Rook Review

Marla lives with her husband, Richard, and enjoys cooking, gardening, and finding exciting new restaurants.

Tip: If you have an air fryer, these wings can be baked at 400°F for 30 to 35 minutes.

You are going to re-train yourself to eat in a way that is satisfying and quenches hunger for more than 30 minutes. This jump-start plan lasts from one to two weeks, and completing the jump-start will make it much easier to adopt the full plan. You decide when you are ready to move on to the full Med-DASH eating program. During your jump-start, you will learn to make veggies the center of your plate and protein the satisfying accompaniment. You will avoid starchy and sugary carbs, so you won’t have sugar crashes that lead to cravings and all-day grazing.

It is important to focus on “foods to include” instead of what to avoid. In the one to two weeks of the jump-start, you are going to focus on including lots of nonstarchy vegetables; lean meats, fish, or poultry (for nonvegetarians); beans, nuts, and seeds; low-fat or nonfat fermented dairy foods; and heart-healthy fats. This array is the foundation of healthy eating advice and of a truly sound lifelong eating style. The advantage of this jump-start plan is that it helps you learn how to eat in a satisfying way that is filling, while not causing blood sugar highs and lows that can lead to overeating. You will learn to naturally moderate how much you eat.

What We Choose

Protein-rich foods

Lean meats, fish, poultry

Fermented (preferably) reduced-fat dairy foods: cheese, yogurt

Eggs

Beans and peas: These are great protein options for vegetarians. Although they do contain a fair amount of starch, they are also fiber-rich, which slows down how quickly your body digests and absorbs them, so there is little concern for them causing you to have a glucose crash from the starch.

Nonstarchy veggies

This includes almost all vegetables, except, for example, potatoes, yams or sweet potatoes, beets, and parsnips. Sweet corn is a grain, even though we tend to think of it as a vegetable. We are skipping grains during the jump-start.

Heart-healthy fats

Olive, peanut, and canola oils

Nuts and seeds (also good protein sources), including peanuts and peanut butter

Avocados

During this optional jump-start, we are putting a few of the key Med-DASH foods on hold. But just for a week or two. Fruit and whole grains are very healthy, so don’t worry, they come right back in after the jump-start. Starchy and sugary vegetables like potatoes, sweet potatoes, parsnips, and beets are foods you want to avoid at this point. All grains are off the table, including wheat, corn, oats, and quinoa. For dairy, we are just going to have small amounts of milk, such as what you’d add to coffee. Yogurt and cheeses are absolutely fine during the jump-start. At this point you are just establishing a new foundation based on protein-rich foods, high-fiber, low-starch, and low-sugar foods; and heart-healthy fats.

How Many Servings?

I like to provide serving size guidance in terms of appetite size: smaller, moderate, or larger. Focusing on calories or being overly rigid doesn’t help you learn how to eat in a way that is pleasant or sustainable. I want you to figure out how much to eat based on what is satisfying for you. Without worrying about calories, you still can lose weight. It happens because you are choosing foods that are bulky and filling (fruits and veggies) as well as satisfying (protein and fats). You want to focus on getting a variety of different food types, which will bring you the right mix of nutrients to improve your health. And as you change your eating habits, your hunger level decreases, so you will be satisfied with smaller servings.

What a great start to an eating plan that will improve your health and be easy to follow! It is a new way of eating, one that will become your eating plan for a lifetime.

What does a typical day on the jump-start plan look like?

Breakfast

Midmorning snack

Afternoon or before-dinner snack

Dinner

Below is a suggested tracking form for the jump-start plan. You can download larger versions of this form at dashdiet.org/forms

Let’s learn a little bit about heart disease. Your arteries can take decades to get to the point of being so blocked that they can start to limit blood flow to parts of your heart muscle and other areas of your body. Long before you are close to having a major blockage and a potential heart attack, you may notice you feel very tired and are easily fatigued. You may think you are just getting older and need to slow down, but in reality, it may be time to go see a cardiologist for a battery of tests. He or she will likely do an EKG, which may lead to a stress test and possibly a nuclear stress test. While we would prefer not to need either, it’s much better to discover you have a blockage via a test, rather than finding out during a heart attack. That heart attack will leave part of your heart muscle with dead tissue. You may never be the same; the majority of women who have heart attacks will never fully recover to their level of health before the attack. The best prevention strategy is to change your habits now. I will make this easy, and at the same time provide you with guidance on how to enjoy delicious food using this eating pattern.

The Big Picture

These conditions are often called silent killers because if you don’t have regular physical exams, you will probably not be aware of having elevated blood pressure, cholesterol, and/or triglycerides until you have an event like a stroke or a heart attack. Just because you feel all right does not mean you can or should avoid regular checkups with your doctor. You would much rather prevent a problem than have to deal with very severe consequences.

Know Your Numbers!

A key objective of this book is to help you keep your heart healthy. The primary problems that we are trying to manage or avoid are atherosclerosis, high blood pressure, and metabolic syndrome. The main numbers you need to know include your total cholesterol, LDL cholesterol (the bad type), HDL cholesterol (the good type since it helps to clean up arteries), and triglyceride, all of which are collectively known as blood lipids. Blood glucose and blood pressure are the other important numbers to know.

Cholesterol is the main component in the plaque, and it is primarily oxidized LDL cholesterol that causes problems. Triglycerides and their metabolic by-products are also involved in this process. The proteins in HDL are packages that clean up cholesterol in your bloodstream and deliver it to the liver to be eliminated. Elevated triglycerides depress HDL levels, resulting in higher LDL-cholesterol and more plaque. Again, it’s not just the large arteries that can get cholesterol deposits. Your eye doctor may be able to see cholesterol crystals in the back of your retina, which may be related to risk for age-related macular degeneration. Cholesterol can also block the small blood vessels in sex organs and lead to erectile dysfunction or to lower responsiveness.

Blood pressure indicates how your heart is functioning to move blood through your arteries and veins. Elevated blood pressure is an indicator that your heart is having to work harder than it should in order to move blood around your circulatory system. If your blood pressure is mildly elevated, you may be able to reverse it through changes to your diet (especially with the DASH diet) and adding regular activity that gets your heart beating a little faster, to improve your entire cardiovascular system.

High Blood Pressure

To better understand your blood pressure health at the start of this program, let’s look in greater detail at what some of these conditions look like and how they are assessed. The 2017 blood pressure guidelines from the American Heart Association (AHA) and the American College of Cardiology, generated by the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC8), have the following blood pressure categories:

Stage 1 hypertension can be treated with lifestyle changes. Along with exercise, reaching and maintaining a healthy weight, the DASH diet and the Mediterranean diet are both recommended for optimal blood pressure. So, if these diets are so beneficial, why don’t doctors recommend them more often? Unfortunately, many physicians think that taking a pill may be easier for their patients than changing their eating and exercise habits. We are going to change that perception.

Foods that are good sources of fiber, calcium, potassium, protein, and unsaturated fats are associated with improved blood pressure. Fortunately, the Med-DASH plan is rich in these key nutrients. By focusing on the important foods to include, you will easily be getting the right minerals, vitamins, antioxidants, and anti-inflammatory compounds to help you reach and maintain healthy blood pressure.

Throughout your life, your initially clean arteries are gradually developing plaque that can eventually create a blockage in a vein or artery. As the result of autopsies done on service members during the Vietnam and Korean Wars, even young men of eighteen or nineteen were seen to have the beginnings of plaque buildup in their arteries. In servicemen killed in the Korean War, 77 percent had atherosclerosis (plaque), while 45 percent of Vietnam War casualties had plaque.

When your blood sugar is under control, you won’t make extra triglycerides from excess glucose. Cardiovascular (aerobic) exercise helps with a whole host of interrelated problems, including excess belly fat, high blood pressure, prediabetes, and heart disease. In the next section, you will learn a lot more about this relationship.

Metabolic Syndrome: Prediabetes, Hypertension, and Heart Disease

We want to stay healthy for our whole lives. One of the most common and devastating conditions that can ruin our health is metabolic syndrome. This is a particular interest of mine, because on one side of my family, almost everyone has it, so I am also at high risk. It is a combination of at least three diseases: prediabetes or type 2 diabetes, high blood pressure, and undesirable levels of cholesterol and triglycerides, and excess weight around the waist. Fortunately, the Med-DASH plan addresses each of these problems.

