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The Mediterranean Diet really is that good for you

 

 

In the 1950s, researchers from across the globe embarked on a sweeping and ambitious study. For decades, they scrutinised the diets and lifestyles of thousands of middle-aged men living in the United States, Europe and Japan and then examined how those characteristics affected their risks of developing cardiovascular disease.

The Seven Countries Study, as it later became known, famously found associations between saturated fats, cholesterol levels and coronary heart disease. But the researchers also reported another notable result: Those who lived in and around the Mediterranean – in countries like Italy, Greece and Croatia – had lower rates of cardiovascular disease than participants who lived elsewhere. Their diets, rich in fruits, vegetables, legumes, whole grains, nuts, seeds, lean proteins and healthy fats, seemed to have a protective effect.

Since then, the Mediterranean diet has become the bedrock of heart-healthy eating, with well-studied health benefits including lower blood pressure and cholesterol, and a reduced risk of Type 2 diabetes.

“It’s one of a small number of diets that has research to back it up,” said Dr Sean Heffron, a preventive cardiologist at NYU Langone Health. “It isn’t a diet that was cooked up in the mind of some person to generate money. It’s something that was developed over time, by millions of people, because it actually tastes good. And it just happens to be healthy.”

Here are some of the most searched questions about the Mediterranean diet, answered by experts.

WHAT EXACTLY IS THE MEDITERRANEAN DIET?

The Mediterranean diet isn’t as much a strict meal plan as it is a lifestyle, said Julia Zumpano, a registered dietitian who specialises in preventive cardiology at the Cleveland Clinic in Ohio. People who follow the Mediterranean diet tend to “eat foods their grandparents would recognise,” Dr Heffron added: Whole, unprocessed foods with few or no additives.

pexels-dana-tentis-1239312.jpg?itok=um0m (Photo: Pexels/Dana Tentis)

The diet prioritises whole grains, fruits, vegetables, legumes, nuts, herbs, spices and olive oil. Fish rich in omega-3 fatty acids, like salmon, sardines and tuna, are the preferred animal protein source. Other lean animal proteins, like chicken or turkey, are eaten to a lesser extent. And foods high in saturated fats, like red meat and butter, are eaten rarely. Eggs and dairy products like yogurt and cheese can also be part of the Mediterranean diet, but in moderation. And moderate alcohol consumption, like a glass of wine at dinner, is allowed.

Breakfast might be smashed avocado on whole-grain toast with a side of fresh fruit and a low-fat Greek yogurt, Dr Heffron said. For lunch or dinner, a vegetable and grain dish cooked with olive oil and seasoned with herbs – roasted root vegetables, leafy greens, a side of hummus and small portions of pasta or whole grain bread, with a lean protein like grilled fish.

“It’s very easy to follow, very sustainable, very realistic,” Ms Zumpano said.

WHAT ARE THE HEALTH BENEFITS OF THE MEDITERRANEAN DIET?

A number of rigorous studies have found that the Mediterranean diet contributes to better health, and in particular better heart health, in a variety of ways. In one study, published in 2018, researchers assessed nearly 26,000 women and found that those who followed the Mediterranean diet most closely for up to 12 years had about a 25 percent reduced risk of developing cardiovascular disease. This was mainly because of changes in blood sugar, inflammation and body mass index, the researchers reported. Other studies, in men and women, have reached similar conclusions.

Research has also found that the diet can protect against oxidative stress, which can cause DNA damage that contributes to chronic conditions like neurological disease and cancer. And some studies suggest it can help reduce the risk of developing Type 2 diabetes.

The diet may also have profound health benefits during pregnancy, said Dr Anum Sohail Minhas, an assistant professor of medicine at Johns Hopkins Medicine. In a recent study of nearly 7,800 women published in December, researchers found that those who followed the Mediterranean diet most closely around the time they conceived and during early pregnancy had about a 21 per cent reduced risk of any pregnancy complications, such as pre-eclampsia, gestational diabetes or preterm birth.

“There definitely seems to be a protective effect,” Dr Minhas said.

On its own, though, the Mediterranean diet isn’t a panacea, Dr Heffron said – it won’t eliminate your chances of developing cardiovascular disease, and it won’t cure a disease, either. It’s important that people also pay attention to other tenets of good heart health, like getting regular exercise and adequate sleep and not smoking.

pexels-jill-wellington-257816.jpg?itok=l (Photo: Pexels/Jill Wellington)

WILL THE MEDITERRANEAN DIET HELP WITH WEIGHT LOSS?

