didn't sound all that different. Ken Toong the Executive Director did add a mention of "stealth health" for example making sliders with a meat blend that's 30% mushrooms. At UMass they've found a way to make healthy affordable. They have 12% waste and the US average is 40%. He also reported that they consumed 22% less soda from 2013 to 2014. They encourage students to drink water by offering sparkling water and water infused with fruit. (I'm already requesting that we do that in our office.) I loved the UMass tagline -- Come for the food, stay for the education. I sure didn't have lobster when I was in college. 

In general it sounds like it is much easier to get children and college students to make healthy choices than adults. Although the effective strategies for adults were much the same as those used for young people -- samplings, tasting tables, talking with chefs -- with the addition of distributing recipe cards. A few other poignant points:

• Many people know they should change what they eat and move more, but feel "stuck" and lack the skills to change.
• Nutritional knowledge is not enough. Culinary literacy is at an all time low. Hands-on training is essential. 
• Each 30 minute reduction in time spent cooking in the US has been associated with an increase in BMI of 0.5.

This made me recall reading, Trends in US home food preparation and consumption: analysis of national nutrition surveys and time use studies which concluded,

"Across socioeconomic groups, people consume the majority of daily energy from the home food supply, yet only slightly more than half spend any time cooking on a given day. Efforts to boost the healthfulness of the US diet should focus on promoting the preparation of healthy foods at home while incorporating limits on time available for cooking."

I had a chance to observe this first hand when we did our Mediterranean Challenge. Many people really struggled with the cooking. Grocery shopping took a long time because they were looking for items that were unfamiliar to them. The kitchen prep work took a long time because they weren't set up for it and their knife skills weren't good. And, they often picked meals that were too ambitious for a week night because they didn't have enough experience judging what could be prepared quickly. I've been planning to organize a knife skills class and a series of cooking classes at ASHA since I learned this. From what I learned at the conference, I'm on the right track with this idea. 

The experience of Todd LeDuc at the Boston Fire Service affirmed something I believe, money is not the best motivator for improving healthy. They started out with some incentive programs that they later eliminated. He shared an example of a communication that I liked, if you eat x you'll have to run x miles to work it off. How much more useful would that kind of message be than our current food labels?

One of the most exciting presentations was David Eisenberg, MD, he hit on many things that I'd been discussing during the breaks with other attendees. He has a program that teaches physicians too cook -- Health Kitchen, Healthy Lives. You can read about it in this New York Times article. I'm wondering how many of the program objectives we could incorporate in our workplace wellness program. Dr. Eisenberg was the first to mention mindfulness. I emailed him and asked if he'd share his slides. I'll definitely be spending some more time reflecting on what he shared. 

As a Blue Zones fan, I enjoyed hearing from Diane Kochilas. I especially liked her take on seasonal foods, 

"Eating foods in their season, when nature intended, brings anticipation, which in turn teaches us to savor and enjoy the moment, a notion obscured by the 24/7 availability of almost everything in American supermarkets and the erroneous -- and, ultimately, unsustainable -- belief that it's our right to have it all in endless choice."

Chef Michael Psilakis described the Mediterranean as the “have your cake and eat it to diet” and they practiced what they preached.  Breakfast was served both days of the conference – Fage plain greek yogurt, fruit, honey, pistachios and veggie filled filo pastries. Lunch was 90 minutes long. It included chicken, farrow, eggplant, salad and wine (no dessert.) Snacks and appetizers were fruits, roasted vegetables, hummus and more filo pastries. I’ve never eaten so well at a conference and all in the name of health. What’s not to love? They also closed the conference with a Greek Food Expo that gave us a chance to try wines, olive oils and other treats imported from Greece. 

With the focus on diet, I don't want to neglect the fact that activity and sleep were mentioned. I sat next to Voula Manousos, a registered dietitian, and she described our need for sleep in an enlightening way. She suggested you imagine your bedroom with everything pulled out of the closet and drawers heaped in the middle of the floor. While you sleep, everything is neatly put away where you can find it the next day. That's why sleep is such a critical component of memory and recall. On that note, I think I'll say good night. 

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I recommend trying the oils from Flying Olive Farms. They're available in Whole Foods in the Raleigh, NC area and I'm begging the Wine Cabinet in Reston, VA to carry them. I loved their balsamic too. 

I recommend the series of Huffington Post articles written by the conference organizers and faculty. 