Anyone who has rheumatoid arthritis (RA), which is also very sensitive to oxidants, can tell you about clinical inflammation. I have a neighbor with severe RA who wants desperately to avoid having to go on one of the biologic medicines, which can have severe side effects. She has discovered that a mostly plant-based diet, with fish, limited poultry, and almost no red meat, has done wonders for her inflammation. She does, however, get serious flare-ups if she has any meat. While she can draw an immediate connection between her diet and her symptoms, most of us cannot, and only find out about subclinical inflammation when we are diagnosed with a disease. Let’s see if we can avoid that.

The Gut, Its Microbiota, and Inflammation

We’ve always known that fiber is good for your gut. Fiber is not digestible, but it can be fermented in the digestive tract, and that fermentation produces gases that actually nourish your intestinal cells. Some types of fiber, such as soluble fiber, nourish the good bacteria in your intestines, which have also been found to be important for maintaining health and a healthy weight. There is a (perhaps disgusting-sounding) procedure called a fecal transplant in which stool from a healthy person is transferred into an unhealthy person. Fecal transplants have also been used in obese patients, and studies have found that if the transplanted fecal matter comes from a vegetarian, it is more likely to result in weight loss in the person who receives it. Vegetarians have a beneficial mix of intestinal bacteria that may be the direct result of a diet particularly high in fiber.

One of the most interesting new areas of exploration regarding inflammation and metabolic disease is of the bacterial population in the colon (large intestine). This microbiota is made up of ten times as many cells as we have in our whole body. These bacteria contain over three million genes, more than 150 times the number of genes we have in our whole bodies. Obviously, these bacteria must be very important for the proper functioning of the body’s systems. As I mentioned earlier, transplanting fecal bacteria (my apologies for this image) from a vegetarian to an overweight person has been shown to induce weight loss. It is now believed that the beneficial bacteria in the transplanted stool are the result of having a plant-rich diet.

The inflammation caused by an oversupply of bad bacteria leads to overproduction of certain immune cells, including mast cells, B-cells, macrophages, neutrophils, and T-cells, some of which can lead to the metabolic dysfunction that is associated with developing insulin resistance and to atherosclerosis.

Inflammation and Heart Disease

People rarely hear about inflammation and heart disease from their physicians. A few years ago, everyone was checking C-reactive protein (CRP) levels along with cholesterol and triglycerides. However, insurance companies balked at another “unnecessary” test, and the practice mostly fell by the wayside. CRP is increased in inflammation, but it isn’t specific for a particular disease. It could signal infection, cancer, heart disease, or several other issues.

We know from long-term studies that many of the key Med-DASH foods reduce the risk of heart disease. Previously we chalked all this up to lower cholesterol and blood pressure. But there is more to this story. Foods that are rich in antioxidants help protect your heart. It is oxidized LDL cholesterol that plugs up arteries. Antioxidants mostly come from plant foods that are rich in fiber to provide an extra boost to lower cholesterol.

A diet rich in fatty fish that are good sources of anti-inflammatory omega-3 oils is associated with a reduced risk of cardiovascular mortality. Recent studies of fish oil supplements have not shown the same advantages, although several older studies did show significant benefit. One of the largest was the GISSI-Prevenzione (Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto) trial, which showed a 40 percent reduction in cardiac sudden death and a 14 to 20 percent reduction in all causes of death by daily consumption of 1 gram of omega-3 fish oils per day for three and a half years. While we are now not so convinced about the supplements, fish as a whole food is beneficial for heart health. As in previously mentioned studies, most evaluations of supplements find that individual nutrients are not as beneficial as the whole foods from which they are derived. It is recommended that people have two or three servings (3 ounces or 90 grams cooked) of fatty fish per week (see Appendix D for good choices).

Oxidation and Disease Risk

It’s not just colorful foods that have antioxidant potential. For example, sulfur compounds that affect taste and scent in foods such as garlic, chives, and cabbage are very powerful antioxidants. Some chemicals in white foods, such as quercetin in potatoes, apples, and onions, have powerful antioxidant properties, and even may be related to slower aging.

Reducing the Risk for Cancer

Some types of cancer are based on genetic mutations, which may have occurred recently or many generations ago. But much cancer risk comes from lifestyle factors. Smoking, eating a diet of junk food, excessive alcohol consumption, too much exposure to sunlight, and inactivity are all choices we make and can therefore change. Some people are very concerned about food additives and pesticides in their foods, but the type of foods being consumed is actually more of a problem than either additives or pesticides. A discussion of these issues is beyond the scope of this book. However, if you choose to avoid industrial pesticides, organic foods are readily available in most regions of the country. Even better is growing some of your fruits and vegetables at home, where you have control over how the food is produced. Many organic farmers’ markets do a very good job of policing their food producers. Because the Med-DASH program is based on unprocessed or minimally processed foods, it is easy to avoid products with food additives.

Of course, a diet rich in fruits and vegetables is also rich in antioxidants. Reducing intake of omega-6 polyunsaturated fats, which are very susceptible to oxidation, is a great step and is encouraged in the Med-DASH plan. Although some wine can be part of the Med-DASH plan, overconsumption of alcohol is in no way part of this program.

Glucose is primarily stored in the muscles and secondarily in the liver, which is the primary reservoir for glucose that helps prevent blood sugar levels from dropping too low. Glucose is stored in the liver as glycogen, which is actually a human-produced form of starch. If your blood sugar drops too low, the hormone glucagon gets produced by the pancreas. It is used by the liver to break down glycogen into glucose, which the liver then pumps into the bloodstream to keep glucose from dropping dangerously low. Glucagon can also help initiate making glucose using amino acids (from protein), glycerol (from fats), and pyruvate and lactic acid (from glucose metabolism).

Many people develop insulin resistance (a component of metabolic syndrome) as they age. This is usually the result of a sedentary lifestyle, although there is also a genetic component to how likely you are to develop insulin resistance (IR). It is estimated that about one-third of adult Americans have IR, so it is quite common. With IR, the muscles stop responding as well to insulin. Your body pumps out extra insulin, trying to keep the glucose under control. However, fat cells, especially abdominal fat, still respond very well to insulin, which results in excess glucose getting stored in fat cells (primarily around your waist). This glucose can then be converted to more fat. As we gain more weight around our middle, the condition is amplified, making it worse and worse. And some of that excess glucose gets stored as fat in our liver. Too much of that results in what is known as nonalcoholic fatty liver disease (NAFLD), which is currently at an epidemic level in Americans.

Eventually, your pancreas is unable to produce enough insulin to keep glucose under control. Then your blood glucose levels rise to above a healthy level and remain elevated, even after you’ve fasted for eight hours. These elevated levels can show up in blood tests, and based on those results, your physician may diagnose you with prediabetes. If your fasting glucose level is over 126, your doctor will probably do additional testing to confirm whether you have type 2 diabetes.

Activity helps your body burn excess glucose for energy and can help resensitize your muscles to insulin. Even people with type 1 diabetes can develop insulin resistance, which causes you to need higher and higher doses of insulin. Three of the key benefits of the Med-DASH plan are that it avoids foods that will give you a sugar rush, it may help you reduce excess abdominal fat, and it encourages regular physical activity to burn glucose and help your muscles become more sensitive to insulin. Improved sensitivity means that your need for insulin decreases, and in the case of type 2 diabetes, it may help you avoid or delay wearing out your ability to produce enough insulin.

A Young, Healthy Brain

Muscle Power

Your body is as old as your muscles. Most people lose muscle as they age. The less muscle mass you have, the older your body is. The more you can preserve or increase muscle mass, the younger you will feel. Everything you do in your daily routine becomes much easier. Strength training is one of the most valuable and one of the most overlooked types of activity for maintaining your physical well-being. Another key element in maintaining muscle tissue is getting sufficient protein in your diet. As we get older, many of us do not consume as much protein as we need. As a percentage of total calories, we need proportionately more protein as we age (or as our body “doesn’t age”). The Med-DASH plan will provide sufficient protein to help keep your muscles strong, assuming that you do your part and stay physically active.

The Framework: Your Bones

The DASH diet and the Mediterranean diet have both been shown to be protective for bone health. Surprisingly, it’s not just the calcium these diets contain, although DASH includes many foods rich in calcium. Let’s learn how this works.

The traditional advice for people with osteopenia and osteoporosis has been to take calcium supplements. However, it has recently been found that these supplements do little for bone health without adequate vitamins D and K and may contribute to worsening the buildup of artery-blocking plaque. On the other hand, people who have diets rich in calcium are less likely to have heart disease.

