Associate Professor Antigone Kouris APD, PhD, Post Grad Dip Diet, Post Grad Dip Bot Med, BSc Biochem/Micro (Hons)
Senior Academic, Discipline Dietetics and Human Nutrition La Trobe University
Director (Clinical Dietitian), Total Nutrition care
Director, Skinnybik Pty Ltd
Author “Medications: Good and Bad Interactions with foods, herbs and nutrients
Author “Food Sources of Nutrients”
Author “Your are what you cook – Mediterranean & South Asian”
Insight into the Mediterranean diet
Study after study has shown that the traditional plant-based Mediterranean diet, high in legumes, fruit, vegetables and olive oil, moderate in grains, dairy, seafood, wine and low in meat, help people live longer.
Med diet pattern
My pioneering PhD put the Mediterranean diet on the map in the 1990s. With the help of Professor Mark Wahlqvist (Head of Medicine at Monash University at the time) and Professor Antonia Trichopoulou (from Athens University), we developed the first Mediterranean diet pattern (MDP) score based on the food groups consumed by Greeks on the Island of Crete in the 1960s (renowned for their longevity). So this score captured the key food groups (and quantities) that made up the traditional Greek Cretan diet of the 1960s. We then applied the score to the food intake data we collected in the 1990s from elderly Greeks in Greece, elderly 1st generation migrant Greek Australians and Anglo-Celtic Australians. We found that the closer they adhered to the MDP (i.e higher score) the longer they lived – reducing the risk of death by 50% after 5 years follow-up. These findings and the score was published in the British Medical Journal in 1995. Much to our surprise, when we did some further statistical anlayses we found that the most protective food group in the MDP was legumes; fish and olive oil came in at a close second but failed to reach statistical significance.
Our novel MDP score has enabled thousands of researchers around the world to study the health benefits of the MDP contributing to the huge body of evidence surrounding this diet. It has since been applied to over 0.5 million study subjects in both Mediterranean and non-Mediterranean countries by other researchers. These studies have also shown that the MDP not only confers longevity, but reduces the risk of cardiovascular disease, can lower the risk or mitigate severity of diabetes, can reduce the risk of several cancers, Alzheimer’s disease, depression and even help manage weight and fatty liver (despite high olive oil content). Over 90% of the studies so far on the “Med diet” are based on our MDP score or a version of our score.
Med diet pattern + cuisine
There have only been TWO studies on the traditional MDP + cuisine. My colleague Professor Catherine Itsiopoulos pioneered the first randomized intervention study with Professor Kerin O’Dea (published in 2011). Her research team prepared traditional Greek dishes (many of which were vegetarian and high in legumes) and provided them to 27 Anglo-Australian subjects with diabetes for 3 months. At the end of the study, the subjects reported lower blood sugars, better skin, better mood and nil weight gain despite being told to eat as much as they like and to eat 3-4 tablespoons extra virgin olive oil daily!
The second study combining the MDP + cuisine was conducted in Spain on over 7000 people (PREDIMED randomized trial). Unlike Itsiopoulos’ study, this study did not provide any precooked dishes. It recommended a MDP and concentrated on the therapeutic effects of eating tomatoes in the form of “sofrito” (a sauce made with tomato, onion, garlic, olive oil, herbs) at least 2 times a week and up to 4 tablespoons of extra virgin olive oil per day. It found these foods, in conjunction with legumes, nuts and seafood (each eaten at least 3 times a week), fruit, vegetables, wine and less red meat, butter, margarine and sweets, lowered heart disease rates (especially strokes) by 30% and diabetes by 52% after 5 years. In contrast, Spaniards randomized to consume a low fat diet had higher rates of heart disease and diabetes!
The Royal Australian College of General Practitioners and Med diet
All this evidence on the MDP and cuisine has given it the highest possible ranking by the NH&MRC (level 1 evidence) for the prevention of chronic diseases.
So convinced by the evidence, the Royal Australian College of General Practitioners has recently released a handout for doctors and dietitians, with the help of Prof Itsiopoulos, on how to advise patients to follow a Mediterranean diet for the prevention of heart disease
Specific foods in the Med diet, Vegan fasting and the Microbiome
While most of the studies have concentrated on the Greek diet, I believe the cuisine from Greece’s Mediterranean neighbours are also a recipe for healthy living. The common thread in all these Mediterranean cuisines is the vegetarian focus. Our research showed that it was the legumes eaten as a meal in place of meat at least twice a week that played the really pivotal role in helping people live longer. However I suspect that specific foods like herbs and spices, olive oil, fermented foods (olives, yoghurt, feta, sour dough bread, wine), grapes, leafy greens, onions, garlic, tomato salsa and religious vegan fasting (which have not been adequately studied) are also playing a role. My PhD student Tania Thodis at La Trobe University is currently investigating their role in explaining the health benefits of the Med diet. In 2014, I coauthored a paper with Prof Itsiopoulos, where we speculated that the Mediterranean diet was probably promoting good health by producing a healthy gut microbiome and in turn less “inflammation” in the body. Recent studies have shown that this is probably true, helping to explain how the Med diet protects against so many diseases.
I was so inspired by our study findings that I have published a cook book “You are what you cook” (www.lulu.com) which helps you implement the key features of the MDP + cuisine and it goes without saying it includes many legume based recipes. I have also developed a healthy range of reduced sugar high fibre gluten free cookies made with lupin flour (a legume!) (www.skinnybik.com).
Until next time…Antigone
Click here to read more about Antigone
“You Are What You Cook, by Dr Antigone Kouris, is a Wellness Cookbook containing 80 easy to prepare healthy recipes for the family using Mediterranean and South Asian flavours. Many of the recipes have been adapted from traditional Greek recipes and made healthier by reducing the calories, fat, carbs and many are naturally gluten free. Therefore most recipes are suitable for weight control and for people with diabetes, high cholesterol and coeliac disease. Recipes have been developed by Dr Kouris using knowledge gained from her Greek mother and mother-in-law, her research on the Mediterranean diet and the latest nutrition research, especially on preferred cooking methods (more stews less grills) and use of herbs and spices (especially oregano and turmeric for their anti-inflammatory properties). The book includes a simple guide for a preferred weekly menu and a ‘plate’ guide for food portions. Click here to purchase a copy.