• Can "Eating Like a Greek" Lead to Healthier Workplaces and Schools? by Stefanos Kales, MD, MPH, FACP, FACOEM
• The Mediterranean Diet: A Healthy Addiction by Chef Michael Psilakis
• Ikaria: The Mindful Mediterranean Diet on the Greek Island Where People Forget to Die by Chef Diane Kochilas

Mediterranean Diet and Workplace Health -- Challenges in Contemporary America and Scientific Evidence

2014 Initiative for Productivity and Health Management Conference at the Harvard School of Public Health

I had the good fortune to attend the Mediterranean Diet and Workplace Health Conference at the Harvard School of Public Health. Someone there evidently Googled “Mediterranean diet workplace wellness,” stumbled across my blog, and sent me an invitation. (Now that's an incentive to keep blogging.) I’m pretty confident I was the only HR person in attendance, so this was a pretty unique learning opportunity for me.  

The first day was entitled Challenges: Diabesity and Contemporary American Nutrition and Value of the Mediterranean Diet. Day 2 was Promoting Dietary Change: Workplace/School Solutions and Other Best Practices from the Field. I walked away with a lot of notes, so I'm breaking them up into two posts. This post will cover Day 1 and a second post will share what I learned Day 2. 

Here’s some of what I made note of the first day…

They clearly defined what it means to eat Mediterranean. I've plunked the main points into the box above. 

I actually learned a lot about olive oil. Look for EVOO, extra virgin olive oil. It should be labeled cold pressed and first pressed. Then, check the ingredient list. A lot of what is sold as olive oil in the U.S. is a blend of oils. Interestingly, in Greece they never mix their olives. Each bottle of olive oil is made from olives from one of three regions Kalamata, Crete, etc... It was suggested that we use a good, but less expensive olive oil for roasting vegetables and other cooking and then have some really nice oils for finishing dishes. Olive oil does have a low smoking point, so if you're making a dish that involves high heat, it was suggested that we use canola or grape seed oil. 

Interestingly, there is no relationship between milk consumption and fracture risk. It was pointed out that the highest rates of fractures are in milk drinking countries.  We were told that calcium needs are overstated in the U.S. (Guess we can thank the dairy lobbyists for that.) Yogurt and cheese are the healthiest way to consume calcium. It was pointed out that in Greece, they don't eat much cows milk cheese, it is usually made from goats milk. 

They defined a moderately high intake of fish as two to three servings a week. I was also happy to hear some definition around "moderate consumption of wine." It was defined as one drink per day for women and two drinks per day for men. A drink can be 12 oz of beer, 5 oz of wine or 1.5 oz of spirits. (There were no special health benefits noted with red wine, so choose what you like.) You should consume your drink slowly. They also clarified a question I'd heard asked on a number of occasions. Most people can safely have up to three drinks in one day as long as they don't exceed the weekly limit of 7 for women and 14 for men. 

They talked about the health benefits of eating nuts. All nuts, which was refreshing. I've so often heard we she eat this nut or that nut, but all nuts have health benefits and I guess you're sort of splitting hairs by picking one over another. 

Nutrition experts at Harvard School of Public Health developed this Healthy Eating Plate to address key flaws in the U.S. Department of Agriculture’s MyPlate.

I found the graph below rather shocking. Of the 20 leading causes of death worldwide, 14 are linked in some way to food, diet and nutrition. Notice how high a diet low in fruits ranks. We were told that each additional serving of fruit a day results in 5% reduction in the risk of diabetes. Volume is more important than variety. Juice doesn't count. Click on the link in the caption if you'd like to learn more about the graph. 

Low Fruits and Vegetables and Mortality Burden

A recent article in JAMA stated, "inadequate intakes of minimally processed foods such as fruits, nuts, vegetables, fish and whole grains together are associated with larger proportions of global death and disability than excess intakes of started fat, trans fat, and sodium." This reinforced that what we eat matters more than what we refrain from eating. I certainly find eating healthy easier when I focus on what I "do" eat rather than on what I "don't." 

There was a presentation by Frank Sacks, MD on randomized clinical trials that was interesting. He was the perfect speaker for after lunch delivering what could have been a dry and complex topic in easy to understand terms with plenty of humor. He said you get the best results lowering blood pressure by combining a low salt and Mediterranean diet. EVOO matters and all nuts have a similar benefits. (Chef Diane Kochilas said olive oil makes vegetables craveable. She has a new cookbook coming out on October 14 that I can't wait to receive.) He showed a slide that summarized the benefits of a Mediterranean diet that have been documented in clinical trials. I recreated that info in this image.  