This is another example of how supplements with isolated nutrients are less beneficial than consuming the whole foods rich in those nutrients. Having said that, many people do need vitamin D supplements. In the northern hemisphere, people living in areas north of Indianapolis, Philadelphia, and San Francisco cannot make enough vitamin D between September 21 and March 21, when the sun’s rays are more indirect, even if they are in the sun frequently. Even during the times of the year when the sun is more direct, many people do not make sufficient vitamin D because they wear sunscreen to protect their skin. Drinking milk and eating yogurt fortified with vitamin D are very beneficial; these foods are a key part of the Med-DASH plan for controlling blood pressure and provide minerals that support bone health. The same fish that are rich in omega-3 fats are very good sources of naturally occurring vitamin D.

Calories: 90

Fat (g): 1

Saturated fats (g): 0

Cholesterol (mg): 80

Rainbow trout

Calories: 140

Fat (g): 6

Saturated fats (g): 2

Cholesterol (mg): 60

Rockfish

Calories: 100

Fat (g): 2

Saturated fats (g): 0

Cholesterol (mg): 40

Salmon, Atlantic/coho

Calories: 160

Fat (g): 7

Saturated fats (g): 1

Cholesterol (mg): 50

Salmon, chum/pink

Calories: 130

Fat (g): 4

Saturated fats (g): 1

Cholesterol (mg): 70

Salmon, sockeye

Calories: 180

Fat (g): 9

Saturated fats (g): 1.5

Cholesterol (mg): 75

Scallops, 6 large, 14 small

Calories: 120

Fat (g): 1

Saturated fats (g): 0

Cholesterol (mg): 55

Shrimp

Calories: 80

Fat (g): 1

Saturated fats (g): 0

Cholesterol (mg): 165

Swordfish

Calories: 130

Fat (g): 4.5

Saturated fats (g): 1

Cholesterol (mg): 40

Tuna, canned in water

Calories: 116

Fat (g): 0.8

Saturated fats (g): 0.2

Cholesterol (mg): 30

White fish

Calories: 172

Fat (g): 7.5

Saturated fats (g): 1.2

Cholesterol (mg): 77

In the next two chapters, you will find examples of various ways to put the Med-DASH diet plan together. These are suggestions. Please customize the meal plans for your own tastes and preferences. The jump-start program in the next chapter will help you relearn how to eat. It will teach you how to create satisfying meals and snacks, and balance foods to satisfy hunger and avoid cravings. In the jump-start program do not skip any meals or snacks. You do not want to let your hunger get out of control. In the full plan, the afternoon snack is optional, according to your hunger level. This is also a very important foundation of the full Med-DASH plan, and the jump-start program teaches you how to accomplish this. You will get all the benefits of the full plan, but intensified.

Welcome to the Med-DASH program.

Grams per serving

ALA: 0.04

DHA: 0.63

EPA: 0.28

Food: Soybean oil, 1 tablespoon

Grams per serving

ALA: 0.92

DHA:

EPA:

Food: Trout, rainbow, wild, cooked, 3 ounces

Grams per serving

ALA:

DHA: 0.44

EPA: 0.40

Food: Black walnuts, 1 ounce

Grams per serving

ALA: 0.76

DHA:

EPA:

Food: Mayonnaise, 1 tablespoon

Grams per serving

ALA: 0.74

DHA:

EPA:

Food: Oysters, eastern, wild, cooked, 3 ounces

Grams per serving

ALA: 0.14

DHA: 0.23

EPA: 0.30

Food: Sea bass, cooked, 3 ounces

Grams per serving

ALA:

DHA: 0.47

EPA: 0.18

Food: Edamame, frozen, prepared, ½ cup

Grams per serving

ALA: 0.28

DHA:

EPA:

Food: Shrimp, cooked, 3 ounces

Grams per serving

ALA:

DHA: 0.12

EPA: 0.12

Food: Refried beans, canned, vegetarian, ½ cup

Grams per serving

ALA: 0.21

DHA:

EPA:

Food: Lobster, cooked, 3 ounces

Grams per serving

ALA: 0.04

DHA: 0.07

EPA: 0.10

Food: Tuna, light, canned in water, drained, 3 ounces

Grams per serving

ALA:

DHA: 0.17

EPA: 0.02

Food: Tilapia, cooked, 3 ounces

Grams per serving

ALA: 0.04

DHA: 0.11

EPA:

Food: Scallops, cooked, 3 ounces

Grams per serving

ALA:

DHA: 0.09

EPA: 0.06

Food: Cod, Pacific, cooked, 3 ounces

Grams per serving

ALA:

DHA: 0.10

EPA: 0.04

Food: Tuna, yellowfin, cooked, 3 ounces

Grams per serving

ALA:

DHA: 0.09

EPA: 0.01

Food: Kidney beans, canned, ½ cup

Grams per serving

ALA: 0.10

DHA:

EPA:

Food: Baked beans, canned, vegetarian, ½ cup

Grams per serving

ALA: 0.07

DHA:

EPA:

Food: Ground beef, 85% lean, cooked, 3 ounces

Grams per serving

ALA: 0.04

DHA:

EPA:

Food: Bread, whole-wheat, 1 slice

Grams per serving

ALA: 0.04

DHA:

EPA:

Food: Egg, cooked, 1

Grams per serving

ALA:

DHA: 0.03

EPA:

Food: Chicken, breast, roasted, 3 ounces

Grams per serving

ALA:

DHA: 0.02

EPA: 0.01

Food: Milk, low-fat (1%), 1 cup

Grams per serving

ALA: 0.01

DHA:

EPA:

Health Myths, Busted!

There are health and nutrition myths that get you off track and prevent you from actually becoming healthier. Many of them even have been and continue to be promoted by health professionals and mainstream media. Some come by word of mouth. But clearly, if we want different results, we need to reexamine our underlying beliefs about the things that will make us healthier, including how we eat. Let’s dispose of the myths.

“I know what I have to eat, I just choose not to do it.” If your eating plan or diet is too hard to follow or doesn’t fit into your lifestyle, perhaps it is off track. And if it doesn’t include the foods you really love, how can you stay with it? Perhaps you don’t know as much as you think about what to eat, and have thought that you have to be very restrictive. If you are looking to improve on what you are doing to get better results, you really need to be open to change and new ideas on diet.

“I watch my calories, but I’m not able to lose weight.” When you follow the guidelines for the Med-DASH program, you don’t need to watch calories. You will be pleasantly satisfied without overdoing calories.

“I do boot camp [or run 5 miles, do 200 crunches, etc.] every day, but I can’t lose weight.” Sometimes, when people start exercising heavily, they either increase their eating or are so fatigued after exercising that they become less active later in the day. In fact, I have seen this when counseling Olympic-caliber figure skaters. After hours of practice, some adopted slug behavior and then found weight creeping on, even while they restricted what they ate. And not all exercise will give you the results you are seeking. Doing 200 crunches or lunges will not provide much benefit for the amount of tedious effort you’re expending, and can make you hate to exercise rather than promoting a healthy, active lifestyle.

Dangerous Nutrition Myths

We don’t just have misconceptions about how to be healthy, but also about what to eat. So let’s throw out what we don’t need from the counterproductive nutrition advice of the past. We will rid ourselves of the dangerous nutrition myths of the last twenty-five years!

Eat 11 or 12 servings of grains each day.

It’s hard to imagine food guidelines recommending that someone should eat eleven or twelve slices of bread every day. But that’s exactly what we got with the Food Guide Pyramid from 1992. People joyfully piled on the carbs. Not beneficial whole grains, but plates heaping with pasta, endless bread baskets, and boxes of fat-free cookies. While Americans became more obese. Research has shown that foods that contain more moisture are more satisfying and filling. Bread? Very dry. Dense with calories. It’s so easy to finish each refill of that endless bread basket, because we don’t get full. Do you remember people eating whole boxes of cookies because they were fat-free? And yet they had the same amount of calories as the regular cookies and were higher in junk carbs.

Juicing and smoothies are a great way to get fruits and veggies into your diet.

Small changes are best.

Weight loss is the goal of your diet.