The diet can be conducive to weight loss, Ms Zumpano said, but you’ll still need to pay attention to calories.

“Nutrient-rich foods aren’t necessarily low in calories,” said Dr Heffron, who noted that the diet includes foods like olive oil and nuts, which are heart-healthy yet high in calories and can lead to weight gain if consumed in large portions. But if you’re changing your diet from one that is rich in calories, saturated fats and added sugars, for instance, with one that prioritises vegetables, fruits and leaner proteins, that can result in some weight loss, he said.

The Mediterranean diet is not meant to be a hack for rapid weight loss, though. Rather, it should inspire a long-term shift in eating behaviour. In one study of more than 30,000 people living in Italy, for instance, researchers found that those who followed the Mediterranean diet most closely for about 12 years were less likely to become overweight or obese than those who followed the diet less closely. A smaller study, published in 2020, enrolled 565 adults who had intentionally lost 10 per cent or more of their body weight in the year prior. It found that those who reported adhering to the Mediterranean diet closely were twice as likely to maintain their weight loss as those who did not closely follow the diet.

HOW LONG DO YOU NEED TO FOLLOW THE MEDITERRANEAN DIET TO GAIN BENEFITS?

If you’re just starting to follow the Mediterranean diet, limited evidence suggests that you may notice some cognitive improvements – including in attention, alertness and contentment, according to one review of studies published in 202 – within the first 10 days or so. But for there to be sustained, long-term payoffs in terms of heart health, people need to stick with it, Zumpano said, ideally for their whole lives.

That being said, she added, the diet allows for some flexibility; the occasional cake or steak won’t undo its overall benefits.

ARE THERE ANY DOWNSIDES TO TRYING THE MEDITERRANEAN DIET?

The diet usually provides a balanced blend of nutrients and adequate protein, so typically there are no significant risks associated with following it, Dr Heffron said.

But because the diet recommends minimising or avoiding red meat, you may want to make sure that you are getting enough iron. Good sources of iron include nuts, tofu, legumes and dark leafy green vegetables like spinach and broccoli. Foods rich in vitamin C, like citrus, bell peppers, strawberries and tomatoes, can also help your body absorb iron. And because the diet minimises dairy, you may want to speak with your doctor about whether you need to take a calcium supplement.

However for the average person, the benefits of the Mediterranean diet likely far outweigh any potential negatives, Dr Minhas said. “These are things we can all try to incorporate into our lives.”

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What is the caloric damage of your favourite CNY snacks?

 

 

SINGAPORE: You made resolutions to eat clean and lose weight at the start of the year. But now that the Chinese New Year (CNY) celebrations are around the corner, that may be easier said than done.

While having one or two pineapple tarts or almond cookies may not tip the weighing scales, consuming these high-calorie treats consistently throughout the holidays will definitely lead to fat gain, said Tyen Rasif, a women’s fitness trainer and fitness personality.

"In general, it takes about eight to 10 hours for food to be stored as fat, and it takes 7,000 excess calories accumulated overtime for a person to gain 1kg. Chances are, most of it might be stored as fat mass if the individual is sedentary," said Rasif.

Most people overeat 39 per cent more calories than they normally do during the festive season, and nearly 45 per cent of people gain an average of 1.7kg during the Chinese New Year holidays, according to a 2012 survey by Taiwan’s Health Promotion Administration.

Excess calories are not the only thing you should be concerned about this CNY. Most traditional festive treats and dishes are packed with sodium and sugar - both of which can lead to water retention and bloating, said Rasif.

According to Bibi Chia, principal dietitian at Raffles Diabetes and Endocrine Centre, eight in 10 Singapore residents exceed the daily salt intake recommendation of less than 5g per day (equivalent to one teaspoon), or 2,300mg of sodium. 

For people with diabetes or pre-diabetes, even short-term overeating can raise blood sugar levels, Chia said.

In the long run, consuming too much high-calorie and fat-laden foods might lead to a host of diseases including diabetes, as well as a higher risk of heart problems and stroke, she added.

Here, we check out the calorie content in popular CNY treats, as well as the daily activities and exercise you will need to do to avoid packing on the kilos. Bear in mind that the exact number of calories you will expend for each physical activity will depend on how hard you exert yourself and your weight.

bak-kwa-1---2225366.png?itok=ldF5Y1c0 BAK KWA(Photo: Lim Wui Liang) File photo of barbecued pork. (Photo: Lim Wui Liang)

As delicious as this CNY staple is, it will easily bust your daily calorie, sodium, saturated fat and sugar intake. One slice of this savoury treat will set you back by 301 calories, 4.1g of saturated fat, 32g of sugar, and over a third of your daily sodium intake at 732mg.