A few times, the cost of eating well was mentioned, but it was never really explored. In the September 3, 2014 issue of JAMA there is an article on The Real Cost of Food. It states that, “Higher-quality diets typically costs more than lower-quality diets – on average, about $1.50 more per person day.” Obviously this can pose a barrier for many people. It reminded me of the work that Dr. Mary Flynn, a research dietician, is doing in Rhode Island. She partnered with food pantries and provided participants six weeks of cooking classes where they were taught the cooking techniques needed to execute simple healthy recipes. After each class, participants were given a bag of groceries to recreate the recipes at home for their families. Six months after completing the program – they cut their spending on groceries in half and most lost weight (although that was not the focus of the study.) I’ve had this in the back of my mind for at least a year and a half. This weekend inspired me to get in touch with the Embry Rucker Shelter in Reston and see if there is a similar initiative where I could volunteer. If not, maybe I can start one. Anyway, this was one perspective I thought was missing in the conference. (You can learn more about Dr. Flynn's initiative in this post, Eating Mediterranean on a Budget.)

That pretty well summarizes Day 1. During Day 2, the focus shifted to how we help people eat a Mediterranean diet. I'll summarize what I learned the second day in my next post. 

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If I've peaked your interest in olive oils, read Tips on Finding the Best Olive Oil With Eataly Expert Nicholas Coleman. I recommend trying the oils from Flying Olive Farms. They're available in Whole Foods in the Raleigh, NC area and I'm begging the Wine Cabinet in Reston, VA to carry them. I loved their balsamic too. 

I also recommend the series of Huffington Post articles written by the conference organizers and faculty. 

• Can "Eating Like a Greek" Lead to Healthier Workplaces and Schools? by Stefanos Kales, MD, MPH, FACP, FACOEM
• The Mediterranean Diet: A Healthy Addiction by Chef Michael Psilakis
• Ikaria: The Mindful Mediterranean Diet on the Greek Island Where People Forget to Die by Chef Diane Kochilas

Mediterranean Challenge Results

30 Day Mediterranean Lifestyle Challenge

We had 50 staff members formally participate in our Mediterranean Lifestyle Challenge and 18 individuals participate in the pre and post screenings we offered. We looked at blood pressure, BMI, cholesterol and glucose. Cyndi Fales and Kellie Burkinshaw at LWS collected and analyzed the results and reported:  

From believe-toachieve.tumblr.com

The flow of risk is exactly what we want to see-- we had people move from 3-4 risk factors to 0-2 risk factors.  Cholesterol and glucose levels showed the most decrease in risk, body fat and blood pressure didn't show as much (if any change).  Overall I think for a 30 day challenge -- the results are heading in the right direction.

I'm really pleased. As much as I believe in following a Mediterranean diet, I wasn't sure that people would get very measurable results over 30 days. 

Our intent was to have people try a Mediterranean lifestyle for 30 days with the hope they would feel better, find it sustainable and want to continue. We're looking at what we can do to support staff and their families going forward. One of the challenges with a campaign style approach to some of our wellness initiatives is in sustaining support after the conclusion of the initiative. I think we're onto something good this time, so we're going to figure it out. Stay tuned!

Med challenge biomentric graphs from Janet McNichol

Mediterranean Potluck

30 Day Mediterranean Lifestyle Challenge

Last Thursday, Diane Paul organized a Mediterranean potluck lunch for those of us who participated in the challenge. We enjoyed chicken, hummus, whole wheat pita, a kale salad, a yummy soup, a spinach salad, an Israeli salad, a black bean salad, a warm spinach and chick pea dish, fresh fruit and I'm sure a few more things I'm overlooking. (I knew I should have written this right after lunch.) 

We chatted a bit about the challenges we faced with our new way of eating -- getting off track with holidays and special occasions, sugar cravings, and a lot of chopping which has put our knife skills to the test. And, the results we'd seen -- some substantial drops in cholesterol and a few pounds lost. We also discussed ways to continue to build on what we've done. Stay tuned on that front. Many thanks to Diane for getting us together.

Confessions of a Backslider -- Guest Post by Gennith Johnson

30 Day Mediterranean Lifestyle Challenge

Gennith is ASHA's Associate Director, Health Care Services in SLP. She's been an active participant in our fitness classes and enthusiastically participated in our challenge -- not without facing a few hurdles along the way though. I asked Gennith to share her story.

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Gennith at her first Cherry
Blossom 10 Miler April 7, 2013

I am always searching for the latest and greatest when it comes to health and wellness. I consider myself adventurous and eager to try new things. When I first heard the news of the 30 Day Mediterranean Lifestyle Challenge at ASHA I was intrigued and ready to get on board. I read the New Sonoma Diet Book, attended the cooking demonstrations, cleared my pantry and purchased lots of new “power foods”. Equipped with an arsenal of information and a great support system I was ready for the challenge. I learned so much about preparing different foods, and found myself loving the Sonoma Diet recipes. I gradually started to notice a change, I had more energy, clothing fit better and I felt great sense of accomplishment for sticking to the “plan”.