Weight loss is not your goal. Sustainable weight loss is your goal (that is, if you need to lose weight). You only want to lose fat, not muscle. In the paragraph above, you learned about maintaining metabolic rate by maintaining muscle. You need to eat enough protein. To lose fat, we don’t want to excessively restrict fat, however, because fats are critical for satisfying hunger. It’s the empty carbs, the ones with no fiber and not much in the way of vitamins or minerals, that are the problem. Empty carbs aren’t just sugar, but also include refined grain products, which are mostly starch. Occasionally they may still be referred to as complex carbohydrates (another holdover from the ’90s). However, they aren’t that complex for the body to break down. And they get broken down into 100 percent glucose. Gram for gram, starch produces more glucose than table sugar (sucrose). Sucrose only breaks down to 50 percent glucose (with the rest being fructose). Over time, excessive intake of starches can wear out your body’s ability to produce sufficient insulin, which can lead to type 2 diabetes. Furthermore, any excess glucose your body doesn’t need for quick energy gets stored in your fat cells, primarily in your belly fat. Excess weight around your middle isn’t just a problem for how your clothes fit—it is associated with increased risk for heart disease, diabetes, high blood pressure, and some types of cancer.

It’s in my genes to be heavy [or to have heart disease, or diabetes, etc.].

Nobody needs to lose weight.

While research has shown that people who journal what they eat are more successful at reaching their health and weight goals, with this program, you do not need to track calories. Rather, you will track how many servings you eat from different food groups. Eating enough fruits, veggies, protein, dairy, etc., is key to getting all the benefits of the Med-DASH eating plan, especially since DASH is based on specific ranges of servings from the various food groups. The hidden benefit of this plan is that you will feel more satisfied with your meals and snacks, without fearing that you are going to overeat. You will develop habits that will take over and make it easy to follow the Med-DASH plan without thinking too much about it. So relax and enjoy the fabulous foods!

To lose weight, just reduce your calorie intake and exercise more to give a 500-calorie-per-day deficit.

But it’s healthy!

Lots of people think that if a food is healthy, they can eat as much as they want. For example, my husband will find a pint of blueberries in the refrigerator and finish it in one sitting. Or some people have several bowls of a whole-grain cereal because it’s healthy. Yes, of course these foods are healthy, but you really want to have a mix of healthy foods. What could you include with the berries to avoid overdoing? Something with some protein, like yogurt. What would help you avoid bingeing on cereal? Perhaps topping it with some of those blueberries or some other favorite fruit. Fill the bowl with lots of milk, which is protein rich. The meal or snack will be more satisfying (and healthy) if it contains a variety of types of foods.

Eat Less, Move More (ELMM).

The Time Is Now. Let’s Start the Rest of Your Life!

Since we are so used to having short, pithy, albeit useless nutrition sayings, perhaps we can work with some that are actually true and helpful. Ones that can help you learn how to eat in a positive way for the rest of your life. Let’s adopt some new nutrition slogans—helpful ones.

If you want different results, you need to do things differently.

Oops! This one is really hard for many people. It can be very difficult to give up all these myths that you were told would make you healthier. For some people, it’s the smoothies or the protein bars that will be difficult to change. For others, it’s adding foods with heart-healthy fats instead of always choosing fat-free foods. They may believe it will be impossible to survive without their old ideas, which have become the bedrock foundation of how they eat. If you are here to get different results and adopt a new way of eating, let’s give it a try and move forward.

Eat to satisfy hunger and stay full longer.

Focus on what to include, not what to limit.

Traditionally, diet books have focused on what to avoid. Bad foods. Excess calories. Scrap that! How much more fun will it be to focus on what you want to include, not what you want to limit? What could be better than fresh foods? Delicious, beautiful food, with a Mediterranean overlay. Italy, Greece, Spain, southern France, Morocco, and the coastal regions of the eastern Mediterranean Sea. This is where the Slow Food movement isn’t just a trend but a way of life. How fabulous to be able to enjoy the flavors of fresh foods and the region’s herbs and spices! All your favorites. This is living!

Follow a lifelong eating pattern.

It is great to find a healthy eating plan. But what good does that do you if you can’t sustain it for the long run, if you are hungry a half hour after you’ve eaten, if you or your family don’t really like the foods on the plan, or if it doesn’t fit into your lifestyle? The Med-DASH plan is going to change all that, right here, right now! Great-tasting, beautiful food. Satisfying meal plans.

Focus on Your Motivation

Taking care of your health can seem quite a challenge in a busy life. And it might seem like it would be okay to wait a few years until you really get concerned about it.

There are all kinds of motivations for getting started on a new plan. But first, you need to think about what you are willing to do. If you set your expectations super high, you may disappoint yourself if you can’t be perfect, quickly. If your goal is to add more cardiovascular (aerobic) activity to your day, you don’t start by trying to run a marathon. Obviously, this would set you up for failure. But can you walk for 10 minutes? Or maybe a half hour? That would be a great start.

You want to set realistic expectations, which are achievable. Focus on your actions rather than the outcomes you are expecting. Can you add more vegetables to your diet? Sure! Can you have some yogurt as a snack? Sure! Can you spend 10 minutes walking today? Sure! Can you go to the grocery store and buy more fresh and frozen vegetables and fruits? Of course! These are practical steps you can take as you get started on this plan. By focusing more on the actions that you will take, you will find that this plan becomes much easier and less stressful than if you focus solely on your desired outcome.

In this book, you will learn strategies to make the Med-DASH plan work for your whole family. This plan will set the stage for your success. You will have meal plans that you can follow precisely or use as templates for your own food preferences. Whether you are a part-time or full-time vegetarian or a dedicated carnivore, you will find support for how you like to eat. You will learn what to keep on hand to make it easy to follow the Med-DASH program—how to stock up, how to do some prep work to make your week easier—and find recipes that are delicious as well as easy to make. Like to eat out frequently? Fear not. You will be able to maintain your lifestyle with our tips.

You are on to a new adventure. Fabulous food, good health, and desirable weight. All in one plan. Your Med-DASH program.

Make it extra special by topping with fresh whipped cream and zest from an orange or lemon.

Note: I tested this recipe using 1 teaspoon of Valencia Dried Orange Peel from McCormick Spices Gourmet Collection.

Instead of buying processed lunch meats, roast a turkey breast or beef roast and slice it after it has cooled. If you are doing some grilling on the weekend, double up. Make twice what people will eat so that you can pull out some healthy grilled chicken breasts or lean hamburgers if you get home late or the kids are starving when they walk in the door. Pack breakfast, snacks, and lunch the night before. Make a sandwich with the sliced beef or turkey. Top it with a slice of cheese and some mustard. Separately, bag up some lettuce and a slice of tomato (you don’t want them making your sandwich soggy). Add some yogurt, cut-up raw veggies, maybe a slice or two of cheese, and some fresh fruit. Pop these in an insulated bag, and you will be on your way quickly in the morning. Prefer salad for lunch? There are many great containers with separate compartments for the salad dressing. (And make sure it isn’t a low-fat or nonfat dressing. Those will not keep you feeling full long enough.)

The Coffee Shop

On the Job

At the Restaurant

Plan what you will order before you go to the restaurant. Then you won’t be tempted to get off track when you’re there. Choose a salad, two vegetables, a good protein source, easy on the starches. Italian restaurant? How about chicken or fish? Chicken Parmesan or piccata? That works. No bread with your salad. Skip dessert. Chinese? Use some steamed vegetables such as broccoli or peppers as the base for your meal instead of rice. You still have all the flavor, but you are having a much lighter meal. Casual American? No bun on the burger, side salad. Fine dining? Lean, protein-rich foods such as a filet mignon (tenderloin is very lean), chicken, or grilled or baked fish. Lots of veggies, and a starting salad or maybe a seafood appetizer.

Fast Food

Kids

When you are making dinner, you don’t have to make a separate meal for yourself. If you are making a meal with potatoes or rice for your family, don’t put them on your plate (but do add an extra vegetable serving to your meal).

The most challenging situation is casseroles. Yes, they can be easy and very tasty family meals. Try to make casseroles that don’t have a high starchy or creamy sauce. Make sure to have “extra veggies” on your plate so you don’t feel like you have to eat all the starch in the meal. And try to avoid high-salt sauces.

If your kids don’t like fish, think about making some of your own lunches with tuna or salmon salad. Or grill some chicken for the kids and some fish for yourself, and make enough so that you have leftovers that you can use to top a salad tomorrow.

Making spaghetti? Have the sauce on top of veggies for your personal meal while the rest of your family has the pasta. I promise it is delicious. And add a side salad to get extra filled up. Make sure there is some lean source of protein such as lean ground beef or turkey in the sauce. If you add sausage, just have a little, and portion out more of the meat sauce for yourself.

It’s a Party!