The World Health Organization recommends that adults and children reduce their daily intake of free sugars to less than 10 per cent of their total energy intake. A further reduction to below 5 per cent, or roughly 25g (6 teaspoons) per day, would provide additional health benefits, Chia said.  

The American Heart Association recommends keeping saturated fat intake to no more than 5 per cent to 6 per cent of total calories. For someone eating 2,000 calories per day, that will be around 11g to 13g of saturated fat, said Chia.

To burn off a single slice of bak kwa, you will need to jog for around 30 minutes or do some heavy-duty household chores like moving and carrying boxes for around 45 to 50 minutes.

PINEAPPLE TART

pineapple-tarts---2487956-data.png?itok=UqhGmSQB (Photo: Facebook/Garden Pastry and Cakes) Pineapple tarts. (Photo: Garden Pastry and Cakes' Facebook page)

A pineapple tart contains 93 calories, 2.3g of saturated fat, 6.2g of sugar and 58mg of sodium. Chances are, you will not stop at one, so be mindful when consuming these yummy morsels.

Pop two pieces into your mouth and you will have to do 25 minutes' of vigorous jumping jacks, or clean the house for more than an hour to get rid of the excess calories.  

KUEH BANGKIT

kueh-bangkit.jpg?itok=SKRMD3b9

If you’re hankering for something sweet to nibble on during CNY house visiting, kueh bangkit might be a lower calorie alternative as a piece contains only 15 calories. Compared to other snacks, it is also lower in saturated fat, sugar and sodium at 0.3g, 0.9g and 2.6mg respectively.

Brisk walk or carry your baby niece or nephew for under five minutes, and you’ll be able to get rid of the calories from having one piece of kueh bangkit.

KUEH LAPIS

kueh-lapis.jpg?itok=qI3yCtrL

This is another calorie bomb, which can easily rival that of bak kwa. A slice of this buttery multi-layered cake will set you back by 237 calories. It contains 10.5g of saturated fat, 12.1g of sugar, and 160mg of sodium.

Work off a slice of this buttery indulgence by swimming for 30 to 40 minutes, jogging for 20 to 25 mins or sweeping the floor for around 90 minutes.

DRIED SHRIMP ROLLS

dried-shrimp-rolls.jpg?itok=YfUKTts-

A piece of shrimp roll will set you back by 23 calories. Its saturated fat, sugar and sodium content are 1g, 0.2g and 41.2 mg respectively. Try to stop at one or two, or you’ll end up with too many hard-to-burn calories and artery-clogging saturated fat.

You will need to burn off a handful of five to six prawn rolls by doing vigorous skipping for around 15 minutes. Alternatively, vacuum the house for about 40 minutes.

LOVE LETTERS

love-letters.jpg?itok=1PLSMzUG

For such a light and airy snack, love letters are pretty calorie-dense. Each piece contains 56 calories, and 0.9g of saturated fat, 4.7g of sugar, and 4.4mg of sodium. Three love letters would take 20 to 25 minutes’ worth of stair-climbing to work off. You could also scrub the toilet floor for about an hour.

cny-snacks-infographic-data.png?itok=LDs

SNACK AND EXERCISE SMART THIS CNY WITH TIPS FROM THE EXPERTS

1. Snack with a purpose

Prioritise your favourite snacks and eat only those. Choose the days you want to indulge, for example, on the eve and first day of CNY, and stick to those days, said Chia.

2. Ration CNY goodies at every relatives' house

Place CNY treats on a small plate or tissue paper, and eat only from there, said Rasif. Eating straight from the box or jar makes you less conscious of how much you are consuming, she said.

3. Throw in a mix of high-intensity cardio and strength training

This helps you boost metabolism and fat burn, Rasif explained. Try this 20- to 30-minute circuit workout: squats, push-ups, sit-ups, lunges and mountain climbers. You can do this in between or after house visiting, for instance.

Aim to do each exercise for 30 to 50 seconds, with 30-second breaks in between. Repeat three or four rounds. If you can add weights, that will be a bonus.  According to Rasif, these compound movements help you target multiple muscle groups and increase the calories you burn.