Then it happened…during Wave 2 I travelled to New Orleans for a wedding. In one three day weekend, I unknowingly traded my Mediterranean Lifestyle for the “good stuff”. I found myself rationalizing that seafood gumbo was not exactly “processed” and there was absolutely no way I could leave a wedding reception without “tasting” every dessert. I returned home, and had subconsciously thrown in the towel. The damage had been done. I noticed some of my favorite snacks and old habits had returned and I was back to my same old routine.

After my backsliding experience, I got back on track. I started Wave 1 of the Sonoma diet all over again. I needed a fresh new start. I think it is important to remember when we attempt to make lifestyle changes; we may not always have the desired success on the first attempt. I’d like to share Health Magazine’s Tina Haupert’s five tips for getting back on track:

1. Don’t dwell on the past -- Instead of dwelling on the mistakes I made in the past, I focus on the future. For me, the most important thing to remember is that those pounds gained are not permanent. With some strength, self-discipline, and hard work, they’ll come off. 
2. Create a plan of attack -- Creating a plan of attack with regard to my eating and exercise routine makes me feel in control. I start by planning my workouts for the week by scheduling them in my calendar. I’ll usually pick a couple of group exercise classes at my gym and schedule them like appointments that I cannot miss. Searching for nutritious recipes online and planning a few healthy meals also boosts my motivation to get (and stay!) on track. 
3. Read health blogs for inspiration -- When I’d rather sit on the couch than go for a run, I read some of my favorite health blogs for inspiration. I almost always find a recipe, new workout, or some words of advice that make me want to change my tune. Seeing others at their healthiest and happiest motivates me to think back to a time when I felt strong and fit. This always gets my butt in gear! 
4. Make a change now -- Instead of waiting to start a diet or new exercise routine on Monday, I make changes right away. I throw on my sneakers for a workout or plan my next meal to include lots of fresh produce, whole grains, and low-fat protein. Jump-starting my motivation right away keeps me from falling further into bad habits that got me off track in the first place. 
5. Be patient -- Weight loss (and even maintenance) includes many ups and downs, so it’s easy to forget my successes. Instead of obsessively checking my progress on the scale and realizing it hasn’t changed as quickly as I’d like, I focus on the progress I’ve made off the scale. For instance, I recently have been incorporating more veggies into my meals. I’ve tried a bunch of new recipes and found easy ways to load up my diet with nutrients. Remembering my successes at times when I need them most gets me back on track (consistency is key!) so I see results. 

This week concludes the 30 day challenge. Since February, I am happy to report that I have lost 2 inches off of my waist, experienced a decrease in percentage of body fat and and BMI. I also had an improvement in my blood pressure reading and lost and gained a few pounds along the way. I cannot help but wonder what kind of progress I would have made if I was committed for the entire duration of the program. I am thankful for the experience and to ASHA’s Wellness Team for replacing the candy jars with fruit and nuts. This made my afternoon visits to HR much easier! I am looking forward to incorporating a few lessons from the New Sonoma Diet into a more permanent lifestyle change.

Move More! How to Incorporate Exercise and Activity into our Busy, Busy Lives -- Guest Post by Kelly Velasquez

30 Day Mediterranean Lifestyle Challenge

Kelly Velasquez is our Associate Director of Credentialing - Research & Quality Management. (Believe it or not, Kelly is not even in the running for the longest job title in the office.) Kelly has been a big supporter of our wellness efforts and is a long standing member of our wellness advisory team. Kelly is a swimmer and a triathlete. She is married to Eduardo who also works for ASHA and has two beautiful little girls. As you can imagine, what she doesn't have is spare time. Yet she logged more activity points during our Backfield in Motion Campaign than just about anyone else on staff, so I asked her to share some of her tips with us.

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Mia

It’s finally Spring, and with warmer weather come thoughts of outdoor activities, cook-outs, bathing suit season, and a chance to get off the treadmill, elliptical, stationery bike, or desk chair and get outside. Not that I think you should jump right into a 10K race if you have never run before, though if that is your thing, go for it. Most fitness experts do think that setting a large goal (e.g., triathlon, 5K, obstacle race, cycling event, etc), and including many smaller, achievable goals along the way (e.g., swam 10 laps without stopping or drowning, took bike into store for tune-up, walked for 15 minutes, etc) is more likely to lead to success than just trying to start working out more.