One of the major pitfalls at parties is drinking. The best strategy is to alternate wine with water. Have the water in your wine glass, so you will still feel like you are drinking and being social and enjoying everything about the party. And you won’t feel like you are missing out on anything.

Got Allergies? No Problem!

Food allergies and food intolerances seem to be spreading to almost everyone we know. The most common food allergies are peanuts, tree nuts, dairy (from cow’s milk), fish and shellfish, soy, and eggs. Fortunately, the Med-DASH program is flexible enough to accommodate almost everyone. When you prepare most of the food that you eat, you have more control over the ingredients and are less likely to encounter hidden food allergens.

Allergies to nuts, seeds, and peanuts are common and can be life-threatening. If you have one of these allergies, clearly you want to avoid any foods that could cause an anaphylactic reaction. You can get more of the same heart-healthy fats from avocados and olives or olive oil.

After U.S. dietary guidelines were changed in the mid-1980s, people were encouraged to dramatically cut down on fats. We had fat-free dressings, fat-free cheese, fat-free cookies. All of it designed to reduce calories. Since fat is calorie-dense (containing 9 calories per gram instead of 4 calories like starch, sugar, and protein), it logically seems that this would help lower calories and make it easy to lose weight. Is that how it turned out? No. Since those guidelines appeared, the United States went from having 15 percent of adults being obese to 38 percent.

How could this happen? One of the benefits of fats is that they help you to feel full after a meal or snack; we call this satiety. And it is a very important concept in feeling satisfied with moderate amounts of food. This might seem like a no-brainer, when you consider how we react to food. And yet fat reduction was pushed as a way to avoid excessive intake of calories.

Another benefit of fats is that they help with the absorption of certain key vitamins, the fat-soluble ones, like vitamin A, vitamin D, vitamin E, and vitamin K. The very important antioxidants, carotenoids, are also fat soluble. They include beta-carotene (the orange in carrots and the provitamin converted to vitamin A in the body), lutein (a pale yellow in sweet corn, and found in especially high levels in spinach), lycopene (the red color from tomatoes), and zeathanthin (a red-orange compound found in high amounts in leafy green vegetables, among others). While the names of these phytochemicals are not important to remember, fruits and vegetables are rich in them, and they can have a significant impact on your overall health and well-being. You have long heard about the health benefits of antioxidant-rich foods, and now you know a little more about how they perform their magic. How sad that the old dietary guidelines emphasized low-fat eating, which reduces the absorbability of these key nutrients during digestion.

Which Fats?

Okay, so which fats should we choose? What makes a fat heart-healthy? Let’s discuss some of the most common fats, including important health information about each.

Olive oil: Olive oil is well-known to be good for your heart and is a very important part of the Mediterranean diet. It is rich in monounsaturated fats, especially oleic acid (so named because it comes from olives). DASH diet studies have shown improvements in blood pressure by replacing empty carbs with olive or canola oil. Olive oil consumption is associated with other benefits, including less inflammation and lower rates of some kinds of cancer.

Furthermore, ALA is very poorly converted to DHA in the body, and DHA and EPA are the omega-3 fats that are truly beneficial for heart health. When evaluating the health benefits of foods, I believe that the most powerful evidence is how it affects health over the long term. There is no long-term evidence of people eating flaxseeds throughout history, although flax was widely grown for making linen. Generally, foods that can be harmful to health are not part of traditional cultural eating habits.

Essential fatty acids include the omega-6 fatty acid linoleic acid (LA) and the omega-3 fatty acid ALA. (An essential fat is one that is essential for health but that your body cannot make on its own, so it must be derived from foods. They should not be confused with essential oils, which are the essences of certain plants.) You want to have more of the anti-inflammatory omega-3 fats in your diet and less of the omega-6 fats. Arachidonic acid (AA) is an omega-6 PUFA made in your body from LA, which can be either beneficial or harmful, depending on the level in your system. Although AA helps to control inflammation at low levels, excessive amounts can trigger rampant inflammation, as can LA, although it is an essential fatty acid. Dietary DHA and EPA fish oils are long-chain omega-3 PUFA that are associated with lower total cholesterol, lower triglycerides, and reduced blood clotting risk. In the United States, dietary omega-6 PUFA come primarily from corn oil and soybean oil. These are precisely the oils that were recommended since the early 1970s as replacements for solid fats like butter. They became widely used in our homes and in the preparation of processed foods. They are relatively neutral tasting and inexpensive, so they have been used extensively. If you consume a high ratio of omega-6 to omega-3 fats, you may have more inflammation. Most experts recommend a ratio of 4:1 to 1:1. The typical American diet is in excess of 10:1, which may be a factor in the current epidemics of chronic disease related to inflammation.

Protein

If you don’t get enough protein, you will lose muscle and your metabolism will slow. Today people are encouraged to get more protein, especially women, the elderly, and people trying to lose weight. The more muscle you have, the faster your metabolic rate, and the healthier you will be. Loss of muscle is one of the key causes of frailty and disability in the aged.

The best-quality protein for sustaining growth and maintaining muscle is egg albumin, closely followed by milk whey protein, beef, and casein (the chief protein in cow’s milk). The quality is primarily due to the mix of essential amino acids in these animal proteins but is also impacted by digestibility. However, it is possible to be perfectly well nourished from eating a vegetarian or vegan diet. At one time it was thought that vegetarians had to have “complementary” proteins at each meal in order to have the right amino acid mix to allow for rebuilding and repair of muscle and other tissues. For example, some plant-based foods that are complementary are rice and beans, peanut butter and wheat bread, and corn and beans. In each of these combinations, one food fills in some of the amino acid inadequacies of the other. Together, they make foods that behave just the same as the complete proteins. We no longer believe that it is critical for adults to have complementary proteins at the same meal. Adults have a large mix (a “pool”) of free amino acids floating around in the bloodstream, so there are adequate amounts of the right amino acids to fill in for any deficiencies in an individual food to have normal protein metabolism for body maintenance and repair and keeping (or building) strong muscles. Children, however, can benefit from food combining to have the complementary proteins at their meals.

Carbs

In many fad diets, “carbs” is considered a dirty word. Certainly, processed grains and added sugars are not essential to anyone’s diet and are basically empty calories which most of us don’t need.

In the original DASH diet research, carbs were used to provide enough calories so that people did not lose weight during the study period. If the participants had lost weight, it would have made it difficult to evaluate whether the diet pattern or weight loss was the beneficial factor for lowering blood pressure. Subsequent DASH diet research has shown that replacing empty carbs with either protein-rich foods or higher levels of MUFA-rich fats actually gave significantly improved blood-pressure-lowering benefits compared with the higher-carb plan and, as a side benefit, helped to lower triglycerides.

During absorption of your digested foods, glucose can be converted to fructose, and vice versa. Both glucose and fructose end up in your bloodstream, but glucose is the sugar that gets measured when people have diabetes. Insulin is required for glucose to be taken up by muscle tissue, whereas fructose does not need insulin to be metabolized. Fructose is more likely to be used by the liver to make triglycerides either for storage (which can result in fatty liver) or for pumping out into the bloodstream.

Vegetables of all kinds are other terrific sources of both soluble and insoluble fiber. I personally don’t care for hot cereals, but most people do, and you probably know that oatmeal and barley are rich in soluble fiber that helps lower cholesterol and can be very filling. I do love cold cereals, such as the whole-wheat or bran cereals, which help to keep you regular. When they are topped with milk, you get a dairy serving; adding berries or bananas brings in fruit and additional fiber. If you eat breakfast at work, you can bring a cup of fruit yogurt and mix dry cereal into it. There are so many ways to add delicious fiber-rich foods into your diet.

The very important point of the Med-DASH program is that you are eating mostly unprocessed or minimally processed foods, such as yogurt, cheeses, milk, and frozen vegetables and fruits. You could also add fresh (or frozen) meat, poultry, and seafood to that list of minimally processed foods. If you choose to eat more unprocessed foods, with few or no additives, it is very easy to follow the Med-DASH eating plan.