4. Workout within eight to 10 hours after feasting

That is the most efficient window for a workout after you consume excess calories, said Rasif. The rate of caloric burn depends on your exercise intensity.

Source: Energy and nutrient composition of snacks from Bibi Chia, principal dietitian at Raffles Diabetes and Endocrine Centre. Energy expenditure sourced from MyFitnessPal.com and Calorielab.com.

Source: CNA/bk
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SINGAPORE – Patients with kidney failure may be able to reverse the damage, if a new treatment is proven to be as good in humans as it is in mice. Safety trials in humans will start in 2023, and if all goes as well, clinical trials in patients will begin in the next two to three years.

“This discovery could be a real game-changer in the treatment of chronic kidney disease – which is a major public health concern in Singapore and globally – bringing us one step closer to delivering the benefits promised by regenerative medicine,” said Professor Thomas Coffman, dean of Duke-NUS Medical School, and a member of the research team.

The team from Duke-NUS Medical School, National Heart Centre Singapore (NHCS), and researchers from Germany, were able to inhibit a protein which plays a major part in organ damage, resulting in the injured kidneys regenerating and renal function restored.

 

The team said this is a first in the world, where treatment has enabled damaged kidneys to regenerate. They had been working on this project for more than a decade, not just in kidneys but also other organs like the lungs and liver.

Kidney failure is a global epidemic with about 850 million people suffering from it, said Assistant Professor Anissa Widjaja, a molecular biologist with Duke-NUS’ Cardiovascular and Metabolic Disorders Programme. Kidneys can be damaged through acute infections or chronic diseases such as diabetes. She said Singapore ranks first in the world for diabetes-induced kidney failure and fourth in terms of kidney failure prevalence.

The researchers said kidneys have the innate ability to regenerate.

 
 

They gave mice with inflamed and scarred kidneys a neutralising antibody against the interleukin-11 (IL-11) protein, which is known for causing damage and scarring in organs such as the kidneys, liver, lungs and heart.

 

The treatment targeted the cells on the lining of the tiny tubes inside the kidney that return nutrients into the body, leaving urine behind. When treated with the neutralising antibodies against IL-11, the tubule cells were able to proliferate and regenerate the kidney, reversing the damage.

There was improvement in all the mice, no matter how badly damaged the kidney was.

The results of the pre-clinical study were published online in the Nature Communications journal in December 2022.

 

“The therapy could be used to treat people at risk of acute kidney disease to prevent it, to treat people who have acute kidney disease to reduce kidney damage, and to treat patients with established chronic kidney disease to reverse it. This is because activating regeneration in the kidney is useful across all types of kidney disease,” said Professor Stuart Cook, a cardiologist with the Duke-NUS’ Cardiovascular and Metabolic Disorders Programme as well as a clinical scientist at the NHCS.

Prof Cook, who was the principal investigator of the study, said: “We showed that anti-IL-11 therapy can treat kidney failure, reverse established chronic kidney disease, and restore kidney function by promoting regeneration in mice, while being safe for long-term use.”

Testing the antibody in healthy humans will begin early in 2023. If that goes well, clinical trials in patients should begin in 2024. These will be done by pharmaceutical giant Boehringer Ingelheim, whose researchers were involved in the study, as it has purchased the licence to do so. The trials in humans are likely to start with patients with fibrotic lungs, with trials among kidney patients coming next.

 

The experiment in mice involved a number of cohorts over several years, to ensure “robustness” in the results. To test its effectiveness against chronic kidney disease, the kidneys in mice were “badly damaged” to lose about a third of their function. After about three weeks to stabilise the damage, the mice were injected with the antibody.

Over a period of three months, the treatment resulted in more than 50 per cent reversal of kidney dysfunction and fibrosis, and the kidneys were visibly “growing back”, said Prof Cook.

The experiments on mice stopped after three months of treatment. If it had been prolonged, he said, there may have been even more improvements.

Prof Cook said the chance of anti-IL-11 working in humans is high, since the study was also carried out on human cells, with the same outcome.

Asked if the regeneration would work as well in older mice, and hence older humans, Prof Cook said yes, based on further experiments, the results of which have yet to be published. “The antibody works in old mice with kidney disease as well as in mice that have kidney disease and diabetes,” he said.

However, the treatment, when it becomes commercial, is likely to be “reasonably expensive”, said Prof Cook, but he added: “The cost of giving a drug that prevents someone going onto kidney dialysis is very small compared with the cost of dialysis itself.”

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