I’m sure we’ve all been there; or at least I know I have – and by there, I mean that I have found an excuse for not working out, yet again. There are so many ways to justify NOT being active (check out this Matt Scott Nike video that lists them all); and on the flip side, there are so many MORE reasons why we should, and why we CAN. According to my informal research, the number one reason is too busy/no time, and certainly that is my number one reason as well (well, that and lack of motivation). Some tips to beat that excuse and other ways to sneak in some exercise include: 

• Set your phone/PC/clock alarm for a pre-determined time(s) and get up to walk to the water cooler to re-fill your cup/bottle…but go the water station two floors below or above you (walking, no elevator!). 
• Meet a work pal for a 15 minute break and do a few sets (walking one, high knees on next, or every other step) of the back stairs in our building – from B-1 to fifth floor. 
• Schedule mini-workouts as you would meetings – you only need 15 minutes, and can break-up your day by scheduling one 15 minute workout break mid-morning and one mid-afternoon, when the post-lunch sleepies hit. 
• Use a pyramid-like plan – do 1 push-up (strength move), 1 jumping jack (cardio), and 1 sit-up/ab move; then add one of each every day to work your way up to 30 of each. 
• Plan your weekends around what activities or more structured workouts you’ll be doing – and then do them. 
• When shopping for groceries, park your cart in one location/part of the store, and make numerous trips to get your needed items and bring them back to your cart. 

Allie

Feeling guilty taking time away from work/family/friends to work out? Try incorporating activity into family events, friend get-togethers, or work. On Sunday, for instance, we went to the National Zoo with the kids, and met our friend and fellow ASHA staffer Tammy there. Little did I know the workout that Tammy and I would get with all of the walking, carrying, stroller-pushing, lifting two 30+ pound children so they could see over various enclosure fences (or because they were scared that the orangutan would charge at them). We were all exhausted after 3 hours, and a side bonus was the long naps the kids took afterwards. Or, meet a friend for a walk or run or hike, and catch up on news while you work-out. Another favorite of mine is to take a mini-break from your desk and go for a walk around the block, or walk to the Mediterranean Café to pick-up lunch. Now that the weather is finally nice, it is easy to find excuses to get outside. We love taking the kids to the Rockville Town Square and letting them run around on the grassy field area and climb the rocks, then grab a bite at one of the family-friendly restaurants in that area. Makes for a great start to the weekend, and I don’t have to cook dinner on a Friday – win/win! And we can’t wait to do family bike rides, though those may be quite a few years away yet – we did get our eldest daughter (who is now 3) out on a hand-me-down tricycle for the first time last weekend, and she loved it.

Finally, find an activity you love to do, and then incorporate it into your daily activities. I am not a dancer, but my girls love to rock out to any kind of music, so I’ll dance/hop up and down with them, and burn more calories in 10 minutes of energetic dancing then an hour of formal, structured ‘cardio.’ Be open to the possibilities, and try something new once; it’s definitely better if you can convince or coerce a pal to try it with you; but getting out of your comfort zone is often just what is needed to get moving more!

References and Resources 

• Six Ways to Work out as a Family 
• General site for all sorts of activities, plus race registrations
• My kids love the treasure hunts; it’s like having Easter every day!
• Let's Move 
• NIH - Tips for Being Active

Wave 3 -- Guest Post by Cyndi Fales

30 Day Mediterranean Lifestyle Challenge

Today is Day 30! Congratulations to everyone who is still working on creating their own little Mediterranean Blue Zone. For those of you that have reached your goal weight, it's time to move onto Wave 3. Cyndi Fales from Lifeworks Strategy tells us how.

Now do a little happy dance and stay the course. Screenings will be held April 17. 

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Once you hit your goal weight—you are ready for Wave 3, the final wave! It may take some people a few weeks to reach their goal while others may need a few months. Continue in Wave 2 until you reach that goal weight and then move on to Wave 3. When you get there, Celebrate—you have earned it!! 

Image from organizedchaos-lisa.blogspot.com 

Wave 3 isn’t too different from Wave 2, same food lists and same plate sizes/portions—you just get to give your self a little more wiggle room. This phase continues to emphasize a variety of wholesome foods and allow for “indulgences,” including: dark chocolate, juices, potatoes and pretzels, which should be limited to special occasions. Now the key is to make sure you don’t wiggle or “indulge” too much off the recommendation or you might have trouble maintaining your healthy weight. Other items to be mindful of to keep at your health weight include: keeping your portion sizes in check, not over snacking, going easy on the fruits and bread, and continuing to be physically active. Ultimately, continue learning and striving to get the maximum nutrients with the minimum number of calories. 

If you “relapse” with sugar and/or refined flours… start back at Wave 1 to eliminate those cravings. If you reach your goal weight after the 10 days you can go right back to Wave 3, or Wave 2 if you don’t get back to your healthy weight after Wave 1. 

If you have been following the Sonoma Diet closely, you may be ready for some new recipe ideas. There are tons of recipes and resources on the Oldways website. You can search through their recipes here. Some of the favorites in my house are Greek Style Lasagna and Stuffed Peppers. When I have family or friends over for dinner, I love doing stuffed peppers, we typically use poblano peppers. I roast peppers ahead of time and then lay out all the “fillings” and let each guest fill their own pepper. You can do any fillings you want, be creative—we like quinoa, black bean, mushrooms, corn, onions, bell peppers, tomatoes, and chicken or shrimp. Stick them in the oven to finish cooking and then serve. By letting each person stuff their own pepper, you have the flexible to control what is in your meal and so do each of the guests. 