Calories: 155

Saturated fat (g): 2.2

Total fat (g): 6

Top loin (strip) steak

Calories: 161

Saturated fat (g): 2.3

Total fat (g): 6

Shoulder petite tender and medallions

Calories: 150

Saturated fat (g): 2.4

Total fat (g): 6.1

Flank steak

Calories: 158

Saturated fat (g): 2.6

Total fat (g): 6.3

Shoulder center (ranch) steak

Calories: 155

Saturated fat (g): 2.4

Total fat (g): 6.5

Tri-tip roast and steak

Calories: 158

Saturated fat (g): 2.6

Total fat (g): 7.1

Tenderloin roast and steak

Calories: 170

Saturated fat (g): 2.7

Total fat (g): 7.1

T-bone steak

Calories: 172

Saturated fat (g): 3

Total fat (g): 8.2

As a diet plan, the Med-DASH eating pattern is all about health. Weight loss is an important side benefit (if that is your goal). You will not feel like you are on a diet. This may be confusing, but it is so much more mentally healthy to not focus on your weight but on how the plan makes you feel. Are your clothes fitting looser? Do you feel more energetic? Have you been to the doctor and been told that your blood pressure is much better or your lipid levels are much improved?

Traditionally people have thought about diets as a way to lose weight. The Med-DASH plan is different. This is an eating pattern designed to be delicious and keep you healthier, and it can support weight loss, especially unhealthy abdominal fat. But how does this plan make us healthier? What have we been doing wrong that gave us these epidemics of obesity, cardiovascular disease (CVD), high blood pressure, and type 2 diabetes? Let’s look at metabolic obesity, which may help us tie things together.

Metabolically Obese

Med-DASH changes the focus from cutting calories and doing strenuous exercise to eating and moving joyfully. It is a plan you can sustain and embrace because it is satisfying on both counts.

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In general, if you are choosing fresh, unprocessed foods, you do not need to worry about food labels.

People who have been trying to lower their blood pressure have heard one thing: Lower sodium intake. However, there can be misconceptions about when sodium in foods is problematic. There is naturally occurring sodium and added sodium. Milk is an example of a whole food that has a fair amount of naturally occurring sodium, but that is not something to avoid, since you get more of the blood-pressure-lowering benefits of DASH when you include milk in the diet than you do without. The added sodium in processed foods is what you want to avoid. Just like with sugars, where we want to limit added sugars. Milk typically has 12 grams of sugar (lactose), but it is not added sugar. Yogurt is even more challenging to understand. The nutrition label reflects the composition of the milk before fermentation. Most of the lactose has actually been converted to lactic acid during that process, so the yogurt’s sugar content is thus much lower than it appears to be based on the label. Greek yogurt can have even less residual lactose than regular yogurt.

First, it is important to note that all serving sizes are based on an “as consumed basis.” This means that meat, poultry, and fish serving sizes are based on the food’s weight after cooking. Cooked grains, like hot cereals, grits, rice, and pasta, are based on the cooked weight. And just to make it more challenging, there are two kinds of ounces. “Fluid ounce” refers to the volume of a liquid, and “ounce” refers to the weight of a solid.

Note: The images above are meant for illustrative purposes to show how the new Nutrition Facts label might look compared to the old label. Both labels represent fictional products. When the original hypothetical label was developed in 2014 (the image on the left-hand side), added sugars was not yet proposed so the “original” label shows lg of sugar as an example. The image created for the “new” label (shown on the right-hand side) lists 12g total sugar and 10g added sugar to give an example of how added sugars would be broken out with a % Daily Value.

Source: U.S. Food and Drug Administration

To the Market!

We have all heard the advice about sticking to the perimeter of the grocery store. This is still great advice. The foundation of the Med-DASH plan is found there. Fruits and veggies in the produce area. Lean meats, poultry, and fish at the meat and fish counters. The dairy cases for milk, yogurt, cheese, and eggs. Beans, nuts, and seeds may be in a bulk bin in the produce area. Venture inside the aisles for canned tuna or salmon. Find your whole-wheat bread. Choose some whole-wheat pasta, beans, and rice. Think about shopping the grocery store in a new way.

Produce

The salad bar can be a great source for cut-up smaller portions of fresh fruits and veggies. Many stores also have cut-up fruits and veggies near the produce section. Since one complaint about fresh food is that it can go bad before you are ready to consume it all, this is a great option to have ready-to-eat freshness in an easily consumable amount with minimal waste.

Let’s hit the seafood counter first. Salmon is always a great choice, both flavor-wise and nutritionally speaking. Farmed and wild salmon are both good choices, rich in the omega-3 fats DHA and EPA, which are so healthy. Tuna, rainbow trout, halibut, and mackerel are additional great choices. Many types of crustaceans are also delicious, healthy options. Lobster and crab have cholesterol levels similar to lean meat but are very low in fat and calories compared with meat. Shrimp has a slightly higher cholesterol content but is also very low in fat and calories. And as we discussed, there is no need to fear eating high-cholesterol meals occasionally.

Inside the Aisles

Find some whole-wheat bread (whole wheat should be the number one ingredient). As a reference point, a typical slice of bread will have about 80 calories, although the Nutrition Facts label will list the calories for 2 slices, as a typical serving size. My personal preference is for light breads, which have about 45 calories per slice, so you can have two slices for your sandwich but only count it as one Med-DASH serving. Multigrain breads are not necessarily healthier than whole-wheat, so choose what you like. If you are choosing flatbreads or tortillas, again, 80 calories is the equivalent of one serving. Many larger tortillas, like those used for wraps, are about 120 calories. This will sneak in extra calories, which is probably not your goal.

When it comes to dried foods, most of the time, choose whole-wheat pasta or other types of pasta with high amounts of fiber, or skip the pasta and use veggies instead. If you like rice, I am going to surprise you and recommend white rice. Brown rice has been shown to have relatively high levels of arsenic (from the soil in which it grows), so you probably want to avoid it, especially if you eat rice frequently, and especially for babies. White basmati rice grown in California, India, or Pakistan, and sushi rice grown in the United States have been shown to have the lowest arsenic levels (as of the writing date of this book). If you’ve never tried basmati, you are in for a treat. I think it tastes “rice-ier” than regular long-grain American rice. When it’s time to cook white rice, don’t wash it first. The added vitamins are applied to the surface, so you don’t want to rinse them away. The same thing is true for adding extra water than is needed for cooking. Please don’t. Discarding excess cooking water discards important vitamins. Use just enough water as recommended by the cooking directions (generally two parts water to one part uncooked rice).

Beans are generally sold near the pasta and rice. Any type of dried bean is great for the Med-DASH plan. Low-sodium canned beans are another good choice and make it super easy to pull together quick, healthy meals.

Grocery List

Following are some ideas to help you create your grocery list to stock up your kitchen with DASH-friendly foods:

Canned, Bottled, and Dry Foods

Dry Foods

Spices and Herbs

Refrigerated

Fresh from the Market (Don’t forget farmers’ markets!)

Meat Counter

Dairy

Having the right equipment will make your life easier, whether you like to cook or don’t want to spend your time cooking. It’s always fun to rethink what you have in your kitchen. Still hanging on to your bread machine, but no room for a Zoodle maker? Let’s look at some interesting ideas for stocking up your kitchen.

Dressings and Sauces

Making your own salad dressings is the only way to be sure they contain healthy oils and avoid unwanted additives. And they’re so easy to make. A side benefit is that it helps you use up your olive oil supply so it doesn’t get old or develop off flavors.

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.

What to Choose

Oils

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.

Lean Meats and Poultry

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

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.

Eggs

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.

Herbs and Spices

Chocolate

Cereals and breads: bran cereals, Mueslix, pumpernickel bread

Meat and poultry: pork and, at lower amounts, beef and poultry

Seafood: halibut, salmon, cod, clams, tuna, rockfish, rainbow trout, lobster, crab

Dairy: milk, yogurt

Miscellaneous: coffee, molasses, tea, tofu

Magnesium-Rich Foods

Fruits and vegetables: avocado, banana, beans, beet greens, black-eyed peas, cassava, fig, lentils, okra, potato with skin, raisins, seaweed, spinach, Swiss chard, wax beans

Whole grains: amaranth, barley, bran, brown rice, buckwheat, bulgur, granola, millet, oats, rye, triticale, whole wheat, wild rice

Dairy: milk, yogurt

Nuts: almonds, Brazil nuts, cashews, flaxseeds, hazel nuts, macadamia nuts, peanuts, pecans, pistachios, pumpkin seeds, sesame seeds, soybeans, sunflower seeds, walnuts

Seafood: salmon, tuna, lobster, halibut, cod

Note: I used Turkish honey from Trader Joe’s.

Would it reassure you to know that there are only two diets that have stood the test of time? And that they are completely compatible, complementary, and even better together? Why not choose the best of the best? This is the moment to change your life.

