The Mediterranean Diet Low-FODMAP Style

May is Mediterranean Diet month and before you disregard it as another fad read on.

IMG_1566There have been literally hundreds of studies done on the health benefits of the Mediterranean diet.  Even the New York Times best-seller “The Blue Zones”, which identified places were people live the longest, found 2 of the 5 “zones” located in the Mediterranean region.  Those being Ikaria, Greece and Sardinia, Italy.  This pattern of eating is associated with a lower incidence of heart disease, stroke, osteoporosis, diabetes and cancer.  There are various reasons for this; lifestyle, community, family connection, high intake plant food, low intake of processed foods and sugar, but I believe, and many studies agree, that the benefits seen is due to lowering of inflammation and oxidative stress.

Inflammation can be either acute or chronic.  Acute inflammation is a red bump after a bee sting or a swollen ankle after an injury.  On the other hand,  Chronic inflammation is quiet, persistent and prolonged.  It is associated with cancer, heart disease, autoimmune disease and diabetes.  Calming chronic inflammation is where the Mediterranean diet helps due to the high consumption of vegetables, fruit, beans, olive oil and nuts.  These plant foods all contain phytochemicals, most notably polyphenols.  Phytochemicals give plants their color and work as antioxidants.  Think purple eggplant, leafy greens, red wine, dark brown coffee, green olive oil, and various herbs like basil, sage and parsley.

How can we eat like we live in…Italy, Spain, Greece while following a low-FODMAP diet?

1. Choose the freshest, whole and unprocessed foods you can find.  Try a local farmers market and buy key vegetable in season.  For example, low-FODMAP choices in warmer months are blueberries, strawberries, eggplant, zucchini, tomatoes, green beans, cucumber and peppers.  In the cooler months buy red cabbage, winter squash, potatoes, radicchio,  escarole and oranges.

2. Replace liquid oils with extra virgin olive oil.  EVOO is delicate so it is best not to use high heat,  instead lightly sauté and drizzle over salads, vegetables and even fruit like sliced oranges. If you are looking for a oil to sautéed with at higher eat choose coconut oil or ghee if you are not dairy sensitive.

3. Drink your antioxidants.  If you drink alcohol choose a glass of red wine with dinner (one glass!), drink a shot of espresso in the morning, green tea in the afternoon and follow everything up with water.  While living in Italy we always had a bottle of sparkling or still water with every meal, this is a good practice to incorporate.

4. Fill 1/2-3/4 of your plate with colorful vegetables.  See #1 for seasonal vegetable ideas but other low-FODMAP Mediterranean vegetables include arugula, fennel up to 1/2 cup, radishes, cucumbers, kale, spinach, broccoli (1/4-1/2 cup)…you get the idea.

The best way to incorporate more plants into your life is to roast a pan of…
Mediterranean vegetables.
It is so easy you don’t need a recipe.
Start with 2-3 cups of low-FODMAP vegetables, similar in texture and cut into equal sizes.
For example, zucchini, carrots, radishes and potatoes or eggplant, zucchini, tomatoes and potatoes.
Place vegetables in large bowl, drizzle with 1-3 Tbs of olive oil and add salt, pepper, dried herbs such as sage, oregano, and crushed red pepper flakes.
Stir well.
Pour into a large baking sheet pan lined with silpat or parchment paper.
Roast or bake at 375 degrees F. until well cooked, about 30 minutes but could be more or less depending on how large the vegetable pieces are.
Optional, sprinkle with freshly ground parmesan cheese.

5. The Mediterranean region consumes moderate portions of beans, grains and nuts.  All of these can be tricky when following a low-FODMAP diet.  Choose up to 1/2 cup of canned lentils and up to 1/4 cup of canned garbanzo bean.  Low-FODMAP grains include polenta (I choose organic corn products), buckwheat and brown rice pasta.  Low FODMAP nuts include walnuts, up to 10 almonds and up to 1 TBS. of tahini.

6. Eat fish at least 3 times per week.  Reduce poultry to once a week or so, and eat red meat even less.  Sustainable fish, that are also high in Omega-3 fatty acids, include sardines, anchovies, mackerel, wild salmon, mussels, clams, wild cod and I like wild halibut, although I have never seen it on the menu in Italy.

Other protein sources to use in place of meat are small amounts of dairy and eggs.  If you choose to eat dairy and eggs opt for organic when you can and look for dairy without added gums and emulsifiers.  Examples are parmesan, 1/2 cup feta, pecorino (made from sheep milk) and lactose free kefir or yogurt such as green valley organics.

7. Use an abundance of fresh and dried herbs.  Herbs are medicinal and due to their high levels of polyphenols they can reduce inflammation and help control diseases such as cancer, Alzheimers, diabetes and heat disease.  Herbs and spices gives bland food a burst of flavor which means you may not need to use as much salt.

Here are some ideas on how to incorporate more herbs and spices into your cooking; basil with tomatoes, sage with brown rice pasta, oregano with eggplant, chives with cucumber slices, thyme with zucchini, rosemary with potatoes, mint in sparkling water, parsley with canned lentils, olive oil and peperoncino on anything!

8. Enjoyment, pleasure and family meals.  The Mediterranean region savors their meals and takes pleasure in dining.  Try this for at least one meal a day; dine without distraction (only dining conversation) and most importantly chew each bite well (try 25 times as a personal challenge.  Chewing well and slowly decreases gut distress and helps being out the nuances of flavor.  Finally dine al fresco when the weather allows.

Immerse yourself into the Mediterranean lifestyle and check out some of my favorite resources and blogs.

Oldways Mediterranean Pyramid
Olive Tomato (Greek recipes and nutrition by a colleague and RD).
Dream Italia for enchanting Italian tours (and beautiful photos of Italy).
The Complete Italian Vegetarian Cookbook by Jack Bishop
Lidia’s Family Table on PBS (this one is recommended by my husband).
Monash University take on the Mediterranean diet

Buon Appetito!

N Engl J Med 2013; 368:1279-1290
J Alzheimers Dis 2012; 29 (4) 773-82
Oxid Med Cell Longev. 2009 Nove-Dec; 2 (5) 270-278


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