By Wave 3, the goal is that you have ultimately learned to “eat for pleasure, eat for health and eating to stay at the best weight.” We hope that you have found that it is not a huge burden—and actually quite delicious and rewarding. You don’t have to eat Mediterranean the rest of your life, but hopefully you can take away a few aspects of the lifestyle to continue in your routine. Keep trying new foods and new recipes, don’t be afraid to go grocery shopping and cook. 

Continue to strive to turn all your meals into slow, satisfying, and sociable experiences. Do whatever you think best to stay within the Mediterranean/Sonoma Diet. It's your diet now. 

Eating Mediterranean on a Budget

30 Day Mediterranean Lifestyle Challenge

Mike Cannon brought an interesting article to my attention -- Study: Mediterranean Diet Can Save Money. I've heard people mention that they are spending more on groceries during our 30 Day Mediterranean Challenge. Most of the people that mentioned this seemed to be following the recipes in the Sonoma Diet book pretty closely. (If anyone has been keeping careful track during our challenge and you're willing to share what you've learned, please let me know.) Anyway, I was very encouraged to see this article. You can feed your family a Mediterranean diet on a budget. 

Image from ehow.com

Dr. Mary Flynn, a research dietician, designed a meal plans consistent with most Mediterranean diet principles, but focused on using inexpensive ingredients to feed a family. Her recipes are all meat free and use ingredients that are available through most food pantries. It's clear she's striking a balance between health and affordability by building meals around pasta, rice and potatoes, but her plan steers clear of processed foods and incorporates plenty of affordable vegetables.

She partnered with food pantries in Rhode Island and launched a program to raise the bar on nutrition. Participants were given six weeks of cooking classes where they were taught the cooking techniques needed to execute simple heathy recipes. After each class, participants were given a bag groceries to recreate the recipes at home for their families. Participants were followed for six months after completing they program -- they cut their spending on groceries in half and most lost weight (although that wasn't the focus of the study.)

You can learn more and see the recipes on Raising the Bar on Nutrition and check out the instructional videos on Common Sense Cooking.

I also ran across 12 Ways to Stop Wasting Food on Whole Foods' website. They indicate that Americans waste up to 40% of their food. For a family of four, this amounts to approximately $2,275 of food waste annually. See the article for tips on curbing your food waste.

Great Grains -- Guest Post by Aryeh Hirsch

30 Day Mediterranean Lifestyle Challenge

Aryeh Hirsch is a senior Community Health major at the University of Maryland, College Park. He is interning at LifeWork Strategies this semester as one of the wellness interns. He is also a certified personal trainer through the National Academy of Sports Medicine and working towards a second certification with the National Council for Certified Personal Trainers. He works part time as a trainer at Golds Gym in Rockville, MD. He has a passion for nutrition and fitness and applies his knowledge towards his clients at the gym as well as serves as a Wellness Coach for LifeWork Strategies. He is very excited to have opportunity to share his knowledge of nutrition during ASHA's 30 day Mediterranean Lifestyle Challenge.

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Image from fitnessladies.net

Carbohydrates have been given a bad rap in the past couple of decades. A lot of the 90’s fad-diets emphasized low or no carbs diets to help shed those extra pounds. New research has shown that carbohydrates are our friends, not our enemy. This is the primary macronutrient used for energy in the human body. Our bodies need carbs to function properly. Studies show that eating whole grains and food that are high in fiber play a beneficial role is preventing cardiovascular disease as well as diabetes according to the Mayo Clinic. Fiber also plays a major role maintaining optimal digestive health.

The Mediterranean diet emphasizes the use of a lot of quality carbohydrate sources such as whole wheat breads and pastas, oatmeal, wild or brown rice, quinoa and fruits and vegetables that are high in fiber. These are carbohydrate sources are also low on the Glycemic index which help control blood sugar levels, keeps us feeling full longer and provides a slow release of energy.

Most of you are in Wave 2 of the diet which allows 3-4 servings of grains a day. I recommend using those extra servings of grains a day because of the numerous health benefits that carbohydrates provide. You should notice an increase in energy throughout the day, feeling more satisfied after meals as well improved digestive function compared to Wave 1.