The DASH diet and the Mediterranean diet are the plans that endure. Year after year. They have stood atop the best diet rankings every year that the panel of experts from U.S. News & World Report has rated all the popular and also-ran diets. The DASH diet is extra rich in fruits and vegetables, low-fat dairy, and nuts, and includes mostly whole grains, lean meats, fish, and poultry, and moderate amounts of heart-healthy fats. The Mediterranean diet is also based on all those foods, along with an emphasis on seafood, olive oil, beans, herbs, and spices, and the optional inclusion of red wine. When you combine DASH with the Mediterranean diet, you truly have the best of the best. Not a fad. The only diets that have stood up under scrutiny. Because they work and have been proven to work in multiple, multiple studies. No diets have been this researched. No other diets have this kind of medical pedigree. Even better together, they help people get healthier and support reaching and maintaining a healthy weight. Easily. Deliciously.

What is the promise of the Med-DASH program? Heart health is what garnered all the attention for the DASH diet and the Mediterranean diet. Lower blood pressure. Lower cholesterol. Reduced rates of heart attack, stroke, and heart failure. And there is so much more. Research shows that DASH is associated with improved brain health and reduced systemic inflammation, along with lower risk for type 2 diabetes, some types of cancers, and fatty liver disease. This is the way healthy people have been eating for generations. Before all the processed foods and easy access to junk food. Back when food was slow and delicious.

Does this seem like a miracle? It may be, but it is based on the real-life results observed by studying how the healthiest people have eaten over the years. Do they eat more vegetables? Check! More fruits? Check! Healthy, protein-rich foods? Check! Add to that the fats that are beneficial for your heart, particularly from olive oil, avocados, nuts, and seafood. The Mediterranean people usually complement their meals with red wine—which is completely optional, but you can do that on this program if you’d like. All these habits combine to make a complete program or eating style that you will love and appreciate for your health, your well-being, and your gastronomic pleasure.

The epidemics of chronic disease are the result of our having destroyed our bodies with low-level inflammation that is mostly the result of unhealthy eating. This inflammation is the root cause of plaque buildup in the arteries. Inflammation causes the body to store excess carbs as belly fat (also called visceral fat) and leads to fatty liver disease, both of which are associated with the development of type 2 diabetes. Inflammation is considered to be a factor in initiating some cancers, including some types of breast cancer and colorectal cancer. Poor diet and unhealthy weight are at the root of this inflammation. We need to reexamine how we eat and find out how to make it easy to follow a realistic, healthy eating plan. We need a sane plan that is time-proven, with self-evident health benefits.

Neither the DASH diet nor the Mediterranean diet was brought to you by any lobbyist. Nor were they promoted by advertising or highly paid publicity agents. These two plans, DASH and Med, were created by looking at what the healthiest people eat and have eaten over long periods of time. But sadly, these scientific breakthroughs were just languishing, waiting for someone to turn them into real-life solutions, with, perhaps, a little of the glamour of the fad diets.

Many of the fad diets have been focused on the “don’t eat” principle. Don’t eat gluten. Don’t eat meat. Don’t eat foods that ever had a face. Don’t eat animal foods at all. Don’t eat white foods. Don’t eat nightshade foods. Surprise! We are not going there. We will focus on the “let’s eat” principle—what you should include. A positive focus that prioritizes delicious, vibrant, beautiful eating.

Another Mediterranean country with lower rates of heart problems is France. They eat lots of cheese, meat, and white bread, yet they do not suffer from high rates of heart disease. This is described as the French Paradox. Of course, they eat moderate portions and are famous for their green salads (salades vertes) with every meal. They are also likely to have fruit for dessert and snacks. They include vegetables with their meals, have regular consumption of coffee and wine, and walk everywhere. When you are on the streets of Paris, you are struck by all the flat bellies. So different from the plump bellies we see on most Americans, which are not just a size issue, but are indicators of metabolic illness.

The DASH diet is a specific eating pattern, rich in plant-based foods, which was originally designed to lower blood pressure without medication. It was, additionally, designed to be the healthiest possible diet that would be acceptable to the eating style of the average American. It well-known that traditional vegetarians living in the United States live longer and have fewer chronic diseases than the average American. A vegetarian diet formed the basis of the DASH diet. However, researchers knew that most Americans wouldn’t want to follow such a strict plan, so DASH also incorporates meats, poultry, and fish. It is extra rich in fruits and vegetables, and includes dairy, beans, nuts and seeds, mostly whole grains, and heart-healthy fats.

The DASH diet delivers the vegetarian benefits, but without making you give up some favorite foods (although it fully supports a wholly vegetarian eating plan, if that’s what you want).

The Mediterranean and the DASH diet plans are so similar that it seems perfect to put them together. Who wouldn’t want the promise of longer, healthier life? Who wouldn’t want the promise of being able to reduce or eliminate dependency on medications? But of course, we want the plan to be something we can actually follow in a real life, with all of its time challenges, and it should accommodate our own personal tastes and food preferences. We want a plant-based diet, with some flexibility, and we are completely willing to incorporate olive oil to make our meals more satisfying.

Our two mash-up plans:

Each is plant-focused and includes beans, nuts, and seeds; dairy; olive oil and other heart-healthy fats; as well as seafood and moderate amounts of meats for those who choose to include them. Both are associated with lower risks for cardiovascular disease and type 2 diabetes.

The health benefits seem almost miraculous. DASH controls high blood pressure as well as the first-line medications. Let that sink in. As well as the first-line medications! The 2017 blood pressure treatment guidelines for stage 1 hypertension recommend the DASH diet, along with the Mediterranean diet, as part of the lifestyle strategies for controlling the “silent killer.” DASH also helps lower cholesterol and is associated with reduced risk of strokes, heart attacks, heart failure, some kinds of cancer, type 2 diabetes, and kidney stones. And though not originally designed as a weight-loss plan, DASH easily adapts, and helps people reach and maintain a healthy weight. It provides more satisfying meals and snacks, which make it easy to manage hunger and avoid overeating. Who would not want all these benefits in one package?

The Mediterranean diet has also been shown to be directly associated with many health benefits. Heart health and longevity were the first observed benefits. New studies have suggested that the Mediterranean diet may help stave off the deterioration of cognitive function on aging, and perhaps even Alzheimer’s disease. It may help relieve depression and reduce the risk for colon cancer.

Let’s learn a little more…

The DASH Diet

As we have noted, it was observed that, in general, vegetarians living in the United States had lower blood pressure and lower rates of heart disease mortality than people eating a more traditional Western diet. But few Americans would be willing to give up meat even if it meant reducing the risk of a heart attack. Being frustrated with the failure of supplements to provide an easy solution for high blood pressure, the researchers decided to create a diet that was rich in the foods containing those nutrients. The diet was replete with plant foods, including fruits, vegetables, beans, nuts, seeds, mostly whole grains, and heart-healthy oils. Reduced-fat dairy was an essential part of the diet, along with limited amounts of lean meats and poultry, and fish. It was based on the knowledge learned about vegetarian diets.

It has been long known that people who live in the Mediterranean region have lower rates of heart disease than people eating a typical Western diet. Since it is a totally delicious way of eating, it can be a great model of how to eat. It would be helpful to learn what the key health factors are and how it works. You can probably guess that it isn’t the pasta and white bread that make it effective. After World War II, one of the foremost nutrition scientists in the world, Ancel Keys, organized a consortium of researchers in several countries to investigate how diet impacted health. During World War II, Dr. Keys had become especially famous for designing military K-rations, and for determining how to nutritionally restore the starving people who would soon be liberated from concentration camps. Under the bleachers at the football stadium of the University of Minnesota, Dr. Keys designed a program to begin successfully refeeding starving people, using volunteers from the ranks of conscientious objectors as his subjects. After the war, Dr. Keys was ready to spearhead pursuing foundational nutrition research to learn how the eating patterns in various countries affected heart health. Thus began the Seven Countries Study.

These meal plans are examples rather than prescriptions. Follow them to the letter, or just use them for models of the kind of meals you want to eat. You will notice that the portion sizes are flexible. You want to learn for yourself how much of these foods you need to eat in order to be satisfied. And that is the goal. Deprivation and starving yourself do not work in developing a sustainable eating pattern and a healthy weight. You will also note that there are no calorie levels or listing of nutrient composition of the meals. You don’t eat calories. You don’t eat nutrients. You eat foods, delicious, whole foods. This is a much more positive and enjoyable way to approach healthy eating and healthy weight.

(Recipes found in this book are marked with*.)