Here are some great recipes that contain quality carbohydrates:

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Heirloom Tomato Salad with Pearl Couscous

Ingredients

• 2 cups vegetable stock
• 1 tablespoon of extra-virgin olive oil
• 1 cup pearl (isreali) couscous
• ½ cup packed fresh basil
• 1/4 cup flat-leaf parsley leaves
• 1 clove garlic, crushed
• 1 tablespoon chopped fresh oregano
• ½ cup pitted green olives
• 4 heirloom tomatoes, quartered
• 15 cherry tomatoes, quartered
• 1 English cucumber, cubed
• ½ small red onion, thinly sliced
• 1 cup crumbled feta cheese
• 1/4 cup white balsamic vinegar
• ½ cup extra-virgin olive oil
• 1 lemon, juiced

Directions

1. Bring the vegetable stock to a simmer in a saucepan over medium heat. Heat 1 tablespoon olive oil in a skillet over medium heat. Stir in the couscous and cook and stir until golden brown, about 10 minutes. Stir the toasted couscous into the hot vegetable stock and return to a simmer. Cover and cook until the stock has been absorbed into the couscous, about 15 minutes. Scrape into a mixing bowl, fluff with a fork, and allow to cool to room temperature.

2. Place the basil, parsley, garlic, oregano, thyme, and olives into a food processor; pulse until the herbs are coarsely chopped. Stir the herb mixture into the couscous along with the heirloom tomatoes, cherry tomatoes, cucumber, red onion, and feta cheese. Drizzle with the vinegar, 1/2 cup olive oil, and lemon juice. Stir until evenly combined.


Greek Penne and Chicken

Ingredients

• 1 (16 ounce) package whole wheat penne pasta
• ½ cup of canola oil
• ½ cup chopped red onion
• 2 cloves garlic, minced
• 1 pound skinless, boneless chicken breast halves - cut into bite-size pieces
• 1 (14 ounce) can artichoke hearts in water
• 1 tomato, chopped 
• ½ cup crumbled feta cheese
• 3 tablespoons chopped fresh parsley
• 2 tablespoons lemon juice
• 1 teaspoon dried oregano
• salt to taste
• ground black pepper to taste

Directions

1. In a large pot with boiling salted water cook penne pasta until al dente. Drain.

2. Meanwhile, in a large skillet over medium-high heat, add the canola oil, add onion and garlic and cook for 2 minutes. Add chopped chicken and continue cooking, stirring occasionally until golden brown, about 5 to 6 minutes.

3. Reduce heat to medium- low. Drain and chop artichoke hearts and add them, chopped tomato, feta cheese, fresh parsley, lemon juice, dried oregano, and drained penne pasta to the large skillet. Cook until heated through, about 2 to 3 minutes.

4. Season with salt and ground black pepper. Serve warm.

Reading Food Labels -- Guest Post by Lydia Lui

30 Day Mediterranean Lifestyle Challenge

Food labels can be confusing and I've tried to sort through some of the muddle in past posts like this one on Debunking Food Labels. I recently asked our friends at LWS for guidance and Lydia Lui agreed to lend us some advice on what we should hone in on as we shop to support our new Mediterranean Lifestyles. 

Lydia Lui is a senior at the University of Maryland working with LifeWork Strategies as a Community Health intern. She has a particular interest in nutrition and really enjoys food, hiking and playing all kinds of sports. She is very excited to be a part of this 30 day challenge and is looking forward to hearing about other people’s experiences with this new diet.

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Image from FDA.gov

When walking down the grocery aisles, it’s easy to grab a snack without reading over the food label. How often do we remember to check to see what’s really inside your food? We might look at the calorie amount, but forget to consider the quality of the food we’re eating.

Check the serving size first when reading food labels. The nutritional information for the food product is based on one serving, so if you were to eat two servings of the food, you would double the nutrient and calorie values. If you eat the whole package, multiply the values by the total number of servings in the package.

Next, take a look at the total calories per serving and the amount that comes from fat. Try to limit foods high in fat calories. Saturated and trans fats raise your “bad” cholesterol, also known as LDL, which puts you at risk of heart disease and stroke.

In general, look to maximize your amount of vitamins and minerals, fiber and protein, and minimize saturated and trans fat, sugar, salt, and cholesterol. Daily intake values are based off of a 2,000 calorie diet, a good guide to help you keep track of your intake in comparison to the daily recommended amount. Here’s a list of some daily recommended amounts for a more heart healthy diet:

• Salt less than 1,500mg 
• Saturated fat less than 16g 
• Trans fat less than 2g 
• Cholesterol less than 300mg 
• Fiber 25-30g: Whole wheat bread should contain at least 2g of fiber per serving. Cereal should have at least 5g. 

Also make sure to check the list of ingredients in your food. Ingredients are listed in descending order by weight. Look for whole grains as the 1st ingredient rather than refined, bleached flours, and make sure there are no added sugars or artificial sweeteners. Also try to eat foods that don’t have sugar as one of the first 5 ingredients, which may be listed as sucrose, fructose, dextrose, or high-fructose corn syrup.

This link from the FDA gives a very informative overview on how to read food labels and what to look for when comparing foods to eat.

The American Heart Association also provides a great resource for definitions of nutrient content claims. For example, what’s the difference between fat free, low fat, and reduced fat?

Go Fish -- Guest Post by Laura DeFilippo

30 Day Mediterranean Lifestyle Challenge

I love fish, but no one else in my family likes it, so I never got in the habit of preparing it often at home. When I took the Mediterranean Diet Quiz, it was my biggest shortfall and something I'm working on during our challenge. 

My friend, Laura, manages to cook and eat a lot more fish than I do. We've dined on fish she caught herself and frozen stuff from Costco. She makes it all taste delicious. So, I asked her to share some tips with us. 

I'm also relying on the seafood folks at my neighborhood Whole Foods market. They're very helpful and share my interest in sustainability. Check out their 12 Easy Fish Feast recipes. I've been enjoying the almond encrusted Tilapia from that recent Washingtonian article too. 

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The health benefits of fish are numerous … fish is a low-fat, high quality protein packed with omega-3 fatty acids, vitamins and nutrients that can reduce the risk of a heart attack or stroke. Fish is an excellent source of calcium and minerals. The American Heart Association recommends eating fish at least two times per week. Fish is packed with protein, vitamins, and nutrients that can lower blood pressure and help reduce the risk of a heart attack or stroke. 

The Washington State Department of Health lists the healthiest fish with the highest health benefits in this link: Healthy Fish Guide.

Omega-3 Fatty Acids
Omega-3 fatty acids are the unsaturated fats contained in fish and are important in maintaining healthy brain function and a healthy heart by lowering blood pressure, reducing the risk of heart attacks, sudden cardiac death, strokes and irregular heart rhythms, among other things. Our bodies do not produce omega-3 fatty acids so we need to get them through food we eat. Omega-3 fatty acids are found in all fish, but are especially high in fatty fish such as salmon, trout, sardines, canned light tuna and oysters. There is also research indicating that omega-3 fatty acids may reduce the risk of depression, ADHD, dementia, diabetes and Alzheimer’s disease, and may prevent inflammation and the risk of arthritis.

Mayo Clinic indicates that eating one or two servings of fish a week can reduce your risk of dying of a heart attack by more than a third. The American Heart Association has long recommended that we eat at least two servings of omega-3-rich fish per week. 

What about the contaminants contained in fish?
The health benefits of eating fish outweigh any associated risks such as the risk of ingesting mercury or other contaminants. The amount of toxins in fish depends on the type of fish and where it's caught.

Generally speaking, the larger the fish, the higher the level of mercury and other contaminants. Larger fish in the food chain such as shark, swordfish and king mackerel tend to have higher levels of mercury than do smaller fish -- larger fish eat smaller fish, gaining higher concentrations of toxins. Additionally, the longer a fish lives, the larger it grows, and the more mercury it can collect.

Many researchers believe that wild-caught fish is healthier than farm-raised fish due to potential harmful effects on people the antibiotics, pesticides and other chemicals used in farming fish can have.

The following is a recipe for my favorite way to prepare my favorite fish, Salmon.

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Sweet Soy Salmon

INGREDIENTS

Wild salmon filets, with or without skin

Soy sauce (or reduced-sodium soy sauce)

2 - 4 T. Brown sugar

2 cloves garlic, crushed

OPTIONAL –

Coarsely chopped scallions

Coarsely chopped fresh ginger

1 small lemon, thinly sliced

DIRECTIONS

Combine soy sauce, brown sugar, garlic and any optional ingredients (except lemon slices) in a large Ziploc bag.  Close the bag and shake to combine ingredients and dissolve sugar.  (If you are using ginger and/or scallions, it will help to first bring all ingredients to a boil to blend the flavors, bring to room temperature, and then put the marinade in Ziploc bag or bowl.)

   

Place the lemon slices and salmon in the Ziploc bag or bowl allowing the marinade to cover the filets.  Marinate for at least 30 minutes but no more than 1 hour, turning the fish in the marinade once or twice.

For grilling:

Preheat grill to medium-high.

Remove the salmon from the marinade, place it skin-side down on the hot grill.  Close the lid and cook for approximately 5 to 7 minutes.  Turn the fish carefully and replace the lemon slices on top at this point, if desired.  Close the lid and cook until the fish is just cooked through, about 5 to 8 more minutes.

For cast-iron skillet (or heavy frying pan):

Drizzle olive oil lightly in the skillet, or use a cooking spray.  Preheat the skillet to medium high.  Remove the salmon from the marinade, place it skin side down on the hot skillet and cook about 5 minutes.  Carefully turn the salmon, place the lemon slices on top, and cook the other side until done.