Day 1

Breakfast

Midmorning snack

Lunch

Afternoon or before-dinner snack

• Dinner

Day 2

Breakfast

Midmorning snack

Lunch

Afternoon or before-dinner snack

Day 3

Breakfast

Midmorning snack

Lunch

Dinner

Day 4

Breakfast

Midmorning snack

Lunch

Afternoon or before-dinner snack

Day 5

Breakfast

Midmorning snack

Lunch

Dinner

Note: This is a great meal when you don’t have much time, but still want to put a hot meal on the table. While you are at the store picking up the chicken, hit the salad bar to get a mix of lettuces and toppings for your salad.

Day 6

Breakfast

Midmorning snack

Lunch

Afternoon or before-dinner snack

Dinner

Day 7

Breakfast

Midmorning snack

Lunch

Dinner

Beverages

Dinner

Snacks

If you plan to do the activity first thing in the morning, lay out your workout clothes the night before, or pack your gym bag. You want to remove excuses for not being active. Just like with your eating plan, you want to set the stage for success.

Unless you are a creature of habit, you may want to mix things up to keep it interesting. If you do cardio on a machine at the gym, you can watch TV, listen to tunes or audiobooks, or maybe read the newspaper or a book, if you are steady enough. But don’t be caught in a trap with only one thing to do. You want to have a variety of ways to stay active so you have a backup plan if you get bored with your choices.

Your Habits

Tracking or journaling seems to be especially powerful. In one study, people were asked to write down everything they ate for one year. That was the only advice they were given. At the end of the year, they had changed their eating habits to a healthier plan overall and had lost weight. Just because they started tracking what they were doing. The Med-DASH tracking forms available for download at dashdiet.org/forms are very simple to use; each day, you check off the number of servings from the different foods groups. This is particularly effective with the Med-DASH plan because it is based on getting servings from all the food groups. You can quickly see if you are missing certain foods and need to either add more servings from certain food groups at dinner or plan to adjust the next day. Immediate feedback.

The Med-DASH plan is an eating pattern and a lifestyle. To protect your health for the long run, you want to develop habits that you can sustain. I maintain that counting calories is not sustainable. It makes food the enemy that keeps you constantly on guard. Planning to eat a variety of beautiful, delicious foods is exciting and motivating. Let’s make friends with food and enjoy eating.

Deprivation does not lead to lasting weight loss. If you are hungry, you should eat. Quench your hunger when it is easier to control. A better strategy is to eat planned meals and snacks on a regular basis throughout your day. But this is not grazing, which isn’t a great idea. How do you know when you have grazed enough? Most people don’t. Plan your meals and snacks ahead of time so you aren’t caught off guard when you’re hungry and find yourself eating foods that aren’t that healthy.

Add lean, protein-rich foods to satisfy your hunger and keep you from being hungry again an hour later.

Protein foods take longer to digest and be absorbed. The energy (and some glucose produced from the protein amino acids) from protein-rich foods will be entering your bloodstream about the time the carbs are leaving, meaning no sugar crash when you have mixed meals and snacks.

Milk is a mixed meal all by itself, since it naturally contains some carbs, a healthy dose of protein, and a little bit of fat. Pair it with something fiber-rich for balance. With milk, whole-grain cereal, and some fruit, you have a quick balanced breakfast, and you are on your way.

Add fresh fruits to satisfy your sweet tooth the healthy way.

If you are craving a sweet snack or a sweet end to your meal, fruits are a great way to satisfy. If you have them on hand, it will be easy to stay on track with your plan.

Nuts and seeds make fun snacks that love your heart.

Surprisingly, nuts can help you lose weight. They are great sources of heart-healthy fats, pack in protein and fiber, and are rich in vitamins and minerals. There is no need to avoid these great, satisfying snacks.

Watch your waistline shrink.

A smaller waist is the outward sign of better metabolic health. By cutting down on blood sugar surges, you won’t force your body to plump up your abdominal fat cells with glucose that then gets turned into more fat. Avoid overtaxing your body with lots of simple carbs (and yes, starch is a simple, very quickly digested carb).

Note: I used Turkish honey from Trader Joe’s.

Note: Alternatively, braise the lamb: Preheat the oven to 350°F. Assemble the dish as directed, but cover the pot and transfer it to the oven after browning the meat. Braise for 1 hour 30 minutes.

Note: The falafel patties will absorb as much oil as you use in the pan, so do not add all the oil to start.

Here is an example. At the end of the chapter, there are fourteen days of sample meal plans.

Breakfast

Midmorning snack

Lunch

Afternoon or before-dinner snack

Dinner

Coffee

Coffee has many health benefits. While it may be under the gun for potentially having a minuscule amount of a cancer-promoting chemical, in real life there appear to be some very important health benefits to coffee. Many studies have shown that people who drink the most coffee are less likely to develop type 2 diabetes. It may reduce your risk of developing Parkinson’s disease, liver cancer, and other liver disease. Caffeine may give you a short-term increase in blood pressure, but seems to be heart healthy in general. Coffee is rich in potassium, which is beneficial for improving blood pressure, and most people don’t get an adequate amount of potassium in their diet. And coffee is the top source of antioxidants in the typical American diet!

Tea

The health benefits of tea have long been promoted throughout human history. In addition to providing a calming break in your day, tea is another very powerful source of antioxidants. It is associated with better lipid profiles (cholesterol and triglycerides) and reduced risk for heart attack.

Flavored Water or Infused Water

Instead of soda or other sweetened beverages, let’s try water with fruit slices. This is such an easy way to get flavor while making the water even more refreshing. Lemon, lime, or orange slices are my favorites. You can also try chunks of melon, such as cantaloupe and watermelon, or cucumber slices. Throw in some herbs, such as fresh cilantro, mint, basil, or rosemary. Add some Tabasco if you like it hot. Another alternative is to make some ice cubes from fresh lemon or orange juice. Drop one or two cubes in your water, and you have the perfect alternative to high-calorie beverages.

Wine is a key part of most meals in the European countries situated around the Mediterranean Sea. Research has shown that people who consume moderate amounts of alcohol live longer than people who do not drink any alcohol. (This does not mean we are encouraging anyone to drink.) Red wine is especially high in antioxidants, and so is grape juice. On this plan, a 3-to 4-ounce glass of wine replaces one serving of fruit. “Moderate” daily intake of alcohol has different definitions depending on the country. By U.S. standards, moderate drinking would be one 4-ounce glass per day for women and two glasses for men, while in some countries, moderate intake is considered two glasses for women and up to three glasses for men.

Milk

Milk substitutes include soy, almond, coconut, and rice milks. It is unknown whether these dairy substitutes provide the exact heart-health benefits as real cow’s milk. For milk substitutes, look for brands that contain similar levels of protein, calcium, and potassium as regular milk. If you are just using it in coffee, all options are on the table. Choose what works for you.

Beverages to Avoid or Limit

Fruit juice. Limit juice to a 4-to 6-ounce serving per day. If you’ve heard people talk about juice belly (particularly in young children), you know what juice can do. Choose whole fruits instead. With all the fiber. Eat most of your fruit, instead of drinking it.

Sample Meal Plans for 14 Days

(Recipes found in the book are marked with *.)

Day 1

Breakfast

Midmorning snack

Lunch

Dinner

Day 2

Breakfast

Midmorning snack

Lunch

Dinner

Day 3

Breakfast

Lunch

Afternoon or before-dinner snack

Dinner

Day 4

Breakfast

Midmorning snack

Lunch

Midmorning snack

Lunch (Vegetarian/Vegan)

Afternoon or before-dinner snack

Dinner

Day 6

Breakfast

Midmorning snack

Lunch

Afternoon or before-dinner snack

Dinner

Day 7

Breakfast

Lunch

Afternoon or before-dinner snack

Dinner

Day 8

Breakfast

Midmorning snack

Lunch

Midmorning snack

Lunch

Afternoon or before-dinner snack

Dinner

Day 10

Breakfast

Midmorning snack

Lunch

Afternoon or before-dinner snack

Dinner

Day 11

Breakfast

Lunch

Afternoon or before-dinner snack

Dinner

Day 12

Breakfast

Midmorning snack

Afternoon or before-dinner snack

Dinner

Day 13

Breakfast

Lunch

Afternoon or before-dinner snack

Dinner

Note: If you want to avoid the pasta, put the sauce on the broccoli, or use zoodles (zucchini noodles).

Day 14

Breakfast

Midmorning snack

Lunch

Dessert